Simplified biplanar (0-90°) fluoroscopic puncture technique for percutaneous nephrolithotomy: the learning curve.

PURPOSE: To evaluate the learning curve of the simplified fluoroscopic biplanar (0-90º) puncture technique for percutaneous nephrolithotomy. METHODS: We prospectively evaluated patients with renal stones treated with percutaneous nephrolithotomy by a single institution's fellows employing the simplified bi-planar (0-90º) fluoroscopic puncture technique for renal access. The learning curve was assessed with the fluoroscopic screening time and the percutaneous renal puncture time. Data obtained were compared to a subset of patients operated by a senior surgeon. RESULTS: Eighty-nine patients were included in the study. Forty patients were operated by fellow-1, 39 by fellow-2, and 10 patients by the senior surgeon. Demographic data of all patients between groups were homogeneous, with no difference in gender (p = 0.432), age (p = 0.92), stone volume (p = 0.78), puncture laterality (p = 0.755), and body mass index (p = 0.365). The mean puncture time was 7.5, 4, and 3.1 min for fellow-1, fellow-2, and expert, respectively. The mean fluoroscopic screening time for the puncture was 10, 11, and 5.1 s for fellow-1, fellow-2, and the expert, respectively. Stone cases, both fellows needed to complete 10 procedures to match the senior surgeon in the mean puncture time (p = 0.046); meanwhile, the fluoroscopic screening time was equal even before to complete 10 procedures. CONCLUSION: This study suggests that with the simplified biplanar (0-90º) puncture technique, the fluoroscopic screening time used in the learning process is brief. A novice fellow could require to complete ten cases to flatten the learning curve treating complex stone cases, and a flat learning curve is seen since the beginning when treating simple renal stones.

Práctica actual de la ureteronefroscopia flexible con láser en América Latina para el tratamiento de la litiasis renal / Current practice in Latin America of flexible ureterorenoscopy with laser for treating kidney stones

Introducción: Actualmente se ha incrementado la ureteronefroscopia flexible para el tratamiento de cálculos renales, existiendo gran variación en la técnica quirúrgica e indicaciones a través de todo el mundo. Objetivos: Conocer la práctica actual, variaciones en la técnica, uso e indicaciones de la ureteronefroscopia flexible para tratamiento de cálculos renales en Latinoamérica. Métodos: Enviamos un cuestionario anónimo de 30 preguntas sobre ureteronefroscopia flexible para el tratamiento de cálculos renales, vía correo electrónico y enlace Web a urólogos de Latinoamérica de enero de 2015 a julio de 2015. Recolectamos las respuestas a través del sistema Survey Monkey. Resultados: Participaron 283 urólogos de 15 países latinoamericanos (tasa de respuesta del 10,8%); 254 contestaron completamente el cuestionario; 52,8% son urólogos de México y 11% de Argentina, 11,8% realizan > 100 casos por año, 15,2% consideran la ureteronefroscopia como tratamiento de elección para cálculos > 2 cm y 19,6% realiza ureteronefroscopia en etapas solo para cálculos > 2,5 cm. El 78,4% utiliza fluoroscopia, el 69,1% utiliza camisa ureteral en todos sus casos, el 55,8% deja el catéter doble J al final de la cirugía, el 37,3% considera estado libre de lito con 0 fragmentos y el 41,2% utiliza radiografía simple para evaluar el estado libre de cálculos. Conclusiones: La mayoría de urólogos participantes considera la ureteronefroscopia flexible como el tratamiento de primera elección para cálculos < 2 cm, un pequeño porcentaje realiza > 100 ureteronefroscopias por año. Más de la mitad utiliza fluoroscopia y camisa de acceso ureteral rutinariamente, el método más frecuente para la evaluación del estado libre de cálculos es la radiografía simple de abdomen

Introduction: The use of flexible ureterorenoscopy for treating kidney stones has increased in recent years, with considerable worldwide variation in the surgical technique and indications. Objectives: To determine the current practice, technique variations, use and indications of flexible ureterorenoscopy for treating kidney stones in Latin American. Methods: We sent (by email and web link) an anonymous questionnaire with 30 questions on flexible ureterorenoscopy for treating kidney stones to Latin American urologists from January 2015 to July 2015. We collected the responses through the Survey Monkey system. Results: A total of 283 urologists in 15 Latin American countries participated (response rate, 10.8%); 254 answered the questionnaire completely; 52.8% were urologists from Mexico and 11% were from Argentina; 11.8% of the responders stated that they performed > 100 cases per year; 15.2% considered ureterorenoscopy as the treatment of choice for stones > 2 cm, and 19.6% performed ureterorenoscopy in single stages for calculi measuring > 2.5 cm. Some 78.4% use fluoroscopy, 69.1% use a ureteral sheath in all cases, 55.8% place double-J catheters at the end of surgery, 37.3% considered a stone-free state to be 0 fragments, and 41.2% use plain radiography to assess the stone-free condition. Conclusions: Most participating urologists consider flexible ureterorenoscopy as the first-choice treatment for stones < 2 cm; a small percentage of these urologists perform > 100 ureterorenoscopies per year. More than half of the urologists routinely used fluoroscopy and ureteral access sheath; the most common method for determining the stone-free state is plain abdominal radiography

Current practice in Latin America of flexible ureterorenoscopy with laser for treating kidney stones. / Práctica actual de la ureteronefroscopia flexible con láser en América Latina para el tratamiento de la litiasis renal.

INTRODUCTION: The use of flexible ureterorenoscopy for treating kidney stones has increased in recent years, with considerable worldwide variation in the surgical technique and indications. OBJECTIVES: To determine the current practice, technique variations, use and indications of flexible ureterorenoscopy for treating kidney stones in Latin American. METHODS: We sent (by email and web link) an anonymous questionnaire with 30 questions on flexible ureterorenoscopy for treating kidney stones to Latin American urologists from January 2015 to July 2015. We collected the responses through the Survey Monkey system. RESULTS: A total of 283 urologists in 15 Latin American countries participated (response rate, 10.8%); 254 answered the questionnaire completely; 52.8% were urologists from Mexico and 11% were from Argentina; 11.8% of the responders stated that they performed >100 cases per year; 15.2% considered ureterorenoscopy as the treatment of choice for stones >2cm, and 19.6% performed ureterorenoscopy in single stages for calculi measuring >2.5cm. Some 78.4% use fluoroscopy, 69.1% use a ureteral sheath in all cases, 55.8% place double-J catheters at the end of surgery, 37.3% considered a stone-free state to be 0 fragments, and 41.2% use plain radiography to assess the stone-free condition. CONCLUSIONS: Most participating urologists consider flexible ureterorenoscopy as the first-choice treatment for stones <2cm; a small percentage of these urologists perform >100 ureterorenoscopies per year. More than half of the urologists routinely used fluoroscopy and ureteral access sheath; the most common method for determining the stone-free state is plain abdominal radiography.

Detección del virus papiloma humano en muestras cervicales de una población de estudiantes de la Universidad Central de Venezuela / Detection of the virus papiloma human in a population's of students of the cervical samples Universidad Central de Venezuela

Se hizo detección y tipificación del VPH en 102 estudiantes universitarios que tenían citología o biopsia con cambios relacionados con el virus, mediante la técnica de reacción en cadena de la polimerasa (RCP) e hibridación. La positividad viral hallada fue del 63,7 por ciento con76,9 por ciento de tipos de alto riesgo oncogénito. Un 9,2 por ciento de la población presentó infección mixta de alto y bajo riesgo. En el 18,5 por ciento de las muestras positivas del tipo de VPH fue indeterminado. Los cambios cambios histológicos por VPH sin atípias se hallaron en el 45 por ciento, NIC I en el 20,6 por ciento, NIC II en el 5,9 por ciento, NIC III en el 1 por ciento. A mayor grado histológico se encontró un aumento de muestras positivas para el virus; en cambios sugestivos por VPH fue de 47,8 por ciento, en NIC 180,9 por ciento, en NIC II 83,3 por ciento, y en NIC III 100 por ciento; la misma relación se halló con los porcentajes de genotipos de altos riesgo: cambios sugestivos por VPH 34,7 por ciento; NIC I 57,1 por ciento; NIC II 100 por ciento, NIC III 100 por ciento. La presencia del virus se observó incrementada en los grupos etareos de mayor edad y también con el mayor número de parejas sexuales