Comparing extracorporeal shock wave lithotripsy and ureteroscopy laser lithotripsy for treatment of urinary stones smaller than 2 cm: a cost-utility analysis in the Spanish clinical setting.

PURPOSE: To analyze the efficiency and cost-utility profile of ureteroscopy versus shock wave lithotripsy for treatment of reno-ureteral stones smaller than 2 cm. METHODS: Patients treated for urinary stones smaller than 2 cm were included in this study (n = 750) and divided into two groups based on technique of treatment. To assess the cost-utility profile a sample of 48 patients (50% of each group) was evaluated. Quality of life survey (Euroqol 5QD-3L) before-after treatment was applied, Markov model was designed to calculate quality of life in each status of the patients (stone or stone-free with and without double-J stent) and to estimate the incremental cost-utility. Monte carlo simulation was conducted for a probabilistic sensitivity analysis. Chi-square was used for comparing qualitative variables and T student's for continuous variables. RESULTS: Shock wave lithotripsy group had 408 (54.4%) and ureteroscopy group had 342 (45.6%) patients. Of them, 56.3% were treated for renal stones and 43.7% for ureteral stones. Ureteroscopy produced slightly higher overall quality of patients' life, but produced a significant higher overall cost per quality-adjusted life year (QALY) than shock wave lithotripsy, exceeding the cost-utility threshold (20,000€/QALY). Sensitivity analysis confirmed results in 93.65% of cases. Difference was maintained in subgroup analysis (ureteral vs renal stones). CONCLUSIONS: Results suggest that in our clinical setting shock wave lithotripsy has better cost-utility profile than ureteroscopy for treatment of reno-ureteral stones less than 2 cm, but excluding waiting times, in ideal clinical setting, ureteroscopy would have better cost-utility profile than shock wave lithotripsy.

[Clinical usefulness of the non-invasive functional study of the lower urinary tract voiding phase as a predictor of resolution after the first endoscopic treatment of vesico-ureteral reflux in children older than 3 years.] / Utilidad del estudio funcional no invasivo de la fase de vaciado del tracto urinario inferior como factor predictor de la resolución tras el primer tratamiento endoscópico del reflujo vesico-ureteral en niños mayores de 3 años.

OBJECTIVES: To determine the usefulnessof voiding diary (VD), uroflowmetry with electromyography(UF-EMG), bladder wall thickness (before micturition)(VWTUS) and residual urine (PVR) (ultrasound measure)in predicting the outcome of the first endoscopic treatment(1ENDT) of vesicoureteral reflux (VUR) in children> 3 years. METHODS: Cross-sectional ambispective study of 48children with vesicoureteral reflux. Those with previousendoscopic treatment, age or neurological abnormalities and a history of urethralor abdominal surgery were excluded. The outcomevariable was the correctness (by isotopic cystography)three months after 1ENDT. Univariate and multivariateanalyses were performed through a Multilayer Perceptronnetwork and a logistic regression model EmpiricalBayesian penalized type LASSO Elastic net. Diagnosticaccuracy were determined. RESULTS: Mean age of the sample was 6.8 +/- 2.28years. The rate of VUR correction after 1ENDT was 77%.The variables selected by both methods were: VD-retentionist(OR 3.90), high PVR (OR 2.69), high VWTUS (OR4.44). Normal UF-EMG was a preventive variable (OR0.38). Diagnostic accuracy (pSp=48.7%), UF+EMG (Se=27.3%(Se=72.7% (AUC=0.8 cut point 20 ml),VWTUS (Se=81.8% (AUC=0.8 cut point4.6 mm). There were no statistical differences betweenPVR and VWTUS. Combined use of UF+EMG+PVR(Se=90.9%in predicting the persistence of VUR after 1ENDT inchildren > 3 years. After screening with a VD, UF-EMG+ RPM combination could be useful to detect these patientsand propose a treatment that improves bladdervoiding function prior to surgery.

OBJETIVOS: Determinar la utilidad deldiario miccional (DIM), la flujometría asociada a laelectromiografía (UF-EMG) y los parámetros ecográficoscomo son el espesor de la pared vesical premiciconal(EPVECO) y el residuo postmiccional (RPM) en la prediccióndel resultado del primer tratamiento endoscópico(1TEND) del Reflujo Vesico-Ureteral (RVU) en niños > 3años.MATERIAL Y MÉTODOS: Estudio transversal ambispectivode 48 niños con RVU. Criterios de exclusión: 1TENDprevio, edad y cirugía uretral o abdominal previas. Variableresultado: corrección del RVU (cistografía isotópica realizadatres meses después del 1TEND). Se realizaronanálisis univariante y multivariante mediante una red perceptrón multicapa y un modelo de regresión logísticapenalizada tipo Empirical Bayesian LASSO Elastic net.Se consideraron significativas las variables elegidas porambos métodos estadísticos. Se estudió el rendimientodiagnóstico de las pruebas individuales y combinadas. RESULTADOS: Media de edad: 6,8 +/- 2,28 años.Tasa de corrección del RVU traspredictoras de la persistencia del RVU tras 1TENDseleccionadas por ambos métodos: DIM-hábito retencionista(OR 3,90), RPM elevado (OR 2,69), EPVECOaumentado (OR 4,44). La UF-EMG sin alteracionesen el trazado se comportó como variable preventiva(OR 0,38). Rendimiento diagnóstico (p(Se=98% (Se=27,3%RPM (Se=72,7% (AUC=0,8 punto decorte óptimo 20 ml), EPVECO (Se=81,8%(AUC=0,8 punto de corte óptimo 4,6 mm).No existierondiferencias entre el uso del RPM y el EPVECO(p>0,05). Uso conjunto de UF-EMG+RPM (Se=90,9%Es=92%) (pCONCLUSIONES: El estudio funcional no invasivo dela fase de vaciado es útil en la predicción de la persistenciade RVU tras el 1TEND en niños >3 años. Trasel cribado con un diario miccional, la UF-EMG+RPMpodrían ser útiles para detectar a estos pacientes y plantearun tratamiento que mejore el vaciado vesical previoa la cirugía.

Utilidad del estudio funcional no invasivo de la fase de vaciado del tracto urinario inferior como factor predictor de la resolución tras el primer tratamiento endoscópico del reflujo vesico-ureteral en niños mayores de 3 años / No disponible

Objetivos: Determinar la utilidad del diario miccional (DIM), la flujometría asociada a la electromiografía (UF-EMG) y los parámetros ecográficos como son el espesor de la pared vesical premiciconal (EPVECO) y el residuo postmiccional (RPM) en la predicción del resultado del primer tratamiento endoscópico (1TEND) del Reflujo Vesico-Ureteral (RVU) en niños > 3 años. Material y métodos: Estudio transversal ambispectivo de 48 niños con RVU. Criterios de exclusión: 1TEND previo, edad y cirugía uretral o abdominal previas. Variable resultado: corrección del RVU (cistografía isotópica realizada tres meses después del 1TEND). Se realizaron análisis univariante y multivariante mediante una red perceptrón multicapa y un modelo de regresión logística penalizada tipo Empirical Bayesian LASSO Elastic net. Se consideraron significativas las variables elegidas por ambos métodos estadísticos. Se estudió el rendimiento diagnóstico de las pruebas individuales y combinadas. Resultados: Media de edad: 6,8 +/- 2,28 años. Tasa de corrección del RVU tras predictoras de la persistencia del RVU tras 1TEND seleccionadas por ambos métodos: DIM-hábito retencionista (OR 3,90), RPM elevado (OR 2,69), EPVECO aumentado (OR 4,44). La UF-EMG sin alteraciones en el trazado se comportó como variable preventiva (OR 0,38). Rendimiento diagnóstico (p(Se=98% (Se=27,3% RPM (Se=72,7% (AUC=0,8 punto de corte óptimo 20 ml), EPVECO (Se=81,8% (AUC=0,8 punto de corte óptimo 4,6 mm).No existieron diferencias entre el uso del RPM y el EPVECO (p>0,05). Uso conjunto de UF-EMG+RPM (Se=90,9% Es=92%). Conclusiones: El estudio funcional no invasivo de la fase de vaciado es útil en la predicción de la persistencia de RVU tras el 1TEND en niños >3 años. Tras el cribado con un diario miccional, la UF-EMG+RPM podrían ser útiles para detectar a estos pacientes y plantear un tratamiento que mejore el vaciado vesical previo a la cirugía

Objectives: To determine the usefulness of voiding diary (VD), uroflowmetry with electromyography (UF-EMG), bladder wall thickness (before micturition) (VWTUS) and residual urine (PVR) (ultrasound measure) in predicting the outcome of the first endoscopic treatment (1ENDT) of vesicoureteral reflux (VUR) in children > 3 years. Methods: Cross-sectional ambispective study of 48 children with vesicoureteral reflux. Those with previous endoscopic treatment, age <4 years, anatomical or neurological abnormalities and a history of urethral or abdominal surgery were excluded. The outcome variable was the correctness (by isotopic cystography) three months after 1ENDT. Univariate and multivariate analyses were performed through a Multilayer Perceptron network and a logistic regression model Empirical Bayesian penalized type LASSO Elastic net. Diagnostic accuracy were determined. Results: Mean age of the sample was 6.8 +/- 2.28 years. The rate of VUR correction after 1ENDT was 77%. The variables selected by both methods were: VD-retentionist (OR 3.90), high PVR (OR 2.69), high VWTUS (OR 4.44). Normal UF-EMG was a preventive variable (OR 0.38). Diagnostic accuracy (p<0.005): VD (Se=98% Sp=48.7%), UF+EMG (Se=27.3% Sp=94.6%), PVR (Se=72.7% Sp=97.3%) (AUC=0.8 cut point 20 ml), VWTUS (Se=81.8% Sp=73%) (AUC=0.8 cut point 4.6 mm). There were no statistical differences between PVR and VWTUS. Combined use of UF+EMG+PVR (Se=90.9% Sp=92%) (p<0.05). Conclusions: Noninvasive voiding study is useful in predicting the persistence of VUR after 1ENDT in children > 3 years. After screening with a VD, UF-EMG + RPM combination could be useful to detect these patients and propose a treatment that improves bladder voiding function prior to surgery

Scrotum Melanoma: Evolution Over One Year in This Unusual Location.

Genitourinary melanoma accounts for 0.1-0.2% of melanoma, the scrotum being its rarest location. We report about an 85-year-old patient who was referred to our outpatient clinic due to the presence of a scrotum black papule for 20 months. Wide local excision was performed, and histology revealed a malignant melanoma. Chest and abdominal CT revealed metastatic disease, so chemotherapy, immunotherapy and radiotherapy were administered. We describe the evolution over 1 year in this unusual location, as well as complications and the currently available therapeutic options to cure this disease.