Medición de la presión intrarrenal durante la ureterorrenoscopia (URS) flexible: antecedentes históricos, innovaciones tecnológicas y perspectivas de futuro / How to measure intra-renal pressure during flexible URS: historical background, technological innovations and future perspectives

Introducción La presión intrarrenal (PIR) alta es un factor de riesgo de complicaciones infecciosas relacionadas con la ureterorrenoscopia (URS). Aunque diversos métodos han sido descritos para reducir la PIR, todavía no es posible evaluar los valores de PIR en tiempo real durante la URS. El objetivo de este estudio es llevar a cabo una revisión sistemática de la bibliografía relativa a los métodos endoscópicos para la medición de la PIR durante la URS. Métodos Se llevó a cabo una búsqueda y revisión sistemática en Medline, PubMed y Scopus, de acuerdo con la declaración Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA), y se redactó una síntesis narrativa de los resultados del estudio. Resultados La investigación abarcó un total de 19 artículos. En ellos se presentaban cuatro métodos no invasivos (es decir, endoscópicos) para medir la PIR: catéter ureteral, cable sensor, sistema de irrigación con sensor de presión integrado, y una novedosa vaina de acceso ureteral que integra succión, irrigación y medición de la PIR. Conclusiones El presente documento proporciona una visión global de los sistemas de medición clínica de la PIR durante la URS existentes. Aún no se ha desarrollado un sistema óptimo, pero pronto los urólogos podrán medir la PIR en su práctica diaria. Las implicaciones de esta información durante la cirugía aún se desconocen. Los sistemas capaces de integrar irrigación y succión con monitoreo de PIR y temperatura parecen ser los mejores. (AU)

Introduction High intrarenal pressure (IRP) is a potential risk factor for infectious complications related to URS. Methods to lower IRP have been described. However, it is still not possible to assess live IRP values during URS. The objective of this study was to perform a systematic review of the literature regarding endoscopic methods to measure IRP during URS. Methods A systematic search and review of Medline, PubMed and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) checklist and a narrative synthesis of the study results was performed. Results A total of 19 articles were included in the review. Four non invasive (i.e. endoscopic) methods to measure IRP were reported: ureteral catheter, sensor wire, pressure sensor proximal to an irrigation system and a novel ureteral access sheath that integrates suction, irrigation, and IRP measurement. Conclusions We provide here a comprehensive overview of the reported clinical measuring systems of IRP during URS. The ideal system has not been developed yet, but urologists will be able to measure IRP during their daily practice soon. The implications of having this type of data during surgery remains unknown. Systems that could integrate irrigation, suction, IRP and temperature seems to be ideal. (AU)

How to measure intra-renal pressure during flexible URS: Historical background, technological innovations and future perspectives.

INTRODUCTION: High intrarenal pressure (IRP) is a potential risk factor for infectious complications related to URS. Methods to lower IRP have been described. However, it is still not possible to assess live IRP values during URS. The objective of this study was to perform a systematic review of the literature regarding endoscopic methods to measure IRP during URS. METHODS: A systematic search and review of Medline, PubMed and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) checklist and a narrative synthesis of the study results was performed. RESULTS: A total of 19 articles were included in the review. Four non invasive (i.e. endoscopic) methods to measure IRP were reported: ureteral catheter, sensor wire, pressure sensor proximal to an irrigation system and a novel ureteral access sheath that integrates suction, irrigation, and IRP measurement. CONCLUSIONS: We provide here a comprehensive overview of the reported clinical measuring systems of IRP during URS. The ideal system has not been developed yet, but urologists will be able to measure IRP during their daily practice soon. The implications of having this type of data during surgery remains unknown. Systems that could integrate irrigation, suction, IRP and temperature seems to be ideal.

Etapa de diagnóstico del Cáncer de Próstata ¿Estamos llegando a tiempo? / Prostate cancer stage at diagnosis. Are we running late?

INTRODUCCIÓN: El cáncer de próstata es el segundo cáncer más diagnosticado en hombres en Chile y el mundo. El tamizaje modificó la etapa de diagnóstico, siendo actualmente en EE.UU. un 80 por cinto localizada, 12 por cinto compromiso regional y 4 por ciento metastásico. Tamizaje con APE no está considerado dentro de un programa nacional en Chile. El objetivo de este estudio es caracterizar a la población diagnosticada de cáncer de próstata en un Hospital público en Chile. MATERIALES Y MÉTODO: Estudio descriptivo, retrospectivo. Se revisaron todas las fichas de los pacientes ingresados al GES por Cáncer de Próstata en el Hospital Carlos Van Buren de Valparaíso desde el año 2014 a 2016. RESULTADOS: Se revisaron 259 fichas y se analizaron 226. Edad promedio fue 70,5 años. 46 por ciento presentó APE sobre 20 ng/dL. 31 por ciento presentó metástasis. 42 por ciento recibió tratamiento paliativo. 57 por ciento se realizó tratamiento curativo, con edad promedio 67,4 años. De estos, 31,8 por ciento a cirugía, 68 por ciento índice Gleason <6 y 90 por ciento APE <20. 68 por ciento a RDT con o sin HT, 44 por ciento índice Gleason <6, 75 por ciento APE <20. DISCUSIÓN: El tamizaje del cáncer de próstata es un tema en discusión. En Chile no hay un programa nacional para realizar APE. Centros de atención primaria con acceso a APE tienen mayor tasa de tamizaje. La etapa al diagnóstico en nuestro centro difiere a las series de países desarrollados, siendo considerablemente superior la etapa metastásica. Esto podría deberse a la poca cobertura para detección temprana. Parece ser necesario implementar un programa nacional con cobertura de tamizaje para cáncer de próstata.(AU)

INTRODUCTION: Prostate cancer is the second most diagnosed cáncer in Chile and the world. Screening modified the stage at diagnosis, beeing now in the US 80 pertcent localized, 12 pertcent with regional compromised and 4 pertcent metastatic. Screening with PSA isn't considerd within a national program in Chile. The objetive of this study is to caracterize men diagnosed with prostate cancer at a public hospital in Chile. MATERIALS AND METHODS: Retrospective and descriptive study. Every patient who entered GES because of prostate cancer at the Carlos Van Buren Hospital from Valparaiso between 2014 and 2016 was review. RESULTS: 259 clinical records were review and 226 analized. Mean age was 70,5 years. 46 pertcent had PSA above 20 ng/dL. 31 % had metástasis. 42 % received paliative treatment. 57 % had curative treatment with a mean age of 67,4 years.From this group 31,8 pertcent surgery with a Gleason index <6 and 90 pertcent PSA <20. 68 pertcent had EBRT with or without HT, 44 pertcent of this group had Gleason index <6 and 75 pertcent PSA <20. DISCUSSION: Prostate cancer screening it's a debated topic. In Chile there's no national program to do a PSA. Primary care centers with acces to PSA have more rate of screening. Stage at diagnosis in our center difers from developed countries series, beeing metastatic stage considerably superior. This could be because of the low screening rate for early diagnosis. It seems necesary to implement a national program for prostate cancer screening.(AU)

[The direct costs of epilepsy in a Chilean population]. / Costes directos de la epilepsia en una población chilena.

INTRODUCTION: Epilepsy Chilean prevalence is 17-21/1,000 inhabitants. In past years, there is concern for the high costs involved in its handling. AIM. To estimate the direct costs of treatment and handling in specific population with epilepsy. PATIENTS AND METHODS: It is a retrospective study, in 6 groups of people with epilepsy: recent diagnosis (RD), remission (R), occasional seizures (OS), active without resistance to drugs (AWRD), resistance to pharmacological treatment (RPT), and epilepsy surgery (S). Data and characteristics tabulation and economical study of each group were made, considering 1 year of treatment. A comparison was made between them and their average in relation to international data. RESULTS: 293 patients. 52% male. 76% adults. 25% students. 55% focal seizures. Costs per group: (USD/patient/year): RD, 443; R, 316; OS, 430; AWRD, 711; RPT, 946; S, 4,262. Direct average cost of treatment for epilepsy in this population: 615 USD/patient/year. CONCLUSIONS: When differentiating in groups of individuals with epilepsy, the highest average annual cost is in surgery and the lowest in remission. In all the groups, except for surgery one, the highest expense is in drugs (average 81%). In relation to other countries, our direct costs are 5 times lower than in some developed countries and 3.5 times higher than in other developing countries. This data is of interest to governmental and financial spheres, so to provide a better quality of life for people with epilepsy, lowering costs and fees for their treatment and contributing to epilepsy and surgery national programs.

Costes directos de la epilepsia en una población chilena / The direct costs of epilepsy in a chilean population

Introducción. La prevalencia de la epilepsia en Chile es de 17-21/1.000 habitantes. Últimamente ha habido preocupación por los costes en su diagnóstico y tratamiento. Objetivo. Calcular los costes directos del tratamiento de una determinada población chilena con epilepsia. Pacientes y métodos. Estudio retrospectivo en seis grupos de pacientes: diagnóstico reciente (DR), remisión (R), crisis ocasionales (CO), activos sin resistencia a fármacos (ASRF), resistencia al tratamiento con fármacos (RTF) y cirugía de la epilepsia (C). Se tabularon datos clínicos y económicos por grupo, considerando un año de tratamiento, además de su comparación entre ellos y su promedio respecto a datos internacionales. Resultados. Hubo 293 pacientes, 52% masculinos, 76% adultos, 25% estudiantes; 16% con trabajo estable; 55% con crisis focales. Los costes promedios por grupos, calculados en dólares estadounidenses (USD)/paciente/año, fueron los siguientes: DR, 443; R, 316; CO, 430; ASRF, 711; RTF, 946; C, 4.262. Conclusiones. El coste más elevado en cada grupo, excepto el quirúrgico, fueron fármacos, con un promedio de 81%. El coste directo promedio grupal fue de 615 USD/paciente/año. En los costes promedios anuales por grupos, el mayor es el de cirugía, y el menor, el de remisión, debido al menor uso de medicamentos, exámenes y consultas. Nuestros costes directos son 5 veces menores que algunos países desarrollados y 3,5 veces superiores que otras naciones en vía de desarrollo. Estos datos pueden contribuir a mejorar la calidad de vida de personas con epilepsias, optimizando costes y tarifas, ayudando a programas nacionales de epilepsia y cirugía de la epilepsia

Introduction. Epilepsy Chilean prevalence is 17-21/1,000 inhabitants. In past years, there is concern for the high costs involved in its handling. Aim. To estimate the direct costs of treatment and handling in specific population with epilepsy. Patients and methods. It is a retrospective study, in 6 groups of people with epilepsy: recent diagnosis (RD), remission (R), occasional seizures (OS), active without resistance to drugs (AWRD), resistance to pharmacological treatment (RPT), and epilepsy surgery (S). Data and characteristics tabulation and economical study of each group were made, considering 1 year of treatment. A comparison was made between them and their average in relation to international data. Results. 293 patients. 52% male. 76% adults. 25% students. 55% focal seizures. Costs per group: (USD/patient/year): RD, 443; R, 316; OS, 430; AWRD, 711; RPT, 946; S, 4,262. Direct average cost of treatment for epilepsy in this population: 615 USD/patient/year. Conclusions. When differentiating in groups of individuals with epilepsy, the highest average annual cost is in surgery and the lowest in remission. In all the groups, except for surgery one, the highest expense is in drugs (average 81%). In relation to other countries, our direct costs are 5 times lower than in some developed countries and 3.5 times higher than in other developing countries. This data is of interest to governmental and financial spheres, so to provide a better quality of life for people with epilepsy, lowering costs and fees for their treatment and contributing to epilepsy and surgery national programs