Prevalencia del cáncer del tracto urinario. Análisis de la cohorte española del estudio IDENTIFY / Prevalence of urinary tract cancer in the Spanish cohort of the IDENTIFY study

Introducción Los tumores malignos del tracto urinario están asociados a gran morbimortalidad siendo su prevalencia variable a nivel global. Recientemente el estudio IDENTIFY ha publicado resultados sobre la prevalencia del cáncer del tracto urinario a nivel internacional. Este estudio evalúa la prevalencia de cáncer dentro de la cohorte española del estudio IDENTIFY para determinar si los resultados publicados son extrapolables a nuestra población. Material y métodos Se realizó un análisis de los datos de la cohorte de pacientes españoles del estudio IDENTIFY. Se trata de una cohorte prospectiva de pacientes derivados al hospital con sospecha de cáncer, predominantemente por hematuria. Los pacientes fueron reclutados entre diciembre de 2017 y diciembre de 2018. Resultados En total 706 pacientes procedente de 9 centros españoles fueron analizados. Doscientos setenta y siete pacientes (39,2%) fueron diagnosticados de cáncer, 259 (36,7%) de cáncer vejiga, 10 (1,4%) de tracto urinario superior, 9 (1,2%) renal y 5 (0,7%) de próstata. El aumento de la edad (OR: 1,05; IC 95%: 1,03-1,06; p<0,001), presencia de hematuria visible (OR: 2,19; IC 95%: 1,13-4,24; p=0,02) y el hábito tabáquico (exfumadores: OR: 2,11; IC 95%: 1,30-3,40; p=0,002; fumadores: OR: 2,36; IC 95%: 1,40-3,95; p=0,001) se asocia con mayor probabilidad de cáncer vesical. Conclusión Este estudio resalta el riesgo que existe en pacientes con HV y hábito tabáquico de presentar cáncer de vejiga. El cáncer de vejiga presentó la mayor prevalencia, siendo esta mayor que la expuesta en series previas y la presentada en el estudio IDENTIFY. Trabajos futuros deben evaluar otros factores asociados que permitan crear modelos de predicción de cáncer para seguir aumentando la detección de estos en nuestros pacientes. (AU)

Introduction Malignant tumors of the urinary tract are associated with high morbidity and mortality, and their prevalence can vary worldwide. Recently, the IDENTIFY study has published results on the prevalence of urinary tract cancer at a global level. This study evaluates the prevalence of cancer within the Spanish cohort of the IDENTIFY study to determine whether the published results can be extrapolated to our population. Patients and methods An analysis of the data from the Spanish cohort of patients in the IDENTIFY study was performed. This is a prospective cohort of patients referred to secondary care with suspected cancer, predominantly due to hematuria. Patients were recruited between December 2017 and December 2018. Results A total of 706 patients from 9 Spanish centers were analyzed. Of these, 277 (39.2%) were diagnosed with cancer: 259 (36.7%) bladder cancer, 10 (1.4%) upper tract urothelial carcinoma, 9 (1.2%) renal cancer and 5 (0.7%) prostate cancer. Increasing age (OR: 1.05; 95% CI: 1.03-1.06; P<.001), visible hematuria (VH) OR: 2.19; 95% CI: 1.13-4.24; P=.02)and smoking (ex-smokers: OR: 2.11; 95% CI: 1.30-3.40; P=.002); (smokers: OR: 2.36; 95% CI: 1.40-3.95; P=.001) were associated with higher probability of bladder cancer. Conclusion This study highlights the risk of bladder cancer in patients with VH and smoking habits. Bladder cancer presented the highest prevalence; higher than the prevalence reported in previous series and presented in the IDENTIFY study. Future work should evaluate other associated factors that allow us to create cancer prediction models to improve the detection of cancer in our patients. (AU)

Prevalence of urinary tract cancer in the Spanish cohort of the IDENTIFY study.

INTRODUCTION: Malignant tumors of the urinary tract are associated with high morbidity and mortality, and their prevalence can vary worldwide. Recently, the IDENTIFY study has published results on the prevalence of urinary tract cancer at a global level. This study evaluates the prevalence of cancer within the Spanish cohort of the IDENTIFY study to determine whether the published results can be extrapolated to our population. PATIENTS AND METHODS: An analysis of the data from the Spanish cohort of patients in the IDENTIFY study was performed. This is a prospective cohort of patients referred to secondary care with suspected cancer, predominantly due to hematuria. Patients were recruited between December 2017 and December 2018. RESULTS: A total of 706 patients from 9 Spanish centers were analyzed. Of these, 277 (39.2%) were diagnosed with cancer: 259 (36.7%) bladder cancer, 10 (1.4%) upper tract urothelial carcinoma, 9 (1.2%) renal cancer and 5 (0.7%) prostate cancer. Increasing age (OR 1.05 (95% CI 1.03-1.06; P < 0.001)), visible hematuria (VH) OR 2.19 (95% CI 1.13-4.24; P = 0.02)) and smoking (ex-smokers: OR 2.11(95% CI 1.30-3.40; P = 0.002); smokers: OR 2.36 (95% CI 1.40-3.95; P = 0.001)) were associated with higher probability of bladder cancer. CONCLUSION: This study highlights the risk of bladder cancer in patients with VH and smoking habits. Bladder cancer presented the highest prevalence; higher than the prevalence reported in previous series and presented in the IDENTIFY study. Future work should evaluate other associated factors that allow us to create cancer prediction models to improve the detection of cancer in our patients.

Impacto de la presentación tardía al servicio de Urgencias por cólico renal agudo en los resultados bioquímicos y clínicos / Impact of a delayed presentation to the emergency department for acute renal colic on biochemical and clinical outcomes

Introducción y objetivo Verificar el impacto en los resultados bioquímicos y clínicos de la demora en acudir al servicio de Urgencias (SU) ante un cólico renal agudo. Materiales y métodos Los datos se recogieron retrospectivamente en 3 instituciones de 2 países europeos, desde el 1 de enero hasta el 30 de abril del 2020. Se incluyó a los pacientes que acudieron a Urgencias con un cólico renal unilateral o bilateral causado por urolitiasis confirmada por imagen durante el periodo de estudio. La consulta en el SU después de 24 h desde el inicio de los síntomas se consideró tardía. Los pacientes que acudieron antes de las 24 h desde el inicio de los síntomas se incluyeron en el grupo A y los pacientes que se presentaron después de las 24 h se adjudicaron al grupo B. Se compararon los parámetros clínicos y bioquímicos, así como el manejo recibido por cada paciente. Resultados Se analizó a 397 pacientes que acudieron a Urgencias con urolitiasis confirmada (grupo A, n = 199; grupo B, n = 198). La mediana (RIC) de demora hasta la consulta fue de 2 días (1,5-4). En el momento de la consulta, no se encontraron diferencias estadísticamente significativas entre los 2 grupos de pacientes en cuanto a los síntomas como fiebre y dolor en el flanco, o la mediana de los niveles séricos de creatinina, proteína C reactiva y leucocitos. No se encontraron diferencias en cuanto al tratamiento conservador o quirúrgico. Conclusiones La demora > 24 h hasta acudir al SU no se asocia a un empeoramiento de los parámetros bioquímicos ni de los resultados clínicos. La mayoría de los pacientes con dolor lumbar agudo no siempre necesitan acudir de forma inmediata a urgencias, pudiendo ser tratados en consultas externas (AU)

Introduction and objective To verify the impact of delay on biochemical and clinical outcomes for patients presenting to the emergency department (ED) with acute renal colic. Materials and methods Data were retrospectively collected from 3 institutions of 2 European countries between 01 January and 30 April 2020. Patients who presented to the ED with unilateral or bilateral renal colic caused by urolithiasis confirmed by imaging tests during the study period were included. A presentation after 24 hours since the onset of symptoms was considered a delay. Patients presenting before 24 hours from the symptom onset were included in Group A, while the patients presenting after 24 hours in Group B. Clinical and biochemical parameters and management were compared. Results 397 patients who presented to ED with confirmed urolithiasis were analyzed (Group A, n = 199; Group B, n = 198. The median (IQR) delay in presentation was 2 days (1,5-4). At presentation, no statistically significant differences were found amongst the 2 groups of patients regarding presenting symptoms such as fever and flank pain, and the median serum levels of creatinine, C reactive protein and white blood cells. No differences were found in terms of conservative or operative management. Conclusions Delay in consultation >24 hours is not associated with worsening biochemical parameters and clinical outcomes. Most patients with acute loin pain do not necessarily need urgent attendance to the ED and may be managed in the outpatients (AU)

Impact of a delayed presentation to the emergency department for acute renal colic on biochemical and clinical outcomes.

INTRODUCTION AND OBJECTIVE: To verify the impact of delay on biochemical and clinical outcomes for patients presenting to the emergency department (ED) with acute renal colic. MATERIALS AND METHODS: Data were retrospectively collected from three institutions of two European countries between 01 January and 30 April 2020. Patients who presented to the ED with unilateral or bilateral renal colic caused by urolithiasis confirmed by imaging tests during the study period were included. A presentation after 24 h since the onset of symptoms was considered a delay. Patients presenting before 24 h from the symptom onset were included in Group A, while the patients presenting after 24 h in Group B. Clinical and biochemical parameters and management were compared. RESULTS: A total of 397 patients who presented to ED with confirmed urolithiasis were analyzed (Group A, n = 199; Group B, n = 198. The median (IQR) delay in presentation was 2 days (1,5-4). At presentation, no statistically significant differences were found amongst the two groups of patients regarding presenting symptoms such as fever and flank pain, and the median serum levels of creatinine, C reactive protein and white blood cells. No differences were found in terms of conservative or operative management. CONCLUSION: Delay in consultation >24 h is not associated with worsening biochemical parameters and clinical outcomes. Most patients with acute loin pain do not necessarily need urgent attendance to the ED and may be managed in the outpatients.

Anterior urethral trauma in childhood: presentation of two cases. / Traumatismos uretrales en la infancia: presentación de dos casos.

INTRODUCTION: The incidence of urethral trauma in children is low given that they have a short, mobile urethra, largely protected by the pubis. CLINICAL CASE: We describe two clinical cases illustrating the variety of presentations anterior urethral lesions can have. The first child had acute urinary retention two months after falling astride, with subsequent diagnosis of urethral stricture following serial voiding cystourethrogram (SVCU). The second child had urinary incontinence after falling off a horse. SVCU showed a urethral diverticulum, characterized through ultrasound imaging. Both were treated with deferred surgery. REMARKS: Urethral lesion should always be suspected after perineal trauma. SVCU is the gold standard diagnostic technique. Deferred urethroplasty is the treatment of choice, with good results, but there is a risk of incontinence and impotence.

INTRODUCCION: La incidencia de traumatismos uretrales en niños es baja dado que su uretra es corta, móvil y está protegida en gran parte por el pubis. CASOS CLINICOS: Exponemos dos casos clínicos que ilustran la variedad de presentaciones de las lesiones en uretra anterior. Primer niño con retención aguda de orina dos meses después de sufrir una caída a horcajadas. Posterior diagnóstico de estenosis uretral con cistouretrografía miccional seriada (CUMS). Segundo niño con incontinencia urinaria tras caída de un caballo. Hallazgo de divertículo uretral en CUMS y caracterización mediante ecografía. Ambos son tratados con cirugía diferida. COMENTARIOS: Es importante sospechar una lesión de uretra después de un traumatismo perineal. La CUMS es la prueba diagnóstica estándar. El tratamiento de elección implica uretroplastia diferida con buenos resultados aunque presenta riesgo de incontinencia e impotencia.

Traumatismos uretrales en la infancia: presentación de dos casos / Anterior urethral trauma in childhood: presentation of two cases

INTRODUCCIÓN: La incidencia de traumatismos uretrales en niños es baja dado que su uretra es corta, móvil y está protegida en gran parte por el pubis. CASOS CLÍNICOS: Exponemos dos casos clínicos que ilustran la variedad de presentaciones de las lesiones en la uretra anterior. Primer niño con retención aguda de orina dos meses después de sufrir una caída a horcajadas. Posterior diagnóstico de estenosis uretral con cistouretrografía miccional seriada (CUMS). Segundo niño con incontinencia urinaria tras caída de un caballo. Hallazgo de divertículo uretral en CUMS y caracterización mediante ecografía. Ambos son tratados con cirugía diferida. COMENTARIOS: Es importante sospechar una lesión de uretra después de un traumatismo perineal. La CUMS es la prueba diagnóstica estándar. El tratamiento de elección implica uretroplastia diferida con buenos resultados, aunque presenta riesgo de incontinencia e impotencia

INTRODUCTION: The incidence of urethral trauma in children is low given that they have a short, mobile urethra, largely protected by the pubis. CLINICAL CASES: We describe two clinical cases illustrating the variety of presentations anterior urethral lesions can have. The first child had acute urinary retention two months after falling astride, with subsequent diagnosis of urethral stricture following serial voiding cystourethrogram (SVCU). The second child had urinary incontinence after falling off a horse. SVCU showed a urethral diverticulum, characterized through ultrasound imaging. Both were treated with deferred surgery. REMARKS: Urethral lesion should always be suspected after perineal trauma. SVCU is the gold standard diagnostic technique. Deferred urethroplasty is the treatment of choice, with good results, but there is a risk of incontinence and impotence

Assessment of trends and clinical presentation in the emergency department of patients with renal colic during the COVID-19 pandemic era. / Evaluación de las tendencias y presentación clínica de pacientes con cólico nefrítico que acuden al servicio de urgencias durante la era pandémica del COVID-19.

INTRODUCTION: We hypothesized that the recent COVID-19 pandemic may lead to a delay in renal colic patients presenting to the Emergency Department due to the fear of getting infected. This delay may lead to a more severe clinical condition at presentation with possible complications for the patients. MATERIAL AND METHODS: Retrospective review of data collected from three institutions from Spain and Italy. Patients who presented to Emergency Department with unilateral or bilateral renal colic caused by imaging confirmed urolithiasis during the 45 days before and after each national lockdown were included. Data collected included patients' demographics, biochemical urine and blood tests, radiological tests, signs, symptoms and the therapeutic management. Analysis was performed between two groups, Group A: patients presenting prior to the national lockdown date; and Group B: patients presenting after the national lockdown date. RESULTS: A total of 397 patients presented to Emergency Department with radiology confirmed urolithiasis and were included in the study. The number of patients presenting to Emergency Department with renal/ureteric colic was 285 (71.8%) patients in Group A and 112 (28.2%) patients in Group B (p<0.001). The number of patients reporting a delay in presentation was 135 (47.4%) in Group A and 63 (56.3%) in Group B (p=0.11). At presentation, there were no statistical differences between Group A and Group B regarding the serum creatinine level, C reactive protein, white blood cell count, fever, oliguria, flank pain and hydronephrosis. In addition, no significant differences were observed with the length of stay, Urology department admission requirement and type of therapy. CONCLUSION: Data from our study showed a significant reduction in presentations to Emergency Department for renal colic after the lockdown in Spain and Italy. However, we did not find any significant difference with the length of stay, Urology department admission requirement and type of therapy.