Post-Ureteroscopic Lesion Scale: limitaciones en su aplicabilidad clínica / Post-Ureteroscopic Lesion Scale to determine ureteral wall damage, not so easy to employ

Objetivo Analizar el nivel de concordancia de la Post-Ureteroscopic Lesion Scale (PULS), y examinar las consecuencias de su aplicación en la práctica clínica con datos estadísticos más fiables que los utilizados en el trabajo original. Métodos Se realizaron 14 ureteroscopias (URS) y 14 micro-ureteroscopias (micro-URS) en 14 cerdos hembra. Todos los procedimientos se grabaron en vídeo y se realizó un análisis anatomopatológico en cada uréter. Dieciséis urólogos (9 endourólogos y 7 urólogos generales) y 4 médicos internos residentes evaluaron las lesiones ureterales según la escala PULS, con grados 0, 1 y ≥2. La concordancia se calculó mediante porcentajes, el Coeficiente W de Kendall, el índice kappa de Fleiss y el alfa de Krippendorff. La concordancia entre evaluadores se calculó con la Correlación de Spearman y el Coeficiente kappa de Cohen. Resultados El porcentaje de concordancia fue del 11,1%. Los coeficientes se clasificaron como bajos o muy bajos, y encontramos una mayor concordancia entre los evaluadores más inexpertos. Por otro lado, no hubo acuerdo entre el 50% de los evaluadores. Conclusiones La baja concordancia entre evaluadores, la especificidad de la PULS y la correlación clínico/patológica sugieren dificultades del uso de esta escala y una curva de aprendizaje probablemente larga. (AU)

Objective To analyze the level of agreement of the Post-Ureteroscopic Lesion Scale (PULS) and the consequences on its application in clinical practice with more reliable statistical data than the one used in the original work. Methods 14 URS and 14 micro-URS were performed in 14 female porcine model. All the procedures were video recorded and an anatomopathological analysis was performed in each ureter. Sixteen urologists (9 endourologists and 7 general urologists) and 4 residents evaluated the ureteral lesions according to the PULS, with degrees 0, 1 and ≥2. The agreement was calculated with percentages, Kendall's W coefficient and the indicators Fleiss’ Kappa and Krippendorff's Alpha, while the inter-rater agreement was calculated with Spearman's correlation and Cohen's Kappa. Results The percent of agreement was 11.1%. The coefficients were likewise classified as low or very low, with the greatest agreement found among the inexperienced. Also, 50% of the raters did not agree with the rest. Conclusions The low inter-rater agreement, the specificity of the PULS and the clinical-pathological correlation suggests that this scale is not simple, and probably has a long learning curve. (AU)

Post-Ureteroscopic Lesion Scale to determine ureteral wall damage, not so easy to employ.

OBJECTIVE: To analyze the level of agreement of the Post-Ureteroscopy Lesion Scale (PULS) and the consequences on its application in clinical practice with more reliable statistical data than the one used in the original work. METHODS: 14 URS and 14 micro-URS were performed in 14 female porcine model. All the procedures were video recorded and an anatomopathological analysis was performed in each ureter. Sixteen urologists (9 endourologists and 7 general urologists) and 4 residents evaluated the ureteral lesions according to the PULS, with degrees 0, 1 and ≥2. The agreement was calculated with percentages, Kendall's W coefficient and the indicators Fleiss' Kappa and Krippendorff's Alpha, while the inter-rater agreement was calculated with Spearman's correlation and Cohen's Kappa. RESULTS: The percent of agreement was 11.1%. The coefficients were likewise classified as low or very low, with the greatest agreement found among the inexperienced. Also, 50% of the raters did not agree with the rest. CONCLUSIONS: The low inter-rater agreement, the specificity of the PULS and the clinical-pathological correlation suggests that this scale is not simple, and probably has a long learning curve.

[Emphysematous cystitis. Case report and review of literature]. / Cistitis enfisematosa. Caso clínico y revisión de literatura.

We present the case of a patient with diagnostic of cystitis enphisematous. We carry out the bibliographical revision of other published cases of this pathology. The cystitis enphisematous is an infectious square of strange presentation and more frequent in patient diabetic women, characterized by the presence of gas in the bladder cavity and infiltration of the walls bladder, due to the infection for germs producing of CO2, mainly gram (-). The peculiarity of our case is due to that the patient didn't suffer diabetes, being much more frequent that this alteration happens in the patients that yes they are it.

Cistitis enfisematosa. Caso clínico y revisión de literatura / Emphysematous cistitis. Case report and review of literature

Presentamos el caso de una paciente con diagnóstico de cistitis enfisematosa. Realizamos la revisión bibliográfica de otros casos publicados de dicha patología. La cistitis enfisematosa es un cuadro infeccioso de rara presentación y más frecuente en pacientes mujeres diabéticas, caracterizado por la presencia de gas en la cavidad vesical e infiltración de las paredes vesicales, debido a la infección por gérmenes productores de CO2, principalmente gram (-). La peculiaridad de nuestro caso se debe a que la paciente no padecía diabetes, siendo mucho más frecuente que acontezca esta alteración en los pacientes que sí lo son (AU)

We present the case of a patient with diagnostic of cystitis enphisematous. We carry out the bibliographical revision of other published cases of this pathology. The cystitis enphisematous is an infectious square of strange presentation and more frequent in patient diabetic women, characterized by the presence of gas in the bladder cavity and infiltration of the walls bladder, due to the infection for germs producing ofCO2, mainly gram (-). The peculiarity of our case is due to that the patient didn’t suffer diabetes, being much more frequent that this alteration happens in the patients that yes they are it (AU)

[Radical prostatectomy: evaluation of learning curve outcomes laparoscopic and robotic-assisted laparoscopic techniques with radical retropubic prostatectomy]. / Prostatectomía radical: comparación de los resultados obtenidos durante las curvas de aprendizaje de la técnica laparoscópica pura y de la técnica asistida por robot con la prostatectomía radical retropúbica.

INTRODUCTION/OBJECTIVE: Radical retropubic prostatectomy (RRP) is the gold standard for the surgical treatment of localized prostate cancer. New techniques are being developed with less invasive methods, including laparoscopic radical prostatectomy (LRP) and robotic-assisted laparoscopic radical prostatectomy (RALP). The aim of the study is to compare LRP and RALP outcomes during the learning curve with RRP, especially operative time and surgical complications. MATERIAL AND METHOD: We performed a retrospective observational study of all the RRP cases attended from January 2000, allthe LRPs performed at the Urology Department of the Galdakao Usansolo Hospital and the first 60 RALPs treated by the Clinic Urology group. Baseline parameters, operative and perioperative parameters (nerve preservation, positive margins, intraoperative bleeding, duration of catheterization, hospital stay) and surgical complications were assessed, and the three techniques were compared. RESULTS: The total number of patients was 192. The mean time operation was of 210 min in the RRP group, 345 min in the LRP group and 209.5 min in the RALP group (p = 0). Intraoperative bleeding was of 1500 mL in RRP, 1275 mL in LRP and 400 mL in RALP (p = 0) (Table 1). Six months after the procedure the continence rate was 60% in the RALP group, 45.90% in the RRP group and 36.40% in the group LRP (p = 0.001) (Table 2). CONCLUSIONS: Laparoscopic radical prostatectomy requires a longer learning curve than robotic-assisted prostatectomy. Operative time in RALP procedures was comparable to RRP cases. RALP showed benefits in terms of continence and intraoperative bleeding.