Teaching Urology to Undergraduates: A Prospective Survey of What General Practitioners Need to Know.

BACKGROUND: Higher education training in Medicine has considerably evolved in recent years. One of its main goals has been to ensure the training of students as future adequately qualified general practitioners (GPs). Tools need to be developed to evaluate and improve the teaching of Urology at the undergraduate level. Our objective is to identify the knowledge and skills needed in Urology for the real clinical practice of GPs. METHODS: An anonymous self-administered survey was carried out among GPs of Primary Care and Emergencies which sought to evaluate urological knowledge and necessary urological skills. The results of the survey were exported and descriptive statistics were performed using IBM SPSS Statistics version 19.0. RESULTS AND LIMITATIONS: A total of 127 answers were obtained, in which 'Urological infections', 'Renal colic', 'PSA levels and screening for prostate cancer', 'Benign prostatic hyperplasia', 'Hematuria', 'Scrotal pain', 'Prostate cancer diagnosis', 'Bladder cancer diagnosis', 'Urinary incontinence', and 'Erectile dysfunction' were rated as Very high or High formative requirements (>75%). Regarding urological skills, 'Abdominal examination', 'Interpretation of urinalysis', 'Digital rectal examination', 'Genital examination', and 'Transurethral catheterization' were assessed as needing Very high or High training in more than 80% of the surveys. The relevance of urological pathology in clinical practice was viewed as Very high or High in more than 80% of the responses. CONCLUSIONS: This study has shown helpful results to establish a differentiated prioritization of urological knowledge and skills in Primary Care and Emergencies. Efforts should be aimed at optimizing the teaching in Urology within the Degree of Medicine which consistently ensures patients' proper care by future GPs.

The effects of tobacco consumption on paternity rates of adults with a history of cryptorchidism.

OBJECTIVE: To determine the effect of tobacco consumption on paternity rates in men with a history of cryptorchidism. To compare the paternity rates between formerly unilateral, bilateral cryptorchid smokers, and nonsmokers. METHODS: A retrospective cohort study of 153 men who had undergone orchiopexy between 1961 and 1985 at the Miguel Servet University Hospital (116 unilateral and 37 bilateral) and a control group of 100 men were evaluated by review of medical records and a questionnaire. RESULTS: A total of 197 men filled the questionnaire (76.7%). There was no difference in paternity rates between smokers compared to nonsmokers (P = 0.21). In the unilateral cryptorchid men (ULC) group, there is no difference in paternity rates when compared with the controls (P = 0.079) or when comparing ULC smokers to ULC nonsmokers (P = 0.35). In the bilateral cryptorchid men (BLC) group, there is no difference in paternity rates when compared to controls (P = 0.075) or when comparing BLC smokers to BLC nonsmokers (P = 0.36). When comparing according to consumption, there is no difference between mild, moderate or heavy smoker cases and controls. CONCLUSION: There is no difference in paternity rates between men with a history of cryptorchidism that consume tobacco compared to nonsmokers or controls. More studies are needed to determine the impact of tobacco consumption in formerly cryptorchid men.

Impacto de la aplicación de una guía clínica basada en la evidencia en el tratamiento del reflujo vesicoureteral primario en el niño / Impact of using an evidence-based clinical guideline for the management of primary vesicoureteral reflux in children

Objetivo: Analizar en qué manera se ha modificado la actitud terapéutica en un hospital de tercer nivel tras la implementación de la guía clínica para el tratamiento del reflujo vesicoureteral (RVU) primario en niños. Población y métodos: Estudio retrospectivo sobre una cohorte de pacientes con RVU primario (1989-2015), de entre 0 y 15 años, en un hospital terciario. Se comparó la conducta terapéutica antes y después de la aparición de la guía clínica (2008). Resultados: Se incluyeron 297 pacientes (49, 8% de niños, 50, 2% de niñas), edad media al momento del diagnóstico de 21, 71 meses. El grado de RVU fue: RVU I-III 45, 1%, RVU IV-V 54, 9%; 124 fueron tratados tras la implementación de la guía clínica (grupo 1), 173, con anterioridad (grupo 2). El período medio de seguimiento fue de 124, 32 meses. El tratamiento conservador fue la terapia de inicio en el 70, 3% de los pacientes del grupo 1 y en el 67, 9% del grupo 2. El número de cirugías se mantuvo constante (31, 45% vs. 31, 79%), con un incremento en el número de procedimientos endoscópicos (p < 0, 005). El perfil de paciente se ha modificado a raíz de la aplicación del algoritmo propuesto por dicha guía. Hubo menos intervenciones en pacientes con RVU IV-V (82, 32% vs. 59, 9%, p= 0, 000) y daño renal al momento del diagnóstico (49, 4% vs. 9, 8%, p= 0, 000). Conclusiones: La aplicación de la guía clínica ha favorecido una conducta conservadora inicial en pacientes con RVU de alto grado y nefropatía, en los que, tradicionalmente, se indicaba la cirugía desde el inicio. La utilización de las guías clínicas favorece una conducta unánime basada en la evidencia, que disminuye los procedimientos invasivos innecesarios.

Objective: To analyze changes in the therapeutic approach at a tertiary care hospital following the implementation of a clinical guideline for the treatment of primary vesicoureteral reflux (VUR) in children. Population and methods: Retrospective study conducted in a cohort of patients with primary VUR (1989-2015) aged 0-15 years at a tertiary care hospital. The therapeutic approach before and after the development of the clinical guideline (2008) was compared. Results: A total of297 patients (49.8% boys, 50.2% girls) were included; their mean age at the time of diagnosis was 21.71 months. VUR grading was: VUR I-III 45.1%, VUR IV-V 54, 9%; 124 were treated after the implementation of the clinical guideline (group 1), and 173, before (group 2). The mean follow-up period was 124.32months. A conservative approach was the initial treatment in 70.3% of group 1 patients and 67.9% of group 2 patients. The number of surgeries remains constant (31.45% versus 31.79%), with an increase in the number of endoscopic surgeries (p < 0.005). The profile of patients has changed based on the application of the algorithm proposed by the guideline. Fewer surgeries were done in patients with VUR IV-V (82.32% versus 59.9%, p= 0.000) and there were fewer cases of kidney damage at diagnosis (49.4% versus 9.8%, p= 0.000). Conclusions: The implementation of the clinical guideline has favored an initially conservative approach in patients with severe grade VUR and nephropathy, for whom surgery was traditionally indicated initially. Using clinical guidelines favors a unanimous, evidence-based approach that reduces the performance of unnecessary invasive procedures.

Impact of using an evidence-based clinical guideline for the management of primary vesicoureteral reflux in children. / Impacto de la apación de una guía clínica basada en la evidencia en el tratamiento del reflujo vesicoureteral primario en el niño.

OBJETIVE: To analyze changes in the therapeutic approach at a tertiary care hospital following the implementation of a clinical guideline for the treatment of primary vesicoureteral reflux (VUR) in children. POPULATION AND METHODS: Retrospective study conducted in a cohort of patients with primary VUR (1989-2015) aged 0-15 years at a tertiary care hospital. The therapeutic approach before and after the development of the clinical guideline (2008) was compared. RESULTS: A total of 297 patients (49.8% boys, 50.2% girls) were included; their mean age at the time of diagnosis was 21.71 months. VUR grading was: VUR I-III 45.1%, VUR IV-V 54,9%; 124 were treated after the implementation of the clinical guideline (group 1), and 173, before (group 2). The mean follow-up period was 124.32 months. A conservative approach was the initial treatment in 70.3% of group 1 patients and 67.9% of group 2 patients. The number of surgeries remains constant (31.45% versus 31.79%), with an increase in the number of endoscopic surgeries (p < 0.005). The profile of patients has changed based on the application of the algorithm proposed by the guideline. Fewer surgeries were done in patients with VUR IV-V (82.32% versus 59.9%, p= 0.000) and there were fewer cases of kidney damage at diagnosis (49.4% versus 9.8%, p= 0.000). CONCLUSIONS: The implementation of the clinical guideline has favored an initially conservative approach in patients with severe grade VUR and nephropathy, for whom surgery was traditionally indicated initially. Using clinical guidelines favors a unanimous, evidencebased approach that reduces the performance of unnecessary invasive procedures.

OBJETIVO: Analizar en qué manera se ha modificado la actitud terapéutica en un hospital de tercer nivel tras la implementación de la guía clínica para el tratamiento del reflujo vesicoureteral (RVU) primario en niños. POBLACIÓN Y MÉTODOS: Estudio retrospectivo sobre una cohorte de pacientes con RVU primario (1989-2015), de entre 0 y 15 años, en un hospital terciario. Se comparó la conducta terapéutica antes y después de la aparición de la guía clínica (2008). RESULTADOS: Se incluyeron 297 pacientes (49,8% de niños, 50,2% de niñas), edad media al momento del diagnóstico de 21,71 meses. El grado de RVU fue: RVU I-III 45,1%, RVU IV-V 54,9%; 124 fueron tratados tras la implementación de la guía clínica (grupo 1), 173, con anterioridad (grupo 2). El período medio de seguimiento fue de 124,32 meses. El tratamiento conservador fue la terapia de inicio en el 70,3% de los pacientes del grupo 1 y en el 67,9% del grupo 2. El número de cirugías se mantuvo constante (31,45% vs. 31,79%), con un incremento en el número de procedimientos endoscópicos (p < 0,005). El perfil de paciente se ha modificado a raíz de la aplicación del algoritmo propuesto por dicha guía. Hubo menos intervenciones en pacientes con RVU IV-V (82,32% vs. 59,9%, p= 0,000) y daño renal al momento del diagnóstico (49,4% vs. 9,8%, p= 0,000). CONCLUSIONES: La aplicación de la guía clínica ha favorecido una conducta conservadora inicial en pacientes con RVU de alto grado y nefropatía, en los que, tradicionalmente, se indicaba la cirugía desde el inicio. La utilización de las guías clínicas favorece una conducta unánime basada en la evidencia, que disminuye los procedimientos invasivos innecesarios.

[Long-term results of the endoscopic treatment of vesicoureteral reflux]. / Resultados a largo plazo del tratamiento endoscópico del reflujo vesicoureteral. Consideraciones al respecto.

OBJECTIVES: To analize results and late complications in patients with vesicoureteral reflux, treated by endoscopic treatment and with several substances. METHODS: In a long bibliographic review we analize results, recurrences and late complications with this treatment using different substances. RESULTS/CONCLUSIONS: In spite of the prescribed substance, VUR may recur several years after treatment. These cases are of low grade and most disappear after a new session of ET VUR can also appear in the other side, not knowing in fact why this happens. Grade IV -V reflux, and also VUR secondary to organic and functional pathology, can be resolved by endoscopic treatment, although the percentage of good results is lower. Parents have to be informed, in detail, of the three therapeutic options for reflux, (medical, endoscopic, and open surgery), and participate in the final decision. Parents use to prefer ET. According to the number of patients treated by ET and the number of follow-up years that possible side effects have been observed, most authors consider that ET is a safe treatment, and it is currently the treatment of choice for patients with reflux.

Resultados a largo plazo del tratamiento endoscópico del reflujo vesicoureteral. Consideraciones al respecto / Long-term results of the endoscopic treatment of vesicoureteral reflux

Objetivo: Analizar los resultados y las complicaciones a largo plazo, aparecidas en pacientes afectos de reflujo vésicoureteral (RVU) y que han sido tratados mediante Tratamiento Endoscópico (TE) con distintas sustancias. Métodos: Realizamos una amplia revisión bibliográfica y analizamos los resultados, las recidivas y las complicaciones aparecidas a largo plazo con este tratamiento y con las distintas sustancias utilizadas. Resultados/Conclusiones: El RVU puede reaparecer después de varios años del tratamiento, independientemente del tipo de sustancia utilizada. Estos reflujos suelen ser de menor grado y la mayoría desaparecen mediante una nueva sesión de TE. El RVU puede también aparecer en el lado contralateral, no sabiéndose con seguridad, las causas por las que esto sucede. Los reflujos de IV y V grado, así como, los reflujo secundarios a patología orgánica y funcional, pueden ser solucionados mediante TE, aunque con menor porcentaje de éxito. Debido a las 3 modalidades existentes actualmente para el tratamiento del reflujo: médico, endoscópico y quirúrgico, los padres deben ser informados detalladamente y participar más en la decisión del tratamiento a elegir. El TE parece ser el preferido de los padres. Basados en el número de pacientes en que se le ha realizado el TE y en el número de años en que se ha podido observar sus posibles efectos secundarios, la mayoría de los autores consideran que el TE es un tratamiento seguro, además de ser el tratamiento de elección actualmente ante pacientes afectos de reflujo (AU)

Objectives: To analize results and late complications in patients with vesicoureteral reflux, treated by endoscopic treatment and with several substances. Methods: In a long bibliographic review we analize results, recurrences and late complications with this treatment using different substances. Results/Conclusions: In spite of the prescribed substance, VUR may recur several years af-ter treatment. These cases are of low grade and most disappear after a new session of ET. VUR can also appear in the other side, not knowing in fact why this happens. Grade IV -V reflux, and also VUR secondary to organic and functional pathology, can be resolved by endoscopic treatment, although the percentage of good results is lower. Parents have to be informed, in detail, of the three therapeutic options for reflux, (medical, en-doscopic, and open surgery), and participate in the final decision. Parents use to prefer ET. According to the number of patients treated by ET and the number of follow-up years that possible side effects have been observed, most authors consider that ET is a safe treatment, and it is currently the treatment of choice for patients with reflux (AU)

[C677T and A1298C MTHFR polymorphisms in the etiology of neural tube defects in Spanish population]. / Implicación de los polimorfismos C677T y A1298C del gen MTHFR en el desarrollo de los defectos del tubo neural en la población española.

BACKGROUND AND OBJECTIVE: The etiology of neural tube defects (NTDs) is multifactorial. The presence of mutated genotypes of C677T and A1298C polymorphisms, and their combined heterozygosity, have been considered risk factors for the occurrence and recurrence of NTDs in some populations. SUBJECTS AND METHOD: This case-control study included 159 healthy controls, 27 NTDs patients, 28 patients' mothers and 23 siblings. The polymorphism study was performed by PCR. For fragment digestion, we used the restriction enzymes Hinf I (C677T) and Mbo II (A1298C). RESULTS: There was no significant difference (p = 0.991) in C677T genotypes between controls (CC: 35%, CT: 50% and TT: 15%) and patients (37, 52 and 11%, respectively), patients' mothers (39, 50 and 11%, respectively) and siblings (35, 48 and 17%, respectively). The prevalence of A1298C genotypes in controls (AA: 49%, AC: 45% and CC: 6%) was similar (p = 0.917) to the prevalence in patients (41, 56 and 4%, respectively), patients' mothers (43, 50 and 7%, respectively) and siblings (52, 39 and 9%, respectively). CONCLUSIONS: The absence of differences in the two polymorphisms between these groups makes us conclude that there is no association with NTDs in the Spanish population.

Implicación de los polimorfismos C677T y A1298C del gen MTHFR en el desarrollo de los defectos del tubo neural en la población española / C677T and A1298C MTHFR polymorphisms in the etiology of neural tube defects in Spanish population

FUNDAMENTO Y OBJETIVO: La etiología de los defectos de tubo neural (DTN) es multifactorial. La presencia del genotipo mutado para los polimorfismos C677T y A1298C y su heterocigosidad combinada se han considerado factores de riesgo en determinadas poblaciones. SUJETOS Y MÉTODO: El estudio de casos y controles estuvo formado por 159 controles sanos, 27 pacientes afectados de espina bífida, 28 madres y 23 hermanos de pacientes con espina bífida. El estudio de los polimorfismos se realizó mediante reacción en cadena de la polimerasa (PCR) y digestión de los fragmentos obtenidos con las enzimas de restricción Hind I (C677T) y MboII (A1298C). RESULTADOS: No se han encontrado diferencias estadísticamente significativas (p = 0,991) entre la prevalencia de los genotipos C677T del grupo control (CC: 35 por ciento; CT: 50 por ciento, y TT: 15 por ciento) y los obtenidos en el grupo de pacientes (37, 52 y 11 por ciento, respectivamente), grupo de madres de pacientes (39, 50 y 11 por ciento, respectivamente) y grupo de hermanos de pacientes (35, 48 y 17 por ciento, respectivamente). Asimismo, la prevalencia de los genotipos A1298C dentro del grupo control (AA: 49 por ciento; AC: 45 por ciento, y CC: 6 por ciento) fue similar (p = 0,917) a la encontrada en el grupo de pacientes (41, 56 y 4 por ciento, respectivamente), grupo de madres de pacientes (43, 50 y 7 por ciento, respectivamente) y grupo de hermanos de pacientes (52, 39 y 9 por ciento, respectivamente). CONCLUSIONES: La ausencia de diferencias estadísticamente significativas de los dos polimorfismos estudiados en los distintos grupos hace concluir que éstos no participan en la etiología de los DTN en la población española (AU)