Catéter ureteral desintegrado / Ureteral stent disintegrated

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Usefulness of measuring renal papillae in Hounsfield units in stone - forming patients

ABSTRACT Introduction: The aim of this work is to study the density of the renal papillae in stone-forming patients and to determine its usefulness. Materials and Methods: This study included a total of 79 patients diagnosed with renal stones and on whom a computed tomography without contrast was performed from June 2014 to May 2015. The patients were divided into two groups: Group 1 (single episode) included 43 patients, and Group 2 (recurrent episodes) included 36 patients. The density of six renal papillae (3 per kidney) was measured, and the means obtained were compared between Groups 1 and 2. Statistical analysis was performed using SPSS 20.0. Results: The mean papillary density in Group 1 was 32.26 (SD 4.07) HU compared to 42.36 (SD 8.03) HU in Group 2 (P=00001). A ROC curve was constructed, obtaining an optimal cut-off point of 36.8HU [area under the curve, 0.881 (95% CI; 0.804-0.958); P=0001], with a sensitivity of 80% and a specificity of 90%. The relative risk was estimated at 40.3 (95% CI; 10.8-151.1), meaning that a patient with a mean papillary density greater than 36.8HU would have a 40 times greater risk of having recurrent renal stones. The positive predictive value (PPV) was 81% and the negative predictive value (NPV) was 90%. Conclusion: The measurement of renal papillary density could be useful in predicting recurrent stone-formers. These results need to be confirmed in future studies with a greater number of patients and a longer follow-up.

Usefulness of measuring renal papillae in Hounsfield units in stone - forming patients.

INTRODUCTION: The aim of this work is to study the density of the renal papillae in stone-forming patients and to determine its usefulness. MATERIALS AND METHODS: This study included a total of 79 patients diagnosed with renal stones and on whom a computed tomography without contrast was performed from June 2014 to May 2015. The patients were divided into two groups: Group 1 (single ep¬isode) included 43 patients, and Group 2 (recurrent episodes) included 36 patients. The density of six renal papillae (3 per kidney) was measured, and the means obtained were compared between Groups 1 and 2. Statistical analysis was performed using SPSS 20.0. RESULTS: The mean papillary density in Group 1 was 32.26 (SD 4.07) HU compared to 42.36 (SD 8.03) HU in Group 2 (P=00001). A ROC curve was constructed, obtaining an optimal cut-off point of 36.8HU [area under the curve, 0.881 (95% CI; 0.804-0.958); P=0001], with a sensitivity of 80% and a specificity of 90%. The relative risk was estimated at 40.3 (95% CI; 10.8-151.1), meaning that a patient with a mean papillary density greater than 36.8HU would have a 40 times greater risk of having recurrent renal stones. The positive predictive value (PPV) was 81% and the negative predictive value (NPV) was 90%. CONCLUSION: The measurement of renal papillary density could be useful in predicting recurrent stone-formers. These results need to be confirmed in future studies with a greater number of patients and a longer follow-up.

Uso de las concentraciones urinarias en mg/dl en relación a los valores absolutos en 24 h para la evaluación de factores litogénicos en pacientes litiásicos / Use of urinary concentrations in mg/dl in relation to absolute values in 24-hour samples for the evaluation of lithogenic factors in stone forming patients

OBJETIVO: El objetivo de este estudio es analizar las concentraciones en orina (mg/dl) de diferentes factores litogénicos en una muestra de 24 h como predictor de estas alteraciones en lugar de valores absolutos que dependen del volumen de diuresis. MÉTODOS: Desde junio 2014 a mayo 2015 se incluyen un total de 131 pacientes, pertenecientes al Área de Gestión Sanitaria Norte de Almería, con litiasis a los que se indica estudio metabólico. Se realiza estudio de concentraciones de calcio, oxalato, úrico y citrato en orina, junto con cociente calcio/citrato. Se tiene en cuenta la clasificación de hipercalciuria (> 260 mg/24h), hiperuricosuria (> 750 mg/24 h), hiperoxaluria (> 40 mg/24h), hipocitraturia (< 320 mg/24h), hipomagnesuria (< 35 mg/24h). Análisis estadístico con SPSS 17.0. RESULTADOS: Para la concentración de calcio en orina se estima un punto de corte de 12,55 mg/dl con sensibilidad 90% y especificidad 85% con RR de 51,2 (13,9-188,4). En relación a la concentración de oxalato se estima un punto de corte de 1,86 mg/dl con sensibilidad del 91% y especificidad del 84%, con un RR estimado de 67,2 (8,3-540,6). En cuanto a la concentración de úrico en orina se estima un punto de corte de 31,2 mg/dl con una sensibilidad 85% y especificidad 70%, con un RR estimado de 12 (3,8-37,6). En cuanto al citrato, el punto de corte estimado para su concentración fue de 18,8 mg/dl con una sensibilidad y especificidad del 82% y 74% respectivamente, estimando un RR de 13,7 (4,4-42,6). El punto de corte para el magnesio fue de 2,26 mg/dl con sensibilidad 95% y especificidad 78% y RR de 67,6 (11,4-398,3). CONCLUSION: La determinación de concentraciones en orina, en lugar de valores absolutos que dependen en gran medida de la diuresis, parece ser útil a la hora de estimar alteraciones metabólicas clásicas, por lo que deben ser tenidos en cuenta en la evaluación de los pacientes con litiasis

OBJECTIVE: The aim of this study is to analyze urine concentrations (mg/dl) of different lithogenic factors in a sample of 24 h as a predictor of these changes rather than absolute values depend on the volume of diuresis. METHODS: A total of 131 patients from the North Almeria Health Management Area (Spain) with urinary stone disease in whom a metabolic study was indicated were included from June 2014 to May 2015. The concentrations of calcium, oxalate, uric acid, citrate and magnesium were measured in the urine, and the calcium/citrate ratio was calculated. The classifications used were: hypercalciuria (> 260 mg/24h), hyperuricosuria (> 750 mg/24h), hyperoxaluria (> 40 mg/24h), hypocitraturia (> 320 mg/24h) and hypomagnesuria (< 35 mg/24h). The statistical analysis was performed using SPSS 17.0. RESULTS: A cut-off point of 12.55 mg/dl, with a sensitivity of 90% and a specificity of 85% and a relative risk (RR) of 51.2 (13.9-188.4), was estimated for urinary calcium. For oxalate the cut-off point was 1.86 mg/dl, with a sensitivity of 91% and a specificity of 84% with an estimated RR of 67.2 (8.3-540.6). As regards the uric acid concentration in urine, a cut-off point of 31.2 mg/dl was estimated, with a sensitivity of 85% and a specificity of 70% and a RR of 12 (3.8-37.6). For citrate the cut-off point was 18.8 mg/dl, with a sensitivity and specificity of 82% and 74%, respectively, with a RR of 13.7 (4.4- 42.6). The cut-off point for magnesium was 2.26mg/dl with a sensitivity of 95% and specificity of 78%, with a RR of 67.6 (11.4-398.3). CONCLUSION: The determination of urine concentrations, instead of absolute values, depends to a large extent on urine output, appears to be useful when estimating classic metabolic alterations and should be taken into account in the evaluation of patients with urinary stone disease

Outpatient holmium laser treatment for recurrent low-grade superficial bladder cancer under local anesthesia.

BACKGROUND: The aim of this paper is to analyze the results of a prospective study conducted on a cohort of patients undergoing outpatient holmium laser fulguration. The "gold standard" treatment of superficial bladder cancer is transurethral resection, although in recent years improvements in laser technology and endoscopy equipment have allowed further therapeutic alternatives. METHODS: This is a descriptive study of a cohort of 37 patients with low-risk recurrent superficial bladder cancer undergoing holmium laser fulguration after bladder instillation of local anesthesia. The study included patients with a history of low-risk primary superficial bladder cancer with papillary tumor recurrence, tumor size ≤10 mm, fewer than 5 tumors, absence of carcinoma in situ, negative cytology, no coagulation disorders and no local anesthesia allergies. Demographic variables, previous history of transurethral resection, safety and oncological results after fulguration were analyzed using the SPSS software. Statistical analyses include calculating mean and frequency, and Kaplan-Meier curve for recurrence. RESULTS: Mean age of the patients was 69.2 years with 86.5% being male. The number of tumors was 1.5±0.8 and the overall average size of 5.5±2.7 mm. The mean duration of the endoscopic procedure was 12±4.3 minutes. Hundred percent of patients had scores on the Visual Analogue Scale ≤3. There was only one case of hematuria, who required hospitalization. After a median follow-up period of 13 months, there was a 35.1% recurrence rate with one case of tumor progression. CONCLUSIONS: Holmium laser treatment of recurrent low-risk superficial bladder tumor is a safe and effective alternative, but long-term clinical trials are necessary to increase the current scientific evidence base.

Fulguración con láser de la recidiva de tumores vesicales superficiales bajo anestesia local: diseño de procesos / Laser fulguration of superficial bladder tumor recurrence under local anesthesia. design process

Introduction: The process design is one of the most interesting tools to ensure the quality of health care before the start of an activity. Although the gold standard treatment of superficial bladder tumors remains transurethral resection (TUR), the onset of laser energy source with better endourological systems allows us to adopt alternative therapies. The aim of this pilot study is to describe the design and protocol in 37 patients with a novel process consisting of outpatient treatment under local anesthesia of bladder tumors with holmium laser. Material and Methods: Pilot study includes 37 patients between January 2012 and December 2013, for the development of a process of holmium laser bladder fulguration without anesthetic infiltration in outpatient study. It analyzes and studies the procedure tolerance, development of immediate complications, visual analog scale (VAS) of pain, patient satisfaction, hospital stays avoided, problems during the application process and development. Results: The mean age of the patients was 69.2 +/- 10.3 years, 100 percent of patients prefer this procedure instead conventional transurethral resection and VAS rating presenting ≤ 3. There were no important complications. Only one patient was admitted at hospital due to hematuria resolved without surgical treatment. Conclusions: The development and implementation of fulguration of superficial papillary bladder tumors with holmium laser process is simple, well tolerated, ambulatory and without complications, with no need of hospital stay.

Introducción: El diseño de procesos es una de las herramientas de mayor interés para asegurar la calidad de la asistencia sanitaria antes del comienzo de una determinada actividad. Aunque el gold standard del tratamiento de los tumores vesicales superficiales sigue siendo la resección transuretral (RTU), la aparición de la fuente de energía láser con mejores medios endourológicos nos permite adoptar otras alternativas terapéuticas. El objetivo de este estudio piloto es describir el diseño y protocolo en 37 pacientes de un proceso novedoso consistente en el tratamiento en régimen ambulatorio y bajo anestesia local intravesical de los tumores de vejiga con láser de holmium. Material y Métodos: Estudio piloto que incluye 37 pacientes entre enero de 2012 y diciembre de 2013, para la elaboración de un proceso de fulguración vesical con láser de holmium sin infiltración anestésica en régimen ambulatorio. Se analiza y estudia tolerancia al procedimiento, desarrollo de complicaciones inmediatas, escala visual analógica (EVA) del dolor, satisfacción del paciente, estancias hospitalarias evitadas, problemas durante la aplicación del proceso y desarrollo del mismo. Resultados: La edad media de los pacientes fue 69,2 +/- 10,3 años, presentando puntuación EVA ≤ 3. No existieron complicaciones importantes. Hubo un ingreso por hematuria tardía que se resolvió de forma conservadora. Conclusiones: La elaboración y aplicación del proceso de fulguración de tumores vesicales papilares superficiales con láser holmium es una técnica sencilla, con buena tolerancia, ambulatoria y sin complicaciones de interés, con eliminación de estancias hospitalarias.

Seminal vesicle biopsies: an useful staging procedure-exposure of seminal vesicle biopsies protocol and review of the literature.

BACKGROUND AND OBJECTIVES: Although new MRI techniques have a high sensitivity but varying specificity with regard to diagnosing the seminal vesicle invasion (SVI) of prostate cancer, the low availability and high cost involved demands incorporating an inexpensive and accessible technique that might support adequate staging. Currently, uniformity does not exist with regard to the indication criteria of seminal vesicle biopsies (SVBs). Our objective is to analyse the protocol of SVBs at Morales Meseguer Hospital and conduct an exhaustive review of the literature in this field. METHODS AND MATERIALS: SVBs were performed in patients who were amenable to a curative treatment and who showed at least one of the following indication criteria: prostate-specific antigen greater than or equal to 15 ng/ml, a prostate cancer nodule in the base of the prostate, or ultrasound abnormalities suggestive of vesicular involvement. SVBs were performed in 70 patients. RESULTS: These results revealed a rate of SVI of 15.7 and 25.58 % among all patients and patients diagnosed with prostate cancer, respectively. All biopsied patients who tested positive for the three indication criteria had T3b prostate cancer. Patients with a prostate cancer that altered the base of the prostate according to either digital rectal examination or ultrasound showed a T3b rate of 53.8 %. CONCLUSIONS: SVBs should be considered a complementary procedure for prostate cancer staging because provide important information and it is easy, inexpensive and has few complications.

Duplicidad uretral. La importancia de una anamnesis y una exploración física detalladas / Urethral duplication. The importance of a detailed anamnesis and physical exploration

La duplicidad uretral es una enfermedad poco frecuente, y se han descrito unos 200 casos en todo el mundo. Hay varios subtipos de duplicidad uretral, y el más frecuente es el subtipo 2A-Y. Presentamos un caso de duplicidad uretral tipo 2A-2, poco relatado en la bibliografía actual, diagnosticado como hallazgo casual durante una cirugía endoscópica urológica. La clínica que supone esta malformación congénita es dependiente del subtipo que se padezca, y puede presentarse como totalmente asintomática o como parte de una compleja malformación caudal (AU)

Urethral duplication is a rare disease, only approximately 200 cases having been reported worldwide. There are several subtypes of urethral duplication, the most frequent subtype being 2A-Y. We report a case of urethral duplication 2A-2, little reported in the current literature. It was diagnosed as incidental finding during endoscopic urological surgery. The symptoms of this congenital malformation depend on the subtype of urethral duplication. They can be completely asymptomatic or present as part of a complex caudal malformation (AU)

[Low-cost laparoscopic training: necessary time for acquiring expertise]. / Entrenamiento laparoscópico de bajo costo: tiempo de entrenamiento necesario para adquirir habilidades laparoscópicas básicas similares a las de un experto.

BACKGROUND: Today laparoscopic approach is essential, but learning is usually expensive and very limited. Homemade and low equipment costs are required. We undertook this study to quantify how many hours of training are necessary for a surgeon without laparoscopic experience in order to acquire the abilities to carry out procedures as a staff member with laparoscopic experience. METHODS: A low-cost laparoscopic trainer was constructed. Four exercises of increasing difficulty have been developed. Five residents without laparoscopic experience and four experts developed the study. A satisfaction questionnaire was completed. Data were analyzed comparing the average times for the accomplishment of each exercise between groups. RESULTS: Data showed that the more difficult an exercise is, the more training is required. The average time needed to acquire similar skills as experts was almost 7 h of training spread over 4 months. The level of confidence for approaching a laparoscopic procedure for residents after completing the training was increased by 70%. CONCLUSION: Laparoscopic training is essential in the formation of all surgeons and a reason why this low-cost and easily accessible method could become a basic tool for learning the first steps of the laparoscopic procedure.