Recurrent Bacteriuria as a Prognosis Marker in the Adjuvant Treatment of Non-Muscle Invasive Bladder Cancer.

PURPOSE: Bacteriuria may affect the response to adjuvant therapy in non-muscle invasive bladder cancer (NMIBC). The main aim of this study was to examine the effect of recurrent bacteriuria (RB) on the prognosis of NMIBC in women receiving intravesical therapy. MATERIALS AND METHODS: We designed a prospective observational study from 2012 to 2019. We included women with bladder cancer treated with transurethral resection of the bladder (TURB) and adjuvant intravesical treatment. Significant bacteriuria was defined as a presence in urine cultures at or above 100,000 colony-forming units per millilitre. The recurrent bacteriuria group included patients with significant bacteriuria in at least two determinations in 6 months or in 3 or more determinations in a year. The institutional board approved the study. RESULTS: One hundred thirty-six patients diagnosed with NMIBC participate in the study, of whom 100 met the inclusion criteria. During follow-up, 48 were categorized in the RB group and 52 formed the non-bacteriuria group (NB). RB GROUP HAD A BETTER OUTCOME: Eight patients (16.67%) experiencing a recurrence of the same grade, with no progression to a higher-grade tumor or muscle-invasive tumor. In the NB group, 18 (34.6%) patients presented a recurrence (P = .001) and 22 (42.3%) progressed to a higher-grade tumor or muscular invasion (P = .001). The presence of RB was identified as a predictor of good response in multivariate regression with a relative risk of 0.13 (P = .018) CONCLUSIONS: Female patients with RB had a better response to adjuvant treatment for NMIBC. The RB group showed lower rates of tumor recurrences and progression.

Robot-Assisted Radical Prostatectomy by Lateral Approach: Technique, Reproducibility and Outcomes.

BACKGROUND: Radical prostatectomy by lateral approach allows performing a prostatectomy through a buttonhole, with direct access to the seminal vesicle and fully sparing the anterior pubovesical complex. Our aim is to show the results of reproducing the technique of robotic radical prostatectomy by lateral approach, in terms of intraoperative, postoperative, oncological and functional parameters. METHODS: We analyzed 513 patients submitted to robotic radical prostatectomy by lateral approach from January 2015 to March 2021, operated on by two surgeons in our institution. The oncological and functional results of both surgeons were compared. RESULTS: When comparing both surgeons, the rate of positive surgical margins (PSM) was 32.87% and 37.9% and significant surgical margins (PSM > 2 mm) were 5.88% and 7.58% (p = 0.672) for surgeon 1 and surgeon 2, respectively. Immediate continence was 86% and 85% and sexual potency at one year 73% and 72%, with a similar rate of complications for surgeon 1 and 2. CONCLUSIONS: Radical prostatectomy by the lateral approach technique with preservation of the anterior pubovesical complex is reproducible and offers good oncological and functional results.

Disfunción eréctil y YouTube: calidad de los vídeos en español / Erectile dysfunction and YouTube: Quality of videos in Spanish

Introducción: La disfunción eréctil (DE) es una de las enfermedades urológicas más prevalentes, pero los datos de la calidad de su información en redes sociales son escasos. El objetivo de nuestro estudio fue evaluar la calidad de la información sobre DE contenida en los vídeos de YouTube. Material y métodos: Estudio descriptivo transversal de los 50 primeros vídeos en castellano publicados en YouTube, evaluados por tres urólogos mediante dos cuestionarios validados: Patient Education Materials Assessment Tool (PEMAT) y DISCERN, clasificándolos según puntuación DISCERN en calidad pobre y moderada-buena. Resultados: La mediana de duración fue de 2,42 minutos, y la de visualizaciones, de 94.197 (2.313-3.027.890), con 682,5 (0-54.020) «me gusta» y 39 (0-2.843) «no me gusta». La mediana de PEMAT fue del 29% en inteligibilidad y del 29% en factibilidad. Con DISCERN, 27 vídeos (57,4%) fueron de calidad pobre y 20 (42,6%), de calidad moderada-buena. No observamos diferencias significativas entre ambos grupos en duración, visualizaciones, número de «me gusta» o de «no me gusta». Sí existieron diferencias en PEMAT de inteligibilidad y de factibilidad. El 86,7% de los protagonizados por personal médico fueron de calidad moderada-buena (p=0,001). El 85,7% de los que describían el tratamiento fueron de calidad moderada-buena y el 84% de los vídeos no médicos fueron de calidad pobre (p=0,001). Conclusiones: La mayoría de los vídeos sobre DE en YouTube son de calidad pobre. Los vídeos de mayor calidad son aquellos realizados por profesionales, aunque no son los más vistos. Sería importante el desarrollo de medidas para evitar la difusión de desinformación entre los usuarios de redes sociales. (AU)

Introduction: Erectile dysfunction (ED) is one of the most prevalent urological diseases, but there is limited data about the quality of its information in social networks. The aim of our study was to assess the quality of ED information contained in YouTube videos. Material and methods: Descriptive study of the first 50 Spanish-language videos, published on YouTube, evaluated by three urologists. We used two validated questionnaires: PEMAT (Patient Education Materials Assessment Tool) and DISCERN. Videos were classified according to DISCERN score into poor or moderate-good quality. Results: The median time duration was 2.42minutes (0.15-3.58), 94,197 views (2,313-3,027,890), 682.5 «likes» (0-54,020) and 39 «dislikes» (0-2843). The median of PEMAT score was 29% (9%-95.5%) in understandability and 29% (0-95.5%) in actionability. According to DISCERN score 27 videos (57.4%) had poor quality and 20 (42.6%) moderate-good quality. There were no significant differences between the two groups in time duration, views, «likes» or «dislikes». There were differences in PEMAT score in understandability and actionability. The 86.7% of the moderate-good quality videos were starred by health care provider (P=.001). Also, the 85.7% of videos that describes treatment had moderate-good quality (P=.001). The 84% of the non-medical videos had a poor quality (P=.001). Conclusion: Most ED videos on YouTube have poor quality. The highest quality videos are those made by professionals, although they are not the most viewed. It would be important to develop measures to prevent the spread of misinformation among social network users. (AU)

ChatGPT and most frequent urological diseases: analysing the quality of information and potential risks for patients.

PURPOSE: Artificial intelligence (AI) is a set of systems or combinations of algorithms, which mimic human intelligence. ChatGPT is software with artificial intelligence which was recently developed by OpenAI. One of its potential uses could be to consult the information about pathologies and treatments. Our objective was to assess the quality of the information provided by AI like ChatGPT and establish if it is a secure source of information for patients. METHODS: Questions about bladder cancer, prostate cancer, renal cancer, benign prostatic hypertrophy (BPH), and urinary stones were queried through ChatGPT 4.0. Two urologists analysed the responses provided by ChatGPT using DISCERN questionary and a brief instrument for evaluating the quality of informed consent documents. RESULTS: The overall information provided in all pathologies was well-balanced. In each pathology was explained its anatomical location, affected population and a description of the symptoms. It concluded with the established risk factors and possible treatment. All treatment answers had a moderate quality score with DISCERN (3 of 5 points). The answers about surgical options contain the recovery time, type of anaesthesia, and potential complications. After analysing all the responses related to each disease, all pathologies except BPH achieved a DISCERN score of 4. CONCLUSIONS: ChatGPT information should be used with caution since the chatbot does not disclose the sources of information and may contain bias even with simple questions related to the basics of urologic diseases.

[Erectile dysfunction and YouTube: Quality of videos in Spanish]. / Disfunción eréctil y YouTube: calidad de los vídeos en español.

INTRODUCTION: Erectile dysfunction (ED) is one of the most prevalent urological diseases, but there is limited data about the quality of its information in social networks. The aim of our study was to assess the quality of ED information contained in YouTube videos. MATERIAL AND METHODS: Descriptive study of the first 50 Spanish-language videos, published on YouTube, evaluated by three urologists. We used two validated questionnaires: PEMAT (Patient Education Materials Assessment Tool) and DISCERN. Videos were classified according to DISCERN score into poor or moderate-good quality. RESULTS: The median time duration was 2.42minutes (0.15-3.58), 94,197 views (2,313-3,027,890), 682.5 «likes¼ (0-54,020) and 39 «dislikes¼ (0-2843). The median of PEMAT score was 29% (9%-95.5%) in understandability and 29% (0-95.5%) in actionability. According to DISCERN score 27 videos (57.4%) had poor quality and 20 (42.6%) moderate-good quality. There were no significant differences between the two groups in time duration, views, «likes¼ or «dislikes¼. There were differences in PEMAT score in understandability and actionability. The 86.7% of the moderate-good quality videos were starred by health care provider (P=.001). Also, the 85.7% of videos that describes treatment had moderate-good quality (P=.001). The 84% of the non-medical videos had a poor quality (P=.001). CONCLUSION: Most ED videos on YouTube have poor quality. The highest quality videos are those made by professionals, although they are not the most viewed. It would be important to develop measures to prevent the spread of misinformation among social network users.

Quality of bladder cancer information on YouTube.

Introduction: YouTube is one of the social networks most widely used as a source of information. However, there are doubts about the scientific quality of the information available. This study aims to characterise this by analysing videos about bladder cancer posted on YouTube. Material and methods: This was a cross-sectional descriptive study of the first 50 Spanish-language videos published on YouTube, leaving 38 for analysis. The videos were evaluated by three urologists using two validated questionnaires: Patient Education Materials Assessment Tool (PEMAT) and DISCERN (quality criteria for consumer health information), classifying them according to the score of the latter, in poor quality (1-2 points) and moderate/good quality (3-5 points). Results: The median PEMAT score was 71.6% (16-5-100%) for understanding and 35.5% (0-100%) for action. According to DISCERN, 26 videos (66.7%) were of poor quality and 12 (30.8%) of moderate/good quality. We found significant differences in terms of PEMAT of understanding (p = 0.004) and action (p = 0.000). In total, 90.9% of those involving medical staff were of low quality, which is paradoxical, but statistically significant (p = 0.01). Furthermore, 52.4% of those describing relevant information were of moderate/good quality, and 94.1% of those not describing relevant information were of poor quality (p = 0.02). Conclusions: More than 60% of the videos published on YouTube about bladder cancer in Spanish are of low quality. This represents an important risk of misinformation for the general public to whom most of them are addressed.

[Effectiveness and safety of intravesical hyaluronic acid for symptom control in chronic bladder diseases.] / Efectividad y seguridad del ácido hialurónico intravesical para el control de los síntomas en cistopatías crónicas.

INTRODUCTION: Chronic bladder disorders are a common condition. Endovesical hyaluronic acid is one of the therapeutic options for these patients. It is intended to verify the effectiveness and safety of treatment with intravesical instillations of hyaluronic acidin patients with bladder symptoms. MATERIAL AND METHODS: We present a series of 32 patients who received intravesical instillations of hyaluronic acid. Demographic characteristics, tolerance, and complications were analyzed, and symptoms before and after treatment were compared. Symptomatic relief achieved with treatment was assessed using the Patient Global Improvement Impression Scale (PGI-I). RESULTS: The median age was 74 years (IQR 60-78) and 65.6% were women. Median follow-up was 10 months (IQR 7-14). Eleven patients were diagnosed with radiotherapy-induced cystitis, 17 with bladder pain syndrome/interstitial cystitis (BPS/IC), and 4 with recurrent cystitis. After treatment, symptoms improved in 81.8% of patients with radical cystitis, 82.3% of patients with BPS/IC, and 75% of the patients with recurrent cystitis. The incidence of hematuria was reduced from 46.9% to 9.4% (p<0.001), filing symptoms from 62.5% to 12.5% (p<0.001) and pain from 40.6% to 12.5% (p= 0.004). 100% of the patients tolerated the treatment well and only 2 adverse effects were recorded (urinary tract infection and acute urine retention). During follow-up, 65.6% showed total control of symptoms and 15.6% partial control, achieving a greater response in the group of patients with hematuria (73.3%). 61.3% of the patients perceived relief of symptoms after treatment according to the PGI-I scale. 88.9% maintained symptomatic improvement at the end of the follow-up. CONCLUSION: Intravesical hyaluronic acid is a safe and effective treatment for filling symptoms, hematuria, and pain in patients with chronic cystopathies. Patients with radiotherapy-induced cystitis seem to especially benefit from treatment.

INTRODUCCIÓN: Las cistopatías crónicas son una patología frecuente. El ácido hialurónico endovesical es una de las opciones terapéuticas para estos pacientes. Se pretende verificar la efectividad y seguridad del tratamiento con instilaciones intravesicales de ácido hialurónico en pacientes con síntomas vesicales.MATERIAL Y MÉTODOS: Se presenta una serie de 32 pacientes que recibieron instilaciones intravesicales de ácido hialurónico. Se analizaron las características demográficas, tolerancia y complicaciones, y se compararon los síntomas antes y después del tratamiento. El alivio sintomático conseguido con el tratamiento se evaluó mediante la escala de impresión de mejoría global del paciente (PGI-I).RESULTADOS: La mediana de edad fue de 74 años (IQR60-78), siendo el 65,6% mujeres. La mediana de seguimiento fue 10 meses (IQR 7-14). Once pacientes fueron diagnosticados de cistitis rádica, 17 de síndrome de dolor vesical/cistitis intersticial (SDV/CI) y 4 de cistitis de repetición. Tras el tratamiento mejoraron los síntomas el 81,8% de los pacientes con cistitis rádica, el 82,3% de los pacientes con SDV/CI y el 75% de los pacientes con cistitis recurrentes. La incidencia de hematuria se redujo del 46,9% al 9,4% (p<0,001), los síntomas de llenado del 62,5% al 12,5% (p<0,001) y el dolor de un 40,6% al 12,5% (p=0,004). El 100% de los pacientes toleró bien el tratamiento y sólo se registraron 2 efectos adversos (infección del tracto urinario y retención agudade orina). Durante el seguimiento un 65,6% mostró un control total de los síntomas y un 15,6% un control parcial, consiguiendo una respuesta mayor en el grupo de pacientes con hematuria (73,3%). El 61,3% de los pacientes percibió alivio de los síntomas tras el tratamiento según la escala PGI-I. El 88,9% mantiene la mejoría de los síntomas al finalizar el seguimiento.CONCLUSIÓN: El ácido hialurónico intravesical es un tratamiento seguro y efectivo para los síntomas de llenado, hematuria y dolor en pacientes con cistopatías crónicas. Los pacientes con cistitis rádica parecen beneficiarse especialmente del tratamiento.

Efectividad y seguridad del ácido hialurónico intravesical para el control de los síntomas en cistopatías crónicas / Effectiveness and safety of intravesical hyaluronic acid for symptom control in chronic cystopathies

Introducción: Las cistopatías crónicas son una patología frecuente. El ácido hialurónicoendovesical es una de las opciones terapéuticas paraestos pacientes. Se pretende verificar la efectividad yseguridad del tratamiento con instilaciones intravesicales de ácido hialurónico en pacientes con síntomas vesicalesMaterial y métodos: Se presenta una serie de 32pacientes que recibieron instilaciones intravesicales deácido hialurónico. Se analizaron las características demográficas, tolerancia y complicaciones, y se compararon los síntomas antes y después del tratamiento. El alivio sintomático conseguido con el tratamiento se evaluómediante la escala de impresión de mejoría global delpaciente (PGI-I). Resultados: La mediana de edad fue de 74 años (IQR60-78), siendo el 65,6% mujeres. La mediana de seguimiento fue 10 meses (IQR 7-14). Once pacientes fuerondiagnosticados de cistitis rádica, 17 de síndrome dedolor vesical/cistitis intersticial (SDV/CI) y 4 de cistitisde repetición. Tras el tratamiento mejoraron los síntomasel 81,8% de los pacientes con cistitis rádica, el 82,3%de los pacientes con SDV/CI y el 75% de los pacientescon cistitis recurrentes. La incidencia de hematuria seredujo del 46,9% al 9,4% (p<0,001), los síntomas dellenado del 62,5% al 12,5% (p<0001), y el dolor de un40,6% al 12,5% (p=0,004). El 100% de los pacientestoleró bien el tratamiento y sólo se registraron 2 efectosadversos (infección del tracto urinario y retención agudade orina). Durante el seguimiento un 65,6% mostró uncontrol total de los síntomas y un 15,6% un control parcial, consiguiendo una respuesta mayor en el grupo depacientes con hematuria (73,3%). El 61,3% de los pacientes percibió alivio de los síntomas tras el tratamientosegún la escala PGI-I. El 88,9% mantiene la mejoría delos síntomas al finalizar el seguimiento.Conclusión: El ácido hialurónico intravesical es untratamiento seguro y efectivo para los síntomas de llenado, hematuria y...(AU)

Introduction: Chronic bladder disorders are a common condition. Endovesical hyaluronicacid is one of the therapeutic options for these patients.It is intended to verify the effectiveness and safety oftreatment with intravesical instillations of hyaluronic acidin patients with bladder symptoms. Material and methods: We present a series of 32patients who received intravesical instillations of hyaluronic acid. Demographic characteristics, tolerance,and complications were analyzed, and symptoms before and after treatment were compared. Symptomaticrelief achieved with treatment was assessed using thePatient Global Improvement Impression Scale (PGI-I).Results: The median age was 74 years (IQR 60-78)and 65.6% were women. Median follow-up was 10months (IQR 7-14). Eleven patients were diagnosed withradiotherapy-induced cystitis, 17 with bladder pain syndrome/interstitial cystitis (BPS/IC), and 4 with recurrentcystitis. After treatment, symptoms improved in 81.8%of patients with radical cystitis, 82.3% of patients withBPS/IC, and 75% of the patients with recurrent cystitis.The incidence of hematuria was reduced from 46.9% to9.4% (p<0.001), filling symptoms from 62.5% to 12.5%(p<0.001), and pain from 40.6% to 12.5% (p=0.004).100% of the patients tolerated the treatment well andonly 2 adverse effects were recorded (urinary tract infection and acute urine retention). During follow-up, 65.6%showed total control of symptoms and 15.6% partialcontrol, achieving a greater response in the group ofpatients with hematuria (73.3%). 61.3% of the patientsperceived relief of symptoms after treatment accordingto the PGI-I scale. 88.9% maintained symptomatic improvement at the end of the follow-up.Conclusion: Intravesical hyaluronic acid is a safeand effective treatment for filling symptoms, hematuria,and pain in patients with chronic cystopathies. Patientswith radiotherapy-induced cystitis seem to especiallybenefit from treatment.

Prostate Mapping for Cancer Diagnosis: The Madrid Protocol. Transperineal Prostate Biopsies Using Multiparametric Magnetic Resonance Imaging Fusion and Micro-Ultrasound Guided Biopsies.

PURPOSE: We assessed the prostate cancer detection accuracy of transperineal prostate biopsy using multiparametric magnetic resonance imaging/ultrasound fusion targeted biopsy and micro-ultrasound during the same procedure. Micro-ultrasound is a new high-resolution imaging system that allows real-time targeted biopsy. MATERIALS AND METHODS: A total of 194 consecutive patients underwent transperineal prostate biopsies using real-time targeted micro-ultrasound (ExactVu™) and ultrasound fusion targeted biopsy (BiopSee®) in the same procedure, from February 2018 to September 2019. Biopsies were performed using a transperineal needle guide attached to the 29 MHz high-resolution micro-ultrasound transducer. RESULTS: The overall positive rate was 56% (108) for prostate cancer and 42% (81) for clinically significant prostate cancer (Gleason Grade Group greater than 1), and adding micro-ultrasound and magnetic resonance imaging detected significantly more clinically significant prostate cancer than systematic biopsy (p <0.001). Micro-ultrasound found 12 of 108 (11%) prostate cancers that were missed by all other techniques and 11 (92%) were clinically significant prostate cancer. PI-RADS® and PRI-MUS™ (Prostate Risk Identification Using Micro-Ultrasound) were strong predictors of clinically significant prostate cancer in a logistic regression model (AUC 0.76). For prostate specific antigen greater than 4 ng/ml, PI-RADS greater than 3, there was an improvement in detection rate between PRI-MUS 4 and PRI-MUS 5 (52% Gleason Grade Group greater than 1 to 92% Gleason Grade Group greater than 1). No fever or clinical infection was observed and 17 (8.7%) patients presented with minor complications (Clavien Dindo I). CONCLUSIONS: This is the first study using a transperineal approach for micro-ultrasound guided biopsy and multiparametric magnetic resonance imaging fusion biopsy. The results show a high accuracy for prostate cancer and clinically significant prostate cancer diagnosis, without infectious complications. The proposed method should be validated in large randomized clinical trials.

Nuevo sistema de comparación de resultados tras nefrolitotomía percutánea de un modo más homogéneo / Standarization of PCNL reporting: Comparative methodology

OBJETIVO: Evaluar el impacto de una nueva clasificación de la litiasis renal sobre la tasa libre de litiasis, para su utilización como sistema que permita comparar distintas series de nefrolitotomía percutánea de un modo más homogéneo. MATERIAL Y MÉTODOS: Se analizaron de forma retrospectiva pacientes sometidos a nefrolitotomía percutánea (NLPC) entre noviembre 2011 y noviembre 2016. Las litiasis se clasificaron en simples (litiasis pélvica y/o calicial que requirieron de un único acceso y/o utilización de un nefroscopio rígido), compleja (requirieron la utilización de más de un acceso percutáneo y/o instrumental flexible y/o acceso combinado) y extremadamente compleja (litiasis coraliforme completa o alteraciones anatómicas), de acuerdo con la clasificación de Ibarluzea-Llanes. También se analizaron las variables edad, sexo, antecedentes de diabetes, hipertensión o toma de anticoagulantes, composición de la litiasis, colocación de nefrostomía posquirúrgica y tiempo quirúrgico. Realizamos un análisis univariado y multivariado mediante el test de chi-cuadrado o de Fisher y regresión logística. RESULTADOS: Se incluyeron 69 procedimientos en 57 pacientes con una edad media de 51,3 años (13-84) y un tiempo medio de seguimiento de 32,57 meses (rango 71). La tasa libre de litiasis fue del 86%, 75% y 55% para una litiasis simple, compleja o extremadamente compleja, tanto a los tres meses como al año. Únicamente el tipo de litiasis se relacionó con una peor tasa libre de litiasis (p 0,03) con RR de 2,5. CONCLUSIONES: La clasificación del tipo de litiasis de Ibarluzea-Llanes resultó ser un buen modelo predictivo de tasa libre de litiasis tras nefrolitotomía percutánea

OBJECTIVE: To evaluate the impact of a new renal lithiasis classification on the stone free rate. The new system would allow standarization of comparison between different series of percutaneous nephrolithotomy. MATERIAL AND METHODS: Patients undergoing NPCL between November 2011 and November 2016 were retrospectively analyzed. The stones were classified as simple (pelvic and/or calyceal stones that required a single access and/or use of a rigid nephroscope), complex (required the use of more than one percutaneous Access and/or flexible instruments and/or combined access) and extremely complex (complete staghorn stones or anatomical alterations), according to the Ibarluzea-Llanes classification. Other variables analyzed were age, sex, diabetes, hypertension or taking anticoagulants, stones composition, placement of postoperative nephrostomy and surgical time. We performed a univariate and multivariate analysis using the chi-square or Fisher test and logistic regression. RESULTS: Sixty-nine procedures were included in 57 patients with a mean age of 51 years (13-84) and a mean follow-up time of 30 months. The stone free rate was 86%, 75% and 55% for a simple, complex or extremely complex stone, both at three months and a year. Only the stone type was associated with a worse stone free rate (p 0.03) with RR of 2.5 for a 95% CI. CONCLUSIONS: The Ibarluzea-Llanes clasification could be used as a new system for standarization of PCNL outcomes reporting

[Standarization of PCNL reporting: Comparative methodology.] / Nuevo sistema de comparación de resultados tras nefrolitotomía percutánea de un modo más homogéneo.

OBJECTIVE: To evaluate the impact of a new renal lithiasis classification on the stone free rate. The new system would allow standarization of comparison between different series of percutaneous nephrolithotomy. MATERIAL AND METHODS: Patients undergoing NPCL between November 2011 and November 2016 were retrospectively analyzed. The stones were classified as simple (pelvic and/or calyceal stones that required a single access and/or use of a rigid nephroscope), complex (required the use of more than one percutaneous access and/or flexible instruments and/or combined access) and extremely complex (complete staghorn stones or anatomical alterations), according to the Ibarluzea-Llanes classification. Other variables analyzed were age, sex, diabetes, hypertension or taking anticoagulants, stones composition, placement of postoperative nephrostomy and surgical time. We performed a univariate and multivariate analysis using the chi-square or Fisher test and logistic regression. RESULTS: Sixty-nine procedures were included in 57 patients with a mean age of 51 years (13-84) and a mean follow-up time of 30 months. The stone free rate was 86%, 75% and 55% for a simple, complex or extremely complex stone, both at three months and a year. Only the stone type was associated with a worse stone free rate (p 0.03) with RR of 2.5 for a 95% CI. CONCLUSIONS: The Ibarluzea-Llanes clasification could be used as a new system for standarization of PCNL outcomes reporting.

OBJETIVO: Evaluar el impacto de una nueva clasificación de la litiasis renal sobre la tasa libre de litiasis, para su utilización como sistema que permita comparar distintas series de nefrolitotomía percutánea de un modo más homogéneo.MATERIAL Y MÉTODOS: Se analizaron de forma retrospectiva pacientes sometidos a nefrolitotomía percutánea (NLPC) entre noviembre 2011 y noviembre 2016. Las litiasis se clasificaron en simples (litiasis pélvica y/o calicial que requirieron de un único acceso y/o utilización de un nefroscopio rígido), compleja (requirieron la utilización de más de un acceso percutáneo y/o instrumental flexible y/o acceso combinado) y extremadamente compleja (litiasis coraliforme completa o alteraciones anatómicas), de acuerdo con la clasificación de Ibarluzea-Llanes. También se analizaron las variables edad, sexo, antecedentes de diabetes, hipertensión o toma de anticoagulantes, composición de la litiasis, colocación de nefrostomía posquirúrgica y tiempo quirúrgico. Realizamos un análisis univariado y multivariado mediante el test de chi-cuadrado o de Fisher y regresión logística. RESULTADOS: Se incluyeron 69 procedimientos en 57 pacientes con una edad media de 51,3 años (13-84) y un tiempo medio de seguimiento de 32,57 meses (rango 71). La tasa libre de litiasis fue del 86%, 75% y 55% para una litiasis simple, compleja o extremadamente compleja, tanto a los tres meses como al año. Únicamente el tipo de litiasis se relacionó con una peor tasa libre de litiasis (p 0,03) con RR de 2,5. CONCLUSIONES: La clasificación del tipo de litiasis de Ibarluzea-Llanes resultó ser un buen modelo predictivo de tasa libre de litiasis tras nefrolitotomía percutánea.

Nefrolitectomía micro-percutánea (NLPC-micro, Microperc): una nueva herramienta en el tratamiento de la litiasis renal. (Comentario Editorial) / Micropercutaneous Nephrolithotomy (Micro-PNL or microperc): A new tool in the treatment of renal lithiasis. (Editorial Comment)

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Análisis de decisión en la evaluación económica del tratamiento de la uropatía obstructiva crónica / Decision analysis for economic evaluation of the management of chronic obstructive uropathy

OBJETIVO: Demostrar cuál es la mejor decisión para tratar una uropatía obstructiva de larga evolución: la derivación urinaria convencional mediante un catéter ureteral doble J o la prótesis metálica termoexpandible Memokath 051, en base a la supervivencia estimada del enfermo, la cantidad de recambios de catéter que va a necesitar y el coste que cada acto terapeútico va a conllevar.MÉTODO: Se recogieron los datos de costes de la inserción de un catéter ureteral doble J teniendo en cuenta visitas preoperatorias y postoperatorias, acto quirúrgico con costes estructurales, médicos, de material fungible y de la prótesis. A continuación se hizo una simulación de los costes de inserción de una prótesis Memokath 051, en base a los datos del cateterismo ureteral. Se realizó un árbol de decisión y un análisis económico de Coste Efectividad (ACE) para medir la efectividad de las dos intervenciones sanitarias. A través de él se identificaron, cuantificaron y valoraron los costes de las dos alternativas de intervención sanitaria disponibles para alcanzar la resolución de la obstrucción ureteral.RESULTADOS: Los datos de costes de cada procedimiento son: catéter doble J en régimen de cirugía Mayor Ambulatoria (CMA) 1.275,44 €, prótesis metálica termoexpandible en CMA 4865,16 €, doble J con ingreso de 1 día 1424,52 € y prótesis con ingreso de un día 5014,24 €.La diferencia de costes entre el catéter ureteral y la prótesis metálica termoexpandible es de 3589,72 € por cada tratamiento en CMA a favor del catéter ureteral.CONCLUSIÓN: A pesar de su alto coste inicial la prótesis metálica termoexpandible ofrece ventajas económicas añadidas al catéter ureteral convencional doble J en el tratamiento de la obstrucción ureteral maligna. A partir del tercer cambio de catéter ureteral doble J, y si la supervivencia del paciente es lo suficientemente prolongada, la opción más coste efectiva es la prótesis metálica en régimen de CMA(AU)

OBJECTIVES: To test which is the best treatment for chronic obstructive uropathy: urinary diversion using a conventional double-J ureteral stent or the metal thermo-expandable Memokath 051 prosthesis.METHODS: We collected cost data of the insertion of a double-J stent taking into account preoperative and postoperative visits and surgery. Structural, medical, consumables and the prosthesis costs were considered. The estimated survival of the patient, number of spare stents and cost of each therapeutic measure were computed. Then, a simulation of the cost of inserting a Memokath 051 prosthesis was conducted, based on data of ureteral catheterization.We performed a decision tree and Cost Effectiveness economic analysis to measure the effectiveness of both health interventions.RESULTS: Cost data of each procedure were: 1275.44 € for the double J catheter in a program of day case surgery (DCS), 4865.16 € for the metal thermo-expandable prosthesis as DCS, and 1424.52 € for the double J stent with 1 day admission and 5014.24 € for the prosthesis with 1 day admission.The cost difference between ureteral stent and metal thermo-expandable prosthesis is 3589.72 € per treatment for the ureteral stent as DCS.CONCLUSIONS: Despite its high initial cost, the metal thermo-expandable prosthesis potentially offers economic advantages over the conventional double-J ureteral stent in the treatment of long evolution ureteral obstruction. After the third change of double-J stent, and if the patient survival is long enough, the metal prosthesis as DCS should be the most cost effective option(AU)

Renocolic fistula as a complication of radiofrequency in the treatment of renal cell carcinoma.

METHOD: Beyond postoperative suspicion, retrograde pyelogram was performed, the images of which are displayed, and demonstrated the fistula. RESULTS: Treatment has been definitive nephrectomy after failed attempt to seal the fistula with suture and TachoSil. CONCLUSIONS: Although radiofrequency ablation can be a valid technique for treating small renal tumors in patients with high morbidity, it is not without significant complications as described in this case, despite the precautions taken.

Fístula renocólica como complicación de radiofrecuencia para tratamiento de carcinoma renal de células claras / Renocólic fistula as a complication of ratiofrequency in the treatment of renal cell carcinoma

OBJETIVO: Describir un caso clínico de fístula reno cólica como complicación de ablación por radiofrecuencia de carcinoma de células renales. Se revisa la literatura y se exponen las diferentes actitudes diagnósticas y terapéuticas. MÉTODO: Tras la sospecha postoperatoria se realizó pielografía retrograda, cuyas imágenes se muestran, que demuestra la fístula. RESULTADO: El tratamiento definitivo ha sido la nefrectomía tras intento fallido de sellar la fístula con sutura y tachosil. CONCLUSIÓNES: Si bien la ablación por radiofrecuencia puede ser una técnica válida para el tratamiento del tumores renales de pequeño tamaño en pacientes con elevada morbilidad, no está exenta de complicaciones importantes como la descrita en este caso, a pesar de las precauciones tomadas(AU)

OBJECTIVES: To describe a clinical case of renocolic fistula as a complication of radiofrequency ablation of renal cell carcinoma. We reviewed the literature and presented different diagnostic and therapeutic approaches. METHOD: Beyond postoperative suspicion, retrograde pyelogram was performed, the images of which are displayed, and demonstrated the fistula. RESULTS: Treatment has been definitive nephrectomy after failed attempt to seal the fistula with suture and TachoSil. CONCLUSIONS: Although radiofrequency ablation can be a valid technique for treating small renal tumors in patients with high morbidity, it is not without significant complications as described in this case, despite the precautions taken(AU)

Carcinoma renal metastásico a peritoneo. A propósito de un caso / Renal carcinoma metastatic to the peritoneum. Case report

OBJETIVO: Aportar un caso de carcinoma renal que presentó implantes peritoneales en su evolución. MÉTODO/RESULTADOS: Describimos el caso de un varón joven que en el seguimiento de su patología neoplásica tras nefrectomía radical presenta sintomatología abdominal inespecífica que conduce al descubrimiento de implantes peritoneales y recidiva local. Se realizó una segunda cirugía exploradora y de citorreductora, con recidiva peritoneal rápida. A los tres meses y a pesar del tratamiento que siguió con Interferón-α, el paciente presento metástasis hepáticas múltiples. CONCLUSIONES: La afectación peritoneal por carcinoma de células renales es un hecho infrecuente y que confiere un mal pronóstico

OBJECTIVE: We describe the case of a young male presenting with non-specific abdominal symptoms on follow-up after radical nephrectomy for renal carcinoma leading to the finding of local recurrence and peritoneal metastases. A second exploratory laparotomy was carried out for tumor reduction, but it was followed by fast peritoneal recurrence. Despite the treatment with alpha interferon, three months later he developed multiple hepatic metastases. CONCLUSIONS: Peritoneal involvement by renal cell carcinoma is rare and implies a bad prognosis