Comentario editorial de Cistectomía radical laparoscópica. ¿Dónde estamos? / Publishing comment of Laparoscopic radical cystectomy. Where do we stand?

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Diagnostic validity of helical CT compared to ultrasonography in renal-ureteral colic.

OBJECTIVES: Helical CT without contrast is currently being evaluated for the diagnosis of renoureteral colic. Ureteral obstruction and other pathologies with similar symptoms can be rapidly identified. This study intends to evaluate the validity of CTh for these patients and to compare it with the ultrasound technique in order to consider the CTh as an efficient diagnostic alternative for these pathologies. METHODS: A diagnostic evaluation study was carried out between January 2004 and December 2006 in patients with persistent renoureteral colic after standard care. They were blindly evaluated by ultrasound and CTh, maintaining the follow up until the "gold standard" confirmation. Qualitative variables were described by frequency and 95%CI and quantitative variables by position and dispersion measures. The Chi2 test was used to compare qualitative variables. Validity indicators and 95% CI were calculated and compared with McNemar test. RESULTS: 124 patients were studied. Lithiasis and the other diagnosis had frequencies of 59.7% and 40.3% respectively. The percentage of lithiasis obtained by ultrasound (92) was 22.8% and by CTh (124) was 59.7%. Validity indicators for CTh were superior to 95%, with 100% sensitivity and positive predictive value. Ultrasound specificity and positive predictive value were 100%, but sensitivity was only 29.6% (p<0.05). CONCLUSION: CTh can be considered a good alternative diagnostic technique in the renoureteral colic management.

Validez diagnóstica de la TAC helicoidal frente a la ecografía en el cólico renoureteral / Diagnostic validity of helical CT compared to ultrasonography in renal-ureteral colic

OBJETIVO: La TAC helicoidal (TACh) sin contraste se evalúa como técnica diagnóstica en el cólico renoureteral. Permite un diagnóstico rápido de obstrucción ureteral y de otras patologías de sintomatología similar. Este estudio pretende evaluar la validez de la TACh frente a la ecografía en el diagnóstico de estos pacientes y plantear su inclusión, como una prueba más, en el algoritmo diagnóstico de esta patología.MÉTODOS: Estudio de evaluación de pruebas diagnósticas realizado entre enero de 2004 y diciembre de 2006 en pacientes valorados por cólico renoureteral no resuelto con atención estándar, estudiándolos de forma ciega mediante ecografía y TACh y siguiéndolos hasta confirmar el diagnóstico con un “patrón oro”. Las variables cualitativas se resumen con su distribución de frecuencias e IC95% y las cuantitativas con medidas de posición y dispersión. Se utilizó el test de χ2 para comparar variables cualitativas. Se calcularon los índices de validez diagnóstica con sus IC95% y se compararon con la prueba de McNemar.RESULTADOS: Se estudió a 124 pacientes, presentando litiasis el 59,7% y otros diagnósticos el 40,3%. Las 92 ecografías efectuadas diagnosticaron un 22,8% de litiasis frente al 59,7% obtenido con 124 TACh. Los índices de validez para la TACh fueron superiores al 95%, con una sensibilidad y valor predictivo positivo (VPP) de 100%. La ecografía presentó una especificidad y un VPP de 100% pero sensibilidad y valor predictivo negativo de 29,6% (p<0,05).CONCLUSIÓN: La TACh puede ser considerada una prueba más a utilizar en el diagnóstico del cólico renoureteral(AU)

OBJECTIVES: Helical CT without contrast is currently being evaluated for the diagnosis of renoureteral colic. Ureteral obstruction and other pathologies with similar symptoms can be rapidly identified. This study intends to evaluate the validity of CTh for these patients and to compare it with the ultrasound technique in order to consider the CTh as an efficient diagnostic alternative for these pathologies.METHODS: A diagnostic evaluation study was carried out between January 2004 and December 2006 in evapatientswith persistent renoureteral colic after standard care. They were blindly evaluated by ultrasound and CTh, maintaining the follow up until the “gold standard” confirmation. Qualitative variables were described by frequency and 95%CI and quantitative variables by position and dispersion measures. The χ2 test was used to compare qualitative variables. Validity indicators and 95% CI were calculated and compared with McNemar test.RESULTS: 124 patients were studied. Lithiasis and the other diagnosis had frequencies of 59.7% and 40.3% respectively. The percentage of lithiasis obtained by ultrasound (92) was 22.8% and by CTh (124) was 59.7%.Validity indicators for CTh were superior to 95%, with 100% sensitivity and positive predictive value. Ultrasound specificity and positive predictive value were 100%, but sensitivity was only 29.6% (p<0.05).CONCLUSION: CTh can be considered a good alternative diagnostic technique in the renoureteral colic management(AU)