Flexible ureteroscopy in extreme elderly patients (80 years of age and older) is feasible and safe.

PURPOSE: To compare the safety and efficacy of RIRS in patients ≥ 80 years to a younger population. METHODS: We retrospectively compared the data from patients ≥ 80 years of age undergoing RIRS with the data of a group of patients from 18 and < 80 years. Perioperative outcomes, complications and emergency department visits were compared between two groups. RESULTS: A total of 173 patients were included in the study. Mean age was 44 (27-79) and 81 years-old (80-94), for younger and elderly group, respectively. Elderly patients had higher ASA scores (≥ 3) (28.6% vs 75.8%; p = 0.0001) and Charlson comorbidity index (1.99 vs 7.86; p = 0.0001), more diabetes (p = 0.006) and respiratory comorbidities (p = 0.002). No statistical difference was found between two groups in stone size (p = 0.614) and number (p = 0.152). Operative time (74.48 vs 102.96 min; p = 0.0001) and duration of hospitalisation (1.7 vs 2.9 days; p = 0.001) were longer for the elderly. Intraoperative complication rate did not show differences between the two groups (p = 0.166). Postoperative complications rates were similar between the cohorts (7.7% vs 9.5%; p = 0.682). The success rates were 67.5% in the younger group and 71.4% in the elderly group (p = 0.584). No difference was seen in stone recurrence (p = 0.73). A higher rate of visits to the emergency department was found in younger cohort (23.6% vs 11.6%; p = 0.046), mostly duo to stent-related symptoms. CONCLUSIONS: Despite the higher rate of comorbidity in the elderly group, RIRS was a safe procedure with similar complication rate and outcomes at an expense of higher operative time and hospital stay.

Efficacy of Direct-acting Antivirals to Improve Clinical Condition, Fibrosis, and Liver Function in Liver Transplant Recipients Infected by Hepatitis C.

BACKGROUND: Direct-acting antivirals (DAAs) have revolutionized the treatment of hepatitis C, including transplant recipients with an advanced fibrosis stage. Our aim in this study was to assess the clinical and functional benefits and improvement in liver fibrosis after treatment with DAAs in liver transplant recipients with chronic hepatitis C virus who achieved sustained virologic response (SVR). METHODS: We retrospectively analyzed 42 patients who underwent liver transplantation (LT) at our institution and were treated with DAAs from June 2014 to December 2015. Two patients died, so we ultimately included 40 transplant patients with chronic hepatitis C who received DAAs and achieved SVR. We assessed liver function, fibrosis stage, and clinical features at the start of the treatment, and then at 6 and 12 months after SVR. The indication for LT was hepatocellular carcinoma in 8 patients (20%) and Child-Pugh score B/C in 32 patients (80%). RESULTS: The DAAs regimens were sofosbuvir plus daclatasvir (45.0%), simeprevir plus sofosbuvir (42.5%), sofosbuvir plus ledipasvir (7.5%), and ombitasvir/paritaprevir/ritonavir (5%). The mean Modified End-stage Liver Disease (MELD) score pretreatment was 10.78, and was 8.46 at 1 year after treatment (P < .05). In addition, fibrosis stage decreased significantly from 14.81 kPa to 9.07 kPa (FibroScan) at 12 months after SVR. Clinically, there was a significant improvement, including control of ascites and chronic hepatic encephalopathy. CONCLUSION: DAAs were used successfully in the treatment of hepatitis C after orthotopic liver transplantation and resulted in significant improvement in liver function as measured by MELD score, fibrosis level, and cirrhotic clinical condition, even in patients with very advanced disease.

Fragmentation targeted at preferred discontinuities: A new concept in endolithotripsy with Holmium laser:YAG. / Fragmentación dirigida a discontinuidades preferentes: un nuevo concepto en endolitotricia con láser Holmium:YAG.

INTRODUCTION: There are currently 3holmium laser, YAG (Ho:YAG) endolithotripsy procedures that are considered basic (fragmentation, pulverisation, "pop-corn" technique). We present the technique of fragmentation targeted at preferred discontinuities (FTPD), a new concept of endolithotripsy by Ho:YAG laser. MATERIAL AND METHODS: The FTPD technique is based on the selective application of energy (targeting a specific preselected point) to an area that is visually prone to the formation of a fracture line or preferred discontinuity (conditioned by the anisotropy of the urolithiasis). The ideal energy regimen (setting) is a high range of working energy (2-3J) with a very low frequency range (5-8Hz) and short pulse width. Between January 2015 to February 2017, the FTPD technique was used in 37 procedures (7 NLP, 16 RIRS, 12 URS, 2 cystolithotomies), with a Ho:YAG laser (Lumenis Pulse 120H®, Tel-Aviv, Israel). Maximum power used: 24W (3J/8Hz) with fibres of 365µ and 273µ (URS, RIRS), and 32W (4J/8Hz) with fibres of 550µ (NLP, cystolithotomy). RESULTS: Strategic improvement was achieved in all cases using the TFPD technique to continue the endolithotripsy or remove fragments. No complications were recorded after the use of this method. CONCLUSIONS: FTPD can be considered a complementary option in combination with the basic methods of fragmentation and pulverisation. In our experience, it constitutes significant progress in optimising the performance of Ho:YAG laser endolithotripsy.

Influencia del apoyo psicológico grupal en la calidad de vida, continuidad y tasas de embarazo, en tratamientos de fecundación in Vitro / The influence of group psychological support on quality of life, discontinuation and pregnancy rates in In vitro fertilization treatments

Pregunta del estudio. ¿La intervención psicológica grupal antes y durante los ciclos de Fecundación in vitro (FIV), es una herramienta eficaz para mejorar la calidad de vida, la continuidad y las tasas de embarazo? Resumen. Las mujeres que participan en un grupo de apoyo psicológico logran una mejor gestión de sus emociones durante los tratamientos, aumentando la tolerabilidad y continuidad frente a los mismos. Así mismo los grupos de apoyo han logrado una influencia positiva en las tasas de embarazo. Lo que ya se conoce. Los tratamientos de Reproducción Asistida afectan negativamente en la calidad de vida de las pacientes en general. El motivo principal de abandono de los tratamientos es el estrés, la afectación en la pareja, y los síntomas de ansiedad y depresión. Por otra parte, las modalidades de intervención psicológica grupal han logrado influir positivamente tanto en el estado emocional como en las tasas de embarazo. Diseño del estudio, tamaño y duración. Estudio de cohorte, prospectivo, 95 mujeres que inician un ciclo de Fecundación Asistida en una clínica privada de la ciudad de Sevilla (España). El proyecto se diseñó en dos etapas. 1ª Etapa: Primer ciclo de fecundación asistida, F1: inicio, F2: final. 2ª Etapa: transferencia de los embriones congelados o nuevo ciclo para aquellas mujeres que no lograron el embarazo en el primer ciclo, F3: inicio, F4: final. El estudio se llevó a cabo desde agosto 2012 hasta agosto 2013. Participantes/materiales, composición y métodos. Mujeres entre 25 y 40 años, que inician un ciclo de FIV. Las pacientes fueron captadas principalmente por vía telefónica; siendo asignadas al grupo control (CG) o al grupo de apoyo (SG). La totalidad de la muestra cumplimentó el Cuestionario de Calidad de Vida en Fertilidad (FertiQol), en el inicio (F1/F3) y tras finalización de cada ciclo realizado o transferencia de embriones congelados (F2/F4). El seguimiento se realizó durante un año y/o dos intentos. Las mujeres del SG participaron durante el primer ciclo en un Programa de Apoyo psicológico realizado en 8 sesiones grupales, de frecuencia semanal cuyo objetivo fue el ajuste emocional, la adopción de recursos adaptativos y de afrontamiento y técnicas de relajación para reducir el estrés durante el tratamiento. Resultados principales. No existen diferencias significativas entre las mujeres participantes de este estudio en cuanto a la edad o en las variables clínicas. Las mujeres del CG tienen un mayor porcentaje de tasas de abandono que las mujeres que recibieron el programa de intervención psicológica, 38 % vs. 8 %, p=0,046. La calidad de vida intergrupal al comienzo del ciclo revela diferencias estadísticamente significativas en el Core FertiQol y en cada una de las subescalas (p=0,001), obteniendo el CG valores más elevados en su calidad de vida inicial. La variación en la calidad de vida durante el transcurso del primer ciclo (F1 vs. F2), en el SG evidencia una tendencia en aumento, presentando diferencias significativas en Core FertiQol y las subescalas Emocional y Mente/Cuerpo, p=0,032, p=0,005, p=0,039, respectivamente. En tanto que en el CG se observa una tendencia a la disminución en Core Fertiqol y en cada una de las cuatro subescalas. En cuanto a la Calidad del Cuidado se observa una tendencia al aumento para el SG en el Módulo de Tratamiento (Treatment FertiQol) y la subescala Entorno con una diferencia significativa en Tolerabilidad, (p=0,001.). La tasa de embarazo logrado para el SG asciende al 64 % mientras que la tasa de embarazo logrado para el CG asciende al 48 % (p=0,668). En la primer fase del estudio las pacientes del SG presentaron tasas superiores de embarazo con respecto al CG, 48 % vs 38 % (p=0,793). La misma tendencia se observa en la segunda fase, 35 % vs. 22 % respectivamente. Limitaciones. Dadas las condiciones del estudio (ajuste temporal y sesiones grupales semanales) la asignación a un grupo u otro fue a voluntad de las participantes. Por esta misma razón la muestra se limitó a 95 mujeres, siendo de interés que futuros estudios puedan extender nuestros resultados a una población mayor. Implicaciones del hallazgo. El Cuestionario FertiQol es un cuestionario validado internacionalmente y sus resultados se pueden analizar en una perspectiva amplia e internacional. Observamos que el apoyo psico-emocional puede mejorar la calidad de vida antes y durante los tratamientos de Fecundación Asistida y disminuir a su vez las tasas de abandono. Financiación del estudio/conflicto de intereses. Este trabajo fue apoyado por Fundación Ginemed en su interés por mejorar la calidad asistencial de sus centros. No hay conflictos de intereses

Study question: Is attending a psychological support group before and during an assisted in In Vitro Fertilization (IVF) treatment a useful tool in, improving quality of life, continued participation and pregnancy rates? Summary answer: Women who participate in a support group improve their quality of life, continue with their treatment and a higher percentage achieve a pregnancy. What is known already: Assisted reproduction treatments negatively affect patients´ quality of life. The principal cause of treatment discontinuation is stress, relational strain and symptoms associated with anxiety and depression. However, psychological intervention in the form of support groups has been demonstrated to have a positive influence on both emotional wellbeing as well as pregnancy rates. Study design, size, duration: Cohort Study, Pilot, 95 women who are beginning an assisted reproduction cycle in a private clinic in Seville (Spain). The project was designed in two stages. 1st Stage: first cycle of IVF (F1 start, F2: end). 2nd Stage: transfer frozen embryos transfer (FET) or new cycle of IVF, for women who failed pregnancy in the first cycle (F3: start, F4: end).The study was undertaken from August 2012 to August 2013. Participants/materials, setting, methods: Women between 25 and 40 years old, who are commencing an IVF cycle. The patients were primarily recruited by telephone; they were assigned to a control group (CG) or to a support group (SG) according to their availability. All of the members of the sample group completed the Fertility Quality of Life Questionnaire (FertiQol) at the beginning (F1/F3) and end of each cycle or frozen embryos transfer (F2/F4). The follow-up took place over a one-year period and/or two attempts. The women from the SG took part, during the first cycle, in a psychological support programme, which took the form of eight group sessions, which took place on a weekly basis and the emphasis of which was emotional well-being, the adoption of behaviour modification and coping strategies, and relaxation techniques aimed at stress reduction. Main results and the role of chance: The ages and clinical variables of the women who participated in the study did not differ significantly. The women from the CG ha a higher drop-out rate than those who took part in the psychological support programme, 38% vs. 8%, p=0.046. The between-group comparison from the initial Quality of Life assessment reveals statistically significant differences in the Core FertiQol and in each of the subscales (p=0.001), with the CG initially obtaining higher quality of life scores. The quality of life of the SG tended to increase over the course of the first cycle (F1 vs. F2), with significant differences being found in the Core FertiQol and in the Emotional and Mind-Body subscales, p=0.032, p=0.005, p=0.039, respectively. Equally, the scores in the Core FertiQol and the four subscales of the CG tended to decrease. In terms of Quality of Care, in the SG a tendency towards an increase is observed in the Treatment FertiQol and the Environment subscale with a significant difference visible in the Treatment Tolerability, p=0.001. This suggests that psychological support improves the patients´ ability to manage their emotions and affords a greater ability to tolerate the burden of the treatment on daily life. Core FertiQol and Total FertiQol for the second cycle IVF or FET reveal similar trends in both groups. In this second cycle or frozen embryo transfer, neither of the groups received psychological support. The total number of pregnancies from both attempts among the group of patients who received the eight psychological support sessions increases to 65%, while the women from the control group obtained a pregnancy rate of 48%, p=0.668. The patients from the SG also achieved superior pregnancy rates during the first fertility treatment in comparison to those from the CG, 49% vs. 39%, p=0.793. Limitations, reasons for caution: Given the conditions of the study (time constraints and weekly group sessions), the participants were able to decide whether they were assigned to one group or the other. The average quality of life from the initial questionnaire (FertiQol) of those who agreed to participate in the SG was significantly lower in comparison to those from the CG. These findings might lead us to believe that those women who perceive psychological distress are more receptive to receiving additional support. Nonetheless, later evaluations also indicate that those patients, who began with an optimal state of mind, experienced a fall in their quality of life during the treatment and had a higher discontinuation rate. Wider implications of the findings: Given that FertiQol is an internationally validated questionnaire, these results can be evaluated within a broad and international perspective. On the other hand, it is interesting to observe how patients, who are at a higher risk of emotional problems can benefit from psychological support, and how those patients who initially do not appear to be at risk of developing emotional problems, but are then unsuccessful in their treatment have high drop-out rates. This could indicate the importance of psychological-emotional support being integrated into assisted reproduction clinical practice. Study funding/competing interest: The Ginemed Foundation, in accordance with their objective to improve the quality of the care available in their centres, funded this study. There are no competing interests

Corinebacterium urealyticum: increased incidence of infection and encrusted uropathy.

INTRODUCTION: Corynebacterium urealyticum (CU) affects patients who are immunosuppressed, chronically ill or have undergone numerous operations. Obstructive uropathy (OU) is a complication of infection. STUDY OBJECTIVE: To demonstrate the growing increase in cases of infection by CU and OU in the past 5 years. MATERIAL AND METHODS: A descriptive study was conducted of urological patients with CU-positive urine cultures (January 2009-December 2014). We calculated the annual distribution and clinical characteristics of infection by CU and OU. Minimum follow-up: 6 months. We obtained the statistical means and ranges of clinical parameters pre/post-therapy. RESULTS: The total number of patients with CU was 115 (men, 87; women, 28). The mean age was 67.9 years (range, 6-95 years), and the annual distribution of cases for 2009, 2010, 2011, 2012, 2013 and 2014 was 9 (7.8%), 13 (11.3%), 9 (7.8%), 20 (17.4%), 31 (27%) and 33 (28.7%), respectively. The increase in cases for 2009-2014 was 300%. Multiple urological surgeries were performed in 89 cases (77.3%), with surgical complications in 77 cases (66.9%). Eighteen (15.6%) patients had OU (men, 13; women, 5), 12 had pyelitis (66.7%), 3 had cystopathy (16.6%), 2 had prostatic capsule disease (11.2%) and 1 had mesh calcification (5.5%). The analysis of the 18 cases with OU showed pre/postantibiotic therapy urine pHs of 8 (r, 6-9) vs. 6 (r, 5-7). All postantibiotic cultures were negative. Acidifying solution was applied in 5 cases, and surgery was performed in 13 cases (72.2%). The results from before/after the multimodal therapy showed renal impairment in 12 (66.6%) vs. 9 cases (50%) and glomerular filtration rates (GFR) of 45.8 (r, 6->90) vs. 52.7 (r, 13->90). The improvement in GFR was 6.94 points (T Wilcoxon; P=.102). The radiology results (incrustations) showed improvement in 13 patients (72.2%) and no change in 5 (27.8%). There was no specific mortality for CU. CONCLUSIONS: The prevalence of infection by CU and OU is increasing. Antibiotic treatment is highly effective. Acidifying solutions are an acceptable option for reducing calcifications.

Uropatía incrustante por Corynebacterium urealiticum: comentarios a partir de tres casos clínicos / Fouling uropathy by Corynebacterium urealyticum: Comments from three clinical cases

La uropatía incrustante es una enfermedad infecciosa del tracto urinario causada por la bacteria urealítica Corynebacterium urealyticum (CU). En nuestra serie (datos no publicados) sólo el 15% de las infecciones por CU produce uropatía incrustante. La formación de incrustaciones de estruvita y apatita en la pared del urotelio puede afectar a pelvis renal (pielitis), uréter, vejiga (cistopatía) y próstata, incluyendo la celda prostática después de resección ("celdopatía"). La pielitis es la más frecuente. La clínica corresponde a la triada orina alcalina, piuria y cristaluria de estruvita. Los pacientes suelen ser inmunodeprimidos o multioperados. El cultivo de orina debe estar dirigido al diagnóstico de CU. La TC es la prueba de imagen de elección. Muestra típicas imágenes de calcificación laminar. El tratamiento de la uropatía incrustante es multimodal. Incluye antibioterapia, acidificación de la orina y cirugía (algunos casos) (AU)

The encrustant uropathy is an infectious disease of the urinary tract caused by urealithic bacteria Corynebacterium urealyticum (CU). In our series (unpublished data) only 15% of CU infections caused encrustant uropathy. Formation of apatite and struvite on the wall of the urothelium can affect renal pelvis (pyelitis), urether, bladder (cystophatie) and prostate, including prostate cell after resection ("cellpathy"). Pyelitis is the most common. Clinical triad corresponds to alkaline urine, pyuria and struvite crystalluria. Patients are usually immunocompromised or or multiple previous surgeries. Urine culture should be directed to the diagnosis of UC. CT is the imaging test of choice. Shows typical images of laminar calcification. Treatment of encrusted uro pathy is multimodal. Includes antibiotics, acidification of urine and surgery (sometimes) (AU)

Hemangioma papilar como causa de macrohematuria. Presentación de un caso y revisión de la literatura / Papillary hemangioma as a cause of macrohematuria. A case report and review of the literature

La hematuria recidivante unilateral supone un reto diagnóstico y terapéutico para el urólogo. El hemangioma renal (HR) figura entre las posibles causas. La localización en la papila renal es típica. Se presenta un caso de hematuria secundaria a HR que fue diagnosticado en primera instancia como síndrome del cascanueces. Tras una revaloración se realizó ureterorrenoscopia que demostró un hemangioma papilar sangrante. La lesión fue tratada con fotovaporización láser con buen resultado. Se revisa la etiopatogenia, diagnóstico y las opciones terapéuticas frente al HR sangrante (AU)

Unilateral recurrent hematuria is a diagnostic and therapeutic challenge for the urologist. The renal hemangioma (RH) is a possible cause. The location is typically the renal papilla. A case of hematuria secondary to RH who was diagnosed at first instance and nutcracker syndrome is presented. After a diagnostic reassessment ureterorenoscopy was performed which showed a bleeding papillary hemangioma. The lesion was treated with laser PVP with good results. The pathogenesis, diagnosis and therapeutic options against the bloody RH is reviewed (AU)

Implications of vitamin D deficiency in lithiasic patient and in general population.

CONTEXT AND OBJECTIVE: Vitamin D deficiency causes problems in mineral metabolism but also overall health. In first place a review of the topic was carried out. Then, in order to contextualize it in lithiasic patient, a study on Vitamin D deficiency and its possible relationship with impaired PTH levels is performed. EVIDENCES ACQUISITION: A review of topics such as metabolism, epidemiology and the relationship of vitamin D deficiency with several pathologies was performed. Besides a multivariate analysis and a correlation study between vitamin D and PTH levels was conducted in 100 lithiasic patients. EVIDENCES SYNTHESIS: We present a review of Vitamin D metabolism, receptors and functions, as well as about its valuation methodology and the treatment of its deficiency. Lithiasic patients show a higher vitamin D deficiency than general population. Vitamin D deficiency has been significantly associated with increased PTH levels. In addition, there is enough literature showing a relationship between vitamin D deficiency not only with bone disease, but also with multiple diseases. CONCLUSION: vitamin D levels should be measured in all lithiasic patients, and those with vitamin D deficiency should be treated.

Infecciones de transmisión sexual en el varón: actitud práctica diagnóstico-terapéutica / STDs in men: diagnostic-therapeutic practical attitude

Las infecciones de transmisión sexual (ITS) son un grupo de enfermedades que afectan a la población que mantiene actividad sexual. Su distribución es muy amplia y afecta a ambos géneros. Para las uretritis por clamidia, ureaplasma y gonococo se utilizan cada vez más las pruebas de ampliación genómica como el test de reacción en cadena de la polimerasa (PCR). La balanitis por gardnerella y candida se diagnostican con cultivo de secreción y se tratan con terapia médica. Para el diagnóstico de la sifilis siguen en vigor las pruebas (reagínicas) como VDRL y las RPR y las treponémicas (no reagínicas) como FTA y TPHA. El tratamiento de todas ellas es antibiótico e incluye a las parejas. El herpes simple (VHS) se diagnostica clínicamente. La serología confirma el diagnóstico. El tratamiento con antivirales mejora el pronóstico. El virus del papiloma humano (VPH) se trata con eliminación química o física de las lesiones. El molusco contagioso se extirpa mecánicamente. En este trabajo se revisa el diagnóstico y el tratamiento práctico de las principales ITS que afectan al género masculino (AU)

Sexually Transmitted Infections (STIs) are a group of diseases affecting population that keeps sexual activity. Their distribution is very wide and affects both sexes. For urethritis chlamydia, ureaplasma and gonococcus genomic tests enlargement as test chain reaction (PCR) are used increasingly. The gardnerela and candida balanitis are diagnosed with secretion culture and treated with medical therapy. For the diagnosis of syphilis remain in reaginic and no reaginic tests). Treatment of these is antibiotic and includes couples. Herpes simplex virus (HSV) is diagnosed clinically. Serology confirms the diagnosis. Antiviral treatment improves prognosis. The Human Papilloma Virus (HPV) is treated with chemical or physical removal of the lesions. Molluscum contagiosum is removed mechanically. In this paper practical diagnosis and treatment of major ITS affecting male is reviewed (AU)

Litiasis úrica coraliforme bilateral de origen intestinal. Presentación de un caso tratado con la combinación quirúrgica NLP/RIRS/ECIRS / Uric bilateral staghorn lithiasis of intestinal origin. Report of a case treated with surgical combination NLP / RIRS / ECIRS

La cirugía endoscópica renal (por vía percutánea o por vía retrograda) se ha consolidado como una técnica de elección para los cálculos renales. En los más voluminosos (mayores de 2-3 cm de diámetro mayor) está indicada la nefrolitotomía percutánea (NLP) y en los menores la cirugía retrógrada intrarrenal RIRS (exceptuando los tratables con litotricia extracorpórea por ondas de choque). La ECIRS es una modalidad mixta. La litotricia endoscópica con láser es un tratamiento eficaz en las tres técnicas. En NLP es necesario usar altas energías La litiasis de AU representan un 10% del total de cálculos en España. Entre los factores etiológicosfiguran la dieta, los procesos inductores de lisis celular (ciertas neoplasias, quimioterapia) y algunos trastornos digestivos. Aunque la bilateralidad es muy frecuente es más raro encontrar coraliformes bilaterales. Presentamos un caso de litiasis renal úrica bilateral coraliforme (AU)

Renal endoscopic surgery (percutaneously or via retrograde) has become a technique of choice for kidney stones. In the more bulky (greater than 2-3 cm in diameter) is indicated percutaneous nephrolithotomy (PCNL). In smaller is indicated intrarenal retrograde surgery (RIRS), excluding those that can be treated with extracorporeal shock wave lithotripsy. The ECIRS is a mixed mode. Endoscopic laser lithotripsy is an effective treatment in the three techniques. In NLP is necessary to use high energy. The uric acid stones account for 10% of all stones in Spain. Etiologic factors include diet, conditions inducing cell lysis (certain malignancies, chemotherapy) and some digestive disorders. Although it is very frequent bilaterality is rare to find bilateral staghorn. We report a case of bilateral staghorn uric kidney stones secondary to intestinal disorder treated with a combination of three pocedures (AU)

Versión española del cuestionario USSQ: evaluación de la tolerancia clínica al catéter ureteral doble jota / Spanish version of the USSQ questionnaire: evaluation of clinical tolerance to double J uretheral catheter

INTRODUCCIÓN: La evaluación de los síntomas debidos a catéter ureteral doble jota (CUJJ) precisa de una herramienta fiable como el cuestionario USSQ. Se presenta una versión traducida al español de este cuestionario (USSQ-E). MATERIAL Y MÉTODOS: La versión en inglés del USSQ ha sido traducida al español siguiendo una sofisticada sistemática lingüística. Una vez obtenido el USSQ-E ha sido probado en un grupo de 70 pacientes portadores de CUJJ. Como grupo control se han tomado 40 personas sin catéter. RESULTADOS: Se ha evaluado el USSQ-E con pruebas de consistencia interna, test-retest, validez convergente, sensibilidad al cambio y validez discriminatoria, siendo todas ellas satisfactorias. CONCLUSIÓN: El USSQ-E es una herramienta válida y fiable para evaluar la sintomatología derivada del CUJJ en población hispanoparlante (AU)

INTRODUCTION: The assessment of symptoms due to double J ureteral catheter (CUJJ) requires a reliable tool like USSQ questionnaire. A translation in Spanish of this questionnaire (USSQ-E) version is presented. MATERIAL AND METHODS: The English version of USSQ has been translated into Spanish language following a systematic sophisticated. After obtaining the USSQ-E has been tested in a group of 70 patients with CUJJ. A control group of 40 people have been taken without catheter. RESULTS: We evaluated the USSQ-E with evidence of internal consistency, test-retest reliability, convergent validity, sensitivity to change and discriminant validity, all of which are satisfactory. CONCLUSION: USSQ-E is a valid and reliable for assessing symptomatology derived CUJJ tool in speaking population (AU)

Urología y recursos predictivos en la Web / Urology and Web predictive resources

No disponible

Extraction of a bladder stone in a child as described by the renaissance physician Cristóbal Méndez.

INTRODUCTION: in his Libro del exercicio y de sus provechos (Book of exercise and profits), the Spanish Renaissance physician Christopher Mendez (1500-1553) describes extracting a bulk stone from the bladder of a child younger than 5 years in the land of colonial Mexico. This is the first description of a surgical procedure in America. MATERIAL AND METHODS: Biographical data were collected on Christopher Mendez. The electronic facsimile of the Book of exercise and profits was read. The historical aspects of perineal lithotomy and etiology of bladder stones were analyzed. RESULTS: In chapter seven of the third treatise (page 120), Mendez speaks about the removal of a bladder stone in a boy named «Villaseñor¼. It uses the word «open¼ to describe the procedure, corresponding to a lithotomy more than a necropsy. It attributes the etiology of excess movements after ingestion and suggests a possible hereditary etiology. DISCUSSION: Perineal lithotomy was a common practice in ancient times for children due to the high incidence of bladder stones. The technique was very invasive and was improved over the centuries. CONCLUSIONS: The surgery described by Mendez for the child called Villaseñor most likely corresponds to a perineal lithotomy. A congenital cause could play a role in its etiology.

Espina bífida y vejiga neurógena. Manejo de un caso complejo con esfínter artificial, ampliación vesical y derivación urinaria / Spina bifida and neurogenic bladder. Managing a complex case with artificial sphincter, bladder augmentation and urinary diversion

Se presenta caso de varón de 26 años con antecedente de espina bífida y mielomeningocele. Diagnosticado de vejiga neurógena con sistema de bajas presiones inicialmente debido a incontinencia de orina fue tratado con esfínter artificial. Después de la operación presentó un patrón de sistema de altas presiones que requirió ampliación vesical, derivación tipo Mitrofanoff y retirada del esfínter. Con ello se consiguió que la presión del detrusor se mantenga dentro de límites seguros durante las fases de llenado y vaciado para proteger la función renal. Es de gran importancia el diagnóstico y seguimiento urológico temprano de los niños y niñas con esta enfermedad mediante los estudios urodinámicos para determinar el patrón vesical y esfinteriano y decidir la mejor estrategia de tratamiento posible. La finalidad fundamental es convertir la vejiga en un sistema de baja presión, conseguir la continencia y preservar la función renal (AU)

Twenty-six years old male with a history of spina bifida and myelomeningocele is presented. Neurogenic bladder with initially low pressure system due to urinary incontinence was treated with artificial sphincter. After the operation presented a pattern of high pressure system that required bladder augmentation, Mitrofanoff diversion and removal of the sphincter. Through these measures safe limits during the phases of filling and emptying of the bladder were achieved, to protect renal function. It is very important the early diagnosis and monitoring of urological children with spina bifida with urodynamic study to determine bladder and sphincter patterns and determine the best possible treatment strategy. The main purpose is to convert the bladder in a low-pressure system, achieve continence and preserve renal function (AU)

Recomendaciones dietéticas en la litiasis de oxalato cálcico / Dietary recommendations in calcium oxalate lithiasis

La dieta puede afectar a los enfermos con litiasis oxálica, aumentando los factores de riesgo para la formación. Una vez completado el estudio metabólico se deben dar algunas normas dietéticas basadas en los datos científicos disponibles. Existen pocos trabajos que hayan analizado de forma completa el contenido de oxalatos en los alimentos de la dieta humana. Se debe insistir en la ingesta hídrica abundante, la reducción de sal y de proteínas animales, manteniendo un correcto aporte de calcio. En el presente trabajo se adjuntan algunas tablas de contenidos de oxalato en diversos alimentos. Los más ricos en oxalato (acelgas, espinacas, coliflor, té, cacao, kiwis) deben ser restringidos

Diet affect oxalic lithiasis patients, increasing the risk factors for stone formation. Upon completion of the metabolic study should give some dietary guidelines based on scientific data. Few studies have analyzed completely the oxalate content in foods of the human diet. It must be emphatized abundant fluid intake, reducing salt and animal protein, maintaining proper calcium intake. In this paper, some tables about oxalate content in various foods are attached. Most rich in oxalate (chard, spinach, cauliflower, tea, cocoa, kiwis) must be restricted