[The Cochrane collaboration and the Cochrane library in urology]. / La colaboración y la Biblioteca Cochrane en Urología.

The Cochrane Collaboration is an international, non-profit making organisation which aims to help people make well-informed health care decisions. The main objective is to prepare, update, promote and facilitate access to systematic reviews on health care interventions. The main product is The Cochrane Library, a quarterly electronic publication. The principles and structure of the Cochrane Collaboration and the structure and content of the Cochrane Library will be described. The importance of systematic reviews and meta-analyses as sources of information for clinicians will be presented, with special emphasis on the contributions of the Cochrane Collaboration to the speciality of urology.

La colaboración y la Biblioteca Cochrane en Urología / The Cochrane collaboration and the Cochrane Library in urology

La Colaboración Cochrane es una organización internacional, sin fines de lucro, que busca ayudar a quienes necesitan tomar decisiones bien informadas en atención sanitaria. Su principal objetivo es: Preparar, actualizar, promover y facilitar el acceso a las revisiones sistemáticas sobre las intervenciones de la atención sanitaria. Su principal producto es la Biblioteca Cochrane (The Cochrane Library), una publicación electrónica trimestral en formato electrónico. Se describen los principios y la estructura de la Colaboración Cochrane y la estructura y contenido de la Biblioteca Cochrane. Se expone la importancia de las revisiones sistemáticas y de los meta-análisis como fuentes de información para los clínicos, destacando las aportaciones de la Colaboración Cochrane en la especialidad de urología (AU)

The Cochrane Collaboration is an international, non-profit making organisation which aims to help people make well-informed health care decisions. The main objective is to prepare, update, promote and facilitate access to systematic reviews on health care interventions. The main product is The Cochrane Library, a quarterly electronic publication. The principles and structure of the Cochrane Collaboration and the structure and content of the Cochrane Library will be described. The importance of systematic reviews and meta-analyses as sources of information for clinicians will be presented, with special emphasis on the contributions of the Cochrane Collaboration to the speciality of urology (AU)

[10 years of evidence-based medicine. Introduction to evidence-based urology]. / Diez años de medicina basada en pruebas. Introducción a la urología basada en pruebas.

The Evidence-based Medicine has become, in ten years of existence, a social phenomenon, that has spread to all the sectors of the health. The MBP has been defined as: the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The critical analysis of the health care, the new methods of clinical investigation and the development of computer science and the communication can be considerate the bases for the appearance of the MBP and other movements or related currents of thought, such as the Health Technology Assessment, the "Critical Appraisal Skills Programme" or the "Cochrane Collaboration". The MBP is a system of self-taught and permanent learning, that consists of the successive execution of the following points: 1) converting the need for information into an answerable question, 2) tracking down the best evidence with which to answer that question, 3) critically appraising that evidence for its validity, impact, and applicability, and 4) the application of the results actually clinical. The MBP model has also received critics and objections, that are analyzed. The "Asociación Murciana de Urología" has created a Working Group for the study, the practice and the application of this methodology in urology.

Diez años de medicina basada en pruebas. Introducción a la urología basada en pruebas / Teen years of evidence-based mediicine. Introduction at evidence-based urology

La Medicina Basada en la Evidencia o Medicina Basada en Pruebas (MBP) se ha convertido, en sus diez años de existencia, en un fenómeno social. La MBP ha sido definida como: el uso consciente explícito y juicioso de las mejores pruebas disponibles en la toma de decisiones sobre el cuidado del paciente individual. El análisis crítico de la atención sanitaria, la incorporación de nuevos métodos de investigación clínica y el desarrollo de la informática y la comunicación pueden considerarse las bases para la aparición de la MBP y otros movimientos relacionados, tales como la Evaluación de Tecnologías Sanitarias, el programa de habilidades en lectura crítica o la Colaboración Cochrane. La MBP es un sistema de aprendizaje autodidacta y permanente, que consiste en la ejecución sucesiva de los siguientes puntos: 1) la conversión de las necesidades de información en preguntas contestables, 2) la obtención de las mejores pruebas, 3) la revisión crítica de esas pruebas en cuanto a su validez, importancia y aplicabilidad y 4) la aplicación de los resultados. El modelo de MBP ha recibido también críticas y objeciones, que se analizan. La Asociación Murciana de Urología ha creado un Grupo de Trabajo para el estudio, la práctica y la aplicación de esta metodología en la especialidad de urología (AU)

The Evidence-based Medicine has become, in ten years of existence, a social phenomenon, that has spread to all the sectors of the health. The MBP has been defined as: the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The critical analysis of the health care, the new methods of clinical investigation and the development of computer science and the communication can be considerate the bases for the appearance of the MBP and other movements or related currents of thought, such as the Health Technology Assessment, the "Critical Appraisal Skils Programme" or the "Cochrane Collaboration". The MBP is a system of self-taught and permanent learning, that consists of the successive execution of the following points: 1) converting the need for information into an answerable question, 2) tracking down the best evidence with which to answer that question, 3) critically appraising that evidence for its validity, impact, and applicability, and 4) the application of the results actually clinical. The MBP model has also received critics and objections, that are analyzed. The "Asociación Murciana de Urología" has created a Working Group for the study, the practice and the application of this methodology in urology (AU)

[Emphysematous cystitis]. / Cistitis enfisematosa.

The presence of gas in the bladder wall and/or lumen (emphysematous cystitis) is an uncommon disease entity that may be caused by infectious organisms. Diabetes and chronic urinary infection are predisposing factors. Its clinical features are unspecific and the prognosis depends on the degree of aggressiveness at presentation. Early diagnosis and treatment (bladder drainage + antibiotics) are very important in order to resolve the condition before severe sequelae are caused. We report on 75-year-old diabetic female with mild emphysematous cystitis caused by Clostridium perfringens which resolved with bladder drainage and antibiotics. The incidence, forms of presentation, pathogenesis, diagnosis and treatment of this condition are discussed.

[Matrix stones]. / Litiasis blanda.

We report a case of matrix stone in a patient with a previous history of infective staghorn stone for which the patient had previously undergone surgery to reduce stone volume and ESWL. The ureteral matrix stone had caused purulent intrarenal retention. Puncture nephrostomy and antibiotics resolved the foregoing condition and the calculus was successfully removed by ureteroscopy. The features of this uncommon disorder and the possibilities of endoscopic treatment are discussed.

[Rigid ureteroscopy. Results and complications]. / Ureteroscopia rígida. Resultados y complicaciones.

Analysis of results and complications of retrograde rigid ureterorenoscopies (URS) performed in our unit between August 1985 and June 1990. Our series includes 122 URS performed in 106 patients: 68% female and 32% male. A rigid ureteroscopy Storz 11.5 Ch was used. URS indications were: 72% treatment of ureteral lithiasis, 14% diagnosis, 7% treatment of ureteral tumores and 3% other reasons. Treated lithiasis were predominantly located in the pelvic ureter. Overall success in the treatment of lithiasis was 92.86% in "primary" lithiasis, and 71.43% in post-ESWL. URS allowed us to resolve troubles of differential diagnosis in 93.75% of cases. With a complications rate of 19.7%, only 3.28% were considered relevant.

[Metastasis in maxillary sinus as presentation form of adenocarcinoma of the prostate]. / Metástasis en seno maxilar como presentación de un adenocarcinoma de próstata.

Presentation of one case of prostate adenocarcinoma its initial clinical manifestation being the appearance of facial tumour secondary to metastatic affectation of left maxillar sinus. After stressing its rarity, the relevance of immunohistochemical studies for the specific prostatic antigen and acid phosphatase in determining the unconnected origin of metastatic lesions is addressed.

[Trigono-cervico-prostatic incision]. / Incisión trígono-cérvico-prostática.

Trigone-cervico-prostatic incision is a surgical alternative in the treatment of urinary obstruction induced by small size prostate. Twenty-three patients were treated in our unit with this procedure, 17 because they were carriers of small size prostate and 6 because they were high risk surgical patients in which the simplicity and swiftness of this technique were essential. Good results have been obtained both clinical and in urological flow in 95.7% cases. The only complication was one stenosis of the urethra requiring internal urethrotomy but there were no cases of vesical cervix contracture or urinary incontinence. Average follow-up was 12.5 months. It is concluded that this is a valid, low morbidity alternative that can be offered to patients with small sized and symptomatic prostate.

[Multilocular renal cyst]. / Quiste multilocular renal.

A case of multilocular renal cyst in a 37-year-old patient is presented, which met all of the diagnostic criteria described by Powell (1951) and Boggs and Kimmelstiel (1956). The frequency of renal hydatid cyst observed in our setting warrants differential diagnosis from this disease entity. Conservative surgery is advocated as treatment.

[Complications during and after extracorporeal lithotripsy in elderly patients]. / Complicaciones per y post-litotricia extracorpórea en los pacientes de edad avanzada.

Report of our experience of complications arisen from treatment of urinary lithiasis with extracorporeal shock-wave lithotripsy, using a Dornier HM3 lithotripter in 218 elderly patients (over 65 years). No complications arose during lithotripsy in 160 patients (73.39%). Most frequent complications (when they happened) were skin disorders, which occurred in 33 patients (15.13%). One hundred and thirty-six (62.38%) patients had no post-lithotripsy non-obstructive urological complications, but when these occurred, renal colic, evident in 52 patients (23.85%), was the most frequent one. During the post-lithotripsy period, 88.53% patients (193) had no obstructive urological complications. When they emerged, they usually developed asymptomatically (13 patients, 5.95%). With regard to the approach used to treat the obstructive cases, the most common one was medical, representing 56%. Surgery was used only in 2 occasions. A total of 175 patients (80.27%) presented no post-lithotripsy complication, fever of up to + 38 degrees C being the most prevalent condition (9.65%).

[Open adenomectomy: review of 223 cases]. / Adenomectomía abierta: revisión de 223 casos.

A retrospective study was undertaken to determine the results achieved in 223 patients with prostatic hypertrophy who underwent open surgery during a period spanning 5 years. Good results were achieved in 88.34% of the cases, the mortality rate was 0.44%, and the post-operative morbidity rate was 31.3%. Urinary infection was the most common complication during this period (21.01%). Late post-operatively, we observed the following low incidence of urethral stenosis and lodge sclerosis, 1.79% and 2.24%, respectively. Six patients (2.69%) were permanently incontinent and one required surgery for recurrent obstruction of prostatic origin.

[Transureteral resection of the prostate. Review of 20 consecutive operations (5 yr)]. / RTU de próstata. Revisión de 210 intervenciones consecutivas (cinco años).

In the present study we reviewed our results in the treatment of prostatic obstruction of adenomatous origin over a period of 5 years and with a follow-up of 1 to 6 years. Of the 210 patients considered evaluable, good results were achieved in 84.28%, with mortality and morbidity rates of 0.45% and 22.82%, respectively. Infections were the most commonly observed complications in the early post-operative period. Urethral stenosis, the most common cause for reoperation, was observed in 9.04% in the late post-operative period.

[Metastasizing kidney cancer. Experience with interferon alfa-2a and vinblastine]. / Cáncer metastásico de riñón. Experiencia con interferón alpha-2a y vimblastina.

Management of renal cells carcinoma still remains a therapeutic challenge. Nephrectomy is the primary therapy when the disease has a definite location. In advanced or disseminated cases, the various traditional procedures, including radiotherapy, chemotherapy or hormonal regimes, have obtained poor responses. Survival shows a direct relationship with the biological aggressiveness of the tumour and histological factors. Results recorded in the literature using specific immunotherapeutic agents are encouraging although the real value of this regimes has not yet been established in large series of prospective studies. The Oncology Unit of our Urology Service has obtained optimal follow-up in a group of patients included in a combined protocol of interferon alpha-2a and vinblastine as cytotoxic agent.