[Evaluation of the consultants to a urology service at hospital level]. / Valoración de las interconsultas realizadas a un servicio de urología, a nivel hospitalario.

OBJECTIVE: The main objectives of this study were to value the quality of the contained information, the characteristics of the consultants (IC) and as well as to know the performance carried out by the service of Urology in our hospital. MATERIAL AND METHODS: It was carried out an observational descriptive study where the documents of IC picked up by the service of Urology during 8 months were analyzed. Previously defined approaches of quality were used by Irazábal et al (changed) and Batista Miranda JE et al. RESULTS: They were picked up a total of 411 IC, arrivals to the service in a serial way. Coming from 27 hospital services. 82.2% of the derivatived patients were male. The half age of the patients was of 63, 25 years. 192 patients had personal urological records of interest (47%). The IC grouped in 27 different reasons. The reason of more frequent consultation was the incidentaloma with 21.5%. Regarding the grade of execution of the document of IC: there was perseverance of filiation data (96.3%), a description of the symptoms was in 68.2% and the physical examination appeared reflected in 8.8% of the total of the IC. They were requested as normal IC 63.4%, preferent 25% and urgent 11.7%. The days of answer to the IC it was of stocking of 1,45 days with typical deviation of 1,65 days. According to the established approaches, to classify the documents for adaptation level, they were classified as inappropriate to 32.9% of the IC (n = 135). They were classified in grade 1 the 44.6% (n = 183), grade 2 20% (n = 82) and grade 3 2.4% (n = 10). The attitude that was taken: it was remitted to External Consultations of Urology to 10.5% of the total of the IC, to the Center of Specialized Attention to 7.8%, it was requested complementary tests to 7.8%, it was remitted to the functional Tests of Urology, for the realization of some complementary test to 61 patients (14.9%), it was presented in Clinical Session of Urology to 5,6% of the patients, he/she moved to the Service of Urology to 2 patients (0.5%) and he/she took some other therapeutic attitude in 19.6%, these results had a p = 0.000 significance. CONCLUSION: In our study, we observe a high percentage as for the perseverance of the data of lightly inferior filiation in the description of the symptoms and considered low in the physical exploration. A high percentage of inappropriate considered IC. Regarding the attitude that took the Service of Urology, maybe had a low used of the Functional Unit. Until the moment and under our knowledge a study carried out in the environment from the realized IC to the Service of Urology in a Hospital of third level only exists and we believe that the realization of studies would improve the quality from the attendance to our patients.

[Post-traumatic renal arteriovenous fistula. Conservative treatment with superselective embolization]. / Fístula arterio venosa renal postraumática. Tratamiento conservador con embolización supraselectiva.

OBJECTIVE: Renal arterial-venous fistula is a low incidence clinical entity generally secondary to processes invasive to such organ. We report a new case with a bibliographic review, and evaluate the diagnostic and therapeutic approach. METHODS/RESULTS: We report the case of a patient who suffered a left flank knife wound and developed an arterial-venous fistula presenting with hematuria that was solved by selective embolization. CONCLUSIONS: Arterial-venous fistula is a low incidence entity, usually secondary to renal trauma (open or blunt) and invasive processes. Renal Doppler-Ultrasound is the initial diagnostic procedure when its diagnosis is strongly suspected and then angiography is both confirmatory and therapeutic.

[Extracorporeal shock-wave lithotripsy as treatment of lithiasis in horseshoe kidney]. / Litotricia extracorpórea por ondas de choque como tratamiento de la litiasis en riñones en herradura.

OBJECTIVES: Horseshoe kidney is the most frequent renal congenital anomaly, with an estimated general population prevalence of 1/400-500. This entity may be asymptomatic for the entire lifetime, or produce symptoms from associated complications such as lithiasis, hydronephrosis, or recurrent infections. The incidence of lithiasis varies between 20% and 80% of the patients. The treatment of lithiasis in this entity is controversial due to problems derived from the anatomy of the kidney and its drainage when stones are treated with external shock wave lithotripsy (ESWL). We tried to evaluate the efficacy of ESWL treatment and to establish the ideal conditions in which this technique may be considered treatment of choice. METHODS & RESULTS: A total of 25 patients were evaluated (17 males and 8 females). Patient age ranged from 8 to 75 year old. Three patients presented with bilateral lithiasis. 27 renal units were treated, 18 of which were left (66.7%) and 7 right. Stone size was measured in cm2 of surface. Lithiasis was located at the renal pelvis in 13 cases (48.1%), and lower calyx in 7 (25.9%). Four patients required JJ stent insertion. Mean number of shock waves per session was 3480 (range 1000-4000). Two Shock wave generators were used for treatment, the Dornier lithotripter S and the Dornier MFL-5000, with a range of 10-120 KV for the first one and 14-23 KV for the second. Follow up KUB X-rays were performed at 3, 6 and 12 months to evaluate fragmentation and elimination rates. In our series total fragmentation was 85.2%, and partial fragmentation (fragments > 6 mm) 14.8%. Elimination rates were satisfactory with 37.4% total elimination, and 48.1% partial elimination (Fragments < 6 mm). 14.8% of the patients had no elimination at all. CONCLUSIONS: We consider ESWL the first therapeutic option for cases of lithiasis with a mean area 4 cm2 or less and pelvic location. In case of great lithiasic areas other therapeutic options should be considered (open surgery or percutaneous nephrolithotomy) either in monotherapy or complementary to ESWL.