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OBJECTIVES: Data about urology malpractice claims in our environment are scarce and should be considered a potential opportunity to “learn from errors”.METHODS: We analyzed every claim for alleged malpractice in Urology managed by the Council of Medical Colleges of Catalonia between 1990 and 2012, and specifically evaluated the clinical and medicolegal features of those cases with medical professional responsibility. RESULTS: We identified 182 cases in 22 years, but only the 25,74% showed professional liability. Testicular torsion misdiagnosis, pregnancies after vasectomy and complications of lithiasis should be noted for their frequency of claims and rate of liability. 246 physicians were involved, 89% were males and mean age was 45.6 years. Most cases (n=137, 75.27%) were processed in the courts. DISCUSSION: Urology has a medium risk of claims, with a moderate rate of medical professional liability and amount of compensation. There are specific actions that would lead to clinical safety improvements, particularly in testicular pathologies, vasectomy and lithiasis. Finally, more attention should be paid to proper patient information.
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OBJECTIVES: To analyze the implantationof laparoscopic radical prostatectomy (LRP) in the PublicHealth System in the Autonomous Community of Madrid(CAM) and to investigate the different results betweenlaparoscopic and open radical prostatectomy.METHODS: We performed a retrospective analysisover a database containing data from 25 hospitalsin CAM. We chose 8225 patients treated by radicalprostatectomy (open or laparoscopic). Data were collected using a questionnaire including hospital, lengthof stay, readmissions and mortality. Values are shown innumber, percentage and rank. Statistical significance isshown with p<0.05.RESULTS: Increase of LRP is shown in the period of study,representing only a 11.9% of the radical prostatectomiesin 2004 and reaching 56.8% in 2012. There wereno significant statistical differences in age, severity orreadmissions when stratified by hospital or by technique.We found a 1.05 days increase in length of stay inlong-standing hospitals compared to newer hospitals.We also found a decrease in length of stay in LRP groupcompared to open retropubic prostatectomy (ORP):4.84 days vs 6.79 days, (p<0.001).CONCLUSIONS: RP is consolidated as a therapy inCAM. LRP has been successfully implemented in CAM,offering advantage over ORP in terms of hospital stay.We observed statistically significant difference in lengthof stay in advantage of recent hospitals regarding long-standing
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OBJECTIVE: We discuss the influence that involvement of fat (perirenal, sinus) and vascular structures (renal vein, segmental veins) have on cancer-specific mortality (CSM) rates in renal cancer. METHODS: We conducted a retrospective analysis of 140 stage pT3a kidney tumors (114 clear cell, 9 type I papillary, 6 type II papillary, 11 chromophobe) surgically treated between 1997 and 2015. We conducted a cancer-specific survival study (Kaplan Meier) and a univariate and multivariate analysis of the variables: perirenal fat invasion, sinus fat invasion, renal vein invasion, segmental vein invasion and Fuhrman grade. RESULTS: With a mean follow-up of 79 months, 47 deaths occurred overall (31.7%), 29 of which were due to the kidney tumor (CSM 20%). There were 50 cases of vascular invasion (35.7%), 40 cases with fat only invasion (28.6%) and 50 cases with invasion of both (35.7%). In the survival study, fat invasion had the least impact (17%), and invasion of both (fat and vascular structures) had the worst survival (48% of total mortality). Vascular invasion represents 35% of the mortality rate. In the multivariate study, Fuhrman grade 3–4 (HR 10.7), renal vein invasion (HR 9.2) and concomitant vascular and fat invasion (HR 5.6) are the factors with the greatest impact. CONCLUSIONS: Tumor fat invasion has a lower impact on the CSM of kidney cancer than vascular invasion.
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OBJECTIVE: To determine the prognosticimpact that tumor size has in patients with pathologicalrenal cancer stage pT3a.METHODS: Retrospective, descriptive study evaluating261 patients diagnosed with renal cancer pathologicalstage pT1-3aN0M0 between 1995 and 2013.Clinical and pathological characteristics were evaluatedin each group. A ROC curve was used to determinethe optimum cutting point of tumor size in relation tothe death by cancer. Metastasis-free survival andcancer specific survival were evaluated by the KaplanMeier method and the differences between the groupswere evaluated by the Log Rank test. Multivariate Coxregression analysis was used to evaluate the relationshipof tumor size and survival of these patients.RESULTS: 261 patients were studied, 166 of which(63.6%) were Stage pT1a-b, 49 (18.8%) pT2 and 46(17.6%) pT3a. Patients with pT3a tumors had higherproportion of symptomatic tumors (56.5% vs 33.6%;p 0.003), tumor size (7.1 cm vs 5.5 cm; 0.0007),Fuhrman grade 3-4 (52.2% vs 19.1%; p 0.0001),coagulative necrosis (62.8% vs 28.8%; p 0,0001),distance metastasis (39.1% vs 14.9%; p 0.0001) anddeath by cancer (23.9% vs 8.9%; p 0.003) whencompared with localized tumors (pT1-2). The ROCcurve demonstrated that a cut-off point of 7cm is theideal tumor size to determine renal cancer mortality.Metastasis-free survival at 5 year was 90% for tumorspT1a-b, 71% for pT2, 83% for pT3a <7cm and 48%for pT3a >7cm, with significant statistical differences(Log-rank test <0.001). In the multivariate analysis, onlypT3a >7cm stage was an independent predictor ofdeath by renal cancer.CONCLUSIONS: Although perirenal fat invasionand renal vein invasion (pT3a stage) are acceptedas prognostic factors, to differentiate this category bytumor size could improve its predictive quality. The tumordiameter (7cm) should be applied to pT3a tumors inorder to improve the accuracy of TNM system.
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OBJECTIVES: To evaluate the associationof positive margins in the intraoperative biopsy duringradical cystectomy (RC) with the risk of recurrence in theuretero-ileal anastomosis or upper urinary tract (UUT),and identify potential risk factors for positive ureteralmargins.METHODS: A retrospective, descriptive study was performedin patients treated with radical cystectomy due totransitional cell carcinoma (TCC), who underwent a coldbiopsy of the ureteral margin at the time of cystectomy. Adescriptive analysis and frequency distribution was performed.Fisher´s test was used to calculate sensitivity andspecificity and a survival analysis was performed.RESULTS: 230 patients were included. Prior to RC, transurethralresection of the bladder tumor and a CT scanwere done. The percentage of positive margins was4.81% for the right ureter and 4.27% for the left. Recurrencewas detected in the anastomosis in 2.64% of thecases. In a 0.88% recurrence was found in the UUT (2cases) at the level of left renal pelvis (1 case) and leftkidney (1 case). In the multivariate analysis, neither recurrencein the anastomosis (p=1) or at the UUT (p=1) levelduring follow-up were significantly associated with thepresence of positive margins. An association was foundbetween the pathological biopsy of the right ureter andcarcinoma in situ (CIS) of the bladder wall with UUT involvement.We found only association between the coldbiopsy of the left ureter and tumor in left UTT. Reimplantationwith positive margins was not statistically associatedwith neither ureteroileal anastomosis or UTT relapse. Arelationship was found between the cold biopsy of bothureters and the definitive pathology.CONCLUSIONS: In our study, the presence of positiveureteral margins was not associated with an increasedrisk of recurrence in the anastomosis or UUT. Althoughit remains a topic for debate, a strategy to follow maybe to adapt ureteral cold biopsies to individual risk, thusperform it in patients with bladder CIS.
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OBJECTIVES: In recent years, differentstudies have mentioned the recurrence of vesicoureteralreflux (VUR) endoscopically resolved, an exceptionalevent after open surgery. The aim of this study is todescribe the evolution of the cases of recurrenceidentified in our center to assess the importance of thisevent.METHOD: We have identified the cases of VUR thatrecurred after successful endoscopic treatment in our anesdepartment.We have analyzed diagnostic tests,management and final outcome.RESULTS: In our series, we have a 19.5% incidenceof VUR recurrence after endoscopic correction. Out ofthese patients, 66.2% were asymptomatic. Ultrasound(US) showed modifications only in two of the cases. Fiveof them had worsen differential renal function in the Tc-99 dimercapto succinyl choline acid scan (DMSA). Weperformed a new endoscopic procedure in 49 ureteralunits with a success rate of 75.5%.CONCLUSIONS: Most patients with VUR recurrencewere asymptomatic, with no alterations in US or DMSAscan. Both endoscopic treatment or surveillance mightbe appropriate in this setting. These data lead us toreckon that the systematic search for VUR relapse in theasymptomatic patient might not be necessary. Similarly,ultrasound or DMSA monitoring should be aimed to theassessment of established reflux nephropathy, regardlessof the possibility of recurrence.
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TThe transdermal route for administration of anticholinergic drugs can provide efficacy with less systemic adverse effects. The transdermal oxybutynin patch (OXYTDS) offers advantages over oral administration for patients treated for Overactive bladder (OAB) syndrome. The limited evidence on the OXY-TDS patch application areas of the skin, makes difficult counseling patients who require a change to skin zones other than those recommended by the manufacturer. The preliminary experience of four patients included in this case report suggests that changing the application area for the OXY-TDS patch outside those skin areas recommended by the manufacturer, seems effective and safe in the treatment of OAB syndrome, regardless of the characteristics of the patients.
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OBJECTIVE: Urolithiasis prevalence is2-20% according to different geographic characteris-tics in different populations. In this study, we aimed topresent the distribution of operation numbers for bothpercutaneous nephrolithotomy (PCNL) and retrogradeintrarenal surgery (RIRS) in terms of age and stone size inorder to reveal the changes over the years.METHOD: Between January 2010 and March 2016,1814 patients were operated for the treatment of re-nal stones. Patients were directed to the two differentoperations according to the surgeons’ choices: RIRS orPCNL. Prospectively collected data was retrospectivelyreviewed.RESULTS: In the years 2010, 2011, 2012, 2013,2014, 2015, and 2016, the number of RIRS appliedfor the treatment of renal stones was 25, 87, 96, 147,166, 174, and 66, respectively. RIRS was significantlypreferred more than PCNL for stones p<1.5cm. Exami-ning the ages, there was no different data described asabove for stone sizesCONCLUSION: Despite RIRS is the new trend for trea-ting stone disease, PCNL remains its important role forespecially the larger stone sizes. RIRS is the raising trendfor small sizes
