Historical research has allowed us to review and document the author of the first description of the intrasinusal route for access to the renal hilum as a strategy for accessing kidney stones through the bibliography. This new route described and published by M. Serés represented a paradigm shift in open surgery for kidney stones. We want to highlight that the Spanish urological anatomical-surgical investigation with the investigations of Manuel Serés, meant a singular contribution and of enormous importance for the History of International Urology, whose value we must claim with its indisputable and reliable references.
INTRODUCTION: The treatment of prostate cancer has recently been questioned because of the adverse effects it causes may outweigh the benefits in many patients, so, it has increased interest in active surveillance for low-risk diseases and tissue preservation with focal therapy, thereby reducing the burden on medical care and side effects that may occur after radical prostatectomy and radiation therapy.OBJECTIVE: provide updated information on the treatment of prostate cancer with high intensity focused ultrasound therapy.MATERIALS AND METHODS: Bibliographic review study and systematic analysis of 27 scientific articles found in the Medline, Scielo and PubMed databases, whose publication dates correspond to the last 5 years. The search criteria used consisted of terms: prostatic neoplasms, ablation techniques, high-intensity focused ultrasound ablation.RESULTS: Focal therapy is a therapeutic option for low-risk prostate cancer, clinical studies report a 75% cancer-free survival, 99% cancer-specific survival and 96% metastasis-free survival, the prostate antigen is maintained at values lower than 0.1 ng/ml in long-term controls, while the adverse effects of surgery such as incontinence and sexual impotence are rare.CONCLUSIONS: HIFU is a less invasive option for the treatment of low-risk prostate cancer, with oncological results similar to radiotherapy and radical prostatectomy.
Nephrolithiasis is a highly prevalent disease presenting itself mostly at a working age, which leads to a great economic burden on health system. Kidney Stone disease should be viewed as a systemic disorder, associated with or predictive of hypertension, insulin resistance, chronic kidney disease and cardiovascular damage. According to current guidelines and evidence, a full screening of risk factors for kidney stones and for cardiovascular damage should be recommended in all cases of kidney stone disease, yet it is rarely performed, and a real-world clinical practice is lacking. The aim of this narrative literature is to serve as guidance for a patient-tailored dietary suggestion after a clinical and biochemistry evaluation, with limited resources, and still offer a rational management of kidney stone patients. Meta-analysis, systematic review, experimental studies, case-control plus high-impact factor journals PubMed and EMBASE, on the topic were included. Search criteria included metabolic profile, metabolic work-up, kidney stone, urolithiasis between 2010 and 2020.
OBJECTIVE: The objective of this paper is identifying the factors that may condition the success or failure of endoscopic therapy for vesicoureteral reflux in the paediatric population. MATERIAL AND METHODS: A bibliographic review was performed in the Cochrane Library and PUBMED of all the studies which the principal subject was about identifying factors involved in the success or failure of endoscopic therapy for vesicoureteral reflux in the paediatric population. RESULTS: Of a total of 1410 studies, 14 studies and 17 factors potentially involved in the success or failure of endoscopic therapy were fully analysed according to the different studies reviewed. After analyzing these studies, we identified that the most widely accepted factors that determine the success or failure of endoscopic therapy are the high degree of pre-surgical reflux, the previous injection of antireflux material, the surgical experience and the presence of dysfunction of the lower urinary tract (UTD). Other factors such as the amount of bulking substance used, meatal morphology, renal damage and age at the time of injection could be potentially involved. The technique used and the bulking material do not seem to be associated with the response to therapy. Exists a great heterogeneity of the reviewed studies, both in relation to the characteristics of the patients included, criteria and surgical technique and evaluation of results. CONCLUSIONS: The degree of pre-surgical reflux, the presence of UTD, previous injections and surgical experience are the most widely accepted determining factors in the results of endoscopic therapy according to the different studies published in this topic.
OBJECTIVE: The World Health Organization declared a pandemic status due to the COVID-19 disease caused by the new coronavirus SARS-Cov-2 in March 2020. This caused high health pressure that has had an impact on the Spanish National Health System and Granada has been one of the most affected provinces nationwide. The high healthcare pressure derived from it has had an impact on the National Health System throughout the Spanish territory, with Granada being one of the most affected provinces nationwide. The increase in the admissions of patients with COVID-19 in such a short time has forced us to optimize hospital resources, prioritizing them in patients with COVID-19 and oncological or urgent pathology. In this context, the increasingly frequent and recurrent lithiasis is treated conservatively. However, the prolongation of the pandemic situation poses the challenge of offering definitive treatment to these patients.MATERIAL AND METHODS: We present the rearrangement performed in our Lithotripsy Unit with the aim of developing a comprehensive and alternative protocol for performing ureteroscopies on an outpatient basis, assuming the patient from admission to hospital discharge, with the collaboration of the Anesthesiology service.RESULTS: In this new protocol, 35 ureteroscopies were performed without noticing intraoperative complications or during the recovery period developed in the Day Hospital integrated within the Lithotripsy Unit.CONCLUSIONS: The redistribution of our resources has allowed us to continue performing ureterorenoscopies on an outpatient basis without the need to use hospital beds and reducing the traffic of patients within the hospital itself with an adequate safety profile.
OBJECTIVE: Transperitoneal laparoscopic adrenalectomy (TLA) is considered the treatment of choice for small and benign adrenal tumors. In the recent years, posterior retroperitoneoscopic adrenalectomy (PRA) has gained popularity due to its advantages over TLA, presenting a shorter surgical time and a faster recovery without increasing complications. Conversely, a greater learning curve is considered because the use of a different and unusual surgical field.MATERIAL AND METHODS: Our objective is to describe the PRA technique to ass our initial experience evaluating its feasibility, safety and effectiveness in a prospective series of patients. A total of 11 (9 left and 2 right) PRA performed between March 2017 and February 2020 were analyzed.RESULTS: Median age was 55 (36-65) years with a median BMI of 25.69 (20.8-34.5) Kg/m2. 54.55% had ASA≥3. 63.37% of adrenal tumors were hormonally functional. The tumor mean size was 4 cm (0.6-8) and cortical adenoma was the predominant pathological anatomy (72.72%). No pheochromocytoma was operated. Median operative time was 87 minutes (35-125) with an intraoperative bleeding of 50 (0-300) mL. No patient presented intraoperative complications or reconversion. Median length of stay was 1 (1-6) days. Only one patient presented postoperative complications.CONCLUSION: The PRA is feasible, reproducible and safe, even during the initial learning curve, presenting a clear early recovery with a shorter surgical time.
Objective: To compare the efficacy and safety of prone and supine percutaneous nephrolithotomy (P/SPNL) with special emphasis on tubeless (T) and totally tubeless (TT) surgery.Material Methods: This retrospective, single-surgeon, consecutive series comparison study involved 361 consecutive patients who underwent PNL operations in either the prone or Galdakao-modified Valdivia supine positions between September 2016 and March 2020. Indication for surgery was a stone diameter greater than 2 cm. The two groups were compared in terms of preoperative demographics, stone parameters, and perioperative data.Results: The groups were similar in terms of preoperative demographics, while the blood transfusion rate was insignificantly higher in PPNL (7% vs 3.3%, p=0.165). Mean operative time (58.0±20.6 vs 54.1±15.9 min., respectively, p=0.165), fluoroscopy time (p=0.895), and Clavien complication rates (p=0.87) were similar. SPNL exhibited a significantly (p<0.001) higher rate of T operations (23, 37.7%) than PPNL (46, 15.3%). TT cases were also higher with SPNL (14% vs 29.5%, p=0.003). Urine leakage (p=0.085) and post-operative JJ stent placement (p=0.180) rates were statistically similar between the two groups. Length of hospital stay was approximately one day shorter for T cases in both groups (PPNL: 1.37±0.80 vs 2.26±1.28 days, p=0.001; SPNL: 1.65±0.83 vs 2.76±2.27 days, p=0.028). Stone free rates were 91.3% and 88.5% for PPNL and SPNL, respectively (p=0.488).Conclusion: SPNL has proved to be as safe and effective as its prone counterpart, with similar stone-free and complication rates. T and TT-PNL seem more viable with SPNL, which will increase patient comfort and allow shorter hospitalization times.
OBJECTIVES: To evaluate the oncological results of hyperthermic Mitomycin C (MMC) in adjuvant treatment of high-risk non-muscle invasive bladder cancer and to assess its side-effect profile. METHODS: Patients who were followed up in two reference university hospitals due to high-risk non-muscle invasive bladder tumors were included in the study. High-risk patients according to the EAU non-muscle invasive bladder cancer guideline, patients who were rejected early cystectomy, patients who could not be treated with BCG due to a shortage, and patients for whom the cystectomy would be too risky due to their comorbidities were included in the study. All patients were followed up for at least 24 months with physical examination, cystos-copy, and urine cytology at 3-month intervals. Transurethral tumor resection was performed in all patients and a non-muscle invasive urothelial carcinoma was diagnosed pathologically. Hyperthermic MMC was administered with Synergo system SB-TS 101. Records were kept prospectively and evaluated retrospectively. RESULTS: Fifty-eight high-risk group patients 18 (31%) of whom were at pTa stage and 40 (69%) at pT1 stage were included in the study. During a mean follow-up of 42 months, 34 (58%) patients had recurrence, while 5 (8%) patients progressed to muscle-invasive disease. Eleven (19%) of the patients underwent radical cystectomy. The mean time to relapse was 10 months (3-34 months), and the mean time to progression was 41 months (6-87 months). Five-year overall survival, cancer-specific survival, progression-free survival, and relapse-free survival of the patients were 76%, 88%, 90% and 38%, respectively. Multifocality alone was found to be an independent risk factor (HR: 0.26; 95% Cl: 0.08-0.78; p=0.016) affecting recurrence. The observed side effects included tachycardia, cystitis, dysuria, macrohematuria, procedure- related pain, and allergic skin reactions. Treatment had to be discontinued in one patient due to a diffuse skin reaction. CONCLUSIONS: Thermal intravesical MMC therapy is a safe treatment and it could be effective treatment option in preventing disease progression in patients with high risk and non-muscle invasive bladder cancer with unsuccessful Bacillus Calmette–Guérin (BCG) or who could not be treated with BCG for other reasons.
Introduction: Although an immediate postoperative instillation of chemotherapy (IPOIC) after transurethral resection of bladder tumors (TURBT) is recommended for the prevention of recurrences of nonmuscle invasive bladder cancer (NMIBC), evidence shows there is an important compliance failure worldwide. We believe that an immediate neoadjuvant instillation of chemotherapy (INAIC) can act similarly, reducing the recurrence risk of NMIBC. Here we present the interim analysis of the PRECAVE clinical trial.Material and methods: Patients with clinically diagnosed NMIBC were randomized to receive an INAIC with mitomycin C before TURBT (Group A) or to a control group with TURBT only (Group B). Primary endpoint was to compare the efficacy of an INAIC in the early recurrence-free survival (RFS). Secondary endpoints were: RFS in patients who did not receive adjuvant treatments, toxicity, and feasibility. Results: A total of 124 patients with Ta/T1 G1-G3 NMIBC were included in the initial analysis (Group A: 64, Group B: 60). Demographics, risk classification, complications, and adjuvant treatments were balanced between groups. Eighty-four patients (Group A: 45, Group B: 39) who completed a one-year follow-up were included in the efficacy analysis and no difference was observed in the RFS between groups (p=0.3). In the subgroup of patients who did not receive adjuvant treatments, we found a significant difference in favor of an INAIC (p=0.009) and an 80% reduction in the risk of early recurrences (Hazard Ratio: 0.20; 95% confidence interval: 0.05-0.81; p=0.0024). No differences were observed in adverse events. Only 4 patients did not receive an INAIC despite being planned. Conclusions: In this interim analysis, although we could not demonstrate a reduction in the RFS of all patients, we did find a significant decrease of recurrences in patients who did not receive adjuvant treatments. The administration of an INAIC seems to be safe and our protocol appears feasible and reproductive.
INTRODUCTION AND OBJECTIVES: Multiple chemical sensitivity (MCS) is a disease due to a disproportionate systemic response to chemical agents present in the environment. ts urinary manifestations are rare and poorly understood. We present a case with recurrent lower urinary tract symptoms (LUTS) and review these symptoms in Spanish and foreign publications.CLINICAL CASE: A 30-year-old woman was referred for study of recurrent lower urinary tract symptoms of 17 years of evolution, triggered by food, perfumes, cleaning products, cosmetics and bleach. Repeated analytical, radiological and functional tests were normal. We suspected that she might suffer from MCS and advised a study in Preventive Medicine. The patient consulted an Environmental Medicine Center, and was diagnosed as having grade III-IV/IV MCS. CONCLUSIONS: This is the first case of MCS diagnosed from urinary clinical manifestations. Among the causes of LUTS we should also think of MCS.
OBJECTIVE: Transurethral resection of the prostate (TURP) is the gold standard for the treatment of obstructive prostatic hyperplasia. A bacteremia leading to infectious endocarditis (IE) can be the result of urological procedures. IE post TURP is rare. METHODS: We report an unusual case of an infectious endocarditis complicating TURP for benign prostatic hyperplasia in absence of known previous cardiovascular risk factors or conditions. RESULTS AND CONCLUSIONS: The patient developed intermittent episodes of fever lasting more than two months starting 3 weeks from hospital discharge, and he was never referred to the hospital by his general practitioner, until he was evaluated by his Surgeon, admitted to the Emergency Department and diagnosed with infectious endocarditis, later dying for cardiac arrest before getting a cardiac valve replacement. This report aims to be a reminder of how invasive procedures can trigger secondary distant complications that should be taken into account while assessing a post-operative patient.