OBJECTIVES: Ureteroscopy has been considered one of the most revolutionary techniques in modern urology for the treatment of urinary stones. The developments of new ureteroscopes, ancillary techniques or fragmentation devices have contributed to that evolution. To describe the evolution of imaging systems, auxiliary techniques and fragmentation methods for treatment of urinary stones from its beginnings to present time, with special emphasis on the different trends in the technique for the nearest future.METHODS: A bibliographic review is performed highlighting the development of technical details, and the impact on the results in terms of stone-free rate, and complications. CONCLUSIONS: Ureteroscopy has evolved into a first-line technique for the treatment of upper urinary tract stones. Technological advances in both imaging equipment and on different ancillary techniques and fragmentation methods have enabled improved stone free rates and decreased morbidity of the technique. Improvements in imaging systems, auxiliary instruments and fragmentation methods allow the treatment of stones progressively more complex.
OBJECTIVES: The diagnosis of prostate cancer is obtained with the performance of a prostate biopsy. Repetition of biopsies is required in patients with negative biopsies when there is high suspicion for cancer. The objective of this study is to know the prostate cancer detection rate in second and third prostatic biopsies and to identify the clinical factors with predictive value for positivity. We also want to establish risk groups for cancer diagnosis after one or two previous negative biopsies.METHODS: Retrospective study of patients undergoing a second or third prostatic biopsy. We determined the rate of cancer diagnosis for both. We performed univariate and multivariate analysis (multiple logistic regression) to analyse any relationship between clinical variables (PSA, PSA density, PSA F/T ratio, PSA velocity, digital rectal examination, transrectal ultrasonography, prostate volume, time between biopsies, pathological result and number of cores obtained in the first biopsy) and positivity in the second and third biopsies. Logistic regression analysis was performed to know which factors are predictors for positivity in 2nd and 3th biopsies. According to the probabilities obtained, different risk groups were established. RESULTS: 4.532 patients underwent prostate biopsy between 1999 and 2010. 663 patients were included for second biopsy and 191 for third biopsy. Detection rates for prostate cancer were 24,3% and 17.8% respectively. According to the multivariate analysis, the probability for positivity on second biopsy increases when first biopsy was sextant (p=0,049), patients were >65 years old (p=0,005) and PSA density was >0,15 (p=0,000). Four risk groups were established with a range of probability for prostate cancer between 7 and 37%. For third biopsy, predictive variables were: suspicious digital rectal examination (p=0,007), age >64 years (p=0,009), and PSA density >0,20 (p=0,001). Also risk groups were established with probabilities between 1,6 and 61%.CONCLUSIONS: Detection rate for prostatic cancer in second and third biopsy is high. According to risk factors we can establish different risk groups.
OBJECTIVES: To review the quality of urodynamic studies performed in one Center in order to assess adherence to the ICS Good Urodynamic Practice Guidelines.METHODS: Sixty-two consecutive urodynamic studies performed between March 2012 and May 2013 were retrospectively reviewed. We followed a list of common features to analyze all records.RESULTS: 10.17% of the studies showed a significant drop in Pabd not mentioned in the study report. We found straining in 15.25% of the traces that was recognized and informed in the reports. We did not find many equipment artifacts, only pump vibrations. Uroflowmetry performed previously to the test is very important to compare its results with the ones obtained at the pressure-flow study. 50.8% of the studies had a non-valuable uroflowmetry. CONCLUSIONS: The high rate of non-valuable uroflowmetries was in most of the cases due to an insufficient voiding volume. We think we meet very good standards although this is not a reference unit; nevertheless we still need to improve in many aspects.
OBJECTIVES: To assess the level of satisfaction with the care provided to hospitalized patients in the Department of Urology at 12 de Octubre Hospital and analyze demographic and clinical factors influencing satisfaction.METHODS: A cross-sectional study was carried out using the SERVQHOS questionnaire, delivered at the time of discharge. A data sheet for each patient was collected, which included if they undergone surgery, type of surgery and whether or not presented postoperative complications, rated by the Clavien scale.RESULTS: 479 surveys were collected, with a participation of 92%. 95.4% of patients rated their overall level of satisfaction with the care received as “satisfied” or “very satisfied”. Top-rated aspects were the kindness of the staff and personalized attention. The worst rated issue was the condition of the rooms, but this did not influence perceived quality. Variables related to greater overall satisfaction were male gender, shorter hospital stay, knowing the name of the nurse, the information received and subjective factors such as personalized service and willingness to help.CONCLUSIONS: Our patients show a high level of satisfaction, which is mainly dependent on subjective factors. The negative issues related to the facilities do not mean lower satisfaction.
OBJECTIVES: The objective of this work was to establish the analgesia protocols for different types of urological surgery and to analyze the impact on pain during the first 24 h after surgery.METHODS: The study included 186 patients undergoing urological surgery between 2011 and 2013. Seven analgesia protocols were established and applied according to the surgical procedure. At 24 h post-surgery, i.e., the initiation of analgesic treatment, patients` pain was evaluated by visual analog scale/numeric scale (VAS/NS), and their degree of satisfaction and nausea were assessed.RESULTS: The study sample comprised 137 males (73.7%) and 49 females (26.3%), with a mean age of 58.5±14.7 yrs. Analgesia protocol 1 was applied in 5.9% of patients, protocol 2 in 17.8%, protocol 3 in 8.6%, protocol 4 in 38.9%, protocol 5 in 13.5%, protocol 6 in 14.6%, and protocol 7 in 0.5%.At 24 h post-surgery, the VAS/NS score was ≤ 3 in 82.3% of patients; hence, only 17.7% required rescue analgesia; 71% of patients were highly satisfied with the treatment provided and 22.6% were satisfied. 6.4% were not satisfied.CONCLUSION: Establishing analgesia protocols according to the type of surgery is a valid and useful measure to control postoperative pain during the first 24 h and to provide appropriate treatment standardization and follow-up.
OBJECTIVE: To report two cases of right crossed non-fused renal ectopia diagnosed in male patients about 30 years of age who arrived to emergency centres with symptoms of renal colic. METHODS: We report two cases of male patients who arrived to an emergency centre complaining of colic lumbar pain. Crossed renal ectopia was finally revealed by means of intravenous urogram after several analytical and imaging examinations.RESULTS/CONCLUSION: Right crossed non-fused renal ectopia is an uncommon congenital anomaly with a higher incidence in males. It is much more common to find a crossed fused renal ectopia of the orthotopic kidney. In contrast, if there is no fusion it may be located on the lower portion of the normal kidney, which is not the case in this instance. This malformation is not usually accompanied by other congenital anomalies. Most of cases are spontaneously solved and they do not require an intercurrent surgical intervention
OBJECTIVE: To present the therapeutic management of intractable hematuria secondary to systemic amyloidosis with bladder involvement.METHODS: We describe the clinical case, the medical management, the endo-urological technique used, and the results supported by relevant published literature.RESULTS: A 50-year-old woman with a 20-year history of rheumatoid arthritis in chronic treatment with corticosteroids and non-steroidal anti-inflammatory drugs in addition to chronic renal insufficiency not requiring hemodialysis. Twenty-four hours after resection of a hepatic hydatid cyst she presented intractable hematuria. The ultrasound and CT scan showed the formation of a large blood clot in the bladder not affecting the upper urinary tract. An intra-operative cystoscopy revealed a distended bladder showing signs of inflammation with diffuse, widespread bleeding. Hemostasis was achieved and a biopsy of the mucosa was taken, associated to bladder irrigation with potassium alum as a hemostatic. Given the persistence of the hematuria, further revision in the operating room as well as blood transfusion were carried out and, due to the hemodynamic instability that could not be controlled, finally selective embolization was performed. Intravesical instillation of dimethyl sulphoxide every 72 hours was used to control any remaining hematuria. The biopsy showed bladder amyloidosis. The addition of intravenous steroids and orally administered colchicine successfully controlled the patient’s clinical status.CONCLUSIONS: Secondary amyloidosis of the bladder is a condition associated with hematuria that is difficult to manage. Hematuria control is often difficult, requiring aggressive treatment in addition to more conservative approaches.
OBJECTIVE: We report three cases of high-flow priapism in three young patients who presented erectile dysfunction after perineal trauma.METHODS: Complete clinical evaluation, blood tests, color Doppler ultrasonography (US), arteriography and selective embolization were performed.RESULTS: The clinical history and physical assessment were compatible with high-flow priapism. Color Doppler US showed a pseudoaneurysm and an arteriocavernosal fistula, which was confirmed and embolized using arteriography.CONCLUSIONS: High-flow priapism has a characteristic clinical presentation and physical examination. The radiologist has an important role in the diagnosis and treatment of this pathology. Color Doppler US and arteriography are essential in the diagnosis and allow embolization of the vascular injury. Prognosis is usually good.
OBJECTIVE: To describe our experience with bladder endometriosis at the Department of Urology of Complejo Hospitalario Universitario de Santiago de Compostela.METHODS: We performed a retrospective analysis of the cases of bladder endometriosis diagnosed during the last 11 years in our hospital, from January 2000 to December 2011.RESULTS: A total of 7 women, with a mean age of 32-year-old have been diagnosed by biopsy of bladder endometriosis. The most common symptoms were dysuria, suprapubic pain, urinary urgency and hematuria. All patients have undergone surgery (5 transurethral resection, 2 partial cystectomy), 6 of them were also treated with post-operative LHRH analogues.CONCLUSIONS: Endometriosis is a common disease in young women, but the involvement of the urinary tract is unusual. There are multiple therapeutic options; despite this there exists a high probability of recurrence.
OBJECTIVE: To describe two clinical cases of staghorn stones in renal allografts and to perform a review of this condition.METHODS/RESULTS: Case 1. 71-year-old woman with a renal transplant and recurrent UTI presented lithiasis in the graft on renal ultrasound. We started medical treatment and later one ESWL session was performed. The subsequent evolution of the patient was bad, requiring transplant nephrectomy. Case 2. 68-year-old woman with renal transplant presented acute deterioration of renal function due to staghorn stones. Emergency ureteral catheter insertion was carried out, medical treatment was started and after one ESWL session she had a good subsequent evolution and normal function of the graft.CONCLUSIONS: Staghorn stones occupy most of the collecting system. They are usually made of struvite. They form in the context of urinary tract infections caused by urea splitting germs. Long-term persistence of staghorn calculi in the kidney causes functional and anatomical deterioration that can lead to kidney loss