Good practices recommendations from the Brazilian Society of Nephrology to Peritoneal Dialysis Services related to the new coronavirus (Covid-19) epidemic / Recomendações de boas práticas da Sociedade Brasileira de Nefrologia aos Serviços de diálise peritoneal em relação à epidemia do novo coronavírus (Covid-19)

ABSTRACT Considering the new coronavirus epidemic (Covid-19), the Brazilian Society of Nephrology, represented by the Peritoneal Steering Committee, in agreement with the and the Dialysis Department, developed a series of recommendations for good clinical practices for peritoneal dialysis (PD) clinics, to be considered during the period of the Covid-19 epidemic. We aim to minimize the disease spread, protecting patients and staff, and ensuring the quality of the treatment provided and adequate follow-up for PD patients. The recommendations suggested at this moment must be adapted to each clinic's reality and the conditions of the structural and human resources, dependent on the adequate financial provision of the public health system for its full implementation.

RESUMO Considerando a nova epidemia de coronavírus (Covid-19), a Sociedade Brasileira de Nefrologia, representada pelo Comitê de Diálise Peritoneal, em concordância com a diretoria e o Departamento de Diálise, desenvolveu uma série de recomendações de boas práticas clínicas para os serviços de diálise peritoneal a serem consideradas durante o período da epidemia de Covid-19, com o objetivo de minimizar a disseminação da doença, proteger pacientes e funcionários e garantir a qualidade do tratamento prestado e acompanhamento adequado para os pacientes em DP. As recomendações aqui sugeridas devem ser adaptadas a cada realidade de serviço e às condições estruturais e de recursos humanos e dependem da provisão financeira adequada do sistema público de saúde para sua plena implementação.

Recommendations from the Brazilian Society of Nephrology for approaching Covid-19 Diagnostic Testing in Dialysis Units / Recomendações da Sociedade Brasileira de Nefrologia para abordagem de exames diagnósticos da Covid-19 nas unidades de diálise

ABSTRACT The Covid-19 pandemic brought several challenges to the healthcare system: diagnosis, treatment and measures to prevent the spread of the disease. With the greater availability and variety of diagnostic tests, it is essential to properly interpret them. This paper intends to help dialysis units concerning the use of clinical criteria and diagnostic tests for decision making regarding the discontinuation of isolation of patients with suspected or confirmed Covid-19, as well as the return to work activities for employees with suspected or confirmed Covid-19.

RESUMO A pandemia da Covid-19 trouxe desafios ao sistema de saúde em diversas esferas: diagnóstico, tratamento e medidas para evitar a disseminação da doença. Com a maior disponibilização e variedades de testes diagnósticos, torna-se fundamental sua adequada interpretação. Este posicionamento pretende orientar unidades de diálise em relação ao uso de critérios clínicos e testes diagnósticos para a tomada de decisão referente à descontinuação do isolamento de pacientes com suspeita ou confirmação de Covid-19, assim como para o retorno às atividades laborais de colaboradores com suspeita ou confirmação de Covid-19.

Recommendations from the Brazilian Society of Nephrology regarding the use of cloth face coverings, by chronic kidney patients in dialysis, during the new coronavirus pandemic (Covid-19) / Recomendações da Sociedade Brasileira de Nefrologia quanto ao uso de máscaras de pano por pacientes renais crônicos em diálise, durante a pandemia pelo novo coronavírus (Covid-19)

ABSTRACT These recommendations were created after the publication of informative note 3/2020- CGGAP/DESF/SAPS/MS, of April 4, 2020, in which the Brazilian Ministry of Health recommended the use of a cloth mask by the population, in public places. Taking into account the necessary prioritization of the provision of Personal Protective Equipment (PPE) for patients with suspected or confirmed disease, as well as for healthcare professionals, the SBN is favorable concerning the wear of cloth masks by chronic kidney patients in dialysis, in public settings, except in the dialysis setting. The present recommendations have eleven items, related to this rationale, the procedures, indications, contraindications, as well as appropriate fabrics for the mask, and hygiene care to be adopted. These recommendations may change, at any time, in the light of new evidence.

RESUMO As presentes recomendações foram elaboradas após a publicação da Nota Informativa nº 3/2020 CGGAP/DESF/SAPS/MS, em 4 de abril de 2020, na qual o Ministério da Saúde recomenda o uso de máscara de pano por toda a população, em locais públicos. Levando-se em consideração a necessária priorização do fornecimento de Equipamentos de Proteção Individual (EPIs) para pacientes com suspeita ou confirmação da doença, assim como para profissionais de saúde, a Sociedade Brasileira de Nefrologia (SBN) posicionou-se favoravelmente ao uso de máscaras de pano por pacientes renais crônicos em diálise, em ambientes públicos, exceto no ambiente da diálise. As presentes recomendações englobam onze itens relativos ao que é racional para posicionamento, procedimentos, indicações, contraindicações, assim como tecidos apropriados para confecção e os cuidados de higiene a serem adotados. Essas recomendações poderão ser modificadas a qualquer momento, à luz de novas evidências.

Descripción del manejo de las fístulas colovesicales en el servicio de Urología del Hospital Luis Vernaza de Guayaquil / Description of the management of colovesical fistulas in the Hospital Urology service Luis Vernaza from Guayaquil

La diverticulitis del colón que se complica en un absceso puede originar una fstula en el 2% de los casos. De estas, el 65% serán vesicocolónicas [1]. Tradicionalmente la cirugía abdominal se realizaba en tres tiempos: una colostomía de descarga, posterior fstulectomia y sigmoidectomia que se acompañaba del cierre de la vejiga. Finalmente, se hacia la anastomosis del descendente y el recto. Todo eso justifcado en el temor a la fstula por dehiscencia de sutura intestinal con la sepsis abdominal que acarreaba, o el temor de la contaminación fecal del tracto urinario. La gran cantidad de cirugía que debía realizarse aumentada la morbilidad y los tiempos resolutivos. En los últimos 10 años se ha buscado realizar un procedimiento en un solo tiempo quirúrgico que disminuye la mortalidad y da buenos resultados, los cuales expondremos junto con las características de los pacientes

Colon diverticulitis that becomes complicated in an abscess may originate a fistula in 2% of cases. Of these, 65% will be vesico-colonic [1]. Traditionally, abdominal surgery was performed in three times: a discharge colostomy, posterior fstulectomy and sigmoidectomy that was accompanied by the closure of the bladder. Finally, the anastomosis of the descending and the rectum was made. All this justified in the fear of the fistula due to dehiscence of intestinal suture with abdominal sepsis carrying, or fear of fecal contamination of the urinary tract. A huge quantity of surgery that had to be performed increased morbidity and resolving times. In the last 10 years, it has been sought a procedure in a single surgical time that decreases the mortality and gives good results, which we will expose together with the characteristics of patients

Caracterización epidemiológica del tipo de urgencias urológicas en el hospital barros luco trudeau (HBLT) período 2008-2012 / Epidemiological characterization of types of urological emergencies at barros luco trudeau hospital, analysis of the 2008-2012 period

INTRODUCCIÓN: En la mayoría de servicios de urgencia estatales no cuentan con un Urólogo de llamado, por lo que la mayoría de los pacientes que acuden al Servicio de Urgencia (SU) son evaluados por cirujanos generales. MATERIALES Y MÉTODO: Estudio observacional retrospectivo de corte transversal de la totalidad de ingresos al SU de nuestro centro entre enero de 2008 y diciembre de 2012, de los cuales se analizaron los pacientes con diagnósticos urológicos. Las variables estudiadas fueron: edad, sexo, diagnóstico determinado según la CIE-10 y si se realizó cirugía de urgencia. RESULTADOS: Media de edad: 48,5 años (D.E.:27,07), Sexo: Masculino 74 por ciento, Media de Consultas totales en SU: 142.138pacientes anuales, Media de consultas Urológicas en SU: 4.837 pacientes anuales, correspondientes al 3,4 por ciento del total. Las consultas más frecuentes fueron: ITU baja: 33,5 por ciento, Cólico Renal: 33,1 por ciento , ITU alta 15,6 por ciento, de los cuales un 0,6 por ciento correspondena Pionefrosis, Patología Genital Infecciosa: 4,7 por ciento, de los cuales un 76 por ciento, corresponden a Orquiepididimitis, Retención Aguda de Orina: 3,7 por ciento, Hematuria Persistente: 2,4 por ciento,, Trauma Urogenital: 1,86 por ciento,, Urgencias Genitales: 0,37 por ciento,. Pacientes que requirieron Cirugía de Urgencia: 1.02 por ciento, CONCLUSIONES: Si bien, el porcentaje de pacientes a los que se realizó una intervención quirúrgica de urgencia es bajo,sería importante implementar en los servicios de urgencia estatales Urólogos de llamado, ya que patologías altamente prevalentes, como la litiásica, podrían tener una mejor resolución. (AU)

Most of the public emergency services do not count with urologist and these patients are evaluated by general surgeons. MATERIALS AND METHODS: cross-section, retrospective study of all admissions in Emergency Services (ES) at our center between January 2008 and December 2012, of patients with urological diagnoses were analyzed. The variables studied were: age, sex, diagnosis determined according to the International Classification Diseases, 10th version and if emergency surgery was performed. RESULTS: Average age: 48.5 years (SD: 27.07), Gender: Male 74 pertcent Average Total consultations in ES: 142,138 patients annually, Media of urological evaluations at ES: 4,837 patients annually, corresponding to 3.4 pertcent of the total. The most frequent diagnosis were: low UTI: 33.5 pertcent,Renal pain: 33.1 pertcent, 15.6 pertcent high UTI, of which 0.6 pertcent are to Pyonephrosis, Infectious Genital Pathology 4.7 pertcent, of which 76 pertcent are Epydidimo- Orchitis, Acute Urinary Retention: 3.7 pertcent, Persistent Hematuria 2.4 pertcent, Genitourinary Trauma: 1.86 pertcent Genital Emergencies: 0.37 pertcent. Patients requiring urgent surgery: 1.02 pertcent CONCLUSIONS: While the percentage of patients who performed an emergency surgical intervention is low, it would be important to implement Urologists in public Emergency Services as highly prevalent diseases such as urolithiasis, could have a better resolution.(AU)

Principais diagnósticos de enfermagem em idosos hospitalizados submetidos às cirurgias urológicas / Main nursing diagnoses in hospitalized elderly people who underwent urological surgery

Objetivo: identificar os principais diagnósticos de enfermagem em idosos no pós-operatório de cirurgias urológicas. Método: estudo transversal, quantitativo em uma unidade de urologia. A coleta de dados ocorreu pelo exame físico e consulta ao prontuário. Participaram 100 idosos internados na instituição. Resultados: procedimentos cirúrgicos urológicos de maior frequência: Ressecção transuretral da próstata (27%) e a Prostatectomia aberta (16%). Dentre os diagnósticos de enfermagem identificados, Integridade da pele prejudicada (100%), Risco de infecção (100%), Risco de volume de líquidos deficiente (84%), Dor aguda (68%) e Conhecimento deficiente (61%) apresentaram maior número de ocorrências. Conclusão: os achados permitiram, mediante os diagnósticos de enfermagem, intervenções de enfermagem no pós-operatório de cirurgia urológicas, possibilitando a implementação de ações eficazes e imediatas para a resolução dos problemas.

Fractura de pene en el Servicio de Urología del Hospital Alberto Sabogal Sologuren del Callao periodo Enero 2000 - Diciembre 2012 / Penile fracture in the Service of Urology of the Hospital Alberto Sabogal Sologuren of Callao period January 2000 - December 2012

El presente trabajo describe las características clínicas, diagnósticas, terapéuticas y complicaciones de los pacientes con fractura de pene que acuden al Hospital Alberto Sabogal del Callao, de Enero 2003 a Diciembre 2012. Se realizó un estudio de tipo descriptivo, con diseño retrospectivo observacional; Para el análisis estadístico se realizó un análisis univariado con tablas de frecuencia, medidas de tendencia central y dispersión y gráficos acordes al tipo de variable. El análisis se realizó en el programa estadístico SPSS STATISTICS 20. Se realizó estadística bivariada con la prueba Chi cuadrado. Los cálculos se realizaron con un intervalo de confianza del 95 por ciento. La fractura de pene o traumatismo del cuerpo cavernoso con solución de continuidad de la túnica albugínea una lesión rara de consulta de Emergencia en el Tópico de Cirugía del Hospital Alberto Sabogal Sologuren. En el Presente trabajo de Investigación se encontró que la causa más frecuente es la lesión a consecuencia del acto sexual o coital, sin mayor relación a antecedente patológico de importancia, constituyéndose como un acto fortuito, tras el cual el síntoma y signo más llamativo fue el chasquido doloroso tras la lesión y la presencia de tumefacción del pene, el paciente afecto no advirtió una evidente incurvación. La edad en la que se presentó fue más frecuente entre los 20 a 40 años y el tiempo de de demanda de la atención oscila en promedio de 4 a 6 hs. Siendo el compromiso mayor en el lado derecho, unilateral y región ventral del pene. Las fracturas bilaterales con compromiso de cuerpo esponjoso y de uretra fueron las causantes de complicaciones posteriores como son la incurvación y trastornos de la erección. El diagnóstico se hizo en el 100 por ciento de casos con el cuadro clínico, en ningún caso se empleo la ecografía ni otro examen complementario, de la misma manera el 100 por ciento de casos fue tributario de tratamiento quirúrgico, no optando en ningún caso de tratamiento...

This research work describes the clinical features, diagnosis, treatment and complications of penile fracture patients attending in Alberto Sabogal Hospital - Callao, from January 2003 to December 2012. We conducted a descriptive study, with retrospective observational design; Statistical analysis Univariate analysis was performed with frequency tables, measures of central tendency and dispersion and graphics accordance with the type of variable. The analysis was performed in the statistical program SPSS Statistics 20. Bivariate analysis was performed with chi square test. The calculations were performed with a confidence interval of 95 per cent. Penile fracture or injury of a cavernous body of with tunica albuginea trauma, consultation rare injury in Emergency Surgery room from Alberto Sabogal Hospital. In the present research work it was found that the most common cause is damage as a result of sexual intercourse, without much regard to antecedent pathological importance, constituting a casualty, after which the symptoms and signs more frequent was the painful clicking after injury and the presence of swelling of the penis, the patient did not notice an obvious incurvation. The age at which they presented was more frequent among 20-40 years time care demand varies on average from four to six hours. Being the damage more frequent on the right side, unilateral ventral penile region. Bilateral fractures with spongiosum body and urethra were causing further complications such as curvature and erectile dysfunction The diagnosis was made in 100 per cent of cases with the signs and symptoms, in no case use ultrasound or other supplementary examination, in the same way 100 per cent of cases was performed surgical treatment, was not in any case opting for conservative treatment.

Evolución histórica del tratamiento de la litiasis urinaria a propósito de una experiencia de 33 años del Servicio de Urología del Hospital Militar de Santiago / Historical evolution of urinary lithiasis treatment after a 33-year experience at the Urology Department of the Santiago Military Hospital

Introducción: La litiasis urinaria es una patología que acompaña al ser humano desde sus inicios. Para el tratamiento de esta enfermedad se han desarrollado diversas técnicas que han evolucionado con la tecnología de cada época. Así hemos visto que el método de elección ha variado cíclicamente, según la efectividad y cuan invasivo sea éste. Método: Se revisaron los libros de pabellón y la base de datos de litotricias extracorpóreas (LEC) del Servicio de Urología del Hospital Militar de Santiago considerando todos los procedimientos urológicos destinados al tratamiento de la urolitiasis, durante el periodo comprendido entre julio de 1978 y diciembre de 2011.Resultados: Se obtuvo un total de 5.762 pacientes tratados por urolitiasis, marcándose en la década de 1970 una preferencia por las técnicas abiertas y posteriormente, en 1986 con la llegada de un ureteroscópio rígido 11 Fr., una preferencia por las técnicas endoscópicas. Con la llegada del primer litotritor en 1990, la litotricia extracorpórea se convierte en el tratamiento más utilizado hasta la fecha. Conclusión: Los recursos son siempre escasos, especialmente en el contexto nacional. La Litotricia extracorpórea (LEC) es un método efectivo para la gran mayoría de los cálculos urinarios, esta disponible prácticamente en cualquier lado y requiere de pocos recursos en comparación a los otros métodos. Si se dispone de todos los medios, el tratamiento más adecuado es el que el médico tratante maneja mejor, el de más fácil acceso y aquél con el cual el paciente se siente mejor servido.

Introduction: Urolithiasis is a disease that has afected humans since the beginning of time. Diferent methods have been developed to treat this a iction, which have evolved depending on the technology of the time. Thus, it has been noticed that the preferred technique has changed in a cyclic manner depending on the e¬ ectiveness and invasiveness of the procedure. Methods: Surgery records as well as the Extracorporeal Shock Wave Lithotripsy data were analyzed at the Urology department at the Santiago Military Hospital. These included all urological procedures for the treatment of urolithiasis from July 1978 through December 2011.Results: A total of 5,762 patients were treated for urolithiasis. In the 1970s open techniques were the most practiced. Later, in 1986 an 11-Fr. rigid ureteroscope arrived at the urology department, and the endoscopic methods became the most practiced for this pathology. Along with the arrival of the first lithotripter in 1990, the extracorporeal shock wave lithotripsy becomes the most popular treatment for urinary calculi up to date. Conclusion: Economic resources are always limited, especially in Chile. Ergo, the extracorporeal shock wave lithotripsy is an efective therapy for most urinary calculi, it is easily available and is less expensive compared to other therapies. If all means are available, then the best treatment for urolithiasis will always be the one that the urologist has more experience, the best access, and the one which the patient feels more comfortable.

Cumplimentación del consentimiento informado para la transfusión de hemoderivados en los Servicios de Urología y Cirugía / Enforcement of informed consent request for blood transfusion in urology and surgery departments

Objetivo: Aplicar un círculo de mejora a la petición de consentimiento informado (CI) para la transfusión de hemoderivados en los servicios de Cirugía General y Urología. Métodos: Durante 8 meses se incluyeron 120 pa­cientes intervenidos en el Hospital General Reina Sofía de Murcia. Tras realizar un análisis de causa-efecto de Ishikawa, se establecieron 4 criterios: C1: identifica­ción del médico; C2: identificación del paciente; C3: firma del paciente; C4: fecha del documento. En el pri­mer periodo se incluyeron 60 pacientes. Se analizaron Ias causas de incumplimiento y se aplicaron las medidas correctoras, reevaluando los criterios en otros 60 pacientes. Resultados: Todos los criterios estaban por debajo del estándar: C1: 3%; C2: 95%; C3: 16% y C4: 65%. En la segunda evaluación el cumplimiento de C1 (70%), C3 (98%) y C4 (88%) mejoró significativamente pero aún así los resultados continúan, también significativamente, por debajo de los estándares establecidos. Los resultados se expresan en porcentaje de cumplimiento con un intervalo de confianza del 95%. Conclusiones: La realización de un ciclo de mejora ha permitido detectar y corregir incumplimientos en el C1 de transfusiones sanguíneas. El nivel de cumplimiento de los criterios mejoró en la segunda evaluación aunque continuamos por debajo del estándar establecido. Hemos conseguido una mayor concienciación por parte de los profesionales a la hora de cumplimentar el consentimiento.

Objective: To analyze the degree of compliance with a variety of standards defined for the quality control of the informed consent request for human blood products transfusion in our departments of Surgery and Urology. Material and method: Retrospective study of patients treated during 8 consecutive months in a university teaching hospital (n=120). Assessment of quality was performed through measurements of compliance using 4 criteria: C1, Physician Identification; C2, patient identification; C3, patient signature; C4, document date. In the first period 60 patients were included. Corrective measures aimed at resolving the quality problem were applied to the deficient criteria during one month, paying particular attention to those criteria with the highest percentage of errors in the study. During a third period of six months (60 patients) the information of all criteria was gathered again and the improvement with regard to the standard values and to the compliance of the first period was evaluated. Results: Compliance of all criteria was significantly below standard values in the first evaluation: C1 :3%; C2: 95%; C3: 16% and C4: 65%. In the second period all the criteria below its standard improved with regard to the first period; nonetheless the results are, also significantly, below the established standards. Conclusions: This improvement cycle enabled us to detect and correct breaches on the informed consent request for human blood products transfusion. Corrective measures introduced were effective since it was improved in all the criteria below standard. We have achieved a good awareness of health professionals to complete the authorization.

The one-stop clinic as the standard of out-patient care in a hospital urology department

PURPOSE: To evaluate the performance of a 'one-stop' clinic in terms of proportion of discharges or inclusion in surgical waiting lists. MATERIALS AND METHODS: All patients were referred from primary care facilities (population 220.646) and from different departments in the hospital. Eight senior urologists, two registered nurses and two nurse attendants participated in the experience. Prior to the start of the project, referral protocols had been agreed with the primary care physicians involved. Compliance with the protocols was periodically tested. Eventually 5537 first visits (January-December 2009) where evaluable. RESULTS: Overall, the 'one-stop' format proved feasible in 74.2 percent of the patients (4108/5537). Patients, who successfully used the 'one-stop' format, were significantly younger than those who required additional consultations (43 vs 50 years old, respectively, Student's t test < 0.001). For obvious reasons the 'one-stop' format was universally possible in male sterilization and penile phimosis patients. Similarly, the 'one-stop' policy was applied in most consultations due to male sexual dysfunction (75 percent) and urinary tract infection (73 percent). Other health problems, such as haematuria (62 percent) and renal colic (46 percent), required more than one visit so that care of the patient reverted to the traditional, outpatient care model. CONCLUSION: A 'one-stop' philosophy is feasible for a number of procedures in a urological outpatient clinic. The costs to implement such an approach would be limited to managerial expenditure.

Por que os pacientes são encaminhados ao urologista?: análise crítica dos encaminhamentos no município de São Bernardo do Campo / Why are patients referred to urological consultation?: critical analysis of referrals in São Bernardo do Campo

Introdução: A elevada demanda por atendimento urológico em São Bernardo do Campo gera uma espera para que pacientes sejam atendidos pelo urologista, após terem sido encaminhados pelo clínico. Objetivos: Avaliar condições associadas a encaminhamentos aos ambulatórios de Urologia da Faculdade de Medicina do ABC, no município. Métodos: Foram avaliados 106 relatórios de encaminhamento de pacientes para consulta urológica em São Bernardo do Campo, entre dezembro de 2009 e março de 2010, e sua correlação com os dados obtidos em consulta urológica. Resultados: Os principais motivos para encaminhamento urológico foram o exame da próstata (29,2%) e a urolitíase (22,6%). Houve concordância entre o motivo referido e o diagnóstico após consulta urológica em 55,7% dos casos, discordância em 20,8% e ausência de menção do motivo da consulta em 23,6%. Observouse que 56,6% dos pacientes não levaram os exames mínimos necessários à consulta com o especialista. Dos encaminhamentos por disfunções sexuais, 17% referiam o real motivo para consulta. Houve concordância em 100% dos encaminhamentos de pacientes oncológicos. Médicos formados há mais de 30 anos encaminharam pacientes mais precisamente. Conclusão: A imprecisão no encaminhamento aos ambulatórios de Urologia e a inexistência de protocolos para tal contribuem para a morosidade do sistema. Propõe-se o uso de protocolos para solicitar exames, previamente ao encaminhamento ao urologista, e o reforço quanto à importância da precisão do encaminhamento junto aos médicos responsáveis pela atenção primária.

Introduction: High demand to urological care in São Bernardo do Campo leads to a delay from the primary care physician referral until urologist?sconsultation. Objetives: To evaluate conditions associated with referrals to the Urology outpatient clinic from Faculdade de Medicina do ABC in thismunicipality. Methods: We analyzed 106 urological referral reports of patients in São Bernardo do Campo, from December 2009 to March 2010, and compared to data obtained after urologic consultation. Results: The main reasons for urological referral were prostatic check-up (29.2%) and urolithiasis (22.6%). There was similarity between referral report and diagnoses after urological consultation in 55.7% of the cases, discordance in 20.8%, while no reason was informed in 23.6% of referral reports; 56.6% of the pacients did not bring their exams to specialist?s consultation. Referrals for sexual disfunction held the real reason for consultation in 17% of the cases, while concordance was found in every referral for oncologyc disease. Moreover, doctors graduated for more than 30 years usually referred pacients more precisely. Conclusion: The lack of accuracy in patient's referral to urological clinics and the absence of referral protocols contribute to the delay in the health care system. We recommend the adoption of guidelines to aid requesting subsidiary exams before referring patients to the urologist as well as the reinforcement towards the need of a proper referral by primary care physicians.

Experiencia de 15 años en el manejo del cáncer de pene / Fifteen years experience in the management of penis cancer

Conocer características clínicas, factores pronósticos, tratamiento quirúrgico y sobrevida en pacientes con cáncer de pene en el Instituto de Oncología Dr. Miguel Pérez Carreño. Estudio descriptivo, transversal, en 50 de 65 pacientes con cáncer de pene en nuestro hospital entre 1995-2009. Obtuvimos 11 pacientes evaluados entre 1995-1998, 12 entre 1999-2002, 15 de 2003 a 2006 y 12 de 2007 a 2009. 32 por ciento fueron < de 50 años, 26 por ciento entre 51-60, 12 por ciento entre 61-70 y 9 por ciento > de 71 años. 80 por ciento fue carcinoma epidermoide, 2 por ciento epidermoide con patrón sarcomatoso y 18 por ciento verrugosos. El 66 por ciento grado histológico GI, 32 por ciento GII y 2 por ciento GIII. La falectomía parcial se practicó en 44 por ciento, esta más linfadenectomía bilateral en 18 por ciento, emasculación en 16 por ciento. El estadio patológico fue de 36 por ciento para I y III 20 por ciento para estadio IV y 8 por ciento estadio II. La realización de vaciamientos inguinales en su mayoría fue en estadios avanzados con un 29,6 por ciento en pT3 G1. La sobrevida global en estadio I fue 88,8 por ciento al primer año y 50 por ciento a 5 años, estadios IV en un año 70 por ciento y cero en 5 años. El pronóstico depende del estadio patológico, afectación ganglionar, grado histológico, los pacientes pT3 y pT4 independientemente del grado histológico tienen peor pronóstico así se describe en la literatura, la linfadenectomía es fundamental en el manejo de estos casos.

To determine clinical characteristics, prognostic factors, surgical treatment and survival in patients with penile cancer at the Institute of Oncology Dr. Miguel Perez Carreño. Descriptive, transversal, in 50 of 65 patients with penile cancer. 11 patients evaluated in the years 1995 to 1998. 12 from 1999 to 2002, 15 patients from 2003 to 2006, and 12 from 2007 to 2009. 32 percent were < 50 years, 26 percent between 51-60, 12 percent between 61-70 and 9 percent > 71 years. 80 percent were squamous cell carcinoma, 2 percent with a sarcomata’s squamous and 18 percent warty. 66 percent was in GI histological grade, 32 percent and 2 percent GII GIII. The partial penectomy were performed in 44 percent, bilateral lymphadenectomy in 18 percent, 16 percent emasculation. The pathological stage was 36 percent for I and III 20 percent for stage IV and 8 percent stage II. The performance of inguinal dissection was mostly in advanced stages with 29.6 percent in pT3 G1. Overall survival of stage I patients was 88.8 percent in the first year and 50 percent at 5 years, while stage IV in 70 percent and zero in five years. Penile cancer prognosis depends on the pathological stage, lymph node involvement and histological grade, pT3 and pT4 patients regardless of histological grade are the ones who have a worse prognosis as described in the literature, therefore, is central lymphadenectomy handling these cases.

Conciliación e información de medicación al alta hospitalaria en un servicio de urología / Conciliation and medication information at the moment of hospital discharge in a service of urology

Analizar los resultados de un programa de conciliación e información de medicación al alta hospitalaria en un servicio de urología. Material y Método: Fueron incluidos los pacientes ingresados en el servicio de urología durante 2009 con mayor complejidad en su tratamiento domiciliario. Éste fue registrado, confirmándose previamente mediante una entrevista con el paciente la adherencia al mismo, así como problemas relacionados con la medicación habitual (PRMs). A partir de la epicrisis, se concilió la medicación prescrita con el tratamiento ambulatorio, resolviendo las discrepancias con el facultativo responsable. Por último, se entregó al paciente un cronopictograma con el listado completo de su medicación a partir del episodio asistencial y recomendaciones sobre su tratamiento con la explicación verbal del mismo. Realizamos una encuesta de satisfacción a los facultativos para conocer el conocimiento del programa y su valoración. Resultados: Se seleccionaron 260 pacientes, de los cuales en 102 (39 por ciento) se detectaron PRMs. Las discrepancias más frecuentes fueron: prescripción incompleta (28 por ciento), administración inadecuada (22 por ciento), medicamento no indicado (18 por ciento) y duplicidad (16 por ciento). Los PRM’s se clasificaron en orden a la severidad, de las 102 discrepancias: el 68 por ciento no habrían causado daño al paciente y el 32 por ciento habría requerido monitorización. La valoración global del programa fue muy positiva para los facultativos. Conclusión: La conciliación de medicación reduce los PRM’s, sobre todo en las transiciones asistenciales de los pacientes. Creemos que esta actividad asistencial debería realizarse de manera habitual en los hospitales, para aumentar la seguridad de los pacientes, en el marco de un sistema de reducción de riesgos para la salud y mejora de la calidad asistencial.

To analyze the results of a medication reconciliation and drug information program at discharge, in an urology department. Materials and Methods: Patients with more complexity in their home treatment, admitted in this facility during 2009, were included in the study. Preadmission regimens were recorded and the patients were asked about drug-related problems (DRP) and drug adherence. On the day of discharge, prescribed medication was reconciled with the outpatient treatment, resolving discrepancies with the prescribers. Finally, the patients were given a complete list of their medications and oral recommendations. We conducted a survey with physicians to enquire about their reconciliation program knowledge and their assessment. Results: 260 patients were selected, of which in 102 (42 percent) DRP were detected. The most frequent discrepancies were: incomplete prescription (28 percent), incorrect administration (22 percent), inappropriate medication (18 percent) and therapeutic duplication (16 percent ). The DRP were classified according to their severity, of the 102 discrepancies, 68 percent would not have caused harm to the patient and 32 percent would require monitoring. On the survey, about the overall evaluation of the program, it was highly regarded for the most of the physicians. Conclusion: Medication reconciliation reduces the DRP, especially at transition in healthcare of patients. We believe that activity should be carried out routinely in hospitals, to increase the patients safety, as part of a system to reduce health risks and improving the quality of care.

Contribuições à técnica cirúrgica em transplante renal: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo / Contributions to the surgical tecniques of kidney transplantation: Clinic Hospital of São Paulo University School of Medicine

Não é infreqüente ouvir que, em transplante renal, inovações de impacto no âmbito cirúrgico já não são mais prováveis. No entanto, soluções de alto impacto econômico ainda surgem com freqüência e muitas delas têm surgido no Brasil, contribuindo significativamente para a mudança de conduta cirúrgica em transplante renal a nível mundial. A técnica cirúrgica do transplante renal propriamente dita está bem estabelecida há anos, sendo muito parecida entre os diversos serviços de transplante. Já no que se refere ao tratamento cirúrgico das complicações do transplante e dos pacientes com doenças associadas à insuficiência renal crônica dialítica (IRCD), observamos considerável controvérsia e variação nas condutas. Este estudo pretende oferecer um panorama sobre as técnicas cirúrgicas utilizadas no transplante renal, as complicações decorrentes deste procedimento e os resultados obtidos pelo Serviço de Transplante Renal do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo...

Is not rare to hear that, on kidney transplantation, improvements on surgical aspects are not probable anymore. Although, solutions with high economical impact arises frequently and, many of them, in Brazil, contributing, significantly, for changes on surgical conduct on kidney transplantation worldwide. The surgical techniques for kidney transplantation are well established and do not change between the groups of transplants. Although, the surgical treatment of complicated outcomes and of patients with diseases related to chronic renal failure is still controversial. This study aims to offer a general overview about the surgical techniques of kidney transplantation, complications inherent to this procedure and the results obtained by the Kidney Transplantation Team of Clinic Hospital of São Paulo University Medical School.

The operational cost of a urology unit.

OBJECTIVES: To assess the operational cost of a urology unit, individual cost for certain index operations in urology, and to develop a framework to audit finances of a unit. DESIGN: A financial audit. SETTING: Urology unit in a teaching hospital. METHODS: Data of cost in providing urology services during one month were collected. It included three main areas: ward, operating theatre and outpatient clinic. Direct costs included staff wages, drugs, consumables, investigations and food. Indirect expenses such as administration, water, electricity and cleaning services were also calculated. For each type of operation a relative value was assigned depending on the nature of the operation. When direct expenses were not available, the hospital was divided into different cost centres and apportioning of the cost was done accordingly. RESULTS: The monthly operational cost of running a 19 bed urology unit with three operating sessions a week was Rs. 1 294 259. Staff wages constituted 61.2% of the cost. The cost of performing a pyelolithotomy was Rs. 18 669. Transurethral resection of the prostate (TURP) was done at a cost of Rs. 21 271. CONCLUSION: When the basic principles and the framework are understood, clinicians can perform financial audit and cost analysis of their units.

Concordancia entre el citrato de sildenafil y el eco Doppler color como prueba diagnóstica de lesión arterial en los pacientes con disfunción eréctil / Concordance between sildenaphil citrate and the eco doppler color as a diagnostic proof of arterial injury in patients with erectile dysfunction

Objetivo. Determinar la correlación entre la respuesta clínica al citrato de sildenafil y los valores de flujo arterial obtenidos en el eco Doppler de los pacientes con disfunción eréctil. Materiales y métodos. Estudio prospectivo con pacientes de la consulta de la Unidad de Urología del Hospital Universitario San Ignacio y del Hospital Central de la Policía, que consultaron por disfunción eréctil. A todos se les aplicó el cuestionario abreviado del Índice Internacional de Función Eréctil (IIEF) (Sexual Health for Inventory Men) al ingreso, se les administraron cuatro tabletas de sildenafil para que tomaran en el transcurso de un mes, y se les repitió el cuestionario. El eco Doppler practicado a todos los pacientes tuvo en cuenta la velocidad de flujo de las arterias cavernosas y el ángulo de la erección. Se practicó la prueba simple kappa del puntaje de los cuestionarios pre y postratamiento con el eco Doppler; se utilizó la prueba t de Wilcoxon para los puntajes del cuestionario postratamiento contra el pretratamiento, y se estableció la correlación existente entre la diferencia de los dos puntajes con el Doppler. Análisis. El kappa simple del cuestionario previo, del cuestionario postratamiento y de la diferencia de los puntajes con el eco doppler no demostraron correlación, (0,103, 0,1206, 0,615). La t de Wilcoxon fue de 8,03, lo cual muestra que en todos los pacientes el sildenafil fue efectivo. Conclusión. El citrato de sildenafil no demostró ser útil como prueba diagnóstica del grado de enfermedad arterial en los pacientes con disfunción eréctil. El citrato de sildenafil es útil como tratamiento de amplio espectro en casos de disfunción eréctil, independientemente de la gravedad de la enfermedad arterial.

Incidencia de disfunción eréctil posprostatectomía transuretral en pacientes con hipertrofia prostática benigna en el Hospital Universitario San Ignacio y la Clínica de la Policía Nacional, Bogotá / Incidence of post-prostatectomy erectile dysfunction in patients with beningn prostatic hypertrophy at Hospital Universitario San Ignacio and Clínica de la Policía Nacional, Bogotá

La resección transuretral de la próstata es el procedimiento quirúrgico que con más frecuencia se realiza para tratar los síntomas de obstrucción de la vía urinaria inferior y se menciona a menudo entre los muchos factores de riesgo relacionados con la producción de disfunción eréctil; sin embargo, los datos existentes en la literatura médica son disímiles y, por lo tanto, no son concluyentes.