[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.

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

Objetivo: Los objetivos principales de este estudio fue valorar la calidad de la información contenida, las características de las interconsultas (IC) y así como conocer la actuación realizada por el servicio de Urología en nuestro hospital. Material y métodos: Se realizó un estudio descriptivo observacional donde fueron analizados los documentos de IC recogidos por el servicio de Urología durante 8 meses. Se utilizaron criterios de calidad previamente definidos por Irazábal et al (modificado) y Batista Miranda JE et al. Pacientes. Resultados: Fueron recogidos un total de 411 IC, llegadas al servicio de forma consecutiva. Procedentes de 27 servicios hospitalarios. El 82,2% de los pacientes derivados fueron varones. La edad media de los pacientes fue de 63,25 años. 192 pacientes tenían antecedentes personales urológicos de interés (47%). Las IC se agruparon en 27 motivos diferentes. El motivo de consulta más frecuente fue el incidentaloma con 21,5% . Respecto al grado de cumplimiento del documento de IC: había constancia de datos de filiación (96,3%), una descripción de la sintomatología adecuada en el 68,2% y la exploración física aparecía reflejada en el 8,8% del total de las IC. Fueron solicitadas como IC normales el 63,4%, preferentes 25% y urgentes 11,7%. Los días de respuesta a las IC fueron de media de 1,45 días con desviación típica de1,65 días. Según los criterios establecidos, para clasificar los documentos por nivel de adecuación, fueron catalogadas como inapropiadas al 32,9% de las IC (n=135). Fueron clasificadas en grado 1 el 44,6% (n=183), grado 2 el 20% (n= 82) y grado 3 el 2,4% (n=10). La actitud que se tomó: se remitió a Consultas Externas de Urología al 10,5% del total de las IC, al Centro de Atención Especializada al 7,8%, se solicitó pruebas complementarias al 7,8%, se remitió al Pruebas funcionales de Urología, para la realización de alguna prueba complementaria a 61pacientes (14,9%), se presentó en Sesión Clínica de Urología al,6% de los pacientes, se trasladó al Servicio de Urología a 2 pacientes (0,5%)y se tomó alguna otra actitud terapéutica en el 19,6%, estos resultados tuvieron una significación de p=0,000. Conclusiones: En nuestro estudio, observamos un alto porcentaje en cuanto a la constancia de los datos de filiación ligeramente inferior en la descripción de la sintomatología y considerados bajos en la exploración física. Un alto porcentaje de IC consideradas inapropiadas. Respecto a la actitud que tomó el Servicio de Urología, quizás hubo una infrautilización de la Unidad de Pruebas funcionales. Hasta el momento y bajo nuestro conocimiento sólo existe un estudio realizado en el ámbito de las IC realizadas al Servicio de Urología en un Hospital de tercer nivel y creemos que la realización de estudios mejoraría la calidad de la asistencia a los pacientes (AU)

Summary: 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 during8 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 derivative 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 urgent11,7%. 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 (AU)

[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.

Litotricia extracorpórea por ondas de choque como tratamiento de la litiasis en riñones en herradura / External shock wave lithotripsy as treatment for lithiasis in horseshoe kidney

OBJETIVO: El riñón en herradura es la anomalía congénita renal más frecuente con una prevalencia aproximada en la población de 1 de cada 400-500 personas. Dicha entidad puede cursar de forma asintomática durante toda la vida o producir sintomatología derivada de complicaciones como litiasis, hidronefrosis e infecciones recurrentes. La incidencia de litiasis oscila entre un 20 per cent y un 80 per cent de pacientes con dicha anomalía. Se trata de un entidad en la que el tratamiento de elección de las litiasis se encuentra aún en controversia debido a los problemas derivados de la propia anatomía del riñón y su drenaje cuando las litiasis son tratadas con litotricia extracorpórea por ondas de choque (LEOC).Tratamos de evaluar la efectividad del tratamiento con LEOC estableciendo las condiciones ideales en la que dicha técnica puede ser considerada de elección en el tratamiento de estos casos. MÉTODO Y RESULTADO: Se evaluaron un total de 25 pacientes (17 varones y 8 mujeres) con edades comprendidas entre 8 y 75 años. Tres pacientes presentaron litiasis bilateral. Se trataron 27 unidades renales, de las cuales 18 fueron izquierdas (66,7 per cent) y 7 derechas. El tamaño del cálculo fue medido en cm2 de superficie. En 13 de los casos (48,1 per cent) la litiasis se localizó a nivel piélico y en 7 casos (25,9 per cent) en cáliz inferior. Cuatro pacientes requirieron la colocación de catéter doble J. El número de ondas medio por sesión fue de 3480 (rango: 1000-4000).Los generadores utilizados fueron Dornier Lithotripter S y Dornier MFL-5000, utilizando un rango de kilovoltaje de entre 10-120 en la primera y 14-23 en la segunda. Se efectuó una evaluación a los 3, 6 y 12 meses del tratamiento mediante radiografía simple de abdomen, objetivando porcentajes de fragmentación y eliminación. En nuestra serie la fragmentación total alcanzó un 85,2 per cent, quedando con fragmentación parcial (fragmentos >6 mm) un 14,8 per cent.Los porcentajes de eliminación fueron satisfactorios con un 37,4 per cent de eliminación total y una eliminación parcial (fragmentos residuales <6 mm) del 48,1 per cent. En un 14,8 per cent de pacientes no se produjo eliminación alguna. CONCLUSIONES: Consideramos la LEOC como la primera maniobra terapéutica a realizar en caso de litiasis con una superficie media menor de 4 cm2 y localización piélica. En caso de grandes superficies litiásicas deberían considerarse otras opciones terapéuticas (cirugía abierta o nefrolitotomía percutánea) como monoterapia o complementarias al tratamiento con LEOC (AU)

[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.

Fístula arterio venosa renal postraumática. Tratamiento conservador con embolización supraselectiva / Postraumatic renal arterial-venous fistula. Conservative treatment with supra-selective embolization

OBJETIVO: La fístula arteriovenosa renal es una entidad clínica de baja incidencia usualmente secundaria a procesos invasivos sobre dicho órgano. Aportamos un nuevo caso con revisión de la literatura y realizamos una valoración del enfoque diagnóstico y terapéutico a seguir. MÉTODO Y RESULTADO: Presentamos el caso de un paciente que sufrió una herida de arma blanca a nivel de flanco izquierdo y que desarrolló posteriormente una fístula arteriovenosa que debutó con hematuria y fue resuelta con éxito mediante embolización supraselectiva. Como ya hemos señalado anteriormente, los resultados de los diferentes tratamientos aplicados a esta paciente han sido decepcionantes. El pronóstico en casos como el nuestro es evidentemente infausto (AU)