Análisis comparativo de costes directos e indirectos de dos técnicas mínimamente invasivas, para el tratamiento de la litiasis renoureteral menor de 2 cm / Comparative analysis of direct and indirect costs of two minimally invasive techniques for the treatment of renal/ureteral calculi smaller than 2 cm

OBJETIVO: Analizar de forma comparativa los costes indirectos y directos de dos técnicas mínimamente invasivas (litotricia extracorpórea (LEOC) vs. ureterorrenoscopia-láser holmium (URS/RIRS)) para el tratamiento de la litiasis reno-ureteral menor de 2 cm. MATERIAL Y MÉTODOS: Estudio prospectivo y comparativo, no aleatorizado de 84 pacientes tratados por litiasis reno-ureteral menor de 2 cm entre enero y diciembre de 2016. De estos, 38 (45,67%) se trataron con LEOC (18 litiasis renales y 20 litiasis ureterales) y 46 (54,32%) con URS/RIRS (22 litiasis renal y 24 litiasis ureteral). Un total de 19 (41,3%) pacientes estaban activos laboralmente en el grupo de URS/RIRS y 15 (39,5%) pacientes en el grupo de LEOC. Las variables analizadas fueron sexo, edad, número y tamaño de las litiasis, días de baja laboral debido al tratamiento, estimación del coste indirecto por la pérdida de productividad laboral y el coste directo del tratamiento aplicado incluyendo el seguimiento (número total de procedimientos, procedimientos auxiliares, visitas y pruebas diagnósticas). Para la estimación del coste indirecto se empleó la Encuesta de Estructura Salarial 2015 (INE). Además, también se utilizó el cuestionario «Work Productivity and Activity Impairment» (WPAI) para determinar el grado de percepción de pérdida de productividad. RESULTADOS: El número medio de sesiones hasta la resolución de la litiasis fue de 2,57 para el grupo de LEOC y de 1,04 para la URS. El promedio de días de baja laboral en el grupo de la URS fue de 7,16 días, mientras que en el caso de la LEOC fue de 3,18 (p = 0,034). Los costes indirectos totales derivados de la pérdida de productividad fueron de 621,55 € y de 276,05 € para la URS y LEOC, respectivamente. Los costes directos en el grupo de la LEOC fueron de 1.382,9 € y 2.317,71 € en el grupo de la URS. El grado de afectación en el trabajo percibido por los pacientes sometidos a URS fue del 18,88% y del 21,33% en el grupo de LEOC. El grado de afectación para realizar actividades cotidianas fue del 24,44% en URS y del 15% en LEOC. CONCLUSIONES: La LEOC es una técnica que precisa de un mayor número medio de sesiones para la resolución de la litiasis reno-ureteral menor de 2 cm, pero con una menor repercusión en los costes totales y en la percepción del grado de afectación

OBJECTIVE: To perform a comparative analysis of indirect and direct costs of two minimally invasive techniques (extracorporeal shock wave lithotripsy (ESWL) vs. ureteroscopy with holmium laser (URS/RIRS)) for the treatment of renal/ureteral calculi smaller than 2 cm. MATERIAL AND METHODS: Prospective, comparative, non-randomized study of 84 patients treated for kidney stones smaller than 2 cm between January and December 2016. Of these, 38 (45.67%) were treated with ESWL (18 renal lithiasis and 20 ureteral lithiasis) and 46 (54.32%) with URS/RIRS (22 renal lithiasis and 24 ureteral lithiasis). A total of 19 (41.3%) patients in the URS/RIRS group and 15 (39.5%) patients in the ESWL group were actively working before treatment. The variables analyzed were sex, age, number and size of lithiasis, time (days) off from work due to treatment, estimate of indirect cost due to labor productivity loss and direct treatment costs including follow-up (total number of procedures, ancillary care, visits and diagnostic tests). The 2015 Wage Structure Survey (INE) was used to estimate the indirect cost. In addition, the «Work Productivity and Activity Impairment» (WPAI) questionnaire was also used to determine the level of perceived productivity loss. RESULTS: The mean number of sessions until lithiasis resolution was achieved was 2.57 for the ESWL group and 1.04 for the URS. The mean number of days off from work in the URS group was 7.16 days and 3.18 (p = 0.034) in the ESWL group. The total indirect costs resulting from productivity loss were EUR 621.55 and EUR 276.05 for the URS and ESWL, respectively. Direct costs in the ESWL group were EUR 1,382.9 and EUR 2,317.71 in the URS group. The level of work impairment perceived by patients undergoing URS was 18.88% and 21.33% in the ESWL group. The degree of impairment for performing activities of daily living was 24.44% in the URS and 15% in ESWL. CONCLUSIONS: The ESWL technique requires a higher number of sessions for the resolution of kidney stones under 2 cm, but it has a lower impact on total costs and on the perceived degree of affectation

Comparative analysis of direct and indirect costs of two minimally invasive techniques for the treatment of renal/ureteral calculi smaller than 2 cm. / Análisis comparativo de costes directos e indirectos de dos técnicas mínimamente invasivas, para el tratamiento de la litiasis renoureteral menor de 2 cm.

OBJECTIVE: To perform a comparative analysis of indirect and direct costs of two minimally invasive techniques (extracorporeal shock wave lithotripsy (ESWL) vs. ureteroscopy with holmium laser (URS/RIRS)) for the treatment of renal/ureteral calculi smaller than 2 cm. MATERIAL AND METHODS: Prospective, comparative, non-randomized study of 84 patients treated for kidney stones smaller than 2 cm between January and December 2016. Of these, 38 (45.67%) were treated with ESWL (18 renal lithiasis and 20 ureteral lithiasis) and 46 (54.32%) with URS/RIRS (22 renal lithiasis and 24 ureteral lithiasis). A total of 19 (41.3%) patients in the URS/RIRS group and 15 (39.5%) patients in the ESWL group were actively working before treatment. The variables analyzed were sex, age, number and size of lithiasis, time (days) off from work due to treatment, estimate of indirect cost due to labor productivity loss and direct treatment costs including follow-up (total number of procedures, ancillary care, visits and diagnostic tests). The 2015 Wage Structure Survey (INE) was used to estimate the indirect cost. In addition, the «Work Productivity and Activity Impairment¼ (WPAI) questionnaire was also used to determine the level of perceived productivity loss. RESULTS: The mean number of sessions until lithiasis resolution was achieved was 2.57 for the ESWL group and 1.04 for the URS. The mean number of days off from work in the URS group was 7.16 days and 3.18 (p = 0.034) in the ESWL group. The total indirect costs resulting from productivity loss were EUR 621.55 and EUR 276.05 for the URS and ESWL, respectively. Direct costs in the ESWL group were EUR 1,382.9 and EUR 2,317.71 in the URS group. The level of work impairment perceived by patients undergoing URS was 18.88% and 21.33% in the ESWL group. The degree of impairment for performing activities of daily living was 24.44% in the URS and 15% in ESWL. CONCLUSIONS: The ESWL technique requires a higher number of sessions for the resolution of kidney stones under 2 cm, but it has a lower impact on total costs and on the perceived degree of affectation.

Factores predictores de complicaciones infecciosas en el postoperatorio de la nefrolitotomía percutánea / Predictive factors of infectious complications in the postoperative period of percutaneous nephrolithotomy

Objetivo: Las complicaciones infecciosas (CI) tras la nefrolitotomía percutánea (NLPC) pueden llegar a ser de gravedad. Nuestro objetivo fue analizar factores predictores preoperatorios de CI tras la NLPC. Materiales y métodos: Se incluyó en un estudio prospectivo a un total de 203 pacientes que se trataron con NLPC entre enero de 2013 y febrero de 2016. Se definió CI postoperatoria como infección urinaria/pielonefritis, síndrome de respuesta inflamatoria sistémica o sepsis. Las variables analizadas fueron: edad, sexo, número, lado y tamaño (cm) de la litiasis; unidades Hounsfield, diabetes (insulinodependiente o no), cultivo de orina preoperatorio, bacteria aislada, multitrayecto, índice de masa corporal y tiempo quirúrgico (min). Se llevó a cabo un análisis multivariante (regresión logística). Resultados: Se produjeron CI en 30 pacientes (14,8%): en 9 de ellos (4,4%) se presentó infección urinaria, en 14 (6,9%) síndrome de respuesta inflamatoria sistémica y en 7 (3,5%) sepsis. Además, 13 (43,3%) tenían un cultivo de orina preoperatorio negativo, 15 (50%) positivo y en 2 (6,7%) no estaba disponible. En la regresión logística, el tamaño de la litiasis, la diabetes insulinodependiente y el sexo femenino resultaron factores predictores independientes de CI (OR: 1,03; 14,6 y 7,8, respectivamente; p = 0,0001). Conclusiones: Pacientes con litiasis de mayor tamaño, diabéticos insulinodependientes y mujeres deberían ser aconsejados de forma preoperatoria sobre el riesgo de CI tras la NLPC, y ser estrechamente seguidos tras la cirugía. Además, un cultivo de orina preoperatorio negativo no ofrece fiabilidad suficiente para excluir el riesgo de CI

Objective: Infectious complications (IC) following percutaneous nephrolithotomy surgery (PCNL) can be life-threatening. Our objective was to analyze preoperative predictors of IC in PCNL. Materials and methods: A total of 203 patients who underwent PCNL were included in a prospective study between January 2013 and February 2016. A postoperative IC was defined as urinary infection/pyelonephritis, systemic inflammatory response syndrome or sepsis. The variables analyzed were age, gender, number, size (cm) and side of stone; Hounsfield units, diabetes (insulin dependent or not), preoperative culture, isolated bacteria, multitract, body mass index and surgical time (min). A multivariate forward stepwise (logistic regression) was performed. Results: IC occurred in 30 patients (14.8%): 9 (4.4%) had urinary infection, 14 (6.9%) systemic inflammatory response syndrome and 7 (3.5%) sepsis. In addition, 13 (43.3%) had negative preoperative urine culture, 15 (50%) positive and in 2 (6.7%) was not available. On the logistic regression analysis, stone size (cm), insulin dependent diabetes and female sex were independently associated with increased risk of IC (odds ratio [OR] 1.03, 14.6 and 7.8, respectively; p = 0.0001). Conclusions: Patients with large stone burdens, insulin-dependentdiabetes condition and female gender, should be counselled properly regarding postoperative infection risks and closely followed up to diagnose IC (specially sepsis) soon enough. Negative preoperative urine culture seems not reliable enough to exclude an infectious complication according to our results

Predictive factors of infectious complications in the postoperative of percutaneous nephrolithotomy. / Factores predictores de complicaciones infecciosas en el postoperatorio de la nefrolitotomía percutánea.

OBJECTIVE: Infectious complications (IC) following percutaneous nephrolithotomy surgery (PCNL) can be life-threatening. Our objective was to analyse preoperative predictors of IC in PCNL. MATERIALS AND METHODS: A total of 203 patients who underwent PCNL were included in a prospective study between January 2013 and February 2016. A postoperative IC was defined as urinary infection/pyelonephritis, systemic inflammatory response syndrome or sepsis. The variables analysed were age, gender, number, size(cm) and side of stone; Hounsfield units,diabetes (insulin dependent or not), preoperative culture, isolated bacteria, multitract, bodymass index and surgical time (min). A multivariate forward stepwise (logistic regression) was performed. RESULTS: IC occurred in 30 patients (14.8%): 9 (4.4%) had urinary infection, 14 (6.9%) systemic inflammatory response syndrome and 7 (3.5%) sepsis. In addition, 13 (43.3%) had negative preoperative urine culture, 15 (50%) positive and in 2 (6.7%) was not available. On the logistic regression analysis, stone size (cm), insulin dependent diabetes and female sex were independently associated with increased risk of IC (odds ratio [OR] 1.03, 14.6 and 7.8, respectively; P=.0001). CONCLUSIONS: Patients with large stone burdens, insulin diabetes condition and female gender, should be counselled properly regarding postoperative infection risks and closely followed up to diagnose IC (specially sepsis) soon enough. Negative preoperative urine culture seems not reliable enough to exclude an infectious complication according to our results.

Litotricia por ondas de choque con música: un tratamiento menos doloroso y más satisfactorio / Shockwave lithotripsy with music: Less painful and more satisfactory treatment

Introducción: El objetivo del estudio fue determinar si escuchar música durante una sesión de litotricia extracorpórea por ondas de choque (LEOC) mejora el dolor de los pacientes. Material y método: Se realizó una aleatorización simple y oculta de pacientes con litiasis renales o ureterales que acudieron por vez primera a una sesión de LEOC de 7.000 ondas, entre septiembre y diciembre de 2014. Un grupo recibió música mientras que el otro no. Se registraron la edad, sexo, localización de la litiasis (renal/ureteral) y 2 cuestionarios pre-LEOC (cuestionario A) y post-LEOC (cuestionario B). Cada cuestionario contiene una pregunta sobre ansiedad y otra sobre dolor en escala Likert (0 al 10). El B, además, contiene otra sobre satisfacción y otra sobre comodidad (Likert 0 al 10). Otras variables fueron la frecuencia cardiaca, respiratoria, tensión arterial sistólica y diastólica en la onda 2.000, 5.000 y 7.000, causa de interrupción del procedimiento, petidina total (mg), analgesia secundaria, energía (J) y frecuencia (Hz). Se realizó un análisis bivariante con t de Student, X2/Fisher y un modelo de regresión lineal múltiple. Resultados: La muestra incluyó a 95 pacientes, con una media de edad de 52 años (±13), 35 mujeres (36,84%), 60 hombres (63,2%); 25 para litiasis ureterales (26,3%) y 70 (26,3%) para renales (73,7%). Un total de 42 pacientes (44,2%) pacientes recibieron música. No hubo diferencias entre las variables demográficas ni en las puntuaciones del cuestionario A. La satisfacción y el dolor fueron mejores en el cuestionario B con música. Conclusión: La música es capaz de disminuir el dolor y mejorar la satisfacción del paciente en los tratamientos con LEOC. Más estudios son necesarios para comprobar este efecto

Introduction: The objective of this study was to determine whether listening to music during a session of extracorporeal shockwave lithotripsy (ESWL) improves patients' pain. Material and method: A simple, blind randomisation was undertaken of patients with kidney and ureter stones attending an ESWL session of 7,000 waves for the first time, between September and December 2014. One group was given music and the other was not. The age, gender, location of stones (kidney/ureter) were recorded and 2 questionnaires: pre ESWL (questionnaire A) and postESWL (questionnaire B). Each questionnaire contained a question about anxiety and another question on pain on the Likert scale (0-10). Questionnaire B also had a question on satisfaction and comfort (Likert 0-10). Other variables included heart rate, respiratory rate, systolic and diastolic blood pressure on wave 2,000, 5,000 and 7,000, reason for halting the procedure, total pethidine (mg), secondary analgesia, energy (J) and frequency (Hz). Bivariate analysis using the Student's t-test, X2/Fisher test and a multiple linear regression model. Results: The sample comprised 95 patients, with a mean age of 52 (±13) years, 35 (36.84%) females, 60 (63.2%) males. A total of 25 (26.3%) ureter stones and 70 (73.7%) kidney stones. A number of 42 (44.2%) patients were given music. There were no differences between the demographic variables or questionnaire A scores. Satisfaction and pain were better on questionnaire B with music. Conclusion: Music can reduce pain and improve patient satisfaction in ESWL treatment. More studies are required to confirm this effect

¿Es la litotricia extracorpórea por ondas de choque en la actualidad un tratamiento vigente para el tratamiento de la litiasis urinaria? Revisión sistemática / Is extracorporeal shock wave lithotripsy a current treatment for urolithiasis? A systematic review

Introducción: Los avances tecnológicos han motivado un cambio en el manejo de la urolitiasis. Las técnicas endourológicas están cobrando mayor importancia, ya que son tratamientos altamente eficaces. El objetivo de este trabajo es responder a la cuestión de si la LEOCH sigue siendo una alternativa competitiva frente a otras modalidades terapéuticas. Adquisición de la evidencia: Se realizó una búsqueda bibliográfica de artículos publicados en los últimos 5 años. Fueron identificados 12 estudios aleatorizados y comparativos. Se evaluó la metodología y el resultado de las variables estudiadas. Se ha realizado una síntesis narrativa de los estudios incluidos. Para resumir las variables se ha utilizado la media y la desviación estándar en variables continuas, y para variables cualitativas el número absoluto y el porcentaje. Análisis de la evidencia: De los estudios revisados, 7 trabajos evaluaban los distintos tratamientos para litiasis renales y 5 para litiasis ureterales. A nivel renal, con LEOCH se alcanza una TLL a los 3 meses entre 91,5-33,33%, mientras que con otras técnicas endourológicas entre 100-90,4%, sin encontrar diferencias estadísticamente significativas en todos los estudios. A nivel ureteral con LEOCH se alcanza una TLL a los 3 meses entre 82,2-73,5%, mientras que con otras técnicas endourológicas entre 94,1-79%, sin encontrar diferencias estadísticamente significativas todos los estudios. Conclusión: Existe una falta de homogeneidad entre los estudios publicados. La LEOCH es un tratamiento mínimamente invasivo, que con una adecuada técnica y selección del paciente alcanza una elevada efectividad, manteniendo un papel importante en la actualidad

Introduction: Technological advances have prompted a change in the management of urolithiasis. Endourological techniques are gaining importance because they are highly effective treatments. The aim of this study was to answer the question of whether extracorporeal shock wave lithotripsy (ESWL) is still a competitive alternative compared with other therapeutic modalities. Acquisition of evidence: We conducted a literature search of articles published in the past 5 years. We identified 12 randomized and comparative studies and assessed the methodology and results of the study variables. We performed a narrative synthesis of the included studies. To summarise the variables, we used the mean and standard deviation for continuous variables and absolute numbers and percentages for the qualitative variables. Analysis of the evidence: Of the studies reviewed, 7 evaluated the various treatments for nephrolithiasis and 5 evaluated the treatments for ureteral lithiasis. At the renal level, a stone-free rate of 33.33-91.5% at 3 months was reached with ESWL, while a rate of 90.4-100% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. At the ureteral level, a stone-free rate of 73.5-82.2% at 3 months was reached with ESWL, while a rate of 79-94.1% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. Conclusion: There is a lack of homogeneity among the published studies. ESWL is a minimally invasive treatment that with an appropriate technique and patient selection achieves high effectiveness, thus maintaining an important role at this time

Shockwave lithotripsy with music: Less painful and more satisfactory treatment. / Litotricia por ondas de choque con música: un tratamiento menos doloroso y más satisfactorio.

INTRODUCTION: The objective of this study was to determine whether listening to music during a session of extracorporeal shockwave lithotripsy (ESWL) improves patients' pain. MATERIAL AND METHOD: A simple, blind randomisation was undertaken of patients with kidney and ureter stones attending an ESWL session of 7,000 waves for the first time, between September and December 2014. One group was given music and the other was not. The age, gender, location of stones (kidney/ureter) were recorded and 2questionnaires: pre ESWL (questionnaire A) and postESWL (questionnaire B). Each questionnaire contained a question about anxiety and another question on pain on the Likert scale (0-10). Questionnaire B also had a question on satisfaction and comfort (Likert 0-10). Other variables included heart rate, respiratory rate, systolic and diastolic blood pressure on wave 2,000, 5,000 and 7,000, reason for halting the procedure, total pethidine (mg), secondary analgesia, energy (J) and frequency (Hz). Bivariate analysis using the Student's t-test, X2/Fisher test and a multiple linear regression model. RESULTS: The sample comprised 95 patients, with a mean age of 52 (±13) years, 35 (36.84%) females, 60 (63.2%) males. A total of 25 (26.3%) ureter stones and 70 (73.7%) kidney stones. A number of 42 (44.2%) patients were given music. There were no differences between the demographic variables or questionnaire A scores. Satisfaction and pain were better on questionnaire B with music. CONCLUSION: Music can reduce pain and improve patient satisfaction in ESWL treatment. More studies are required to confirm this effect.

Is extracorporeal shock wave lithotripsy a current treatment for urolithiasis? A systematic review. / ¿Es la litotricia extracorpórea por ondas de choque en la actualidad un tratamiento vigente para el tratamiento de la litiasis urinaria? Revisión sistemática.

INTRODUCTION: Technological advances have prompted a change in the management of urolithiasis. Endourological techniques are gaining importance because they are highly effective treatments. The aim of this study was to answer the question of whether extracorporeal shock wave lithotripsy (ESWL) is still a competitive alternative compared with other therapeutic modalities. ACQUISITION OF EVIDENCE: We conducted a literature search of articles published in the past 5 years. We identified 12 randomized and comparative studies and assessed the methodology and results of the study variables. We performed a narrative synthesis of the included studies. To summarise the variables, we used the mean and standard deviation for continuous variables and absolute numbers and percentages for the qualitative variables. ANALYSIS OF THE EVIDENCE: Of the studies reviewed, 7 evaluated the various treatments for nephrolithiasis and 5 evaluated the treatments for ureteral lithiasis. At the renal level, a stone-free rate of 33.33-91.5% at 3 months was reached with ESWL, while a rate of 90.4-100% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. At the ureteral level, a stone-free rate of 73.5-82.2% at 3 months was reached with ESWL, while a rate of 79-94.1% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. CONCLUSION: There is a lack of homogeneity among the published studies. ESWL is a minimally invasive treatment that with an appropriate technique and patient selection achieves high effectiveness, thus maintaining an important role at this time.

[Impact in the quality of life of the patients with double J catheter.] / Impacto en la calidad de vida de los pacientes con catéter doble J.

OBJECTIVE: Double J ureteral stents are frequently used to allow free diuresis from the kidney to the bladder, but their presence has a major impact on patient's quality of life (QoL). Our aim is to describe such impact, and to describe possible solutions that can alleviate the symptoms associated with their use. METHODS: Systematic search in bibliographic sources including Cochrane library, UpToDate, Pubmed, Tripdatabase, selecting publications between 2000- 2015, and also the EAU European guidelines (2016). Studies that assessed QoL with double J stents and possible solutions were selected. RESULTS: We included 6 qualitative studies on QoL, 6 clinical trials of double J catheters new designs, and 3 systematic reviews. Most studies used the USSQ (QoL) questionnaire and main problems are described, being storage symptoms and pain the most frequent and important. Possible solutions include modifications in design and composition of the catheter and specially, the use of alpha-blockers and anticholinergics to improve QoL. CONCLUSION: Double J stents have an important symptomatic impact that impairs QoL. They should be used under appropriate indication; their duration should be limited and we must employ all the technological and pharmacological approaches to mitigate their effects.

Análisis del perfil de seguridad del tratamiento con un número ampliado de ondas de choque por sesión en litotricia extracorpórea / Analysis of the safety profile of treatment with a large number of shock waves per session in extracorporeal lithotripsy

Objetivo: Evaluar la seguridad del incremento del número de ondas por sesión en el tratamiento de la litiasis urinaria mediante litotricia extracorpórea. Material y métodos: Estudio prospectivo, comparativo, no aleatorizado, de grupos paralelos de pacientes con litiasis reno-ureteral e indicación de litotricia extracorpórea incluidos consecutivamente entre 2009 y 2010. Se comparó un grupo i (160 pacientes) tratado programadamente con un número medio de ondas/sesión estándar (2858,3 ± 302,8) y un litotriptor Dornier Lithotripter U/15/50, frente a un grupo ii (172 pacientes) tratado con un número medio de ondas/sesión ampliado (6728,9 ±889,6) y un litotriptor Siemens Modularis. Las variables analizadas fueron edad, sexo, localización, tamaño de la litiasis, número de ondas/sesión y totales hasta la resolución, tasa libre de litiasis (TLL) y tasa de complicaciones (clasificación Clavien-Dindo). Para el análisis estadístico fueron empleados la «t» de Student y la Chi cuadrado. Resultados: La tasa de complicaciones totales fue 11,9% para el grupo i y 10,46% para el grupo ii (p = 0,39). Todas ellas fueron complicaciones menores grado i (Clavien-Dindo). La más frecuente en el grupo i fue el dolor cólico y en el grupo ii la hematuria, con tasa de intolerancia al tratamiento similar (p > 0,05). El número de ondas totales necesarias fue inferior en el grupo ii respecto al grupo i (p = 0,001), con TLL del 96,5% y 71,5% respectivamente (p = 0,001). Conclusión: El tratamiento con un número ampliado de ondas por sesión en litotricia extracorpórea no implica mayor tasa de complicaciones ni mayor severidad de las mismas. Sin embargo, podría aumentar la efectividad global del tratamiento

Objective: To assess the safety of increasing the number of waves per session in the treatment of urolithiasis using extracorporeal lithotripsy. Material and methods: Prospective, comparative, nonrandomized parallel study of patients with renoureteral lithiasis and an indication for extracorporeal lithotripsy who were consecutively enrolled between 2009 and 2010. We compared group I (160 patients) treated on schedule with a standard number of waves/session (mean 2858,3 ± 302,8) using a Dornier lithotripter U/15/50 against group II (172 patients) treated with an expanded number of waves/session (mean, 6728,9 ± 889,6) using a Siemens Modularis lithotripter. The study variables were age, sex, location, stone size, number of waves/session and total number of waves to resolution, stone-free rate (SFR) and rate of complications (Clavien-Dindo classification). Student's t-test and the chi-squared test were employed for the statistical analysis. Results: The total rate of complications was 11.9% and 10.46% for groups I and II, respectively (P = .39). All complications were minor (Clavien-Dindo grade I). The most common complications were colic pain and hematuria in groups I and II, respectively, with a similar treatment intolerance rate (P > .05). The total number of waves necessary was lower in group II than in group I (P = .001), with SFRs of 96.5% and 71.5%, respectively (P = .001). Conclusion: Treatment with an expanded number of waves per session in extracorporeal lithotripsy does not increase the rate of complications or their severity. However, it could increase the overall effectiveness of the treatment

Analysis of the safety profile of treatment with a large number of shock waves per session in extracorporeal lithotripsy.

OBJECTIVE: To assess the safety of increasing the number of waves per session in the treatment of urolithiasis using extracorporeal lithotripsy. MATERIAL AND METHODS: Prospective, comparative, nonrandomized parallel study of patients with renoureteral lithiasis and an indication for extracorporeal lithotripsy who were consecutively enrolled between 2009 and 2010. We compared group I (160 patients) treated on schedule with a standard number of waves/session (mean 2858,3±302,8) using a Dornier lithotripter U/15/50 against group II (172 patients) treated with an expanded number of waves/session (mean, 6728,9±889,6) using a Siemens Modularis lithotripter. The study variables were age, sex, location, stone size, number of waves/session and total number of waves to resolution, stone-free rate (SFR) and rate of complications (Clavien-Dindo classification). Student's t-test and the chi-squared test were employed for the statistical analysis. RESULTS: The total rate of complications was 11.9% and 10.46% for groups I and II, respectively (P=.39). All complications were minor (Clavien-Dindo grade I). The most common complications were colic pain and hematuria in groups I and II, respectively, with a similar treatment intolerance rate (P>.05). The total number of waves necessary was lower in group II than in group I (P=.001), with SFRs of 96.5% and 71.5%, respectively (P=.001). CONCLUSION: Treatment with an expanded number of waves per session in extracorporeal lithotripsy does not increase the rate of complications or their severity. However, it could increase the overall effectiveness of the treatment.

[De novo urological neoplasms in kidney transplant patients: experience in 1,751 patients]. / Neoplasias urológicas de novo en pacientes trasplantados renales: experiencia en 1.751 pacientes.

INTRODUCTION: Immunosuppressive treatment promotes development of neoplasms in kidney transplant patients. Cancer prevalence in these patients is 4 to 5 times higher as compared to the general population. Tumors are also known to behave more aggressively in transplant patients. OBJECTIVE: To perform a descriptive analysis of de novo urological tumors in kidney transplant patients and to analyze patient survival. MATERIALS AND METHODS: A retrospective study was conducted in 1751 transplant patients from January 1980 to December 2006. Patients in whom the tumor occurred in the first year after transplantation were excluded. The primary variables considered included sex, age at transplant, age at cancer diagnosis, site, clinical stage, treatment, and outcome. A Chi-square test was used for univariate statistical analysis. Survival was assessed using the Kaplan-Meier method. RESULTS: Twenty-nine de novo tumors (1.6%) were diagnosed in the 1751 transplanted patients, with a median follow-up of 35.28 months (2-121) from tumor diagnosis. Tumors were found in 24 males (82%) and 5 females (18%). Median age at transplantation was 50.8 (17-70) years, and median age at tumor diagnosis was 56.4 (19-79) years. Eleven patients (38%) were diagnosed with prostate cancer, seven (24%) with bladder tumors, 4 (60%) with non-muscle invasive tumors, and 3 (40%) with muscle invasive tumors. A renal adenocarcinoma in the primitive kidney was diagnosed in 6 patients (20%). Five patients (18%) were detected a tumor in the transplanted kidney. Median survival was 75 months for patients with bladder tumors, 82 months for prostate cancer, 59 months for tumors in the native kidney, and 86 months for graft tumors. CONCLUSIONS: In our series, de novo urological tumors in kidney transplant recipients were more common in males. Prostate cancer is the most common tumor and renal cell carcinoma of the native kidney has the worst survival rate.

Neoplasias urológicas de novo en pacientes trasplantados renales: experiencia en 1.751 pacientes / De novo urological neoplasms in kidney transplant patients: experience in 1.751 patients

Introducción: el tratamiento inmunosupresor en pacientes que reciben un trasplante renal favorece el desarrollo de neoplasias. La prevalencia de neoplasias en trasplantados es de 4 a 5 veces mayor que en la población general. Además se sabe que los tumores en trasplantados se comportan con una mayor agresividad. Objetivo: evaluar mediante un análisis descriptivo las neoplasias de novo urológicas en pacientes trasplantados renales y analizar la supervivencia de los mismos. Material y métodos: estudio retrospectivo desde enero de 1980 hasta diciembre de 2006 sobre 1.751 pacientes trasplantados. Se excluyeron aquellos en los que la neoplasia apareció durante el primer año tras el trasplante. Se consideraron las principales variables: sexo, edad al trasplante, edad al diagnóstico de la neoplasia, localización, estadio clínico, tratamiento y evolución. Para el análisis estadístico univariante se utilizó la prueba de Chi cuadrado. La supervivencia fue evaluada mediante el método de Kaplan Meier. Resultados: se diagnosticaron 29 (1,6%) neoplasias de novo en un total de 1.751 trasplantados, con una mediana de seguimiento de 35,28 meses (2-121) desde el diagnóstico de la neoplasia. La distribución por sexos fue de 24 varones (82%) frente a 5 mujeres (18%). La mediana de edad en el momento del trasplante fue de 50,8 (17-70) años y la mediana de edad en el diagnóstico de neoplasia fue de 56,4 (19-79) años. Se diagnosticó a 11 pacientes (38%) de cáncer próstata, a 7 pacientes (24%) de neoplasias de vejiga a 4 (60%) no músculo invasivas y a tres (40%) de tumor músculo invasivo y en 6 pacientes (20%) se diagnosticó un adenocarcinoma renal sobre el riñón primitivo. En 5 sujetos (18%) se detectó una neoplasia del riñón trasplantado. La mediana de supervivencia fue de 75 meses para tumores de vejiga, 82 meses en el cáncer de próstata, 59 meses en el riñón primitivo y 86 meses para el riñón trasplantado. Conclusiones: en nuestra serie las neoplasias urológicas de novo en trasplantados renales son más frecuentes en varones. El cáncer de próstata es la neoplasia más frecuente y el adenocarcinoma renal del riñón primitivo es la de menor supervivencia(AU)

Introduction: Immunosuppressive treatment promotes development of neoplasms in kidney transplant patients. Cancer prevalence in these patients is 4 to 5 times higher as compared to the general population. Tumors are also known to behave more aggressively in transplant patients. Objective: To perform a descriptive analysis of de novo urological tumors in kidney transplant patients and to analyze patient survival. Materials and methods: A retrospective study was conducted in 1751 transplant patients from January 1980 to December 2006. Patients in whom the tumor occurred in the first year after transplantation were excluded. The primary variables considered included sex, age at transplant, age at cancer diagnosis, site, clinical stage, treatment, and outcome. A Chi-square test was used for univariate statistical analysis. Survival was assessed using the Kaplan-Meier method. Results: Twenty-nine de novo tumors (1.6%) were diagnosed in the 1751 transplanted patients, with a median follow-up of 35.28 months (2-121) from tumor diagnosis. Tumors were found in 24 males (82%) and 5 females (18%). Median age at transplantation was 50.8 (17-70) years, and median age at tumor diagnosis was 56.4 (19-79) years. Eleven patients (38%) were diagnosed with prostate cancer, seven (24%) with bladder tumors, 4 (60%) with non-muscle invasive tumors, and 3 (40%) with muscle invasive tumors. A renal adenocarcinoma in the primitive kidney was diagnosed in 6 patients (20%). Five patients (18%) were detected a tumor in the transplanted kidney. Median survival was 75 months for patients with bladder tumors, 82 months for prostate cancer, 59 months for tumors in the native kidney, and 86 months for graft tumors. Conclusions: In our series, de novo urological tumors in kidney transplant recipients were more common in males. Prostate cancer is the most common tumor and renal cell carcinoma of the native kidney has the worst survival rate(AU)

[Pneumoscrotum secondary to bilateral tension pneumothorax]. / Neumoescroto secundario a un neumotórax a tensión bilateral.

We present a case of pneumoscrotum due to bilateral tension pneumothorax. Although the pneumoescrotum is an uncommon and light disease it can be a symptom of a life threatening pathology. The treatment of the pnemoescrotum is ethiological. It is necessary to treat the specific disease responsible of the pneumoescrotum.

Neumoescroto secundario a un neumotórax a tensión bilateral / Pneumoscrotum secondary to bilateral tension pneumothorax

Presentamos un caso clínico de neumoescroto secundario a un neumotórax a tensión bilateral de gran tamaño. A pesar de que el neumoescroto es una entidad clínica poco frecuente que generalmente se resuelve con tratamiento conservador, puede ser síntoma de un proceso grave y potencialmente mortal. El tratamiento del neumoescroto estará encaminado a tratar la causa que lo produjo (AU)

We present a case of pneumoscrotum due to bilateral tension pneumothorax. Although the pneumoescrotum is an uncommon and light disease it can be a symptom of a liFe threatening pathology. The treatment of the pnemoescrotum is ethiological. It is necessary to treat the specific disease responsible of the pneumoescrotum (AU)

Desarrollo de un Modelo Matemático preliminar para la detección de cáncer de próstata en los pacientes con biopsias prostáticas de repetición / A preliminar mathematical model for patients with a previous negative prostate biopsy

Objetivo: Analizamos las variables clínicas e histopatológicas de los pacientes hombres a biopsiar por sospecha de cáncer de próstata y cuáles de ellos tienen carácter pronóstico para los pacientes con biopsia previa sin hallazgos de neoplasia. Pretendemos desarrollar un nomograma que nos ayude en la decisión de indicar la repetición de la prueba. Material y método: Incluimos 179 pacientes con, al menos una biopsia previa sin hallazgos neoplásicos. Registramos, antes de cada biopsia, edad del paciente, antígeno próstatico específico (PSA) total, PSA libre/total, densidad del PSA, velocidad del PSA, tacto rectal, volumen ecográfico, aparición de área sospechosa en la escala de grises durante la ecografía transrectal, número de cilindros biopsiados, lesiones histológicas premalignas en alguna de las biopsias previas, así como el tiempo transcurrido entre las biopsias. Mediante un modelo de regresión logística determinamos la asociación de cada variable con la presencia de cáncer (biopsia positiva). Construimos un nomograma con las variables estadísticamente más relevantes y averiguamos la capacidad de discriminación del modelo mediante el índice de concordancia. Resultados: Nuestras biopsias de repetición consiguen una tasa de detección de cáncer del 46%. En el estudio univariante la edad, el tacto rectal, el volumen prostático, la densidad del PSA, las zonas sospechosas en la escala de grises, y las lesiones histológicas premalignas se asocian a biopsia de repetición positiva para cáncer (p <0.05). En el análisis multivariante, la edad, el tacto rectal, el volumen prostático y los antecedentes histológicos de una lesión preneoplásica se asociaron a biopsia positiva. Construimos un nomograma con un índice de concordancia de 0,80.Conclusión: A expensas de una validación prospectiva externa de nuestro modelo, el nomograma desarrollado podría ser de ayuda en la difícil de tarea de indicar una biopsia de repetición (AU)

Introduction and objectives: It is usual to identify patients with a negative prostate biopsy who are still at risk of prostate cancer. We try to analyse if the classical variables used in the prostate cancer screening are useful for those patients with a previous negative prostate biopsy, and if there is a possibility for making a nomogram witch would help us in the decision to repeat the biopsy. Material and methods: We studied 179 patients with at least 1 initial negative biopsy. At each biopsy session we recorded: Patient age, serum prostate specific antigen (PSA), free PSA/total PSA, PSA slope, digital rectal examination, prostate volume, PSA density, cancer suspicion in previous transrectal ultrasounds findings, number of negative cores previously obtained, history of precarcinomatous lesions and time between biopsies. Through Logistic regression analysis we determined the association of each variable a positive biopsy. A nomogram was constructed using all variables and discrimination was calculated as the concordance index. Results: Overall 46% of patients had cancer at the repeated biopsy session. In the univariate analysis: Age, digital rectal examination, prostate volume, PSA density, cancer suspicion in ultrasounds findings, and precarcinomatous lesions were associated with repeat positive biopsy for cancer (all p <0.05). In the multivariate study, age, digital rectal examination, prostate volume and history of precarcinomatous lesions were associated with repeat positive biopsy. Anomogram was constructed that had a concordance index of 0.80 (AU)