Análisis comparativo entre nefrolitotomía percutánea y ureteroscopia flexible en litiasis renal de 2-3cm / Comparative analysis between percutaneous nephrolithotomy and flexible ureteroscopy in kidney stones of 2-3cm

Introducción: Comparar la nefrolitotomía percutánea y la ureterorrenoscopia flexible para el tratamiento de la litiasis renal entre 2 y 3 cm. Material y métodos: Estudio prospectivo, comparativo, no aleatorizado en 108 pacientes con litiasis renal entre 2 y 3 cm; a 54 se les realizó nefrolitotomía percutánea y a 54 una ureteroscopia flexible. Las variables comparadas son: tasa libre de litiasis (%), tiempo quirúrgico, requerimiento de proceso auxiliar, complicaciones postoperatorias, estancia hospitalaria, tasas de reingreso y tiempo de recuperación. Resultados: No existieron diferencias en la tasa libre de litiasis entre ambas técnicas quirúrgicas (76% ureteroscopia, 87% nefrolitotomía) (p = 0,1), ni en las complicaciones (nefrolitotomía: 29%; ureteroscopia: 27%; p = 0,4). Se ha requerido mayor número de procesos auxiliares en el grupo de ureteroscopia (20%) frente al de nefrolitotomía (7%) (p = 0,04). El tiempo quirúrgico fue más largo en el grupo de nefrolitotomía (121 ± 52 min) que en el grupo de ureteroscopia (93 ± 42 min) (p = 0,004). El grupo de ureteroscopia tuvo menor estancia hospitalaria (2,1 ± 1,6 vs. 3,9 ± 1,9 días, p = 0,002), menor convalecencia (8,1 ± 4,9 vs. 13,3 ± 4,2 días, p = 0,005) y mayores tasas de reingreso (7,4% vs. 0%, p = 0,05) que el grupo de nefrolitotomía. Conclusiones: La nefrolitotomía y la ureteroscopia tienen una eficacia similar para el tratamiento de la litiasis renal entre 2-3 cm, sin diferencias en las complicaciones. La ureteroscopia tiene menor estancia hospitalaria, una recuperación más rápida pero mayor reingreso y necesidad de procedimiento auxiliar

Introduction: To compare percutaneous nephrolithotomy and flexible ureterorenoscopy for treating kidney stones between 2 and 3 cm. Material and methods: A prospective, comparative, nonrandomised study was conducted with 108 patients with kidney stones between 2 and 3 cm. Fifty-four patients underwent percutaneous nephrolithotomy and 54 underwent flexible ureteroscopy. We compared the following variables: lithiasis-free rate (%), surgical time, the need for an auxiliary process, postoperative complications, hospital stay, readmission rates and recovery time. Results: There were no differences in the lithiasis-free rate between the 2 surgical techniques (76% for ureteroscopy vs. 87% for nephrolithotomy; P = .1) or in the complications (29% for nephrolithotomy vs. 27% for ureteroscopy; P = .4). A larger number of auxiliary process were needed for the ureteroscopy group (20%) than for the nephrolithotomy group (7%) (P = .04). The surgical time was longer for the nephrolithotomy group (121 ± 52 min) than for the ureteroscopy group (93 ± 42 min) (P = .004). The ureteroscopy group had shorter hospital stays (2.1 ± 1.6 vs. 3.9 ± 1.9 days; P = .002), shorter convalescence (8.1 ± 4.9 vs. 13.3 ± 4.2 days; P = .005) and higher readmission rates (7.4% vs. 0%, P = .05) than the nephrolithotomy group. Conclusions: Nephrolithotomy and ureteroscopy have similar efficacy for treating kidney stones measuring 2-3 cm, with no differences in complications. Ureteroscopy results in shorter hospital stays, quicker recoveries but more readmissions and a greater need for auxiliary procedures

Comparative analysis between percutaneous nephrolithotomy and flexible ureteroscopy in kidney stones of 2-3cm. / Análisis comparativo entre nefrolitotomía percutánea y ureteroscopia flexible en litiasis renal de 2-3cm.

INTRODUCTION: To compare percutaneous nephrolithotomy and flexible ureterorenoscopy for treating kidney stones between 2 and 3cm. MATERIAL AND METHODS: A prospective, comparative, nonrandomised study was conducted with 108 patients with kidney stones between 2 and 3cm. Fifty-four patients underwent percutaneous nephrolithotomy and 54 underwent flexible ureteroscopy. We compared the following variables: lithiasis-free rate (%), surgical time, the need for an auxiliary process, postoperative complications, hospital stay, readmission rates and recovery time. RESULTS: There were no differences in the lithiasis-free rate between the 2 surgical techniques (76% for ureteroscopy vs. 87% for nephrolithotomy; P=.1) or in the complications (29% for nephrolithotomy vs. 27% for ureteroscopy; P=.4). A larger number of auxiliary process were needed for the ureteroscopy group (20%) than for the nephrolithotomy group (7%) (P=.04). The surgical time was longer for the nephrolithotomy group (121±52min) than for the ureteroscopy group (93±42min) (P=.004). The ureteroscopy group had shorter hospital stays (2.1±1.6 vs. 3.9±1.9 days; P=.002), shorter convalescence (8.1±4.9 vs. 13.3±4.2 days; P=.005) and higher readmission rates (7.4% vs. 0%, P=.05) than the nephrolithotomy group. CONCLUSIONS: Nephrolithotomy and ureteroscopy have similar efficacy for treating kidney stones measuring 2-3cm, with no differences in complications. Ureteroscopy results in shorter hospital stays, quicker recoveries but more readmissions and a greater need for auxiliary procedures.

Factores influyentes en el tiempo hasta la progresión bioquímica después de prostatectomía radical / Time-influencing factors for biochemical progression following radical prostatectomy

Introducción: Se han evaluado los factores clínico-patológicos influyentes en el tiempo hasta la progresión bioquímica en una serie homogénea de una única institución. Material y métodos: Análisis retrospectivo de 278 pacientes con progresión bioquímica trasprostatectomía. Se consideró progresión bioquímica PSA > 0,4 ng/ml. Se realizó estudio mediante modelo de Cox (univariado y multivariado) y «t» de Student para comparación de medias. Resultados: Con una media de seguimiento de 4 años (± 3 DE) el estudio univariado reveló una media hasta la progresión para el score Gleason 2-6 en la biopsia de 824 días y 543 para Gleason 7-10 (p = 0,003). Para los márgenes quirúrgicos negativos la media fue 920 días y 545para los márgenes positivos (p = 0,0001). En el caso del score Gleason del espécimen 2-7 la media fue 806 días y 501 para el Gleason 8-10 (p = 0,001). Por último, la media para los casos con Ki-67 negativo en el espécimen (< 10%) fue de 649 días y 345 para Ki-67 positivo (> 10%)(p = 0,003). En el estudio multivariado Ki-67 (OR 1,028; IC 95% 1-1,01; p = 0,0001) y Gleason 8-10(OR 1,62; IC 95% 1,05-2,45; p = 0,026) en el espécimen, y PSA inicial > 10 ng/ml (OR 1,02; IC 95%1,01-1,04; p = 0,0001) fueron variables independientes. Utilizando estas variables se diseña un modelo predictivo con tres grupos. El tiempo hasta la progresión en cada grupo fue de 1.081,551 y 218 días respectivamente. Conclusión: El Gleason 7-10 en la biopsia prostática, la presencia de Ki-67, los márgenes positivos y el Gleason 8-10 en el espécimen y el PSA inicial >10 ng/ml son factores influyentes en el tiempo hasta la progresión bioquímica. Gleason patológico 8-10, PSA > 10 ng/ml y Ki-67 son factores independientes (AU)

Introduction: We assessed the time-influencing clinical-pathological factors for biochemical progression of an equal series of patients from a single institution. Materials and methods: Retrospective analysis of 278 patients with biochemical progression following prostatectomy. We considered biochemical progression to be PSA>0.4 ng/ml. We performed the trial using the Cox model (univariate and multivariate) and using the Student’s t-test to compare averages. Results: With a mean follow-up of 4 (±3 DE) years, the univariate study showed a mean until progression for the Gleason score 2-6 in the biopsy of 824 days and 543 for the Gleason score 7-10(p = 0.003). For negative surgical margins, the mean was 920 days and 545 for positive margins (p = 0.0001). In the case of a Gleason score 2-7 in the specimen, the mean was 806 days and 501for a Gleason score 8-10 (p = 0.001). Lastly, the mean for the cases with Ki-67 negative in the specimen (< 10%) was 649 days and 345 for Ki-67 positive (> 10%) (p = 0.003). In the multivariate study, Ki-67 (OR 1.028; IC 95% 1-1.01; p = 0.0001) and Gleason score 8-10 (OR 1.62; IC 95% 1.5-2.45; p = 0.026) in the specimen, and initial PSA >10 ng/ml (OR 1.02; IC 95% 1.01-1.04; p = 0.0001) were independent variables. Using these variables, we designed a predictive model with three groups. The time until the progression of each group was 1,081, 551 and 218 days respectively. Conclusion: The Gleason score 7-10 in the prostate biopsy, the presence of Ki-67, the positive margins and the Gleason score 8-10 in the specimen, and the initial PSA > 10 ng/ml are time-influencing factors until biochemical progression. Pathological Gleason score 8-10, PSA> 10 ng/ml and Ki-67 are independent factors (AU)

[Time-influencing factors for biochemical progression following radical prostatectomy]. / Factores influyentes en el tiempo hasta la progresión bioquímica después de prostatectomía radical.

INTRODUCTION: We assessed the time-influencing clinical-pathological factors for biochemical progression of an equal series of patients from a single institution. MATERIALS AND METHODS: Retrospective analysis of 278 patients with biochemical progression following prostatectomy. We considered biochemical progression to be PSA>0.4 ng/ml. We performed the trial using the Cox model (univariate and multivariate) and using the Student's t-test to compare averages. RESULTS: With a mean follow-up of 4 (±3 DE) years, the univariate study showed a mean until progression for the Gleason score 2-6 in the biopsy of 824 days and 543 for the Gleason score 7-10 (p=0.003). For negative surgical margins, the mean was 920 days and 545 for positive margins (p=0.0001). In the case of a Gleason score 2-7 in the specimen, the mean was 806 days and 501 for a Gleason score 8-10 (p=0.001). Lastly, the mean for the cases with Ki-67 negative in the specimen (< 10%) was 649 days and 345 for Ki-67 positive (> 10%) (p=0.003). In the multivariate study, Ki-67 (OR 1.028; IC 95% 1-1.01; p=0.0001) and Gleason score 8-10 (OR 1.62; IC 95% 1.5-2.45; p=0.026) in the specimen, and initial PSA >10 ng/ml (OR 1.02; IC 95% 1.01-1.04; p=0.0001) were independent variables. Using these variables, we designed a predictive model with three groups. The time until the progression of each group was 1,081, 551 and 218 days respectively. CONCLUSION: The Gleason score 7-10 in the prostate biopsy, the presence of Ki-67, the positive margins and the Gleason score 8-10 in the specimen, and the initial PSA > 10 ng/ml are time-influencing factors until biochemical progression. Pathological Gleason score 8-10, PSA > 10 ng/ml and Ki-67 are independent factors.

Collagen graft interposition in vesicovaginal fistula treatment.

Vesicovaginal fistula (VVF) is a quite rare complication of gynecological surgery. The first attempt to repair the fistulous tract offers the best opportunity for cure. We report the successful repair of VVF in 2 patients using a combined anterior vaginal approach and porcine dermal collagen grafting as interposition tissue. Favorable results confirm technical simplicity, safety and efficacy of this procedure.