Percutaneous lithotripsy in Valdivia-Galdakao decubitus position: our experience.

Percutaneous nephrolithotripsy (PNL) is actually the first therapeutic option to resolve complex renal stones. Our department initiated its experience in 1985 and treated the first 585 patients in ventral decubitus, as the original technique was described. Then, in 1998, the dorsal decubitus was adopted (Valdivia Uria), in which 695 patients were treated. Since 2006 the Valdivia Galdakao variant has been used. The Valdivia Galdakao position is an intermediate dorsal decubitus with extension of its homolateral lower limb and flexion of the contralateral. It is a practical way to place the patient for percutaneous renal surgery, avoiding hyperextensions and hyperflexions that can result in articular damage. It preserves cardiovascular and ventilatory dynamics and allows a better access to the respiratory tract. In this position, the bowel slips away from the puncture area lowering the risk of its damage. A single lumbar and genital sterile surgical field is created allowing antegrade and retrograde simultaneous endoscopic and even laparoscopic access, increasing efficiency and safety of the minimal invasive procedures. Between April 2006 and March 2008, 175 PNLs were performed in our department with the patient in Valdivia Galdakao position. The aim of this article is to describe our experience in this decubitus confirming that the Valdivia Galdakao is a safe, practical and versatile position that should be considered as first choice when a percutaneous renal surgery is indicated.

[Randomized study on urinary continence after radical prostatectomy with previous kinesic perineal physiotherapy]. / Estudio randomizado sobre continencia urinaria postprostatectomía radical con rehabilitación perineal kiesica previa.

OBJECTIVES: Urinary incontinence is one of the main complications after radical prostatectomy (RP). Preoperative kinetic physiotherapy could be useful as a preventive treatment of these complication. The objective of this work is to demonstrate the usefulness of preoperative perineal kinetic physiotherapy for early recovery of urinary continence after radical prostatectomy. METHODS: Randomized controlled clinical trial. 38 patients were divided into groups of 19 before radical prostatectomy. The first group (K) received preoperative kinesic treatment whereas the second group (NK) did not (control group). Urinary continence was evaluated at 14, 30 and 60 days after catheter retrieval. RESULTS: There were not epidemiological or tumor biology differences between groups. The percentages of continent patients in group K at 14, 30 and 60 days were 47.36%, 47.36% and 78.9% respectively, whereas in the NK group where 47.36%, 47.36%, and 89.4% respectively (p > 0.05). CONCLUSIONS: Kinesic perineal exercises before radical prostatectomy did not diminish the times of urinary continence recovery or its appearance.

Estudio randomizado sobre continencia urinaria postprostatectomía radical con rehabilitación perineal kiesica previa / Randomized study on urinary continence after radical prostatectomy with previous kinesic perineal physiotherapy

Objetivo: La incontinencia urinaria es una de las principales complicaciones luego de la realización de prostatectomía radical (PR). La rehabilitación kinésica preoperatoria, podría ser de utilidad como tratamiento preventivo de esta complicación. Demostrar la utilidad de la kinesiología perineal preoperatoria en la recuperación precoz de la continencia urinaria post prostatectomía radical. Métodos: Ensayo Clínico Controlado Randomizado Aleatorizado. 38 pacientes fueron divididos en dos grupos de 19 previo a la realización de la PR. El primer grupo (K) recibió tratamiento kinésico preoperatorio, mientras que el segundo grupo (NK) no (grupo control). Se evaluó la continencia de orina a los 14, 30 y 60 días post extracción de sonda. Resultados: No hubo diferencias epidemiológicas y de biología tumoral entre grupos. El porcentaje de pacientes continentes en el grupo K al los 14, 30 y 60 días, respectivamente fue de 47,36%, 47,36% y 78,9%, respectivamente, mientras que en el grupo NK fueron de 47,36%, 47,36% y 89,4%, respectivamente (p>0,05). Conclusión: Los ejercicios kinésicos perineales previos a la prostatectomía radical, no disminuyeron los tiempos de recuperación de la continencia urinaria ni la ocurrencia de la misma (AU)

Objectives: Urinary incontinence is one of the main complications after radical prostatectomy (RP). Preoperative kinetic physiotherapy could be useful as a preventive treatment of these complication. The objective of this work is to demonstrate the usefulness of preoperative perineal kinetic physiotherapy for early recovery of urinary continence after radical prostatectomy. Methods: Randomized controlled clinical trial. 38 patients were divided into groups of 19 before radical prostatectomy. The first group (K) received preoperative kinesic treatment whereas the second group (NK) did not (control group). Urinary continence was evaluated at 14, 30 and 60 days after catheter retrieval. Results: There were not epidemiological or tumor biology differences between groups. The percentages of continent patients in group K at 14,30 and 60 days were 47.36%, 47.36% and 78.9% respectively, whereas in the NK group where 47.36%, 47.36%, and 89.4% respectively (p > 0.05). Conclusions: Kinesic perineal exercises before radical prostatectomy did not diminish the times of urinary continence recovery or its appearance (AU)

[Preoperative prognostic variables in renal cancer]. / Variables preoperatorias pronósticas en el cáncer de riñión.

OBJECTIVES: To analyze the correlation between preoperative variables in patients with kidney cancer and subsequent finding of bad prognosis factors. METHODS: Retrospective cohort study reviewing the charts of all patients undergoing surgery at the HIBA bet- ween June 1988 and April 2003. 555 patients were included, registering age, gender, and clinical presentation. Pathology reports were classified following WHO for histology, Furhman for tumor grade, and AJCC for tumor stage. Intrarenal disease was defined as tumors < or = T2; the rest of the tumors were considered extrarenal. Statistical analysis was performed using the Statistic 7 Software, performing Students t test, proportions comparison test, chi-square test, and odds ratio. RESULTS: Mean age was 58.8 years (r: 20-94), 388 (69.9%) patients were males and 167 (30.1%) females. 209 (37.7%) were smokers or ex-smokers. 256 (46.1%) tumors were incidentally diagnosed, 299 (53.9%) were symptomatic. The right kidney was affected more often (54.6%), and 2.3% were bilateral synchronic tumors. Grade II was the most frequent grade (62.2%). T1 was the predominant TNM with 273 patients (49.2%). Mean tumor size was 6.7 cm, with 5.54 cm for the intrarenal tumors and 8.67 cm for the extrarenal (Student t test p < 0.00001). 49.6% (127) of the 256 asymptomatic patients have extrarenal tumors, in comparison with only 26.4% (79) of the 299 symptomatic patients (chi-square p < 0.00001). Ninety-two (44%) of the 209 smokers had extrarenal tumors in comparison with 114 (32.9%) of the non-smokers. CONCLUSIONS: We may say that patients having a symptomatic renal tumor have between 2 and 3 times more probability to have non organ-confined disease at the time of surgery This also increases, although in smaller amounts, between smokers and older than 70 years patients. The presence of a tumor greater than 7 cm almost triplicates of the possibility of extrarenal involvement.

Variables preoperatorias pronósticas en el cáncer de riñón / Preoperative prognostic variables in renal cancer

OBJETIVO: Analizar la correlación existenteentre factores preoperatorios en pacientes con cáncer de riñón, y el hallazgo posterior de factores de mal pronostico.MÉTODOS: Estudio de cohorte retrospectiva, con revisiónde historias clínicas de pacientes operados entre juniode 1988 y abril 2003 en el HIBA. Se seleccionaron 555 pacientes, de los cuales se tomaron edad, sexo y forma de presentación. Las anatomías patológicas fueronclasificadas según el W.H.O. para histología, Fuhrmanpara grado tumoral, y según la A.J.C.C. para estadiotumoral. Se consideraron tumores con enfermedad intrarrenal (EIR) a aquellas con enfermedad menor a T2, siendo extrarrenales (EER) los restantes. Los datos fueron evaluados estadísticamente con el Student T test, Test de comparaciones de proporciones, Test Chi-Cuadrado y el Odds Ratio. Se utilizo el software Statistic 7 para la realización de los test descriptos.RESULTADOS: La edad promedio fue de 58,8 años (r:20-94), 388 (69,9%) hombres y 167 (30,1%) mujeres.Del total, 209 (37,7%) eran tabaquistas o ex –tabaquistas. En forma incidental se presentaron 256 (46,1%) y 299 (53,9%) en forma sintomática. El riñón derecho fue el mas afectado (54,6%), y 2,3% fueron sincrónicos bilaterales. El 85,4% (474) eran carcinomasde células claras. El grado tumoral más frecuente fue el II con un 62,2%. El TNM que predomino fue el T1 con 273 pacientes(49,2). La media de tamaño tumoralfue de 6,7cm. Siendo para los EIR de 5,54 cm, mientras que los EER fue de 8,67 cm. (Student T test, p<0,00001). De los 256 pacientes sintomáticos, el 49,6% (127) presentaron EER, mientras que de los 299 sintomáticos solo el 26,4% (79) (Chi2 p<0,00001). De los 209 pacientes tabaquistas, 92 (44%) presentaronEER, mientras que de los 346 no tabaquistas 114 (32,9%) se presentaron de este modo.CONCLUSIÓN: Podemos decir que los pacientes portadoresde tumor renal sintomático tienen entre 2 y 3 veces más probabilidades de tener enfermedad no confinadaal riñón en el momento de la cirugía. Esto tambiénaumenta, aunque en menor medida en tabaquistas y mayores de 70 años. La presencia de un tumor mayor de 7 cm casi triplica la posibilidad de EER

OBJECTIVES: To analyze the correlation between preoperative variables in patients with kidney cancer and subsequent finding of bad prognosis factors. METHODS: Retrospective cohort study reviewing the charts of all patients undergoing surgery at the HIBA between June 1988 and April 2003. 555 patients were included, registering age, gender, and clinical presentation. Pathology reports were classified following WHO for histology, Furhman for tumor grade, and AJCC for tumor stage. Intrarenal disease was defined as tumors <= T2; the rest of the tumors were considered extrarenal. Statistical analysis was performed using the Statistic 7 Software, performing Students t test, proportions comparison test, chi-square test, and odds ratio. RESULTS: Mean age was 58.8 years (r: 20-94), 388 (69.9%) patients were males and 167 (30.1%) females. 209 (37.7%) were smokers or ex-smokers. 256 (46.1%) tumors were incidentally diagnosed, 299 (53.9%) were symptomatic. The right kidney was affected more often (54.6%), and 2.3% were bilateral synchronic tumors. Grade II was the most frequent grade (62.2%). T1 was the predominant TNM with 273 patients (49.2%). Mean tumor size was 6.7 cm, with 5.54 cm for the intrarenal tumors and 8.67 cm for the extrarenal (Student t test p < 0.00001). 49.6% (127) of the 256 asymptomatic patients have extrarenal tumors, in comparison with only 26.4% (79) of the 299 symptomatic patients (chi-square p < 0.00001). Ninety-two (44%) of the 209 smokers had extrarenal tumors in comparison with 114 (32.9%) of the non-smokers. CONCLUSIONS: We may say that patients having a symptomatic renal tumor have between 2 and 3 times more probability to have non organ-confined disease at the time of surgery. This also increases, although in smaller amounts, between smokers and older than 70 years patients. The presence of a tumor greater than 7 cm almost triplicates of the possibility of extrarenal involvement