[Stab wounds of the kidney: conservative management. Two new cases and review of the literature]. / Manejo conservador de los traumatismos renales por arma blanca. Presentación de dos nuevos casos y revisión de la literatura.

INTRODUCTION: Stab wounds of the kidney have traditionally been managed by open surgery. Nowadays the conservative management of stab wounds injuries is extended in order to avoid unnecessaries nephrectomies and laparotomies without increasing morbidity and mortality. Although there is no a strong evidence to recommend when to operate or what sort of follow up we must do. MATERIAL AND METHODS: We present two new cases of stab wounds injuries managed conservatively. We performed a systematic review of the literature. RESULTS: Both patients evolved favorably although one of them presented hematuria 7 days after the traumatism and we performed an embolization of an arteriovenous fistula. Most of the articles are based on series of cases or retrosprospective studies. CONCLUSIONS: The diagnosis and staging of stab wounds of the kidney must be done with clinic and CT scan. Conservative management is required when the patient is not hemodinamically unstable and injuries do not require inmediate repair. These patients require a long-term follow up to prevent the appearance of complications. Randomized prospective multicenter trials are needed to support the optimum management for each kidney injury degree.

Manejo conservador de los traumatismos renales por arma blanca. Presentación de dos nuevos casos y revisión de la literatura / Stab wounds of the kidney: conservative management. Two new cases and review of the literature

Introducción: El tratamiento de los traumatismos renales por arma blanca ha sido tradicionalmente quirúrgico. Desde hace más 20 años se aboga por un tratamiento conservador con el fin de evitar laparotomías innecesarias y preservar unidades renales. Los criterios para intervenir de forma urgente o las pautas de seguimiento no están establecidos debido a la falta de estudios de calidad. Material y métodos: Presentamos dos nuevos casos de traumatismo renal por arma blanca en los que se llevó a cabo un manejo conservador y realizamos una revisión de la literatura. Resultados: Los dos pacientes evolucionaron favorablemente, si bien uno de ellos presentó hematuria durante el postoperatorio inmediato y fue necesaria una embolización selectiva de una fístula arterio-venosa. La mayor parte de los artículo se basan en series de casos o estudios observacionales retrosprospectivos. Conclusiones: En los traumatismos renales por arma blanca el diagnóstico es clínico y el estadiaje de las lesiones radiológico con una tomografía computarizada. El manejo conservador es de elección cuando el paciente está estable hemodinámicamente y las lesiones no requieren reparación inmediata. Estos pacientes requieren un seguimiento a largo plazo para monitorizar la aparición de complicaciones. Son necesarios estudios de mayor calidad que aporten una mayor evidencia científica (AU)

Introduction: Stab wounds of the kidney have traditionally been managed by open surgery. Nowadays the conservative management of stab wounds injuries is extended in order to avoid unnecessaries nephrectomies and laparotomies without increasing morbidity and mortality. Although there is no a strong evidence to recommend when to operate or what sort of follow up we must do. Material and methods: We present two new cases of stab wounds injuries managed conservatively. We performed a systematic review of the literature. Results: Both patients evolved favorably although one of them presented hematuria 7 days after the traumatism and we performed an embolization of an arteriovenous fistula. Most of the articles are based on series of cases or retrosprospective studies. Conclusions: The diagnosis and staging of stab wounds of the kidney must be done with clinic and CT scan. Conservative management is required when the patient is not hemodinamically unstable and injuries do not require inmediate repair. These patients require a long term follow up to prevent the appearance of complications. Randomized prospective multicenter trials are needed to support the optimum management for each kidney injury degree (AU)

[Urodynamic findings in patients older than 65 years: experience in the Department 19 of the health-care area of Valencia (HCAV)]. / Hallazgos urodinámicos en mayores de 65 años: experiencia en el departamento 19 de la Agencia Valenciana de Salud (AVS).

OBJECTIVES: This work tries to analyze the urodynamic studies performed in patients over the age of 65 years in the Department 19 of HCAV with the aim of reviewing our activity in this population segment between January 2001 and September 2006, and to perform a clinical-urodynamic correlation which will help to find a diagnosis avoiding the need to repeat urodynamic tests. METHODS: We perform a descriptive transversal study with retrospective analysis of data from patients older than 65 years who underwent urodynamic tests. Total population in this age range in our health-care department (HCD) (HCD 19) is 35.260 inhabitants (12% of total population) (Valencia health care agency. Healthcare Management HCD 19. Alicante General University Hospital. May 2005). In this population 41% are males (14.620 people) and 59% females (20.637 people). RESULTS: Among males, the most frequent urodynamic finding is infravesical obstruction in almost half of the cases (48%), followed by bladder hyperactivity in 197%, and idiopathic bladder hyperactivity and urgency incontinence with 10%, respectively. No reproducibilily of the symptoms reaches 9% of the cases. On the other hand, in females the most frequent finding is mixed urinary incontinence in 25% of the cases, followed by bladder hyperactivity 17%, urgency incontinence 14% and stress urinary incontinence 13%. No reproducibility of the symptoms reached 11%. In the opposite extreme are intravesical obstruction and sphincter/detrusor dyssynergia without any case. CONCLUSIONS: We find that people between 70 and 75 years old are the population group undergoing a greater number of urodynamic tests in our area. The most frequent urodynamic tests performed at our department was pressure/flow study with evaluation of post void residual. Urethra profile was reserved for recurrent stress urinary incontinence after surgery. Obstructive symptoms in males and mixed urinary incontinence in females were the most frequent causes for the indication of urodynamic tests. Our symptom no-reproduceability rates were below 10% of the cases.

Hallazgos urodinámicos en mayores de 65 años: experiencia en el departamento 19 del Área Valenciana de Salud (AVS) / Urodynamic findings in patients older than 65 years: experience in the Department 19 of the health-care area of Valencia (HCAV)

Objetivo: En este trabajo se pretende analizar los estudios urodinámicos realizados en mayores de 65 años en el Departamento 19 de la Agencia Valenciana de Salud (AVS) a fin de revisar nuestra actividad en ese segmento poblacional adscrito, durante el periodo de enero del 2001 y septiembre del 2006 y realizar una correlación clínico-urodinámica que ayude a alcanzar un diagnóstico evitando la necesidad de repetición de pruebas urodinámicas. Métodos: Para ello, se ha realizado un estudio descriptivo transversal con análisis retrospectivo de los pacientes mayores de 65 años a los que se ha realizado un estudio urodinámico. El total de la población comprendida en este rango de edad de nuestro Departamento Sanitario (D.S. número 19) es de 35260 habitantes (12% del total de la población). Agencia Valenciana de Salud. Dirección Asistencial Departamento Sanitario número 19. Hospital General Universitario de Alicante. Mayo 2005). Dentro de este grupo poblacional, el 41% son varones (14620 personas) y el 59% son mujeres (20637 personas). Resultados: En varones, el hallazgo exploratorio urodinámico más frecuente es el de obstrucción infravesical en casi la mitad de los casos (48%), siendo en segundo lugar la hiperactividad vesical con un 19% y la hiperactividad vesical idiopática a la par de la IUU con un 10% de nuestra población masculina. La no reproductibilidad de los síntomas alcanza el 9% de los casos. Por otro lado, no se confirma ningún caso de IUM, urgencia sensitiva ni micción no coordinada en los varones. Por otro lado, en la mujer lo más frecuente es la IUM con un 25% de los casos, seguido de la hiperactividad vesical con un 17%, la IUU con un 14% y la IUE con un 13% de la población femenina. La no reproductibilidad de los síntomas alcanza el 11%. En el otro extremo se encuentra la obstrucción infravesical y la disinergia detrusor/esfinteriana en los que no se presenta en ningún caso. Conclusión: Como conclusión encontramos que es la población entre 70 y 75 años el grupo poblacional al que se realizaron mayor número de exploraciones urodinámicas, en nuestro trabajo. El test urodinámico más frecuentemente practicado en nuestro Servicio fue el Estudio P/F con medición del residuo postmiccinal. El test de perfil uretral se reservó para la IUE recidivante tras cirugía previa. La sintomatología obstructiva en el varón y la IUM en la mujer fueron las causa que más condujeron a solicitar test urodinámicos. Nuestras tasas de no reproductibilidad de síntomas no superaron el 10% de los casos (AU)

Objectives: This work tries to analyze the urodynamic studies performed in patients over the age of 65 years in the Department 19 of HCAV with the aim of reviewing our activity in this population segment between January 2001 and September 2006, and to perform a clinical-urodynamic correlation which will help to find a diagnosis avoiding the need to repeat urodynamic tests. Methods: We perform a descriptive transversal study with retrospective analysis of data from patients older than 65 years who underwent urodynamic tests. Total population in this age range in our health-care department (HCD) (HCD 19) is 35.260 inhabitants (12% of total population)(Valencia health care agency. Healthcare Management HCD 19. Alicante General University Hospital. May 2005). In this population 41% are males (14.620 people) and 59% females (20.637 people) Results: Among males, the most frequent urodynamic finding is infravesical obstruction in almost half of the cases (48%), followed by bladder hyperactivity in 19%, and idiopathic bladder hyperactivity and urgency incontinence with 10%, respectively. No reproducibility of the symptoms reaches 9% of the cases. On the other hand, in females the most frequent finding is mixed urinary incontinence in 25% of the cases, followed by bladder hyperactivity 17%, urgency incontinence 14% and stress urinary incontinence 13%. No reproducibility of the symptoms reached 11%. In the opposite extreme are intravesical obstruction and sphincter/detrusor dyssynergia without any case. Conclusions: We find that people between 70 and 75 years old are the population group undergoing a greater number of urodynamic tests in our area. The most frequent urodynamic tests performed at our department was pressure/flow study with evaluation of post void residual. Urethra profile was reserved for recurrent stress urinary incontinence after surgery. Obstructive symptoms in males and mixed urinary incontinence in females were the most frequent causes for the indication of urodynamic tests. Our symptom no-reproduceability rates were below 10% of the cases (AU)