Flexible ureteroscopy in extreme elderly patients (80 years of age and older) is feasible and safe.

PURPOSE: To compare the safety and efficacy of RIRS in patients ≥ 80 years to a younger population. METHODS: We retrospectively compared the data from patients ≥ 80 years of age undergoing RIRS with the data of a group of patients from 18 and < 80 years. Perioperative outcomes, complications and emergency department visits were compared between two groups. RESULTS: A total of 173 patients were included in the study. Mean age was 44 (27-79) and 81 years-old (80-94), for younger and elderly group, respectively. Elderly patients had higher ASA scores (≥ 3) (28.6% vs 75.8%; p = 0.0001) and Charlson comorbidity index (1.99 vs 7.86; p = 0.0001), more diabetes (p = 0.006) and respiratory comorbidities (p = 0.002). No statistical difference was found between two groups in stone size (p = 0.614) and number (p = 0.152). Operative time (74.48 vs 102.96 min; p = 0.0001) and duration of hospitalisation (1.7 vs 2.9 days; p = 0.001) were longer for the elderly. Intraoperative complication rate did not show differences between the two groups (p = 0.166). Postoperative complications rates were similar between the cohorts (7.7% vs 9.5%; p = 0.682). The success rates were 67.5% in the younger group and 71.4% in the elderly group (p = 0.584). No difference was seen in stone recurrence (p = 0.73). A higher rate of visits to the emergency department was found in younger cohort (23.6% vs 11.6%; p = 0.046), mostly duo to stent-related symptoms. CONCLUSIONS: Despite the higher rate of comorbidity in the elderly group, RIRS was a safe procedure with similar complication rate and outcomes at an expense of higher operative time and hospital stay.

Corynebacterium urealyticum: aumento de la incidencia de infección y uropatía incrustante / Corinebacterium urealyticum: increased incidence of infection and encrusted uropathy

Introducción: Corynebacterium urealyticum (CU) afecta a pacientes inmunodeprimidos, crónicos o multioperados. La uropatía incrustante (UI) representa una complicación de la infección. Objetivo del estudio: demostrar el aumento creciente de casos de infección por CU y UI en los últimos 5 años. Material y métodos: Estudio descriptivo de pacientes urológicos con urocultivo positivo a CU (enero de 2009-diciembre de 2014). Cálculo de distribución anual y características clínicas de infección por CU y UI. Seguimiento mínimo: 6 meses. Obtención de medias y rangos estadísticos de parámetros clínicos pre/postratamiento. Resultados: Total de pacientes con CU: 115 (hombres 87: mujeres 28). Edad: 67,9 años (rango 6-95). Distribución anual (casos) 2009: 9 (7,8%), 2010: 13 (11,3%), 2011: 9 (7,8%), 2012: 20 (17,4%), 2013: 31 (27%), 2014: 33 (28,7%). Incremento 2009-2014: 300%. Cirugía urológica múltiple: 89 casos (77,3%). Complicaciones quirúrgicas: 77 casos (66,9%). Pacientes con UI: 18 casos (15,6%) (hombres 13: mujeres 5): pielitis 12 (66,7%), cistopatía 3 (16,6%), prostatic capsule disease 2 (11,2%), calcificación de la malla uno (5,5%). Análisis de 18 casos con UI: PH orina pre/postantibiótico: 8 (r = 6-9) vs 6 (r = 5-7). Cultivo negativo postantibiótico: 100%. Aplicación de solución acidificante: 5 casos. Cirugía: 13 casos (72,2%). Resultados pre/postratamiento multimodal: insuficiencia renal: 12 (66,6%) vs 9 (50%), filtrado glomerular (FG): 45,8 (r = 6- > 90) vs 52,7 (r = 13- > 90). Mejoría del FG: 6,94 puntos (T Wilcoxon p = 0,102). Radiología (incrustaciones): mejoría 13 (72,2%), igual 5 (27,8%). No mortalidad específica por CU. Conclusiones: La prevalencia de infección por CU y la UI está aumentando. El tratamiento antibiótico es muy eficaz. Las soluciones acidificantes son una opción aceptable para reducir calcificaciones

Introduction: Corynebacterium urealyticum (CU) affects patients who are immunosuppressed, chronically ill or have undergone numerous operations. Obstructive uropathy (OU) is a complication of infection. Study objective: To demonstrate the growing increase in cases of infection by CU and OU in the past 5 years. Material and methods: A descriptive study was conducted of urological patients with CU-positive urine cultures (January 2009-December 2014). We calculated the annual distribution and clinical characteristics of infection by CU and OU. Minimum follow-up: 6 months. We obtained the statistical means and ranges of clinical parameters pre/post-therapy. Results: The total number of patients with CU was 115 (men, 87; women, 28). The mean age was 67.9 years (range, 6-95 years), and the annual distribution of cases for 2009, 2010, 2011, 2012, 2013 and 2014 was 9 (7.8%), 13 (11.3%), 9 (7.8%), 20 (17.4%), 31 (27%) and 33 (28.7%), respectively. The increase in cases for 2009-2014 was 300%. Multiple urological surgeries were performed in 89 cases (77.3%), with surgical complications in 77 cases (66.9%). Eighteen (15.6%) patients had OU (men, 13; women, 5), 12 had pyelitis (66.7%), 3 had cystopathy (16.6%), 2 had prostatic capsule disease (11.2%) and 1 had mesh calcification (5.5%). The analysis of the 18 cases with OU showed pre/postantibiotic therapy urine pHs of 8 (r, 6-9) vs. 6 (r, 5-7). All postantibiotic cultures were negative. Acidifying solution was applied in 5 cases, and surgery was performed in 13 cases (72.2%). The results from before/after the multimodal therapy showed renal impairment in 12 (66.6%) vs. 9 cases (50%) and glomerular filtration rates (GFR) of 45.8 (r, 6- > 90) vs. 52.7 (r, 13- > 90). The improvement in GFR was 6.94 points (T Wilcoxon; P = .102). The radiology results (incrustations) showed improvement in 13 patients (72.2%) and no change in 5 (27.8%). There was no specific mortality for CU. Conclusions: The prevalence of infection by CU and OU is increasing. Antibiotic treatment is highly effective. Acidifying solutions are an acceptable option for reducing calcifications

Corinebacterium urealyticum: increased incidence of infection and encrusted uropathy.

INTRODUCTION: Corynebacterium urealyticum (CU) affects patients who are immunosuppressed, chronically ill or have undergone numerous operations. Obstructive uropathy (OU) is a complication of infection. STUDY OBJECTIVE: To demonstrate the growing increase in cases of infection by CU and OU in the past 5 years. MATERIAL AND METHODS: A descriptive study was conducted of urological patients with CU-positive urine cultures (January 2009-December 2014). We calculated the annual distribution and clinical characteristics of infection by CU and OU. Minimum follow-up: 6 months. We obtained the statistical means and ranges of clinical parameters pre/post-therapy. RESULTS: The total number of patients with CU was 115 (men, 87; women, 28). The mean age was 67.9 years (range, 6-95 years), and the annual distribution of cases for 2009, 2010, 2011, 2012, 2013 and 2014 was 9 (7.8%), 13 (11.3%), 9 (7.8%), 20 (17.4%), 31 (27%) and 33 (28.7%), respectively. The increase in cases for 2009-2014 was 300%. Multiple urological surgeries were performed in 89 cases (77.3%), with surgical complications in 77 cases (66.9%). Eighteen (15.6%) patients had OU (men, 13; women, 5), 12 had pyelitis (66.7%), 3 had cystopathy (16.6%), 2 had prostatic capsule disease (11.2%) and 1 had mesh calcification (5.5%). The analysis of the 18 cases with OU showed pre/postantibiotic therapy urine pHs of 8 (r, 6-9) vs. 6 (r, 5-7). All postantibiotic cultures were negative. Acidifying solution was applied in 5 cases, and surgery was performed in 13 cases (72.2%). The results from before/after the multimodal therapy showed renal impairment in 12 (66.6%) vs. 9 cases (50%) and glomerular filtration rates (GFR) of 45.8 (r, 6->90) vs. 52.7 (r, 13->90). The improvement in GFR was 6.94 points (T Wilcoxon; P=.102). The radiology results (incrustations) showed improvement in 13 patients (72.2%) and no change in 5 (27.8%). There was no specific mortality for CU. CONCLUSIONS: The prevalence of infection by CU and OU is increasing. Antibiotic treatment is highly effective. Acidifying solutions are an acceptable option for reducing calcifications.

En referencia al artículo «Prevalencia de la litiasis renal en Andalucía: resultados del estudio PreLiRenA» / In reference to paper «Prevalence of renal stones in andalusian population: Results of PreLiRenA study»

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Implicaciones del déficit de vitamina D en el paciente litiásico y en la población general / Implications of vitamin D deficiency in lithiasic patient and in general population

Contexto y objetivo: El déficit de vitamina D ocasiona problemas en el metabolismo fosfocálcico, pero también de salud general. El objetivo es realizar una revisión del tema, y para contextualizarlo en el paciente litiásico realizar un estudio sobre el déficit de vitamina D y su posible relación con la alteración de los valores de PTH. Adquisición de evidencias: Revisión del metabolismo, la epidemiología y la relación del déficit de vitamina D con varias enfermedades. Análisis multivariable y estudio de correlación entre los niveles de vitamina D y PTH en 100 pacientes litiásicos. Síntesis de evidencias: Se presenta una revisión sobre el metabolismo, receptores, funciones y valoración de la vitamina D, así como del tratamiento de su déficit. Se ha encontrado un déficit de vitamina D superior en el paciente litiásico que en la población general y que se relaciona significativamente con un incremento de los valores de PTH. Además hay suficiente literatura que muestra una relación del déficit de vitamina D no solo con enfermedad ósea, sino con múltiples enfermedades. Conclusión: En todo paciente litiásico debe descartarse y tratarse un posible déficit de vitamina D

Context and objective: Vitamin D deficiency causes problems in mineral metabolism but also overall health. In first place a review of the topic was carried out. Then, in order to contextualize it in lithiasic patient, a study on Vitamin D deficiency and its possible relationship with impaired PTH levels is performed. Evidences acquisition: A review of topics such as metabolism, epidemiology and the relationship of vitamin D deficiency with several pathologies was performed. Besides a multivariate analysis and a correlation study between vitamin D and PTH levels was conducted in 100 lithiasic patients. Evidences synthesis: We present a review of Vitamin D metabolism, receptors and functions, as well as about its valuation methodology and the treatment of its deficiency. Lithiasic patients show a higher vitamin D deficiency than general population. Vitamin D deficiency has been significantly associated with increased PTH levels. In addition, there is enough literature showing a relationship between vitamin D deficiency not only with bone disease, but also with multiple diseases. Conclusion: vitamin D levels should be measured in all lithiasic patients, and those with vitamin D deficiency should be treated

Implications of vitamin D deficiency in lithiasic patient and in general population.

CONTEXT AND OBJECTIVE: Vitamin D deficiency causes problems in mineral metabolism but also overall health. In first place a review of the topic was carried out. Then, in order to contextualize it in lithiasic patient, a study on Vitamin D deficiency and its possible relationship with impaired PTH levels is performed. EVIDENCES ACQUISITION: A review of topics such as metabolism, epidemiology and the relationship of vitamin D deficiency with several pathologies was performed. Besides a multivariate analysis and a correlation study between vitamin D and PTH levels was conducted in 100 lithiasic patients. EVIDENCES SYNTHESIS: We present a review of Vitamin D metabolism, receptors and functions, as well as about its valuation methodology and the treatment of its deficiency. Lithiasic patients show a higher vitamin D deficiency than general population. Vitamin D deficiency has been significantly associated with increased PTH levels. In addition, there is enough literature showing a relationship between vitamin D deficiency not only with bone disease, but also with multiple diseases. CONCLUSION: vitamin D levels should be measured in all lithiasic patients, and those with vitamin D deficiency should be treated.

Por qué y cómo hemos de analizar los cálculos urinarios / Why and how we must analyse urinary calculi

Contexto: Existe una heterogeneidad de criterio sobre la utilidad del análisis del cálculo urinario, así como de cuál es la metodología más adecuada. En esta revisión se presenta el análisis de la litiasis mediante la técnica del estudio morfoconstitucional basada en la combinación de la microscopía estereoscópica (MEST) con el estudio de infrarrojos (EIR). Resumen de evidencia: Existen múltiples técnicas de análisis del cálculo: análisis químico, microscopía electrónica, difracción por rayos X, MEST y EIR. Mediante la revisión de cada una de estas técnicas y el estudio de varios casos clínicos, el presente trabajo muestra la utilidad clínica del análisis del cálculo, así como las ventajas e inconvenientes de cada uno de los citados métodos. Por otro lado, se evidencia cómo el análisis mediante el estudio morfoconstitucionales el que más información clínica de utilidad ofrece al urólogo. Asimismo, se presenta la clasificación de las litiasis basadas en este método y su correlación clínica con el paciente. Conclusiones: El análisis del cálculo mediante la técnica del estudio morfoconstitucional aporta más información que el resto de técnicas y permite establecer una clasificación del cálculo de gran utilidad clínica y diagnóstica (AU)

Context: There is heterogeneity of criteria on the utility of urinary stone analysis as well as on which is the most suitable methodology. This review presents the analysis of the lithiasis using the morphoconstitutional analysis technique based on the combination of the stereoscopic microscopy (SM) with infrared study (IRS). Summary of the evidence: There are many techniques to analyze the stone: chemical analysis, electron microscopy, X-ray diffraction, SM and IRS. Reviewing each one of these techniques and through the study of several clinical cases, this review shows the usefulness of stone analysis and the pros and cons of each one of the mentioned techniques. Furthermore, it can be clearly seen how the morphoconstitutional analysis is the one that offers the most useful clinical information to the urologist. In addition, classification of the lithiasis based on this method and its clinical correlation with patients is presented. Conclusions: Using the morphoconstitutional study to analyze the stone offers more information than the other techniques and it makes it possible to establish a stone classification of important clinical and diagnostic utility (AU)

[Why and how we must analyse urinary calculi]. / Por qué y cómo hemos de analizar los cálculos urinarios.

CONTEXT: There is heterogeneity of criteria on the utility of urinary stone analysis as well as on which is the most suitable methodology. This review presents the analysis of the lithiasis using the morphoconstitutional analysis technique based on the combination of the stereoscopic microscopy (SM) with infrared study (IRS). SUMMARY OF THE EVIDENCE: There are many techniques to analyze the stone: chemical analysis, electron microscopy, X-ray diffraction, SM and IRS. Reviewing each one of these techniques and through the study of several clinical cases, this review shows the usefulness of stone analysis and the pros and cons of each one of the mentioned techniques. Furthermore, it can be clearly seen how the morphoconstitutional analysis is the one that offers the most useful clinical information to the urologist. In addition, classification of the lithiasis based on this method and its clinical correlation with patients is presented. CONCLUSIONS: Using the morphoconstitutional study to analyze the stone offers more information than the other techniques and it makes it possible to establish a stone classification of important clinical and diagnostic utility.

[The cystic component in the renal cancer: conceptual overiew]. / Componente quístico del cáncer renal: Revisión conceptual.

The renal cancer (RC) cystic component is on the radiological tests and could be consolidate with pathological analysis. The concepts "cystic renal cancer" or "cystic renal tumor" contain a group of entities range from cystic grown pattern RCs to pseudocystic tumors as well as cystic renal diseases coinciding with the RC. The CR and the cystic renal diseases have a great variety to sorts of presentations, giving different ways of radiological images, blending solid and cystic areas. Some papers use indiscriminately expression "cystic" without pathologic proof. Just cystic grown pattern RCs and multilocular cystic carcinoma could be named "cystic renal tumors". For de rest, especially over image study, is more suitable to use expressions as "renal tumor of cystic configuration", while pathologic report are available.

Componente quístico del cáncer renal: revisión conceptual / The cystic component in the renal cancer: conceptual overview

El componente quístico del cáncer renal (CR) aparece en el estudio radiológico y queda consolidado con el examen anatomopatológico. El concepto 'cáncer renal quístico' o 'tumor renal quístico' es de uso habitual y comprende una serie de entidades que van desde los CR con patrón de crecimiento quístico a aquellos que poseen cavidades pseudoquísticas o se hallan imbricados en cualquiera de las enfermedades renales que presentan quistes renales. Diversas publicaciones utilizan de forma indistinta el calificativo 'quístico' sin esperar al estudio anatomopatológico, provocando confusión en la terminología. La gran variabilidad en la forma de presentación tanto del CR como de las enfermedades quísticas renales produce distintas formas de presentación radiológica en que se mezclan áreas sólidas y otras de contenido líquido, aunque sólo el examen patológico podrá afirmar que se trata de un CR quístico genuino. Sólo el CR con patrón de crecimiento quístico y el carcinoma multilocular quístico pueden ser llamados con propiedad tumores renales quísticos. Para el resto de entidades, en especial durante el estudio iconográfico, es más adecuado utilizar expresiones no concluyentes como 'masa renal de configuración quística' o 'tumor renal de aspecto quístico' (AU)

The renal cancer (RC) cystic component is on the radiological tests and could be consolidate with pathological analysis. The concepts 'cystic renal cancer' or 'cystic renal tumor' contain a group of entities range from cystic grown pattern RCs to pseudocystic tumors as well as cystic renal diseases coinciding with the RC. The CR and the cystic renal diseases have a great variety to sorts of presentations, giving different ways of radiological images, blending solid and cystic areas. Some papers use indiscriminately expression 'cystic' without pathologic proof. Just cystic grown pattern RCs and multilocular cystic carcinoma could be named 'cystic renal tumors'. Forde rest, especially over image study, is more suitable to use expressions as 'renal tumor of cystic configuration', while pathologic report are available (AU)

Small renal masses: incidental diagnosis, clinical symptoms, and prognostic factors.

Introduction. The small renal masses (SRMs) have increased over the past two decades due to more liberal use of imaging techniques. SRMs have allowed discussions regarding their prognostic, diagnosis, and therapeutic approach. Materials and methods. Clinical presentation, incidental diagnosis, and prognosis factors of SRMs are discussed in this review. Results. SRMs are defined as lesions less than 4 cm in diameter. SRM could be benign, and most malignant SMRs are low stage and low grade. Clinical symptoms like hematuria are very rare, being diagnosed by chance (incidental) in most cases. Size, stage, and grade are still the most consistent prognosis factors in (RCC). An enhanced contrast SRM that grows during active surveillance is clearly malignant, and its aggressive potential increases in those greater than 3 cm. Clear cell carcinoma is the most frequent cellular type of malign SRM. Conclusions. Only some SRMs are benign. The great majority of malign SRMs have good prognosis (low stage and grade, no metastasis) with open or laparoscopic surgical treatment (nephron sparing techniques). Active surveillance is an accepted attitude in selected cases.

[Incidence and prevalence of published studies about urolithiasis in Spain. A review]. / Incidencia y prevalencia de la urolitiasis en España: Revisión de los datos originales disponibles hasta la actualidad.

INTRODUCTION: San Antonio, Somacarrera (1977) and Rousaud-Inmark (1984) studies established the first data of incidence and prevalence about urolithiasis in Spain. Other regional or national epidemiologic details were given for several authors from 1977 to 2002. MATERIAL AND METHOD: Sixteen papers with original data about incidence or prevalence have been selected, 5 of them are about incidence, 8 about prevalence and 3 include both. Ten papers are based on poblational research (San Antonio, Martin, Pedrajas, Rousaud-Inmark, Torres, Ripa, Romero, Grases, Alapont, Aíbar), 5 on subjective estimations (Solé-Balcells, Cifuentes, Puigvert, Serrallach, Conte) and one include both (Somacarrera). Seven papers are nationwide and 9 are about local areas. A map with different location studies is presented and a data register show incidence and prevalence medians. RESULTS: The Spanish median urolithiasis incidence is 0.73%, corresponding to 325,079 new cases per year; and the prevalence is 5.06%, corresponding to 2,233,214 cases. DISCUSSION: Methodologically the best epidemiologic studies about lithiasis are based on general population survey. The commonest slant is extract data from retrospective clinical registers. Most studies have significant methodological difficulties, but they reflected interest about epidemiology of stone disease in Spain. There is a concordance between Spanish results and international published data.

[History of robotics: from archytas of tarentum until Da Vinci robot. (Part II)]. / Historia de la rob6tica: de arquitas de tarento al robot da Vinci. (Parte II).

Robotic surgery is a reality. In order to to understand how new robots work is interesting to know the history of ancient (see part i) and modern robotics. The desire to design automatic machines imitating humans continued for more than 4000 years. Archytas of Tarentum (at around 400 a.C.), Heron of Alexandria, Hsieh-Fec, Al-Jazari, Bacon, Turriano, Leonardo da Vinci, Vaucanson o von Kempelen were robot inventors. At 1942 Asimov published the three robotics laws. Mechanics, electronics and informatics advances at XXth century developed robots to be able to do very complex self governing works. At 1985 the robot PUMA 560 was employed to introduce a needle inside the brain. Later on, they were designed surgical robots like World First, Robodoc, Gaspar o Acrobot, Zeus, AESOP, Probot o PAKI-RCP. At 2000 the FDA approved the da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, CA, USA), a very sophisticated robot to assist surgeons. Currently urological procedures like prostatectomy, cystectomy and nephrectomy are performed with the da Vinci, so urology has become a very suitable speciality to robotic surgery.

[History of robotics: from Archytas of Tarentum until da Vinci robot. (Part I)]. / Historia de la robótica: de Arquitas de Tarento al robot da Vinci (Parte I).

Robotic surgery is the newst technologic option in urology. To understand how new robots work is interesting to know their history. The desire to design machines imitating humans continued for more than 4000 years. There are references to King-su Tse (clasic China) making up automaton at 500 a. C. Archytas of Tarentum (at around 400 a.C.) is considered the father of mechanical engineering, and one of the occidental robotics classic referents. Heron of Alexandria, Hsieh-Fec, Al-Jazari, Roger Bacon, Juanelo Turriano, Leonardo da Vinci, Vaucanson o von Kempelen were robot inventors in the middle age, renaissance and classicism. At the XIXth century, automaton production underwent a peak and all engineering branches suffered a great development. At 1942 Asimov published the three robotics laws, based on mechanics, electronics and informatics advances. At XXth century robots able to do very complex self governing works were developed, like da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, CA, USA), a very sophisticated robot to assist surgeons.