Mujer y urología: ¿cuál es la situación en España? / Women in urology: What is their current situation in Spain?

Objetivo Analizar la situación actual de las mujeres en la especialidad de Urología en España. Material y métodos Estudio descriptivo a partir de los resultados de una encuesta electrónica remitida entre febrero y abril de 2020 a través de la base de datos del grupo de Residentes y Jóvenes Urólogos (RAEU) de la Asociación Española de Urología (AEU). Se analizaron las características demográficas de la encuesta y los resultados de la misma. Resultados Se obtuvieron 257 respuestas, correspondientes a 210 mujeres (81,71%) y 47 hombres (18,29%) procedentes de 111 hospitales en total. Se obtuvieron diferencias estadísticamente significativas (p<0,001), con una mayor proporción de hombres en todas las categorías, excepto en el grupo de adjuntas y adjuntos jóvenes (29-39años; p=0,789) y en el de residentes mujeres frente a residentes hombres (p=0,814). En los hospitales con unidades subespecializadas se encontró un mayor número de hombres en todas, excepto en la unidad de suelo pélvico, en la que no se observó una diferencia estadísticamente significativa (p=0,06). Respecto a cargos de responsabilidad, en solo 7 de 111 hospitales había jefas de servicio. Conclusiones La presencia de las mujeres en la especialidad de Urología es cada vez mayor, debido mayoritariamente a las generaciones más jóvenes. Sin embargo, el acceso de estas mujeres a puestos de relevancia es anecdótica (AU)

Objective To analyze the current state of women in urology in Spain. Material and methods Descriptive study based on the results of an online survey sent between February and April 2020 through the database of the Residents and Young Urologists group (RAEU) of the Spanish Association of Urology (AEU). Demographic characteristics of the survey and its results were analyzed. Results In total, 257 responses were obtained from 210 women (81.71%) and 47 men (18.29%) belonging to 111 hospitals. Statistically significant differences were observed (P<.001) with a higher proportion of men in all categories except for the group of young female and male attendings (29-39 years, P=.789), and the group of female residents against male residents (P=.814). The number of men was higher in hospitals with subspecialty units except for the Pelvic Floor Unit, where no statistically significant difference was observed (P=.06). Regarding positions of responsibility, only 7 out of 111 hospitals had female department chiefs. Conclusions Women's representation in urology is increasing, mainly due to the younger generations. However, the access of these women to relevant positions is anecdotal (AU)

Women in urology: what is their current situation in Spain?

OBJECTIVE: To analyze the current state of women in urology in Spain. MATERIAL AND METHODS: Descriptive study based on the results of an online survey sent between February and April 2020 through the database of the Residents and Young Urologists group (RAEU) of the Spanish Association of Urology (AEU). Characteristics of the survey and its results were analyzed. RESULTS: In total, 257 responses were obtained from 210 women (81.71%) and 47 men (18.29%) belonging to 111 hospitals. Statistically significant differences were observed (p < 0.001) with a higher proportion of men in all categories except for the group of young female and male attendings (29-39 years, p = 0.789), and the group of female residents against male residents (p = 0.814). The number of men was higher in hospitals with subspecialty units except for the Pelvic Floor Unit, where no statistically significant difference was observed (p = 0.06). Regarding positions of responsibility, only 7 out of 111 hospitals had female Department Chiefs. CONCLUSIONS: Women's representation in urology is increasing, mainly due to the younger generations. However, the access of these women to relevant positions is anecdotal.

Resultados de la cirugía retrógrada intrarrenal en el tratamiento de litiasis renales mayores de 2 cm / Results of retrograde intrarenal surgery in the treatment of renal stones greater than 2 cm

Objetivo: Analizar los resultados de la cirugía retrógrada intrarrenal (CRIR) en pacientes con litiasis ≥ 2 cm tratados en nuestro centro. Material y métodos: Revisión retrospectiva de 106 pacientes con litiasis renales ≥ 2 cm sometidos a RIRS (período comprendido entre enero de 2009 y diciembre de 2011). Los procedimientos se realizaron bajo anestesia general utilizando como fuente de fragmentación el láser Holmium (Litho 30 W Quantasystem) y ureteroscopios flexibles (Storz Flex X2, Olympus P5) a través de vainas de acceso ureteral.Se analizan variables demográficas (edad, antecedentes patológicos, tratamientos antiagregantes o anticoagulantes, tratamiento de litiasis, IMC, ASA), variables de litiasis tratada (tamaño, número, unidades Hounsfield, composición bioquímica) y variables intra y postoperatorias (tiempo quirúrgico, número de pulsos, estancia hospitalaria, complicaciones) con la realización de un análisis descriptivo de las mismas. Para definir nuestros resultados consideramos éxito la ausencia completa de restos litiásicos o residuales < 5 mm en las pruebas de imagen posteriores. Resultados: La media de tamaño de las litiasis tratadas fue de 2,46 cm, siendo la litiasis única en el 87,7% de los casos. La localización más frecuente de la litiasis fue la pelvis renal (44%) seguida del cáliz inferior (39%). La tasa de complicaciones postoperatoria fue del 6,7%, siendo todas de escasa relevancia. El porcentaje de éxito con un único procedimiento fue de un 79,4%, alcanzando el 94,1% con retratamiento. Conclusión: La CRIR es una alternativa válida para el tratamiento de litiasis renales ≥ 2 cm por su alta tasa de éxito y escasas complicaciones si se realiza en centros especializados

Objective: To analyze the results of retrograde intrarenal surgery (RIRS) in patients with ≥2 cm stones treated in our center. Material and methods: A retrospective review of 106 patients with renal calculi underwent RIRS ≥2 cm (period January 2009-December 2011). The procedures were performed under general anesthesia as a source of fragmentation using the holmium laser (30 W Litho Quanta system) and flexible ureteroscopes (X2 Flex Storz, Olympus P5) through ureteral access sheaths. It discusses demographic variables (age, medical history, antiplatelet or anticoagulant treatment, treatment of urolithiasis, BMI, ASA), treated stones variables (size, number, Hounsfield units, biochemical composition) and intra-and postoperative variables (operative time, number of pulses, hospital stay, complications) with the completion of a descriptive analysis of the same. To define our results we consider success to the complete absence of fragments or residual <5 mm posterior imaging tests. Results: The mean stone size was 2.46 cm treated, being the only stone in 87.7% of cases. The most frequent location was the renal pelvis stones (44%) followed by the lower calyx (39%).The postoperative complication rate was 6.7%, with all of little relevance. The success rate with a single procedure was 79.4% to 94.1% with retreatment. Conclusion: RIRS is a valid alternative for the treatment of kidney stones ≥ 2 cm for its high success rate and few complications if performed in specialized centers

Estudio comparativo entre nefrolitotomía percutánea en decúbito supino frente cirugía endoscópica intrarrenal combinada con instrumento flexible / A Comparative Study of Percutaneous Nephrolithotomy in Supine Position and Endoscopic Combined Intrarenal Surgery With Flexible Instrument

Objetivo: Comparar los resultados obtenidos en la nefrolitotomía percutánea tras la introducción del ureteroscopio/nefroscopio flexible (cirugía endoscópica intrarrenal combinada [CEIRC]) con nefrolitomías con solo nefroscopio rígido (nefrolitotomía percutánea estándar [NLPC]). Material y método: Estudio retrospectivo de 171 NLPC en posición de Galdakao realizadas entre enero de 2005 y diciembre de 2011. Comparamos los resultados obtenidos en aquellos procedimientos en los que se realizó CEIRC con aquellos en los solo se utilizó nefroscopio rígido (NLPC). Se estimó el éxito específico y el global, el porcentaje de carga litiásica eliminada, los días de estancia hospitalaria y las complicaciones derivadas. Definimos el éxito por la ausencia completa de litiasis o la presencia de residual < 5 mm. Diferenciamos el éxito específico, el conseguido solo con la cirugía percutánea, y el éxito global, el alcanzado tras una segunda línea de tratamiento. Resultados: En 73 procedimientos (42,4%) se realizó CEIRC con endoscopios flexibles, mientras que 98 (57,6%) fueron NLPC. Ambos grupos fueron comparables en cuanto a parámetros demográficos y características de las litiasis. Las tasas de éxito en el primer procedimiento y de éxito global fueron superiores para el grupo de CEIRC (75,3 vs 40,8% y 93,1 vs 74,5%), siendo las diferencias estadísticamente significativas (p < 0,05). No se encontraron diferencias estadísticamente significativas en cuanto a las complicaciones (28,8 vs 28,3%; p = 0,86) o los días de estancia hospitalaria (4,5 vs 5,0; p = 0,18). Conclusiones: El uso de ureteroscopio/nefroscopio flexible en la NLPC (CEIRC) mejora las tasas de éxito y de eliminación de carga litiásica, permitiendo en la mayoría de casos realizar la cirugía con un acceso único

Objective: To compare the results obtained in percutaneous nephrolithotomy after introduction of flexible ureteroscopy/nephroscopy (endoscopic combined intrarenal surgery - ECIRS) with nephrolitomies with only rigid nephroscopy (standard percutaneous nephrolithotomy; sPCNL). Materials and methods: A retrospective study of 171 sPCNL in Galdakao position performed between January 2005 and December 2011 was conducted. We compared the results obtained in those procedures in which endoscopic combined intrarenal surgery (ECIRS) was performed with those in which only the rigid nephroscopy (sPCNL) was used. Specific and global success, percentage of lithiasic load eliminated, days of hospital stay and complications derived were calculated. We defined success by complete absence of lithiasis or residual presence of <5 mm. We differentiated specific success, that only achieved with percutaneous surgery, from global success, or that achieved after a second line of treatment. Results: In 73 procedures (42.4%) ECIRS was performed with flexible endoscopy while in 98 (57.6%) it was done with sPCNL. Both groups were comparable in regards to demographic parameters and characteristics of the lithiasis. The success rates in the first procedure and global success were superior for the ECIRS group (75.3% vs. 40.8% and 93.1% vs. 74.5%), the differences being statistically significant (P < 0.05). No statistically significant differences were found in regards to the complications (28.8% vs. 28.3%; P = .086) or days of hospital stay (4.5 vs. 5.0; P = 0.18). Conclusions: Use of the flexible ureteroscopy/nephroscopy in sPCNL (ECIRS) improves the success rates and elimination of lithiasic load, making it possible to perform the surgery with a single access in most of the cases

A comparative study of percutaneous nephrolithotomy in supine position and endoscopic combined intrarenal surgery with flexible instrument.

OBJECTIVE: To compare the results obtained in percutaneous nephrolithotomy after introduction of flexible ureteroscopy/nephroscopy (endoscopic combined intrarenal surgery - ECIRS) with nephrolitomies with only rigid nephroscopy (standard percutaneous nephrolithotomy; sPCNL). MATERIAL AND METHOD: A retrospective study of 171 sPCNL in Galdakao position performed between January 2005 and December 2011 was conducted. We compared the results obtained in those procedures in which endoscopic combined intrarenal surgery (ECIRS) was performed with those in which only the rigid nephroscopy (sPCNL) was used. Specific and global success, percentage of lithiasic load eliminated, days of hospital stay and complications derived were calculated. We defined success by complete absence of lithiasis or residual presence of<5mm. We differentiated specific success, that only achieved with percutaneous surgery, from global success, or that achieved after a second line of treatment. RESULTS: In 73 procedures (42.4%) ECIRS was performed with flexible endoscopy while in 98 (57.6%) it was done with sPCNL. Both groups were comparable in regards to demographic parameters and characteristics of the lithiasis. The success rates in the first procedure and global success were superior for the ECIRS group (75.3% vs 40.8% and 93.1% vs 74.5%), the differences being statistically significant (P<.05). No statistically significant differences were found in regards to the complications (28.8% vs 28.3% P=.86) or days of hospital stay (4.5 vs 5.0 P=.18). CONCLUSIONS: Use of the flexible ureteroscopy/nephroscopy in sPCNL (ECIRS) improves the success rates and elimination of lithiasic load, making it possible to perform the surgery with a single access in most of the cases.

Results of retrograde intrarenal surgery in the treatment of renal stones greater than 2 cm.

OBJECTIVE: To analyze the results of retrograde intrarenal surgery (RIRS) in patients with ≥2 cm stones treated in our center. MATERIAL AND METHODS: A retrospective review of 106 patients with renal calculi underwent RIRS ≥2 cm (period January 2009-December 2011). The procedures were performed under general anesthesia as a source of fragmentation using the holmium laser (30 W Litho Quantasystem) and flexible ureteroscopes (X2 Flex Storz, Olympus P5) through ureteral access sheaths. It discusses demographic variables (age, medical history, antiplatelet or anticoagulant treatment, treatment of urolithiasis, BMI, ASA), treated stones variables (size, number, Hounsfield units, biochemical composition) and intra-and postoperative variables (operative time, number of pulses, hospital stay, complications) with the completion of a descriptive analysis of the same. To define our results we consider success to the complete absence of fragments or residual <5 mm posterior imaging tests. RESULTS: The mean stone size was 2.46 cm treated, being the only stone in 87.7% of cases. The most frequent location was the renal pelvis stones (44%) followed by the lower calyx (39%). The postoperative complication rate was 6.7%, with all of little relevance. The success rate with a single procedure was 79.4% to 94.1% with retreatment. CONCLUSION: RIRS is a valid alternative for the treatment of kidney stones ≥2 cm for its high success rate and few complications if performed in specialized centers.

Tratamiento de las complicaciones hemorrágicas de la nefrolitotomía percutánea en posición de Galdakao / Treatment of hemorrhagic complications of percutaneous nephrolithotomy in Galdakao position

Objetivo: La nefrolitotomía percutánea (NLPC) es una técnica con buenos resultados para el tratamiento de la litiasis renal, sin embargo, las complicaciones hemorrágicas derivadas de la misma puedes ser graves si no son diagnosticadas y tratadas eficazmente. El objetivo de este estudio es evaluar las complicaciones hemorrágicas derivadas de la nefrolitotomía percutánea en posición de Galdakao y su manejo terapéutico. Material y métodos: Estudio longitudinal retrospectivo de 172 NLPC realizadas en el Hospital La Ribera entre enero de 2005 y diciembre de 2011, analizando sus complicaciones hemorrágicas y el tratamiento establecido para su resolución. Resultados: Presentaron complicaciones hemorrágicas 20 pacientes (11,6%). El requerimiento transfusional de esta serie fue de 8,1% y la causa más frecuente de transfusión el hematoma perirrenal post-operatorio (7,5%). Hubo 6 lesiones arteriales (3,5%), 5 de ellas tratadas satisfactoriamente con arteriografía y embolización selectiva de la lesión. Conclusiones: Las lesiones arteriales por NLPC son poco frecuentes pero pueden ser graves. La posibilidad de realizar de manera urgente arteriografía y embolización selectiva, ante el diagnóstico de una lesión vascular tras NLPC, permite el tratamiento de la hemorragia de una manera eficaz y segura sin riesgo para la unidad renal afectada (AU)

Objetive: Percutaneous Nephrolithotomy (PCNL) is a technique with good results for the treatment of kidney stones, however, bleeding complications derived can be serious if not diagnosed and treated effectively. The aim of this study is to assess bleeding complications resulting from PCNL in Galdakao position and therapeutic management. Material and methods: Retrospective-longitudinal study of 172 PCNL performed in La Ribera Hospital between January 2005 and December 2011, analyzing their bleeding complications and the treatment provided for resolution. Results: Had bleeding complications 20 patients (11.6%). The need for transfusion in this series was 8.1% and the most common cause of blood transfusion the presence of postoperative retroperitoneal (7.5%). There were 6 arterial injuries (3.5%), 5 of them successfully treated with angiography and arterial selective embolization. Conclusions: The arterial injuries following PCNL are rare but can be serious. The possibility of an urgent arteriography and selective embolization to the diagnosis permits an effective and safe treatment of bleeding without risk to the affected renal unit (AU)

Estudio de factores predictivos para complicaciones tras nefrolitotomía percutánea ajustado a la clasificación de Clavien / Study of Predictive Factors for Complications After Percutaneous Nephrolithotomy According to the Clavien Classification

Objetivo: Establecer factores predictivos de complicaciones en nefrolitotomía percutánea (NLPC) utilizando el sistema de Clavien modificado. Material y método: Estudio retrospectivo en el que se incluyen 172 NLPC en posición de Galdakao realizadas en el Hospital La Ribera entre enero de 2005 y diciembre de 2011. Se clasifican las complicaciones derivadas de estos procedimientos utilizando el sistema de Clavien modificado. Se realiza un análisis univariante (test Chi-cuadrado y V de Cramer) y multivariante (regresión logística) de factores predictivos de estas complicaciones (p < 0,05). Resultados: En 49 de los 172 procedimientos se detectaron complicaciones (28,5%). Las complicaciones más frecuentes fueron de grado 1 (9,9%), 12 complicaciones (6,9%) fueron clasificadas como grado 2 por requerir tratamiento médico adicional, 6 como grado 3A (3,5%), 7 como grado 3B (4,1%), 2 como 4A (1,1%), 4 como 4B (2,3%) y una como 5 (0,6%). En el análisis univariante el cultivo de orina positivo previo a la intervención, las litiasis complejas y el tamaño mayor de 40 mm de las mismas mostraron una asociación estadísticamente significativa con la aparición de complicaciones (p < 0,05). El cultivo positivo (OR: 2,96) y las litiasis complejas (OR: 3,03) demostraron ser variables independientes de predicción de complicaciones en el análisis multivariante. Conclusiones: El sistema de Clavien permite utilizar un lenguaje común para clasificar las complicaciones, expresando el grado de las mismas según la complejidad del tratamiento requerido para su resolución. La positividad del urinocultivo preoperatorio y las litiasis complejas demostraron ser factores predictivos de estas complicaciones en nuestra serie (AU)

Objective: Set predictors of complications in percutaneous nephrolithotomy (PCNL) using the modified Clavien system. Material and methods: Retrospective study included 172 PCNL in Galdakao position made in the La Ribera Hospital between January 2005 and December 2011. They classified the complications of these procedures using the modified Clavien system. We performed a univariate analysis (Chi2 Test and Cramer's V) and multivariate (logistic regression) of predictors of these complications (P <0 .05). Results: In 49 of the 172 procedures complications were detected (28.5%).The most frequent complications were grade 1 (9.9%), 12 complications (6.9%) were classified as grade 2 by requiring additional medical treatment, 6 as grade 3A (3.5%), 7 as grade 3B (4.1%), 2 and 4A (1.1%), 4 and 4B (2.3%) and one and 5 (0.6%). In the univariate analysis, positive urine culture before surgery, the stones complex and larger than 40 mm of the same, showed a statistically significant association with the occurrence of complications (P < .05). The positive culture (OR: 2.96) and complex stones (OR: 3.03) proved to be independent variables predicting complications in multivariate analysis. Conclusions: Clavien system allows a common language for classifying complications, expressing the degree of the same as the complexity of treatment required for resolution. The preoperative urine culture positivity and complex stone proved predictors of these complications in our serie (AU)

Study of predictive factors for complications after percutaneous nephrolithotomy according to the Clavien classification.

OBJECTIVE: Set predictors of complications in percutaneous nephrolithotomy (PCNL) using the modified Clavien system. MATERIAL AND METHODS: Retrospective study included 172 PCNL in Galdakao position made in the La Ribera Hospital between January 2005 and December 2011. They classified the complications of these procedures using the modified Clavien system. We performed a univariate analysis (Chi(2) Test and Cramer's V) and multivariate (logistic regression) of predictors of these complications (P < .05). RESULTS: In 49 of the 172 procedures complications were detected (28.5%).The most frequent complications were grade 1 (9.9%), 12 complications (6.9%) were classified as grade 2 by requiring additional medical treatment, 6 as grade 3A (3.5%), 7 as grade 3B (4.1%), 2 and 4A (1.1%), 4 and 4B (2.3%) and one and 5 (0.6%). In the univariate analysis, positive urine culture before surgery, the stones complex and larger than 40 mm of the same, showed a statistically significant association with the occurrence of complications (P < .05). The positive culture (OR: 2.96) and complex stones (OR: 3.03) proved to be independent variables predicting complications in multivariate analysis. CONCLUSIONS: Clavien system allows a common language for classifying complications, expressing the degree of the same as the complexity of treatment required for resolution. The preoperative urine culture positivity and complex stone proved predictors of these complications in our serie.

Treatment of hemorrhagic complications of percutaneous nephrolithotomy in Galdakao position.

OBJECTIVE: Percutaneous Nephrolithotomy (PCNL) is a technique with good results for the treatment of kidney stones, however, bleeding complications derived can be serious if not diagnosed and treated effectively. The aim of this study is to assess bleeding complications resulting from PCNL in Galdakao position and therapeutic management. MATERIAL AND METHODS: Retrospective-longitudinal study of 172 PCNL performed in La Ribera Hospital between January 2005 and December 2011, analyzing their bleeding complications and the treatment provided for resolution. RESULTS: Had bleeding complications 20 patients (11.6%). The need for transfusion in this series was 8.1% and the most common cause of blood transfusion the presence of postoperative retroperitoneal (7.5%). There were 6 arterial injuries (3.5%), 5 of them successfully treated with angiography and arterial selective embolization. CONCLUSIONS: The arterial injuries following PCNL are rare but can be serious. The possibility of an urgent arteriography and selective embolization to the diagnosis permits an effective and safe treatment of bleeding without risk to the affected renal unit.