Identificación endoscópica de la composición de los cálculos urinarios: un estudio del Southeastern Group for Lithiasis Research (SEGUR 2) / Endoscopic identification of urinary stone composition: A study of South Eastern Group for Urolithiasis Research (SEGUR 2)

INTRODUCCIÓN Y OBJETIVOS: Evaluar la capacidad del endourólogo para evaluar la composición del cálculo mediante la observación de imágenes endoscópicas. MATERIALES Y MÉTODOS: Una serie de 20 videoclips de tratamientos endoscópicos de cálculos urinarios que también estaba disponible el resultado de la espectroscopia infrarroja se cargó en un sitio de YouTube accesible solo a miembros del South Eastern Group for Urolithiasis Research (SEGUR), a quienes se les preguntó para identificar la composición de los cálculos. RESULTADOS: Un total de 32 endourólogos de 9 países diferentes participaron en el estudio. El número promedio de detecciones correctas de participantes fue de 7,81 ± 2,68 (1-12). La precisión general fue del 39% (250 de 640 predicciones). Cálculos de dihidrato de oxalato de calcio se han detectado correctamente en el 69,8%, monohidrato de oxalato de calcio en el 41,8%, ácido úrico en el 33,3%, oxalato de calcio/ácido úrico en el 34,3% y cistina en el 78,1%. Las tasas de precisión para estruvita (15,6%), fosfato de calcio (0%) y oxalato de calcio/fosfato de calcio (9,3%) fueron bastante bajas. CONCLUSIONES: La observación del cálculo durante el procedimiento endoscópico no fue confiable para identificar la composición de la mayoría de los cálculos, aunque los cálculos de oxalato de calcio dihidrato y cistina pueden identificarse con buena precisión. Sin embargo, se debe alentar la presentación de fotos o videos de cálculo intacto y su estructura interna para implementar los resultados del análisis de cálculo después de la cirugía. Los endourólogos deben mejorar su capacidad de identificación visual de los diferentes tipos de cálculos

INTRODUCTION AND OBJECTIVES: To assess the surgeon's ability to evaluate the composition of the stone by observation of endoscopic images. MATERIALS AND METHODS: A series of 20 video clips of endoscopic treatments of urinary stones of which was also available the result of infrared spectroscopy was uploaded to a YouTube site accessible only to members of the South Eastern Group for Urolithiasis Research (SEGUR) who were asked to identify the composition of the stones. RESULTS: A total of 32 clinicians from 9 different countries participated in the study. The average number of correct detections of participants was 7.81 ± 2.68 (range 1-12). Overall accuracy was 39% (250 out of 640 predictions). Calcium oxalate dihydrate stones have been correctly detected in 69.8%, calcium oxalate monohydrate in 41.8%, uric acid in 33.3%, calcium oxalate/uric acid in 34.3% and cystine in 78.1%. Precision rates for struvite (15.6%), calcium phosphate (0%) and mixed calcium oxalate/calcium phosphate (9.3%) were quite low. CONCLUSIONS: Observation of the stone during the endoscopic procedure was not reliable to identify the composition of most stones although it gave some information allowing to identify with a good sensitivity calcium oxalate dihydrate and cystine stones. Nevertheless, photo or video reporting of the intact stone and its internal structure could should be encouraged to implement results of still mandatory post-operative stone analysis. Endourologists should improve their ability of visual identification of the different types of stones

Endoscopic identification of urinary stone composition: A study of South Eastern Group for Urolithiasis Research (SEGUR 2). / Identificación endoscópica de la composición de los cálculos urinarios: un estudio del Southeastern Group for Lithiasis Research (SEGUR 2).

INTRODUCTION AND OBJECTIVES: To assess the surgeon's ability to evaluate the composition of the stone by observation of endoscopic images. MATERIALS AND METHODS: A series of 20 video clips of endoscopic treatments of urinary stones of which was also available the result of infrared spectroscopy was uploaded to a YouTube site accessible only to members of the South Eastern Group for Urolithiasis Research (SEGUR) who were asked to identify the composition of the stones. RESULTS: A total of 32 clinicians from 9 different countries participated in the study. The average number of correct detections of participants was 7.81 ± 2.68 (range 1-12). Overall accuracy was 39% (250 out of 640 predictions). Calcium oxalate dihydrate stones have been correctly detected in 69.8%, calcium oxalate monohydrate in 41.8%, uric acid in 33.3%, calcium oxalate/uric acid in 34.3% and cystine in 78.1%. Precision rates for struvite (15.6%), calcium phosphate (0%) and mixed calcium oxalate/calcium phosphate (9.3%) were quite low. CONCLUSIONS: Observation of the stone during the endoscopic procedure was not reliable to identify the composition of most stones although it gave some information allowing to identify with a good sensitivity calcium oxalate dihydrate and cystine stones. Nevertheless, photo or video reporting of the intact stone and its internal structure could should be encouraged to implement results of still mandatory post-operative stone analysis. Endourologists should improve their ability of visual identification of the different types of stones.

Estrogen reduction by aromatase inhibition for benign prostatic hyperplasia: results of a double-blind, placebo-controlled, randomized clinical trial using two doses of the aromatase-inhibitor atamestane. Atamestane Study Group.

BACKGROUND: The concept of estrogen withdrawal by an aromatase inhibitor in the treatment of benign prostatic hyperplasia (BPH) was assessed in a prospective, randomized, double-blind, placebo-controlled multicenter trial. METHODS: Two hundred and ninety-two patients with clinical symptoms of BPH were randomly allocated to one of the following treatments for 48 weeks: placebo or the selective aromatase inhibitor, atamestane, at a daily dose of 100 mg or 300 mg. Both doses of atamestane significantly reduced serum concentrations of estradiol and estrone, and produced a slight, dose-dependent, counter-regulatory increase in peripheral androgen concentration. RESULTS: Clinical symptoms improved during treatment in all three groups. Even after 48 weeks, the effect of active treatment did not exceed the effect seen with placebo. Overall tolerance of 100 mg atamestane was excellent, but 300 mg showed a slightly increased incidence of side effects compared with placebo. CONCLUSIONS: The conclusion from this study is that the reduction in estrogen concentration using the selective aromatase inhibitor atamestane has no effect on clinically established BPH.

Influence of indomethacin and aspirin on the vesicosphincteric dynamics of prostatectomized patients.

The urodynamic and clinical effects of two known prostaglandin synthetase inhibitors--indomethacin and aspirin--were analysed using 59 prostatectomized patients as experimental subjects. We obtained clinical and urodynamic results within each group by comparing the situation before and after medication. A placebo group of 12 patients was used to get an idea of the natural evolution of the situation. A urodynamic workup was done 1 h and 30 min after the administration of the drugs and placebo and the clinical results were analysed on the 8th day of treatment, at which time a few patients were again studied urodynamically. The clinical results were again evaluated a short time after the treatment had been terminated. Marked clinical and urodynamic changes showed that bladder and urethral structures had been affected. Urodynamic modifications, were statistically analysed. We concluded that changes noted were at least partially due to prostaglandin synthesis inhibition and the resulting inhibition of prostaglandin action.