Análisis de los factores que influyen en la pérdida hemática en la nefrolitotomía percutánea: registro de la Asociación Española de Urología sobre la posición supina / Analysis of the Factors Affecting Blood Loss in Percutaneous Nephrolithotomy: A Registry of the Spanish Association of Urology in the Supine Position

Objetivo: La nefrolitotomía percutánea (NLP) es la técnica mínimamente invasiva de elección para el tratamiento de la litiasis renal mayor de 2 cm. El objetivo de este estudio es analizar los diferentes factores que influyen en el descenso de hemoglobina durante el procedimiento, realizado en posición supina. Material y métodos: Realizamos un estudio prospectivo multicéntrico observacional de la nefrolitotomía percutánea en posición supina, basado en el registro de la AEU. Se estudian los diferentes factores que influyen en el descenso de hemoglobina: datos demográficos y antropométricos, comorbilidad asociada, localización y tamaño de la litiasis, variantes anatómicas y aspectos técnicos del procedimiento. Resultados: Desde septiembre de 2008 hasta diciembre de 2012 se han registrado 397 NLP en posición supina, realizadas en 15 centros españoles. El descenso medio de hemoglobina fue 2,3 ± 1,5 g/dl y la tasa de transfusión de 5,5%. No hubo diferencias significativas en el descenso de hemoglobina entre varones y mujeres, IMC ni por grupos de edad. Tampoco existen diferencias entre los pacientes con antecedentes cardiovasculares, diabetes, HTA o tratamiento anticoagulante. El tamaño y la localización de la litiasis no influyen de forma significativa en la pérdida hemática. La duración del procedimiento (> o < 120 min), técnica de punción (ecografía, fluoroscopia), el tipo de dilatación del trayecto percutáneo (Alken, balón o Amplatz) y la ausencia de catéter de nefrostomía final (tubeless) no afectaron al descenso de hemoglobina. Únicamente el número de trayectos percutáneos (≥ 2) y el acceso a través de un cáliz medio tuvieron repercusión estadísticamente significativa en la pérdida hemática (p = 0,03 y p = 0,01 respectivamente) (AU)

Conclusiones: La NLP en posición supina es un procedimiento mínimamente invasivo para el tratamiento de litiasis renales múltiples y de gran tamaño (> 2 cm), que implica escasa pérdida hemática, con mínima tasa de transfusión de hemoderivados. Los únicos factores relacionados con mayor descenso de hemoglobina fueron el número de accesos percutáneos y la localización del trayecto en el cáliz medio (AU)

Objective: Percutaneous nephrolithotomy (PCNL) is the minimally invasive procedure of choice for removing renal stones larger than 2 cm. This study has aimed to identify the different variables that might influence decrease of hemoglobin during the surgery performed in supine position. Material and methods: A prospective, multicenter, observational study of supine PCNL, based on the Spanish Association of Urology database, was analyzed. The different preoperative and postoperative factors that might affect the decrease of hemoglobin were assessed: demographics and anthropometric data, comorbidities, size and location of the stones, anatomical variants and technical aspects of the procedure. Results: From September 2008 to December 2012, 397 supine PCNL procedures performed in 15 Spanish centers were registered. Mean hemoglobin decrease was 2.3 ± 1.5 g/dl and overall blood transfusion rate was 5.5%. No statistically significant differences were found between genders, body mass index (BMI) and age in terms of blood loss. There were also no differences between patients with cardiovascular, hypertensive, diabetic and anticoagulant treatment background. Blood loss was not significantly influenced by stone size and location. Technical aspects of the procedure as operative time (> 120 min ≤), access to the pelvi-caliceal system (ultrasound, fluoroscopy), percutaneous tract dilation technique (Alken, balloon or Amplatz) or placement of nephrostomy (tube versus tubeless) were not associated with differences in pre-op/post-op hemoglobin. Only multiple percutaneous tracts (≥ 2) and middle calix access were statistically significantly (P = 0.03 and P = 0.01) related with less blood loss (AU)

Conclusions: PCNL in supine position is a minimally invasive procedure for removal of large (≥ 2 cm) and multiple renal stones, with a low incidence of blood loss and minimal transfusion rate. Multiple percutaneous tracts and middle calix puncture were the only statistically significant variables associated with decrease in hemoglobin levels (AU)

Analysis of the factors affecting blood loss in percutaneous nephrolithotomy: a registry of the Spanish Association of Urology in the supine position.

OBJECTIVE: Percutaneous nephrolithotomy (PCNL) is the minimally invasive procedure of choice for removing renal stones larger than 2 cm. This study has aimed to identify the different variables that might influence decrease of hemoglobin during the surgery performed in supine position. MATERIAL AND METHODS: A prospective, multicenter, observational study of supine PCNL, based on the Spanish Association of Urology database, was analyzed. The different preoperative and postoperative factors that might affect the decrease of hemoglobin were assessed: demographics and anthropometric data, comorbidities, size and location of the stones, anatomical variants and technical aspects of the procedure. RESULTS: From September 2008 to December 2012, 397 supine PCNL procedures performed in 15 Spanish centers were registered. Mean hemoglobin decrease was 2.3±1.5 g/dl and overall blood transfusion rate was 5.5%. No statistically significant differences were found between genders, body mass index (BMI) and age in terms of blood loss. There were also no differences between patients with cardiovascular, hypertensive, diabetic and anticoagulant treatment background. Blood loss was not significantly influenced by stone size and location. Technical aspects of the procedure as operative time (> 120 min ≤), access to the pelvi-caliceal system (ultrasound, fluoroscopy), percutaneous tract dilation technique (Alken, balloon or Amplatz) or placement of nephrostomy (tube versus tubeless) were not associated with differences in pre-op/post-op hemoglobin. Only multiple percutaneous tracts (≥2) and middle calix access were statistically significantly (P=.03 and P=.01) related with less blood loss. CONCLUSIONS: PCNL in supine position is a minimally invasive procedure for removal of large (≥2 cm) and multiple renal stones, with a low incidence of blood loss and minimal transfusion rate. Multiple percutaneous tracts and middle calix puncture were the only statistically significant variables associated with decrease in hemoglobin levels.

[Maternal and perinatal data of hypospadic in a 25 year period]. / Análisis de los datos maternos y perinatales en pacientes con hipospadias en un periodo de 25 años.

OBJECTIVE: To analyze maternal and perinatal risk factors related to the onset and severity of hypospadias. MATERIAL AND METHODS: Data of 614 boys operated on hypospadias in our county during 25 years (1972-1998) has been studied. The patients were divided into 3 groups according the malformation severity: proximal, middle, and distal hypospadias. We use two periods, before and after 1980 to analyze the differences in risk factors along the time. RESULTS: There were 9% of proximal hypospadias, 13.6% middle hypospadias, and 77.5% distal hypospadias. We found statistical significance in several risk factors related to severe hypospadias: low birth weight, intrauterine growth restriction, preterm births, and associated malformations (p < 0.001). We did not find statistical significance with maternal age, toxic exposure, associated diseases, and x-ray exposure during pregnancy. After 1980, there were more severe hypospadias and less gestational age. CONCLUSIONS: Several events during pregnancy can contribute to the development of hypospadias in the fetus. In our experience, since 1980 there is a rise in the number and severity of hypospadias.

Análisis de los datos maternos y perinatales en pacientes con hipospadias en un periodo de 25 años / Maternal and perinatal data of hypospadic in a 25 year period

Introducción: El objetivo del estudio es definir los factores de riesgo materno-fetales que pueden influir en la aparición de hipospadias al nacimiento y en la gravedad del mismo. Material y Métodos: Se han recogido los datos de 614 recién nacidos con hipospadias operados en nuestra comunidad en los últimos 25 años (1972-1998). Para su estudio se han dividido en tres grupos de gravedad de la malformación (proximales, medios y distales) y en dos periodos de tiempo, antes y después de 1980, analizándolos en función de los posibles factores predisponentes. Resultados: El 9% presentaban hipospadias proximales, un 13,6% medios y un 77,5% distales. Se ha encontrado una relación estadísticamente significativa entre la gravedad del hipospadias y el bajo peso al nacimiento, retraso en el crecimiento intrauterino, prematuridad y existencia de malformaciones asociadas (p<0,001). No se ha encontrado significación estadística entre la gravedad del hipospadias y la edad materna, hábitos tóxicos, existencia de enfermedades o exposición a radiaciones en el embarazo. A partir del año 1980, los pacientes presentan hipospadias más severos y una edad gestacional menor. Conclusiones: Existen ciertos acontecimientos en el embarazo que pueden favorecer el desarrollo de hipospadias en el feto. Se esta produciendo un incremento en el número de pacientes con hipospadias y gravedad de estos desde 1980

Objective: To analyze maternal and perinatal risk factors related to the onset and severity of hypospadias. Material and Methods: Data of 614 boys operated on hypospadias in our county during 25 years (1972-1998) has been studied. The patients were divided into 3 groups according the malformation severity: proximal, middle, and distal hypospadias. We use two periods, before and after 1980 to analyze the differences in risk factors along the time. Results: There were 9% of proximal hypospadias, 13,6% middle hypospadias, and 77,5% distal hypospadias. We found statistical significance in several risk factors related to severe hypospadias: low birth weight, intrauterine growth restriction, preterm births, and associated malformations (p<0,001). We did not find statistical significance with maternal age, toxic exposure, associated diseases, and x-ray exposure during pregnancy. After 1980, there were more severe hypospadias and less gestational age. Conclusions: Several events during pregnancy can contribute to the development of hypospadias in the fetus. In our experience, since 1980 there is a rise in the number and severity of hypospadias

[Analysis of the absorcion's factors of irrigating fluid during transurethral resection of the prostate]. / Análisis de los factores de reabsorción de líquido de irrigación durante la RTU de próstata.

OBJECTIVES: In this study it was our intention to evaluate the relation between the reabsorption of irrigating fluid and three variables: time of the intervention, volume of solution of glicina employee and weight of the fragments, during the RTU of prostate fulfilled to low hydraulic pressure. MATERIAL AND METHOD: We study 74 patients that RTU of prostate was performed with suprapúbica derivation with Amplatz's pod 30 ch. The ethanol was monitored in expired air every 15 minutes during the intervention. Likewise we annotated the time of the intervention, the volume of glicina used and the weight of the fragments extracted. Statistically Anova's text was in use for comparison of averages. RESULTS: 13,6% of the patients absorbed irrigating fluid in some quantity. The range of absorption belongs to 100 cc until 2.000 cc. We did not find a statistically significant difference in the averages of time of resection, volume of glicina and weight of the fragments between the group of patients that had absortion of irrigating fluid and they that didn't had. CONCLUSIONS: Our data show that the operative time, the volume of irrigating fluid and the weight of the resected fragments do not influence the reabsorption of liquid of irrigation when a RTU is realized to low hydraulic pressure.

[Quality analysis of the statistical used resources (material and methods section) in thesis projects of a university department]. / Análisis de calidad de los recursos estadísticos (sección material y método) en los proyectos de tesis de un departamento universitario.

INTRODUCTION AND OBJECTIVES: Studies about quality in thesis and investigation projects in biomedical sciences are unusual, but very important in university teaching because is necessary to improve the quality elaboration of the thesis. The objectives the study were to determine the project's quality of thesis in our department, according to the fulfillment of the scientific methodology and to establish, if it exists, a relation between the global quality of the project and the statistical used resources. MATERIAL AND METHODS: Descriptive study of 273 thesis projects performed between 1995-2002 in surgery department of the Zaragoza University. The review realized for 15 observers that they analyzed 28 indicators of every project. Giving a value to each of the indicators, the projects qualified in a scale from 1 to 10 according to the quality in the fulfillment of the scientific methodology. RESULTS: The mean of the project's quality was 5.53 (D.E: 1.77). In 13.9% the thesis projects was concluded with the reading of the work. The three indicators of statistical used resources had a significant difference with the value of the quality projects. DISCUSSION: The quality of the statistical resources is very important when a project of thesis wants to be realized by good methodology, because it assures to come to certain conclusions. In our study we have thought that more of the third part of the variability in the quality of the project of thesis explains for three statistical above-mentioned articles.

[Transurethral prostatic resection with bipolar scalpel]. / Resección transuretral de próstata con bisturí bipolar.

UNLABELLED: FUNDAMENTAL: [corrected] To show our initial experience in the TUR of prostate with bipolar axipolar bistoury. MATERIAL AND METHODS: Five patients with an average age of 72 years old, were operated between may and june 2002. They showed important increased in questionnaire symptoms (IPSS). The average ecographic volume has been 57.4 g. We employed Gyrus resector and physiological salt solution for continue irrigation. RESULTS: The average operative time was 70 minutes. None of the patients showed hyponatremia needed blood transfusion. In all the cases the sound was removed 48 hours after operation, one of them have urinary retention (UR) and need sound tow more days. Hospital stay was tree days except the patient how had UR. At 1 and 6 month there is improvement in the IPSS. CONCLUSIONS: TUR of prostate with bipolar axipolar bistoury can avoid the secondary effects of glicine and allows us to work with prostates of bigger volumes due to we have more time to do it. Nevertheless bigger and better studies are required to value the effectiveness of this new technology opposite the TUR of prostate with monopolar bistoury which keeps being the gold standard.

[Modified technique for transurethral resection of the prostate with suprapubic drainage and local anesthesia]. / Técnica modificada para la resección transuretral de próstata con drenaje suprapúbico y anestesia local.

PURPOSE: To establish a technique for transurethral resection of the prostate (TURP), combining the use of local anaesthesia with an Amplatz suprapubic tube, in patients at high surgical risk. MATERIALS AND METHOD: A study was carried out in 32 patients who underwent TURP with a 30 F Amplatz suprapubic tube following local anaesthesia. This technique was indicated where surgery presented a general risk, in elderly patients, and for patients refusing to undergo spinal intradural or general anaesthesia. The mean age of the patients was 70 years (61-82 years). The risk of surgery was assessed according to the ASA classification. RESULTS: According to the ASA classification, 7 patients were ASA III (21.9%), and 25 patients were ASA IV (78.1%). In 31 of the 32 patients the operation was completed in one session. When questioned about the pain they felt, 11 patients reported no pain, 12 slight discomfort and 3 occasional pain. In the latter three patients, intravenous sedation was enhanced with 0.1 mg etomidate per kg body weight. The volume of the resected fragments ranged from 18 to 120 ml, with a mean of 47 ml, except in one patient with 205 ml who required two treatment sessions. CONCLUSIONS: Large prostate resection in patients at high surgical risk was performed comfortably using a combination of local anaesthesia and an Amplatz suprapubic tube. This procedure is one possible option to be considered as an alternative to other treatments.

[Endoscopic treatment of vesicoureteral reflux]. / Tratamiento endoscópico del reflujo vesicoureteral.

AIM: We report our experience of the endoscopic treatment of vesicoureteric reflux in children by submucosal injection of polytetrafluoroethylene (Teflon). PATIENTS AND METHODS: From April 1995 to September 1999 we treated 30 cases of vesicoureteric reflux in 22 children aged 19 months to 8 years. All the children underwent general anesthesia and subureteric injection of polytetrafluoroethylene paste with a pediatric cystoscope. Patients were discharged the day of the operation and were followed-up 15 days, six months and one year postoperatively with ultrasound and radionuclide cystography. When reflux persisted, the treatment was repeated. RESULTS: Open surgery was performed in one patient with reflux after two repeat injections. Another patient underwent a second, successful, injection. The overall success rate with endoscopic treatment was 96.5% and only one injection was required in 93.1%. None of the patients required hospitalization because of complications due to the operation or the endoscopic technique. CONCLUSIONS: We consider submucosal injection of Teflon to be a first-line technique in the treatment of vesicoureteric reflux in children. The success rate is similar to that of open surgery but with endoscopic treatment morbidity and costs are lower and hospital stay is shorter.

Clinical, physical, sperm and hormonal data in 251 adults operated on for cryptorchidism in childhood.

OBJECTIVE: To determine the clinical, physical, sperm and hormonal status during adulthood in cryptorchid patients operated on during childhood, and to assess these variables according to the age at surgery and preoperative testicular position. PATIENTS AND METHODS: A letter was sent to all 890 patients > 18 years old who underwent surgery for cryptorchidism during childhood; 274 responded and were assessed using a sexual history, physical examination, pituitary axis study and sperm analysis. Data were complete for 251 patients (mean age 21 years, range 18-30); 196 had unilateral (25 anorchic) and 55 had bilateral cryptorchidism. Clinical, surgical and anatomopathological records at surgery during childhood were also reviewed. RESULTS: The mean (SD) age at orchidopexy was 6.4 (3.3) years and the mean age at assessment 21.1 (2.7) years. Semen samples generally showed abnormalities; 10 patients (4%) with bilateral and 57 (23%) with unilateral cryptorchidism had semen values within the normal range. There was no correlation between the sperm count and age at surgery for unilateral or bilateral cases (Spearman test). There was a significant correlation (r = - 0.41) between the sperm count and level of follicle-stimulating hormone (FSH). There were no significant differences in the sperm count for patients with different testicular locations (ANOVA) or in those treated or untreated with human chorionic gonadotrophin (Student's t-test). The only significant relationship (P < 0.001) was between the sperm count and unilateral or bilateral cryptorchidism. CONCLUSIONS: The sperm quality of adults operated on for cryptorchidism during childhood is independent of the age at surgery or testicular location, but is influenced by whether the cryptorchidism was unilateral or bilateral. FSH levels were negatively correlated with sperm density.

[Fertility survey. Approximation to normal values]. / Encuesta de fertilidad. Aproximación a los valores de normalidad.

OBJECTIVE: To determine the fertility data in Aragón, Spain. METHODS: A survey was conducted in several companies during 1997 and 1998. Participation in the survey was optional, participants were not identified and a table of random figures was utilized. Error 2 +/- 2.98, 95% confidence interval, P = Q = 50%. RESULTS: 139 employees participated in the survey; 94% were male, 6.4% were single, 87.7% married, 5.7% had a stable partner, 12.3% had higher level, 53.6% medium and 34% elementary level education. Mean number of children per couple was 1.7 and mean number of children desired was 1.9. Mean time from decision to have children to pregnancy was 4.5 months. Mean age at conception of the first child was 28 years for the men and 25 years for the women. One of the partners was employed in 42.7% of the cases. Mean working hours was 8.3 and mean number of years in the same job was 14.5. Twenty-one percent considered they were exposed to toxic substances. Mean hours of sleep was 6 hours, 35% took warm baths and 24.4% used tight-fitting underclothes. Ninety percent drank alcohol and/or coffee mild to moderately and 50% were smokers. No significant differences were found in the number of children according to level of education, type of work or if one of the partners or both were employed. A clearly negative correlation was found between the year of birth and the number of children desired. CONCLUSION: In Aragón, the birthrate trend remains low and does not appear to be influenced by the economic level, life style, type of job or whether or not both partners are employed.