Sacral neuromodulation therapy for urinary and defecatory disorders: experience in a Latin American public hospital.

Objective: To show the experience of a Latin American public hospital, with SNM in the management of either OAB, NOUR or FI, reporting feasibility, short to medium-term success rates, and complications. Methods: A retrospective cohort was conducted using data collected prospectively from patients with urogynecological conditions and referred from colorectal surgery and urology services between 2015 and 2022. Results: Advanced or basic trial phases were performed on 35 patients, 33 (94%) of which were successful and opted to move on Implantable Pulse Generator (GG) implantation. The average follow-up time after definitive implantation was 82 months (SD 59). Of the 33 patients undergoing, 27 (81%)reported an improvement of 50% or more in their symptoms at last follow-up. Moreover, 30 patients (90%) with a definitive implant reported subjective improvement, with an average PGI-I "much better" and 9 of them reporting to be "excellent" on PGI-I. Conclusion: SNM is a feasible and effective treatment for pelvic floor dysfunction. Its implementation requires highly trained groups and innovative leadership. At a nation-wide level, greater diffusion of this therapy among professionals is needed to achieve timely referral of patients who require it.

Sacral neuromodulation therapy for urinary and defecatory disorders: experience in a Latin American public hospital

Abstract Objective: To show the experience of a Latin American public hospital, with SNM in the management of either OAB, NOUR or FI, reporting feasibility, short to medium-term success rates, and complications. Methods: A retrospective cohort was conducted using data collected prospectively from patients with urogynecological conditions and referred from colorectal surgery and urology services between 2015 and 2022. Results: Advanced or basic trial phases were performed on 35 patients, 33 (94%) of which were successful and opted to move on Implantable Pulse Generator (GG) implantation. The average follow-up time after definitive implantation was 82 months (SD 59). Of the 33 patients undergoing, 27 (81%)reported an improvement of 50% or more in their symptoms at last follow-up. Moreover, 30 patients (90%) with a definitive implant reported subjective improvement, with an average PGI-I "much better" and 9 of them reporting to be "excellent" on PGI-I. Conclusion: SNM is a feasible and effective treatment for pelvic floor dysfunction. Its implementation requires highly trained groups and innovative leadership. At a nation-wide level, greater diffusion of this therapy among professionals is needed to achieve timely referral of patients who require it.

Urodynamic and clinical features in women with overactive bladder: When to suspect concomitant voiding dysfunction?

AIM: The aim of this study is to describe the prevalence and type of female voiding dysfunction (FVD) in patients with overactive bladder (OAB) who were studied by urodynamics and its relationship with voiding symptoms. METHODS: This is a cross-sectional study of female adult patients with OAB syndrome who underwent UDS in a University Hospital in Chile between January 2015 and April 2020. FVD was defined either as bladder outlet obstruction (BOO) or detrusor underactivity (DU). BOO was established if the Solomon-Greenwell BOO index was higher than 18. DU was diagnosed when the invasive maximum flow rate (Qmax) was ≤15 ml/sec, detrusor pressure at Qmax (Pdet@Qmax) was ≤20 cmH2 O and postvoid residual (PVR) was greater than 10%. Urodynamic data and clinical features were compared between groups. RESULTS: Two hundred and ninety-nine UDS were selected and analyzed. Bladder outlet obstruction was diagnosed in 59 patients (19.7%), whereas DU was found in 10 patients (3.3%). In the multivariate analysis, the logistic regression to predict BOO demonstrated that night-time frequency, the presence of detrusor overactivity and a higher PVR were independent predictors of BOO. Instead, for DU, the only independent predictor was a smaller voided volume in the pressure-flow study. CONCLUSION: Female voiding dysfunction was found in 23% of patients with overactive bladder. BOO is more frequent than DU, and should be suspected in patients with higher night-time frequency, presence of detrusor overactivity and a high PVR. Instead, DU should be suspected in patients with a smaller voided volume.

Single-Stage Reconstruction of Fossa Navicularis Strictures Using a "Sliding-T" Dorsal Inlay Urethroplasty With Buccal Mucosal Graft.

OBJECTIVE: To describe a single-stage urethroplasty for fossa navicularis strictures using a "sliding-T" dorsal inlay technique with buccal mucosa. Strictures of the fossa navicularis are challenging. Endoscopic treatments typically offer only temporary relief and necessitate lifelong instrumentation. Reconstruction should provide an unobstructed urethra, slit-like meatus, preserve sexual function, and create a cosmetically appealing glans. The ideal urethroplasty technique has not yet been elucidated despite various described single-stage and multistaged approaches. METHODS: A retrospective review from January 2013 to May 2018 was performed to identify patients undergoing single-stage urethroplasty for fossa navicularis strictures. The primary outcome was urethroplasty success defined as the ability to easily pass a 16 Fr flexible cystoscope with a minimum of 12-month follow-up. Secondary outcome measures included 90-day complications, de novo erectile dysfunction, chordee, and patient satisfaction assessed at ~6-months postoperatively with the question, "Overall, are you satisfied with the result of your operation for urethral stricture?" RESULTS: Twenty-seven patients underwent reconstruction of fossa navicularis strictures using buccal mucosa with a "sliding-T" dorsal inlay urethroplasty technique. Stricture etiology was most commonly lichen sclerosus (70.4%; n = 19), iatrogenic (18.5%; n = 5), or idiopathic (11.1%; n = 3). Mean stricture length was 3.2 cm ± 1.2 [1-4] and mean patient age was 47.3 years [19-71]. Around 92.6% (n = 25) of patients failed prior endoscopic treatment while 7.4% (n = 2) failed prior urethroplasty. At a mean follow-up of 29.6 (12-60) months the success rate was 92.4% (n = 25). Both recurrences were managed successfully with meatotomy. 90-day complications (Clavien ≥2) occurred in 2 patients (7.4%) (surgical site infection treated with antibiotics). Functionally, 1 patient (3.7%) experienced de novo erectile dysfunction, 1 (3.7%) reported mild chordee, and 96.3% (26/27) of patients were satisfied with the outcome of surgery. CONCLUSION: Reconstruction of fossa navicularis strictures using buccal mucosa with a single-stage "sliding-T" dorsal inlay technique provides satisfying anatomic and functional outcomes with a low rate of associated complications.

Intrasphincteric anastomotic urethroplasty allows preservation of continence in men with bulbomembranous urethral strictures following benign prostatic hyperplasia surgery.

PURPOSE: Injury to the external sphincter during urethroplasty at or near the membranous urethra can result in incontinence in men whose internal sphincter mechanism has been compromised by previous benign prostatic hyperplasia (BPH) surgery. We present outcomes of a novel reconstructive procedure, incorporating a recent anatomic discovery revealing a connective tissue sheath between the external sphincter and membranous urethra, which provides a surgical plane allowing for intrasphincteric bulbo-prostatic urethroplasty (ISBPA) with continence preservation. METHODS: Stricture at or near the membranous urethra after transurethral resection (TURP) or open simple prostatectomy (OSP) was reconstructed with ISBPA. The bulbomembranous junction is approached dorsally with a bulbar artery sparing approach and the external sphincter muscle is carefully reflected, exposing the wall of the membranous urethra. Gentle blunt dissection along this connective tissue plane allows separating the muscle away up to the prostatic apex, where healthy urethra is found for anastomosis. RESULTS: From January 2010 to August 2019, 40 men (18 after TURP and 22 after OSP) underwent ISBPA at a single institution. Mean age was 67 years (54-82). Mean stricture length was 2.6 cm (1-6) with obliterative stricture identified in 10 (25%). At a mean follow-up of 53 months (10-122), 36 men (90%) are free of stricture recurrence and 34 (85%) were completely dry or using one security pad. CONCLUSION: This novel intrasphincteric urethroplasty technique for stricture following BPH surgery is feasible and safe, allowing successful reconstruction with continence preservation in most patients. A larger series and reproduction in other centers is needed.

Female urethral reconstruction: dorsal buccal mucosa graft onlay.

PURPOSE: Female urethral stricture (FUS) is an infrequent entity, but may cause significant morbidity. Despite a rising interest in recent years, there is still scarce published information. In this article, we review FUS with a special attention to the use of dorsal buccal mucosa grafts (DBMG). METHODS: A literature search was conducted summarizing information about etiology, anatomy, diagnosis, and management. A detailed description of our technique for DBMG urethroplasty is given, with a summary report of our experience and results. RESULTS: FUS accounts for about 1% of all women consulting for lower urinary tract symptoms (LUTS). Diagnosis is suspected in front of persistent LUTS suggestive of obstruction. Confirmatory tests are uroflowmetry, endoscopy, and urethrography; true anatomic strictures must be differentiated from functional or physiological obstructions. Initial management may include dilations, but recurrence is frequent. On the contrary, reconstructive surgery is highly efficient, with overall curative rates around 90%. For reconstruction, DBMG has gained popularity, because it would maintain intact the ventro-lateral urethral supporting structures, important for continence. The pathology of female strictures is unknown and neither the pre nor the intraoperative assessment allows determining the precise location and extent or the urethral damage; therefore, we advise extensive grafting of the entire urethra. Collected success of DBMG is 86% at a mean follow-up of 21 months. Morbidity is very low and de novo stress incontinence has not been reported. CONCLUSIONS: Because of its many advantages, DMBG currently represents a prime choice for FUS reconstruction.

[Small renal masses. Analysis of 152 cases]. / Masas renales pequeñas: predictores de malignidad en una serie de 10 años.

BACKGROUND: Small renal masses (SRM) are defined as complex organ-confined solid or cystic lesions < 4 cm. Up to 20% of these can be benign. A conservative management with active surveillance can be done in some patients. However, it is difficult to identify patients with a higher risk of malignancy. AIM: To characterize the clinical, radiological and histopathological aspects of patients with SRM, analyzing predictive factors for tumor aggressiveness. MATERIAL AND METHODS: Retrospective analysis of a cohort of patients undergoing partial or total nephrectomy for renal tumors between 2006 and 2016. All tumors of 4 cm or less were included. Four histological groups were defined: benign, favorable, intermediate and unfavorable. Two categories of risk were also defined: low and high. Preoperative clinical and radiological variables of these patients were analyzed. RESULTS: Data of 152 patients were analyzed. Six percent had a benign histology, and the majority was of intermediate risk (74%). According to histological type, clear cell carcinoma was the most common type (74%). Three percent were benign angiomyolipomas. No malignancy predictive variable was identified. CONCLUSIONS: In these patients, the percentage of benign SRM was low. No variable that could predict the presence of a benign or malignant lesion in the definitive biopsy was identified.

Transmigración de canino mandibular: etiología, manejo quirúrgico y consideraciones especiales / Mandibular canine transmigration: etiology, surgical management and special considerations

En raras ocasiones, el canino mandibular derecho o izquierdo se coloca en el lado opuesto al habitual. Esta perturbación se define como la transmigración. Existen diversas teorías de su etiología, así como factores que la condicionan. La transmigración mandibular es un término que no está descrito en la literatura contemporánea y son pocos los casos reportados a nivel mundial. Presentamos un caso de trasmigración de canino mandibular derecho, posicionado por debajo del agujero mentoniano de lado izquierdo, cerca del borde basal mandibular, el cual se extrajo bajo anestesia general. Presentamos la etiología, técnica quirúrgica y consideraciones especiales en casos de trasmigración de canino mandibular (AU)

In rare occasions right or left mandibular canine is positionated at opposed side of habitual. This disturbance is defined as transmigration. There exist diverse theories about its etiology as well as conditioning factors. Mandibular transmigration is a non described term in modern literature and there are only a few reported cases at world level. We present one case of right canine transmigration positionated intimately below of left side mentonian hole near of mandibular basal edge which it was extracted under general anesthesia. We present also the etiology, surgical technique and special considerations of mandibular canine transmigration cases (AU)

Canadian Experience with the Adjustable Transobturator Male System for Post-Prostatectomy Incontinence: A Multicenter Study.

PURPOSE: We assessed the efficacy and safety profile of the ATOMS® (Adjustable Transobturator Male System) for post-prostatectomy incontinence in a multicenter North American setting. MATERIALS AND METHODS: We reviewed outcomes from 8 centers in men who underwent treatment of post-prostatectomy incontinence with an ATOMS. Primary study outcomes were pad changes and continence, defined as requiring 1.0 or 0 pad postoperatively in patients who required 2.0 or more pads preoperatively and 0 pad in those who required more than 1.0 or 2.0 pads preoperatively. Secondary outcomes included improvement, 90-day complications and patient satisfaction. RESULTS: A total of 160 patients were enrolled in study with a median followup of 9.0 months. Preoperative median pad use was 4 per day (IQR 3-5). Of the patients 36.3% reported severe preoperative incontinence, 31.3% received prior radiotherapy and 16.3% underwent previous incontinence surgery. Median postoperative pad use after adjustments was 0.5 per day (IQR 0-1, p <0.001). The overall continence rate was 80.0% with improvement in 87.8% of cases. Of the patients 70.1% underwent a mean ± SD of 2.4 ± 2.7 adjustments (IQR 0-16). The patient satisfaction rate was 86.3%, 22.3% experienced 90-day complications of any grade and 7 (4.4%) experienced Clavien III complications primarily related to the injection port. Patients with a history of radiotherapy were less likely to be continent (62.5% vs 87.9%, p=0.002), improved (77.1% vs 92.6%, p=0.02) or satisfied (69.8% vs 93.2%, p=0.001). Similarly patients with previous incontinence surgery had lower rates of continence, improvement and satisfaction (57.7%, 73.1% and 69.6%, respectively). CONCLUSIONS: In the short term the ATOMS is a safe and efficacious device to treat post-prostatectomy incontinence. Patients with concurrent radiotherapy and previous incontinence surgery respond to treatment but are less likely to be continent, improved or satisfied.

Masas renales pequeñas: predictores de malignidad en una serie de 10 años / Small renal masses: analysis of 152 cases

Background: Small renal masses (SRM) are defined as complex organ-confined solid or cystic lesions < 4 cm. Up to 20% of these can be benign. A conservative management with active surveillance can be done in some patients. However, it is difficult to identify patients with a higher risk of malignancy. Aim: To characterize the clinical, radiological and histopathological aspects of patients with SRM, analyzing predictive factors for tumor aggressiveness. Material and Methods: Retrospective analysis of a cohort of patients undergoing partial or total nephrectomy for renal tumors between 2006 and 2016. All tumors of 4 cm or less were included. Four histological groups were defined: benign, favorable, intermediate and unfavorable. Two categories of risk were also defined: low and high. Preoperative clinical and radiological variables of these patients were analyzed. Results: Data of 152 patients were analyzed. Six percent had a benign histology, and the majority was of intermediate risk (74%). According to histological type, clear cell carcinoma was the most common type (74%). Three percent were benign angiomyolipomas. No malignancy predictive variable was identified. Conclusions: In these patients, the percentage of benign SRM was low. No variable that could predict the presence of a benign or malignant lesion in the definitive biopsy was identified.

Characterization and outcomes of urethroplasty for hypospadias-associated urethral strictures in adults.

INTRODUCTION: Urethral stricture is one of the most commonly encountered complications after hypospadias repair but remains poorly described. The aim of this study is to better characterize hypospadias-associated urethral strictures (HAUS) and treatment outcomes. METHODS: We conducted a retrospective analysis of 84 patients who underwent urethroplasty (UP) for HAUS from 2003-2017. Patients were characterized with regard to demographics, stricture length, location, concurrent pathology, previous surgery, type of urethroplasty, 90-day complications, and surgical success defined as the absence of stricture on cystoscopy. Univariate and survival multivariate analysis was performed. RESULTS: Overall success was 88.1% at a mean followup of 19 months, with a 90-day complication rate of 9.5%, a 21.4% rate of urethrocutaneous fistula requiring a mean of 1.4 surgeries. Patients were categorized into one of four groups based on stricture length, location, and number of previous procedures: group 1 (66.7%) - previous failed hypospadias repair (HR) with stricture involving the entire repair; group 2 (7.1%) - "junctional stricture" at the junction of the "neourethra" and native urethra; group 3 (11.9%) - isolated bulbar stricture outside the repaired urethra; group 4 (14.3%) - urethral stricture in untreated hypospadias. Despite differing by technique (p<0.0001), stricture length (p=0.02), location (p<0.001), and number of previous repairs (p<0.001), groups did not significantly differ by success (p=0.82), complications (p=0.16), or urethrocutaneous fistula (p=0.19), whereas individual techniques did. CONCLUSIONS: UP for HAUS is often successful but patients frequently require more than one operation and have a significant risk of associated complications. Despite a broad spectrum of presentation, patients can often be categorized into one of four groups, which can help direct decision-making and obtain similar outcomes regardless of baseline differences.

Estrechez de uretra bulbopeneana de 16 centímetros, ¿es posible resolverla en un sólo tiempo? / 16-centimeter Penile Bulbar Urethral Stricture: Can it be Solved in Only One Stage?

La panestenosis de la uretra anterior tradicionalmente se ha resuelto mediante la uretroplastía en etapas. Esto implica un grave deterioro en la calidad de vida del paciente, ya que debe permanecer con la uretra expuesta y orinando sentado por unos 2 a 6 meses, entre las cirugías. Nuestro objetivo es detallar una técnica alternativa. Materiales y métodos: Presentamos un paciente de 60 años, con antecedentes de uropatía obstructiva baja de larga data, sin estudio previo. Durante una hospitalización para recambio valvular aórtico, presenta una retención aguda de orina. El sondeo uretral resulta frustro y debe instalarse una cistostomía. Posteriormente, se estudia con cistouretroscopía retrógrada y anterógrada flexible, encontrándose estrecheces en uretras peneana y bulbar, además de extensa espongiofibrosis. La uretrocistografía confirma una panestenosis anterior y muestra una uretra posterior indemne. Se decide resolver mediante uretroplastía con técnica de Asopa, utilizando un abordaje ventral, con injerto doble de mucosa oral, dispuesto en inlay dorsal, en un solo tiempo. Con bisturí oftálmico, se realiza una amplia y profunda uretrotomía dorsal, donde se fijarán los injertos más adelante. Simultáneamente, otro equipo cosecha la mucosa oral de ambas mejillas y prepara los injertos. Estos se fijan con sutura corrida en todos sus extremos y, mediante puntos interrumpidos, a la línea media sobre la albugínea dorsal. Una vez que los injertos están fijos, se instala una sonda foley siliconada de 16Fr y se procede a realizar la uretrorrafia del abordaje ventral, sobre la sonda. Finalmente se procede al cierre del cuerpo esponjoso, músculo bulboesponjoso, fascia de Colles, tejido subcutáneo y piel. Resultados: No hubo complicaciones intraoperatorias ni postoperatorias. El paciente se dio de alta a sudomicilio a los 4 días postoperatorios. La sonda se mantuvo por 34 días en total y se retiró previa realización de una pericateterografía. A los 6 meses de seguimiento, tiene un IPSS=5 y un Qmax de 17ml/seg. Conclusiones: Es factible y seguro resolver una panestenosis de uretra anterior, de 16 centímetros, mediante la técnica de Asopa, en un solo tiempo.

The pananterior urethral strictures has traditionally been solved by urethroplasty in stages. This implies serious deterioration in the life quality of patients, since the patient's urethra must remain exposed and urination must take place in a sitting position for 2 to 6 months between surgeries. Our goal is to detail an alternative technique. Materials and methods: We present a 60-year old patient with a history of long-standing lower obstructive uropathy with no previous study. During hospitalization for aortic valve replacement, he exhibits acute urinary retention. Urethral sounding is unsuccessful and cystotomy must performed. Later, he is subject to a flexible retrograde and antegrade cystourethroscopy study, finding a strictured penile and bulbar urethra, plus extensive spongiofibrosis. Urethrocystography confirms pananterior stenosis and shows an unscathed posterior urethra. It was decided to resolve the condition by urethroplasty with Asopa technique, using a ventral approach, with oral mucosa double graft, placed in a one-stage dorsal inlay. An ophthalmic scalpel is used to perform a broad and deep dorsal urethrotomy, where the grafts will be later placed. Simultaneously, another team harvest the oral mucosa from both cheeks and prepares the grafts. The latter are fastened with running suture in all ends and by interrupted stitches to the midline on the dorsal tunica albuginea. Once the grafts are fastened, a 16Fr silicone Foley catheter is installed and uretrorraphy is performed by ventral approach over the catheter. Finally, the spongy body, bulbospongiosus muscle, Colles' fascia, subcutaneous tissue and skin are closed. Results: There were no intraoperative or postoperative complications. The patient was discharged 4 days after surgery. The catheter was maintained for 34 days in total and removed after pericatheterogram. On the 6-months follow-up, it presents IPSS = 5 and Qmax of 17ml / sec. Conclusions: It is feasible and safe to resolve a pananterior urethral stenosis of 16 centimeters, using the technique of Asopa in one stage.

[Urethroplasty with buccal mucosa graft or penile skin graft for anterior urethral stricture?]. / ¿Uretroplastía con injerto de mucosa oral o piel prepucioescrotal para el tratamiento de la estrechez de uretra anterior?

Currently the treatment for urethral stricture considers various techniques, including augmentation urethroplasty using tissue from different parts of the body. The more used are the buccal mucosa and penile skin, but are there any differences in success between both tissues? Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified one systematic review including 18 primary studies addressing this question, six of them prospective. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded there is uncertainty about the superiority of one technique over another because the certainty of the evidence is very low. A new systematic review is urgently needed on this topic as randomized studies have been published after the most recent review, which could provide greater certainty.

Actualmente el tratamiento para la estrechez de uretra considera diversas técnicas, entre ellas la uretroplastía de aumento utilizando tejidos provenientes de distintas partes del cuerpo, siendo los más utilizados la mucosa oral y la piel prepucioescrotal. Sin embargo ¿existen diferencias en el éxito entre ambos tejidos? Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos una revisión sistemática, que incluye 18 estudios que abordan esta pregunta, entre ellos seis estudios prospectivos. Realizamos una tabla de resumen de los resultados utilizando el método GRADE. Concluimos que existe incertidumbre sobre la superioridad de una técnica sobre otra porque la certeza de la evidencia es muy baja. Se necesita con urgencia una nueva revisión sistemática en este tópico ya que existen estudios publicados con posterioridad a la revisión más reciente que podrían entregar una certeza mayor.

Validation of a high-fidelity model in ureteroscopy incorporating hand motion analysis.

PURPOSE: To establish the construct validity of a semirigid ureteroscopy in a high-fidelity simulation model, incorporating hand motion analysis as a paramount part of evaluation. METHODS: Participants were divided into 3 groups: group 1 (9 junior residents, without experience in ureteroscopy), group II (9 senior residents, with variable experience in ureteroscopy) and group III (2 experts in endourologist); each group performed a single practice session in the high-fidelity bench model, which was previously prepared with small urinary stone phantom in the mid-ureter. Assessment was done using motion tracking device (ICSAD). Procedures were recorded in external vision and endoscopic vision and scored by two blinded evaluators using a Global Rating Scale and ureteral checklist (OSATS). RESULTS: Significant differences were observed in time taken, path length, numbers of movements, Global Rating Scale and checklist in favor of the experts group. Subanalysis demonstrated no relevant differences between groups II and III in general dexterity parameters except for the non-dominant hand, where experts showed a significant less number of movement (34 vs 221; p = 0.03) and path length (12.1 vs 45.1; p = 0.03). The interrater reliability of the GRS was excellent (0.81; p < 0.001), while for checklist ICC was moderate (0.45; p = 0.03). CONCLUSIONS: The incorporation of ICSAD into the construct validity of this ureteroscopy model complements traditional methods used to achieve construct validity (OSATS). To our knowledge, this study is the first report using motion analysis as a tool for performance evaluation in a simulated endourological procedure.

Uso rutinario del dispositivo antimigratorio Accordion para prevenir la retropulsión de cálculos ureterales durante la litotripsia intracorpórea con laser Holmium: ¿se justifica su uso? / Routine use of Accordion® antimigratory device for preventing the retropulsion of ureteral stones during intracorporeal lithotripsy with holmium laser: is it justified?

Evaluar el impacto del dispositivo Accordion® (Percsys, Palo Alta, CA) en la prevención de la migración de cálculos ureterales. Materiales y Métodos: Un total de 68 pacientes con cálculos ureterales fueron evaluados en este estudio caso-control. 34 fueron destinados al grupo I (grupo Accordion®) y 34 al grupo II (grupo control). Como objetivo primarios se evaluó la diferencia en tiempo de fragmentación durante el procedimiento. Objetivos secundarios evaluados fueron el tiempo operatorio total, tasa de éxito en la fragmentación del cálculo, requerimiento de catéter ureteral posterior al procedimiento y complicaciones perioperatorias. Resultados: Ambos grupos de pacientes resultaron comparables en término de variables demográficas y características de la litiasis. El tiempo de fragmentación intraoperatoria fue similar entre los grupos (25 minutos en el grupo I vs 24 minutos en el grupo II; p=0,94). No fue encontrada ninguna diferencia estadísticamente significativa en tiempo operatorio total (45 minutos en el grupo I vs 50 minutos en el grupo II; p =0,67) o tasa de éxito en la fragmentación (100 por ciento grupo I vs 97 por ciento grupo II). El análisis multivariado demostró una disminución significativa en la necesidad de instalación de catéter doble J al término del procedimiento con el uso de Accordion durante la ureteroscopía (OR 0.24; CI 0,07-0,90; p=0.034).Conclusión: Ambos grupos en nuestro estudio se comportaron de manera similar con respecto a los resultados inmediatos de la ureteroscopía. La disminución en la necesidad de instalación de un catéter doble J y el costo asociado a éste constituyen un argumento a favor de utilizar el dispositivo Accordion®...

To evaluate the impact of Accordion® (Percsys, Palo Alto , CA) device in preventing stone migration. Methods: A total of 68 patients with ureteral stones were evaluated in this case control study, 34 in group I (Accordion group) and 34 in group II (control group) . As primary outcome we evaluated difference in fragmentation time during the procedure. Secondary outcomes were total operative time, stone free rates, postoperative ureteral catheter requirement and perioperative complications. Results: Both groups of patients were comparable in terms of demographics variables and stone characteristics. Intraoperative fragmentation time was similar between groups (25 minutes for group I vs 24 minutes for group II; p=0,94). No statistically significant difference were found in total operative time (45 minutes for group I vs 50 minutes for group II; p =0,67) or stone free rates (100 percent group I vs 97 percent group II). Multivariate model showed a significant decrease in the need to install a double J catheter at the end of the procedure with the use of Accordion during ureteroscopy (OR 0.24; CI 0,07 -0,90; p=0.034).Conclusions: Both groups in our study behaved similarly with respect to immediate outcome of ureteroscopy. The decrease in the installation of double J stent and the cost associated with it constitutes an argument in favor of the use of Accordion device...

Ureteroscopic lithotripsy for distal ureteral calculi: comparative evaluation of three different lithotriptors.

INTRODUCTION AND OBJECTIVES: We report the results of a randomized controlled trial comparing three different lithotriptors using semirigid ureteroscopy (URS) for distal ureteral stones. METHODS: Between September 2009 and November 2010 69 patients undergoing ureteroscopy were randomized to three groups: LithoClast classic (Group 1), Holmium Laser (Group 2), and StoneBreaker™ (Group 3). A 7.5F semirigid ureteroscope was used in all procedures. The primary outcome was differences in fragmentation time. Secondary outcomes were stone-free rates, intraoperative complications, stone-up migration, hospital stay, analgesic requirement, and need for auxiliary procedures. Patients were followed up at 15 days, 30 days, and 3 months. The stone-free status was defined with noncontrast computed tomography performed at first control. Univariate and multivariate analysis were performed to determine clinical and surgical factors that have direct impact on the success of ureteroscopy. Chi-square test and Analysis of Covariance (ANCOVA) tests were used for statistical comparisons. RESULTS: There were no differences between sociodemographic variables. Average stone size was 7.17±2.04 mm in Group 1; 7.89±2.73 mm in Group 2; and 7.79±2.97 mm in Group 3 (p=0.79). Fragmentation time were similar between lithotriptors; 27.12±4.07 minutes in Lithoclast group; 21.78±2.81 minutes in Laser group, and 27.14±4.71 minutes in StoneBreaker group (p=0.74). Stone-free rates were 96%±11.18% (group 1), 96.9%±8% (group 2), and 96.9%±8.4% (group 3) (p=0.1). No difference was observed in stone-up migration, postoperative Double-J stent placement, or auxiliary procedures. Stone size and the placement of a second working wire were associated with shorter fragmentation time (p<0.01). CONCLUSIONS: The three lithotripsy devices evaluated behaved similarly in terms of the ability to fragment stones, and were equally effective for distal ureteral stones. Adequate fragmentation and fragment removal are mainly dependant on stone size and surgical technique (use of auxiliary wire).

Relación entre índice de masa corporal, cáncer de próstata, antígeno prostático específico y score de Gleason / Is body mass index related to prostate cancer, PSA and Gleason score?

Objetivo: Evaluar la relación entre índice de masa corporal (IMC), riesgo de cáncer de próstata, antígeno prostático específico (APE) y score de Gleason en 505 pacientes sometidos a biopsia prostática. Pacientes y Métodos: Se realizó un estudio caso control evaluando la relación entre IMC y cáncer de próstata. En los pacientes con cáncer de próstata se evaluó la relación entre IMC (<25, <25<30, <30), APE y score de Gleason. Resultados: Adenocarcinoma de próstata fue diagnosticado en 201 pacientes. Al estratificar el IMC (<25, <25<30, <30) de los pacientes y relacionarlo con la presencia o ausencia de cáncer no se encontró asociación estadísticamente significativa entre los grupos. Se encontró un mayor riesgo de cáncer de próstata en los pacientes de mayor estatura. En los pacientes con cáncer no se encontró asociación estadísticamente significativa entre IMC, APE y score de Gleason. Conclusión: No se encontró asociación entre obesidad y cáncer de próstata. Existe un mayor riesgo de cáncer de próstata a mayor estatura. En los pacientes con diagnóstico de cáncer de próstata no se encontró asociación entre obesidad, APE y score de Gleason.

Objetive: To evaluate the relationship between Body Mass Index (BMI), prostate cancer risk, prostate specific antigen (PSA) and Gleason score in 505 patients who underwent transrectal prostatic biopsy. Patients and Methods: We designed a Case-Control study to evaluate the relationship between BMIand the presence of prostate cancer. In the patients with the diagnosis of prostate cancer we evaluated the relationship between BMI (<25, <25<30, <30), PSA levels and Gleason score. Results: Prostate cancer was diagnosed in 201 patients. BMI (<25, <25<30, <30) was not related to the presence of prostate cancer. Height was associated with an increased risk of prostate cancer. Noassociation was found between BMI, PSA levels and Gleason score in patients with prostate cancer. Conclusions: The results of this study support the hypothesis that BMI is not associated with prostate cancer risk in Chilean population. Height is associated with an increased risk of prostate cancer. Inpatients with prostate cancer no association was found between BMI, PSA levels and Gleason score.