Bifidez pieloureteral proximal derecha incompleta y triplicidad pieloureteral proximal izquierda incompleta / Right proximal partial bifidus pelvis and ureter and left partial proximal pyeloureteral triplicity

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[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.

[Recurrent neobladder rupture: conservative management]. / Rotura recurrente de neovejiga ileal: manejo conservador.

PURPOSE: To present a case of recurrent neobladder rupture treated in a conservative fashion. To review the articles on conservative management of cases like this one published from 1985. RESULTS: Nineteen articles have been published since 1985 on spontaneous neobladder rupture, 4 of which describe the possibility of a successful conservative management, provided that the patients are carefully selected. CONCLUSIONS: Faced to abdominal pain in patients with neobladder, it is essential to suspect spontaneous perforation and, if possible, to confirm such suspicions by means of cystography or CT. An exploratory laparotomy may be necessary in many instances, sometimes due to lack of a diagnosis and sometimes because the patient's status rules out any other procedure, but in selected and precisely diagnosed cases a conservative management can be resolvent.

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

Introducción: Los estudios de San Antonio y Somacarrera en 1977, y de Rousaud-Inmark en 1984, establecen las primeras cifras de incidencia y prevalencia de la urolitiasis en España, seguidas de otras apreciaciones epidemiológicas regionales o nacionales realizadas por otros autores. Material y métodos: Se han seleccionado los trabajos con datos originales sobre incidencia o prevalencia, de ellos 5 son incidencia, 8 prevalencia y 3 contienen ambos. Diez grupos se basan en estudios poblacionales (SanAntonio, Martín, Pedrajas, Rousaud-Inmark, Torres, Ripa, Romero, Grases, Alapont, Aíbar), 5 en estimaciones subjetivas (Solé-Balcells, Cifuentes, Puigvert, Serrallach, Conte) y uno es mixto (Somacarrera). Siete trabajos son de ámbito nacional y 9 son sobre zonas concretas. Se presenta un mapa con los enclaves de los diferentes estudios. Se ha realizado un registro de datos para proceder al cálculo de la media nacional de incidencia y prevalencia. Resultados: La media de incidencia de la urolitiasis en España es del 0,73%, correspondiente a 325.079 nuevos casos por año; y la de prevalencia es del 5,06%, correspondiente a 2.233.214 casos totales. Discusión: Los estudios más válidos desde el punto de vista metodológico se han basado en las encuestas a la población general. Un sesgo común en la mayoría de estudios es extraer el dato epidemiológico de los registros asistenciales retrospectivos. Aunque la mayoría de trabajos reflejan dificultades metodológicas, sus datos coinciden con los datos publicados internacionalmente, y muestran el interés por la epidemiología en el ámbito de laurolitiasis

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 ofthem are about incidence, 8 about prevalence and 3 include both. Ten papers are based on poblational research (San Antonio, Martín, 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

Rotura recurrente de neovejiga ileal: manejo conservador / Recurrent neobladder rupture: conservative management

Objetivo. Exposición de un caso de rotura recurrente de neovejiga tratada de forma conservadora. Revisión de los artículos publicados desde 1985 sobre tratamiento conservador en estos casos. Resultados. Desde 1985 se han publicado 19 artículos sobre rotura espontánea de neovejigas, de los cuales, 4 hablan de la posibilidad de tratamiento conservador con éxito, siempre que los paciente sean bien seleccionados. Conclusiones. En pacientes con neovejiga es fundamental sospechar una perforación espontánea ante dolor abdominal, y, si es posible, confirmarlo mediante cistografía o TC. En muchas ocasiones, será necesaria una laparotomía exploradora, bien por la falta de diagnóstico, bien porque el estado del paciente no permite otra actitud, pero en casos seleccionados y con un diagnóstico preciso, el tratamiento conservador puede ser resolutivo

Purpose. To present a case of recurrent neobladder rupture treated in a conservative fashion. To review the articles on conservative management of cases like this one published from 1985. Results. Nineteen articles have been published since 1985 on spontaneous neobladder rupture, 4 of which describe the possibility of a successful conservative management, provided that the patients are carefully selected. Conclusions. Faced to abdominal pain in patients with neobladder, it is essential to suspect spontaneous perforation and, if possible, to confirm such suspicions by means of cystography or CT. An exploratory laparotomy may be necessary in many instances, sometimes due to lack of a diagnosis and sometimes because the patient’s status rules out any other procedure, but in selected and precisely diagnosed cases a conservative management can be resolvent

[Prognostic factor and prediction tables for clinically localized prostate cancer]. / Factores pronósticos y tablas predictivas del cáncer de próstata clínicamente localizado.

INTRODUCTION AND OBJECTIVES: To identify the independent prognostic factors of prostate cancer and to develop a table for predicting the probabilities of not-localised prostate cancer occurrence, thus permitting to restrict the radical prostatectomy indication to those patients who have greater probabilities of being cured by the procedure. METHODS: 1293 patients with clinically localised prostate cancer, with histories of neither hormone therapy nor prostate radiation therapy, in whom radical prostatectomy was performed during the period 1990-2003, were retrospectively evaluated. In order to analyse the prognostic factors, logistic regression was carried out by studying all the potential confusion and interaction factors, and by introducing the independent variables in a forward fashion with the following criteria: BCON(0.0001) LCON(0.00001) ITER(50) POUT(0.1). The prognostic variables were categorised, and the prediction table of the not-localised prostate cancer probability was developed from them. RESULTS: Clinical stage, prostatic specific antigen and Gleason's "grade" were identified as prognostic factors, taking into account that the higher they are, the higher the probability of not-localised prostate cancer occurrence. Logistic regression enabled us to develop a table to predict the probability of not-localised prostate cancer in which, taking a 50% probability as the cutoff point, a 26.13% sensitivity and a 94.65% specificity are obtained. The pathological examination of the prostate and the lymphadenectomy showed that, globally, 70% of the tumours were localised. CONCLUSIONS: Application of tables to predicting the probability of having not-localised prostate cancer offers the possibility of improving the prognostic accuracy of the so-called "risk groups", and enables to issue a therapeutic indication better adjusted to the actual status of the disease.

Factores pronósticos y tablas predictivas del cáncer de próstata clínicamente localizado / Prognostic factor and prediction tables for clinically localized prostate cancer

Introducción y objetivos: Identificar los factores pronósticos independientes del cáncer de próstata y construir una tabla predictiva de la probabilidad de cáncer de próstata no localizado que permitirá ajustar la indicación de prostatectomía radical a aquellos pacientes con mas probabilidad de que ésta fuera curativa. Métodos: Se analizaron retrospectivamente 1.293 pacientes con cáncer de próstata clínicamente localizado, sin antecedentes de tratamiento hormonal ni de radioterapia prostática, a los que se practicó una prostatectomía radical en el periodo 1990- 2003. Para analizar los factores pronósticos se realizó una regresión logística estudiando los posibles factores de confusión e interacción e introduciendo las variables independientes de forma 'forward' con los siguientes criterios: BCON(0,0001) LCON(0,00001) ITER(50) POUT (0,1). Las variables pronosticas se categorizaron y a partir de éstas se construyó la tabla predictiva de probabilidad de cáncer de próstata no localizado. Resultados: Se identificaron como factores pronósticos independientes el estadio clínico, el antígeno prostático específico y el 'grado' de Gleason, observando que a medida que éstos aumentan también lo hacía la probabilidad de cáncer de próstata no localizado. La regresión logística permitió la construcción de una tabla predictiva de la probabilidad de cáncer de próstata no localizado, en la que tomando como punto de corte una probabilidad del 50% se obtiene una sensibilidad del 26,13% y una especificidad del 94,65%. El estudio anatomopatológico de la próstata y la linfadenectomía demostró que globalmente el 70% de los tumores estaban localizados. Conclusiones: El uso de tablas predictivas de la probabilidad de cáncer de próstata no localizado permite mejorar la exactitud pronostica de los llamados 'grupos de riesgo' permitiendo una indicación terapéutica más acorde con la realidad de la enfermedad

Introduction and objectives: To identify the independent prognostic factors of prostate cancer and to develop a table for predicting the probabilities of not-localised prostate cancer occurrence, thus permitting to restrict the radical prostatectomy indication to those patients who have greater probabilities of being cured by the procedure. Methods: 1293 patients with clinically localised prostate cancer, with histories of neither hormone therapy nor prostate radiation therapy, in whom radical prostatectomy was performed during the period 1990-2003, were retrospectively evaluated. In order to analyse the prognostic factors, logistic regression was carried out by studying all the potential confusion and interaction factors, and by introducing the independent variables in a forward fashion with the following criteria: BCON(0.0001) LCON(0.00001) ITER(50) POUT(0.1). The prognostic variables were categorised, and the prediction table of the not-localised prostate cancer probability was developed from them. Results: Clinical stage, prostatic specific antigen and Gleason’s 'grade' were identified as prognostic factors, taking into account that the higher they are, the higher the probability of not-localised prostate cancer occurrence. Logistic regression enabled us to develop a table to predict the probability of not-localised prostate cancer in which, taking a 50% probability as the cutoff point, a 26.13% sensitivity and a 94.65% specificity are obtained. The pathological examination of the prostate and the lymphadenectomy showed that, globally, 70% of the tumours were localised. Conclusions: Application of tables to predicting the probability of having not-localised prostate cancer offers the possibility of improving the prognostic accuracy of the so-called 'risk groups', and enables to issue a therapeutic indication better adjusted to the actual status of the disease

[Emphysematous prostatitis, apropos of a case]. / Prostatitis enfisematosa, a propósito de un caso.

OBJECTIVE: To describe a case of emphysematous prostatitis in a 70-year-old male patient. The rarity of this condition is underscored, the diagnostic and therapeutic aspects are discussed and the literature briefly reviewed. METHODS/RESULTS: The diagnosis of emphysematous prostatitis was based on the findings of a plain x-ray of the pelvis, which demonstrated gas in the prostatic region in the AP and oblique views. The diagnosis was confirmed by transrectal US, which also permitted percutaneous drainage. CONCLUSIONS: A plain x-ray of the pelvis is simple and low-cost, and can be useful in orienting the diagnosis in patients with features of prostatic abscess. However, transrectal US is the diagnostic method of choice, which also permits treatment by percutaneous drainage with antibiotic protection.

[Role of percutaneous endopyelotomy in the treatment of pyeloureteral junction stenosis after failed ureteropyeloplasty]. / Papel de la endopielotomía percutánea en el tratamiento de la estenosis de la unión pieloureteral tras el fracaso de la ureteropieloplastia.

OBJECTIVE: To determine the value of percutaneous endopyelotomy (PE) in the treatment of ureteropelvic junction (UPJ) obstruction, particularly after failed ureteropelvioplasty. METHODS: A series of 14 (PE) procedures performed at our institution were retrospectively studied. The patients were divided into two groups: group I comprised patients in whom PE was used for primary repair and group II comprised patients submitted to PE after failed ureteropelvioplasty. The patients were assessed for hydronephrosis, lithiasis, previous procedures performed, operating time, duration of hospital stay and outcome. The Fisher test and Mann-Whitney U test were used for statistical analysis. RESULTS: The success of PE did not correlate with the degree of hydronephrosis, the presence of calculus or a previous procedure. The operating times were similar for both groups and for patients with and without lithiasis. The results were better for group II than for group I (p = 0.01). CONCLUSIONS: 1. In correctly selected cases, PE appears to be a good method of treatment for recurrent UPJ obstruction after failed ureteropelvioplasty. 2. The difficulty and the operating time of PE for recurrent UPJ obstruction is not different to that of previously untreated cases. No factor was found to correlate more with the success or failure of PE.

[Emphysematous pyelonephritis associated with splenic infarction: conservative approach. Apropos of a case and review of the literature]. / Pyélonéphrite emphysémateuse associée à un infarctus splénique: attitude conservatrice. A propos d'un cas avec revue de la littérature.

A case report of a emphysematous pyelonephritis associated with a splenic infarction is presented. The point of this case is the association of two rare pathologies and their management by the placement of a percutaneous nephrostomy. A review of the literature could not find any similar case.

[Determination of prognostic factors in incidental prostatic carcinoma]. / Determinación de factores pronósticos en el carcinoma prostático incidental.

Over a ten year period, 5,954 patients with benign prostatic hyperplasia (BPH) were hospitalized in our Institution. Of these, 1,000 cases were randomly chosen for the present study. Surgery was performed in 930 patients: transurethral resection (TUR) in 665 (72%) and open prostatectomy in 265 (28%). The pathological analyses revealed prostatic adenocarcinoma in 36 patients (4%). Seven patients were excluded: 5 due to a short follow-up (less than one year), one who had died from pulmonary embolism immediately postoperatively and one who had developed metastatic disease a few months after the operation. The age of the 29 evaluable patients ranged from 53 to 91 years (mean 72.7 years) and the overall mean follow-up was 43 months. Eighteen patients staged A1 were treated conservatively and followed from 12 to 127 months (mean 53.5 months). Two patients (11%) showed progression, one locally at 42 months (5.5%) and one developed bone metastasis at 15 months (5.5%) and died at 27 months (Mortality: 5.5%). Of the eleven patients with stage A2 prostatic cancer, 7 were managed conservatively (watchful waiting), 1 underwent radical prostatectomy and 3 received early hormone therapy for undifferentiated lesions. Five patients progressed (45%), including the three patients treated with early hormone therapy, 3 local (27%) and 2 systemic (18%). Two of the 11 patients died from cancer (18%) and 2 from unrelated causes. The Gleason grading system and tumor volume (focal or diffuse) were compared as prognostic factors using the Kaplan-Meyer and log-rank test.(ABSTRACT TRUNCATED AT 250 WORDS)

[English and Spanish nomenclature of catheters and other urological instruments]. / Sobre la nomenclatura en inglés y castellano de sondas y otros instrumentos urológicos.

We analyze names given to urologic devices that are apparently similar in English and Spanish but with different meanings. The translation of the commonest terms for instruments and some problematic words are reviewed. Although some of the equivalents are a convention, it is interesting to know the more widely used nowadays.