Fluoroscopy-free semirigid ureteroscopy for ureteral stone treatment: A prospective single-arm study of feasibility, efficacy, and safety.

Objectives: Patients with urolithiasis receive a significant amount of radiation during diagnosis, treatment, and follow-up of their pathology, with nearly 20% receiving more than the annual recommended, creating a growing concern regarding radiation exposure faced by patients and health personnel. The objectives of the study were to describe a standardized fluoroscopy-free (FF) semirigid (SR) ureteroscopy (URS) technique for ureteral stone treatment and to determine the feasibility, efficacy, and safety of this technique for the treatment of ureteral stones comparing it to a historical cohort of fluoroscopy-guided (FG) SR-URS. Materials and Methods: A prospective single-arm study of patients submitted to FF SR-URS was conducted. Visual and tactile cues were employed to avoid the use of ionizing radiation. The success (feasibility), stone-free (efficacy), and complication (safety) rates of each procedure were registered. The results were compared to a historical cohort of patients that underwent FG SR-URS at our center. Results: One hundred and five patients subjected to FF SR-URS were included in the study and compared to a historical cohort of 87 patients subjected to FG SR-URS. The main characteristics were comparable among groups. Ninety-seven patients (92.38%) were completed without any use of ionizing radiation. The stone-free rate was 92.45%, similar to the historical cohort. Only Clavien I and II complications were found without statistical difference between the study groups. The average dose of radiation exposure for the historical cohort was approximately 0.5 mSv. Conclusions: FF SR-URS is a feasible, efficacious, and safe technique for treating the ureteral stones for urologists with good practice of the traditional technique. Implementing this procedure allows a decrease in radiation exposure to both patients and health personnel.

Mitomicina C: Una Nueva Alternativa para la Estenosis de Cuello Vesical / Mitomycin C: A New Alternative for Bladder Neck Stenosis

Introducción: La mitomicina C es un agente quimiotera-péutico en virtud a su actividad antiproliferativa y anti-biótica. Se evalúa el resultado de la cervicotomía radial endoscópica combinada con la inyección intralesional de mitomicina C para el tratamiento de las estenosis severas de cuello vesical luego del fracaso del trata-miento tradicional. Materiales y método: Revisión retrospectiva de los pa-cientes con estenosis severa de cuello vesical intervenidos entre julio de 2013 y agosto de 2015 con la utilización de mitomicina C. El 54.5% de los pacientes había fracasado al menos una vez con la realización de cervicotomía interna y/o resección endoscópica de cuello vesical. En nuestra intervención se realizaron tres o cuatro incisiones endoscópicas con corte frío en el cuello de la vejiga, seguido por la inyección intralesional de 0.3 a 0.4 mg/ml de mitomicina C en cada sitio de incisión. Resultados: Un total de 11 pacientes fueron tratados con incisión endoscópica con corte frío en el cuello de la vejiga combinado con la inyección de mitomicina C. Antes de la operación, 4 pacientes (36%) eran usuarios de cistotomía. En un seguimiento medio de 9 meses (rango 1-20) 9 pacientes (82%) se encuentran con micción espontánea posterior a un procedimiento, mientras que 2 pacientes (18%) lograron dicho objetivo después de 2 procedimientos con utilización de mitomicina C. Conclusiones: El tratamiento para la estenosis del cuello vesical con cervicotomía radial endoscópica con corte frío combinada con inyección intralesional de mitomicina C, resultó en la permeabilidad del cuello vesical en el 82% de los pacientes después de 1 procedimiento y en el 100% después de 2 procedimientos. Aunque los primeros resultados son prometedores, se requiere de estudios prospectivos y aleatorizados con seguimiento prolongado en el tiempo para validar estos hallazgos.

Introduction: The mitomycin C is a chemotherapeutic agent by virtue of its antiproliferative and antibiotic ac-tivity. We evaluated the outcome of endoscopic radial cervicotomy combined with intralesional mitomycin C injection for the treatment of severe bladder neck ste-nosis after traditional treatment failure.Materials and methods: It was a retrospective review of patients with severe bladder neck stenosis who had a surgery between July 2013 and August 2015 with mi-tomycin C. The 54.5% of patients had failed at least 1 time with internal cervicotomy and/or endoscopic re-section of the bladder neck. In our intervention, three or four endoscopic incisions were performed with a cold cut in the neck of the bladder, followed by intralesio-nal injection of 0.3 to 0.4 mg / ml of the mitomycin C at each incision site.Results: A total of 11 patients were treated with endos-copic incision with a cold cut in the neck of the bladder combined with mitomycin C injection. Before the sur-gery 4 patients (36%) were cystostomy users. At a mean follow-up of 9 months (range 1-20), 9 patients (82%) had spontaneous urine after 1 procedure, while 2 patients (18%) achieved this goal after 2 procedures using mi-tomycin C.Conclusions: The treatment for bladder neck stenosis with endoscopic radial cervicotomy with cold cut com-bined with intralesional mitomycin C injection resulted in bladder neck permeability in 82% of patients after 1 procedure and 100% after 2 procedures. Although the first results are promising, some prospective and rando-mized studies with long-term monitoring are required to validate these findings.

Hemostatic agents for access tract in tubeless percutaneous nephrolithotomy: Is it worth?

INTRODUCTION: The role of hemostatic agents as an adjunct for closure of the nephrostomy tract in tubeless percutaneous surgery (tubeless percutaneous nephrolithotomy [tPNL]) has been previously evaluated, observing a potential benefit in terms of reduced bleeding and urinary leakage. We assessed the rate of postoperative complications after the use of hemostatic agents for sealing the nephrostomy tract in patients undergoing tPNL at our institution. SUBJECTS AND METHODS: We performed a retrospective analysis of 52 consecutive patients undergoing tPNL at our center between January 2010 and December 2013. No substance was placed within the tract in 25 patients (Group 1). A cylinder of Surgicel(®) in addition to 1 unit of Gelita(®) were placed within the access tract in 27 patients (Group 2). We accounted for demographic variables, stone size, operative time, postoperative pain, development of hematoma, postoperative hematocrit drop, urinary leakage, residual lithiasis, and hospital stay length. RESULTS: Age and sex differed significantly between the two groups (P = 0.0002 and P = 0.048 respectively). However, there were no significant differences in terms of body mass index and stone burden. No significant differences between groups were found with regards to operative time, postoperative hematocrit drop, postoperative pain and presence of residual lithiasis. CONCLUSION: The use of Gelita(®) and Surgicel(®) as hemostatic agents in tPNL is safe, but we were not able to demonstrate any significant benefit in terms of postoperative morbidity after comparing the use of these agents in tPNL. We concluded that the uses of hemostatic agents needed to be evaluated in prospective randomized trials to define its benefits.

[Prostate cancer screening is associated with educational level and knowledge about the disease]. / Nivel educacional como determinante en tamizaje de cáncer de próstata.

BACKGROUND: The screening of prostate cancer allows an earlier diagnosis, allowing more therapeutic options. This screening depends in part on spontaneous patients'’ consultation, which is largely related to their educational level. AIM: To evaluate the association between educational level, knowledge of the disease, and prostatic screening. MATERIAL AND METHODS: A questionnaire was applied to 377 men aged between 50 and 90 years to determine their educational level, knowledge of the disease, if they had any prostate screening and age at first screening. Data was analyzed with R Commander. RESULTS: Eighty one percent of respondents had some knowledge of the disease and of these, 68% had prostate screenings compared with 34% of those without knowledge of the disease. Information about prostate cancer was reported by 71% and 96% of respondents with primary and university education, respectively. Fifty nine and 90% of respondents with primary and university education had prostate screenings performed, respectively. CONCLUSIONS: Those respondents with a prostate cancer screening had a better knowledge of the disease and a higher educational level.

Nivel educacional como determinante en tamizaje de cáncer de próstata / Prostate cancer screening is associated with educational level and knowledge about the disease

Background: The screening of prostate cancer allows an earlier diagnosis, allowing more therapeutic options. This screening depends in part on spontaneous patients’ consultation, which is largely related to their educational level. Aim: To evaluate the association between educational level, knowledge of the disease, and prostatic screening. Material and methods: A questionnaire was applied to 377 men aged between 50 and 90 years to determine their educational level, knowledge of the disease, if they had any prostate screening and age at first screening. Data was analyzed with R Commander. Results: Eighty one percent of respondents had some knowledge of the disease and of these, 68% had prostate screenings compared with 34% of those without knowledge of the disease. Information about prostate cancer was reported by 71% and 96% of respondents with primary and university education, respectively. Fifty nine and 90% of respondents with primary and university education had prostate screenings performed, respectively. Conclusions: Those respondents with a prostate cancer screening had a better knowledge of the disease and a higher educational level.