Influence of the diagnostic protocol and age on the prostate cancer incidence rate in Castilla y León according to the national registry 2010.

OBJECTIVE: Cross-sectional descriptive observational study of incidence and association, to determine whether the higher incidence of prostate cancer in Castilla y León (with respect to the national rate) could be due to modifiable factors. LOCATION: University Hospital Río Hortega. PARTICIPANTS: New prostate cancer diagnoses. MAIN MEASUREMENTS: Incidence rate (IR). Age, family history, symptoms, comorbidity, rectal examination, ultrasound volume (cc), PSA (ng/mL), cylinders, volume cylinder ratio, Gleason, TNM and D'Amico groups. RESULTS: Castilla y León showed the highest prostate cancer IR in Spain (141.1 per 100,000 inhabitants per year), with a peak of early incidence (65-74 years) and significant differences in < 64 and 65-74 years. Age at diagnosis was the lowest (Castilla y León, 66.9 ±7.1 vs. Spain, 69.1 ±â€¯8.2 years; P < .001). No differences: family history, symptoms, comorbidity and PSA. The number of cylinders was 10.7 ±â€¯1.8. In multivariate analysis (AUC = 0.801; P < .001), they were more frequent in Castilla y León: grade i rectal examination, non-palpable rectal examination, Gleason < 6, stage T2c and the volume cylinder ratio < 6 (only in < 64 years: OR 5.2; 95% CI 1.2-22-22.3; P = .027). In Spanish regions, volume cylinder ratio showed inverse correlation with IR in < 74 years, while age showed positive correlation in all age groups. CONCLUSIONS: The higher prostate cancer IR in Castilla y León in 2010 was not associated to an older population. However, the biopsy technique influenced IR, as more cylinders were obtained in younger subjects, without conditioning overdiagnosis.

Influencia del protocolo diagnóstico y la edad en la tasa de incidencia de cáncer de próstata en Castilla y León según el registro nacional de 2010 / Influence of the diagnostic protocol and age on the prostate cancer incidence rate in Castilla y León according to the national registry 2010

Objetivo: Estudio observacional descriptivo transversal de incidencia y asociación, para conocer si la mayor incidencia de cáncer de próstata en Castilla y León (respecto a la tasa nacional) pudiera deberse a factores modificables.EmplazamientoHospital Universitario Río Hortega.ParticipantesNuevos diagnósticos de cáncer de próstata.Mediciones principalesTasa de incidencia (TI). Edad, antecedentes familiares, síntomas, comorbilidad, tacto rectal, volumen ecográfico (cc), PSA (ng/ml), cilindros, relación volumen cilindros, Gleason, TNM y grupos D’Amico.ResultadosLa TI en Castilla y León fue la más alta (141,1 por 100.000 habitantes-año), con un pico de incidencia precoz (65-74 años) y diferencias significativas en<64 y 65-74 años. La edad al diagnóstico fue la más baja (66,9±7,1 vs. 69,1±8,2 años; p<0,001). No hubo diferencias en: antecedentes familiares, síntomas, comorbilidad y PSA. El número de cilindros fue 10,7±1,8. En el análisis multivariante (AUC=0,801; p<0,001) fueron más frecuentes: tacto rectal grado i, tacto rectal no palpable, Gleason<6, estadio T2c y la relación volumen cilindros <6 (solo en<64 años: OR 5,2; IC 95% 1,2-22,3; p=0,027). En las CC. AA., la relación volumen cilindros mostró una correlación inversa con la TI en<74 años, mientras que la edad presentó correlación positiva en todos los tramos.ConclusionesLa mayor TI de cáncer de próstata en Castilla y León 2010 no guardó relación con una población más envejecida. Sin embargo, la técnica de biopsia influyó en la TI, al obtenerse más cilindros en los sujetos más jóvenes, sin condicionar sobrediagnóstico. (AU)

Objective: Cross-sectional descriptive observational study of incidence and association, to determine whether the higher incidence of prostate cancer in Castilla y León (with respect to the national rate) could be due to modifiable factors.LocationUniversity Hospital Río Hortega.ParticipantsNew prostate cancer diagnoses.Main measurementsIncidence rate (IR). Age, family history, symptoms, comorbidity, rectal examination, ultrasound volume (cc), PSA (ng/mL), cylinders, volume cylinder ratio, Gleason, TNM and D’Amico groups.ResultsCastilla y León showed the highest prostate cancer IR in Spain (141.1 per 100,000 inhabitants per year), with a peak of early incidence (65-74 years) and significant differences in<64 and 65-74 years. Age at diagnosis was the lowest (Castilla y León, 66.9±7.1 vs. Spain, 69.1±8.2 years; P<.001). No differences: family history, symptoms, comorbidity and PSA. The number of cylinders was 10.7±1.8. In multivariate analysis (AUC=0.801; P<.001), they were more frequent in Castilla y León: grade i rectal examination, non-palpable rectal examination, Gleason<6, stage T2c and the volume cylinder ratio<6 (only in<64 years: OR 5.2; 95% CI 1.2-22.3; P=.027). In Spanish regions, volume cylinder ratio showed inverse correlation with IR in<74 years, while age showed positive correlation in all age groups.ConclusionsThe higher prostate cancer IR in Castilla y León in 2010 was not associated to an older population. However, the biopsy technique influenced IR, as more cylinders were obtained in younger subjects, without conditioning overdiagnosis. (AU)

Flexible ureteroscopy in extreme elderly patients (80 years of age and older) is feasible and safe.

PURPOSE: To compare the safety and efficacy of RIRS in patients ≥ 80 years to a younger population. METHODS: We retrospectively compared the data from patients ≥ 80 years of age undergoing RIRS with the data of a group of patients from 18 and < 80 years. Perioperative outcomes, complications and emergency department visits were compared between two groups. RESULTS: A total of 173 patients were included in the study. Mean age was 44 (27-79) and 81 years-old (80-94), for younger and elderly group, respectively. Elderly patients had higher ASA scores (≥ 3) (28.6% vs 75.8%; p = 0.0001) and Charlson comorbidity index (1.99 vs 7.86; p = 0.0001), more diabetes (p = 0.006) and respiratory comorbidities (p = 0.002). No statistical difference was found between two groups in stone size (p = 0.614) and number (p = 0.152). Operative time (74.48 vs 102.96 min; p = 0.0001) and duration of hospitalisation (1.7 vs 2.9 days; p = 0.001) were longer for the elderly. Intraoperative complication rate did not show differences between the two groups (p = 0.166). Postoperative complications rates were similar between the cohorts (7.7% vs 9.5%; p = 0.682). The success rates were 67.5% in the younger group and 71.4% in the elderly group (p = 0.584). No difference was seen in stone recurrence (p = 0.73). A higher rate of visits to the emergency department was found in younger cohort (23.6% vs 11.6%; p = 0.046), mostly duo to stent-related symptoms. CONCLUSIONS: Despite the higher rate of comorbidity in the elderly group, RIRS was a safe procedure with similar complication rate and outcomes at an expense of higher operative time and hospital stay.

The impact of time from biopsy to radical prostatectomy on Gleason score undergrading and other related factors. / Impacto del tiempo desde la biopsia a la prostatectomía radical en la infragradación del grado de Gleason y análisis de factores relacionados.

INTRODUCTION: Gleason score biopsy undergrading (GSBU) can have an impact on the management and prognosis of patients with prostate cancer. We analyze the possible impact of time and other clinical and analytical factors in the appearance of GSBU in our series. PATIENTS AND METHOD: Ambispective, multicenter study of 1955 patients with localized prostate cancer undergoing radical prostatectomy between 2005 and 2018. Descriptive statistics and hypothesis testing are reported by univariate and multivariate analyses. RESULTS: Mean age 63.69 (44-80) years, median PSA 8.70 ng / ml (1.23-99). GSBU was observed in 34.7% of the entire cohort. In 72.8% of the cases, the GSBU occurred in one consecutive Gleason score, with the progression from 3 + 3 to 3 + 4 being the most frequent (289 patients, 47.6%). Performing radical prostatectomy 90-180 days before or after the biopsy does not have an impact on its undergrading in any of the groups. In the univariate and multivariate analysis, the presence of tumor or pathological rectal examination in both lobes, the tumor load ≥50% of cylinders and a DPSA ≥0.20, showed independent discriminative capacity to select patients who presented GSBU. CONCLUSIONS: The time from biopsy to radical prostatectomy did not show impact on GSBU. The number of affected cylinders, bilateral tumor and DPSA are easily accessible parameters that can help us select patients with greater probability of presenting GSBU.

Actual incidence of prostate cancer in healthcare areas of the autonomous community of Castilla-Leon during 2014. CAPCYL registry data. / Incidencia real de cáncer de próstata en las áreas sanitarias de la comunidad autónoma de Castilla y León durante el año 2014. Datos del registro CAPCYL.

OBJECTIVE: To determine the actual incidence of prostate cancer (PC) in the healthcare areas of Castilla-Leon in 2014. MATERIAL AND METHODS: A multicentre study was conducted with the participation of 7 of the 9 healthcare areas of Castilla-Leon. We collected retrospective data that included 87.8% of the target population (men diagnosed with PC with histopathological confirmation in 2014). We calculated the raw and age-adjusted incidence rates based on the direct method and consulted the community and national epidemiological data in the Spanish National Institute of Statistics. RESULTS: A total of 1198 new cases of PC were diagnosed, with a raw incidence rate in the community of 109.54 cases per 100,000 men. The adjusted rates for the Spanish and European populations were 115.41 and 110.07, respectively. The age group with the highest diagnostic concentration was the 60-70-year group, with 41.97% of the diagnoses. The group with the highest incidence was the 70-80-year group, with 438.87 cases per 100,000 inhabitants. There were differences in the raw and age-adjusted incidence rates and in the age at diagnosis among the various included healthcare areas. CONCLUSIONS: The community raw incidence rate was higher than most existing data. We observed significant differences among the various geographical areas, which could be explained mainly by the age distribution and the opportunistic screening policies for each area.

Small-calibre percutaneous nephrolithotomy (SC-PCNL). Therapeutic decision algorithm. / Nefrolitectomía percutánea de calibre reducido (NLP-CR). Algoritmo de decisión terapéutica.

INTRODUCTION: The progressive reduction in the calibre of the tract in percutaneous kidney surgery to the point of miniaturisation has expanded its use to smaller stones that until now have been treated with extracorporeal shock wave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS). OBJECTIVE: To provide an update on the various techniques of small-calibre nephrolithotomy (SC-PCNL) analyse their efficacy, safety and indications and determine their degree of implantation at this time. MATERIAL AND METHODS: We performed a review in PubMed of Spanish and English medical literature on the various techniques of SC-PCNL. RESULTS: The use of SC-PCNL has reduced the morbidity associated with standard PCNL, particularly bleeding, and has enabled tubeless nephrolithotomy with greater safety. There are various techniques with blurred terminology (Miniperc, Microperc, Mini-microperc, Ultraminiperc), which differ in terms of gauge employed and in certain technical aspects that require their indications be specified. Currently, SC-PCNL competes with techniques that are less invasive than standard PCNL such as ESWL and the RIRS in treating small stones, but the role of SC-PCNL is still not sufficiently understood and continues to be the subject of debate. CONCLUSIONS: The indications for PCNL are expanding to small stone sizes due to the miniaturisation of the technique. PCNL competes in this field with ESWL and RIRS. Larder studies are needed to establish the specific indications for PCNL in treating nephrolithiasis.

Predicción de resultados de cistoscopias en la práctica / Predicting Results of Daily-practice Cystoscopies

Objetivo: Elaborar un modelo predictivo de cáncer de vejiga en una población clínica no seleccionada derivada a cistoscopia. Materiales y métodos: Pacientes consecutivos sometidos a cistoscopia debida a sospecha o seguimiento de un cáncer de vejiga previamente diagnosticado. Todos los pacientes fueron sometidos a citología urinaria y un BTA-stat®-test (BTA). Para evitar sesgos de evaluación, BTA, citologías y cistoscopias fueron realizados de forma ciega. Usamos regresión logística para predecir los resultados de la cistoscopia a partir de citología, BTA y variables clínicas. Resultados: Entre agosto de 2011 y julio de 2012 seleccionamos 244 pacientes y 237 fueron válidos para el análisis. Un 13% fueron de nuevo diagnóstico y un 87% de seguimiento. Las sensibilidades de la citología y el BTA fueron 57,9% (IC 95%: 42,2-72,1) y 63,2% (IC 95%: 47,3-76,6) con especificidades de 84,4% (IC 95%: 78,7- 88,8) y 82,9% (IC 95%: 77,1-87,5). El modelo predictivo incluyó BTA, citología, tiempo transcurrido desde el diagnóstico del tumor previo y tratamiento con mitomicina o BGC en los últimos 3 meses. La precisión del modelo (AUC) fue 0,85 (0,78-0,92), y bajó a 0,79 al excluir el BTA (p = 0,026). En los casos de seguimiento, un umbral de 10% en las probabilidades predichas por el modelo resultó en un valor predictivo negativo de 95,7%, y 95,0% en los tumores de bajo grado. Conclusión: En un contexto de contención de costes nuestro modelo puede usarse para espaciar las cistoscopias en pacientes con tumores de bajo grado previos, resultando en un uso más eficiente de recursos del sistema de salud

Objective: Our objective was to elaborate a predictive model of bladder cancer, in an unselected clinical population submitted to cystoscopy. Materials and methods: We recruited consecutive patients who underwent cystoscopy due to suspicion of bladder cancer or surveillance of a previously diagnosed bladder cancer. Urine cytology and a BTA-stat® (BTA) test were carried out for all patients. To avoid an assessment bias, the BTA-tests, cytologies and cystoscopies were conducted in a blinded fashion. We used logistic regression to predict cystoscopy results from cytology, BTA-test and clinical variables. Results: From August 2011 to July 2012, we recruited 244 patients and 237 were valid for analysis. Newly diagnosed and surveillance cases were 13% and 87% respectively. Cytology and BTA-test sensitivities were 57.9% (CI 95: 42.2-72.1) and 63.2% (CI 95: 47.3-76.6) with specificities of 84.4% (CI 95: 78.7-88.8) and 82.9% (CI 95: 77.1-87.5). The predictive model included the BTA-test, cytology, time since previous tumor, and treatment with mitomicin or BGC during the last three months. The model predictive accuracy (AUC) was 0.85 (0.78-0.92), and dropped to 0.79 when excluding the BTA-test (p = 0.026). For the surveillance of bladder cancer, a 10% threshold on the model predicted probabilities resulted in an overall negative predictive value of 95.7%, and 95.0% in low grade tumors. Conclusion: In a cost containment environment, our prediction model could be used to space out cystoscopies in patients with previous, low grade tumors, resulting in a more efficient use of resources in the healthcare system

Predicting results of daily-practice cystoscopies.

OBJECTIVE: Our objective was to elaborate a predictive model of bladder cancer, in an unselected clinical population submitted to cystoscopy. MATERIALS AND METHODS: We recruited consecutive patients that underwent cystoscopy due to suspicion of bladder cancer or surveillance of a previously diagnosed bladder cancer. Urine cytology and a BTA-stat® (BTA) test were carried out for all patients. To avoid an assessment bias, the BTA-tests, cytologies and cystoscopies were conducted in a blinded fashion. We used logistic regression to predict cystoscopy results from cytology, BTA-test and clinical variables. RESULTS: From August 2011 to July 2012, we recruited 244 patients and 237 were valid for analysis. Newly diagnosed and surveillance cases were 13% and 87% respectively. Cytology and BTA-test sensitivities were 57.9% (CI 95: 42.2-72.1) and 63.2% (CI 95: 47.3-76.6) with specificities of 84.4% (CI 95: 78.7-88.8) and 82.9% (CI 95: 77.1-87.5). The predictive model included the BTA-test, cytology, time since previous tumour, and treatment with mitomicin or BGC during the last three months. The model predictive accuracy (AUC) was .85 (.78-.92), and dropped to 0.79 when excluding the BTA-test (P=.026). For the surveillance of bladder cancer, a 10% threshold on the model predicted probabilities resulted in an overall negative predictive value of 95.7%, and 95.0% in low grade tumours. CONCLUSION: In a cost containment environment, our prediction model could be used to space out cystoscopies in patients with previous, low grade tumours, resulting in a more efficient use of resources in the healthcare system.

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.

Consenso sobre el impacto clínico de la nueva evidencia científica disponible sobre hiperplasia benigna prostática / Consensus on the Clinical Impact of the New Scientific Evidence Available on Benign Prostatic Hyperplasia

Objetivos: Explorar la opinión técnica de un panel experto y alcanzar un consenso de criterio profesional en relación con la más reciente evidencia científica en hiperplasia benigna de próstata (HBP) en los ámbitos del diagnóstico, de los criterios de progresión, del tratamiento médico y del tratamiento quirúrgico. Material y métodos: Revisión sistematizada de la literatura de los últimos 10 años en HBP por medio de un comité científico y elaboración de un cuestionario de 64 preguntas repartidas en tres áreas estratégicas: a) diagnóstico y estratificación de los pacientes con HBP atendiendo a los factores de riesgo de progresión; b) novedades en el tratamiento médico; y c) nuevas aportaciones en el tratamiento quirúrgico y mínimamente invasivo en HBP. Se seleccionó un panel de 50 urólogos destacados en el conocimiento de la HBP repartidos por toda la geografía nacional, instaurando para el estudio la metodología Delphi mediante la aplicación de dos encuestas sucesivas on line. Resultados: Los 50 expertos consultados completaron las dos rondas del cuestionario. En la primera se apreció un consenso de criterio en 50 de las 64 cuestiones analizadas, logrando en la segunda ronda un consenso en 59/64 ítems (92,5%) que incluyen aspectos de morbilidad de los síntomas del tracto urinario inferior (STUI), pruebas diagnósticas necesarias en la evaluación inicial del especialista, estratificación de los pacientes en relación con el riesgo de progresión, estrategias de terapia médica escalonada y de combinación en pacientes con riesgo de retención aguda de orina (RAO) o cirugía y de las indicaciones de terapia quirúrgica y el papel de los nuevos tratamientos menos invasivos. Conclusiones: En una patología de alta prevalencia, como la HBP, donde hemos asistido en los últimos años a cambios de calado en todo su espectro, la consecución de un elevado consenso al que han contribuido un amplísimo número de especialistas de referencia en esta patología, será de gran importancia para el manejo clínico habitual de esta enfermedad (AU)

Objectives: To study the technical opinion of an expert panel and reach a consensus of professional criterion in relation to the most recent scientific evidence in Benign Prostatic Hyperplasia(BPH) in the scopes of diagnosis, progression criteria, medical treatment and surgical treatment. Material and methods: Systematized review of the literature of the last 10 years in BPH by means of a scientific committee and elaboration of a 64-question questionnaire divided into three strategic areas: 1.- Diagnosis and stratification of the patients with BPH considering the progression risk factors. 2.-Novelties in the medical treatment and 3.- New contributions in the surgical and minimally invasive treatment in BPH. A panel of 50 urologists standing out for their knowledge in BPH distributed throughout the national geographic area was chosen, establishing the Delphi methodology for the study through the application of two successive online surveys. Results: The 50 experts consulted completed the two groups of the questionnaire. In the first, a consensus of criterion was observed in 50 out of the 64 questions analyzed, achieving a consensus in 59/65 (92.5%) in the second round, which included aspects of morbidity of the lower urinary tract symptoms (LUTS), diagnostic tests necessary in the initial evaluation of the specialist, stratification of the patients in relation to the risk of progression, strategies of step-by-step medical therapy and combination in patients with risk of Acute Urinary Retention(AUR) or surgery and of the indications of surgical therapy and the role of new less invasive treatments. Conclusions: In a condition of the high prevalence of BPH, in which we have seen important changes in its entire spectrum in recent years, the obtaining of an elevated consensus to which a large number of reference specialists in this condition have contributed will be of great importance for the usual clinical management of this disease (AU)

[Consensus on the clinical impact of the new scientific evidence available on benign prostatic hyperplasia]. / Consenso sobre el impacto clínico de la nueva evidencia científica disponible sobre hiperplasia benigna prostática.

OBJECTIVES: To study the technical opinion of an expert panel and reach a consensus of professional criterion in relation to the most recent scientific evidence in Benign Prostatic Hyperplasia (BPH) in the scopes of diagnosis, progression criteria, medical treatment and surgical treatment. MATERIAL AND METHODS: Systematized review of the literature of the last 10 years in BPH by means of a scientific committee and elaboration of a 64-question questionnaire divided into three strategic areas: 1.- Diagnosis and stratification of the patients with BPH considering the progression risk factors. 2.-Novelties in the medical treatment and 3.- New contributions in the surgical and minimally invasive treatment in BPH. A panel of 50 urologists standing out for their knowledge in BPH distributed throughout the national geographic area was chosen, establishing the Delphi methodology for the study through the application of two successive online surveys. RESULTS: The 50 experts consulted completed the two groups of the questionnaire. In the first, a consensus of criterion was observed in 50 out of the 64 questions analyzed, achieving a consensus in 59/65 (92.5%) in the second round, which included aspects of morbidity of the lower urinary tract symptoms (LUTS), diagnostic tests necessary in the initial evaluation of the specialist, stratification of the patients in relation to the risk of progression, strategies of step-by-step medical therapy and combination in patients with risk of Acute Urinary Retention (AUR) or surgery and of the indications of surgical therapy and the role of new less invasive treatments. CONCLUSIONS: In a condition of the high prevalence of BPH, in which we have seen important changes in its entire spectrum in recent years, the obtaining of an elevated consensus to which a large number of reference specialists in this condition have contributed will be of great importance for the usual clinical management of this disease.

Comentario editorial al trabajo «Nueva técnica para realizar nefrolitotripsia percutánea 'decúbito dorsal total'» / Comments on article 'A new technique to perform percutaneous nephrolithotripsy in 'total dorsal decubitus position'

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[Comparison between Valdivia position and prone position in percutaneous nephrolithotomy]. / Comparacin entre la posición de Valdivia y la posición prona en la nefrolitectomía percutánea (NLP).

INTRODUCTION: Although the supine position created by Dr. Valdivia two decades ago to perform the procedure known as percutaneous nephrolitectomy (PNL) presents advantages against the prone position in some aspects concerning anesthesia and surgical ergonomy, its use has failed to spread widely among the urology community due to certain technical difficulties, a lower rate of calculi clearing and a higher rate of complications, in spite of the fact that the scarce comparative studies do not show enough data to support this opinion. The present study compares both positions considering the technical difficulties encountered, their effectiveness and their results and complications. MATERIAL AND METHODS: A series of 50 patients that underwent PCNL by prone position is compared retrospectively with another series of 54 patients that underwent consecutively PCNL by prone position. All procedures were performed under general anesthesia, the inferior calyx approach was the one used the most over the supracostal approach, and the sole tract over the multi-tract approach was predominant. Dilatation of the nephrostomy tract was done, in most of the cases, with a high-pressure balloon catheter. The stone surface treated was 399.93+/-58.2 mm2 for the supine group, and 416.36+/-46.54 mm2 for the prone one (p=0.456). The management of the stones was carried out by ultrasonic or ballistic fragmentation, and a small group of patients underwent direct stone removal. RESULTS: As far as demographic parameters and operative variables such as number of tracts performed, calyx election, type of tract dilatation and kind of energy used for fragmentation, both groups were homogeneous. In 3 cases of each group there was a failure to access the kidney. The rate of failure was 6%, and 5.56%, for the supine and prone groups, respectively (p=0.716). Average operating time was 74.55+/-25.54 and 91.82+/-24.82 minutes, respectively, p=0.123. A postoperative x-ray showed a stone-free rate of 76% for the supine group and 74% for the prone group, p=0.308. ESWL was the supplementary treatment for 12% of the patients in the supine group, and for 12.96% of the patients in the prone group p= 0.478, and a second procedure was performed on 4 (8%) patients in the supine group and on 3 (5.56%) in the prone one, p=0.697. Hospital stay was the same for both groups (5.89+/-4.7 for the supine group, and 5.5+/-4.09 for the prone one, p=0.694). As far as analgesia required, 6.89+/-4.87 was administered for the supine against 6.18+/-4.09 for the prone, p=0.580. The complications rate was very low for both groups and also very similar; one of the patients in the supine group suffered a lesion to the colon. CONCLUSION: Valdivia position is as feasible as the prone position for PCNL. Success rates, as far as stone clearing, and complications are similar for both positions.

Comparación entre la posición de Valdivia y la posición prona en la nefrolitectomía percutánea (NLP) / Comparison between Valdivia position and prone position in percutaneous nephrolithotomy

Introducción: La posición supina, ideada por Valdivia hace dos décadas para la nefrolitectomía percutánea (NLP), a pesar de aventajar a la posición prona en aspectos concernientes a la anestesia y a la ergonomía quirúrgica, no ha tenido una amplia difusión en la comunidad urológica debido a que se ha asociado a una mayor dificultad técnica, menor tasa de limpieza de cálculos y mayor tasa de complicaciones, aunque los escasos estudios comparativos existentes no sustenten estos argumentos. En este trabajo se comparan ambas posiciones en la NLP analizando los resultados desde el punto de vista de la dificultad técnica, la eficacia en la resolución de la litiasis y de las complicaciones. Material y Métodos: Una serie de 50 pacientes a los que se les realizó una NLP en posición supina fue comparada de forma retrospectiva con otra de 54 pacientes intervenidos consecutivamente por NLP en posición prona. Todas las intervenciones fueron realizadas bajo anestesia general, predominando los abordajes del cáliz inferior y los trayectos únicos sobre los múltiples en ambos grupos. La dilatación del tracto de nefrostomía se realizó mayoritariamente con catéter balón de alta presión. El área litiásica media tratada fue de 399,93+58,2 mm2 en el grupo supino y de416,36+46,54 mm2 para el prono, (p= 0,456). La manipulación de la litiasis se llevó a cabo mediante fragmentación ultrasónica, mecánica y en un reducido número de pacientes se realizó extracción directa con pinzas. Resultados: Ambos grupos fueron semejantes en cuanto a los parámetros demográficos y a variables referentes a la técnica quirúrgica como el número de trayectos realizados, cáliz elegido para la punción, tipo de dilatación del tracto de nefrostomía o clase de energía utilizada en la fragmentación. Se fracasó en el acceso a las cavidades renales en 3 casos en cada grupo (6% para el grupo supino y 5,56% para el prono, (p= 0,716)). El tiempo operatorio medio fue de 74,55+25,54 min. para el grupo supino frente a 91,82+24,82 min. para el prono, (p=0,123). En el postoperatorio inmediato se observó, mediante una radiografía simple, una tasa de limpieza de cálculo de 76% para el grupo en supino y del 74% para el grupo en prono, (p= 0,308). Se empleó LEOCH como tratamiento complementario en el 12% de los pacientes del grupo supino y en el 12,96% del prono, (p=0,478), y se realizó una segunda NLP por litiasis residual en 4 (8%) y en 3 pacientes (5,56%) del grupo supino y del prono respectivamente (p=0,697). Hubo equivalencia en el postoperatorio de ambos grupos en cuanto a los días de hospitalización (5,89+4,7 para el supino vs 5,5+4,09 para el prono, p= 0,694), y en cuanto a la analgesia que precisaron (6,89+4,87 dosis en el supino frente a 6,18+4,09 dosis en el prono, (p=0,580). No hubo diferencias entre la tasa de complicaciones, que fue baja para ambos grupos, si bien, en un caso del grupo supino se produjo una lesión del colon. Conclusión: La posición de Valdivia es igual de factible que la posición prona en la NLP. Las tasas, tanto de éxito en cuanto a resolución litiásica, como de complicaciones son similares entre ambas posiciones (AU)

Introduction: Although the supine position created by Dr. Valdivia two decades ago to perform the procedure known as percutaneous nephrolitectomy (PNL) presents advantages against the prone position in some aspects concerning anesthesia and surgical ergonomy, its use has failed to spread widely among the urology community due to certain technical difficulties, a lower rate of calculi clearing and a higher rate of complications ,in spite of the fact that the scarce comparative studies do not show enough data to support this opinion. The present study compares both positions considering the technical difficulties encountered, their effectiveness and their results and complications. Material and Methods: A series of 50 patients that underwent PCNL by prone position is compared retrospectively with another series of 54patients that underwent consecutively PCNL by prone position. All procedures were performed under general anesthesia, the inferior calyx approach was the one used the most over the supracostal approach, and the sole tract over the multi-tract approach was predominant. Dilatation of the nephrostomy tract was done, in most of the cases, with a high-pressure balloon catheter. The stone surface treated was 399.93+58.2 mm2 for the supine group, and 416.36+46.54 mm2 for the prone one (p=0.456). The management of the stones was carried out by ultrasonic or ballistic fragmentation, and a small group of patients underwent direct stone removal. Results: As far as demographic parameters and operative variables such as number of tracts performed, calyx election, type of tract dilatation and kind of energy used for fragmentation, both groups were homogeneous. In 3 cases of each group there was a failure to access the kidney. The rate of failure was 6%, and 5.56%, for the supine and prone groups, respectively (p=0.716). Average operating time was 74.55+25.54 and 91.82+24.82 minutes, respectively, p=0.123. A postoperative x-ray showed a stone-free rate of 76% for the supine group and 74% for the prone group, p=0.308. ESWL was the supplementary treatment for 12% of the patients in the supine group, and for 12.96% of the patients in the prone group p=0.478, and a second procedure was performed on 4 (8%) patients in the supine group and on 3 (5.56%) in the prone one, p=0.697. Hospital stay was the same for both groups (5.89± 4.7 for the supine group, and 5.5 ± 4.09 for the prone one, p= 0.694). As far as analgesia required, 6.89 ± 4.87 was administered for the supine against 6.18±4.09 for the prone, p= 0.580. The complications rate was very low for both groups and also very similar; one of the patients in the supine group suffered a lesion to the colon. Conclusion: Valdivia position is as feasible as the prone position for PCNL. Success rates, as far as stone clearing, and complications are similar for both positions (AU)

La tutoría en laparoscopia / Training tutorial in laparoscopy

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[Effects of chronic alcohol drinking on rat's prostate. Experimental study]. / Efectos de la ingesta crónica de alcohol sobre la próstata de la rata. Estudio experimental.

OBJECTIVE: We have studies both the morphologic and morphometric modifications that the alcohol induces in subjected rats to chronic intake of alcohol and to evaluate the reversibility of this alterations after suppressing the ingesta of alcohol. MATERIAL AND METHODS: The animals underwent diverse outlines of chronic intake of alcohol and diverse morphometric parameters of the prostate were valued at the level of optic microscopy. RESULTS: Two morphologic prostatic patterns was observed according to the studied group of animals (experimental or control). It seems to be that the dose of alcohol was the factor that more it influenced in the morphometric variations of the cells.

Efectos de la ingesta crónica de alcohol sobre la próstata de la rata. Estudio experimental / Effects of chronic alcohol intake in the rate prostate. Experiment study

OBJETIVO: Estudio de las modificaciones morfológicas y morfométricas, que el alcohol induce en ratas sometidas a ingesta crónica de alcohol, y evaluar la reversibilidad de dichas alteraciones tras suprimir la ingesta de alcohol. MATERIAL Y MÉTODOS: Los animales se sometieron a diversos esquemas de ingesta crónica de alcohol, y se valoraron diversos parámetros morfométricos prostáticos al nivel de microscopia óptica. RESULTADOS: Se observaron dos patrones morfológicos prostáticos según el grupo de animales estudiado (experimental o control). Parece ser que la dosis de alcohol fue el factor que más influyó en las variaciones morfométricas celulares (AU)