Flexible Ureteroscopy as a Major Ambulatory Surgery Procedure. Single Center Experience and Analysis of Variables Related to Hospital Readmission.

OBJECTIVE: To assess our experience in flexible ureteroscopy (fURS) in major ambulatory surgery (MAS) and to detect variables related to unplanned medical assistance after surgery. MATERIAL & METHODS: We conducted a retrospective study among patients with renal stones undergoing a fURS from 2014 to 2019 in MAS at our hospital. VARIABLES: Age, gender, ASA physical status, type of anesthetic technique performed, stone characteristics, influence of double J stent before or after surgery, and postoperative complications according to the Clavien-Dindo modified classification. We evaluated variables related to hospital readmission or visit to the emergency room after surgery. RESULTS: A total of 222 consecutive fURS for stone disease were performed in MAS. Patients' average age was 52.9 ± 13.91 years old. The mean operating time was 57.86 ± 21.11 minutes. The mean stone size was 1.92 ± 1.43 with a diameter of 10.01 ± 4.24 mm. 47.3% of patients had a double J stent before fURS, and in 35.14% of cases, a stent was placed after surgery. 7.65% of patients required unplanned hospitalization. 14.86% of patients presented to the emergency room in the following month after surgery. Among them, one-third consulted for symptoms related to the double J. Patients who carried a double J stent before the fURS had 64% less risk of visiting the emergency department in the following month after surgery [OR = 0,363; IC95% (0.153-0.798)]. All other variables (age, gender, operating time...) did not modify the risk of unplanned medical assistance. CONCLUSION: The low complication rate following flexible ureteroscopy allows its performance as an ambulatory surgery. Patients who carry double J stent before the procedure have less risk of requiring unplanned medical assistance after the surgery.

Estudio de la eficacia y preferencia de los pacientes con disfunción eréctil grave después de tomar los 3 inhibidores de la fosfodiesterasa 5 / Study of the efficacy and preferences among severe erectile dysfunction patients after taking 3 phosphodiesterase 5 inhibitors

Objetivo: Evaluar la eficacia de sildenafilo (100 mg), vardenafilo (20 mg) y tadalafilo (20 mg) en el tratamiento de la disfunción eréctil grave. Evaluar la preferencia de los pacientes después de tomar los 3 fármacos. Material y metodos: Los pacientes tomaron de forma secuencial sildenafilo (100 mg), vardenafilo (20 mg) y tadalafilo (20 mg) al menos 4 veces cada uno durante 30-45 días con un período de lavado entre un fármaco y otro de 7 días. En total, se incluyó a 151 pacientes para obtener una muestra válida de 108 casos (18 por cada grupo de aleatorización, 6 grupos en total). Los pacientes incluidos tenían disfunción eréctil grave. Resultados: Las puntuaciones del índice internacional de función eréctil mejoraron con respecto a las basales, y estas fueron estadísticamente significativas en todos los casos (P < 0,0001). Cuando se compararon las puntuaciones del índice internacional de función eréctil, el Erectile Dysfunction Inventory of Treatment Satisfaction, versión paciente, Erectile Dysfunction Inventory of Treatment Satisfaction, versión pareja y Sexual Encounter Profile (SEP) mediante el test no paramétrico para medidas relacionadas de Friedman, se observaron diferencias estadísticamente significativas en todos ellos menos en SEP-2 y SEP-3. Cuando se compararon entre ellos mediante el test de Wilcoxon, encontramos diferencias estadísticamente significativas en el índice internacional de función eréctil entre tadalafilo y sildenafilo (P < 0,003) y entre tadalafilo y vardenafilo (P < 0,001). También las encontramos en el Erectile Dysfunction Inventory of Treatment Satisfaction, versión pareja entre sildenafilo y vardenafilo (P < 0,013). En todos los otros casos, excepto en el SEP-2 y SEP-3, las diferencias entre tadalafilo y los otros 2 fármacos fue muy cercana a la significancia. No hubo ninguna diferencia entre sildenafilo y vardenafilo. Cuando se evaluó la preferencia por un fármaco u otro, 20 eligieron sildenafilo (18,5%), 19 vardenafilo (17,8%), 43 tadalafilo (39,8%) y 22 no eligieron ninguno por falta de eficacia (24,05%). Conclusiones: Las diferencias estadísticamente significativas observadas cuando se compararon los diferentes cuestionarios utilizados llevan a creer que aparte de la preferencia subjetiva de los pacientes per se, su preferencia se basa también en la respuesta superior a un fármaco en comparación con los otros (AU)

Objective: To evaluate the efficacy of sildenafil (100 mg), vardenafil (20 mg) and tadalafil (20mg) in the treatment of severe erectile dysfunction and to evaluate their preferences after having taken all three drugs. Material and methods: The patients took sildenafil (100 mg), vardenafil (20 mg) and tadalafil (20 mg) sequentially at least four times each over 30-45 days with a wash-out period of 7 days between one drug and the next. In total, 151 patients were included to obtain a valid sample of 108 cases (18 for each randomization group, six groups in total). The included patients had severe erectile dysfunction. Results: The IIEF scores improved compared to baseline values, these improvements being statistically significant in all cases (P<0.0001). When the scores on the IIEF, EDITS patient version, EDITS partner version and SEP using Friedman's non-parametric test for related measures were compared, statistically significant differences were observed in all of them except SEP-2 and SEP-3. When compared with each other using Wilcoxon's test, we found statistically significant differences in the IIEF between tadalafil and sildenafil (P<0.003) and between tadalafil and vardenafil (P<0.001). We also found these in the EDITS partner version between sildenafil and vardenafil (P<0.013). In the other cases except SEP-2 and SEP-3, the differences between tadalafil and the other two drugs were very close to significance. There was no difference between sildenafil and vardenafil. As for their preference for one drug over the others, 20 chose sildenafil (18.5%), 19 vardenafil (17.8%), 43 tadalafil (39.8%) and 22 did not choose any due to lack of efficacy (24.05%). Conclusions: The statistically significant differences observed when comparing the different questionnaires used lead to the belief that, apart from the subjective preference of patients per se, their preference is also based on a greater response to one drug in comparison with the others (AU)

[Fournier gangrene. A retrospective study of 41 cases]. / Gangrena de Fournier: Estudio retrospectivo de 41 casos.

INTRODUCTION: Fournier's gangrene is a rapidly progressing necrotizing fascitis that affects the perineal and genital area. Mortality still remains high. The aim of this study was to evaluate the epidemiological progression and morbidity-mortality of Fournier's gangrene at our centre over the past 10 years. METHODS: Retrospective study of 41 patients treated for Fournier's gangrene between 1998 and 2007. Variables studied included, demographic variables, aetiology, microbiology, surgical and antibiotic treatment, morbidity, and mortality. RESULTS: The mean age of the patients was 60, and 93% were male. The most common co-morbidity was diabetes (49%), followed by alcoholism (46%) and immunosuppression or neoplasia (34%). The origin was perianal in 66% of cases, followed by a urological origin (32%). The median time from the onset of symptoms to diagnosis was 3 days. Several surgical debridements were required in 49% of the patients, and the mortality rate was 29%. Most cases had positive cultures (93%), and in 76% more than one microorganism was isolated (enterobacteriaceae and anaerobic flora). In the bivariate analysis, antimicrobial treatment with carbapenems and the absence of systemic complications were associated with lower mortality. CONCLUSIONS: Fournier's gangrene continues to be a severe surgical emergency, with a high mortality rate. Early diagnosis and aggressive surgical and antibiotic therapy are necessary for adequate management.