[Epidemiological characteristics of bladder tumors in the Cuenca area throughout a seventeen-year period]. / Características epidemiológicas de las neoplasias vesicales en la provincia de Cuenca en los ultimos 17 años.

OBJECTIVE: Bladder cancer is such an important health problem and accounts for most of the surgical duty in the urology departments. We achieve to draw the features of patients diagnosed with bladder tumors in the Cuenca area throughout a seventeen-year period. MATERIAL AND METHOD: From January 1985 to December 2002 we recorded in the Cuenca area the entire urologic tumor recently diagnosed. The following features were recorded: gender, age, pathology, TNM classification, risk factors (alcohol, cigarette smoking and coffee), social demography (rural/ urban) and the presence of metastasis. RESULTS: We achieve significant differences within pathology, age at diagnosis, incidence, social demography and some risk factors throughout the seventeen-year period. CONCLUSIONS: More bladder cancers are diagnosed along this time, more of them are infiltrating, in an aging population and from a rural precedence although a slightly decrease in the overall population in this are has been documented.

[Development of a clinical pathway for radical prostatectomy]. / Implantación de una vía clínica para la prostatectomía radical.

OBJECTIVE: To describe the clinical care path for retropubic radical prostatectomy of the La Paz teaching hospital and the results achieved after the first 6 months. METHODS: We have developed a clinical care path for radical prostatectomy with a hospital stay of 6 days. Thirty-one patients submitted to retropubic radical prostatectomy from June to November 1998 were included in the program. The mean length of total, preoperative and postoperative stay were analyzed and compared with those of 31 patients who had undergone radical prostatectomy before the program was developed. Readmissions, adverse effects and patient satisfaction were also analyzed. RESULTS: Of the 31 patients included in the clinical care path, 22 (71%) had a stay equal to or less than the program's length of stay. The mean total, pre and postoperative stay for the group of patients included in the clinical care path were 6.0 days (SD = 1.1), 1 day (SD = 0.0) and 4.9 days (SD = 1.1), respectively. The length of stay was significantly longer before the program was developed [mean total 10.2 days (SD = 4.9), mean preoperative 2.6 days (SD = 2.6) and mean postoperative 7.6 days (SD = 3.6)] (p < 0.001). Twenty-four patients (77.4%) completed the questionnaire on patient satisfaction, which was highly positive, the overall patient satisfaction rate being higher than the 90% standard. There were no readmissions or significant events ascribable to the program. CONCLUSIONS: In our experience, the clinical care path for radical prostatectomy is a useful tool to reduce the unwanted variability. Its design is based on the best possible evidence, therefore the scientific and technical quality, patient satisfaction and efficiency are enhanced. In our view, our results are attainable and feasible in any health care setting.

[Recurrent nonparasitic chyluria]. / Quiluria redicivante no parasitaria.

OBJECTIVE: To describe a case of recurrent chyluria and review the diagnostic and therapeutic methods. METHODS/RESULTS: A case of non parasitic recurrent chyluria is presented. Retrograde pyelography demonstrated pyelolymphatic reflux. The patient presented chemical pyelitis secondary to the contrast medium which caused remission of the condition. CONCLUSIONS: Chyluria is uncommon in our setting. Postprandial cystoscopy permits identification of the compromised renoureteral unit and perform pyelic instillation of sclerosing agents. Surgery should be reserved for those cases in whom conservative management has failed.