[Health care safety: The discrepancies between experience and degree of satisfaction of hospitalized patients observed in interviews performed by user representatives]. / La sécurité liée aux soins : écarts entre l'expérience et la satisfaction de patients hospitalisés à partir d'entretiens menés par des représentants d'usagers.

INTRODUCTION: The purpose of this article is to present the results of a qualitative survey conducted by user representatives (URs) focusing on the health care safety experience of hospitalized patients. The authors wished to identify factors associated with safety of care and, more specifically, with the possibly ominous medical events reported by patients. METHODS: After being trained with these objectives in mind, eight URs conducted semi-directive interviews with fourteen patients hospitalized in eleven separate hospital units in nine different hospitals. RESULTS: Eight types of factors consisting in 30 contributing factors liable to be reported by patients were identified: 1) factors related to patients' basic needs; 2) personalization of care; 3) professional factors; 4) organizational factors; 5) communication factors; 6) caregiver responsiveness; 7) infectious risks; 8) continuity of care. Patients' overall feelings about their hospitalization remained excellent notwithstanding more tempered, even negative experiences. CONCLUSION: This paradoxical result shows that the patients' actual experience is far more instructive than their degree of satisfaction. In light of this study, the acceptability of this type of research (i.e. research conducted by URs) is excellent and it also appears highly feasible, whatever the limitations imposed by organizational considerations.

[Robotic radical prostatectomy: first 100 patients in Fundació Puigvert]. / Prostatectomía radical robótica: análisis después de 100 casos en la Fundació Puigvert.

OBJECTIVE: We present the 100 first robotic radical prostatectomy with Da Vinci (RRPdaV), corresponding to the first experience in Spain. METHODS: We reviewed the first 100 patients that underwent transperitoneal RRPda performed in Fundació Puigvert between July 2005 and January 2007. All cases were performed by 5 surgeons, being the learning curve for all of them. We analyzed surgical time, blood loss, conversion rate, intra and postoperative complications, hospital stay and days of bladder catheterization. Also, rates and location of surgical margins, as well as functional outcomes with an average follow up of 10.3 months. RESULTS: Mean operating time was 180 minutes (100-310) and blood loss 210 mL (100-390). Blood transfusion was required in 2 cases. There were no intraoperative complications and neither any conversion to open surgery. There were 3 outstanding postoperative events, a compartmentalize syndrome, an acute urinary retention after removal of urethral catheter, and a paresthesias due to brachial plexus compression. Mean hospital stay were 3.7 days. (2-21). We had 21 cases of positive surgical margins (21%). The most frequent location was posterior lateral. 69 of 100 patients (69%) reached early (<3 months) total continence, 91% achieved in 9 months, and remaining 9% required use of at least one pad. Concerning to sexual function, 13 of 100 patients (13%) had preoperative erectile dysfunction, of remaining cases, 62% preserved potency at review, and 38% had postoperative erectile dysfunction. CONCLUSIONS: RRPDAv is a safe and reproducible procedure, and offers promising oncological and functional results with a minimal invasive technique. In spite of include the learning curve of 5 surgeons; we obtain an excellent rate of continence, and an acceptable sexual function. The individual improvement, with more experience, and a longer follow-up, will allow to value evolution of the technique, and it results.

Prostatectomía radical robótica: Análisis después de 100 casos en la Fundació Puigvert / Robotic radical prostatectomy: first 100 patients in Fundació Puigvert

Objetivo: Realizar un análisis de los primeros 100 casos de nuestra serie de prostatectomía radical robótica con Da Vinci (PRRdaV) realizadas en nuestro Centro, que corresponden a la primera serie en España. Material y Métodos: Se realiza un estudio retrospectivo de las 100 primeras PRRdaV consecutivas realizadas en la Fundació Puigvert entre Julio de 2005 y Enero de 2007. El procedimiento fue realizado por 5 cirujanos distintos, siendo la curva de aprendizaje para todos ellos. El abordaje fue transperitoneal en todos los casos. Se analizan, tiempo operatorio, pérdidas hemáticas, tasa de conversión, complicaciones intra y postoperatorias, estancia hospitalaria y días de sonda vesical. También se revisan las tasas y la localización de los márgenes positivos, así como los resultados funcionales, con un seguimiento medio de 10,3 meses. Resultados: La media de tiempo operatorio fue de 180 minutos (100-310) y la pérdida hemática media de 210 mL (100- 390). En 2 casos se realizó transfusión postoperatoria. No se presentaron complicaciones intraoperatorias, y tampoco ninguna reconversión. Como acontecimientos postoperatorios destacan un síndrome compartimental, una retención aguda urinaria tras retirada de sonda vesical, y unas parestesias por compresión del plexo braquial. La estancia hospitalaria media fue 3,7 días (2-21). Se obtuvieron 21 casos con márgenes quirúrgicos positivos (21%). La localización más frecuente fue posterolateral. El 69% fueron continentes de forma precoz (<3 meses), el 91% lo fueron a los 9 meses, el 9% restante requiere de compresa de seguridad. Referente a la función sexual, el 62% conservan potencia y el 38% presentaron disfunción eréctil postoperatoria. Conclusiones: La PRRdaV es un procedimiento seguro, reproducible y que ofrece unos resultados oncológicos y funcionales muy prometedores con un abordaje mínimamente invasivo. A pesar de incluir la curva de aprendizaje de 5 cirujanos, obtenemos una excelente tasa de continencia, y una buena función sexual. La mejora individual, con mayor experiencia, así como un mayor seguimiento, permitirá valorar la evolución de la técnica, así como de sus resultados (AU)

Objective: We present the 100 first robotic radical prostatectomy with Da Vinci (RRPdaV), corresponding to the first experience in Spain. Methods: We reviewed the first 100 patients that underwent transperitoneal RRPda performed in Fundació Puigvert between July 2005 and January 2007. All cases were performed by 5 surgeons, being the learning curve for all of them. We analyzed surgical time, blood loss, conversion rate, intra and postoperative complications, hospital stay and days of bladder catheterization. Also, rates and location of surgical margins, as well as functional outcomes with an average follow up of 10.3 months. Results: Mean operating time was 180 minutes (100-310) and blood loss 210 mL (100-390). Blood transfusion was required in 2 cases. There were no intraoperative complications and neither any conversion to open surgery. There were 3 outstanding postoperative events, a compartmentalize syndrome, an acute urinary retention after removal of urethral catheter, and a paresthesias due to brachial plexus compression. Mean hospital stay were 3.7 days. (2-21). We had 21 cases of positive surgical margins (21%). The most frequent location was posterior lateral. 69 of 100 patients (69%) reached early (<3 months) total continence, 91% achieved in 9 months, and remaining 9% required use of at least one pad. Concerning to sexual function, 13 of 100 patients (13%) had preoperative erectile dysfunction, of remaining cases, 62% preserved potency at review, and 38% had postoperative erectile dysfunction. Conclusions: RRPDAv is a safe and reproducible procedure, and offers promising oncological and functional results with a minimal invasive technique. In spite of include the learning curve of 5 surgeons; we obtain an excellent rate of continence, and an acceptable sexual function. The individual improvement, with more experience, and a longer follow-up, will allow to value evolution of the technique, and it results (AU)

[Transperitoneal laparoscopic partial nephrectomy in the renal tumor treatment]. / Nefrectomía parcial laparoscópica transperitoneal en el tratamiento del tumor renal.

Laparoscopic surgery is a surgical technique the urologist should add to his surgical armamentarium. Its performance tries to mimic the surgical phases of open surgery, and also its indications. Laparoscopic partial nephrectomy is a sophisticated technique that requires wide experience in the performance of endoscopic strategies. We are submitting our experience with 35 laparoscopic partial transperitoneal nephrectomies with a mean follow-up of 25 months. The mean surgical time was 200 minutes, the mean bleeding 190 cc, and the mean hospitalisation five days. Two postoperative bleedings were identified, there were no conversions, and positive margins were notified in two cases, where upon a conservative attitude was adopted.

Nefrectomía parcial laparoscópica transperitoneal en el tratamiento del tumor renal / Transperitoneal laparoscopic partial nephrectomy in the renal tumor treatment

La cirugía laparoscópica constituye una técnica quirúrgica que el urólogo debe incorporar a su armamentario quirúrgico. Su realización intenta simular los pasos quirúrgicos de la cirugía abierta, así como sus indicaciones. La nefrectomía parcial laparoscópica es una técnica compleja que implica para su desarrollo una experiencia amplia en el manejo de las técnicas endoscópicas. Presentamos nuestra experiencia de 35 nefrectomías parciales laparoscópicas transperitoneales con una media de seguimiento de 25 meses. El tiempo medio de cirugía fue de 200 minutos, el sangrado de 190 cc, y la estancia media de cinco días. Se han objetivado dos sangrados postoperatorios, ninguna conversión y en dos casos se informó de márgenes positivos, optándose por una actitud conservadora

Laparoscopic surgery is a surgical technique the urologist should add to his surgical armamentarium. Its performance tries to mimic the surgical phases of open surgery, and also its indications. Laparoscopic partial nephrectomy is a sophisticated technique that requires wide experience in the performance of endoscopic strategies. We are submitting our experience with 35 laparoscopic partial transperitoneal nephrectomies with a mean follow-up of 25 months. The mean surgical time was 200 minutes, the mean bleeding 190 cc, and the mean hospitalisation five days. Two postoperative bleedings were identified, there were no conversions, and positive margins were notified in two cases, whereupon a conservative attitude was adopted

Simulación y práctica en laparoscopia en Urología / Simulation and practice in urological laparoscopy

El tratamiento endovesical con quimioterapia o inmunoterapia después de la resección transuretral de un tumor vesical superficial es un procedimiento estándar. El mecanismo de acción del bacilo de Calmette-Guérin depende de una reacción inmunitaria de la vejiga, que se evidencia con una respuesta que se puede evaluar en orina (citoquinas, leucocituria). Presentamos una revisión del tema ya que la utilización para la investigación ofrece posibilidades de valorar diferentes esquemas terapéuticos y su relación con la respuesta tumoral

Endovesical treatment by means of eitber cbemotberapy or immunotberapy following transuretbral resection of a superficidal bladder tumour is a standard procedure. Tbe mecbanism of actions oftbe bacilus Calmette-Guérin depends upon an immunitary reaction by tbe bladder; shown by a response tbat can be asessed in tbe urine (cytokines, leukocyturia). We present berein a review of tbe issue, since its use witb researcb purposes offers tbe possibility of evaluating different tberapeutic schemes as weU as its relationsbip to tbe tumour response

Clamping of the renal artery in laparoscopic partial nephrectomy: an old device for a new technique.

OBJECTIVE: We describe our experience with the transient clamping of the renal artery during laparoscopic partial nephrectomy for renal cancer with a double loop clamping device, inspired by the Rumel tourniquet. The silastic rubber loop is positioned around the renal artery and clinched, thus achieving arterial occlusion. METHODS: From November 2002 until July 2004, fourteen consecutive patients (mean age of 58 +/- 11.6 years) underwent laparoscopic transperitoneal partial nephrectomy using the silastic rubber clamping device, eight of them on the right side and six on the left side. Hemorrhage of the renal defect was controlled with bipolar electrocoagulation, argon beam coagulation, laparoscopic sutures, surgical and fibrin glue. RESULTS: : The mean surgical time was 198.92 +/- 39.95 min for a mean tumour size of 2.9 +/- 2.32 cm and a mean blood loss of 104.57 +/- 77.69 ml. The clamping device was easily and successfully positioned around the renal artery in 2.05 +/- 0.45 min and the mean warm ischemic time was 25.21 +/- 6.07 min. CONCLUSIONS: The clamping device procures successful atraumatic occlusion of the renal artery during laparoscopic partial nephrectomy without the need for an additional port. As such, it could be considered as an alternative for the laparoscopic bulldog and Satinsky clamp.

Nefrectomía parcial laparoscópica por tumor renal / No disponible

La cirugía conservadora renal se ha convertido en una opción terapéutica ampliamente aceptada cuando un adenocarcinoma involucra un riñón solitario, una pobre función renal contralateral o en pacientes con tumores sincrónicos bilaterales. Mientras la cirugía conservadora renal a cielo abierto es el procedimiento estándard para el tratamiento de estos tumores renales, la nefrectomía parcial laparoscópica ha emergido recientemente como una alternativa potencial. Presentamos el caso clínico de una paciente afecto de un tumor renal sólido exofitico y de disposición en el polo inferior del riñón izquierdo. Se muestra la técnica empleada en nefrectomía parcial laparoscópica y la aplicación de un diseño de clampaje arterial con vasel-loop, inspirada en el torniquete de Rumel, en la oclusión atraumática de la arteria renal. Presentamos nuestra experiencia de 16 casos de nefrectomía parcial, comparándose con otras series publicadas en la literatura (AU)

The ranal conservative surgery has become a broadly accepted therapeutic option when an adenocarcinoma involves a single kidney, a poor contralateral renal function or a patient with bilateral synchonous tumors. Laparoscopic radical nephrectomy is now routinely performed at many institutions worldwide and should be considered the standard of care for localized renal tumors not amendable to partial nephrectomy. With the advancement in techniques, instruments and surgical expertise, laparoscopic partial nephrectomy is emerging as a viable treatment alternative for selected patients who are candidates for nephron sparing surgery. We present the clinical case of a patient with a solid renal tumor, located at the lower pole of the left Kidney. We describe the laparoscopic partial nefrectomy with a double loop clamping device, inspired by the Rumel tourniquet, for transient atraumatic occlusion of the renal artery during laparoscopic partial nephrectomy. We present our experience in 16 cases of partial nephrectomy, being compared with others in the literature (AU)

Protocolo asistencial: crioterapia prostática / No disponible

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Contemporary non-imaging methods in diagnosis of bladder cancer: a review.

The early diagnosis of bladder cancer is central to the effective treatment of the disease. Presently, the detection of bladder tumors relies on cystoscopy and there are no methods available to easily and specifically identify the presence of bladder cancer cells. A variety of new technologies and potential tumor markers are being studied in bladder cancer and some are being translated into clinical use. It is important to realise that all available results on the diagnostic value of tumor markers do not allow firm clinical recommendations, but tests based on biomarkers will undoubtedly influence the management of bladder cancer in the near future.