Correlación entre síntomas y resultado del estudio urodinámico tras la prostatectomía radical / Correlation between symptoms and urodynamic results in patients with urinary incontinence after radical prostatectomy

OBJETIVOS: La incontinencia urinaria (IU) es una importante complicación tras la prostatectomía radical (PR). Aunque la incompetencia esfinteriana es la causa predominante; la disfunción vesical puede contribuir considerablemente. Nuestro objetivo fue evaluar los resultados del estudio urodinámico (EUD) en hombres con IU tras PR y analizar su relación con la clínica. MÉTODOS: Evaluamos retrospectivamente aquellos pacientes remitidos a nuestra unidad con IU tras PR entre 2004 y 2014. Describimos sintomatología, hallazgos urodinámicos y analizamos la correlación entre ambos. RESULTADOS: Incluimos 74 pacientes con una mediana de pañales al día de 3. El 61% referían urgencia, 63% IU esfuerzo (IUE), 11% IU urgencia (IUU) y 26% IU mixta (IUM).El EUD mostró IUE urodinámica en el 53%, hiperactividad del detrusor en el 53% y una acomodación vesical disminuida en el 43%. Del total con acomodación vesical disminuida, referían IUU el 56%. El EUD no demostró IU en el 16%, de los cuales el 80% referían clínicamente IUU. Se observa obstrucción del tracto de salida vesical en el 17% e hipoactividad del detrusor o detrusor acontráctil en el 36%. De los pacientes con obstrucción, en el 46% se objetivó incontinencia por hiperactividad del detrusor. Al correlacionar la clínica y resultados urodinámicos observamos que pacientes con IUE, un 31% sólo presentaban incontinencia por hiperactividad del detrusor. En aquellos con IUM, en un 42% sólo se observó IUE urodinámica y en el 33% sólo incontinencia por hiperactividad del detrusor. Sólo en el 27% de los que referían urgencia se objetivó incontinencia por hiperactividad del detrusor. CONCLUSIONES: En pacientes con IU tras PR existe un elevado porcentaje de obstrucción del tracto urinario, hiperactividad del detrusor y disminución de la acomodación vesical, que podría contribuir a la IU. Además, la correlación entre la clínica y EUD es baja

OBJECTIVES: Urinary incontinence (UI) is a significant complication after radical prostatectomy (RP). Although sphincter incompetence is considered the main cause; bladder dysfunction can contribute substantially. Our objective was to evaluate the results of the urodynamic study (UDS) in men with UI after radical prostatectomy and analyze the correlation between symptoms and urodynamic parameters. METHODS: We carried out a retrospective study reviewing the symptoms and urodynamics in patients with urinary incontinence after RP. We describe the symptoms, urodynamic findings and we analyze the correlation between both. RESULTS: Our study included 74 patients. The median number of pads used per day was 3. 61% reported urgency, 63% stress urinary incontinence, 11% urgency urinary incontinence and 26% mixed urinary incontinence. The UDS showed stress urinary incontinence in 53% of patients, detrusor overactivity in 53% and, reduced bladder compliance in 43%. Urgency urinary incontinence was reported in 56% of patients with reduced bladder compliance. Urodynamics showed no incontinence in 16% of patients, of whom 80% showed urgency urinary incontinence. Urodynamics data showing obstruction of the urinary tract was reported in 17% and detrusor hypo or acontractility in 36%. Among patients with obstruction, 46% showed incontinence due to detrusor overactivity. The correlation of symptoms and urodynamics showed that only 31% of patients with stress urinary incontinence had incontinence due to detrusor overactivity in urodynamics. Among those with mixed urinary incontinence, urodynamic stress urinary incontinence only was found in 42% and 33% incontinence due to detrusor overactivity only. Finally, among those with symptoms of urgency urinary incontinence, the urodynamics showed detrusor overactivity in 27%. CONCLUSIONS: In patients with urinary incontinence after radical prostatectomy, there is a high percentage of patients with urinary tract obstruction, detrusor overactivity and decreased compliance. Moreover, the correlation between symptoms and urodynamics is low

[Correlation between symptoms and urodynamic results in patients with urinary incontinence after radical prostatectomy.] / Correlación entre síntomas y resultado del estudio urodinámico tras la prostatectomía radical.

OBJECTIVES: Urinary incontinence (UI) is a significant complication after radical prostatectomy (RP). Although sphincter incompetence is considered the main cause; bladder dysfunction can contribute substantially. Our objective was to evaluate the results of the urodynamic study (UDS) in men with UI after radical prostatectomy and analyze the correlation between symptoms and urodynamic parameters. METHODS: We carried out a retrospective study reviewing the symptoms and urodynamics in patients with urinary incontinence after RP. We describe the symptoms, urodynamic findings and we analyze the correlation between both. RESULTS: Our study included 74 patients. The median number of pads used per day was 3. 61% reported urgency, 63% stress urinary incontinence, 11% urgency urinary incontinence and 26% mixed urinary incontinence. The UDS showed stress urinary incontinence in 53% of patients, detrusor overactivity in 53% and, reduced bladder compliance in 43%. Urgency urinary incontinence was reported in 56% of patients with reduced bladder compliance. Urodynamics showed no incontinence in 16% of patients, of whom 80% showed urgency urinary incontinence. Urodynamics data showing obstruction of the urinary tract was reported in 17% and detrusor hypo or acontractility in 36%. Among patients with obstruction, 46% showed incontinence due to detrusor overactivity. The correlation of symptoms and urodynamics showed that only 31% of patients with stress urinary incontinence had incontinence due to detrusor overactivity in urodynamics. Among those with mixed urinary incontinence, urodynamic stress urinary incontinence only was found in 42% and 33% incontinence due to detrusor overactivity only. Finally, among those with symptoms of urgency urinary incontinence, the urodynamics showed detrusor overactivity in 27%. CONCLUSIONS: In patients with urinary incontinence after radical prostatectomy, there is a high percentage of patients with urinary tract obstruction, detrusor overactivity and decreased compliance. Moreover, the correlation between symptoms and urodynamics is low.

Use of onabotulinum toxin A in patients with idiopathic overactive bladder and a lack of efficacy, intolerance or contraindication with anticholinergics / Uso de la onabotulinumtoxina A en pacientes con vejiga hiperactiva idiopática con falta de eficacia, intolerancia o contraindicación para los anticolinérgicos

Objective To assess the efficacy and safety of onabotulinum toxin A in patients with idiopathic overactive bladder inadequately managed with anticholinergics. Materials and Methods A prospective, open-label, single centre, and interventional study was conducted, from 2008 to 2013, on consecutive patients with idiophatic overactive bladder that showed lack of efficacy or intolerance to anticholinergic agents. Results The study included 73 female patients aged 58.9 ± 12.9 years. A dose of 100 and 200 units of toxin were administered in 89 and 5 cases, respectively. Nineteen patients received a second injection, 8 patients received 3, and one patient was treated 4 times. Clinically, it was observed that 98% patients had urge urinary incontinence at baseline, as compared with 42% under treatment. Similar results were obtained regarding the number of pads used per day, from 2.8 at baseline to 0.5 after treatment as regards the urodynamic parameters, the first desire to void volume improved from 97 ± 63 mL to 139 ± 81 mL. Similar results were obtained as regards cystometric capacity and the volume of the first involuntary detrusor contraction. One patient had a positive urine culture resolved using a conventional oral antibiotic regimen. Intermittent catheterisation was required in 5 patients during the first week. Conclusions Onabotulinum toxin A injections significantly improved, not only the clinical symptoms, but also the urodynamic parameters in patients with idiopathic overactive bladder inadequately managed with anticholinergic drugs. This is a simple technique with minimal adverse effects and generally well tolerated.

Objetivo Evaluar la eficacia y seguridad de onabotulinumtoxina A en pacientes con vejiga hiperactiva idiopática con falta de eficacia, intolerancia o contraindicación para el uso de anticolinérgicos. Material and Métodos Se realizó un estudio observacional, prospectivo, abierto en un único centro entre 2008 y 2013, en pacientes consecutivos con vejiga hiperactiva idiopática con falta de eficacia o intolerancia a los anticolinérgicos. Resultados Las 73 pacientes fueron mujeres con edad de 58,9 ± 12,9 años. Se administraron 100 y 200 unidades de toxina en 89 y 5 casos, respectivamente. Diecinueve pacientes recibieron una segunda inyección, 8 pacientes 3 inyecciones y un paciente 4. Clínicamente se observó que inicialmente un 98% de las pacientes tenían incontinencia urinaria de urgencia y después del tratamiento solo un 42%; el número de absorbentes por día, pasó de 2,8 al inicio a 0,5 después del tratamiento. Respecto a los parámetros urodinámicos, el volumen del primer deseo miccional mejoró de 97 ± 63 mL a 139 ± 81 mL. Se obtuvieron resultados similares en capacidad cistométrica y el volumen de la primera contracción involuntaria del detrusor. Una paciente tuvo urocultivo positivo, resolviéndose con un régimen de antibiótico oral convencional. El cateterismo intermitente fue necesario en 5 pacientes durante la primera semana. Conclusiones Las inyecciones de onabotulinumtoxina A mejoraron significativamente no solo los síntomas clínicos, sino también los parámetros urodinámicos en pacientes con vejiga hiperactiva idiopática inadecuadamente manejados con anticolinérgicos. Esta es una técnica simple, con efectos adversos mínimos y generalmente bien tolerada.

Urinary Infections in Patients with Catheters in the Upper Urinary Tract: Microbiological Study.

BACKGROUND: Infections related to catheters in the upper urinary tract (CUUT) are associated with specific characteristics. METHODS: A prospective observational study was carried out from 2012 to 2015 to evaluate infections in patients with CUUT. RESULTS: A total of 209 infections were included (99 with double-J, 81 with nephrostomy, and 29 with internal/external nephroureteral stents). Among nephrostomy tube carriers, the most frequently isolated microorganisms were Pseudomonas and Enterococcus. In those with an internal/external nephroureteral stent, Klebsiella was the most common, and 57.1% were extended-spectrum beta-lactamase-producing Klebsiella. In double-J carriers, Escherichia coli and Enterococcus were the most common microorganisms. Multiple-drug resistance (MDR) microorganisms were isolated in 28.6, 47.1, and 58.3% of patients with double-J, nephrostomy, and internal-external nephroureteral stents. A percutaneous CUUT (p = 0.005) and immunosuppression (p = 0.034) were risk factors for MDR microorganisms. CONCLUSIONS: Non-E. coli bacteria are commonly isolated in patients with CUUT. MDR microorganisms are frequent, mainly in percutaneous approach or immunosuppression.

Prospective study analyzing risk factors and characteristics of healthcare-associated infections in a Urology ward.

PURPOSE: Healthcare-associated infections (HAIs) in urological patients have special features due to specific risk factors. Our objective was to evaluate the characteristics and risk factors for HAIs in patients hospitalized in a Urology ward. MATERIALS AND METHODS: We evaluated prospectively, from 2012 to 2015, the incidence, types and risk factor for HAIs, microbiological and resistance patterns. RESULTS: The incidence of HAIs was 6.3%. The most common types were urinary infections (70.5%) and surgical site infections (22.1%). Univariate analysis showed an increased risk of HAIs among patients with American Society of Anesthesiologists physical status classification system III-IV (odds ratio [OR], 1.39; p<0.001), immunosuppression (OR, 1.80; p=0.013), previous urinary infection (OR, 4.46; p<0,001), and urinary catheter before admission (OR, 1.74; p<0.001). The surgical procedures with the highest incidence of HAIs were radical cystectomy (54.2%) and renal surgery (8.7%). The most frequently isolated microorganisms were Escherichia coli (25.1%), Enterococcus spp. (17.5%), Klebsiella spp. (13.5%) and Pseudomonas aeruginosa (12.3%). Enterococcus sp was the most common microorganism after radical cystectomy and in surgical site infections, E. coli showed resistance rates of 53.5% for fluoroquinolones, 9.3% for amikacin. The percentage of extended-spectrum betalactamase producing E. coli was 24.7%. Klebsiella spp. showed resistance rates of 47.8% for fluoroquinolones, 7.1% for amikacin and 4.3% for carbapenems. Enterococcus spp showed resistance rates of 1.7% for vancomycin and; P. aeruginosa of 33.3% for carbapenems and 26.2% for amikacin. CONCLUSIONS: Comorbidities, previous urinary infections, and urinary catheter are risk factors for HAIs. The microorganisms most commonly isolated were E. coli, Enterococcus and P. aeruginosa. Prospective monitoring may decrease the incidence of infections.

Perigraft fluid collections after kidney transplantation: Does the type of donor (uncontrolled donation after circulatory death vs. donation after brain death) have a role?

INTRODUCTION: Perigraft fluid collection (PFC) is a common complication after kidney transplant. Its etiology is not clear and not all the causes have been identified. The influence of the type of donor has never been evaluated. Our aim was to compare the incidence, severity and management of PFC in recipients of grafts from uncontrolled donors after circulatory death (DCD) with normothermic extracorporeal membrane oxygenation (NECMO) versus recipients of grafts from donors after brain death (DBD). MATERIAL AND METHODS: We conducted a retrospective cohort study of 300 kidney transplants performed in our center between 2007 and 2012. Patients were divided in two groups: 150 recipients of Maastricht II DCD graft and 150 recipients of the DBD graft. Incidence, severity according to Clavien scale and management were analyzed in both groups, and comparison was carried out using Chi-square. RESULTS: Of the 300 kidney recipients analyzed, 93 (31.4%) suffered PFC, showing no difference between DBD (32.0%) and DCD (30.8%) groups (p = 0.9). Complicated PFC rate (defined as a PFC generating vascular compression, fever or urinary tract obstruction) was 22.9% in the DBD group versus 22.2% in the DCD group (p = 1); most complicated PFC were due to urinary tract obstruction (81%), with no difference between the groups (p = 1). Concerning Clavien scale, 78.5% of the PFC in our series were Clavien I, 19.4% Clavien IIIa and 2.2% Clavien IIIb, with no difference between both groups (p = 1). CONCLUSIONS: PFC is a frequent complication that appears in a third of our patients, showing no difference in the incidence or severity between DBD and uncontrolled DCD graft recipients.

Multidisciplinary approach to giant paratesticular liposarcoma.

Primary paratesticular tumours are very rare and the spermatic cord (SCT) is the most frequent site of origin, with 20% of malignancy. Although liposarcoma is the most frequent histotype (46.6 %), less than 200 cases have been reported in the literature. We report the case of a 56-year-old man who presented a giant scrotal mass of 25 years of evolution and measuring 40 × 40 cm. It could be considered the greatest paratesticular liposarcoma described to date. Computed tomogaphy (CT) revealed mass features consistent with liposarcoma and the simultaneous presence of bilateral inguinal hernia with bladder involvement. A multidisciplinary approach was taken to remove the mass, solve the hernia, and provide functional results.

Extended-Spectrum Beta-Lactamase-Producing Bacteria in a Urology Ward: Epidemiology, Risk Factors and Antimicrobial Susceptibility Patterns.

INTRODUCTION: Our aim was to describe the incidence and risk factors associated with extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and their resistance rate in a urological ward. MATERIAL AND METHODS: We carried out a prospective observational study from November 2011 to December 2014, reviewing healthcare-associated infections (HAIs) in our department. We evaluated the infections caused by ESBL-producing Enterobacteriaceae. RESULTS: The incidence of HAIs in our urology ward was 6.8%. Enterobacteriaceae including Escherichia coli (24.9%), Klebsiella spp. (12.1%), Enterobacter spp. (5.9%), Morganella spp. (1.5%), Proteus spp. (1.5%), and Citrobacter spp. (1.5%) represented 47.4% of the isolated pathogens. The percentage of ESBL-producing Enterobacteriaceae was 26.4. Risk factors associated with a higher incidence of ESBL-producing bacteria were prior urinary tract infection (UTI; p < 0.001), hypertension (p = 0.042), immunosuppression (p = 0.004), and urinary stone (p = 0.027). The multivariable analysis confirmed prior UTI, immunosuppression and urinary stone as risk factors. ESBL-producing strains showed resistance rates of 85.3% for fluoroquinolones and 11.8% for carbapenems. Moreover, 16.7% of ESBL-Klebsiella were resistant to carbapenems. CONCLUSIONS: ESBL-producing enterobacteria are associated with higher cross resistance to antibiotics such as quinolones. Higher resistance rates are reported in ESBL-producing Klebsiella. Among patients admitted in a urology ward, risk factors for ESBL-producing strains were previous UTI, immunosuppression, and urinary stone.

Infecciones del tracto urinario de origen hospitalario en pacientes portadores de catéter urinario: factores de riesgo, características microbiológicas y resistencias a antibióticos / Healthcare-associated urinary tract infections in patients with a urinary catheter: Risk factors, microbiological characteristics and patterns of antibiotic resistance

OBJETIVO: Las infecciones del tracto urinario asociadas a catéteres urinarios (ITU-AC) son la causa más frecuente de infección nosocomial, presentando altas tasas de resistencias. Están asociadas a complicaciones potencialmente severas, implicando mayor coste económico. Nuestro objetivo fue analizar las características de las ITU nosocomiales asociadas a catéter urinario en un Servicio de Urología. MÉTODOS: Llevamos a cabo un estudio prospectivo desde Noviembre de 2011 hasta Octubre de 2013, evaluando la incidencia de infecciones nosocomiales asociadas a los catéter de derivación urinaria en una planta de hospitalización urológica. Además evaluamos los factores de riesgo como comorbilidades, sondaje previo al ingreso y cirugía durante la hospitalización. Se presentan los patrones microbiológicos y tasas de resistencia de los gérmenes aislados. RESULTADOS: La incidencia de ITU-AC nosocomial fue de 8,2% (189/2283 pacientes portadores d e catéteres urinarios). La edad media fue de 67,4 ± 14,26 años, el 90,2% fueron sometidos a un procedimiento quirúrgico (p< 0,001), 14,8% tenían litiasis urinaria (p = 0,058) y el 46% portaban cateterismo urinario previo al ingreso (p < 0,001). Los microorganismos más frecuentemente aislados fueron Escherichia coli (22,6%), Enterococcus (21,9%) y Pseudomonas aeruginosa (13,9%). E.coli mostró una resistencia de 41,9% para quinolonas y un 33,3% fueron productores de β-lactamasas de espectro extendido (ESBL). P.aeruginosa presentaba 42,1% de resistencias a quinolonas y hasta un 21,1% a carbapenems. CONCLUSIONES: Portar un catéter urinario previo al ingreso y la realización de un procedimiento quirúrgico urológico durante el ingreso son factores de riesgo de ITU nosocomial en pacientes ingresados en el Servicio de Urología. Existe una elevada incidencia de gérmenes resistentes y de patógenos no clásicos como Enterococcus spp

OBJECTIVE: Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial acquired infections, with high resistance rates. CAUTIs are a potentially severe complication in hospitalized patients and imply higher costs. Our aim was to analyze the characteristics of CAUTIs in our Urology department. METHODS: Between November 2011 and October 2013, a prospective observational study was carried out analyzing the incidence of healthcare-associated urinary tract infections in patients admitted to the urology ward with an indwelling urinary catheter. Furthermore, we evaluated associated risks factors and comorbidities such as urinary catheter at the time of admission or urological surgery during the hospitalization. We also presented our results regarding the microbiological characteristics and patterns of resistance to antibiotics in patients with CAUTI admitted in our service. RESULTS: The incidence of CAUTI was 8.2% (189/2283 patients who had urinary catheter). Mean age was 67.4 ± 14.26 years, 90.2% underwent a surgical procedure (p < 0.001), 14.8% had a urinary stone (p = 0.058) and 46% had a urinary catheter before admission (p < 0.001). The most commonly isolated pathogens were Escherichia coli (22.6%), Enterococcus (21.9%) and Pseudomonas aeruginosa (13.9%). E.coli showed resistance rates of 41.9% for quinolones, 33.3% of them produced extended spectrum βeta-lactamase (ESBL). P.aeruginosa showed resistance rates of 42.1% for quinolones and 21.1% for carbapenems. CONCLUSIONS: Healthcare-associated CAUTI in patients hospitalized in a urology ward are related to risks factors such as having a urinary catheter before admission and undergoing a surgical procedure. Moreover, CAUTIs have higher incidence of pathogens with antibiotic resistances and non-common pathogens such as Enterococcus spp

[Healthcare-associated urinary tract infections in patients with a urinary catheter: Risk factors, microbiological characteristics and patterns of antibiotic resistance]. / INFECCIONES DEL TRACTO URINARIO DE ORIGEN HOSPITALARIO EN PACIENTES PORTADORES DE CATÉTER URINARIO: FACTORES DE RIESGO, CARACTERÍSTICAS MICROBIOLÓGICAS Y RESISTENCIAS A ANTIBIÓTICOS.

OBJECTIVE: Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial acquired infections, with high resistance rates. CAUTIs are a potentially severe complication in hospitalized patients and imply higher costs. Our aim was to analyze the characteristics of CAUTIs in our Urology department. METHODS: Between November 2011 and October 2013, a prospective observational study was carried out analyzing the incidence of healthcare-associated urinary tract infections in patients admitted to the urology ward with an indwelling urinary catheter. Furthermore, we evaluated associated risks factors and comorbidities such as urinary catheter at the time of admission or urological surgery during the hospitalization. We also presented our results regarding the microbiological characteristics and patterns of resistance to antibiotics in patients with CAUTI admitted in our service. RESULTS: The incidence of CAUTI was 8.2% (189/2283 patients who had urinary catheter). Mean age was 67.4±14.26 years, 90.2% underwent a surgical procedure (p<0.001), 14.8% had a urinary stone (p=0.058) and 46% had a urinary catheter before admission (p<0.001). The most commonly isolated pathogens were Escherichia coli (22.6%), Enterococcus (21.9%) and Pseudomonas aeruginosa (13.9%). E.coli showed resistance rates of 41.9% for quinolones, 33.3% of them produced extended spectrum Β-lactamase (ESBL). P.aeruginosa showed resistance rates of 42.1% for quinolones and 21.1% for carbapenems. CONCLUSIONS: Healthcare-associated CAUTI in patients hospitalized in a urology ward are related to risks factors such as having a urinary catheter before admission and undergoing a surgical procedure. Moreover, CAUTIs have higher incidence of pathogens with antibiotic resistances and non-common pathogens such as Enterococcus spp.

Survey of satisfaction in hospitalized patients at a urology department.

OBJECTIVES: To assess the level of satisfaction with the care provided to hospitalized patients in the Department of Urology at 12 de Octubre Hospital and analyze demographic and clinical factors influencing satisfaction. METHODS: A cross-sectional study was carried out using the SERVQHOS questionnaire, delivered at the time of discharge. A data sheet for each patient was collected, which included if they undergone surgery, type of surgery and whether or not presented postoperative complications, rated by the Clavien scale. RESULTS: 479 surveys were collected, with a participation of 92%. 95.4% of patients rated their overall level of satisfaction with the care received as "satisfied" or "very satisfied". Top-rated aspects were the kindness of the staff and personalized attention. The worst rated issue was the condition of the rooms, but this did not influence perceived quality. Variables related to greater overall satisfaction were male gender, shorter hospital stay, knowing the name of the nurse, the information received and subjective factors such as personalized service and willingness to help. CONCLUSIONS: Our patients show a high level of satisfaction, which is mainly dependent on subjective factors. The negative issues related to the facilities do not mean lower satisfaction.

Estudio de satisfacción en pacientes hospitalizados en un Servicio de Urología / Survey of satisfaction in hospitalized patients at a Urology Department

OBJETIVO: Evaluar el grado de satisfacción con la atención prestada de los pacientes hospitalizados en el servicio de Urología del Hospital 12 de Octubre y analizar los factores sociodemográficos y clínicos que influyen en el grado de satisfacción. MÉTODOS: Estudio transversal utilizando el cuestionario SERVQHOS, entregado en el momento del alta. Se recogió una hoja de datos de cada paciente que incluía si se había sometido a intervención quirúrgica, el tipo de cirugía y si había presentado complicaciones postquirúrgicas valoradas mediante la escala Clavien. RESULTADOS: Se recogieron 479 encuestas, con una participación del 92%. El 95,4% de los pacientes calificaban su nivel de satisfacción global con los cuidados recibidos como satisfechos o muy satisfechos. Los aspectos mejor calificados fueron la amabilidad del personal y el trato personalizado. Destaca como aspecto peor valorado el estado de las habitaciones, aunque no influye en la calidad percibida. Las variables relacionadas con una mayor satisfacción global fueron el sexo masculino, menor estancia hospitalaria, conocer el nombre de la enfermera, la información recibida y factores subjetivos como el trato personalizado y la disposición a ayudar. CONCLUSIONES: Nuestros pacientes presentan unos índices de satisfacción elevados, que se relacionan sobre todo con los factores subjetivos. Los aspectos negativos relacionados con las instalaciones no suponen un menor grado de satisfacción (AU)

OBJECTIVES: To assess the level of satisfaction with the care provided to hospitalized patients in the Department of Urology at 12 de Octubre Hospital and analyze demographic and clinical factors influencing satisfaction. METHODS: A cross-sectional study was carried out using the SERVQHOS questionnaire, delivered at the time of discharge. A data sheet for each patient was collected, which included if they undergone surgery, type of surgery and whether or not presented postoperative complications, rated by the Clavien scale. RESULTS: 479 surveys were collected, with a participation of 92%. 95.4% of patients rated their overall level of satisfaction with the care received as "satisfied" or "very satisfied". Top-rated aspects were the kindness of the staff and personalized attention. The worst rated issue was the condition of the rooms, but this did not influence perceived quality. Variables related to greater overall satisfaction were male gender, shorter hospital stay, knowing the name of the nurse, the information received and subjective factors such as personalized service and willingness to help. CONCLUSIONS: Our patients show a high level of satisfaction, which is mainly dependent on subjective factors. The negative issues related to the facilities do not mean lower satisfaction (AU)

Implementing an action protocol on prostatic disease in primary care and impact on referrals to urology.

OBJECTIVES: To determine the impact of implementing a joint action protocol on prostatic disease on the referrals to Urology from Primary Care in a health care area. METHODS: We drafted a protocol for managing patients consulting for clinical signs and symptoms associated to benign prostatic hyperplasia (BPH) and to test PSA in asymptomatic males. At the same time, three e-mail addresses were opened for consultations generated from Primary Care, and joint sessions were carried out in the primary health care centers. We measured the impact of the protocol by assessing the adequacy of prostatic disease referrals to Urology, as well as by determining the course of the total number of referrals in three peripheral specialized health care centers (PSHCC). RESULTS: From January 2011, a better compliance to the referrals to Urology protocol for prostatic disease has been produced, going from 47% (assessment prior to implementing the protocol) to 64%. These results are especially good when we consider referrals associated to PSA, which went from a compliance of 33% to 84%. Regarding the course of the referrals to Urology, the referral rate (referrals per 1000 inhabitants) has decreased by 15% (from 13,8 to 11,7). CONCLUSIONS: The collaboration between Urology and Primary health care, by means of implementing joint protocols, and also by establishing new communication channels (e-mail, joint sessions), achieves a better adequacy of patients referred for prostatic disease, as well as a reduction in the total number of referrals.

Implantación de un protocolo de actuación en patología prostática en atención primaria e impacto en las derivaciones a urología / Implementing an action protocol on prostatic disease in primary care and impact on referrals to urology

OBJETIVO: Determinar el impacto sobre las derivaciones a Urología desde Atención Primaria, de un protocolo de actuación conjunta en patología prostática en un área sanitaria. MÉTODOS: Se elaboró un protocolo para el manejo del paciente que consulta por clínica relacionada con hiperplasia prostática y para la realización de PSA en varón asintomático. Al mismo tiempo, se abrieron tres direcciones de correo electrónico para consultas generadas desde Atención Primaria y se realizaron sesiones conjuntas en los Centros de Salud. Medimos el impacto del protocolo valorando la adecuación de las derivaciones a Urología por patología prostática, así como determinando la evolución del número total de derivaciones en tres centros de especialidades periféricas. RESULTADOS: Desde enero de 2011, se ha producido una mejor adecuación de las derivaciones a Urología por patología prostática, que han pasado de un 47% de adecuación (valoración previa a la implantación del protocolo) a un 64%. Estos resultados son especialmente buenos cuando consideramos las derivaciones relacionadas con el PSA, que han pasado de un 33% a un 84% de adecuación. En cuanto a la evolución de las derivaciones a Urología, la tasa de derivación (derivaciones por 1000 habitantes) ha descendido en un 15% (de 13,8 a 11,7). CONCLUSIONES: La colaboración entre Urología y Atención Primaria, mediante la implantación de protocolos conjuntos, así como estableciendo nuevos medios de comunicación (correo electrónico, sesiones conjuntas), consigue una mejor adecuación de los pacientes derivados por patología prostática, así como una disminución en el número total de derivaciones (AU)

OBJECTIVES: To determine the impact of implementing a joint action protocol on prostatic disease on the referrals to Urology from Primary Care in a health care area. METHODS: We drafted a protocol for managing patients consulting for clinical signs and symptoms associated to benign prostatic hyperplasia (BPH) and to test PSA in asymptomatic males. At the same time, three e-mail addresses were opened for consultations generated from Primary Care, and joint sessions were carried out in the primary health care centers. We measured the impact of the protocol by assessing the adequacy of prostatic disease referrals to Urology, as well as by determining the course of the total number of referrals in three peripheral specialized health care centers (PSHCC). RESULTS: From January 2011, a better compliance to the referrals to Urology protocol for prostatic disease has been produced, going from 47% (assessment prior to implementing the protocol) to 64%. These results are especially good when we consider referrals associated to PSA, which went from a compliance of 33% to 84%.Regarding the course of the referrals to Urology, the referral rate (referrals per 1000 inhabitants) has decreased by 15% (from 13,8 to 11,7). CONCLUSIONS: The collaboration between Urology and Primary health care, by means of implementing joint protocols, and also by establishing new communication channels (e-mail, joint sessions), achieves a better adequacy of patients referred for prostatic disease, as well as a reduction in the total number of referrals (AU)

Complicaciones infecciosas tras biopsia prostática transrectal. Análisis de nuestra experiencia / Infectious complications after transrectal ultrasound-guided prostatic biopsy. Analysis of our experience

OBJETIVO: Establecer la tasa de complicaciones infecciosas derivadas de la realización de una biopsia prostática transrectal ecodirigida (BPTRE), identificar su perfil microbiológico y los factores de riesgo relacionados.MÉTODOS: Diseñamos un estudio prospectivo no aleatorizado donde se incluyeron 220 pacientes sometidos a BPTRE en nuestro centro entre Abril y Septiembre de 2008. Los criterios de inclusión fueron: tacto rectal sospechoso, PSA >10ng/ml y en aquellos con PSA 4-10 ng/ml se tiene valora el cociente PSA libre/total. Los criterios de exclusión empleados fueron: ser portador de catéter urinario, administración de tratamiento antibiótico la semana previa a la realización de la biopsia, manipulación de la vía urinaria en el mes previo a la biopsia, alergia a quinolonas y riesgo de endocarditis, incumplimiento de la pauta de profilaxis antibiótica y pérdida de seguimiento.Analizamos la relación entre ser diabético, inmunodeprimido, ITU o prostatitis previas y urocultivo prebiopsia positivo con la aparición de fiebre, disuria o bacteriuria tras la biopsia.RESULTADOS: La edad media fue de 69,5 años (+/-7,9), el PSA total medio 12,7ng/ml (+/-28,7), el volumen prostático medio 50,6cc (+/-29,6) y el número medio de cilindros obtenidos por biopsia 13,5 (+/-1,7).El 25% de los pacientes tenía disuria tras la biopsia, el 3,2% fiebre, el 4,5% bacteriuria. El E.coli fue el patógeno más frecuentemente hallado en los urocultivos pre y post biopsia.No encontramos relación estadísticamente significativa entre la aparición de disuria y la fiebre con la condición de diabético, inmunosupresión, ITU o prostatitis previas, volumen prostático y número de cilindros obtenidos en la biopsia.Únicamente la existencia de un urocultivo prebiopsia positivo y una biopsia con más de 14 cores, demostraron tener asociación estadísticamente significativa con la existencia de bacteriuria tras la biopsia, p=0,007 y p= 0,018 respectivamente. CONCLUSIONES: Nuestra tasa de complicaciones infecciosas fue similar a la descrita para otras series. La existencia de un urocultivo prebiopsia positivo y obtener más de 14 cilindros por biopsia demostró tener relación estadísticamente significativa con la existencia de bacteriuria tras la biopsia. El E.coli fue el patógeno más frecuentemente aislado (AU)

OBJECTIVES: To establish the rate of infectious complications derived from the use of transrectal ultrasound-guided prostate biopsy (TRUS), identify its mi-crobiological profile and related risk factors.METHODS: We designed a prospective non-randomi-zed study in which we enrolled 220 patients undergoing TRUS biopsy at our centre between April and September 2008. The inclusion criteria were: suspicious digital rectal exa-mination, PSA >10 ng/ml, and free/total ratio of PSA is assessed in patients with PSA 4-10 ng/ml. The exclu-sion criteria were: having an indwelling urinary catheter, the administration of antibiotic treatment in the week before the needle biopsy, manipulation of the urinary tract in the month prior to the needle biopsy, allergy to quinolones and risk of endocarditis, failure to comply with the anti-biotic prophylaxis regimen and loss to follow-up.We analyzed the relationship between diabetes, immunodepression, previous UTI or prostatitis and positi-ve pre-biopsy urine culture with the appearance of fever, dysuria or bacteriuria following needle biopsy.RESULTS: Mean age was 69.5 years (+/-7.9), mean total PSA 12.7ng/ml (+/-28.7), mean prostate volu-me 50.6 cc (+/-29.6) and mean number of cores ob-tained by needle biopsy 13.5 (+/-1.7). 25% of the patients had dysuria following needle biopsy, 3.2% fever and 4.5% bacteriuria. E.coli was the pathogen most frequently found in pre- and post-biopsy urine cultures.No statistically significant relationship was found bet-ween the appearance of dysuria and fever and being diabetic, having immunosuppression, previous UTI or prostatitis, prostate volume and number of cores obtai-ned in the biopsy.Only the existence of a positive pre-biopsy urine culture and biopsy with more than 14 cores proved to have a statistically significant association with the existence of bacteriuria following biopsy, p=0.007 and p= 0.018, respectively. CONCLUSIONS: Our rate of infectious complications was similar to that described in other series. The existence of a positive pre-biopsy urine cul-ture and obtaining more than 14 cores per biopsy was related, with statistical significance, to the existence of bacteriuria following the biopsy. E.coli was the most frequently isolated pathogen (AU)

Can partial nephrectomy preserve renal function and modify survival in comparison with radical nephrectomy?

OBJECTIVE: To investigate whether radical nephrectomy (RN) and nephron-sparing surgery (NSS) for T1 renal cell carcinoma influence renal function, oncological outcome or survival rate. MATERIAL AND METHODS: A retrospective study was performed, including 290 nephrectomies for tumours of a diameter of less than 7 cm; 174 radical nephrectomies were compared to 116 nephron-sparing surgeries. Preoperative and pathological data were compared between the two groups. The glomerular filtration rate was estimated using the abbreviated Modification of Diet and Renal Disease (MDRD4) study equation. The evolution of renal function was analysed from 6 months to 4 years after surgery, and the oncological outcomes were evaluated by means of cancer and non-cancer survival curves. RESULTS: The results showed a major impairment in renal function in the RN group compared to those who underwent NSS (25 vs 7 ml/min/1.73 m², 6 months after surgery), a difference that was maintained over time. Moreover, patients undergoing RN had a greater chance of developing renal failure. Overall, the survival curves showed a higher mortality rate for the RN group (p = 0.034), although the cancer-specific mortality rate did not show any statistically significant differences (p = 0.079). CONCLUSIONS: For stage T1 renal cortical tumours, NSS should, whenever possible, be regarded as the primary therapeutic option, given that it obtains similar oncological outcomes to RN and preserves renal function, which seems to translate into a lower overall mortality rate.

[Open partial nephrectomy. Experience at the 12 de Octubre University Hospital]. / Nefrectomía parcial abierta. Experiencia del Hospital Universitario 12 de Octubre.

INTRODUCTION: Radical nephrectomy has traditionally been considered as the standard treatment for renal tumors. Nephron-sparing surgery was introduced two decades ago. Its excellent oncological and functional results have led to widespread use of this procedure. This procedure was first performed at our institution in 1991. Our experience with open partial nephrectomy is reported. MATERIALS AND METHODS: Our series of 83 open partial nephrectomies performed from 1991 to date for oncological purposes is analyzed. The demographic, intraoperative, postoperative, oncological, and functional results are reported. A survival analysis and renal function evaluation is also provided. RESULTS: Thirty-four of the 83 open partial nephrectomies (42%) were non-elective. Mean tumor size was 36 mm (12-120). Fifty-two percent of tumors were exophytic and 38% endophytic. The most relevant intraoperative variables included a median surgery time of 160 min, an ischemia time of 15 min, a blood loss of 500 mL, and a 9-day hospital stay. Twenty-four percent of patients experienced complications, of which fistula was the most common, occurring in 6 patients (8.8%). The pathological study revealed clear renal cell carcinoma in 57% of patients and benign tumors in 25%. Stage at diagnosis was pT1A in 61% of patients, pT1B in 27%, pT2 in 3%, and pT3 in 9%. Grade 2 of Furham classification was most common (40%). Positive surgical margins were seen in 4% of patients. Cancer-specific survival rates were 94% at 5 years and 85% at 10 years. A slight increase was seen in median creatinine levels when preoperative and postoperative values were compared: 0.04, 0.11, 0.08, and 0.03 at 6, 12, 24, and 36 months respectively. A minimum, statistically significant increase was found in mean creatinine levels 6, 12, 24, and 36 months after surgery as compared to preoperative values. CONCLUSIONS: Open partial nephrectomy is a feasible procedure routinely used in our standard practice. Its oncological results are satisfactory and consistent with those reported in the literature. The procedure also has a low complication rate and an excellent functional outcome, and is therefore the procedure of choice for a wide spectrum of patients when performed by experienced surgeons.

Nefrectomía parcial abierta. Experiencia del Hospital Universitario 12 de Octubre / Open partial nephrectomy. Experience at the 12 de Octubre University Hospital

Introducción: La nefrectomía radical ha sido considerada clásicamente como el tratamiento estándar de los tumores renales. Desde hace ya dos décadas se comenzó a extender el uso de cirugía conservadora. Con el paso del tiempo los resultados oncológicos y funcionales han justificado su expansión. En nuestro centro la introdujimos en 1991. Presentamos nuestra serie de nefrectomía parcial abierta como tratamiento de neoplasias. Material y métodos: Realizamos una revisión de las 83 nefrectomías parciales abiertas, indicadas con fines oncológicos, desde el año 1991hasta la actualidad. Describimos los resultados poblacionales, intraoperatorios, postoperatorios, oncológicos, funcionales, análisis de supervivencia y evaluación de la evolución de la función renal para el total de los enfermos y para las nefrectomías parciales no electivas. Resultados: De las 83 nefrectomías parciales abiertas, 34 (42%) han sido no electivas. El tamaño tumoral medio fue de 36 mm (12-120). La localización tumoral fue en el 52% exofítica y en el 38% endofítica. Las variables intraoperatorias más importantes fueron, mediana del tiempo de cirugía de 160 min; tiempo de isquemia 15 min; sangrado 500 ml y hospitalización 9 días. El 24% de los enfermos sufrieron algún tipo de complicación, la más frecuente fue fístula en 6 (8,8%) de los casos. El estudio anatomopatológico mostró un 57% de carcinoma renal de células claras y un 25% de tumores benignos. El 61% presentaron estadio pT1A , 27% pT1B, 3% pT2 y 9% pT3. El grado 2 de Furham fue el más habitual (40%). Un 4% mostraron márgenes positivos. La supervivencia cáncer específica a los 5 años fue del 94% y a los 10 años del 85 %. En cuanto a la función renal, se objetivó un escaso incremento del valor de la mediana de creatininemia post cirug de 0,04; 0,11;0,08 y 0,03 a los 6, 12, 24 y 36 meses respectivamente. Se evidenció un aumento mínimo del valor medio de creatinina al evaluarlo pre y postquirúrgico a los 6, 12, 24 y 36 meses con significación estadística. Conclusiones: La NPA es una técnica factible e integrada en nuestro medio. Los resultados oncológicos alcanzados son satisfactorios y equiparables con los existentes en la literatura. La baja incidencia de complicaciones y el resultado funcional excelente, hace que hoy en día, en manos experimentadas, se deba elegir como técnica de elección en un amplio espectro de pacientes (AU)

Introduction: Radical nephrectomy has traditionally been considered as the standard treatment for renal tumors. Nephron-sparing surgery was introduced two decades ago. Its excellent oncological and functional results have led to widespread use of this procedure. This procedure was first performed at our institution in 1991. Our experience with open partial nephrectomy is reported. Materials and methods: Our series of 83 open partial nephrectomies performed from 1991 to date for oncological purposes is analyzed. The demographic, intraoperative, postoperative, oncological, and functional results are reported. A survival analysis and renal function evaluation is also provided. Results: Thirty-four of the 83 open partial nephrectomies (42%) were non-elective. Mean tumor size was 36 mm (12-120). Fifty-two percent of tumors were exophytic and 38% endophytic. The most relevant intraoperative variables included a median surgery time of 160 min, an ischemia time of 15 min, a blood loss of 500 mL, and a 9-day hospital stay. Twenty-four percent of patients experienced complications, of which fistula was the most common, occurring in 6 patients (8.8%). The pathological study revealed clear renal cell carcinoma in 57% of patients and benign tumors in 25%. Stage at diagnosis was pT1A in 61% of patients, pT1B in 27%, pT2 in 3%, and pT3 in 9%. Grade 2 of Furham classification was most common (40%). Positive surgical margins were seen in 4% of patients. Cancer-specific survival rates were94% at 5 years and 85% at 10 years. A slight increase was seen in median creatinine levels when preoperative and postoperative values were compared: 0.04, 0.11, 0.08, and 0.03 at 6, 12, 24, and 36 months respectively. A minimum, statistically significant increase was found in mean creatinine levels 6, 12, 24, and 36 months after surgery as compared to preoperative values. Conclusions: Open partial nephrectomy is a feasible procedure routinely used in our standard practice. Its oncological results are satisfactory and consistent with those reported in the literature. The procedure also has a low complication rate and an excellent functional outcome, and is therefore the procedure of choice for a wide spectrum of patients when performed by experienced surgeons (AU)

[Local anesthesia significantly improves the tolerance of prostate biopsy]. / La anestesia local mejora significativamente la tolerancia de la biopsia prostática.

UNLABELLED: Transrectal biopsy is one of the most frequent procedures in urological practice. Generally, transrectal biopsies have been practiced without anesthesia, because of a supposed good tolerance. Nevertheless, it is not infrequent to find patients with a high level of pain and adverse effects attributable to such procedure. OBJECTIVES: In the present article the effect of transrectal local anesthesia in order to significantly diminish the perception of pain by the patient is evaluated. METHODS: A total of 131 consecutive patients undergoing transrectal prostate biopsy are included in the study. After randomization, 76 patients were biopsiated with anesthesia and 55 represent the control group. Cases and control groups do not differ in age or prostate volume. Anesthesia consisted on a periprostatic nerve blockage with injection of 5 cc of 1% mepivacaine solution in the angle between prostate and seminal vesicles bilaterally. A visual analogical scale for pain was used; it was given to the patient at the end of the procedure. RESULTS: Mean pain value was 2.41 with a median of 2.0 in the group with anesthesia, and 4.02 with a median of 4 in the control group. A Student's t test comparing the means showed a statistically significant difference of 1.61 (p < 0.0001). Pain in the scale was 66% greater in the control group. CONCLUSION: The use of anesthesia in the performance of transrectal biopsies significantly diminishes the perception of pain by patients. This effect, along with the tendency to increase the number of biopsies, will result in short time in a more generalized use of local anesthesia.

La anestesia local mejora significativamente la tolerancia de la biopsia prostática / Local anesthesia significantly improves the tolerance of prostate biopsy

La biopsia transrectal es uno de los procedimientos mas frecuentes en la práctica urológica. Usualmente las biopsias transrectales se han practicado sin administrarse anestesia, ante la consideración de una buena tolerancia. Sin embargo no es infrecuente encontrarnos ante pacientes con un nivel del dolor alto e incluso efectos adversos atribuibles al mismo. OBJETIVO: Se evalúa en el presente trabajo si la anestesia local transrectal puede disminuir significativamente la percepción del dolor por el paciente. MÉTODOS: Se incluyen en el siguiente estudio 131 pacientes consecutivos y sometidos a biopsia transrectal. Efectuándose la randomización 76 pacientes fueron biopsiados con anestesia y 55 representan el grupo control. Casos y controles no difieren en edad ni volumen prostático. La anestesia se efectuó administrándose 10 cc del anestésico mepivacaína al 1%, 5 cc en cada lado en el ángulo entre la próstata y las vesículas seminales. Se empleó una escala analógica y visual del dolor que se suministró al paciente una vez acabado el procedimiento. RESULTADOS: En el grupo de pacientes anestesiados la media de valoración del dolor fue de 2,41 con una mediana de 2 y en el grupo control se obtuvo una media de 4,02 con una mediana de 4. Se realizó test de comparación de medias (t de Student), obteniéndose entre los grupos una diferencia estadísticamente significativa de 1,61 (< 0,0001). Porcentualmente encontramos una diferencia en la escala del dolor de un 66 % más en el grupo control. CONCLUSIÓN: La utilización de anestesia en la realización de las biopsias transrectales disminuye significativamente la percepción del dolor por los pacientes. Este efecto junto a la tendencia en incrementar el número de biopsias, generalizará en poco tiempo el empleo de la anestesia local

Transrectal biopsy is one of the most frequent procedures in urological practice. Generally, transrectal biopsies have been practiced without anesthesia, because of a supposed good tolerance. Nevertheless, it is not infrequent to find patients with a high level of pain and adverse effects attributable to such procedure. OBJECTIVES: In the present article the effect of transrectal local anesthesia in order to significantly diminish the perception of pain by the patient is evaluated. METHODS: A total of 131 consecutive patients undergoing transrectal prostate biopsy are included in the study. After randomization, 76 patients were biopsiated with anesthesia and 55 represent the control group. Cases and control groups do not differ in age or prostate volume. Anesthesia consisted on a periprostatic nerve blockage with injection of 5 cc of 1% mepivacaine solution in the angle between prostate and seminal vesicles bilaterally. A visual analogical scale for pain was used; it was given to the patient at the end of the procedure. RESULTS: Mean pain value was 2.41 with a median of 2.0 in the group with anesthesia, and 4.02 with a median of 4 in the control group. A Student´s t test comparing the means showed a statistically significant difference of 1.61 (p<0.0001). Pain in the scale was 66% greater in the control group. CONCLUSION: The use of anesthesia in the performance of transrectal biopsies significantly diminishes the perception of pain by patients. This effect, along with the tendency to increase the number of biopsies, will result in short time in a more generalized use of local anesthesia