Randomized clinical trial on the use of IMAGE1 S LIGHT (SPIES) vs. white light in the prevention of recurrence during transurethral resection of bladder tumors: Analysis after 12-month follow-up.

INTRODUCTION: The improved image resolution of IMAGE1 S technology will increase tumor detection, achieve a greater number of complete resections, and would probably have an impact on the reduction of recurrences. AIM: The primary objective was to compare the recurrence rates of IMAGE1 S vs. white light during transurethral resection of the bladder (TUR); the secondary objective was to compare the complication rates according to Clavien-Dindo (CD) at 12 months of follow-up. METHODS: Prospective, randomized 1:1, blinded clinical trial. Recurrence and complication rates according to CD were analyzed using chi-square/U Mann-Whitney tests and recurrence-free survival (RFS) using Kaplan-Meier curves. The European Association of Urology (EAU) 2021 scoring model was used. RESULTS: The analysis included 103 participants; 49 were assigned to the IMAGE1 S group and 54 to the white light group. Recurrence rates were 12.2% and 25.9%, respectively (P = .080). The low and intermediate risk group had a lower recurrence rate with IMAGE1 S (7.7% vs. 30.8%, P = .003) and a higher RFS with IMAGE1 S (85.2% vs. 62.8% Log Rank: 0.021), with a Hazard Ratio of 0.215 (95% CI: 0.046-0.925). No differences were observed in the high and very high-risk groups. Complications were mostly grade I and rates were similar between both groups (IMAGE1 S 20.4% vs. white light 7.4% P = .083). CONCLUSIONS: There were no differences in the recurrence rates between groups. However, the low and intermediate risk group had a lower recurrence rate with IMAGE1 S. In addition, perioperative complication rates were not higher.

Evaluación de la teleconsulta en el paciente urológico durante la pandemia COVID-19 / Evaluation of teleconsultation system in the urological patient during the COVID-19 pandemic

INTRODUCCIÓN: La pandemia global de COVID-19 ha provocado una rápida implantación de la telemedicina, pero existe escasa información sobre la satisfacción percibida por el paciente como alternativa a la asistencia presencial. OBJETIVO: Se evalúa la satisfacción del paciente urológico con la teleconsulta durante la pandemia COVID-19. MATERIAL Y MÉTODOS: Estudio observacional, prospectivo transversal, no intervencionista, mediante encuesta telefónica durante el periodo considerado pico de pandemia (marzo-abril 2020). Se realiza una encuesta de calidad compuesta por 11 preguntas sobre la atención urológica durante la pandemia COVID-19 por los facultativos, seleccionando una muestra representativa de los pacientes atendidos en el periodo por teleconsulta. RESULTADOS: Doscientos pacientes fueron contactados telefónicamente para responder a una encuesta de calidad sobre teleconsulta. La distribución de pacientes encuestados entre las consultas monográficas fue homogénea entre el número de consultas citadas en el periodo, requiriendo el 18% de ellos ayuda por familiar. El 60% de los pacientes evitaron acudir a un centro médico durante la pandemia. El 42% de los pacientes encuestados tenían cancelada alguna prueba complementaria, el 59% alguna consulta médica, el 3,5% tratamientos y el 1% intervenciones. El 10% apreciaron un empeoramiento de su sintomatología urológica durante el confinamiento. La resolución subjetiva de la consulta por el facultativo fue alcanzada en el 72% de los casos, siendo la teleconsulta por el urólogo habitual en el 81%. El grado de satisfacción global con la teleconsulta fue de 9 (RIQ 8-10), considerando la teleconsulta como una «opción de asistencia sanitaria» pasada la crisis sanitaria por el 61,5% de los encuestados. CONCLUSIÓN: La teleconsulta ha sido valorada con un alto grado de satisfacción durante la pandemia COVID-19, ofreciendo asistencia continuada a los pacientes urológicos durante la crisis sanitaria. La calidad percibida ofrece un campo de asistencia telemática opcional en pacientes seleccionados, que debe reevaluarse fuera de una situación de confinamiento

INTRODUCTION: The global pandemic of COVID-19 has led to rapid implementation of telemedicine, but there is little information on patient satisfaction of this system as an alternative to face-to-face care. OBJECTIVE: To evaluate urological patient satisfaction with teleconsultation during the COVID-19 pandemic. MATERIAL AND METHODS: Observational, prospective, cross-sectional, non-interventional study carried out by telephone survey during the period considered as the peak of the pandemic (March-April 2020). A quality survey composed of 11 questions on urological care provided by physicians during the COVID-19 pandemic was conducted, selecting a representative sample of patients attended by teleconsultation. RESULTS: Two hundred patients were contacted by telephone to answer a survey on the quality of teleconsultation. The distribution of patients surveyed among the specialized consultations was homogeneous with the number of consultations cited in the period; 18% of them required assistance from family members. Sixty percent of patients avoided going to a medical center during the pandemic. Of the surveyed patients, 42% had cancelled diagnostic tests, 59% had cancelled medical consultations, 3.5% had cancelled treatments and 1% had cancelled interventions. Ten percent reported a worsening of urological symptoms during confinement. According to physicians, consultations were effectively delivered in 72% of cases, with teleconsultation being carried out by their usual urologist in 81%. Teleconsultation overall satisfaction level was 9 (IQI8-10), and 61.5% of respondents consider teleconsultation as a «health care option» after the healthcare crisis. CONCLUSION: Teleconsultation has been evaluated with a high level of satisfaction during the COVID-19 pandemic, offering continuous care to urological patients during the healthcare crisis. The perceived quality offers a field of optional telematic assistance in selected patients, which should be re-evaluated in a period without confinement measures

Evaluation of teleconsultation system in the urological patient during the COVID-19 pandemic. / Evaluación de la teleconsulta en el paciente urológico durante la pandemia COVID-19.

INTRODUCTION: The global pandemic of COVID-19 has led to rapid implementation of telemedicine, but there is little information on patient satisfaction of this system as an alternative to face-to-face care. OBJECTIVE: To evaluate urological patient satisfaction with teleconsultation during the COVID-19 pandemic. MATERIAL AND METHODS: Observational, prospective, cross-sectional, non-interventional study carried out by telephone survey during the period considered as the peak of the pandemic (March-April 2020). A quality survey composed of 11 questions on urological care provided by physicians during the COVID-19 pandemic was conducted, selecting a representative sample of patients attended by teleconsultation. RESULTS: Two hundred patients were contacted by telephone to answer a survey on the quality of teleconsultation. The distribution of patients surveyed among the specialized consultations was homogeneous with the number of consultations cited in the period; 18% of them required assistance from family members. Sixty percent of patients avoided going to a medical center during the pandemic. Of the surveyed patients, 42% had cancelled diagnostic tests, 59% had cancelled medical consultations, 3.5% had cancelled treatments and 1% had cancelled interventions. Ten percent reported a worsening of urological symptoms during confinement. According to physicians, consultations were effectively delivered in 72% of cases, with teleconsultation being carried out by their usual urologist in 81%. Teleconsultation overall satisfaction level was 9 (IQI8-10), and 61.5% of respondents consider teleconsultation as a «health care option¼ after the healthcare crisis. CONCLUSION: Teleconsultation has been evaluated with a high level of satisfaction during the COVID-19 pandemic, offering continuous care to urological patients during the healthcare crisis. The perceived quality offers a field of optional telematic assistance in selected patients, which should be re-evaluated in a period without confinement measures.

Indicación de cistectomía precoz en el cáncer vesical no músculo infiltrante. Revisión de la literatura / Indication for early cystectomy in nonmuscle-invasive bladder cancer. Literature review

Contexto: El cáncer vesical no músculo infiltrante de alto riesgo es una enfermedad que integra un grupo heterogéneo de pacientes, en los que se recomienda un seguimiento estrecho debido al riesgo de progresión a tumor músculo infiltrante. El tratamiento de elección de estos tumores es la resección transuretral de vejiga seguido de un programa de instilaciones con BCG. Existe un subgrupo de pacientes que tiene un mayor riesgo de progresión, y que se benefician de un tratamiento radical de inicio. Objetivo: Identificar qué grupo de pacientes con cáncer vesical no músculo infiltrante se benefician de un tratamiento radical precoz. Búsqueda de la evidencia: Se realizó una revisión bibliográfica para identificar los factores de riesgo de progresión de estos pacientes, y así poder recomendar un tratamiento que mejore su tasa de supervivencia. Síntesis de la evidencia: Se identificaron los diferentes factores pronósticos asociados a progresión tumoral: la persistencia de tumor T1 en la re-resección transuretral de vejiga, la presencia de carcinoma in situ, refractariedad al tratamiento con BCG, los mayores de 70 años, los tumores mayores 3cm, la subestadificación de los tumores T1, la presencia de invasión linfovascular y la presencia de tumor en la uretra prostática. Igualmente se comentan las ventajas del tratamiento radical frente al conservador, apreciando que la realización de una cistectomía precoz por un tumor vesical no infiltrante de alto riesgo tiene un mejor pronóstico oncológico en comparación con aquellos en los cuales se difiere la realización de la misma hasta la progresión. Conclusiones: En esta enfermedad es importante individualizar a los pacientes, para así ofrecerles un tratamiento personalizado. En pacientes con las características mencionadas previamente se recomienda no demorar la cistectomía precoz

Context: High-risk nonmuscle-invasive bladder cancer is a disease that includes a heterogeneous group of patients, for whom close follow-up is recommended due to the risk of progression to a muscle-invasive tumour. The treatment of choice for these tumours is transurethral resection of the bladder tumour followed by a programme of bacillus Calmette-Guerin instillations. There is a subgroup of patients who have a greater risk of progression and who benefit from early radical treatment. Objective: To identify which patient group with nonmuscle-invasive bladder cancer will benefit from early radical treatment. Searching the evidence: We performed a literature review to identify the risk factors for progression for these patients and thereby recommend a treatment that improves their survival rate. Synthesis of the evidence: We identified the various prognostic factors associated with tumour progression: the persistence of T1 tumour in re-resection of the bladder tumour, the presence of carcinoma in situ, patients refractory to bacillus Calmette-Guerin treatment, patients older than 70 years, tumours larger than 3 cm, the substaging of T1 tumours, the presence of lymphovascular invasion and the presence of a tumour in the prostatic urethra. Similarly, we comment on the advantages of radical versus conservative treatment, considering that the performance of an early cystectomy due to a high-risk noninvasive vesical tumour has a better cancer prognosis than those in which the operation is deferred until the progression. Conclusions: In this disease, it is important to individualise the patients to provide them personalized treatment. For patients with the previously mentioned characteristics, it is recommended that early cystectomy not be delayed

Indication for early cystectomy in nonmuscle-invasive bladder cancer. Literature review. / Indicación de cistectomía precoz en el cáncer vesical no músculo infiltrante. Revisión de la literatura.

CONTEXT: High-risk nonmuscle-invasive bladder cancer is a disease that includes a heterogeneous group of patients, for whom close follow-up is recommended due to the risk of progression to a muscle-invasive tumour. The treatment of choice for these tumours is transurethral resection of the bladder tumour followed by a programme of bacillus Calmette-Guerin instillations. There is a subgroup of patients who have a greater risk of progression and who benefit from early radical treatment. OBJECTIVE: To identify which patient group with nonmuscle-invasive bladder cancer will benefit from early radical treatment. SEARCHING THE EVIDENCE: We performed a literature review to identify the risk factors for progression for these patients and thereby recommend a treatment that improves their survival rate. SYNTHESIS OF THE EVIDENCE: We identified the various prognostic factors associated with tumour progression: the persistence of T1 tumour in re-resection of the bladder tumour, the presence of carcinoma in situ, patients refractory to bacillus Calmette-Guerin treatment, patients older than 70 years, tumours larger than 3cm, the substaging of T1 tumours, the presence of lymphovascular invasion and the presence of a tumour in the prostatic urethra. Similarly, we comment on the advantages of radical versus conservative treatment, considering that the performance of an early cystectomy due to a high-risk noninvasive vesical tumour has a better cancer prognosis than those in which the operation is deferred until the progression. CONCLUSIONS: In this disease, it is important to individualise the patients to provide them personalized treatment. For patients with the previously mentioned characteristics, it is recommended that early cystectomy not be delayed.

Impacto del cáncer de próstata localmente avanzado/metastásico en la calidad de vida / Impact of locally advanced or metastatic prostate cancer on the quality of life

Objetivo: El objetivo de este estudio fue evaluar la calidad de vida relacionada con la salud en pacientes con cáncer de próstata en fases avanzadas para obtener información adicional sobre la salud de los pacientes. El creciente interés por conocer la perspectiva del paciente y la escasez de estudios prospectivos en esta población motivaron esta investigación. Material y métodos: Se presenta un estudio observacional realizado en 131 consultas de urología, con una muestra de 601 pacientes con cáncer de próstata localmente avanzado o metastásico, evaluados en 2 visitas: basal y a los 12 meses. Se recogieron variables sociodemográficas, clínicas, de calidad de vida (cuestionarios PROSQoLI y EuroQoL-5D-5L) y ansiedad/depresión (cuestionario HADS). Resultados: La edad media (DE) era de 73,8 (8,2) años y el 87,2% eran jubilados o pensionistas. El 58,7% de los pacientes presentaba cáncer de próstata localmente avanzado. La sintomatología urinaria fue la más frecuente, disminuyendo significativamente al cabo de un año (p < 0,05). Los problemas urinarios y el cansancio fueron las dimensiones más afectadas y el dolor/malestar la dimensión presente en más pacientes (65,3%). Según el modelo de regresión lineal, la astenia y el dolor fueron 2 de los factores más relacionados con una peor calidad de vida. La presencia de ansiedad/depresión fue baja. Finalmente, el estado de salud valorado por el clínico fue más positivo que el valorado por los pacientes. Conclusiones: Este estudio amplía la escasa información existente sobre la calidad de vida de la población con cáncer de próstata avanzado, información de utilidad en el manejo clínico de los pacientes

Objective: The aim of this study was to assess the health-related quality of life of patients with prostate cancer in advanced phases to obtain additional information on the patients’ health. The growing interest in understanding the patient's perspective and the scarcity of prospective studies of this population motivated this research study. Material and methods: We present an observational study performed on 131 urology consultations, with a sample of 601 patients with locally advanced or metastatic prostate cancer, assessed during 2 visits: baseline and at 12 months. We collected demographic, clinical, quality-of-life (PROSQoLI and EuroQoL-5D-5L questionnaires) and anxiety/depression (HADS questionnaire) endpoints. Results: The mean age (SD) was 73.8 (8.2) years, and 87.2% of the participants were retired or pensioners. Some 58.7% of the patients presented locally advanced prostate cancer. Urinary symptoms were the most common, decreasing significantly after one year (P< .05). Urinary problems and fatigue were the most affected measures, and pain/discomfort was the dimension present in most patients (65.3%). According to the linear regression model, asthenia and pain were 2 of the factors most closely related to a poorer quality of life. The presence of anxiety/depression was low. Finally, the health condition as assessed by the clinician was more positive than when assessed by the patients. Conclusions: This study broadens the scarce information on the quality of life of the population with advanced prostate cancer, information of use for the clinical management of these patients

Impact of locally advanced or metastatic prostate cancer on the quality of life. / Impacto del cáncer de próstata localmente avanzado/metastásico en la calidad de vida.

OBJECTIVE: The aim of this study was to assess the health-related quality of life of patients with prostate cancer in advanced phases to obtain additional information on the patients' health. The growing interest in understanding the patient's perspective and the scarcity of prospective studies of this population motivated this research study. MATERIAL AND METHODS: We present an observational study performed on 131 urology consultations, with a sample of 601 patients with locally advanced or metastatic prostate cancer, assessed during 2 visits: baseline and at 12 months. We collected demographic, clinical, quality-of-life (PROSQoLI and EuroQoL-5D-5L questionnaires) and anxiety/depression (HADS questionnaire) endpoints. RESULTS: The mean age (SD) was 73.8 (8.2) years, and 87.2% of the participants were retired or pensioners. Some 58.7% of the patients presented locally advanced prostate cancer. Urinary symptoms were the most common, decreasing significantly after one year (P<.05). Urinary problems and fatigue were the most affected measures, and pain/discomfort was the dimension present in most patients (65.3%). According to the linear regression model, asthenia and pain were 2 of the factors most closely related to a poorer quality of life. The presence of anxiety/depression was low. Finally, the health condition as assessed by the clinician was more positive than when assessed by the patients. CONCLUSIONS: This study broadens the scarce information on the quality of life of the population with advanced prostate cancer, information of use for the clinical management of these patients.

[Diagnosis of urethral stenosis and follow-up after Urethroplasty]. / Diagnóstico de las estenosis uretrales y seguimiento después de Uretroplastia.

This article presents a review of the different tests used for the evaluation and follow-up of urethral strictures. Because there is no consensus on how to assess urethral pathology, we reviewed each of the next follow-up tests: questionnaires, uroflowmetry, ultrasound, urethroscopy, urethrogram, CT scan and MRI, outlining their benefits and limitations in the diagnosis and follow-up of urethral stricture. Urethrogram and urethroscopy are the most commonly used tests, as they are those that give us more information on the evaluation of stenosis and for surgery planning. Questionnaires and uroflowmetry play a key role in the follow-up of these patients. Ultrasonography has high sensitivity and specificity for evaluating the spongiofibrosis, however it is not done routinely. The CT/MRI is recommended in the evaluation of pelvic trauma associated with fractures.

Linfadenectomía inguinal izquierda endoscópica modificada / Modified Endoscopic Left Inguinal Lymphadenectomy

Introducción: La linfadenectomía inguinal endoscópica es una evolución de la cirugía laparoscópica que resulta posible gracias a los conocimientos previos en este tipo de técnicas. Se trata de una nueva técnica y sus indicaciones en el campo de los tumores de pene están ampliándose hoy en día. La técnica busca reducir la morbilidad del procedimiento sin comprometer el control oncológico ni reducir el área de resección. Material y métodos: Presentamos la realización de linfadenectomía inguinal endoscópica modificada en un varón de 70 años con diagnóstico de melanoma de pene y ganglio centinela positivo en la región inguinal izquierda. Se colocaron 3 trocares de trabajo sobre un triángulo femoral previamente dibujado sobre la región inguinal izquierda del paciente. Se describen los datos intraoperatorios, anatomopatológicos, postoperatorios y de seguimiento oncológico. Resultados: El tiempo operatorio fue de 120 min. Se obtuvieron 9 ganglios, siendo todos negativos en el estudio anatomopatológico. El drenaje fue retirado al quinto día postoperatorio. No hubo complicaciones. Después de 12 meses de seguimiento no hay signos de progresión de la enfermedad. Conclusión: La linfadenectomía inguinal endoscópica es factible en la práctica clínica. Nuevos estudios con mayor número de pacientes y seguimiento a largo plazo pueden confirmar la eficacia y posible menor morbilidad de este nuevo abordaje (AU)

Introduction: Endoscopic inguinal lymphadenectomy is an evolution of laparoscopic surgery thanks to background in these techniques. This is a new technique and the indications in the field of penile tumors today are expanding. The technique aims at reducing the morbidity of the procedure without compromising the cancer control or reducing the template of the dissection. Material and methods: We present the modified endoscopic inguinal lymphadenectomy in a 70-year-old male patient with penile melanoma and positive sentinel lymph node in left inguinal limb. Intraoperative data, pathology, post operatory evolution and oncological follow-up are described. Results: Operative time was 120 min. Nine lymph nodes were retrieved and none of them showed positivity at pathology. There were no complications. The drain was kept for five days. After 12 months of follow up, no signs of disease progression were noted. Conclusion: The endoscopic inguinal lymphadenectomy is feasible in clinical practice. New studies with a greater number of patients and long-term follow-up may confirm the oncological efficacy and possible lower morbidity of this new approach (AU)

Modified endoscopic left inguinal lymphadenectomy.

INTRODUCTION: Endoscopic Inguinal Lymphadenectomy is an evolution of laparoscopic surgery thanks to background in these techniques. This is a new technique and the indications in the field of penile tumors today are expanding. The technique aims at reducing the morbidity of the procedure without compromising the cancer control or reducing the template of the dissection. MATERIAL AND METHODS: We present the modified endoscopic inguinal lymphadenectomy in a 70 years-old male patient with penile melanoma and positive sentinel lymph node in left inguinal limb. Intraoperative data, pathology, post operatory evolution and oncological follow-up is described RESULTS: Operative time was 120 min. Nine lymph nodes were retrieved and none of then showed positivity at pathology. There were no complications. The drain was kept for five days. After 12 months of follow up, no signs of disease progression were noted. CONCLUSION: The endoscopic inguinal lymphadenectomy is feasible in clinical practice. New studies with a greater number of patients and long-term follow-up may confirm the oncological efficacy and possible lower morbidity of these new approach.

Leiomioma de la cápsula renal: presentación de un caso y revisión de la literatura / Leyomioma of the renal capsule: a case report and literature review

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Laparoscopic radical cystectomy

Open radical cystectomy with lymph node dissection remains the gold standard treatment for recurrent, high-grade, non-muscle-invasive and for muscle-invasive bladder cancer. The excellent perioperative and long-term results provided by laparoscopic surgery and the advances in instrumentation design have naturally paved the way for development of laparoscopic radical cystectomy (LRC). In this review, surgical and long-term oncological outcomes of LRC are analysed. The advantages of this technique compared with open surgery are described. The differences between pure laparoscopic technique or laparoscopic cystectomy and extracorporeal urinary diversion have also been analysed (AU)

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Adecuación de las derivaciones desde Atención Primaria a un Servicio de Urología / Adequacy of referral from primary care to a department of urology

Objetivo: Valorar indirectamente el grado de adhesión de los médicos de Atención Primaria (AP) a un protocolo de derivación consensuado con Atención Especializada (AE) sobre diez motivos de consulta urológica. Material y métodos: Se analizaron todas las derivaciones al servicio de urología llevadas a cabo durante un período de 19 meses por 135 médicos adscritos a 10 centros de AP (CAP). El urólogo juzgó como 'confome' o 'no conforme al protocolo' la derivación. Se compararon los porcentajes de adecuación de las derivaciones desde cada CAP. Se exploraron las diferencias en la adecuación de las derivaciones procedentes de cada CAP en función del problema de salud. La relación entre el número de derivaciones y el número de canalizaciones adecuadas se exploró mediante un modelo de regresión lineal. Resultados: El análisis tuvo lugar sobre 2841 derivaciones. El 57,2% de esas derivaciones se ajustó al protocolo. No se detectaron diferencias significativas en los porcentajes de derivaciones ‘conforme al protocolo’ en relación a los CAP. Se detectaron diferencias significativas entre CAP en las derivaciones por cólico nefrítico e incontinencia urinaria. Se detectó una relación entre el número de pacientes remitidos y el número de remisiones 'no conforme al protocolo' (r2=0,86). Conclusiones: La adecuación al protocolo fue escasa. Algunos problemas de salud deberían de ser revisados a nivel local; la mayoría de los motivos de derivación (de modo particular la microhematuria) deberían de revisarse en todos los CAP

Objetive: To indirectly address the adequacy of referrals from general practitioners (GP) to specialized care taking into account a previously agreed protocol on ten urological topics. Materials & methods: The study analyzed all referrals to the Urology department originated in 10 primary care centres (135 GPs involved) throughout a 19-month period. Adequacy of 2841 referrals was checked. The urologist judged the referral as compliant (adequate) or not compliant (inadequate) with the terms of the protocol. Compliance per primary care centres was compared. Also referral adequacy corrected per centre and clinical topic was compared. The relationship between 'absolute number of referrals' and 'adequate referrals' was tested using a linear regression model. Results: 57.2% of the referrals were inadequate. Overall, no significant differences were detected between primary care centres. Nevertheless significant differences between centres were evident in terms of referrals due to renal colic and female urinary incontinence. 70% (94/135) of the GPs complied with the protocol in, at least, 50% of the cases. A strong association between 'absolute number of referrals' and 'adequate referrals' was evident (r2=0.86). Conclusions: Overall compliance with the protocol was modest. While no significant differences between centres were detected in terms of adequacy of referrals certain conditions have to be locally revisited; most of the topics (particularly microhematuria) have to be revisited in every center

[Adequacy of referral from primary care to a Department of Urology]. / Adecuación de las derivaciones desde Atención Primaria a un Servicio de Urología.

OBJECTIVE: [corrected] To indirectly address the adequacy of referrals from general practitioners (GP) to specialized care taking into account a previously agreed protocol on ten urological topics. MATERIALS & METHODS: The study analyzed all referrals to the Urology department originated in 10 primary care centres (135 GPs involved) throughout a 19-month period. Adequacy of 2841 referrals was checked. The urologist judged the referral as compliant (adequate) or not compliant (inadequate) with the terms of the protocol. Compliance per primary care centres was compared. Also referral adequacy corrected per centre and clinical topic was compared. The relationship between "absolute number of referrals" and "adequate referrals" was tested using a linear regression model. RESULTS: 57.2% of the referrals were inadequate. Overall, no significant differences were detected between primary care centres. Nevertheless significant differences between centres were evident in terms of referrals due to renal colic and female urinary incontinence. 70% (94/135) of the GPs complied with the protocol in, at least, 50% of the cases. A strong association between "absolute number of referrals" and "adequate referrals" was evident (r2=0.86). CONCLUSIONS: Overall compliance with the protocol was modest. While no significant differences between centres were detected in terms of adequacy of referrals certain conditions have to be locally revisited; most of the topics (particularly microhematuria) have to be revisited in every center.

[Iatrogenic injury of the lumbar ureter and iliac vessels after lumbar discectomy: urologic treatment using kidney autotransplantation]. / Lesión iatrogénica de uréter lumbar y vasos ilíacos tras discectomía lumbar: tratamiento urológico mediante autotrasplante renal.

We report a case of a patient with a secondary injury of external iliac artery and vein in the L4-L5 laminectomy and discectomy course. An immediately vein suture and ilio-iliac by-pass with Dacron was made. In the postoperative a iatrogenic lumbar ureter section was discovered and treated with renal autotransplantation. We review the options described in the literature in the management of these complex ureteral injuries.

Lesión iatrogénica de uréter lumbar y vasos ilíacos tras discectomía lumbar: tratamiento urológico mediante autotrasplante renal / Iliac vessels and lumbar ureter yatrogenic injuries after lumbar discectomy: urological management by renal autotransplantation

Presentamos el caso de una paciente con una sección de arteria iliaca externa izquierda y desgarro de vena iliaca externa izquierda en el desarrollo de una discectomía lumbar L4-L5. Tras la sutura venosa y la realización de un by-pass ilio-iliaco, en el postoperatorio inmediato, se diagnosticó una sección iatrógena de uréter lumbar resuelta mediante autotrasplante renal. Analizamos las posibles soluciones descritas en la literatura para la resolución de lesiones ureterales complejas. (AU)

[Prognostic value of inverted papilloma of the lower urinary tract]. / Valor pronóstico del papiloma invertido del tracto urinario inferior.

OBJECTIVE: Inverted papilloma of the urothelium accounts for 2.2% of urothelial neoplasms. Its oncologic significance is unclear; its potential for recurrence and/or progression is not well-known. Our experience from 1976 to 1999 is reviewed. METHODS: From 1976 to 1999, 31 patients with urothelial inverted papilloma of the lower urinary tract have been treated in our service: 17 presented previous and/or synchronous association with urothelial carcinoma (group I) and 14 had primary inverted papilloma (group II). The recurrence and progression rates for each group were determined and compared. The overall recurrence and progression rates were also determined. Two patients (one from each group) were lost to follow-up. The remaining 29 patients had a mean follow-up of 51.3 months (range 3-125). RESULTS: 12 patients (41.4%) showed recurrence in the form of bladder carcinoma; 10 from group I (10/16; 62.3%) and 2 from group II (2/13; 15.4%) (p < 0.05). Mean time to recurrence was 17.9 months (range 3-58). Disease free interval was higher in group II (p < 0.05). Progression to infiltrating tumor was observed in three patients; all three had associated superficial bladder carcinoma (group I). The mean time to progression was 30.7 months (range 18-38). No statistically significant differences were found in the percentage of progression between both groups. CONCLUSIONS: Inverted papilloma of the lower urinary tract showed a high incidence of association with urothelial carcinoma and a high recurrence rate, even in primary tumors. Therefore it should be considered a tumor of low grade malignancy that should be followed regularly.