[Analysis of the absorcion's factors of irrigating fluid during transurethral resection of the prostate]. / Análisis de los factores de reabsorción de líquido de irrigación durante la RTU de próstata.

OBJECTIVES: In this study it was our intention to evaluate the relation between the reabsorption of irrigating fluid and three variables: time of the intervention, volume of solution of glicina employee and weight of the fragments, during the RTU of prostate fulfilled to low hydraulic pressure. MATERIAL AND METHOD: We study 74 patients that RTU of prostate was performed with suprapúbica derivation with Amplatz's pod 30 ch. The ethanol was monitored in expired air every 15 minutes during the intervention. Likewise we annotated the time of the intervention, the volume of glicina used and the weight of the fragments extracted. Statistically Anova's text was in use for comparison of averages. RESULTS: 13,6% of the patients absorbed irrigating fluid in some quantity. The range of absorption belongs to 100 cc until 2.000 cc. We did not find a statistically significant difference in the averages of time of resection, volume of glicina and weight of the fragments between the group of patients that had absortion of irrigating fluid and they that didn't had. CONCLUSIONS: Our data show that the operative time, the volume of irrigating fluid and the weight of the resected fragments do not influence the reabsorption of liquid of irrigation when a RTU is realized to low hydraulic pressure.

[Quality analysis of the statistical used resources (material and methods section) in thesis projects of a university department]. / Análisis de calidad de los recursos estadísticos (sección material y método) en los proyectos de tesis de un departamento universitario.

INTRODUCTION AND OBJECTIVES: Studies about quality in thesis and investigation projects in biomedical sciences are unusual, but very important in university teaching because is necessary to improve the quality elaboration of the thesis. The objectives the study were to determine the project's quality of thesis in our department, according to the fulfillment of the scientific methodology and to establish, if it exists, a relation between the global quality of the project and the statistical used resources. MATERIAL AND METHODS: Descriptive study of 273 thesis projects performed between 1995-2002 in surgery department of the Zaragoza University. The review realized for 15 observers that they analyzed 28 indicators of every project. Giving a value to each of the indicators, the projects qualified in a scale from 1 to 10 according to the quality in the fulfillment of the scientific methodology. RESULTS: The mean of the project's quality was 5.53 (D.E: 1.77). In 13.9% the thesis projects was concluded with the reading of the work. The three indicators of statistical used resources had a significant difference with the value of the quality projects. DISCUSSION: The quality of the statistical resources is very important when a project of thesis wants to be realized by good methodology, because it assures to come to certain conclusions. In our study we have thought that more of the third part of the variability in the quality of the project of thesis explains for three statistical above-mentioned articles.

[Transurethral prostatic resection with bipolar scalpel]. / Resección transuretral de próstata con bisturí bipolar.

UNLABELLED: FUNDAMENTAL: [corrected] To show our initial experience in the TUR of prostate with bipolar axipolar bistoury. MATERIAL AND METHODS: Five patients with an average age of 72 years old, were operated between may and june 2002. They showed important increased in questionnaire symptoms (IPSS). The average ecographic volume has been 57.4 g. We employed Gyrus resector and physiological salt solution for continue irrigation. RESULTS: The average operative time was 70 minutes. None of the patients showed hyponatremia needed blood transfusion. In all the cases the sound was removed 48 hours after operation, one of them have urinary retention (UR) and need sound tow more days. Hospital stay was tree days except the patient how had UR. At 1 and 6 month there is improvement in the IPSS. CONCLUSIONS: TUR of prostate with bipolar axipolar bistoury can avoid the secondary effects of glicine and allows us to work with prostates of bigger volumes due to we have more time to do it. Nevertheless bigger and better studies are required to value the effectiveness of this new technology opposite the TUR of prostate with monopolar bistoury which keeps being the gold standard.

[Modified technique for transurethral resection of the prostate with suprapubic drainage and local anesthesia]. / Técnica modificada para la resección transuretral de próstata con drenaje suprapúbico y anestesia local.

PURPOSE: To establish a technique for transurethral resection of the prostate (TURP), combining the use of local anaesthesia with an Amplatz suprapubic tube, in patients at high surgical risk. MATERIALS AND METHOD: A study was carried out in 32 patients who underwent TURP with a 30 F Amplatz suprapubic tube following local anaesthesia. This technique was indicated where surgery presented a general risk, in elderly patients, and for patients refusing to undergo spinal intradural or general anaesthesia. The mean age of the patients was 70 years (61-82 years). The risk of surgery was assessed according to the ASA classification. RESULTS: According to the ASA classification, 7 patients were ASA III (21.9%), and 25 patients were ASA IV (78.1%). In 31 of the 32 patients the operation was completed in one session. When questioned about the pain they felt, 11 patients reported no pain, 12 slight discomfort and 3 occasional pain. In the latter three patients, intravenous sedation was enhanced with 0.1 mg etomidate per kg body weight. The volume of the resected fragments ranged from 18 to 120 ml, with a mean of 47 ml, except in one patient with 205 ml who required two treatment sessions. CONCLUSIONS: Large prostate resection in patients at high surgical risk was performed comfortably using a combination of local anaesthesia and an Amplatz suprapubic tube. This procedure is one possible option to be considered as an alternative to other treatments.

[Endoscopic surgery in urology]. / Cirugía endoscópica en urología.

At this moment in time, endourology is incorporating extraluminal endoscopic techniques (laparoscopy, lumboscopy, retziuscopy), which the urologist is expected to master. The current advanced stage of development of intraluminal endoscopic surgery is mainly due to the most recent technological achievements (miniaturization of the lens, the use of more versatile materials and new energy sources). In the current cystourethroscopic procedures, compact endoscopes and flexible cystoscopes play an important role. The most important of these new techniques include tissue vaporisation procedures, interstitial application of substances or energies, low-pressure transurethral resection and percutaneous vesical surgery. Upper endoluminal procedures have been the ones to most benefit from modern technological developments. The most important features of present day ureterorenoscopes and their clinical applications are studied and also those of percutaneous nephroscopy (lithiasis, neoformations and others). In a review on the current situation of extraluminal endoscopy, a wide range of laparoscopic techniques--applicable to adrenal regions, kidneys, ureters, retroperitoneal and lymphatic systems, testicles and sperm ducts, bladder and prostrate gland--are discussed as well as the indications, advantages and drawbacks involved and the preferential surgical approaches.

[Endoscopic treatment of vesicoureteral reflux]. / Tratamiento endoscópico del reflujo vesicoureteral.

AIM: We report our experience of the endoscopic treatment of vesicoureteric reflux in children by submucosal injection of polytetrafluoroethylene (Teflon). PATIENTS AND METHODS: From April 1995 to September 1999 we treated 30 cases of vesicoureteric reflux in 22 children aged 19 months to 8 years. All the children underwent general anesthesia and subureteric injection of polytetrafluoroethylene paste with a pediatric cystoscope. Patients were discharged the day of the operation and were followed-up 15 days, six months and one year postoperatively with ultrasound and radionuclide cystography. When reflux persisted, the treatment was repeated. RESULTS: Open surgery was performed in one patient with reflux after two repeat injections. Another patient underwent a second, successful, injection. The overall success rate with endoscopic treatment was 96.5% and only one injection was required in 93.1%. None of the patients required hospitalization because of complications due to the operation or the endoscopic technique. CONCLUSIONS: We consider submucosal injection of Teflon to be a first-line technique in the treatment of vesicoureteric reflux in children. The success rate is similar to that of open surgery but with endoscopic treatment morbidity and costs are lower and hospital stay is shorter.

[Laparoscopic approach through optic trocars]. / Abordaje laparoscópico a través de trócares ópticos.

OBJECTIVE: Laparoscopy has not reached the same levels of development in Urology as it has in other surgical specialties. Consequently, the average urologist is not sufficiently accustomed to using laparoscopic trocars, a difficulty which becomes even more noteworthy since treatment is occasionally preferably by the extraperitoneal approach (preperitoneoscopy and retroperitoneoscopy). Our experience with different visualizing trocars is presented. METHODS: We reviewed our experience with different visualizing trocars. The advantages and inconveniences of each type, utilized in different approaches, are discussed. RESULTS: Active visualizing trocars are preferred because they are safe and permit pre and retroperitoneal blunt dissection without difficulty. However, cost is the major disadvantage of these instruments because they are not reusable. CONCLUSION: Lately, we are more inclined to utilize the reusable visualizing trocars with the helicoidal cannula, which are very safe for the transperitoneal and perhaps slightly less for the extraperitoneal approach. These instruments cause less injury when they go through the abdominal wall and, furthermore, they cost less.

[Surgery of abdominal aortic aneurysm in horseshoe kidney. Report of a case and review of the literature]. / Cirugía del aneurisma de aorta abdominal en presencia de riñón en herradura, a propósito de un caso y revisión de la literatura.

OBJECTIVE: A case of coexistent abdominal aortic aneurysm and horseshoe kidney is presented. The diagnostic difficulties and the different treatments are discussed. METHODS/RESULTS: A 55-year-old male patient with aneurysm of the abdominal aorta associated with a horseshoe kidney is described and the literature is reviewed. The diagnosis was made by CT and arteriography. Treatment was by the transperitoneal approach, division of the renal isthmus and placement of an aortoiliac dacron graft. CONCLUSION: Horseshoe kidney associated with abdominal aortic aneurysm requiring surgical management is uncommon, but when it occurs, aortic repair is significantly more difficult.

Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position.

PURPOSE: Percutaneous nephroscopy is usually performed with the patient prone, which is uncomfortable for the patient and does not prevent damage to the colon. We assess the possibility of performing percutaneous nephroscopy using local anesthesia with the patient supine, and evaluate the advantages and complications. MATERIALS AND METHODS: A total of 557 consecutive percutaneous nephroscopies were attempted in 221 men and 242 women in the supine position. Patient age ranged from 8 to 87 years (mean 55.1). Patients are supine with a 3 l. serum bag below the ipsilateral flank. We catheterize the affected uretheral meatus with a 5F catheter through a flexible cystoscope. The tract is infiltrated with local anesthesia. The skin is punctured in the posterior axillary line which corresponds to approximately 1 cm. above the bag. We use an Alken set to dilate the tract to 30F, which is the size of the Amplatz sheath we commonly use. RESULTS: Nephroscopy was performed in 519 cases (93.1%). Mean operation time was 85 minutes (range 15 to 240). Serious bleeding occurred in 3 cases. The colon was never damaged in patients treated in the supine position. CONCLUSIONS: Percutaneous nephroscopy using local anesthesia with the patient supine is safe and easy. According to our experience the advantages in comfort to the patient and feasibility to the surgeon justify its use.

[Rectal hemorrhage as a first sign of renal cell adenocarcinoma]. / Rectorragia como primera manifestación de adenocarcinoma de células renales.

Renal cell carcinoma accounts for 85% of all renal primary tumours, the remaining 15% tumours originating either in the renal pelvis or the renal capsule. Clinical signs and symptoms of renal adenocarcinoma can be classified in four groups: specifically urological signs and symptoms, unspecific general symptoms, paraneoplastic syndromes, and metastasis-derived symptoms. The classical triad consists of haematuria, pain and palpable abdominal mass; at present this triad appears in a minority of cases, and is usually a late finding. The number of cases diagnosed from unspecific signs and symptoms is increasingly larger. Routine use of ultrasound and CAT allows a higher number of diagnosis, which frequently occur in the less advanced stages. The present paper presents a case report of renal cell adenocarcinoma, diagnosed from an infrequent early symptom such as rectal bleeding.

Aspectos éticos de la experimentació animal / Ethical aspects in experimentation with animals

Muchos de los progresos en el campo de la medicina se han logrado gracias a la experimentación con animales. La urología se ha enriquecido mucho, tanto en su vertiente clínica como quirúrgica, de la cirugía experimental.Incluso actualmente, el entrenamiento quirúrgico de las nuevas generaciones de urólogos en técnicas quirúrgicas complejas y de uso poco frecuente requiere del empleo de animales de experimentación. Téngase en cuenta que tan sólo el 1,7 por ciento del total de animales de experimentación se utiliza para la enseñanza y la formación quirúrgica. La inmensa mayoría de ellos se emplea para la investigación de nuevos fármacos, productos o aparatos, o en la investigación básica. Estamos muy lejos de la antigua "vivisección", y nuestra mejor respuesta a la opinión pública, que se encuentra muy sensibilizada por los argumentos- en ocasiones sin fundamento- esgrimidos por las sociedades protectoras de animales, consiste en dar una detallada información de nuestras actividades que, además de cumplir con las normas que al respecto señala la legislación de cada país, se realizan en centros autorizados, dirigidos por personas experimentada, capaces de identificar los signos que pudieran indicar la presencia de dolor o sufrimiento en los animales, con vistas a reducirlo o evitarlo por completo

Aspectos éticos de la experimentació animal / Ethical aspects in experimentation with animals

Muchos de los progresos en el campo de la medicina se han logrado gracias a la experimentación con animales. La urología se ha enriquecido mucho, tanto en su vertiente clínica como quirúrgica, de la cirugía experimental.Incluso actualmente, el entrenamiento quirúrgico de las nuevas generaciones de urólogos en técnicas quirúrgicas complejas y de uso poco frecuente requiere del empleo de animales de experimentación. Téngase en cuenta que tan sólo el 1,7 por ciento del total de animales de experimentación se utiliza para la enseñanza y la formación quirúrgica. La inmensa mayoría de ellos se emplea para la investigación de nuevos fármacos, productos o aparatos, o en la investigación básica. Estamos muy lejos de la antigua "vivisección", y nuestra mejor respuesta a la opinión pública, que se encuentra muy sensibilizada por los argumentos- en ocasiones sin fundamento- esgrimidos por las sociedades protectoras de animales, consiste en dar una detallada información de nuestras actividades que, además de cumplir con las normas que al respecto señala la legislación de cada país, se realizan en centros autorizados, dirigidos por personas experimentada, capaces de identificar los signos que pudieran indicar la presencia de dolor o sufrimiento en los animales, con vistas a reducirlo o evitarlo por completo(AU)

[Wilms' tumor. The experience of the University Clinical Hospital of Zaragoza]. / Tumor de Wilms. Experiencia del Hospital Clínico Universitario de Zaragoza.

OBJECTIVES: The present study reviewed the records of patients with Wilms' tumor treated at the University Hospital of Zaragoza from January, 1980 to January, 1995. METHODS: A retrospective study was conducted in 12 patients (5 boys and 7 girls) with Wilms' tumor, aged 9 months to 9.5 years, with special reference to the clinical symptoms and signs. RESULTS: In 9 of the 12 cases, the tumor was localized to the left kidney and 3 cases had right-sided involvement. No patient showed an unfavorable histological finding, intraoperative rupture or the associated phenotypic manifestations that are frequently described in cases with this tumor type. CONCLUSION: The mortality and survival rates are comparable with those reported by other authors in our country.

Tecnología urológica del futuro / Uro-Technology of the Future

Nuestra especialidad, tras haber experimentado cambios radicales con el advenimiento de la RTU y de la ESWL, mantiene un constante clima innovador impulsada por los avances tecnológicos. El urólogo que desee seguir ejerciendo como tal en un futuro no muy lejano, debe iniciar, cuanto antes, una aproximación, toma de contacto y análisis de la tecnología de nuevo desarrollo. De lo contrario, verá reducido drásticamente su campo de acción. Se describen los progresos previsibles en la tecnología diagnóstica y terapeútica que apoyarán en el futuro el ejercicio del urólogo, destacándose el papel de la ecografía, doppler color, radiología convencional, TAC, RM, endoscopia, radioisótopos, imágenes en 3D, informática urológica, endourología, angiorradiología intervencionista, cirugía laparoscópica, robótica, telecirugía y realidad virtual

Tecnología urológica del futuro / Uro-Technology of the Future

Nuestra especialidad, tras haber experimentado cambios radicales con el advenimiento de la RTU y de la ESWL, mantiene un constante clima innovador impulsada por los avances tecnológicos. El urólogo que desee seguir ejerciendo como tal en un futuro no muy lejano, debe iniciar, cuanto antes, una aproximación, toma de contacto y análisis de la tecnología de nuevo desarrollo. De lo contrario, verá reducido drásticamente su campo de acción. Se describen los progresos previsibles en la tecnología diagnóstica y terapeútica que apoyarán en el futuro el ejercicio del urólogo, destacándose el papel de la ecografía, doppler color, radiología convencional, TAC, RM, endoscopia, radioisótopos, imágenes en 3D, informática urológica, endourología, angiorradiología intervencionista, cirugía laparoscópica, robótica, telecirugía y realidad virtual (AU)

[Nephrectomy through lumbar endoscopy. Report of 3 cases]. / Nefrectomía a través de lumboscopia. A propósito de tres casos.

After a long experience with transperitoneal laparoscopic surgery of the kidney, we have incorporated the Gaur balloon technique for dissection. We report our experience of 3 nephrectomy procedures performed via lumboscopy, with the patients lying in the lumbotomy position. A 12 mm skin incision is made in the axillary midline. Blunt dissection of the muscle planes is carried out and the retroperitoneal space is explored digitally. A 16 F balloon-tipped catheter is introduced and the balloon is distended with 720 ml saline solution. The catheter is removed and a Hasson trocar with optics and 3 accessory trocars are inserted. The kidney is dissected and the elements of the vascular pedicle are clipped or stapled independently. The kidney is fragmented inside a Lapsac and removed. In our view, this procedure is easier to perform and carries less morbidity than transperitoneal laparoscopic nephrectomy.

[Laparoscopic management of complex lithiasis in horseshoe kidneys]. / Abordaje laparoscópico de la litiasis compleja en riñones en herradura.

Based on the fact that the results obtained with extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are uncertain in cases of complex lithiasis in horseshoe kidney, and counting on a wide laparoscopic experience as the most suitable solution in these cases, the authors present their initial experience in two cases of double lithiasis in right hemikidney. Approach was done through transperitoneal laparoscopy, after placement of a stent catheter and under the support of a radiological C-arc. After removal of the stones, the renal pelvis was closed with loose 4 zero reabsorbable suture with kots done intracorporeally. The post-operative had no complications with the exception of a transient leak of urine (5 days) that cause no further complications or subsequent sequelae. Monitoring at 6 months showed absence of residual lithiasis and good morphology and renal function of the sides operated.

[Laparoscopic ablation of renal cysts]. / Ablación laparoscópica de quistes renales.

The therapeutic indications for renal cysts, a pathology observed in more than 50% of subjects aged over fifty years, are currently limited to their symptomatic forms or those of uncertain diagnosis. The approach has changed from the unroofing procedure to percutaneous sclerotherapy and, thereafter, to percutaneous resection or endourological marsupialization to the urinary tract. Only a year ago, some isolated cases of laparoscopic treatment of renal cysts were reported. Our experience of 13 cases using this latter technique is described. The procedure is performed under general intravenous anesthesia (with intubation), using three or four laparoscopic ports (one of 11 mm and 5 mm for the rest), electric scissors, two grasping forceps and an aspiration/irrigation system. After opening the parietocolic space at the cyst level, a 4 cm window is dissected in the peritoneal tissue, on its wall. After punctioning and emptying the cyst, we explore it inside and dissect its free wall for complete excision. The early and late results (some cases have a follow-up of more than one year) are excellent. For this reason, we advocate the use of this procedure for symptomatic renal cysts over 8 cm in diameter that do not present an exclusively intrarenal development.