The Spanish linguistic validation of the ureteral stent symptom questionnaire.

BACKGROUND AND PURPOSE: Ureteral Stent Symptoms Questionnaire (USSQ) is an intervention-specific health-related quality-of-life (HrQoL) measure. We describe development and validation of the Spanish version. MATERIALS AND METHODS: We followed established methods to develop the Spanish version of the original USSQ. After pilot testing, we conducted a formal validation study; 70 patients, undergoing placement of ureteral stents, successfully completed the Spanish USSQ as well as the EuroQoL-5D (male and female), the ICIQ male and female lower urinary tract symptoms questionnaires at weeks 1 and 4 after stent insertions, and at week 4 after their removal. In addition, 40 healthy people acted as a control group and completed the same questionnaires twice at 3-week intervals. Statistical analyses were performed to evaluate reliability, validity, and sensitivity to change of the Spanish USSQ. RESULTS: After revision of the initial two drafts after translation, back translation, and pilot testing, a final draft was developed that underwent field testing. Psychometric analyses revealed satisfactory internal consistencies (Cronbach alpha coefficients: 0.73-0. 85) and test-retest reliability (Spearman correlation coefficient: >0.6) for the domains of urinary symptom, body pain, and general health. It demonstrated satisfactory discriminant validity (sensitivity to change, p<0.01), convergent validity (good correlations between the domains of the USSQ and existing validated questionnaires), and test-retest reliability (p<0.001). Analysis of the domains of the sexual matter (21.4%) and work performance (35.7%) were limited because of the small proportion of the study population for whom it was applicable. CONCLUSIONS: Results of our development and validation study demonstrate that the new Spanish version of the USSQ is a psychometrically valid intervention-specific measurer for use in the second most common language in the world. It is a reliable outcome measure that could be used for both clinical and research purposes.

Upper urinary tract urothelial cell carcinoma: location as a predictive factor for concomitant bladder carcinoma.

OBJECTIVE: To investigate the existence of predictive factors for concomitant, primary UUT-UCC and BC. Upper urinary tract urothelial cell carcinoma (UUT-UCC) is a pan-urothelial disease of the transitional epithelial cells. Although several studies have shown the association of bladder recurrence following UUT-UCC, little is known on the incidence of concomitant UUT-UCC and bladder cancer (BC) without previous BC. MATERIALS AND METHODS: A retrospective review of 673 patients diagnosed and treated for UUT-UCC was performed. Patients with history of BC were excluded. We investigated age, sex, location of the upper tract tumor (calyx, renal pelvis, upper ureter, mid-ureter, lower ureter), multifocality, clinical symptoms, tumor grade and pathological stage. Contingency tables and chi-square test were used for categorical variables and analysis of variance (ANOVA) for quantitative variables. RESULTS: 450 patients eligible for inclusion were identified. Of these, 76 (17 %) presented concomitant primary UUT-UCC and BC. Location of primary UUT-UCC was in calyx and/or renal pelvis in 25 patients (34 %), upper ureter 8 (11 %) and lower ureter 37 (49 %). In 6 patients (8 %), data were missing. Concomitant BC was found in 10, 18, and 33 % of patients with primary caliceal/renal pelvis, upper ureter and lower ureter UUT-UCC, respectively. On multivariate analysis, location of UUT-UCC was the only predictive factor for concomitant bladder tumor (OR: 1.7; 95 % CI, 1.007-2.906 p = 0.047). CONCLUSIONS: Our findings suggest that the possibility of concomitant BC in primary diagnosed patient with UUT-UCC is as high as 33 % and mainly depends on upper tract tumor location.

Manifestaciones genitourinarias de la enfermedad de células falciformes / Genitourinary manifestations of sickle cell disease

OBJETIVO: La drepanocitosis es una de las enfermedades hereditarias mas frecuentes. Las tendencias migratorias y el mestizaje han elevado la incidencia de esta enfermedad en Europa. Se ha publicado mucho sobre esta enfermedad, pero existen en la literatura pocas revisiones que traten en conjunto sus manifestaciones sobre el sistema genitourinario.MÉTODOS: Se ha llevado a cabo una revisión exhaustiva, usando como instrumento principal la base de datos online PubMed, sobre los avances en la fisiopatología y manifestaciones uro-nefro-andrológicas de esta enfermedad.RESULTADOS: Entre estas manifestaciones se encuentran la nefropatía de células falciformes, enuresis, nicturia, hematuria, priapismo, carcinoma medular renal e infartos y necrosis en diversos órganos del aparato genitourinario.CONCLUSIONES: Las particularidades de este síndrome y el espectro multisistémico que abarca, hacen necesario el conocimiento de esta enfermedad y de sus manifestaciones genitourinarias(AU)

OBJECTIVES: Sickle cell disease is one of the most common hereditary diseases, and migration trends and cross breeding have increased its incidence in Europe. While much has been published about the disease, there are few reviews in the literature dealing with its manifestations in the genitourinary system.METHODS: We conducted a comprehensive review, using as our main instrument the PubMed online database, on recent advances in knowledge of the pathophysiology and urological, nephrological, and andrological manifestations of the disease.RESULTS: Manifestations include sickle cell nephropathy, enuresis, nocturia, hematuria, priapism, renal medullary carcinoma, and infarctions and necrosis in various organs of the genitourinary system.CONCLUSIONS: The characteristics of this important disease and the multisystemic spectrum it covers make knowledge of its genitourinary manifestations necessary(AU)

Key areas in the learning curve for robotic urological surgery: a Spanish multicentre survey.

BACKGROUND: The number of robotic-assisted procedures offered in Spain is rapidly increasing despite a lack of consensus criteria for training and credentialling. OBJECTIVE: This national multicentre study was designed to analyze the different areas of the robotic urological surgery learning curve. MATERIAL AND METHODS: A questionnaire was sent to all 13 urology units in Spain with an active robotics programme requesting information on training and problems encountered. RESULTS: In most centres (n = 11, 84.6%), training programmes were animal-based; cadavers were used at only 2 (15.4%). Proctoring in initial procedures was practiced by 12 groups (92.3%). When initiating the robotics programme, the console was shared at 8 units (61.5%). Prior experience in open and/or laparoscopic surgery was reported by 10 of the groups (76.9%), and experience in open surgery only by 2 (15.4%) or robotic surgery alone by 1 (7.7%). The procedure with which the robotics programme was started in all 13 participating units was radical prostatectomy. The number of cases needed to complete the learning curve for this procedure was 20-25 cases according to 8 (61.5%) surgery teams. CONCLUSIONS: Up until March 26, 2010, 1,692 operations, mostly radical prostatectomies, were conducted using the da Vinci robot in our country.

[Laparoscopic renal cryotherapy: preliminary experience]. / Crioterapia renal laparoscópica: experiencia inicial.

OBJECTIVE: Renal cryotherapy has been described as a minimally invasive procedure that represents an alternative for selected patients with small renal tumors. Our preliminary experience with this procedure is reported. MATERIAL AND METHODS: [corrected] Eighteen patients with 21 tumors with a mean tumor size of 2.2 cm (1-4) in the preoperative CT scan underwent renal cryotherapy using a double freeze-thaw cycle. The group consisted of 14 males (64%) and 4 females (18% with a mean age of 68 years (32-84). All patients had undergone prior surgery for renal tumor in the treated or the opposite kidney. A transperitoneal laparoscopic approach was used in all patients. RESULTS: Mean operating time was 196 minutes (120-140), and no patient received transfusions during or after surgery. No complications occurred in 14 patients (64%). Perirenal abscess, splenic laceration, ureteral lesion, and polar artery lesion occurred in one patient each. Peroperative biopsy was performed in 5 patients (22.7%) and was positive for renal cancer in two cases, while material was insufficient in three patients. Mean hospital stay was 6 days (2-16). Creatinine levels were 106 mg% (48-230) before surgery and 123 mg/% (52-270) 6 months after surgery. A CT scan was performed in all patients one and six months after surgery, showing a residual enhancement area in two of them. Sixteen patients (88.8%) are disease-free after a mean follow-up time of 46 months (6-116). Metastatic disease occurred in two patients (11%) in the setting of a prior renal tumor in the same or the opposite kidney and required treatment with antiangiogenic agents. CONCLUSIONS: This is the largest series reporting renal cryosurgery in Spain, in complex cases and with adequate follow-up. Results are encouraging and allow for considering renal cryotherapy among the minimally invasive procedures for nephron-sparing surgery.

Crioterapia renal laparoscópica: experiencia inicial / Laparoscopic renal cryotherapy: preliminary experience

Objetivo: La crioterapia renal se ha descrito como una técnica mínimamente invasiva que constituye una alternativa para pacientes seleccionados con tumores renales de pequeño tamaño. Presentamos nuestra experiencia preliminar con este procedimiento. Material y métodos: Dieciocho pacientes (21 tumores) con un tamaño medio de 2,2 cm (1-4) en TC prequirúrgico se trataron mediante crioterapia renal con doble ciclo de congelación. Catorce (64%) varones y 4 (18%) mujeres con una edad media de 68 años (32-84). Todos los pacientes habían tenido cirugías previas: 3 por tumor renal en el riñón que recibió el tratamiento o en el contralateral. El abordaje fue laparoscópico transperitoneal en todos los pacientes. Resultados: La media de tiempo operatorio fue de 196 min (120-420) y ningún paciente recibió transfusión intra o postoperatoria. No presentaron complicaciones 14 (64%) pacientes, y hubo un absceso perirrenal en 1 caso, laceración esplénica (1), lesión ureteral (1) y lesión de la arteria polar (1). Se realizó biopsia peroperatoria en 5 (22,7%) casos, que resultó positiva para carcinoma renal en 2 casos y material insuficiente en 3. La estancia media fue de 6 días (2-16). Los valores de creatinina preoperatorios fueron de 106 mg/% ( 48-230) y a los 6 meses de 123 mg/% (52-270). En todos los pacientes se realizó una tomografía computariza al mes y a los 6 meses de la cirugía; en 2 de ellos había una zona hipercaptante residual. Con un tiempo medio de seguimiento de 46 meses (6-116), 16 (88,8%) pacientes se encuentran libres de enfermedad. En 2 (11%) casos apareció enfermedad metastásica en el contexto de un enfermedad previa tumoral en el mismo riñón o en el contralateral, que requirió tratamiento con antiangiogénicos. Conclusiones: Se trata de la serie más amplia en nuestro país, en casos complejos y con un buen seguimiento. Los resultados son prometedores y permiten considerar la crioterapia del tumor renal dentro de las técnicas mínimamente invasivas de cirugía conservadora renal (AU)

Objective: Renal cryotherapy has been described as a minimally invasive procedure that represents an alternative for selected patients with small renal tumors. Our preliminary experience with this procedure is reported. Material y methods: Eighteen patients with 21 tumors with a mean tumor size of 2.2 cm (1-4) in the preoperative CT scan underwent renal cryotherapy using a double freeze-thaw cycle. The group consisted of 14 males (64%) and 4 females (18% with a mean age of 68 years (32-84). All patients had undergone prior surgery for renal tumor in the treated or the opposite kidney. A transperitoneal laparoscopic approach was used in all patients. Results: Mean operating time was 196 minutes (120-140), and no patient received transfusions during or after surgery. No complications occurred in 14 patients (64%). Perirenal abscess, splenic laceration, ureteral lesion, and polar artery lesion occurred in one patient each. Peroperative biopsy was performed in 5 patients (22.7%) and was positive for renal cancer in two cases, while material was insufficient in three patients. Mean hospital stay was 6 days (2‑16). Creatinine levels were 106 mg% (48-230) before surgery and 123 mg/% (52-270) 6 months after surgery. A CT scan was performed in all patients one and six months after surgery, showing a residual enhancement area in two of them. Sixteen patients (88.8%) are disease-free after a mean follow-up time of 46 months (6-116).Metastatic disease occurred in two patients (11%) in the setting of a prior renal tumor in the same or the opposite kidney and required treatmet with antiangiogenic agents. Conclusions: This is the largest series reporting renal cryosurgery in Spain, in complex cases and with adequate follow-up. Results are encouraging and allow for considering renal cryotherapy among the minimally invasive procedures for nephron-sparing surgery (AU)

[The Open Access Initiative (OAI) in the scientific literature]. / La Iniciativa Open Access (OAI) en la literatura científica.

According to the declaration of the Budapest Open Access Initiative (OAI) is defined as a editorial model in which access to scientific journal literature and his use are free. Free flow of information allowed by Internet has been the basis of this initiative. The Bethesda and the Berlin declarations, supported by some international agencies, proposes to require researchers to deposit copies of all articles published in a self-archive or an Open Access repository, and encourage researchers to publish their research papers in journals Open Access. This paper reviews the keys of the OAI, with their strengths and controversial aspects; and it discusses the position of databases, search engines and repositories of biomedical information, as well as the attitude of the scientists, publishers and journals. So far the journal Actas Urológicas Españolas (Act Urol Esp) offer their contents on Open Access as On Line in Spanish and English.

[Robotic radical cystoprostatectomy: oncological and functional analysis]. / Cistoprostatectomía radical robótica: análisis oncológico y funcional.

INTRODUCTION: The da Vinci robotic laparoscopic surgery, has been shown in radical prostatectomy, optimal functional and oncological results with a lower learning curve, greater comfort and vision for the surgeon, and proper preservation of the neurovascular bundles. This has led to begin the experience with robotic radical cystectomy (RRC). OBJECTIVES: Review our initial experience in CRR, evaluating surgical and functional results obtained, and also immediate and short-term complications. MATERIAL AND METHODS: Between December 2007 and January 2009 we performed nine robotic radical cystoprostatectomy and in seven patients robotic lymphadenectomy (LDN). Five patients had a muscle-invasive disease and 4 non-muscle invasive bladder cancer. The median age was 57 years (range 34-81). Urinary diversion was performed extracorporeally in all cases, 3 cases an ileal conduit and 6 an Studer neobladder in 3 of these 6 cases, the urethra-neobladder anastomosis was performed intracorporeally. RESULTS: The average time of surgery was 300 minutes (range 280-420) in the ileal conduit and 360 (range 330-540) in the Studer. No cases required conversion or blood transfusion. The median number of nodes removed by LDN robotics was 10 (range 6-18). The pathology revealed 3 pT0. 2 CIS, 3 pT3, 1 pT4b (positive margins). With a median follow up of 7 months there have been no peritoneal implant and only one ureteral stenosis. Oral diet was initiated in 5 cases at 48 hours. Of the 6 patients with preserved sexual function preoperatively and followup of more than 3 months, 2 had full erection at 1 month, 2 at 3 and 6 months, and the remaining 2 presented with a full erection with 5 PD inhibitors at 3 and 9 months. All patients with neobladder presented correct daytime continence. The average hospital stay was 8.5 days (range 7-19). CONCLUSIONS: The radical robotic cystectomy with extracorporeal reconstruction of the urinary diversion offers good early functional and surgical outcomes. The careful preservation of the neurovascular bundles in radical pelvic surgery provides excellent results in urinary and sexual function.

[Spanish bottled and tap water analysis and their relation with urinary lithiasis]. / Análisis de las aguas embotelladas y de grifo españolas y de las implicaciones de su consumo en la litiasis urinaria.

OBJECTIVE: To perform a chemical analysis of all the available waters in Spain with the idea of offering consume recommendations to lithiasic patients. MATERIAL AND METHODS: Information research of the chemical composition of Spanish tap and bottled water in publications, supermarkets and Internet. A descriptive study, and a correlation study between water components by means of Pearson test were performed. RESULTS: Information about composition from tap water of most of the main Spanish cities and 85 bottled water brands was found. A significant correlation between calcium and magnesium concentration (p = 0.0001) and high correlation between bicarbonate and sodium concentration (p = 0.0001, Pearson coefficient 0.958) was found. It is also offered water classifications according to calcium, bicarbonate, sodium and magnesium concentrations. CONCLUSION: A guideline about water election for lithiasic patients is offered according to their geographical origin and dietetic preferences, mainly lactic consume.

[Female urethral stricture: etiology, diagnostic and treatment]. / Estenosis uretral en la mujer: etiología, diagnóstico y tratamiento.

Female urethral stricture is an infrequent cause of bladder outlet obstruction, which is also a rare clinical entity in women. The most frequent etiology is the previous urogenital surgery. Periurethral fibrosis is the final cause regardless the etiology. Considerably controversie surrounds in the diagnostic criteria but the estrictures are structural obstructions which involve media and distal third of the female urethra. There is no treatment consensus, but less agresive maneuvers such as dilatations and urethrotomies are chosen to treat primary estrictures, although the high recurrence rates. Reconstructive tecniques with the use of several flaps and grafts should be considered in recurrent cases and when there is a partial or total urethral defect.

[Limits of laparoscopic surgery in the treatment of renal tumors]. / Límites de la cirugía laparoscópica en el tratamiento del tumor renal.

Laparoscopic radical nephrectomy is considered to be the technique of choice in the mangement of stage T1 and T2 renal cancer, though increased mastery of this alternative type of surgery has served to expand its indications. In any case, these procedures have a series of limitations which are tied to the intrinsic characteristics of laparoscopic surgery, and which are associated with the patient and tumor characteristics, and the experience of the surgeon. The present study discusses the different indications and establishes the current limits of laparoscopic surgery applied to the management of renal tumors. Its role in cell-reducing therapy in metastatic disease, and the methods available for reducing tumor implantation in the surgical ports are also commented.

La Iniciativa Open Access (OAI) en la literatura científica / The Open Access Initiative (OAI) in the scientific literature

Según la declaración de Budapest sobre la iniciativa Open Access (OAI) se define como un modelo editorial en el que el acceso a la literatura científica y su uso son gratuitos. Internet permite la libre circulación de información y ha sido la base de esta iniciativa. Las declaraciones de Bethesda y de Berlín, secundadas por diversos organismos investigadores internacionales proponen exigir a los investigadores que depositen una copia de todos sus artículos publicados en un autoarchivo o en un repositorio Open Access; y alentar a los investigadores a publicar sus artículos de investigación en revistas que permitan libre acceso a sus contenidos. En el presente trabajo se revisan las claves de la OAI, con sus aspectos positivos y sus controversias; y se analiza la posición de las bases de datos, buscadores y repositorios de información biomédica, así como la actitud de científicos, empresas editoriales y publicaciones periódicas. Hasta la actualidad la revista Actas Urológicas Españolas ofrece sus contenidos en Open Access en su versión On Line en español e inglés (AU)

According to the declaration of the Budapest Open Access Initiative (OAI) is defined as a editorial model in which access to scientific journal literature and his use are free. Free flow of information allowed by Internet has been the basis of this initiative. The Bethesda and the Berlin declarations, supported by some international agencies, proposes to require researchers to deposit copies of all articles published in a self-archive or an Open Access repository, and encourage researchers to publish their research papers in journals Open Access. This paper reviews the keys of the OAI, with their strengths and controversial aspects; and it discusses the position of databases, search engines and repositories of biomedical information, as well as the attitude of the scientists, publishers and journals. So far the journal Actas Urológicas Españolas (Act Urol Esp) offer their contents on Open Access as On Line in Spanish and English (AU)

Cistoprostatectomía radical robótica: análisis oncológico y funcional / Robotic radical cystoprostatectomy: oncological and functional analysis

Introducción: La cirugía laparoscópica robotizada da Vinci, ha demostrado en la prostatectomía radical, óptimos resultados funcionales y oncológicos con menor curva de aprendizaje, mayor comodidad y visión para el cirujano, y correcta preservación de las bandeletas neurovasculares. Esto ha dado lugar a que iniciar la experiencia con cistectomía radical robótica (CRR), fuera de nuestro país. Objetivos: Revisar nuestra experiencia inicial en CRR, valorando los resultados quirúrgicos y funcionales obtenidos, y complicaciones inmediatas y a corto plazo. Material y métodos: Entre diciembre del 2007 y enero del 2009 hemos realizado nueve cistoprostatectomías radicales robóticas yen siete de los nueve casos con linfadenectomía (LDN) robótica. En 5 pacientes por tumor músculo-invasivo y 4 por no músculo invasivo de alto riesgo. La mediana de edad fue 57 años (rango 34-81). La derivación urinaria se realizó extracorpóreamente, en 3casos un conducto ileal, en los 6 restantes una neovejiga tipo Studer, en 3 de estos 6 casos la anastomosis uretro-neovejiga se realizó intracorpóreamente. Resultados: El tiempo medio total de cirugía fue 300 minutos (rango 280-420) en el conducto ileal y 360 (rango 330-540) en el Studer. Ningún caso requirió conversión ni transfusión sanguínea. La mediana de ganglios extraidos mediante LDN robótica fue 10(rango 6-18). La AP de la pieza reveló 3 pT0, 2 CIS, 3 pT3, 1 pT4b (márgenes positivos). Con mediana de seguimiento de 7 meses no se ha observado ningún implante peritoneal y únicamente una estenosis ureteral. Se inició dieta oral en 5 casos a las 48 horas. De los 6 pacientes con función sexual conservada preoperatoria y seguimiento > 3 meses, 2 tenían erección completa al mes, 2 a los 3 y 6 meses, y los 2 restantes presentan erección completa con inhib de la 5PDE a los 3 y 9 meses. Todos los pacientes con neovejiga presentan correcta continencia diurna. La estancia media hospitalaria fue de 8,5 días (rango 7-19). Conclusiones: La cistectomía radical más linfadenectomía robótica, con reconstrucción extracorpórea de la derivación urinaria ofrece buenos resultados quirúrgicos y funcionales tempranos. La preservación cuidadosa de las bandeletas neurovasculares en esta cirugía radical pélvica permite obtener excelentes resultados en la función sexual y miccional (AU)

Introduction: The da Vinci robotic laparoscopic surgery, has been shown in radical prostatectomy, optimal functional and oncological results with a lower learning curve, greater comfort and vision for the surgeon, and proper preservation of the neurovascular bundles. This has led to begin the experience with robotic radical cystectomy (RRC).Objectives: Review our initial experience in CRR, evaluating surgical and functional results obtained, and also immediate and short-term complications. Material and methods: Between December 2007 and January 2009 we performed nine robotic radical cystoprostatectomy and in seven patients robotic lymphadenectomy (LDN). Five patients had a muscle-invasive disease and 4 non-muscle invasive bladder cancer. The median age was 57 years (range 34-81). Urinary diversion was performed extracorporeally in all cases, 3 cases an ileal conduit and 6 an Studer neobladder in 3 of these 6 cases, the urethra-neobladder anastomosis was performed intracorporeally. Results: The average time of surgery was 300 minutes (range 280-420) in the ileal conduit and 360 (range 330-540) in the Studer. No cases required conversion or blood transfusion. The median number of nodes removed by LDN robotics was 10 (range 6-18).The pathology revealed 3 pT0, 2 CIS, 3 pT3, 1 pT4b (positive margins). With a median follow up of 7 months there have been noperitoneal implant and only one ureteral stenosis. Oral diet was initiated in 5 cases at 48 hours. Of the 6 patients with preserved sexual function preoperatively and follow up of more than 3 months, 2 had full erection at 1 month, 2 at 3 and 6 months, and there maining 2 presented with a full erection with 5 PD inhibitors at 3 and 9 months. All patients with neobladder presented correct day time continence. The average hospital stay was 8.5 days (range 7-19). Conclusions: The radical robotic cystectomy with extracorporeal reconstruction of the urinary diversion offers good early functional and surgical outcomes. The careful preservation of the neurovascular bundles in radical pelvic surgery provides excellent results in urinary and sexual function (AU)

Análisis de las aguas embotelladas y de grifo españolas y de las implicaciones de su consumo en la litiasis urinaria / Spanish bottled and tap water analysis and their relation with urinary lithiasis

Objetivo: Realizar un análisis de la composición de las aguas disponibles en España para ofrecer unas recomendaciones de consumo a los pacientes litiásicos. Material y Métodos: Búsqueda de información sobre la composición de aguas de grifo y embotelladas en publicaciones, supermercados e Internet. Estudio descriptivo y de la correlación entre los distintos componentes mediante el coeficiente de correlación de Pearson. Resultados: Se obtuvo información sobre la composición de agua de grifo de la mayoría de capitales españolas y de 85marcas de agua embotellada. Se encontró una correlación entre la concentración de calcio y magnesio (p=0,0001) y una intensa relación entre la de bicarbonato y sodio (p=0,0001, coeficiente Pearson 0,958). Se ofrece clasificación de las aguasen función de la concentración de calcio, bicarbonato, sodio y magnesio. Conclusión: Se propone una guía de elección de agua del paciente litiásico en función de su procedencia geográfica y de sus preferencias dietéticas, principalmente el consumo de lácteos (AU)

Objective: To perform a chemical analysis of all the available waters in Spain with the idea of offering consume recommendations to lithiasic patients. Material and Methods: Information research of the chemical composition of Spanish tap and bottled water in publications, supermarkets and Internet. A descriptive study, and a correlation study between water components by means of Pearson test were performed. Results: Information about composition from tap water of most of the main Spanish cities and 85 bottled water brands was found. A significant correlation between calcium and magnesium concentration (p=0.0001) and high correlation between bicarbonate and sodium concentration (p=0.0001, Pearson coefficient 0.958) was found. It is also offered water classifications according to calcium, bicarbonate, sodium and magnesium concentrations. Conclusion: A guideline about water election for lithiasic patients is offered according to their geographical origin and dietetic preferences, mainly lactic consume (AU)

Estenosis uretral en la mujer: Etiología, diagnóstico y tratamiento / Female Urethral Stricture: Etiology, diagnostic and treatment

La estenosis uretral en la mujer es una causa poco frecuente de obstrucción infravesical, entidad ya de por sí poco habitual en el sexo femenino. La mayoría de los casos son secundarios a procedimientos quirúrgicos del área urogenital, la fibrosis periuretral es el mecanismo de acción implicado independientemente de la causa. Existe cierta controversia en cuanto a los criterios diagnósticos pero parece claro que se trata de obstrucciones estructurales que afectan al tercio medio y distal de la uretra. No existe un consenso en cuanto al tratamiento, pero maniobras menos agresivas como las dilataciones o la uretrotomia interna son las técnicas de elección para las estenosis primarias, teniendo en cuenta el alto porcentaje de recidivas que presentan. Las técnicas de reconstrucción uretral mediante el uso de diversos tipos de injertos oflaps estarían indicadas en aquellos casos recidivados o bien en los que existe un defecto parcial o total uretral (AU)

Female urethral stricture is an infrequent cause of bladder outlet obstruction, which is also a rare clinical entity in women. The most frequent etiology is the previous urogenital surgery. Periurethral fibrosis is the final cause regardless the etiology. Considerably controversie sorrounds in the diagnostic criteria but the estrictures are structural obstructions which involve media and distal third of the female urethra. There is no treatment consensus, but less agresive maneuvers such as dilatations and urethrotomies are chosen to treat primary estrictures, although the high recurrence rates. Reconstructive tecniques with the use of several flaps and grafts should be considered in recurrent cases and when there is a partial or total urethral defect (AU)

Carcinoma escamoso de uretra metastático / Metastasic urethral squamous-cell a cancer

El carcinoma primario de uretra es una neoplasia poco común, constituyendo menos del 1% de los tumores genitourinarios. Éste es más habitual en el sexo femenino, en una proporción 4:1, apareciendo en la sexta o séptima década de la vida, siendo el tipo histológico más frecuente el carcinoma de células escamosas. Los primeros signos y síntomas son más propios de estenosis benigna de uretra que de malignidad. El periodo entre los primeros síntomas y el diagnóstico suele ser de alrededor de tres años. Por consiguiente la mayoría de estos tumores son localmente avanzados en el momento del diagnóstico y a pesar de ser sometidos a tratamientos agresivos tiene mal pronóstico. El tratamiento depende del estadio y la localización de la lesión. Debido a la rareza de esta neoplasia no existe un consenso de tratamiento, pero parece ser que éste debe ser multimodal, con cirugía, radioterapia y quimioterapia. Presentamos el caso de un varón de 80 años afecto de un carcinoma escamoso de uretra, localmente avanzado en el momento del diagnóstico. Ante la imposibilidad de recibir tratamiento quirúrgico fue tratado con quimioterapia más radioterapia, presentando al poco tiempo progresión precoz de la enfermedad (AU)

Urethral cancer is an infrequent pathology, less than 1% of the genitourinary tumors. It is more frequent in women (4:1), in the sixth or seventh decade of life. The most frequent histology being squamous cell carcinoma. First signs and symptoms usually are more attributable to benign stricture disease, rather than malignicy. The interval between the onset of symptoms and diagnosis may be as long as three years. Therefore most of these tumors are locally advanced at the time of diagnosis with generally poor prognosis despite aggressive treatment. Therapeutic management varies with the stage and location of the lesion. Because of the rarity of this pathology, no consensus has been reached on treatment modalities, but seems to be that must be a multimodal one, including surgery, radiotherapy and chemotherapy. We present the case of an 80 year-old male, with a diagnosis of urethral squamous-cell cancer, locally advanced at the time of diagnosis. Surgery was not feasible. The patient underwent chemotherapy and radiotherapy with evidence of quick progression thereafter (AU)

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

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