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Introduction: Urinary lithiasis involves a major source of morbidity and economic costs. The aim of this study was to evaluate the adherence to the European Association of Urology Guidelines on Urolithiasis with regard to treatment among Spanish urologists. Methods: A total of 723 patients were included in a prospective study between May 1, 2014, and July 31, 2014. The study involved 8 hospitals responsible of urolithiasis in a geographical area of Spain (Comunidad Valenciana) with approximately 4,500,000 inhabitants. Data were collected about the demographic characteristics of the patients, the characteristics of the stones, and the indicated treatment, in order to analyze the adherence to the clinical guidelines. A 90% threshold was used in concordance with the indications in the guidelines. Results: Adherence to guidelines was poor in chemolysis, distal and ureteral calculi, and >2 cm renal calculi. Adherence was high in Conclusions: In our study, the overall adherence to the clinical guidelines regarding the therapeutic indication for urinary lithiasis has been low. In the case of both renal and ureteral stones, the adherence in small lithiasis has been greater, compared with larger ones. In our survey, a trend has been observed in favor of endoscopic procedures even in large lithiasis.

Transrectal ultrasonography-guided prostate biopsy is still the main technique in prostate cancer diagnosis. In spite of being a relatively well-tolerated exploration, often results in an awkward and painful procedure, especially in those cases in which the number of samples increase. We designed a prospective randomized study that compares biopsies tolerance with the use of intravenous analgesia and intrarectal gel with or without intracapsular prostatic anesthesia.We have included an amount of 80 procedures between June 2006 and December 2007. Intravenous analgesia was given to all patients and 12.5 gr. of lidocaine gel (which contains 250 mg of lidocaine hydrochloride) was instilled into the rectal vault. All patients underwent methodically 10 cores biopsy after having an intracapsular injection of 8 ml. of 2% lidocaine in a randomized group. A questionnaire with three measurements of the visual analogue scale of pain was given immediately after the procedure and another one thirty minutes later, as well as a satisfaction survey.The average age of patients in control group was 68 years (48-73 range) and 69 years (50-75 range) in treatment group. The average PSA was 7.1 ng/mL (4.8-9.8 range) in the first group and 7.3 ng/mL (4.5-9.7 range) in the second one. Average pain in the visual analogue scale in patients without intracapsular anesthesia was 8.3 (2 - 9)in the first questionnaire and 2 (0 - 4) in the second one, against 4 (0 - 8) and 1.33 (0-2) of the group who did receive anesthesia. If we compare both groups, we find statistically significant differences only in immediately measurements ( p0,01) , not in the second questionnaire (p=0,2) . We didn't find statistically significant differences as for urethral bleeding, rectorrhagia or infection between both groups.We consider the injection of intracapsular lidocaine a reproductible technique and effective for both improving tolerance and diminishing the pain related to transrectal ultrasound-guided prostate biopsy without increasing morbidity.

Over the last years numerous semiquantitative PSA tests have appeared, based on serum or plasma immunochromatography. We present our experience using the SD BIOLINE PSA test, which is performed with plasma or serum for fast qualitative determination of PSA; the cutpoint is 3 ng/ml.We analized 54 patients who were admitted in our hospital ward. Two blood samples were obtained from every patient, one for cuantitative PSA determination at the hospital laboratory and the other one for qualitative determination with the SD BIOLINE PSA test, and the results were compared.. Two urologists independently interpreted the test without knowing the PSA values from the lab. To calculate the effect of test reading time, readings were performed at 15, 20 and 25 minutes. Results were classified in a classic contingency table, which enabled us to calculate sensitivity and specificity of the test, as well as positive and negative predictive values.Mean age was 71. 1 years (range 43-96 yr). From 54 patients in the study 26 (48. 14%) had a PSA3 ng/ml (Mean 18.5 ng/ml, range 3.9-66.9 ng/ml) and 28 (51.86%) PSA3 ng/ml (mean 0.8 ng/mL, range 0-2.9 ng/mL), in the conventional test. Results for each interval and observer were: 15 min: Observer 1: Sensitivity (S) 76,92%, specificity (E) 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 82.35%; Observer 2: S 76.92%, E 100%, PPV 100%, NPV 82.35%. 20 minutes: Observer 1: S 100%, E 93.33%, PPV 92.30%, NPV 100%; Observer 2: S 100%, E 93.33%, PPV 92.30%, NPV 100%. 25 minutes: Observer 1: S 100%, E 85.71%, PPV 86.66%, NPV 100%; Observer 2: S 92.30%, E 92.85%, PPV 92.30%, NPV 92.85%.The SD Bioline PSA test complies with the characteristics required to be used as a test for prostate cancer detection, it is simple, fast, cheap, not much invasive, and has a good efficacy.

Therapy with protease inhibitors is commonly used in patients infected by human inmunodeficency virus (HIV). 20% of the administered dose is excreted by the kidney, and when alkaline urine is present, indinavir may crystallize forming stones and patients may experience renal colic due to this fact.Between January 1998 and June 2005, 26 patients receiving antiretroviral treatment with protease inhibitors received care at our hospital because of renal colic or flank pain. All of them underwent physical examination, echography and urography as well as blood and urine analysis. Patients were treated ambulatory excepting those in whom oral analgesics were insufficient to control the pain.All patients had been treated with indinavir for longer than 12 months. They represented 4% of all patients treated with the recommended dose of Crivixan. Most of them presented flank pain, associated in most cases to microhaematuria. Five of them required hospitalization because of persistent pain in spite of endovenous analgesia. Imaging tests (echography and urography) showed functional delay of the kidney (2 cases), ureteral stasis (4 cases) and little lithiasic concretions of mild radiologic density (5 cases). Urinalysis revealed suggestive christaluria and alkaline pH. All patients required hidratation and analgesic treatment. In 3 patients indinavir dose was reduced, it was retired in another one, and 100 mg of rito-navir were added in another one. Unsuccesfuly ureteral cateterization was tried in one patient. All of them presented symptomatic improvement.We ought to know the capability of indinavir to form urolithiasis in HIV patients treated with protease inhibitors, although its use is decreasing along time. Prevalence of urolithiasis in these patients seems to be higher as length of treatment becomes longer. Metabolic alterations in urine have been proved in these patients, contributing to a higher incidence of lithiasis than in general population.

Objetivo: Los antirretrovirales inhibidores de la proteasa (IP) son fármacos utilizados en el tratamiento de pacientes afectos por el virus de la inmunodeficiencia humana (VIH). Un 20% de la dosis administrada se excreta por el riñón, que en presencia de orina alcalina puede precipitar formando cristales del propio fármaco susceptibles de provocar crisis renoureterales. Métodos: Entre enero del 1998 y junio de 2005 hemos atendido en nuestro centro a 26 pacientes con síntomas de urolitiasis y bajo el tratamiento con antirretrovirales IP. Todos ellos fueron sometidos a exploración física minuciosa, ecografía renoureteral y vesical, urografía intravenosa. Así mismo, se realizó análisis de sangre y anormales y sedimento de orina. Los pacientes fueron tratados ambulatoriamente, salvo aquellos en los que la analgesia con AINEs no fue suficiente para el control del cuadro álgico. Resultados: Todos los pacientes llevaban más de 12 meses de tratamiento con Indinavir. Los 26 pacientes con síntomas de nefrolitiasis representaban un 4% de los sujetos tratados con la dosis recomendada de Crivixan®. La mayoría presentaron dolor en fosa renal casi siempre asociado a microhematuria. De ellos, cinco pacientes requirieron ingreso en nuestra unidad por clínica no controlable de forma ambulatoria. Las pruebas diagnósticas (ecografía y/o UIV) revelaron retraso funcional del riñón (2 casos), ectasia de vía (8 casos) y pequeñas concreciones litiásicas de escasa o nula densidad cálcica (5 casos). El análisis urinario mostró cristaluria sugestiva y un pH alcalino. Todos requirieron tratamiento analgésico e hidratación. En tres casos se redujo la dosis de indinavir, en otro se retiró la medicación y en otro se añadieron 100 mgr de ritonavir. En un caso se intento cateterismo ureteral infructuosamente. La evolución fue satisfactoria en todos ellos. Conclusiones: Es preciso conocer la posibilidad de litiasis medicamentosa en pacientes HIV tratados con IP, si bien, afortunadamente, cada vez se emplean menos. La prevalencia de urolitiasis en los VIH + parece más elevada en función del tiempo de tratamiento con indinavir. Se han observado alteraciones metabólicas en la orina de estos pacientes que contribuyen a una mayor incidencia de litiasis que en la población general.

Objetivo: En los últimos años han aparecido numerosos test semicuantitativos para la determinación de PSA, basados en la inmunocromatografía, realizados sobre suero o plasma. Presentamos nuestra experiencia en el uso del test SD BIOLINE PSA, que se realiza en plasma o suero para determinación cualitativa de PSA de forma rápida, y que usa como punto de corte 3 ng/mL. Método: Se analizaron un total de 54 pacientes que estuvieron ingresados en nuestra sala de hospitalización. Se extrajeron dos muestras de sangre a todos los paciente una para determinación cuantitativa de PSA en el laboratorio de nuestro hospital y otra para la determinación cualitativa con el test SD BIOLINE PSA, posteriormente comparamos ambos resultados. Dos urólogos interpretaron de forma independiente el test sin conocer los valores de PSA obtenidos en laboratorio. Para calcular el efecto del tiempo de lectura del test se leyó a los 15, 20 y 25 minutos. Los resultados fueron clasificados en una tabla de contingencia clásica, lo cual nos permitió calcular la sensibilidad y especificidad del test, así como el valor predictivo positivo y el valor predictivo negativo. Resultados: La edad media fue de 71.1 años (rango de 43-96 años). De los 54 pacientes sometidos al estudio 26 (48.14%) tuvieron un PSA > 3 ng/mL (media 18,5 ng/mL, rango 3.9-66.9 ng/mL) y 28 (51.86%) presentaron un PSA < 3 ng/mL (media 0.8 ng/mL, rango 0-2.9 ng/mL), en el análisis ordinario. Los resultados en cada intervalo y por observador fueron los siguientes: 15 minutos: Observador 1: sensibilidad (S) 76.92%, especificidad (E) 100%, valor predictivo positivo (VPP) 100%, valor predictivo negativo (VPN) 82.35%; Observador 2: S 76.92%, E 100%, VPP 100%, VPN 82.35. 20 minutos: Observador 1: S 100%, E 93.33%, VPP 92.30%, VPN 100%; Observador 2: S 100%, E 93.33%, VPP 92.30%, VPN 100%. 25 minutos: Observador 1: S 100%, E 85.71%, VPP 86.66%, VPN 100%; Observador 2: S 92.30%, E 92.85%, VPP 92.30%, VPN 92.85%. Conclusiones: El test SDBioline cumple las características necesarias para ser utilizado como prueba de detección del PSA, es simple, rápido, barato, poco invasivo y presenta una buena efectividad.

Despite the fact that transurethral resection of the prostate (TURP) continues being the gold standard for the surgical treatment of benign prostatic hyperplasia (BPH), the good results obtained with the use of new energy sources have led to their use in daily practice.Between September 2005 and January 2007, we have treated 63 patients with KTP laser photoselective vaporization of the prostate (PVP) in our service. Preoperatively we asked for IPSS, performed physical exam, digital rectal exam, abdominal , renal, bladder and prostatic ultrasound measuring postvoid residual volume, as well as flowmetry and PSA determination. Patients were revised after 1, 3, 6 and 12 months, undergoing uroflowmetry, IPSS, ultrasound and PSA; a satisfaction survey was also fulfilled at this interviews.Mean age was 67 years (range 58-85) and mean preoperative prostatic volume was 48cc (range 34-67), mean preoperative IPSS was 17.7 and mean maximum flow 8.1 mL/s. 12 patients presented post void residual volume larger than 100 mL. Most patients presented medium or high anaesthetic risk. Mean operative time was 64 minutes (range 45-95). In most cases we used just one fibre, and mean energy released was 175,000 Joules (range 85,000-24,000). Mean hospital stay was 32.2 hours (range 19-55). In postoperative revisions we could state a significant decrease of IPSS, improvement in maximum flow, and also good or very good satisfaction degree in about 80% of the patients. Only 3 of them presented hematuria that needed to be attended by the urologist, none of them needed transfusion. One patient was admitted for severe urinary infection and eight patients referred irritative low urinary tract symptoms in their first postoperative checkup.KTP laser PVP is a safe, reproducible technique with optimal short and middle term outcomes, which should be considered as the first choice surgical treatment in elderly patients, patients with chronic anaemic diseases or anticoagulated, and patients with high anaesthesic or surgical risk.

Objetivo: A pesar de que la Resección Transuretral de Próstata (RTUP) continúa siendo el patrón de referencia en el tratamiento quirúrgico de la Hiperplasia Benigna de Próstata (HBP), los buenos resultados obtenidos con el uso de nuevas fuentes de energía han asentado su uso en nuestra práctica diaria. Métodos: Entre septiembre del 2005 y enero del 2007 hemos tratado a 63 pacientes mediante fotovaporización prostática con láser KTP en nuestro servicio. En la visita preoperatoria se realizó IPSS, examen físico y tacto rectal así como ecografía renovesical y prostática con medición del residuo postmiccional, flujometría y determinación del PSA. Posteriormente los pacientes fueron revisados al mes, y a los 3, 6 y 12 meses donde se les realizó flujometría, IPSS, ecografía, PSA y se les invitó a contestar a una encuesta de satisfacción sobre el procedimiento. Resultados: La media de edad de los pacientes fue de 67 años (rango 58-85) y el volumen prostático medio preoperatorio de 48cc, (rango 34-67) presentaron niveles medio preoperatorio de IPSS de 17,7 y flujo máximo (Qmax) medio de 8,1 mL/s. 12 pacientes presentaban volúmenes residuales postmiccionales por encima de los 100 mL. La mayoría de pacientes era de medio o elevado riesgo quirúrgico anestésico. El tiempo medio quirúrgico fue de 64 minutos, (rango 45-95) usando en la mayoría de los casos una sola fibra por procedimiento, con una media de energía liberada de 175.000 Julios (rango 85.000-240.000). La estancia hospitalaria media fue de 32,2 horas (rango 19-55). En las revisiones postoperatorias se pudo constatar una disminución significativa del IPSS y una mejoría del flujo máximo medio, así como una satisfacción global con el procedimiento buena o muy buena en cerca del 80% de los pacientes. Tan solo 3 pacientes presentaron hematuria que requiera alguna medida adicional, no precisando ninguno de ellos hemotransfusión. Un paciente reingresó por infección urinaria febril y 8 pacientes refirieron disuria en grado leve o moderado en la primera visita postoperatoria. Conclusiones: La fotovaporización prostática con láser KTP es una técnica segura, reproducible y con buenos resultados a corto y medio plazo, que podría ser considerada de elección para pacientes afectos de HBP de elevado riesgo quirúrgico anestésico, añosos, con anemia crónica, o en tratamiento con antiagregantes o anticoagulantes.

Background The present study was aimed at determining the prophylactic efficacy of American cranberry (AC) extract (Cysticlean®) in women with recurrent symptomatic postcoital urinary tract infections (PCUTI), non-consumer of AC extract in the past 3 months before inclusion, and to determine changes in their quality of life (QoL). Methods This was a single center, observational, prospective study in a total of 20 women (mean age 35.2 years; 50.0% were married). Patients were followed up for 3 and 6 months during treatment. Results The number of PCUTIs in the previous 3 months prior to start the treatment with Cysticlean® was 2.8±1.3 and it was reduced to 0.2±0.5 at Month 6 (P