Search

Objective To measure the tolerance of urodynamic testing (UDT) in the pediatric patient by means of the Visual Analog Scale (VAS). To analyze which clinical and UDT-related variables influence pain perception. Material and methods. Cross-sectional study of 139 pediatric patients undergoing UDT (December 2013 - May 2018). Inclusion criteria: understanding and expressing their experience after UDT (preschool and school age). No adolescents were included. Measurement instrument Visual Analog Scale (0−10). Other clinical and UDT-associated variables were obtained. Statistical analysis: Mann-Whitney U test, Kruskal Wallis test. Spearman’s rank correlation analysis (rs). Multivariate analysis through ordinal logistic regression. Significance p Results Mean age 7.7 years (SD 2.4), median VAS score, 2 (2–6). In 41% (n = 57), the score was ≥ 4 (moderate pain). Multivariate analysis. Explanatory variables for obtaining a high VAS score: high APUDT score (identifying patient anxiety prior to UDT), sensory-motor alteration in the lower limbs, difficult bladder catheterization and the appearance of pain during the filling phase. Age and duration of the UDT have not influenced the VAS score. Conclusions Although the UDT has resulted in 40% of the pediatric patients in our study expressing discomfort or pain, it is a well-tolerated test. The variables that have influenced on pain perception were patient’s anxiety prior to UDT, a sensory-motor alteration located in the lumbosacral metameres, difficult bladder catheterization and the appearance of pain during bladder filling.

Resumen Objetivo Medir la tolerancia del estudio urodinamico (EUD) en el paciente pediatrico, mediante una escala visual analogica. Analizar que variables clinicas y relacionadas con el EUD influyen en la percepcion del dolor. Material y metodos Estudio transversal de 139 pacientes pediatricos tras un EUD (entre diciembre del 2013 a mayo del 2018). Criterio de inclusion: entender y expresar su experiencia tras el EUD (edad preescolar y escolar). No se incluyeron adolescentes. La herramienta de evaluacion: escala visual analogica del dolor (EVA 0-10). Se obtuvieron otras variables clinicas y asociadas al EUD. Analisis estadistico: U de Mann-Whitney, Kruskal-Wallis. Analisis de correlacion de Spearman (rs). Analisis multivariante mediante regresion logistica ordinal. Significacion p Resultados Media de edad 7,7 anos (DE 2,4), mediana puntuacion EVA, 2 (2-6). En un 41% (n = 57), la puntuacion fue ≥ 4 (dolor moderado). Analisis multivariante. Variables explicativas de obtener una puntuacion EVA alta: puntuacion APEUD alta (identificar en el paciente nerviosismo previo al EUD), alteracion sensitivo-motora de MMII, una dificultad en el sondaje vesical y que aparezca dolor durante el llenado. La edad y el tiempo de duracion del EUD no han influido en dicha puntuacion EVA. Conclusiones Aunque el EUD ha generado que un 40% de los pacientes pediatricos de nuestro estudio expresaran molestias o dolor, es una prueba bien tolerada. Las variables que han influido en la percepcion del dolor han sido: el nerviosismo del paciente previo al EUD, una alteracion sensitivo-motora localizada en metameras lumbosacras, una dificultad en el sondaje vesical y que aparezca dolor durante el llenado vesical.

Resumen Objetivo Analizar de forma comparativa los costes indirectos y directos de dos tecnicas minimamente invasivas (litotricia extracorporea (LEOC) vs. ureterorrenoscopia-laser holmium (URS/RIRS)) para el tratamiento de la litiasis reno-ureteral menor de 2 cm. Material y metodos Estudio prospectivo y comparativo, no aleatorizado de 84 pacientes tratados por litiasis reno-ureteral menor de 2 cm entre enero y diciembre de 2016. De estos, 38 (45,67%) se trataron con LEOC (18 litiasis renales y 20 litiasis ureterales) y 46 (54,32%) con URS/RIRS (22 litiasis renal y 24 litiasis ureteral). Un total de 19 (41,3%) pacientes estaban activos laboralmente en el grupo de URS/RIRS y 15 (39,5%) pacientes en el grupo de LEOC. Las variables analizadas fueron sexo, edad, numero y tamano de las litiasis, dias de baja laboral debido al tratamiento, estimacion del coste indirecto por la perdida de productividad laboral y el coste directo del tratamiento aplicado incluyendo el seguimiento (numero total de procedimientos, procedimientos auxiliares, visitas y pruebas diagnosticas). Para la estimacion del coste indirecto se empleo la Encuesta de Estructura Salarial 2015 (INE). Ademas, tambien se utilizo el cuestionario «Work Productivity and Activity Impairment» (WPAI) para determinar el grado de percepcion de perdida de productividad. Resultados El numero medio de sesiones hasta la resolucion de la litiasis fue de 2,57 para el grupo de LEOC y de 1,04 para la URS. El promedio de dias de baja laboral en el grupo de la URS fue de 7,16 dias, mientras que en el caso de la LEOC fue de 3,18 (p = 0,034). Los costes indirectos totales derivados de la perdida de productividad fueron de 621,55 € y de 276,05 € para la URS y LEOC, respectivamente. Los costes directos en el grupo de la LEOC fueron de 1.382,9 € y 2.317,71 € en el grupo de la URS. El grado de afectacion en el trabajo percibido por los pacientes sometidos a URS fue del 18,88% y del 21,33% en el grupo de LEOC. El grado de afectacion para realizar actividades cotidianas fue del 24,44% en URS y del 15% en LEOC. Conclusiones La LEOC es una tecnica que precisa de un mayor numero medio de sesiones para la resolucion de la litiasis reno-ureteral menor de 2 cm, pero con una menor repercusion en los costes totales y en la percepcion del grado de afectacion.

Resumen Objetivos Analizar si existe mayor prevalencia de trastornos del sueno y desordenes en su higiene en los pacientes con enuresis monosintomatica (ENM) con respecto a la poblacion general y a los pacientes con ENM corregida. Valorar la utilidad de la escala de cribado de trastornos del sueno en la infancia BEARS en la ENM. Material y metodos Estudio observacional transversal (n = 341) clasificados en: ENM (n = 122), ENM corregida (> = 1 a un ano sin recidiva) (ANTENUR) (n = 47) y controles (n = 172). Se utilizo el cuestionario de cribado de trastornos del sueno en la infancia BEARS. Se recopilaron variables clinicas, asi como variables en referencia a la higiene del sueno. Estadisticos: chi cuadrado, t de Student, ANOVA, U Mann-Whitney y Kruskall-Wallis. Significacion p Resultados Media de edad 9,7 ± 3,0 anos. No existieron diferencias estadisticamente significativas con respecto a edad, genero, IMC, antecedente de amigdalectomia, asma y numero de horas de sueno. Con respecto a la higiene del sueno, los pacientes con ENM presentaron mayor porcentaje de alteraciones con respecto a los controles. En cuanto al cuestionario BEARS, demostro mayor prevalencia de alteraciones del sueno en el grupo de pacientes con ENM, con respecto a los otros dos grupos. Un 60,7% (n = 74) frente al 18,6% (n = 32) y el 38,3% (n = 18) de los controles y ANTENUR, respectivamente (p Conclusiones Los ninos con ENM presentaron mayor prevalencia de desordenes durante el sueno asi como en la higiene de este, con respecto a los controles. El cuestionario BEARS es una herramienta clinica util en la deteccion de los desordenes del sueno en el nino.

Objectives To assess the diagnostic performance of urinary dysfunction patterns associated with vesicoureteral reflux (VUR) in children over the age of 3 according to the result of the first endoscopic treatment (ENDT1), grouped into a classification designed by our group (CMD.URI-La Fe). Comparison with other current classifications such as that of Van Batavia et al. Material and methods Ambispective cross-cutting study of a sample of 50 children. Exclusion criteria: previous ENDT, age ≤ 3 years, anatomical or neurological anomalies and a history of ureteral or abdominopelvic surgery. Prior to the ENDT1, a bladder voiding function assessment by uroflowmetry + electromyography (UF-EMG) and post-mictional residue (ultrasound). Other variables from the bladder diary, pre-mictional bladder wall thickness and other clinical variables. The correction of VUR was assessed by isotope cystography 3 months after the treatment. Urinary patterns were classified according to the significant variables (URI-La Fe), and the diagnostic performance of this classification was assessed, comparing it to the classification of patients as proposed by Van Batavia et al. Results Mean age: 6.8 ± 2.28 years. Males/females (44%/56%). Grades of VUR (mild/moderate/severe). ENDT1 VUR correction rate: 77% (n = 38). Diagnostic performance (Van Batavia; URI-La Fe): correct prediction (37.5%; 75%), sensitivity (32.4%; 87.8%), specificity (54.5%; 46.6%), positive predictive value (70.6; 78.3%) and negative predictive value (19.4%; 63.6%). Conclusions Our results show the usefulness of the non-invasive test and the classification of urinary dysfunction in children aged over 3 years prior to the first endoscopic treatment of VUR.

[EN] Objective: To perform a comparative analysis of indirect and direct costs of two minimally invasive techniques (extracorporeal shock wave lithotripsy (ESWL) vs. ureteroscopy with holmium laser (URS/RIRS)) for the treatment of renal/ureteral calculi smaller than 2 cm. Material and methods: Prospective, comparative, non-randomized study of 84 patients treated for kidney stones smaller than 2 cm between January and December 2016. Of these, 38 (45.67%) were treated with ESWL (18 renal lithiasis and 20 ureteral lithiasis) and 46 (54.32%) with URS/RIRS (22 renal lithiasis and 24 ureteral lithiasis). A total of 19 (41.3%) patients in the URS/RIRS group and 15 (39.5%) patients in the ESWL group were actively working before treatment. The variables analyzed were sex, age, number and size of lithiasis, time (days) off from work due to treatment, estimate of indirect cost due to labor productivity loss and direct treatment costs including follow-up (total number of procedures, ancillary care, visits and diagnostic tests). The 2015 Wage Structure Survey (INE) was used to estimate the indirect cost. In addition, the "Work Productivity and Activity Impairment" (WPAI) questionnaire was also used to determine the level of perceived productivity loss. Results: The mean number of sessions until lithiasis resolution was achieved was 2.57 for the ESWL group and 1.04 for the URS. The mean number of days off from work in the URS group was 7.16 days and 3.18 (p = 0.034) in the ESWL group. The total indirect costs resulting from productivity loss were EUR 621.55 and EUR 276.05 for the URS and ESWL, respectively. Direct costs in the ESWL group were EUR 1,382.9 and EUR 2,317.71 in the URS group. The level of work impairment perceived by patients undergoing URS was 18.88% and 21.33% in the ESWL group. The degree of impairment for performing activities of daily living was 24.44% in the URS and 15% in ESWL. Conclusions: The ESWL technique requires a higher number of sessions for the resolution of kidney stones under 2 cm, but it has a lower impact on total costs and on the perceived degree of affectation., [ES] Objetivo Analizar de forma comparativa los costes indirectos y directos de dos técnicas mínimamente invasivas (litotricia extracorpórea (LEOC) vs ureterorrenoscopia-láser holmium (URS/RIRS)) para el tratamiento de la litiasis reno-ureteral menor de 2¿cm. Material y métodos Estudio prospectivo y comparativo, no aleatorizado de 84 pacientes tratados por litiasis reno-ureteral menor de 2¿cm entre enero y diciembre de 2016. De estos, 38 (45,67%) se trataron con LEOC (18 litiasis renales y 20 litiasis ureterales) y 46 (54,32%) con URS/RIRS (22 litiasis renal y 24 litiasis ureteral). Un total de 19 (41,3%) pacientes estaban activos laboralmente en el grupo de URS/RIRS y 15 (39,5%) pacientes en el grupo de LEOC. Las variables analizadas fueron sexo, edad, número y tamaño de las litiasis, días de baja laboral debido al tratamiento, estimación del coste indirecto por la pérdida de productividad laboral y el coste directo del tratamiento aplicado incluyendo el seguimiento (número total de procedimientos, procedimientos auxiliares, visitas y pruebas diagnósticas). Para la estimación del coste indirecto se empleó la Encuesta de Estructura Salarial 2015 (INE). Además también se utilizó el cuestionario ¿Work Productivity and Activity Impairment¿ (WPAI) para determinar el grado de percepción de pérdida de productividad. Resultados El número medio de sesiones hasta la resolución de la litiasis fue de 2,57 para el grupo de LEOC y de 1,04 para la URS. El promedio de días de baja laboral en el grupo de la URS fue de 7,16 días, mientras que en el caso de la LEOC fue de 3,18 (p¿=¿0,034). Los costes indirectos totales derivados de la pérdida de productividad fueron de 621,55 euros y de 276,05 euros para la URS y LEOC respectivamente. Los costes directos en el grupo de la LEOC fueron de 1382,9 euros y 2317,71 euros en el grupo de la URS. El grado de afectación en el trabajo percibido por los pacientes sometidos a URS fue del 18,88% y del 21,33% en el grupo de LEOC. El grado de afectación para realizar actividades cotidianas fue del 24,44% en URS y del 15% en LEOC. Conclusiones la LEOC es una técnica que precisa de un mayor número medio de sesiones para la resolución de la litiasis reno-ureteral menor de 2¿cm, pero con una menor repercusión en los costes totales y en la percepción del grado de afectación.

Resumen Objetivo Investigar si el numero y el porcentaje de cilindros positivos de la biopsia identifica un subgrupo de cancer de prostata (CaP) Gleason 3 + 4 de comportamiento biologico similar a los Gleason 3 + 3. Material y metodo Estudio observacional, tras prostatectomia radical, de una cohorte de 799 pacientes con CaP localizado de riesgo bajo (n = 582; Gleason 6; PSA 3) y porcentaje de cilindros positivos (≤33% vs. >33%). Se analizo su asociacion con el riesgo de recidiva bioquimica (ReB) y mortalidad cancer especifica (MCE). Se realizaron diferentes modelos predictivos mediante regresion de Cox y se estimo ( C -index) y comparo su capacidad predictiva. Resultados Con una mediana de seguimiento de 71 meses, la probabilidad de ReB y de MCE en el grupo de pacientes con tumores Gleason 3 + 4 y numero (≤3) o porcentaje bajo (≤33%) de cilindros positivos no fue significativamente diferente de las de los pacientes con tumores Gleason 6. A 5 y 10 anos, no se observaron diferencias significativas en el numero de ReB, en la probabilidad de permanecer libre de ReB, en el numero de muertes por CaP ni en la probabilidad de muerte por CaP entre ambos grupos. Por el contrario, los pacientes con tumores Gleason 3 + 4 y >33% de cilindros positivos presentaron mayor numero de muertes por CaP que los pacientes con tumores Gleason 6 y, a 10 anos, la probabilidad de MCE fue significativamente mayor. Este subgrupo de tumores presento un riesgo significativamente mayor de ReB (RR = 1,6; p = 0,02) respecto a los Gleason 6 y, sobre todo, de MCE (RR = 5,8; p = Conclusiones Un numero

Resumen Introduccion El objetivo del estudio fue determinar si escuchar musica durante una sesion de litotricia extracorporea por ondas de choque (LEOC) mejora el dolor de los pacientes. Material y metodo Se realizo una aleatorizacion simple y oculta de pacientes con litiasis renales o ureterales que acudieron por vez primera a una sesion de LEOC de 7.000 ondas, entre septiembre y diciembre de 2014. Un grupo recibio musica mientras que el otro no. Se registraron la edad, sexo, localizacion de la litiasis (renal/ureteral) y 2 cuestionarios pre-LEOC (cuestionario A) y post-LEOC (cuestionario B). Cada cuestionario contiene una pregunta sobre ansiedad y otra sobre dolor en escala Likert (0 al 10). El B, ademas, contiene otra sobre satisfaccion y otra sobre comodidad (Likert 0 al 10). Otras variables fueron la frecuencia cardiaca, respiratoria, tension arterial sistolica y diastolica en la onda 2.000, 5.000 y 7.000, causa de interrupcion del procedimiento, petidina total (mg), analgesia secundaria, energia (J) y frecuencia (Hz). Se realizo un analisis bivariante con t de Student, X2/Fisher y un modelo de regresion lineal multiple. Resultados La muestra incluyo a 95 pacientes, con una media de edad de 52 anos (±13), 35 mujeres (36,84%), 60 hombres (63,2%); 25 para litiasis ureterales (26,3%) y 70 (26,3%) para renales (73,7%). Un total de 42 pacientes (44,2%) pacientes recibieron musica. No hubo diferencias entre las variables demograficas ni en las puntuaciones del cuestionario A. La satisfaccion y el dolor fueron mejores en el cuestionario B con musica. Conclusion La musica es capaz de disminuir el dolor y mejorar la satisfaccion del paciente en los tratamientos con LEOC. Mas estudios son necesarios para comprobar este efecto.

Resumen Introduccion Los avances tecnologicos han motivado un cambio en el manejo de la urolitiasis. Las tecnicas endourologicas estan cobrando mayor importancia, ya que son tratamientos altamente eficaces. El objetivo de este trabajo es responder a la cuestion de si la LEOCH sigue siendo una alternativa competitiva frente a otras modalidades terapeuticas. Adquisicion de la evidencia Se realizo una busqueda bibliografica de articulos publicados en los ultimos 5 anos. Fueron identificados 12 estudios aleatorizados y comparativos. Se evaluo la metodologia y el resultado de las variables estudiadas. Se ha realizado una sintesis narrativa de los estudios incluidos. Para resumir las variables se ha utilizado la media y la desviacion estandar en variables continuas, y para variables cualitativas el numero absoluto y el porcentaje. Analisis de la evidencia De los estudios revisados, 7 trabajos evaluaban los distintos tratamientos para litiasis renales y 5 para litiasis ureterales. A nivel renal, con LEOCH se alcanza una TLL a los 3 meses entre 91,5-33,33%, mientras que con otras tecnicas endourologicas entre 100-90,4%, sin encontrar diferencias estadisticamente significativas en todos los estudios. A nivel ureteral con LEOCH se alcanza una TLL a los 3 meses entre 82,2-73,5%, mientras que con otras tecnicas endourologicas entre 94,1-79%, sin encontrar diferencias estadisticamente significativas todos los estudios. Conclusion Existe una falta de homogeneidad entre los estudios publicados. La LEOCH es un tratamiento minimamente invasivo, que con una adecuada tecnica y seleccion del paciente alcanza una elevada efectividad, manteniendo un papel importante en la actualidad.

Introduction Technological advances have prompted a change in the management of urolithiasis. Endourological techniques are gaining importance because they are highly effective treatments. The aim of this study was to answer the question of whether extracorporeal shock wave lithotripsy (ESWL) is still a competitive alternative compared with other therapeutic modalities. Acquisition of evidence We conducted a literature search of articles published in the past 5 years. We identified 12 randomized and comparative studies and assessed the methodology and results of the study variables. We performed a narrative synthesis of the included studies. To summarize the variables, we used the mean and standard deviation for continuous variables and absolute numbers and percentages for the qualitative variables. Analysis of the evidence Of the studies reviewed, 7 evaluated the various treatments for nephrolithiasis and 5 evaluated the treatments for ureteral lithiasis. At the renal level, a stone-free rate of 33.33–91.5% at 3 months was reached with ESWL, while a rate of 90.4–100% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. At the ureteral level, a stone-free rate of 73.5–82.2% at 3 months was reached with ESWL, while a rate of 79–94.1% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. Conclusion There is a lack of homogeneity among the published studies. ESWL is a minimally invasive treatment that with an appropriate technique and patient selection achieves high effectiveness, thus maintaining an important role at this time.

Objective: To validate the technique of selective sentinel node biopsy for diagnosing and staging intermediate to high-risk prostate cancer by comparing the technique with conventional extended lymphadenectomy (eLFD) in a prospective, longitudinal comparative study. Methods: We applied the technique to 45 patients. After an intraprostatic injection of Tc-99m-nanocolloid and preoperative single-photon emission computed tomography (SPECT/CT), we extracted the sentinel lymph nodes, guided by a portable Sentinella (R) gamma camera and a laparoscopic gamma-ray detection probe. The eLFD was completed to establish the negative predictive value of the technique. Results: SPECT/CT showed radiotracer deposits outside the eLFD territory in 73% of the patients and the laparoscopic gamma probe in 60%. The mean number of active foci per patient was 4.3 in the SPECT/CT and 3.2 in the laparoscopic gamma probe. The mean number of extracted sentinel lymph nodes was 4.3 (0-14), with 26% outside the eLFD territory. The lymph nodes were metastatic in 10 patients (22%), 6/40 (15%) when the prostatectomy was the primary treatment. In all cases with metastatic lymph nodes, there was at least one positive sentinel node. Metastatic sentinel lymph nodes were found outside the eLFD territory in 3/10 patients (30%). The sensitivity was 100%, the specificity was 94.73%, the positive predictive value was 81.81%, and the negative predictive value was 100%. Conclusion: Selective sentinel node biopsy is superior to eLFD for diagnosing lymph node involvement and can avoid eLFD when metastatic sentinel lymph nodes are not found (85%), with the consequent functional advantages. (C) 2016 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

Resumen Objetivo Validar la tecnica de biopsia selectiva de ganglio centinela en el diagnostico y estadificacion del cancer de prostata de riesgo intermedio y alto mediante comparacion con la linfadenectomia extendida convencional (eLFD) en un estudio prospectivo longitudinal y comparativo. Metodos Hemos aplicado la tecnica a 45 pacientes. Previa inyeccion intraprostatica de 99mTc-nanocoloide y SPECT-TC preoperatoria, se han extraido los ganglios centinela guiados con gammacamara portatil Sentinella® y sonda detectora de rayos gamma laparoscopica. Se completo la eLFD para establecer el valor predictivo negativo de la tecnica. Resultados La SPECT-TC mostro depositos del radiotrazador fuera del territorio de la eLFD en el 73% de los pacientes y la gammasonda laparoscopica en el 60%. La media de focos activos por paciente en la SPECT-TC fue de 4,3 y con gammasonda laparoscopica de 3,2. La media de ganglios linfaticos centinelas extraidos fue 4,3 (0-14), el 26% fuera del territorio de la eLFD. En 10 pacientes (22%) se encontraron ganglios metastasicos, 6/40 (15%) cuando la prostatectomia fue el tratamiento primario. En todos los casos con ganglios metastasicos hubo, al menos, un ganglio centinela positivo. Se encontraron ganglios centinela metastasicos fuera del territorio de la eLFD en 3/10 pacientes (30%). La sensibilidad fue del 100%, la especificidad del 94,73%, el valor predictivo positivo del 81,81% y el valor predictivo negativo del 100%. Conclusion La biopsia selectiva del ganglio centinela es superior a la eLFD en el diagnostico de afectacion ganglionar, y puede evitar la eLFD cuando no se encuentren ganglios centinela metastasicos (85%), con las consecuentes ventajas funcionales.

Resumen Objetivo Estimar el riesgo de muerte cancer especifica (MCE) frente al riesgo competitivo de mortalidad por otras causas (MOC) en pacientes con cancer de prostata localizado (CaP-Lo) tratados mediante prostatectomia radical (PR). Material y metodo Estudio observacional de una cohorte de 982 pacientes con CaP-Lo tratados mediante PR seleccionados de la base de datos del registro de CaP de nuestro servicio. Se ha realizado un analisis de riesgos competitivos calculando la probabilidad de MCE en presencia del riesgo competitivo por MOC. Se han construido curvas de incidencia acumulada y se han llevado a cabo estimaciones puntuales a 5, 10 y 15 anos. El analisis se ha estratificado por edad (≤ 65 vs. > 65 anos) y por grupos de riesgo: bajo (Gleason ≤ 6 y pT2abc); intermedio (Gleason = 7 y pT2abc) y elevado (Gleason 8-10 o pT3ab). Resultados Con una mediana de seguimiento de 60 meses, la probabilidad global de fallecer por CaP fue del 3,5% y la de fallecer por otras causas del 9%. Se evidencio un efecto competitivo por MOC. El riesgo de MOC fue de casi 3 veces superior al de MCE. Este efecto se mantuvo para todos los grupos de riesgo, si bien su magnitud disminuyo progresivamente conforme aumento el nivel del grupo de riesgo. A 10 anos, la MCE fue unicamente de 0, 1 y 2% para los grupos de riesgo bajo, intermedio y elevado respectivamente, mientras que la probabilidad MOC fue de 4, 4 y 10%. El riesgo de fallecer se evidencio a partir de 10 anos de seguimiento y fue mas frecuente por otras causas no atribuibles al CaP y en pacientes de edad > 65 anos. Conclusiones El beneficio de la PR puede estar sobreestimado, ya que el riesgo de MOC es superior al de MCE independientemente del grupo de edad y grupo de riesgo, sobre todo a partir de los 10 anos de seguimiento. Lo unico que varia es la magnitud de la razon MCE/MOC. Esta informacion puede ayudar a decidir el tratamiento activo en pacientes con CaP-Lo y corta expectativa de vida.

Objective: To determine the risk of cancer-specific mortality (CSM) versus the competing risk of mortality by other causes (MOC) in patients with localised prostate cancer (LPC) treated with radical prostatectomy (RP). Material and method: An observational cohort study of 982 patients with LPC treated with RP selected from our department's PC registry database. A competing risk analysis was performed, calculating the probability of CSM in the presence of the competing risk of MOC. Cumulative incidence curves were constructed, and point estimates were performed at 5, 10 and 15 years. The analysis was stratified by age ( 65 years) and risk group: low (Gleason score

To analyze if there is a higher prevalence of sleep disturbances and hygiene disorders in patients with monosymptomatic enuresis (MEN) with respect to general population and to patients with corrected MEN. Assess the usefulness of the BEARS sleep disorder screening tool for children with MEN.Transverse observational study (n=341) classified as: MEN (n=122), corrected MEN (≥ 1 one year without recurrence) (ANTENUR) (n=47) and controls (n=172). The BEARS childhood sleep disorder screening questionnaire was used. Clinical variables were collected, as well as variables related to sleep hygiene.Chi-square, Student's t, ANOVA, Mann-Whitney U and Kruskal-Wallis. Significance p.05.Mean age 9.7±3.0 years. There were no statistically significant differences in terms of age, sex, BMI, history of tonsillectomy, asthma and sleep time hours. With respect to sleep hygiene, patients with MEN presented a higher percentage of alterations than controls. As for the BEARS questionnaire, it showed a higher prevalence of sleep disorders in the group of patients with MEN, with respect to the other two groups: 60.7% (n=74) versus 18.6% (n=32) and 38.3% (n=18) of controls and ANTENUR, respectively (p.05).Children with MEN had a higher prevalence of sleep disturbances and sleep disorders than controls. The BEARS questionnaire is a useful clinical tool in the detection of sleep disorders in children.

To perform a comparative analysis of indirect and direct costs of two minimally invasive techniques (extracorporeal shock wave lithotripsy (ESWL) vs. ureteroscopy with holmium laser (URS/RIRS)) for the treatment of renal/ureteral calculi smaller than 2 cm.Prospective, comparative, non-randomized study of 84 patients treated for kidney stones smaller than 2 cm between January and December 2016. Of these, 38 (45.67%) were treated with ESWL (18 renal lithiasis and 20 ureteral lithiasis) and 46 (54.32%) with URS/RIRS (22 renal lithiasis and 24 ureteral lithiasis). A total of 19 (41.3%) patients in the URS/RIRS group and 15 (39.5%) patients in the ESWL group were actively working before treatment. The variables analyzed were sex, age, number and size of lithiasis, time (days) off from work due to treatment, estimate of indirect cost due to labor productivity loss and direct treatment costs including follow-up (total number of procedures, ancillary care, visits and diagnostic tests). The 2015 Wage Structure Survey (INE) was used to estimate the indirect cost. In addition, the «Work Productivity and Activity Impairment» (WPAI) questionnaire was also used to determine the level of perceived productivity loss.The mean number of sessions until lithiasis resolution was achieved was 2.57 for the ESWL group and 1.04 for the URS. The mean number of days off from work in the URS group was 7.16 days and 3.18 (p = 0.034) in the ESWL group. The total indirect costs resulting from productivity loss were EUR 621.55 and EUR 276.05 for the URS and ESWL, respectively. Direct costs in the ESWL group were EUR 1,382.9 and EUR 2,317.71 in the URS group. The level of work impairment perceived by patients undergoing URS was 18.88% and 21.33% in the ESWL group. The degree of impairment for performing activities of daily living was 24.44% in the URS and 15% in ESWL.The ESWL technique requires a higher number of sessions for the resolution of kidney stones under 2 cm, but it has a lower impact on total costs and on the perceived degree of affectation.

INTRODUCTION AND OBJECTIVES:The failure mode and effects analysis (FMEA) has been used as a tool in risk management and quality improvement to reduce the occurrence of human or system failures.The ...

An endophytic renal tumor represents a special surgical challenge in terms of location and safe removal. For this reason we wanted to review the existing literature on this subject. In high-activity robotic centers, robot-assisted partial nephrectomy (RAPN) is a safe and efficacious surgical approach for completely endophytic renal tumors. As research innovation, the application of the radio-guided occult lesion localization technique (ROLL) facilitates the location and complete excision of the tumor during surgery. There are few studies that specifically report the experience with completely endophytic renal tumors. The endophytic tumor is usually smaller than exophytic. Frequently it represents a high complexity value in the different Score systems reported in the last decade. This surgery should be performed by experienced urologists regardless of the surgical approach they prefer (open, laparoscopic, or robotic). It is necessary to develop new techniques for intraoperative easy localization and intraoperative evaluation of surgical margins.

To assess the diagnostic performance of urinary dysfunction patterns associated with vesicoureteral reflux (VUR) in children over the age of 3 according to the result of the first endoscopic treatment (ENDT1), grouped into a classification designed by our group (CMD.URI-La Fe). Comparison with other current classifications such as that of Van Batavia et al. MATERIAL AND METHODS: Ambispective cross-cutting study of a sample of 50 children.previous ENDT, age ≤ 3 years, anatomical or neurological anomalies and a history of ureteral or abdominopelvic surgery. Prior to the ENDT1, a bladder voiding function assessment by uroflowmetry+electromyography (UF-EMG) and post-mictional residue (ultrasound). Other variables from the bladder diary, pre-mictional bladder wall thickness and other clinical variables. The correction of VUR was assessed by isotope cystography 3 months after the treatment. Urinary patterns were classified according to the significant variables (URI-La Fe), and the diagnostic performance of this classification was assessed, comparing it to the classification of patients as proposed by Van Batavia et al. RESULTS: Mean age: 6.8±2.28 years. Males/females (44%/56%). Grades of VUR (mild/moderate/severe). ENDT1 VUR correction rate: 77% (n=38). Diagnostic performance (Van Batavia; URI-La Fe): correct prediction (37.5%; 75%), sensitivity (32.4%; 87.8%), specificity (54.5%; 46.6%), positive predictive value (70.6; 78.3%) and negative predictive value (19.4%; 63.6%).Our results show the usefulness of the non-invasive test and the classification of urinary dysfunction in children aged over 3 years prior to the first endoscopic treatment of VUR.

Main objective: to perform a descriptive study of patients with nephroblastoma, diagnostic tests, medical and surgical treatment. Secondary objective: to evaluate the rate of relapse and 5-year survival and risk factors for relapse and death.Retrospective study of patients with nephroblastoma treated according to the protocol of the SIOP-2001. Demographic variables, comorbidities and associated syndromes were collected. Other data were tumor location, size, extent and stage. The relapse rate and the development of other secondary tumors as well as the long-term survival were also studied.We collected 33 patients with nephroblastoma. A biopsy was performed in 7 patients (21.2%). The Kaplan-Meir curve for event-free survival (tumor recurrence) was 84% with a 95% CI = [0.73-0.98] and the Kaplan-Meier overall survival curve was 0.93 95% CI [0.85-1]. Recurrence occurred in all patients before the first year.Nephroblastoma is a tumor with a favorable prognosis. The unfavorable histology as well as advanced stages are factors of a poor prognosis. The follow-up must be exhaustive during the first year after the diagnosis.Objetivo principal: realizar un estudio descriptivo de los pacientes con nefroblastoma, las pruebas diagnósticas, el tratamiento médico y la actitud quirúrgica. Objetivo secundario: valorar la tasa de recidiva y de supervivencia a 5 años y los factores de riesgo para la recidiva y el fallecimiento.Estudio retrospectivo de pacientes con nefroblastoma tratados según el protocolo de la SIOP-2001. Se recogieron las variables demográficas, comorbilidades y síndromes asociados. Otros datos fueron la localización del tumor, el tamaño, la extensión y el estadio. Se estudió también la tasa de recidiva y/o el desarrollo de otros tumores secundarios así como la supervivencia a largo plazo.Se recogieron 33 pacientes con nefroblastoma. En 7 pacientes (21,2%) se realizó una biopsia. La curva de Kaplan-Meir para la supervivencia libre de evento (recidiva tumoral) fue del 84% con un IC 95%= [0,73-0,98] y la curva de Kaplan-Meier de supervivencia global fue de 0,93 IC 95% [0,85-1]. La recidiva se produjo en todos los pacientes antes del primer año.El nefroblastoma es un tumor con buen pronóstico. La histología desfavorable así como estadios avanzados son factores de mal pronóstico. El seguimiento debe ser exhaustivo durante el primer año tras el diagnóstico.

Objective To assess the safety of increasing the number of waves per session in the treatment of urolithiasis using extracorporeal lithotripsy. Materials and methods Prospective, comparative, nonrandomized parallel study of patients with renoureteral lithiasis and an indication for extracorporeal lithotripsy for the patients who were consecutively enrolled between 2009 and 2010. We compared group I (160 patients) treated on schedule with a standard number of waves/session (mean 2858.3 ± 302.8) using a Dornier lithotripter U/15/50 against group II (172 patients) treated with an expanded number of waves/session (mean, 6728.9 ± 889.6) using a Siemens Modularis lithotripter. The study variables were age, sex, location, stone size, number of waves/session and total number of waves to resolution, stone-free rate (SFR) and rate of complications (Clavien–Dindo classification). Student's t -test and the chi-squared test were employed for the statistical analysis. Results The total rate of complications was 11.9% and 10.46% for groups I and II , respectively ( p = .39). All complications were minor (Clavien–Dindo grade I ). The most common complications were colic pain and hematuria in groups I and II , respectively, with a similar treatment intolerance rate ( p > .05). The total number of waves necessary was lower in group II than in group I ( p = .001), with SFRs of 96.5% and 71.5%, respectively ( p = .001). Conclusion Treatment with an expanded number of waves per session in extracorporeal lithotripsy does not increase the rate of complications or their severity, however, extracorporeal lithotripsy could increase the overall effectiveness of the treatment.

Resumen Objetivo Evaluar la seguridad del incremento del numero de ondas por sesion en el tratamiento de la litiasis urinaria mediante litotricia extracorporea. Material y metodos Estudio prospectivo, comparativo, no aleatorizado, de grupos paralelos de pacientes con litiasis reno-ureteral e indicacion de litotricia extracorporea incluidos consecutivamente entre 2009 y 2010. Se comparo un grupo i (160 pacientes) tratado programadamente con un numero medio de ondas/sesion estandar (2858,3 ± 302,8) y un litotriptor Dornier Lithotripter U/15/50, frente a un grupo ii (172 pacientes) tratado con un numero medio de ondas/sesion ampliado (6728,9 ±889,6) y un litotriptor Siemens Modularis. Las variables analizadas fueron edad, sexo, localizacion, tamano de la litiasis, numero de ondas/sesion y totales hasta la resolucion, tasa libre de litiasis (TLL) y tasa de complicaciones (clasificacion Clavien-Dindo). Para el analisis estadistico fueron empleados la «t» de Student y la Chi cuadrado. Resultados La tasa de complicaciones totales fue 11,9% para el grupo i y 10,46% para el grupo ii (p = 0,39). Todas ellas fueron complicaciones menores grado i (Clavien-Dindo). La mas frecuente en el grupo i fue el dolor colico y en el grupo ii la hematuria, con tasa de intolerancia al tratamiento similar (p > 0,05). El numero de ondas totales necesarias fue inferior en el grupo ii respecto al grupo i (p = 0,001), con TLL del 96,5% y 71,5% respectivamente (p = 0,001). Conclusion El tratamiento con un numero ampliado de ondas por sesion en litotricia extracorporea no implica mayor tasa de complicaciones ni mayor severidad de las mismas. Sin embargo, podria aumentar la efectividad global del tratamiento.

Introduction: The objective of this study was to determine whether listening to music during a session of extracorporeal shockwave lithotripsy (ESWL) improves patients' pain. Material and method: A simple, blind randomisation was undertaken of patients with kidney and ureter stones attending an ESWL session of 7,000 waves for the first time, between September and December 2014. One group was given music and the other was not. The age, gender, location of stones (kidney/ureter) were recorded and 2 questionnaires: pre ESWL (questionnaire A) and postESWL (questionnaire B). Each questionnaire contained a question about anxiety and another question on pain on the Likert scale (01 0). Questionnaire B also had a question on satisfaction and comfort (Likert 0-10). Other variables included heart rate, respiratory rate, systolic and diastolic blood pressure on wave 2,000, 5,000 and 7,000, reason for halting the procedure, total pethidine (mg), secondary analgesia, energy (J) and frequency (Hz). Bivariate analysis using the Student's t-test, X-2/Fisher test and a multiple linear regression model. Results: The sample comprised 95 patients, with a mean age of 52 (+/- 13) years, 35 (36.84%) females, 60 (63.2%) mates. A total of 25 (26.3%) ureter stones and 70 (73.7%) kidney stones. A number of 42 (44.2%) patients were given music. There were no differences between the demographic variables or questionnaire A scores. Satisfaction and pain were better on questionnaire B with music. Conclusion: Music can reduce pain and improve patient satisfaction in ESWL treatment. More studies are required to confirm this effect. (C) 2017 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

To evaluate the diagnostic performance of gray scale transrectal ultrasound-B-mode US (BMUS), power Doppler (PDUS), and sonographic contrast (CEUS) in early imaging-based diagnosis of localized prostate cancer (PCa) and to compare the diagnostic profitability of randomized biopsy (RB), US-targeted prostate biopsy by means of PDUS and CEUS.A single-center, prospective, transversal, epidemiological study was conducted from January 2010 to January 2014. We consecutively included patients who an imaging study of the prostate with BMUS, PDUS, and CEUS was performed, followed by prostate biopsy due to clinical suspicion of prostate cancer (PSA 4-20ng/mL and/or rectal exam suggestive of malignancy). The diagnostic performance of BMUS, PDUS, and CEUS was determined by calculating the Sensitivity (S), Specificity (Sp), Predictive values (PV), and diagnostic odds ratio (OR) of the diagnosis tests and, for these variables, in the population general and based on their clinical stage according to rectal exam (cT1 and cT2). PCa detection rates determined by means of a randomized 10-core biopsy scheme were compared with detection rates of CEUS-targeted (SonoVue) 2-core biopsies.Of the initial 984 patients, US contrast SonoVue was administered to 179 (18.2%). The PCa detection rate by organ of BMUS/PDUS in the global population was 38% versus 43% in the subpopulation with CEUS. The mean age of the patients was 64.3±7.01years (95% CI, 63.75-64.70); mean total PSA was 8.9±3.61ng/mL (95% CI, 8.67-9.13) and the mean prostate volume was 56.2±29cc (95% CI, 54.2-58.1). The detection rate by organ of targeted biopsy with BMUS, PDUS, and CEUS were as follows: Global population (10.6, 8.2, 24.5%), stage cT1 (5.6, 4.2, 16.4%), and stage cT2 (32.4, 22.3, 43.5%). Comparing the detection rates of the CEUS-targeted biopsy and randomized biopsy, the following results were obtained: Global population (24.5% vs. 41.8%), stage cT1 (16% vs. 35%), and stage cT2 (43.5% vs. 66.6%), with a p value0.05. Following the "core-by-core" analysis, the detection rates by core of CEUS-targeted biopsy versus randomized biopsy were: Global population (16% vs. 13%), stage cT1 (30.3% vs. 28%), and stage cT2 (48% vs. 37%), with a p value0.05. The NNT for CEUS-targeted biopsy was 83.3.The low sensitivity, specificity, positive predictive and negative predictive values of gray scale-B-mode, PDUS and CEUS represent scant diagnostic performance of these variables in prostate cancer detection. Prostate cancer detection rates yielded by randomized biopsy were superior than the detection rate of targeted biopsy using B-mode, PDUS and CEUS; as a result, randomized biopsy versus CEUS-targeted biopsies cannot be excluded from biopsy strategy plans for the diagnosis of prostate cancer.

To validate the technique of selective sentinel node biopsy for diagnosing and staging intermediate to high-risk prostate cancer by comparing the technique with conventional extended lymphadenectomy (eLFD) in a prospective, longitudinal comparative study.We applied the technique to 45 patients. After an intraprostatic injection ofSPECT/CT showed radiotracer deposits outside the eLFD territory in 73% of the patients and the laparoscopic gamma probe in 60%. The mean number of active foci per patient was 4.3 in the SPECT/CT and 3.2 in the laparoscopic gamma probe. The mean number of extracted sentinel lymph nodes was 4.3 (0-14), with 26% outside the eLFD territory. The lymph nodes were metastatic in 10 patients (22%), 6/40 (15%) when the prostatectomy was the primary treatment. In all cases with metastatic lymph nodes, there was at least one positive sentinel node. Metastatic sentinel lymph nodes were found outside the eLFD territory in 3/10 patients (30%). The sensitivity was 100%, the specificity was 94.73%, the positive predictive value was 81.81%, and the negative predictive value was 100%.Selective sentinel node biopsy is superior to eLFD for diagnosing lymph node involvement and can avoid eLFD when metastatic sentinel lymph nodes are not found (85%), with the consequent functional advantages.

To determine the risk of cancer-specific mortality (CSM) versus the competing risk of mortality by other causes (MOC) in patients with localised prostate cancer (LPC) treated with radical prostatectomy (RP).An observational cohort study of 982 patients with LPC treated with RP selected from our department's PC registry database. A competing risk analysis was performed, calculating the probability of CSM in the presence of the competing risk of MOC. Cumulative incidence curves were constructed, and point estimates were performed at 5, 10 and 15 years. The analysis was stratified by age (≤65 vs.65 years) and risk group: low (Gleason score ≤6 and pT2abc); intermediate (Gleason score of 7 and pT2abc) and high (Gleason score of 8-10 or pT3ab).With a median follow-up of 60 months, the overall probability of dying from PC was 3.5%, and the probability of dying from other causes was 9%. A competing effect for MOC was observed. The risk of MOC was almost 3 times greater than that of CSM. This effect remained for all risk groups, although its magnitude decreased progressively according to the risk group level. At 10 years, CSM was only 0%, 1% and 2% for the low, intermediate and high-risk groups, respectively, while the likelihood of MOC was 4%, 4% and 10%, respectively. The mortality risk was shown after 10years of follow-up and was higher for other causes not attributable to PC and for patients older than 65years.The benefit of RP might be overestimated, given that the risk of MOC is greater than that of CSM, regardless of the age group and risk group, especially after 10years of follow-up. The only parameter that varied was the magnitude of the CSM/MOC ratio. This information could help in choosing the active treatment for patients with LPC and short life expectancies.