Álvaro Páez Borda

Cirugía de la incontinencia urinaria femenina en régimen de cirugía mayor ambulatoria: Estudio de impacto presupuestario

Resumen es: Objetivo: Las tecnicas de insercion de mallas periuretrales libres de tension para el tratamiento de la incontinencia urinaria de esfuerzo (IUE) son senc...OBJECTIVES: The surgical procedures for the insertion of tension free vaginal tapes in the treatment of female stress urinary incontinence (SUI) are simple and can be done as outpatient operations. The aim of this study was to perform a budget study comparing TVT in an outpatient basis with transobturator tape (TOT) with hospital admission. METHODS: Retrospective analysis of the medical records of 23 patients undergoing surgery for SUI between October 2004 and October 2005. 13 patients were treated by TVT in an outpatient basis (group 1, Department of Urology), 10 patients were treated by TOT with hospital admission (Group 2, Department of Gynaecology). Cost analysis was carried out by the construction of a Marcov model, incorporating the time sequence of the treatment, including adverse events and results. Variables considered for the analysis: number of visits, preoperative tests, operative time, tape cost, hospital stay, unpredicted visits in the first postoperative month at the outpatient clinics or emergency room, and hospital readmissions. Statistical analysis was performed with the G-Stat software. Students t test was used to compare quantitative variables. RESULTS: 11/13 patients (84.6%) in group 1 completed the day-surgery protocol. Mean surgical time was 61.7 min. (SD 16.2; 35-100) and 61.6 min. (SD 8.3; 50-73) for groups I and 2 respectively. Two cases in group 1 had perioperative complications (15.4%); no patient in group 2 had perioperative complications. Mean hospital stay was 1.3 days for group 1 (SD 0.85; 1-4) and 2.9 days for group 2 (SD 0.31; 2-3). Three patients in group 1 (23%) and 2 in group 2 (20%) presented postoperative complications. Mean cost per process was 4740 EUR for group 1 and 7099 EUR for group 2. CONCLUSIONS: SUI correction by tension free tapes as day surgery is a valid option which saves a substantial amount of resources.

Impacto de la climatología sobre el nivel sérico de antígeno específico prostático (PSA)

OBJECTIVES: To analyze the impact of season and weather parameters on serum PSA values in men without prostate cancer. METHODS: Retrospective study including medical records from the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). EXCLUSION CRITERIA: prostate cancer diagnosis, PSA > = 10 ng/ml, or PSA > = 3 ng/ml and/or digital rectal examination abnormalities unless a negative prostate biopsy was provided. Univariate relationships between PSA value, season and several weather parameters were assessed. A multivariate logistic regression model was used to identify independent predictors of a PSA value > = 3 ng/ml. RESULTS: A total of 2,147 men entered into the study. Median age and PSA level were 57 years and 0.9 ng/ml respectively. A non-significant trend to higher PSA levels was observed during autumn and winter. Multivariate logistic regression analysis identified only maximum temperature (p = 3 ng/ml. Mean age-adjusted PSA levels at maximum temperatures of =26 degrees C were 1.25, 1.20, 1.17 and 1.09 ng/ml respectively. CONCLUSIONS: PSA levels are slightly higher during cold weather conditions. Because of the small magnitude of this PSA increment we do not recommend to change biopsy indication based solely on climatic parameters.

Postraumatic high-flow priapism in pediatric patient treated with selective arterial embolization

El priapismo arterial es una rara patologia en pacientes pediatricos, originada por una fistula entre la arteria cavernosa y los sinusoides del cuerpo cavernoso, habitualmente secundaria a un traumatismo perineal. Presentamos el caso de un varon de 16 anos con priapismo arterial de 5 dias de evolucion tras una caida a horcajadas, tratado satisfactoriamente mediante embolizacion arterial supraselectiva con material reabsorbible. Seis meses despues, el paciente presenta detumescencia completa sin disfuncion erectil asociada. La embolizacion arterial en pacientes pediatricos es compleja debido al menor calibre arterial y la necesidad de control de la arteria pudenda interna contralateral para evitar el desarrollo de complicaciones. La utilizacion de material reabsorbible permite disminuir el riesgo de disfuncion erectil posterior y, aunque presenta un mayor indice de recurrencias, constituye una alternativa eficaz en el tratamiento de esta patologia.(AU) Arterial priapism is a rare condition in pediatric patients, caused by a fistula between the cavernous artery and the sinusoids of the corpus cavernosum, usually secondary to perineal trauma. We report the case of a 16 year old child with arterial priapism of 5 days duration following a fall astride, successfully treated by superselective arterial embolization with absorbable material. Six months later the patient had complete detumescence without secondary erectile dysfunction. Arterial embolization in pediatric patients is complex due to the smaller arterial size and the need to control the contralateral internal pudendal artery to prevent the development of complications. The use of absorbable material helps reduce the risk of subsequent erectile dysfunction and, although it has a higher rate of recurrence, is an alternative for the treatment of this pathology.(AU)Arterial priapism is a rare condition in pediatric patients, caused by a fistula between the cavernous artery and the sinusoids of the corpus cavernosum, usually secondary to perineal trauma. We report the case of a 16 year old child with arterial priapism of 5 days duration following a fall astride, successfully treated by superselective arterial embolization with absorbable material. Six months later the patient had complete detumescence without secondary erectile dysfunction. Arterial embolization in pediatric patients is complex due to the smaller arterial size and the need to control the contralateral internal pudendal artery to prevent the development of complications. The use of absorbable material helps reduce the risk of subsequent erectile dysfunction and, although it has a higher rate of recurrence, is an alternative for the treatment of this pathology.

Priapismo de alto flujo postraumático en paciente pediátrico tratado con embolización arterial selectiva

El priapismo arterial es una rara patologia en pacientes pediatricos, originada por una fistula entre la arteria cavernosa y los sinusoides del cuerpo cavernoso, habitualmente secundaria a un traumatismo perineal. Presentamos el caso de un varon de 16 anos con priapismo arterial de 5 dias de evolucion tras una caida a horcajadas, tratado satisfactoriamente mediante embolizacion arterial supraselectiva con material reabsorbible. Seis meses despues, el paciente presenta detumescencia completa sin disfuncion erectil asociada. La embolizacion arterial en pacientes pediatricos es compleja debido al menor calibre arterial y la necesidad de control de la arteria pudenda interna contralateral para evitar el desarrollo de complicaciones. La utilizacion de material reabsorbible permite disminuir el riesgo de disfuncion erectil posterior y, aunque presenta un mayor indice de recurrencias, constituye una alternativa eficaz en el tratamiento de esta patologia.(AU) Arterial priapism is a rare condition in pediatric patients, caused by a fistula between the cavernous artery and the sinusoids of the corpus cavernosum, usually secondary to perineal trauma. We report the case of a 16 year old child with arterial priapism of 5 days duration following a fall astride, successfully treated by superselective arterial embolization with absorbable material. Six months later the patient had complete detumescence without secondary erectile dysfunction. Arterial embolization in pediatric patients is complex due to the smaller arterial size and the need to control the contralateral internal pudendal artery to prevent the development of complications. The use of absorbable material helps reduce the risk of subsequent erectile dysfunction and, although it has a higher rate of recurrence, is an alternative for the treatment of this pathology.(AU)Arterial priapism is a rare condition in pediatric patients, caused by a fistula between the cavernous artery and the sinusoids of the corpus cavernosum, usually secondary to perineal trauma. We report the case of a 16 year old child with arterial priapism of 5 days duration following a fall astride, successfully treated by superselective arterial embolization with absorbable material. Six months later the patient had complete detumescence without secondary erectile dysfunction. Arterial embolization in pediatric patients is complex due to the smaller arterial size and the need to control the contralateral internal pudendal artery to prevent the development of complications. The use of absorbable material helps reduce the risk of subsequent erectile dysfunction and, although it has a higher rate of recurrence, is an alternative for the treatment of this pathology.

Fistula renocólica como complicación de radiofrecuencia para tratamiento de carcinoma renal de células claras

Resumen es: Objetivo: Describir un caso clinico de fistula reno colica como complicacion de ablacion por radiofrecuencia de carcinoma de celulas renales. Se revisa l...

Nuevas posibilidades organizativas en la era de la historia clínica electrónica

La historia clínica electrónica (HCE) representa un instrumento de trabajo singular. A los beneficios organizativos más explícitos de su utilización (desaparición de archivos, legibilidad de las anotaciones, inalterabilidad...), se unen otros mucho más trascendentes; entre otros, la plataforma electrónica que subyace a toda HCE posibilita nuevas formas de organización y de prestación de los servicios. En relación con la gestión del conocimiento, la HCE facilita el tránsito desde la historia clínica narrativa tradicional a la historia clínica estructurada, un formato documental mucho más robusto en términos de potencial explotación científica y empresarial. Este documento recoge las iniciativas emprendidas en este Servicio de Urología para extraer el mayor rendimiento de las posibilidades que proporciona un hospital dotado de HCE.