J.L. Gutiérrez Baños

NMP 22, BTA stat Test and Cytology in the Diagnosis of Bladder Cancer: A Comparative Study

Objective: To evaluate the usefulness of the NMP 22 and BTA stat test in the diagnosis and follow-up of bladder cancer and to compare these tests to cytology and cystoscopy, routineObjective: To evaluate the usefulness of the NMP 22 and BTA stat test in the diagnosis and follow-up of bladder cancer and to compare these tests to cytology and cystoscopy, routine diagnostic methods. Methods: 150 patients followed up for bladder cancer or symptoms suggestive of bladder cancer underwent cystoscopy after cytology, NMP 22 and BTA stat test using a recently voided urine sample. In suspect cases, TUR and histopathological analysis were performed. Results: Bladder cancer was proven in 76 patients and excluded in 74. For NMP 22 we have used the cutoff value recommended by the manufacturer (10 U/ml) and that obtained by our receiver-operating characteristic curve (6 U/ml). Sensitivity was 84.21% for NMP 22 at the cutoff value of 6 U/ml and 76.32% with 10 U/ml; 72.37% for BTA stat test; 69.74% for cytology, and 100% for cystoscopy. Specificity was 86.49% for NMP 22 at a cutoff value of 6 U/ml and 90.54% at 10 U/ml; 89.19% for the BTA stat test; 93.24% for cytology and 89.19% for cystoscopy. NMP 22 sensitivity for grades 1, 2, and 3 was 68.75, 75.86 and 100%, respectively, at a cutoff value of 6 U/ml, and 50, 68.97 and 96.77%, respectively, at a cutoff level of 10 U/ml; for BTA stat the sensitivity was 56.25% in G1, 62.07% in G2 and 90.32% in G3, and for cytology the sensitivity was 43.75, 62.07 and 90.32%, respectively. The sensitivity of NMP 22 was 68.75% in stage Ta, 84.78% in T1 and 100% in T2–T4 at a cutoff level of 6 U/ml and 50, 80.43 and 92.86%, respectively, at a cutoff level of 10 U/ml; BTA stat sensitivity was 50% in Ta, 73.91% in T1 and 92.86% in T2–T4; and in cytology the results were 37.50, 73.91 and 85.71%, respectively. Using the McNemar test, there was only a significant difference between the sensitivity of NMP 22 at a cutoff level of 6 U/ml and cytology in the overall sample. Conclusions: The high sensitivity of the NMP 22 and BTA stat test in combination with the data obtained from the parameters used for the evaluation of the test demonstrate their usefulness in the diagnosis and follow-up of bladder cancer. NMP 22 at a cutoff value of 6 U/ml is significantly more sensitive than cytology and consequently a thoroughly valid diagnostic tool in the diagnosis of bladder cancer which may substitute voided urine cytology.

Infección nosocomial y del sitio quirúrgico en un hospital de tercer nivel (2002-2005)

Resumen Introduccion La medida de las tasas de infeccion nosocomial constituye un indicador de calidad asistencial, permitiendo adoptar medidas de prevencion y control. Se ha desarrollado un plan de vigilancia de infeccion nosocomial en los hospitales, demostrando ser un metodo eficaz para disminuir su incidencia. Objetivo Conocer los indicadores y caracteristicas de la infeccion nosocomial en general y de la infeccion del sitio quirurgico en particular en un servicio de Urologia de forma global y por procedimientos. Material y Metodos Estudio prospectivo mediante el sistema de vigilancia epidemiologica entre 2002-2005 en 4.618 pacientes ingresados al menos 24 horas, practicandose un total de 3.096 intervenciones. Resultados Se observo una tasa global de infeccion nosocomial del 6,10%, de infeccion urinaria del 3,42% y de infeccion del sitio quirurgico del 2,81%. De esta ultima por procedimientos, la cistectomia se situa en el 22,8%, seguido de la cirugia del rinon y ureter (6,6%) y de la cirugia abierta de prostata (4,36%). Los germenes mas frecuentemente aislados en la infeccion del sitio quirurgico son Escherichia Coli (43,6%) y Pseudomonas aeruginosa (15%). En la infeccion urinaria los germenes mas frecuentes son Escherichia Coli (43,6%) y Pseudomonas aeruginosa (15%) Conclusion Las tasas de infeccion nosocomial son inferiores a los valores estandares publicados. La mayor tasa de infeccion del sitio quirurgico se presenta en las cirugias mas complejas tecnicamente, siendo Escherichia Coli, el agente etiologico mas frecuente. La vigilancia de la infeccion del sitio quirurgico y factores relacionados permiten incorporar elementos de mejora en la practica clinico-quirurgica, aportando un indicador de referencia en analisis posteriores.

Schwannoma benigno retroperitoneal. Aportación de un nuevo caso

Resumen El schwannoma es una neoformacion originada a partir de las celulas de Schwann de la vaina nerviosa, siendo su localizacion retroperitoneal bastante infrecuente. Clinicamente inespecificos, originan en la mayoria de los casos sintomas por compresion de estructuras vecinas cuando su localizacion es retroperitoneal, no siendo raro su diagnostico casual, confirmandose el mismo por el estudio anatomopatologico de la pieza. Su tratamiento lo constituye la exeresis quirurgica completa de la pieza, con posterior seguimiento. Aportamos un nuevo caso de esta inusual patologia retroperitoneal, en una paciente que presentaba una sintomatologia inespecifica y que tras 2 anos de su extirpacion quirurgica, permanece asintomatica y sin evidencia radiologica de recidiva.

Aspectos quirúrgicos en los terceros y cuartos retrasplantes renales

SURGICAL ASPECTS IN THE THIRD AND FOURTH KIDNEY RETRANSPLANT Introduction and objectives: A quarter of patients waiting for kidney transplantation are patients with previous graft failure. Outcome of first and second renal transplant make these the gold standard for end renal stage disease, but this is not so clear in the case of third and further renal transplant, especially at the time of organ shortage. We revise our experience in patients with three or more kidney transplants focusing on surgical aspects and graft outcome. Material and method: 1364 renal transplants have been carried out in our centre since 1975 until December 2003. We have ret- rospectively revised the 34 patients with three renal transplants and the 5 with four. We analyse the surgical technique, surgical com- plications and graft outcome. Results: Mean age was 42 years (21-65). Average mismatches between donor and recipient was 3.2. All kidneys, but one case of living donor, were harvested from cadaver donors, mostly in multiple organ-procurement. Average time from the last renal transplant was 5 years (3 days-17 years) and from the last transplant carried out in the iliac fossa reused until the new transplant was 9 years (3 days-17.5 years). All implants were performed through an iterative lumboliliac incision (25 on the right side, 11 on the left one and in 3 cases where side was not registered). Mean average duration of the procedure was 166 minutes (100-300). Nephrectomy of pre- vious graft at the moment of the implant was carried out in 13 patients (33%). Vascular anastomosis was made on the common iliac vessels (50%) or on the external ones (50%) in end to side way. Ureteroneocystostomy was performed in an extravesical way except in 1 patient with cutaneous diversion. Vascular complications were 4 haemorrages (1 patient died), 3 venous and 2 arterial thrombosis. We had an abscess secondary to intestinal fistulae. Other surgical complications were 4 lymphoceles, three of them needed surgical treatment, and one perirenal haematoma treated in a conservative way. No urological complications were seen. In total 6 grafts (15%) were lost due to surgical complications. Graft actuarial survival rate at 1 year was 65%, 40% at 5 and 28% at 10 years. Conclusions: Three and four renal transplant survival rates are shorter than first and second ones. Iterative access through lum- boiliac incision is associated with a higher vascular complication rate, probably in these patients a transperitoneal access would be better. Multicentric studies with higher numbers of patients are needed to define more clearly which patients would benefit from mul- tiple kidney retransplants.

Tumor renal en ectopia renal cruzada con fusión

Resumen La ectopia renal cruzada es una anomalia renal congenita poco frecuente y en la mayoria de los casos se presenta con fusion de ambos rinones. Estos pacientes suelen permanecer asintomaticos hasta la 4a-5a decada y desarrollar entonces problemas de infecciones urinarias, litiasis, masa abdominal o dolor que simula un problema gastrointestinal. Presentamos el caso de un tumor de celulas renales aparecido en un paciente con ectopia renal cruzada con fusion, descubierto en un TAC realizado por sospecha de patologia gastrointestinal.

Carcinoma de células renales multicéntrico en injerto renal

Resumen El desarrollo de neoplasias despues de la realizacion de un trasplante es un hecho conocido; pero el desarrollo de una neoplasia sobre el organo trasplantado es raro. Las pruebas diagnosticas incluyen la ecografia rutinaria y la TC. En algunos casos seleccionados, si el injerto es funcionante y es tecnicamente factible, se puede realizar cirugia conservadora de nefronas. El patron estandar de tratamiento es la trasplantectomia. Presentamos un caso de carcinoma renal multicentrico en un rinon trasplantado 17 anos antes.

Complicaciones de una serie consecutiva de 133 casos de prostatectomía radical

Resumen Objetivo Evaluar las complicaciones quirurgicas de la prostatectomia radical (PR) en nuestro medio Pacientes y metodo Desde agosto de 1991 a diciembre de 1999, hemos realizado 138 PR en pacientes con adenocarcinoma de prostata (CaP) clinicamente localizado. Analizamos solo los 133 casos de los que conocemos la evolucion. La tecnica utilizada ha sido la ascendente descrita por Walsh por via retropubica. La edad media era de 64,8 y la media del PSA era de 17,6 ng/ml Resultados Con un seguimiento medio de 43 meses diferenciamos las complicaciones precoces de las tardias. Entre las primeras tenemos la fistula urinaria (9%), la linforrea (5,22%) y la lesion rectal (2,2%). De las tardias la mas preocupante es la incontinencia de orina (27%) de la que el 4,5% es grave. La mas frecuente es la disfuncion erectil (98%) y la estenosis de la anastomosis (12%) es la menos preocupante. Solo tres pacientes han fallecido debido a la neoplasia. Comparamos nuestros resultados con las series mas amplias nacionales y extranjeras Conclusiones La cirugia radical de prostata en nuestro medio tiene una morbilidad similar a otras series. La incontinencia urinaria y la disfuncion erectil son las secuelas mas preocupantes que los pacientes deben conocer para decidir otras opciones terapeuticas

Tumor de células de Leydig. Aportación de dos casos y revisión de la literatura

Resumen El tumor de celulas de Leydig es el mas frecuente de los tumores testiculares no germinales. La clinica de este tipo de tumores depende de la edad de presentacion. Aportamos dos nuevos casos de Tumor de Celulas de Leydig, diagnosticados en un nino de 8 anos con pseudopubertad precoz y en un adulto de 42 con ginecomastia. Realizamos una revision de la literatura existente con respecto a esta rara patologia y consideramos que la iconografia aportada es de gran interes para el conocimiento de la misma

Cumplimiento de profilaxis antibiótica en un Servicio de Urología

PERFORMANCE OF ANTIBIOTIC PROPHYLAXIS IN OUR UROLOGIC DEPARTMENT Introduction: The rate of surgical site infection is a good indicator of the quality of care in surgical departments. Antibiotic prophyla- xis represents a measure of proven efficiency in preventing the infection in a surgical site, and its fulfilment is a main goal in management contracts of health services. The efficiency of this preventive measure requires the existence of updated protocols and performance eva- luation. Objective: To evaluate the compliance of this antibiotic protocol in our Urology Department with the global analysis of the causes of inadequate prophylaxis and by procedures. Matherial and Methods: The Department of Preventive Medicine as an outside observer, through a retrospective study, analyzed 695 urological surgical procedures (inpatient and outpatient) during the years 2003 and 2006 for its annual assessment of compliance with the antibiotic prophylaxis protocol. Administration of non-indicated prophylaxis, non-administration of indicated prophylaxis and inco- rrect dosage are considered as inappropriate prophylaxis. Results: The compliance of the protocol was appropriate in 83.16% of the operations. The cause of the most frequent inadequacy was an incorrect pattern in 15.3%. Within this incorrect pattern the main reason was the delay of administration of prophylactic antibiotic and to a lesser extent an incorrect length of the antibiotic regime Conclusions: The percentage of compliance with the antibiotic protocol in our Urology Department is high. The evaluation detected two problems of a different nature and solution: to adapt the timing of antibiotics is a functional, structural and organizational problem to be resolved in accordance with the Anaesthesiology Department. The number of doses of antibiotics in open prostate surgery requires knowledge and strict adherence to the guidelines by the surgeons. The efficiency of antibiotic prophylaxis requires the existence of appropriated and updated protocols for the unifications of criteria among professionals to detect new problems as well as to find solutions for its adequate compliance.

Quiste epidermoide testicular: una rara entidad de difícil diagnostico preoperatorio

TESTICULAR EPIDERMOID CYST: UNCOMMON LESION OF DIFFICULT PREOPERATIVE DIAGNOSIS Intratesticular epidermoid cysts are rare tumours that constitute one percent of all testicular masses. They are bening lesions that make differential diagnosis from malignant testicular tumours difficult. The absence of serum markers elevation and ultrasound imaging could support these lesions being bening epidermoid cysts, and in that case, conservative surgery is adequate. We present the case of a 22 years old patient who complains of a left testicular mass. In this case ultrasound diagnosis was non-specific and a left radical inguinal orchiectomy was performed.