Implantación de un programa de mininefrolitotomía percutánea ambulatoria: presentación del protocolo y resultados iniciales

ObjectiveTo present our program for ambulatory mini percutaneous nephrolithotomy and evaluate its initial results.Material and methodsWe analyzed the implementation of the protocol into the clinical practice with the first 30 outpatient mini percutaneous nephrolithotomy cases performed in our center between April 2021 and September 2022. Demographic characteristics, perioperative variables, complications and need for unplanned health care, stone-free rate, stone type and patient satisfaction with the major ambulatory surgery process were collected.ResultsA total of 30 patients with a mean age of 60.2 ± 11.6 years who met the inclusion criteria underwent surgery. The mean stone size was 15 mm [range: 5-20]. No intraoperative complications were recorded. All patients except one were discharged the same day of surgery as planned. In the month following discharge, the rate of complications, emergency department revisits or hospital readmissions rates were 0%. Stone-free-rate at 3 months was 83%. Overall satisfaction with the whole perioperative process was assessed with the EVAN-G questionnaire, obtaining 124.3 points out of a maximum of 150, which is equivalent to a 78.6% level of satisfaction.ConclusionAmbulatory mini percutaneous nephrolithotomy can be implemented as a treatment option in centers with experience in endourology, an established major ambulatory surgery unit, and strictly selected patients. Our initial results show an adequate safety profile and high overall satisfaction perceived by patients undergoing the ambulatory approach.     

Aplicación de la medicina regenerativa y la bioimpresión 3D en urología

In the last two decades, a new purpose has collected great efforts from scientists in all branches of medicine. It is about the possibility to make the body regenerate ill tissues and organs by itself with de right artificial stimuli or the construction of new functional organs to replace the damaged ones. This process comprises various interdisciplinary approaches to healthcare, such as tissue engineering, molecular medicine, biotechnology, and three-dimensional printing. Urologists have been remarkably active in this field of medicine called Regenerative Medicine. The searching of the different requirements like suitable and compatible biomaterials, versatile cells, adequate techniques to construct tissues, available biomolecules, and the knowledge of all these minimizing risks, are some of the aims and the approximations until now. Despite many obstacles, in vitro and in vivo studies are already showing encouraging options. We will review the advances related to the bladder, urethra, ureter, and kidneys. Difficulties such as ethical issues, time investment and high costs, have been some of the drawbacks encountered. Further studies are still required for its clinical application in daily life.     

Revisión sobre la experiencia y evidencias del Pygeum africanum en Urología

ContextPygeum africanum (P. africanum) is still being employed in urology practice for the treatment of lower urinary tract symptoms secondary to benign prostate hyperplasia.Evidence acquisitionA non-exhaustive review has been carried out about P. africanum, its mechanisms of action “in vitro” as well as “in vivo”, clinical trials and routine clinical practice.Evidence synthesisThe conclusions of the review and the reflections of the authors on the use of P. africanum are described.ConclusionsAlthough with an evidence level IV (based on expert opinion) the use of P. africanum seems to be an option in the urological therapeutic arsenal.     

Fístulas rectoneovaginales en pacientes tras cirugía de reasignación de sexo. Descripción de nuestra experiencia y revisión de la literatura

Male-to-female reassignment surgery or vaginoplasty includes those surgical procedures that aim to recreate a functional and cosmetically acceptable female perineum with minimal scarring. The technique of choice at our center is penile inversion vaginoplasty with or without scrotal skin grafts. We present 4 cases diagnosed with rectoneovaginal fistulas treated at our center with favorable evolution. The first patient was diagnosed in the late postoperative period during dilation. She underwent 2 failed vaginal repair attempts. Finally, a temporary colostomy and a rectal flap were performed. The second patient was diagnosed 2 weeks after the initial surgery due to aggressive dilation and was treated with a temporary colostomy and secondary wound closure. The third patient was diagnosed on the fifth post-operative day after removal of the vaginal packing. Dietary restriction was indicated, and a rectal flap was performed. A fourth patient was diagnosed within the late postoperative period; she was submitted to surgical exploration and a rectal wall flap was created. Rectoneovaginal fistulas after sex reassignment surgery has an incidence of about 2-17% and they are the most common type of fistula after this procedure. In most cases, it is secondary to rectal injury during the initial surgery. The management of these fistulas ranges from primary closure, diverting colostomies, conservative management, or the performance of flaps. A multidisciplinary team approach is recommended for the diagnosis and treatment of this complication.     

Notificación y clasificación de complicaciones después de procedimientos quirúrgicos urológicos: una evaluación y recomendaciones del panel de guías clínicas de la EAU

ContextThe incidence of postoperative complications is still the most frequently used surrogate marker of quality in surgery, but no standard guidelines or criteria exist for reporting surgical complications in the area of urology.ObjectiveTo review the available reporting systems used for urologic surgical complications, to establish a possible change in attitude towards reporting of complications using standardised systems, to assess systematically the Clavien-Dindo system when used for the reporting of complications related to urologic surgical procedures, to identify shortcomings in reporting complications, and to propose recommendations for the development and implementation of future reporting systems that are focused on patient-centred outcomes.Evidence acquisitionStandardised systems for reporting and classification of surgical complications were identified through a systematic review of the literature. To establish a possible change in attitude towards reporting of complications related to urologic procedures, we performed a systematic literature search of all papers reporting complications after urologic surgery published in European Urology, Journal of Urology, Urology, BJU International, and World Journal of Urology in 1999–2000 and 2009–2010. Data identification for the systematic assessment of the Clavien-Dindo system currently used for the reporting of complications related to urologic surgical interventions involved a Medline/Embase search and the search engines of individual urologic journals and publishers using Clavien, urology, and complications as keywords. All selected papers were full-text retrieved and assessed; analysis was done based on structured forms.Evidence synthesisThe systematic review of the literature for standardised systems used for reporting and classification of surgical complications revealed five such systems. As far as the attitude of urologists towards reporting of complications, a shift could be seen in the number of studies using most of the Martin criteria, as well as in the number of studies using either standardised criteria or the Clavien-Dindo system. The latter system was not properly used in 72 papers (35.3%).ConclusionsUniformed reporting of complications after urologic procedures will aid all those involved in patient care and scientific publishing (authors, reviewers, and editors). It will also contribute to the improvement of the scientific quality of papers published in the field of urologic surgery. When reporting the outcomes of urologic procedures, the committee proposes a series of quality criteria.     

Rotura traqueal postintubación de instauración clínica tardía. Breve revisión etiopatológica y del tratamiento

Iatrogenic tracheal rupture is a rare complication with a high morbidity and mortality. Tracheal intubation is the main cause and its origin is multifactorial. The diagnosis is based on non-specific but highly suggestive signs and symptoms, such as subcutaneous emphysema, pneumothorax, respiratory distress, or haemoptysis. Confirmation of the diagnosis requires an examination by bronchoscopy. Surgical repair has traditionally been the treatment of choice although the current trend is conservative management.     

Papel de la terapia presión negativa en la prevención de infección del sitio quirúrgico en cirugía colorrectal

BackgroundSurgical site infection (SSI) is one of the most frequent complications in colorectal surgery. It is diagnosed in 10 - 20% of colorectal procedures. Negative Pressure Wound Therapy (NPWT) has shown efficacy in the treatment of chronic and traumatic wounds, wound dehiscence, flaps and grafts. The main objective of this study is to assess NPWT in the prevention of SSI in colorectal surgery. Hospital stay reduction and SSI risk factors are secondary objectives.MethodsWe present a prospective case-control study including 80 patients after a colorectal diagnosis and surgical procedure (elective and non-elective) in 2017. Forty patients were treated with prevention NPWT for one week. Forty patients were treated according to the standard postoperative surgical wound care protocol.ResultsNo significant differences were found in demographic variables, comorbidities, surgical approach, elective or non-elective surgery, mechanical bowel preparation and surgical procedure. Three patients has SSI in the NPWT group (8%) (95%CI 0 – 17.5). Ten patients presented SSI in the control group (25%) (95%CI 12.5 – 37.5) (p = 0.034); OR 0.7 (95%CI 0.006-0.964). Hospital stay in the NPWT group was 8 days versus 12 days in the non-NPWT group (p = 0.22). In the multivariate analysis, mechanical bowel preparation was found to be the only risk factor for SSI (p = 0.047; OR: 0.8, CI 0.45-0.93).ConclusionsNPWT is a useful SSI prevention treatment in colorectal surgery.     

Afección laríngea obstructiva y síndrome de apnea obstructiva del sueño,una asociación con severo riesgo perioperatorio

We present the case of a patient who was diagnosed with chronic bronchitis, obstructive sleep apnoea syndrome, and large Reinke laryngeal oedemas that were removed by transoral laser microsurgery. In the immediate post-operative period acute respiratory insufficiency occurred due to pharyngeal collapse that required emergency re-intubation, after which the patient was transferred to the ICU where mechanical ventilation was given for18 h. Subsequent progress was normal. We describe the combination of various risk-factors related to anaesthetic management and the importance of considering each one of them, especially the preoperative detection of the severity of obstructive sleep apnoea syndrome.     

Proyectos de estandarización del tratamiento del cáncer de la unión esofagogástrica: centralización,registros y formación

Surgical treatment of oesophagogastric junction adenocarcinomas is based on total gastrectomies or oesophagectomies, which are complex procedures with potentially high morbidity and mortality. Population-based registers show a considerable variability of protocols and outcomes among different hospitals and regions. One of the main strategies to improve global results is centralization at high-volume hospitals, a process that should take into account the benchmarking of processes and outcomes at referral hospitals. Minimally invasive surgery can improve postoperative morbidity while maintaining oncological guaranties, but is technically more demanding than open surgery. This fact underlines the need for structured training and mentorship programs that minimize the impact of surgical teams’ training curves without affecting morbidity, mortality or oncologic radicality.     

Diseño y evaluación de un modelo de simulación de fractura de pene

ObjectiveTo design and assess a novel penile fracture simulation model for teaching penile fracture repair.MethodsWe used a validated circumcision simulator to create a model. Foreskin for a circumcision was divided into two halves. A transverse slit (“simulated fracture”) was created on one part of the first half of the foreskin (mimicking “tunica”) and was applied over the penile model. A red jelly tablet (“clot”) was placed underneath the cut. A second full-length of foreskin was applied over it to cover the defect. The model was assessed by participants and expert faculty at the Urology Simulation Boot Camp. Evaluation was performed using a 5-point Likert Scale questionnaire. Data was analysed using Microsoft Excel and IBM SPSS Statistics V25. The intra-class correlation was calculated using a “One-way random model”.ResultsTwenty-two urology trainees and four experts participated in the evaluation. The majority of trainees strongly agreed (59%, n = 13) the model is useful for training with experts similarly agreeing in 75% of cases. The appearance of penile fracture was considered good by both trainees (68%, n = 14) and faculty (75%). Overall, the ability of the model to represent a realistic simulation of the task was considered excellent by 23% of participants and good by 64%. Personal confidence after simulation in managing a similar situation was considered high among trainees. The main difficulties reported were related to fascial planes and urethra.ConclusionThis is the first simulation model for penile fracture repair and has demonstrated face validity at a national urology bootcamp.