Foreskin trapped by zipper: a case report

We present an 84 year-old-male patient with foreskin trapped by his zipper. After several failed attempts with scissors, screwdriver and others we practise an elliptic incision to resolve the problem. Foreskin injuries are frequent in children but are rare in adult men. There are some techniques described for solving the problem using scissors, screwdriver, traction and surgery

Treatment of Lower Pole Renal Stones. Extracorporeal Shockwave Lithotripsy Versus Intrarenal and Percutaneous Surgery

Introducción: la litotricia extracorpórea por ondas de choque (LEOC) es el tratamiento usado en el 80-90% de los casos de litiasis renal. Las técnicas endourológicas como la cirugía intrarrenal retrógrada (CIR), la nefrolitotomía percutánea (NLP) y sus miniaturizaciones (miniperc) están ganando importancia gracias a su alta eficacia. Cuando se trata del cáliz inferior la litotricia extracorpórea es la que presenta peores resultados, pero es difícil determinar las indicaciones para tratar con una técnica concreta. El objetivo de esta revisión es determinar la eficacia y seguridad de estas técnicas en el manejo de la litiasis renal en cáliz inferior. Material y métodos: revisión de 12 estudios que evalúan resultados de una, dos o las tres técnicas en términos de eficacia, tiempo de intervención, estancia hospitalaria, complicaciones, maniobras auxiliares y re-tratamiento. Resultados: la LEOC presenta peores resultados cuando el cálculo es de mediano tamaño, menor tiempo de intervención y estancia, más complicaciones y altas tasas de re-tratamiento. La eficacia de la CIR y la NLP no se ve tan afectada por el tamaño de la litiasis, presentando buenos resultados y menores tasas de litiasis residuales, pero mayor tiempo de intervención y de estancia hospitalaria. Conclusiones: la litotricia extracorpórea presenta resultados inferiores, pero bastante aceptables considerando su baja invasividad y corta estancia hospitalaria, características que la hacen preferible en pacientes seleccionados. Las técnicas endourológicas demuestran una gran eficacia a expensas de ser más invasivas y costosas, aunque a veces sean preferibles para evitar la necesidad de re-tratamiento.Introduction: extracorporeal shockwave lithotripsy (SWL) is used in the 80-90% of the cases of renal lithiasis. Endourological techniques such as retrograde intrarenal surgery (RIRS) or percutaneous nephrolithotomy (PCNL) and its miniaturizations (miniperc) are gaining importance because they are highly effective treatments. Regarding the treatment of the nephrolithiasis of the lower pole, the extracorporeal lithotripsy presents worse results, but it still difficult to set up the indications to treat with a certain technique. The purpose of this review is to stablish the effectivity and safety profile of these techniques in the management of the lower renal pole lithiasis. Materials and Methods: we conducted a review of 12 studies that evaluate results of one, two or three of the techniques in terms of effectivity, operative time, hospital stay, complications, auxiliary procedures and re-treatment. Results: SWL presents lower stone-free rates when the lithiasis is medium or big sized, shorter operative time and hospital stay, more complications and high rates of re-treatment. The effectivity of RIRS and PCNL does not change a lot with larger lithiasis, presenting good results and lower residual lithiasis rates. The longer operative time was performed with RIRS and the longer hospital stay with PCNL. The complications rate varies, being more important with PCNL. Re-treatment rates are low with RIRS and PCNL. Conclusions: these three techniques show good results in the management of lower pole lithiasis, although SWL presents worse results in comparison, but considering its reduced invasiveness and short hospital stay, it is the chosen technique for many patients. Endourological techniques show better results at expense of their invasiveness and higher cost, although sometimes they are preferable in order to prevent re-treatment

Cutaneous metastases in renal cell carcinoma: a case report

Renal cell carcinoma is the most common form of malignant renal tumour and is extremely lethal. About 25% of the patients develop metastasis at the time of diagnosis, and in many cases during the course of the disease, affecting the lung, lymphatic ganglions, liver, and bone, with skin metastases being quite rare

Wünderlich syndrome from a malignant epithelioid angiomyolipoma

Angiomyolipoma of the kidney has classically been considered as a tumor of the connective tissue composed of fat, vascular tissue, and smooth muscle. In most cases, it is a tumor with benign behavior that may appear sporadically or associated with tuberous sclerosis syndrome. Macroscopically, these tumors are greyish yellow in color, and under an optical microscope, they are characterised by presenting the three components described. In recent years, several authors have published cases of epithelioid angiomyolipomas characterized by a minimal presence of fat in the tumor, positive for the melanoma-specific antigen, HMB- 45,(1) and on occasion, positive for desmin, melan-A, and others.(2,3) Computed axial tomography and nuclear magnetic resonance studies hardly differentiate epithelioid angiomyolipomas from renal cell carcinoma.(3) We present a case of malignant epithelioid angiomyolipoma in a woman with no tuberous sclerosis, the debut of which was spontaneous retroperitoneal hemorrhage causing hypovolemic shock that required left radical nephrectomy

Analysis of time and course of surgical urologic activity. Measures to develop for improve surgical activity

Objetivos: El desarrollo de las unidades de gestión clínica en los servicios quirúrgicos, hacen que el Área Quirúrgica tenga una importancia vital en el desarrollo y utilización de recursos por parte de las mismas. Este trabajo pretende revisar la actividad quirúrgica de nuestro servicio durante el año 2012 y proponer medidas de mejora de los resultados. Material y Métodos: Hemos realizado una búsqueda telemática a través de la aplicación Acquiro® de la Consejería de Salud de la Junta de Andalucía de la actividad quirúrgica desde el 1 de Enero de 2012 al 31 de diciembre de 2012 de los servicios de Cirugía General, Traumatología, Ginecología y Obstetricia, Angiología y Cirugía Vascular y Urología para analizar diferentes parámetros y compararlos entre sí con la de otras especialidades. Resultados: La UGC de Urología presenta un índice de ocupación de quirófano de 0,774, encontrándose en un nivel intermedio al compararlo con las otras especialidades. Se observa que la proporción de cirugía ambulatoria es mucho más elevada en comparación con las demás especialidades. Conclusión: Para aumentar el índice de ocupación de quirófano y optimizar los recursos se propone mantener constante el personal de quirófano no médico, optimizar el número de urólogos por cirugía y el inicio y llegada a la sala quirúrgica, así como modificar el contenido de los partes quirúrgicos con el fin de no modificar la técnica quirúrgica y/o anestésica entre una y otra cirugía.Introduction: The development of clinical management units in surgical services, make the surgical area has a vital importance in the development and use of resources by them. This work reviews the surgical activity of our service in 2012 and propose measures to improve the results. Material and Methods: We conducted a search through the telematics Acquiro ® implementation of the Health of the Andalusian surgical activity from January 1, 2012 to December 31, 2012 from the services of General Surgery, Orthopedics, Gynecology and Obstetrics, Angiology and Vascular Surgery and Urology for analyzing different parameters and compare them with those of other specialties. Results: The Urology Clinic Unit presents an operating room occupancy rate of 0.774, being at an intermediate level when compared with other specialties. It is noted that the ratio of day surgery is much higher compared to other specialties. Conclusion: To increase operating room occupancy rate and optimize resources intends to maintain constant the nonmedical surgical staff, optimizing the number of urologists for surgery and the start and arrival in the operating room, and modify the contents of the parts surgical not to modify the surgical procedure and / or between one and another anesthetic surger

Teaching and new techonologies in the school of medicine

Introduction: Continuous changes in university educational models necessitate the progressive updating of professors and student involvement in university teaching. The aim of this paper is to analyze the characteristics of teaching and new technologies in a public school of (Faculty of Medicine of Granada). Material and methods: An anonymous survey was performed to a total of 137 students of the Faculty of Medicine of the University of Granada, with 15 questions to analyze the characteristics of the teaching in the center. Results: In general the students surveyed are moderately satisfied with the teaching received to date, being the weakest points of their answers the practical teaching. Study methods remain through the notes in class and in general the students are aware of new teaching innovations implemented as teaching boards (MOODLE / SWAD). Conclusion: We believe that the current teaching of medicine should be directed to the application of theoretical knowledge in clinical practice and it is important to the continuous updating of teachers as well as the stimulus to the student, who should participate actively in teacher teaching process conducted at the University.Introducción: Los continuos cambios en los modelos educativos universitarios hacen necesario la actualización progresiva del profesorado y la implicación del alumno en la docencia universitaria. El objetivo de este trabajo es analizar las características de la docencia en un centro público de enseñanza de ciencias de la salud (Facultad de Medicina de Granada). Material y métodos: Se realiza una encuesta anónima a un total de 137 alumnos de la Facultad de Medicina de la Universidad de Granada, con un total de 15 preguntas para analizar las características de la docencia impartida y recibida en dicho centro. Resultados: En líneas generales el alumno encuestado está moderadamente satisfecho con la docencia recibida hasta el momento, siendo los puntos más débiles de sus respuestas la enseñanza práctica y el profesorado docente. Los métodos de estudio siguen siendo a través de los apuntes en clase y en general se deduce de las respuestas que el alumno está al tanto de las nuevas innovaciones docentes puestas en marcha como los tablones de docencia o el tablón MOODLE/SWAD. Conclusión: Creemos que la actual docencia en Medicina debe ir encaminada a la aplicación de los conocimientos teóricos en la práctica clínica habitual y para ello es importante la continua actualización del profesorado, así como el estímulo diario del mismo hacia el alumno, que deberá participar de forma activa en la formación docente llevada a cabo en la Universidad

Patients with periodontitis and erectile dysfunction suffer a greater incidence of major adverse cardiovascular events: A prospective study in a Spanish population

DATA AVAILABILITY STATEMENT The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available because of privacy or ethical restrictions.Background Periodontitis and erectile dysfunction (ED) have been linked with cardiovascular disease. The association of periodontitis and ED with the occurrence of major adverse cardiovascular events has not been previously assessed. The aim of this study was to determine if the presence of periodontitis and ED has any effect on the incidence of major adverse cardiovascular events. Methods Male patients that attended the Urology service were enrolled in a prospective study. Erectile dysfunction was diagnosed according to the International Index of Erectile Function. Sociodemographic data and periodontal clinical parameters were gathered (pocket probing depth, clinical attachment loss, bleeding on probing (BoP), plaque index and number of teeth) at baseline. Major adverse cardiovascular events occurred both before and during the follow-up time were registered. Bivariate analyses, as well as a multivariate analysis were performed, adjusting for potential confounders. Results A total of 158 patients were included, with a mean follow-up of 4.2 years. A greater number of major adverse cardiovascular events occurred in the group that presented periodontitis and ED (P = 0.038). After adjusting by age and previous cardiovascular disease in the multivariate analysis, the annual major adverse cardiovascular event rate was estimated to be 3.7 times higher in the same group (P = 0.049). Other periodontal clinical variables together with ED supported these results and were close to statistical significance. Conclusions Patients with periodontitis and ED, adjusted by age and a cardiovascular disease, showed 3.7 times more risk of suffering major adverse cardiovascular events after mean follow-up of 4.2 years.Research Group #CTS-583 (Junta de Andalucía, Granada, Spain

Analysis of the effect of the basic subjects in clinical teaching

Introducción: La licenciatura en Medicina y Cirugía está sufriendo diferentes cambios y modificaciones en los últimos años con los nuevos planes formativos nacionales y europeos. El objetivo de este trabajo es analizar la enseñanza docente Urología en la facultad de Medicina de Granada mediante la elaboración y análisis de encuestas a los alumnos de 5º curso. Material y métodos: Se realizan un total de 14 preguntas de respuesta rápida que en 76 alumnos de 5º Curso de la Facultad de Medicina. De los alumnos encuestados, 23 fueron hombres y 53 fueron mujeres. Entre las preguntas, destaca un bloque de ellas acerca de la docencia y tipo de docencia impartida y otro bloque de conocimientos básicos que se consideran necesarios para iniciar el estudio de la Urología en el 5º curso de la licenciatura. Resultados: La mayoría de los encuestados ha asistido a clase (88% de los alumnos), prefieren clase magistral (31,6% de los encuestados) y exposición con power point como primera opción de docencia (42,1%). El método de evaluación preferido por los alumnos sigue siendo el examen tipo test de respuesta múltiple. En cuanto a las preguntas de conocimientos básicos, sólo el 41,4% de los encuestados acierta 3 o más preguntas, existiendo diferencias entre hombres y mujeres sólo en una pregunta. Conclusiones: Las asignaturas básicas de la licenciatura de Medicina deben favorecer un enfoque clínico que ayuden el aprendizaje ulterior de las asignaturas clínicas.Introduction: The degree of Medicine and Surgery is undergoing various changes and modifications in recent years due to new national and European training plans. The aim of this paper is to analyze education in Urology at Granada Faculty of Medicine through the development and analysis of surveys to students in 5th course. Material and methods: A total of 14 questions for quick response are carried out on 76 students in 5th Course of the Faculty of Medicine. Of the students surveyed, 23 were men and 53 were women. Among the questions, there are a block of them about teaching and type of teaching and a block about basic skills considered necessary to initiate the study of urology at the 5th course graduation. Results: Most students had attended the faculty usually (88% of students), they prefer lectures (31.6% of respondents) and power point presentation with teaching as their first choice (42.1%). The preferred evaluation method for students was the multiple choice test. As to questions of basic knowledge, only 41.4% of answered 3 or more questions, no differences between men and women were found in Knowledge but in one question. Conclusions: The basic subjects of the degree of Medicine should promote a clinical approach that encourages further learning in the clinical subjects

Pilot study for the implementation of metabolic study in patients with urinary stones in a local hospital following reccomendations of urolithiasis asistencial process

Objetivo: El objetivo de este estudio piloto fue analizar los primeros resultados tras la implantación del estudio metabólico según las recomendaciones del Proceso Asistencial Integrado de Urolitiasis de la Consejería de Salud de la Junta de Andalucía en nuestra área de salud. Material y Métodos: Estudio piloto prospectivo que incluye a una cohorte de 16 pacientes a los que se realiza un estudio metabólico por presentar litiasis múltiple/de repetición tras la implantación de un protocolo, posterior a un análisis DAFO. Se analiza coste del estudio metabólico, resultados del estudio metabólico y realización de tratamiento individualizado. Además se analizan los costes directos/indirectos de la litiasis urinaria y la necesidad e indicación de estudio metabólico, así como cumplimiento de indicador de calidad asistencial. Resultados: De los 16 pacientes a los que se realizó el estudio, se observa que se cumple en el 100% el indicador estudiado de prescripción de estudio metabólico en pacientes con litiasis de riesgo. Se detecta una o más alteraciones metabólicas en el 75% de los pacientes, lo que conlleva unas pautas de tratamiento médico individuales que facilitarán la reducción de las recidivas y el ahorro económico de costes directos/indirectos derivado de la litiasis. El coste medio del estudio metabólico por paciente fue de 37.7 euros. Conclusión: La elaboración de un protocolo previo de un análisis de situación, junto con la solicitud de un estudio metabólico y un tratamiento individual es una medida de calidad en salud en los pacientes con litiasis urinaria que presumiblemente favorecerá la reducción de la recidiva y de los costes.Objective: The aim of this pilot study was to analyze the first results after implantation of the metabolic study as recommended by the care process Integrated Urolitiasis of the Ministry of Health of the Government of Andalusia in our health area. Material and Methods: Prospective pilot study including a cohort of 16 patients in whom a metabolic study is performed to present multiple/recurrent stones after implantation of protocol, a posterior to a SWOT analysis. Cost metabolic study, results of metabolic study and implementation of individualized treatment is analyzed. Besides the direct / indirect costs of urolithiasis and the need and indication of metabolic study and compliance indicator of quality are analyzed. Results: Of the 16 patients that the study was conducted, it appears that the prescription studied metabolic study in patients with nephrolithiasis risk indicator is fulfilled in 100%. One or more alterations in 75% of patients is detected, leading to a single medical treatment guidelines that facilitate reducing recurrence and economic saving direct/indirect costs arising from the stones. The average cost of metabolic study per patient is 37.7 euros. Conclusion: The development of a protocol, previous a situation analysis, together with the application of a metabolic study and individual treatment is a measure of health quality in patients with nephrolithiasis presumably favor the reduction of recurrence and costs