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

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

Improving plan to optimize the outpatient office waiting list in an urology clínical unit

La lista de espera, es un problema que existe en la mayoría de los sistemas nacionales de salud que aseguran a los ciudadanos la cobertura universal y la financiación pública. Además, constituye una de las principales causas de insatisfacción de los pacientes con el sistema nacional de salud. Una de las mayores preocupaciones de las autoridades sanitarias, ha sido buscar alternativas para solucionar esta problemática. Por ello, es necesario gestionar las listas de espera a través de una política integral, implicando a la administración, los centros sanitarios, los profesionales y la sociedad en general. En particular desde el ámbito del centro asistencial y los profesionales, la mejora de las listas de espera pasa ineludiblemente por la gestión clínica, la cual permite potenciar actividades asistenciales que mejoren resultados en niveles de salud, eficiencia, uso de tecnologías y utilización de recursos humanos. El objetivo principal de este trabajo fue identificar posibles problemas en el sistema de citación, derivación y tiempo de espera, y establecer propuestas de mejora que permitan optimizar la lista de espera de consultas externas en una unidad de gestión clínica de urología.The waiting list is a problem that exists in most national health systems which ensure universal coverage of citizens and public funding. It also constitutes one of the leading causes of patient dissatisfaction with the national health system. A major concern of health authorities has been to seek alternatives to solve this problem. Therefore, it is necessary to manage the waiting lists through a comprehensive and complete policy involving the administration, health centers, professionals and society. Particularly since the scope of health center and professionals, improving waiting lists inevitably passes for clinical management, which allows to increase care activities that improve health levels outcomes, efficiency, use of technology and human resource utilization. The main objective of this study was to identify potential problems in the appointment system, referral and waiting time, and to establish proposals to improve the waiting list in outpatient in a management urology clinic

Reduction of ureteral stent encrustation by modulating the urine pH and inhibiting the crystal film with a new oral composition: a multicenter, placebo controlled, double blind, randomized clinical trial

Background: Encrustation of ureteral double J stents is a common complication that may affect its removal. The aim of the proposed study is to evaluate the efficacy and safety of a new oral composition to prevent double J stent encrustation in indwelling times up to 8 weeks. Methods: A double-blinded, multicenter, placebo-controlled trial was conducted with 105 patients with indwelling double J stents enrolled across 9 public hospitals in Spain. The patients were randomly assigned (1:1) into intervention (53 patients) or placebo (52 patients) groups for 3 to 8 weeks and both groups self-monitored daily their morning urine pH levels. The primary outcome of analysis was the degree of stent ends encrustation, defined by a 4-point score (0 - none; 3 - global encrustation) using macroscopic and electron microscopy analysis of crystals, after 3 to 8-w indwelling period. Score was exponentially transformed according to calcium levels. Secondary endpoints included urine pH decrease, stent removal, and incidence of adverse events. Results: The intervention group benefits from a lower global encrustation rate of stent ends than placebo group (1% vs 8.2%; p < 0.018). Mean encrustation score was 85.12 (274.5) in the placebo group and 18.91 (102.27) in the intervention group (p < 0.025). Considering the secondary end points, treated patients reported greater urine pH decreases (p = 0.002). No differences in the incidence of adverse events were identified between the groups. Conclusions: Our data suggest that the use of this new oral composition is beneficial in the context of ureteral double J indwelling by decreasing mean, as well as global encrustation

Meta-Analysis of Studies Analyzing the Role of Human Papillomavirus in the Development of Bladder Carcinoma

Journal Article;PURPOSE We aimed to ascertain the degree of association between bladder cancer and human papillomavirus (HPV) infection. MATERIALS AND METHODS We performed a meta-analysis of observational studies with cases and controls with publication dates up to January 2011. The PubMed electronic database was searched by using the key words "bladder cancer and virus." Twenty-one articles were selected that met the required methodological criteria. We implemented an internal quality control system to verify the selected search method. We analyzed the pooled effect of all the studies and also analyzed the techniques used as follows: 1) studies with DNA-based techniques, among which we found studies with polymerase chain reaction (PCR)-based techniques and 2) studies with non-PCR-based techniques, and studies with non-DNA-based techniques. RESULTS Taking into account the 21 studies that were included in the meta-analysis, we obtained a heterogeneity chi-squared value of Q(exp)=26.45 (p=0.383). The pooled odds ratio (OR) was 2.13 (95% confidence interval [CI], 1.54 to 2.95), which points to a significant effect between HPV and bladder cancer. Twenty studies assessed the presence of DNA. The overall effect showed a significant relationship between virus presence and bladder cancer, with a pooled OR of 2.19 (95% CI, 1.40 to 3.43). Of the other six studies, four examined the virus's capsid antigen and two detected antibodies in serum by Western blot. The estimated pooled OR in this group was 2.11 (95% CI, 1.27 to 3.51), which confirmed the relationship between the presence of virus and cancer. CONCLUSIONS The pooled OR value showed a moderate relationship between viral infection and bladder tumors.Ye