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Article ; Online: Does success in percutaneous nephrolithotomy depend only on stone size? Analysis of the predictive capacity for success and complications of the current nephrolithometry scoring systems and their relationship with the stone surface.

Fernández Baltar, C / Gude Sampedro, F / Pérez Fentes, D

Actas urologicas espanolas

2024

Abstract: Objective: To analyze the predictive capacity of the nephrolithometry scoring systems (GSS, STONE, CROES and S-ReSC) and stone surface regarding success and complications following percutaneous nephrolithotomy (PCNL).: Methods: We studied 392 ... ...

Abstract	Objective: To analyze the predictive capacity of the nephrolithometry scoring systems (GSS, STONE, CROES and S-ReSC) and stone surface regarding success and complications following percutaneous nephrolithotomy (PCNL). Methods: We studied 392 patients who had undergone PCNL in our center. Only patients with a non-contrast CT (n = 240) were finally included for analysis. The predictive capacities for success and complications of the different scoring systems were evaluated using ROC curves and their area under the curve (AUC). Results: Regarding success, the S-ReSC system had the highest predictive capacity with an AUC of 0.681 (95% CI 0.610 - 0.751), followed by the CROES with 0.667 (95% CI 0.595 - 0.738), the STONE with 0.654 (95% CI 0.579 - 0.728) and finally the GSS with 0.626 (95% CI 0.555 - 0.698). The stone surface as a single variable had an AUC of 0.641 (95% CI 0.565 - 0.718). As for complications, the S-ReSC had the highest AUC with 0.664 (95% CI 0.57 - 0.758), followed by STONE with 0.663 (95% CI 0.572 - 0.755), GSS with 0.626 (95% CI 0.555). - 0.698) and CROES with 0.614 (95% CI 0.518 - 0.7). The stone surface alone had an AUC of 0.616 (95% CI 0.522 - 0.715). Conclusion: The nephrolithometry scales analyzed show a moderate predictive capacity for success and complications in patients undergoing PCNL in our center. Moreover, stone surface as an independent variable demonstrates moderate predictive capacity for both outcomes.
Language	Spanish
Publishing date	2024-05-10
Publishing country	Spain
Document type	Journal Article
ISSN	2173-5786
ISSN (online)	2173-5786
DOI	10.1016/j.acuroe.2024.05.010
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Article ; Online: 'Case of the Month' from the University of Santiago de Compostela, Spain: challenging the status quo in percutaneous stone surgery for horseshoe kidneys, the Galdakao-modified supine Valdivia position is a safe alternative for complex cases.

Pérez Fentes, Daniel

BJU international

2021 Volume 127, Issue 5, Page(s) 520–523

Language	English
Publishing date	2021-04-29
Publishing country	England
Document type	Journal Article
ZDB-ID	1462191-5
ISSN	1464-410X ; 1464-4096 ; 1358-8672
ISSN (online)	1464-410X
ISSN	1464-4096 ; 1358-8672
DOI	10.1111/bju.15352
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Article: Complicaciones de los catéteres doble jota y su manejo endourológico.

Pérez-Fentes, D

Archivos espanoles de urologia

2016 Volume 69, Issue 8, Page(s) 527–543

Abstract: The insertion of a double J catheter (DJ) has widespread, becoming a usual procedure and standard of care in urology. Despite its relative simplicity it is not free from intraoperative risks or problems during the weeks after the implant. Conversely, ... ...

Title translation	Complications of double j catheters and their endourological management.
Abstract	The insertion of a double J catheter (DJ) has widespread, becoming a usual procedure and standard of care in urology. Despite its relative simplicity it is not free from intraoperative risks or problems during the weeks after the implant. Conversely, despite great advances in design of these catheters the ideal material has not been discovered yet, one that is perfectly biocompatible with urine and avoids completely the advent of complications. The range of problems associated with DJs is variable: from mild self-limited dysuria or hematuria to more complex situations with higher risk, such as catheter migration, complete calcification, breakage, obstruction and renal unit loss. The treatment of theses complications must combine maximal efficacy for their resolution with the least possible surgical aggression. Accordingly, the different options of endourological approach become very important and they are the cornerstone for the treatment of the complications associated with ureteral catheters. The objective of this review is to present the main complications derived from the insertion of a DJ, their diagnosis, prevention and treatment, focusing mainly in the different endourological techniques.
MeSH term(s)	Algorithms ; Equipment Design ; Equipment Failure ; Humans ; Minimally Invasive Surgical Procedures ; Postoperative Complications/therapy ; Urinary Catheters/adverse effects
Language	Spanish
Publishing date	2016-10
Publishing country	Spain
Document type	Journal Article ; Review
ZDB-ID	211673-x
ISSN	0004-0614
ISSN	0004-0614
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Article ; Online: Initial results of endourological treatment of renoureteral lithiasis by means of flexible ureteroscopy and percutaneous surgery in an outpatient procedure in a tertiary care center.

Martínez-Corral, M E / Núñez-Otero, J J / Fernández-Baltar, C / Masid-Gómez, A / Valiño-Hortas, C / Pérez-Fentes, D

Actas urologicas espanolas

2022 Volume 47, Issue 1, Page(s) 15–21

Abstract: Objective: Urinary lithiasis is a prevalent disease with a high socioeconomic impact, where endourological surgery has shown excellent results with minimal complications. For its part, outpatient surgery is an efficient, safe and quality care model. We ... ...

Abstract	Objective: Urinary lithiasis is a prevalent disease with a high socioeconomic impact, where endourological surgery has shown excellent results with minimal complications. For its part, outpatient surgery is an efficient, safe and quality care model. We present our experience in the outpatient endourological treatment of lithiasis and a review of the main series. Material and methods: Prospective analysis of 85 flexible or percutaneous procedures for the treatment of lithiasis, carried out in our center between January 2021 and April 2022. The main objective was to analyze the rate of unplanned admission and the success and incidence of complications as secondary objectives. The patients were selected following the inclusion criteria of the care process. Results: The mean age was 56 ± 14 years. Urine culture was positive in 13.9% of the patients, 38% had a pre-surgical double-J catheter. Median stone surface was 55 mm 2 (961 ± 323 Hounsfield Units). 73 flexible and 12 percutaneous procedures were performed. 8 patients required immediate unplanned admission and another 2 during the first month. 94% were stone-free at the third month. No intraoperative complications were detected, although 16.5% of the patients presented some type of postoperative complication. Conclusion: In our experience, with a strict selection of patients and following a care process with multidisciplinary participation, endourological procedures are feasible and safe in the outpatient setting. Periodic monitoring of the results is essential for the sake of a constant improvement of the process.
MeSH term(s)	Humans ; Adult ; Middle Aged ; Aged ; Ureteroscopy/methods ; Kidney Calculi/surgery ; Kidney Calculi/etiology ; Lithiasis/etiology ; Tertiary Care Centers ; Outpatients
Language	Spanish
Publishing date	2022-10-01
Publishing country	Spain
Document type	Review ; Journal Article
ISSN	2173-5786
ISSN (online)	2173-5786
DOI	10.1016/j.acuroe.2022.09.004
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Article: Técnicas para el acceso percutáneo durante la nefrolitotomía percutánea.

Pérez-Fentes, Daniel

Archivos espanoles de urologia

2017 Volume 70, Issue 1, Page(s) 155–172

Abstract: The creation of the access is one of the main steps in percutaneous nephrolithotomy, the most complicated for many urologists and the one that limited most the universalization of the technique. From a purely technical point of view, it includes puncture ...

Title translation	Techniques for percutaneous access during percutaneous nephrolithotomy.
Abstract	The creation of the access is one of the main steps in percutaneous nephrolithotomy, the most complicated for many urologists and the one that limited most the universalization of the technique. From a purely technical point of view, it includes puncture of the excretory tract and dilatation of the percutaneous tract to end with the introduction of an Amplatz type working sheath. The objective of the puncture is to try to access the excretory system through the renal papilla, minimizing the risk of bleeding. The puncture may be guided by ultrasound, fluoroscopy, both, under endoscopic or laparoscopic control, by CT scan or MRI, or even by application of new technologies (Robotic, augmented reality, electromagnetic navigation,...). Due to the versatility and independence involved in having the ability to perform the renal puncture in the operative room, as well as its influence in the results of PCNL, it must be the urologist himself who performs this basic step of percutaneous surgery. The tract may be dilated by Alken type metallic dilators, semirrigid Amplatz type dilators or high pressure balloons. To date, there is no single ideal dilatation method, being the selection based on the endourologist's experience and the knowledge of the advantages and limitations of each option. The objective of this review is to present the main methods for puncture guiding and tract dilatation for PCNL, as well as to provide technical details to improve its result.
MeSH term(s)	Dilatation/instrumentation ; Dilatation/methods ; Equipment Design ; Fluoroscopy ; Humans ; Nephrolithiasis/diagnostic imaging ; Nephrolithiasis/surgery ; Nephrostomy, Percutaneous/methods ; Punctures/methods ; Surgery, Computer-Assisted ; Ureteroscopy
Language	Spanish
Publishing date	2017-01
Publishing country	Spain
Document type	Journal Article ; Review
ZDB-ID	211673-x
ISSN	0004-0614
ISSN	0004-0614
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Article ; Online: Technological innovations in shock wave lithotripsy.

Mosquera Seoane, L / Ortiz Salvador, J B / Budia Alba, A / Perez Fentes, D A

Actas urologicas espanolas

2023 Volume 48, Issue 1, Page(s) 105–110

Abstract: Introduction: Since 1980, extracorporeal shock wave lithotripsy (SWL) has been employed in the treatment of urolithiasis, offering noninvasive alternatives to surgical techniques. In addition to being limited by the size and location of the stones, its ... ...

Abstract	Introduction: Since 1980, extracorporeal shock wave lithotripsy (SWL) has been employed in the treatment of urolithiasis, offering noninvasive alternatives to surgical techniques. In addition to being limited by the size and location of the stones, its efficacy is influenced by several factors. Despite the advancement of other surgical techniques, SWL could maintain its position with new improvements. Our objective is to review the existing literature on the latest advances in the extracorporeal treatment of lithiasis. Material and methods: A non-systematic literature review was carried out from 2017 to 2023 to obtain 26 articles on three different emerging technologies in extracorporeal lithotripsy: Burst Wave Lithotripsy (BWL), Histotripsy, and Microbubble Lithotripsy (ML). Results: The BWL uses sinusoidal bursts of US waves delivered at lower and higher frequencies than conventional SWL. Its mechanism of action generates a higher quality fragmentation (fine fragments) instead of generating tensile stresses for stone fracture resulting in larger fragments, as in traditional SWL. Studies in pigs and humans have shown effective fragmentation with a good safety profile. Based on High Intensity Focused Ultrasound (HIFU) technology, histotripsy fragments tissue through cavitation. Good in vitro results have been shown, but the formation of microbubbles between the stone and ultrasound waves hinders the progress of this technique. Microbubble Lithotripsy (ML) combines microbubbles and ultrasound for safe and effective stone fragmentation. In vitro and pig results are promising. This technique can help optimize treatments and reduce energy levels. Conclusions: Technological innovation is not only being applied to endourological techniques, but also to ESWL. New techniques such as BWL, histotripsy and ML are promising, with good results in the research phase.
MeSH term(s)	Humans ; Animals ; Swine ; Inventions ; Urolithiasis/therapy ; Lithotripsy/methods ; Ultrasonography
Language	Spanish
Publishing date	2023-10-17
Publishing country	Spain
Document type	Journal Article ; Review
ISSN	2173-5786
ISSN (online)	2173-5786
DOI	10.1016/j.acuroe.2023.09.001
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Article ; Online: Current status of radiological protection in endourological procedures in Spain.

Pérez-Fentes, D / Pombar-Cameán, M / Álvarez-Ossorio Fernández, J L

Actas urologicas espanolas

2019 Volume 43, Issue 4, Page(s) 205–211

Abstract: Objective: To discover the extent of training in radiological protection (RP) of Spanish urologists who perform endourological procedures, and to analyse the use of on ionising radiation control and protection measures.: Material and methods: A ... ...

Title translation	Estado actual de la protección radiológica en procedimientos endourológicos en España.
Abstract	Objective: To discover the extent of training in radiological protection (RP) of Spanish urologists who perform endourological procedures, and to analyse the use of on ionising radiation control and protection measures. Material and methods: A survey conducted through the Plataforma de Investigación de Estudios Multicéntricos (PIEM) (Multicentre Study Research Platform) on the 1,894 associates of the Spanish Association of Urology, between April and October 2015. The questionnaire comprised 21 questions on endourological activity undertaken, RP training, and the use of protective measures, and personal dosimetry. Seventeen percent responded, and 238 surveys were eventually validated for study. Results: Sixty-three percent of the respondents had received no type of RP training, 25% had first level accreditation, and only 12% second level. Fifty-seven percent, 27%, and 2% of the urologists used flap, wrist and crystalline dosimetry respectively. Use of radiation protection measures was insufficient. Fifty-three percent of the urologists at greatest risk of exposure had had no training in RP, 30% did not use flap dosimetry, and 40% used neither an apron or thyroid collar during the endourological procedures. Conclusions: RP training, dosis monitoring, and the use of ionising radiation protective measures are insufficient, even by practitioners most exposed to radiation. It is essential that these serious shortcomings in RP are corrected, at the level of the individual, in urology departments, scientific societies, and the health authorities.
MeSH term(s)	Accreditation/statistics & numerical data ; Catheterization ; Clinical Competence/statistics & numerical data ; Fluoroscopy ; Health Care Surveys ; Health Knowledge, Attitudes, Practice ; Humans ; Nephrolithiasis/diagnostic imaging ; Nephrolithiasis/therapy ; Nephrolithotomy, Percutaneous/adverse effects ; Nephrolithotomy, Percutaneous/methods ; Radiation Protection/instrumentation ; Radiation Protection/methods ; Radiation Protection/standards ; Radiation, Ionizing ; Radiometry/instrumentation ; Radiometry/methods ; Radiometry/statistics & numerical data ; Spain ; Surveys and Questionnaires/statistics & numerical data ; Urologists/education ; Urologists/statistics & numerical data
Language	Spanish
Publishing date	2019-02-26
Publishing country	Spain
Document type	Journal Article
ISSN	2173-5786
ISSN (online)	2173-5786
DOI	10.1016/j.acuro.2018.04.006
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Article: Extracellular Vesicles' Genetic Cargo as Noninvasive Biomarkers in Cancer: A Pilot Study Using ExoGAG Technology.

Herrero, Carolina / Ferreirós, Alba / Pérez-Fentes, Daniel / León-Mateos, Luis / López-López, Rafael / Abal, Miguel / Alonso-Alconada, Lorena

Biomedicines

2023 Volume 11, Issue 2

Abstract: The two most developed biomarkers in liquid biopsy (LB)-circulating tumor cells and circulating tumor DNA-have been joined by the analysis of extracellular vesicles (EVs). EVs are lipid-bilayer enclosed structures released by all cell types containing a ... ...

Abstract	The two most developed biomarkers in liquid biopsy (LB)-circulating tumor cells and circulating tumor DNA-have been joined by the analysis of extracellular vesicles (EVs). EVs are lipid-bilayer enclosed structures released by all cell types containing a variety of molecules, including DNA, mRNA and miRNA. However, fast, efficient and a high degree of purity isolation technologies are necessary for their clinical routine implementation. In this work, the use of ExoGAG, a new easy-to-use EV isolation technology, was validated for the isolation of EVs from plasma and urine samples. After demonstrating its efficiency, an analysis of the genetic material contained in the EVs was carried out. Firstly, the sensitivity of the detection of point mutations in DNA from plasma EVs isolated by ExoGAG was analyzed. Then, a pilot study of mRNA expression using the nCounter NanoString platform in EV-mRNA from a healthy donor, a benign prostate hyperplasia patient and metastatic prostate cancer patient plasma and urine samples was performed, identifying the prostate cancer pathway as one of the main ones. This work provides evidence for the value of using ExoGAG for the isolation of EVs from plasma and urine samples, enabling downstream applications of the analysis of their genetic cargo.
Language	English
Publishing date	2023-01-30
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2720867-9
ISSN	2227-9059
ISSN	2227-9059
DOI	10.3390/biomedicines11020404
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Article ; Online: Incidence of upper tract urothelial carcinoma in Spain.

Fernandez Aparicio, T / Galan Llopis, J A / Cansino Alcaide, R / Pérez Fentes, D / Cepeda Delgado, M / Alvarez-Ossorio, J L

Actas urologicas espanolas

2020 Volume 44, Issue 7, Page(s) 512–518

Abstract: Introduction and objectives: The incidence of upper urinary tract tumors is currently unknown. The aim of this study is to determine the real incidence of upper tract urothelial carcinoma (UTUC) in Spain.: Material and methods: A descriptive, ... ...

Title translation	Incidencia del carcinoma transicional del tracto urinario superior en España.
Abstract	Introduction and objectives: The incidence of upper urinary tract tumors is currently unknown. The aim of this study is to determine the real incidence of upper tract urothelial carcinoma (UTUC) in Spain. Material and methods: A descriptive, prospective and multicenter epidemiological study was conducted in 31 Spanish facilities by means of the Platform for Multicenter Studies of the Spanish Association of Urology. Recruitment was opened from May 1 Results: The incidence adjusted to Spanish population from raw data was 3.27 cases per 100.000 inhabitants per year (2.93 - 3.61 95% CI) and 3,3 cases per 100.000 inhabitants per year (2.96-3.66 95%CI) when adjusted to European population by age. The mean age at diagnosis was 70 years, and 77% of patients were male. Thirty-four percent of patients had an incidental diagnosis. Tumors were most commonly located in the pyelocalyceal system (54%), followed by the distal ureter (22%). Prior ureteroscopy was performed in 114 patients: this technique modified the subsequent treatment indication in 58% of cases. Radical nephroureterectomy was performed in 311 patients. Kidney-sparing surgery was the elected treatment in 76 patients (20%). Complications were found in 69% of cases, most of them classified as Clavien 1 and 2 (86% of all complications). Postoperative mortality rate was 1.7%. Conclusions: UTUC adjusted incidence rate in Spain is 3.27 and 3.3 in Europe. Prior URS modified the treatment indication in 18% of patients. We found a 69% complication rate and a 1.7% mortality rate.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Carcinoma, Transitional Cell/epidemiology ; Epidemiologic Studies ; Female ; Humans ; Incidence ; Kidney Neoplasms/epidemiology ; Male ; Middle Aged ; Prospective Studies ; Spain/epidemiology ; Ureteral Neoplasms/epidemiology
Language	Spanish
Publishing date	2020-07-01
Publishing country	Spain
Document type	Journal Article ; Multicenter Study
ISSN	2173-5786
ISSN (online)	2173-5786
DOI	10.1016/j.acuro.2020.03.007
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Article ; Online: Safety of percutaneous nephrolithotomy in patients on chronic anticoagulant or antiplatelet therapy.

Fernández-Baltar, C / Pérez-Fentes, D / Sánchez-García, J F / García-Freire, C

Urolithiasis

2018 Volume 46, Issue 6, Page(s) 581–585

Abstract: In developed countries, the incidence of cardiovascular disease is increasing, therefore, anticoagulant and antiplatelet drugs are a widespread treatment nowadays. Percutaneous nephrolithotomy (PNL) is the first-line treatment for large or complex stones ...

Abstract	In developed countries, the incidence of cardiovascular disease is increasing, therefore, anticoagulant and antiplatelet drugs are a widespread treatment nowadays. Percutaneous nephrolithotomy (PNL) is the first-line treatment for large or complex stones (> 2 cm) and remains an alternative for the smaller ones. The objective of this study is to analyze whether PNL surgery is a safe procedure in patients under a treatment discontinuation protocol for anticoagulant or antiplatelet therapies. We retrospectively studied 301 patients who underwent PNL in our hospital between 2008 and 2016 and identified 46 patients on chronic antiplatelet or anticoagulation treatment. With respect to PNL outcomes, the stone-free rate was similar (78 vs 74%, p = 0.762) in both groups, without any significant differences in the overall postoperative complications (17 vs 26%, p = 0.203). The incidence of hemorrhagic complications was similar between groups (12 vs 9%, p = 0.492), as demonstrated by the mean drop in hemoglobin (Hb), which was comparable in both cohorts (2.2 ± 1.3 vs 2.0 ± 1.4 p = 0.270) and the blood transfusion rate (14% in group A and 8% in group B, p = 0.205). No thromboembolic events were found within the year after the PNL procedure. PNL is a safe and effective intervention in patients under a treatment discontinuation protocol for anticoagulant or antiplatelet therapies. Although our study demonstrates the feasibility of this protocol, new scientific evidence aims to stratify the thromboembolic and bleeding risk of each patient to individualize the perioperative management thereafter.
MeSH term(s)	Adult ; Aged ; Anticoagulants/therapeutic use ; Cardiovascular Diseases/therapy ; Feasibility Studies ; Female ; Humans ; Incidence ; Kidney Calculi/surgery ; Male ; Middle Aged ; Nephrolithotomy, Percutaneous/adverse effects ; Nephrolithotomy, Percutaneous/methods ; Platelet Aggregation Inhibitors/therapeutic use ; Postoperative Hemorrhage/epidemiology ; Postoperative Hemorrhage/etiology ; Postoperative Hemorrhage/prevention & control ; Retrospective Studies ; Treatment Outcome
Chemical Substances	Anticoagulants ; Platelet Aggregation Inhibitors
Language	English
Publishing date	2018-01-22
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2703553-0
ISSN	2194-7236 ; 2194-7228
ISSN (online)	2194-7236
ISSN	2194-7228
DOI	10.1007/s00240-018-1034-1
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