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OBJECTIVE: Symptoms related toureteral double-J stent are the most common complaintamong patients. Back pain during micturition isone of the most frequent but intensity and durationmay vary between them. This study aimed to assessthe relationship between hydronephrosis grade beforeureteral double-j stent insertion and back pain duringmicturition. PATIENTS AND METHODS: All consecutive patientsundergoing a ureteral double-j insertion secondaryto urolithiasis between 2017 and 2019 were prospectivelyenrolled. Hydronephrosis was assessed using aCT scan and was categorized according to renal pelvismeasure as 0-10 mm (low group), and ≥10 mm(moderate group). At one week postoperative, patientsymptoms were evaluated using the Spanish validatedversion of the Ureteral Stent Symptom Questionnaire(USSQ) and 10 cm visual analog scale (VAS). Meanscores for USSQ domains and mean VAS scores werecompared. RESULTS: 149 patients were included and evaluated.The mean age was 48.2±15.1 years. We found no significantdifferences in mean scores for each main domainin the USSQ or VAS. The presence of flank painduring micturition was present in 73.5% and 52.5 %for the low vs moderate hydronephrosis group respectively(p=0.01). Sub-analysis by gender was 78.7 % vs44.0 % (p=0.00) and 58.6% vs 66.6% (p=0.6) of low andmoderate group in men and women respectively.Analysis of the USSQ item score revealed thatthe moderate hydronephrosis group presented less''pain or discomfort when urinating,'' less ''presenceof back pain when urinating,'' less ''admission orprocedure because of discomfort,'' and less ''feelingabout reinsertion''. CONCLUSION: Patients in the moderate hydronephrosisgroup did not have significant advantagesin terms of voiding symptoms, pain, general health,sexual matters, or additional problems determined bythe USSQ or in VAS. However, sub-analysis reportedadvantages concerning pain and additional questions.Men with moderate hydronephrosis presented statisticallysignificantly less pain during micturition.

INTRODUCCIÓN Y OBJETIVO: Lossíntomas relacionados con el catéter ureteral doble-Json la queja más común en los pacientes. El dolor deespalda durante la micción es uno de los más frecuentes,pero la intensidad y la duración varían entre ellos.El objetivo de este estudio fue evaluar la relación entreel grado de hidronefrosis antes de la inserción del catéterureteral doble-J y el dolor de espalda durante lamicción. PACIENTES Y MÉTODOS: Se incluyeron prospectivamentetodos los pacientes consecutivos que sesometieron a la inserción de un catéter ureteral doblej debido a la urolitiasis entre 2017 y 2019. La hidronefrosisse evaluó mediante una tomografía computarizaday se clasificó según la medida de la pelvis renalcomo 0-10 mm (grupo bajo), y ≥10 mm (grupo moderado/severo). Una semana después de la operación,los síntomas del paciente se evaluaron utilizando laversión validada en español del Cuestionario de Síntomasdel Catéter Ureteral (USSQ) y la la escala visualanáloga (EVA) de 10 cm. Se compararon las puntuaciones medias de los dominios del USSQ y las puntuacionesmedias de la EVA. RESULTADOS: Se incluyeron y evaluaron 149 pacientes.La edad media fue de 48,2±15,1 años. No seencontraron diferencias significativas en las puntuacionesmedias de cada dominio principal en la USSQo la EVA. La presencia de dolor en el flanco durante lamicción estuvo presente en el 73,5% y el 52,5% parael grupo de hidronefrosis baja vs. moderada respectivamente(p=0,01). El subanálisis por género fue 78,7% vs 44,0 % (p=0,00) y 58,6 % vs 66,6 % (p=0,6) delgrupo de baja y moderada en hombres y mujeres respectivamente.El análisis de la puntuación de los ítems de laUSSQ reveló que el grupo de hidronefrosis moderadapresentó menos "dolor o molestia al orinar", menos"presencia de dolor de espalda al orinar", menos "admisióno procedimiento por molestia" y menos "sensaciónde reinserción". CONCLUSIÓN: Los pacientes del grupo de hidronefrosismoderada no ofrecen ventajas significativas encuanto a los síntomas de evacuación, el dolor, la saludgeneral, las cuestiones sexuales o los problemasdeterminados por el USSQ o en EVA. Sin embargo, elsubanálisis informó de ventajas relativas al dolor ypreguntas adicionales. Los hombres con hidronefrosismoderada presentaban un dolor estadísticamente significativodurante la micción.

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OBJECTIVE: Most of the studies regarding natural history of renal masses are based on active surveillance series and suggest that the renal masses have a slow growth rate. Nevertheless, only a few studies report the time between a normal computed tomography (CT) scan to the first detection of a tumor. We aimed to analyze the growth rate in newly diagnosed kidney tumors. MATERIAL AND METHODS: We analyzed patients with enhancing renal masses that developed after a normal CT scan, which was performed at most 12 months earlier. Variables examined included patient age, gender, tumor size, volume, tumor linear growth rate (LGR). All cases were surgically treated. Mann-Whitney U test was used to compare variables. A p<0.05 was considered as statistically significant. RESULTS: We found 31 patients with 33 lesions. Male to female ratio was 1.58 (19/12). The average age was 59.2 years (standard deviation [SD]±12.1), and the mean tumor size was 4.27 cm (SD±4.3). Tumor LGR was 0.87 cm/month (range: 0.28-1.66) and presumed to be 10.4 cm at 1 year (range: 3.36-19.9). Tumor LGR for time detection at <6 month or ≥6 months were 1.1 cm/month and 0.68 cm/month (range: 0.27-1.08 and 0.88-1.76, respectively; p=0.0004), respectively. Tumor LGRs for low- and high-grade tumors were 0.89 cm/month and 0.83 cm/month (p=0.65), respectively. Median volume was 36.1 cm3 (range: 2.61-143.7), and for low and high grade the median volumes were 27.9 cm3 and 47.6 cm3, respectively (p=0.54). Malignant pathology was present in 93.9 % (31 of 33) of masses (lesions). CONCLUSION: We found differences in tumor LGR in tumors detected before and after 6 months. We did not find any correlation between tumor growth rate and Fuhrman grade system, gender, histology, or age. We found the highest LGR published up to date.

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Introduction: Ejaculatory dysfunction is a common complication of surgeries for benign prostatic obstruction. It causes a clear deterioration in quality of life. Techniques have been developed to attempt to preserve antegrade ejaculation (AE). Our objective was to analyze results of ejaculatory function using an AE preservation technique during anatomical vaporization with XPS 180-W. Methods: Between 2017 and 2019, sexually active patients were treated using this technique by the same surgical team. A questionnaire (MSHQ-EjD Short Form) was mailed, patients who did not answer were contacted by phone or personally during follow-up. Responses were analyzed. Voiding function was evaluated using International Prostatic Symptoms Score (IPSS), Qmax, and postvoid residual volume. t-Test for paired samples was used to compare conformity of patients with and without AE and voiding results. A p < 0.05 was considered statistically significant. Results: In total, 77 of 112 patients (68.8%) completed questionnaires and were included. Mean age was 64.1 years (standard deviation [SD] 6.9) and median prostate size was 57.2 g (interquartilic range 30-85). A total of 68 of 77 (88.3%) patients reported AE. Of these, 58 (85.3%) reported AE always or most of the time and 10 (14.7%) reported AE half of the time. In total, 42 (61.7%) patients had preserved strength or slightly less than before the procedure, and 33 (48.5%) reported the same or slightly less volume than before. In terms of satisfaction, the average response values of patients with preserved AE and ejaculatory disfunction were 0.97 (SD 1.12) and 2.7 (SD 1.78), respectively (p = 0.000). Pre- and postoperative variables were as follows: mean Qmax was 11.6 mL/sec vs 19.6 (p = 0.00), mean IPSS was 13.8 vs 8.9 (p = 0.000), and mean postvoiding residual urine was 125.3 vs 33.1 mL (p = 0.00), respectively. Conclusion: It is feasible to perform the AE preservation technique with anatomical vaporization XPS 180-W. In our medium size prostate series, we had a satisfactory patient perception of the ejaculatory function and satisfactory voiding function results.

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Introduction and Background: Urinary diversion with the endoscopic Double-J stent is a frequent procedure; complications can include irritation, suprapubic or flank pain, vesicoureteral reflux, hematuria, or urinary infection. We report a case of hepatic subcapsular hematoma secondary to Double-J stent placement. Case Presentation: A 28-year-old woman presented with a history of Sjögren's disease, nephrocalcinosis, and chronic kidney disease (CKD). The patient underwent multiple percutaneous and endoscopic procedures during the previous 2 years: right kidney: extracorporeal shock wave lithotripsy (SWL) × 4, ureteroscopic lithotripsy × 2, percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery; left kidney: SWL × 2, ureteroscopic lithotripsy × 5, and PCNL. Ultrasound imaging showed severe dilation in the right kidney and moderate dilation in the left kidney. CT scanning without contrast revealed a right pyelourethral dilation caused by a 13 mm ureteral lithiasis; also, cortical atrophy was observed. Urosepsis with exacerbated CKD was diagnosed and bilateral 7F Double-J stents were placed on both sides under general anesthesia. On postoperative day (POD) 8, the patient presented with pain in the right hemithorax and dullness to percussion. CT scans showed a heterogeneous hepatic subcapsular collection, of 15 × 7 × 23 cm, of hematic aspect, displacing vascular structures, and no active bleeding. Treatment was expectant and symptomatic. On POD 16, a new CT scan ruled out progression of the hematoma. The patient was finally discharged on POD 19. Four months later, bilateral semirigid ureteroscopy showed a right ureteral lithiasis of 8 × 7 mm, which was fragmented with a holmium laser. Nineteen months after the first episode, the patient is asymptomatic, with no residual lithiasis or hepatic hematoma. Conclusion: This case shows a very rare complication of Double-J stent placement that could be managed by conservative treatment.

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