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      Rentabilidad de la Ecografía en un Servicio de Urología Translated title: Cost-effectiveness of ultrasound in a urology department

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          Abstract

          La ecografía ha demostrado ser una prueba diagnóstica de gran sensibilidad, especificidad y exactitud. El urólogo es el profesional mas capacitado para sacar el máximo rendimiento a esta técnica, de forma que la disponibilidad de ecógrafos por parte de los Servicios de Urología racionaliza y limita la demanda de ecografías, disminuye de forma importante la petición de exploraciones radiológicas y reduce el número de cistoscopias, siendo un elemento indispensable en las consultas de Alta Resolución. Presentamos la estadística sobre la utilización de la ecografía en nuestro Servicio, en el que ha desaparecido la demanda de ecografías desde las Consultas de Urología al Servicio de Radiodiagnóstico. La tasa de utilización es muy alta y refleja el criterio funcional de uso de los ecógrafos. Al analizar la rentabilidad económica nos hemos encontrado con la ausencia casi total de ensayos clínicos controlados que comparen desde el punto de vista de rentabilidad económica las distintas técnicas de imagen utilizadas en Urología. No existen estudios de costes que comparen las ecografías realizadas por urólogos con las ecografías solicitadas a los Servicios de Radiología.

          Translated abstract

          Ultrasonography has demonstrated to be a precise test with high sensitivity and specificity. The urologist is the most capable professional to obtain the maximum effectiveness of this technique, so that the availability of ultrasound machines in urology departments rationalizes and limits the demand of ultrasound tests, diminishes significantly the indication of radiological tests and the number of cystoscopies, being an indispensable element in high-resolution office consultations. We report the statistics of the use of ultrasound in our department, with the disappearance of the demand of ultrasound tests from the urology outpatient clinic to the radiology department. The use rate is high, reflecting the functional criteria for use of the ultrasound equipment. In the economic analysis we found there is an almost complete absence of controlled clinical trials comparing the cost effectiveness of imaging tests in urology. There are not cost studies comparing ultrasounds performed by the urologist with those performed by radiologists.

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          Ultrasound vs CT for the detection of ureteric stones in patients with renal colic.

          The aim of our study was to compare the accuracy of non-contrast spiral CT with ultrasound (US) for the diagnosis of ureteral calculi in the evaluation of patients with acute flank pain. 62 consecutive patients with flank pain were examined with both CT and US over a period of 9 months. All patients were prospectively defined as either positive or negative for ureterolithiasis, based on follow-up evaluation. 43 of the 62 patients were confirmed as having ureteral calculi based on stone recovery or urological interventions. US showed 93% sensitivity and 95% specificity in the diagnosis of ureterolithiasis; CT showed 91% and 95%, respectively. Pathology unrelated to urinary stone disease was demonstrated in six patients. Although both modalities were excellent for detecting ureteral stones, consideration of cost and radiation lead us to suggest that US be employed first and CT be reserved for when US is unavailable or non-diagnostic.
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            Evaluation of renal masses detected by excretory urography: cost-effectiveness of sonography versus CT.

            The purpose of this study was to compare the cost-effectiveness of sonography and CT for the evaluation of renal masses discovered at excretory urography. The records of 225 patients with a renal mass shown by urography who then had either sonography or CT within 3 months were reviewed retrospectively. The number, location, and size of lesions; initial and subsequent imaging tests; and final diagnoses were determined. Using the current Medicare reimbursements for sonography and CT, we calculated the economic implications of using sonography or CT as the initial examination. Any effect of the location or size of the lesion on the most cost-effective examination was also determined. Twenty-one percent of patients had both initial sonography and follow-up CT because of indeterminate findings or detection of a solid mass that required further staging. When CT was done first, CT findings were equivocal in 12%, necessitating follow-up sonography. At the prevailing charges, CT would have to be needed in 70% of patients initially imaged with sonography to justify the use of CT as the initial examination. The location and size of the lesion did not affect the need for CT at a rate (greater than 70%) that would economically justify use of CT as the first imaging test. Eighty-six percent of patients with a mass detected by urography had either a simple cyst or no evidence of a mass on sonography or CT. Sonography is the most cost-effective imaging method for the workup of a renal mass detected at urography. The number of sonographic examinations in which findings are indeterminate or positive (for a solid mass) is not sufficiently high to warrant replacement of sonography by CT, regardless of the size and location of the lesion. CT should be reserved for a limited number of specific indications.
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              Resultados de una serie de 6000 pacientes con biopsia transrectal ecodirigida de próstata: Parte I: Anatomía patológica, tacto rectal, ecografía transrectal y PSA

              OBJETIVOS: Analizar los resultados de la Biopsia Transrectal Ecodirigida (BTE) prostática realizadas en 6000 pacientes así como su relación con los diferentes parámetros clínicos empleados habitualmente. MÉTODO: Se han recogido los datos de PSA, tacto rectal, características ecográficas y anatomía patológica de 6000 pacientes a los que se realizó BTE sextante desde 1994 a diciembre de 2002. De ellos 861 se han biopsiado en más de una ocasión sumando un total de 7127 biopsias. De forma general se realizó biopsia sextante obteniendo las muestras de la región más lateral de forma que incluyeran únicamente zona periférica. Se analizan los resultados patológicos y su relación con los parámetros estudiados. RESULTADOS: El porcentaje total de cáncer en las biopsias fue del 42,6% con un 39,1% en la primera biopsia. El conjunto de rebiopsias supone un incremento diagnóstico del 3,5%. Se detectó PIN o Atipia Glandular Focal en un 2 y 2,1% respectivamente. El porcentaje de pacientes con Gleason de 6 o menor aumentó del 41,8% en la primera biopsia al 70% en la tercera. Igualmente la afectación de un único cilindro pasó del 21,8 al 65%. La especificidad del tanto rectal y la presencia de nódulos hipoecogénicos fue del 82,6 y 78,2% respectivamente. La incidencia de cáncer con PSA entre 4 y 10 ng/ml fue del 29,6% y del 16,7% en aquellos con PSA inferior a 4 ng/ml . CONCLUSIÓN: La BTE de los cuernos laterales prostáticos mantiene una buena rentabilidad diagnóstica comparada con la mayoría de series de biopsias ampliadas. La sensibilidad de la ETR ha descendido pero mantiene una especificidad elevada por lo que no debe olvidarse al plantear la estrategia de la BTE.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                urol
                Archivos Españoles de Urología (Ed. impresa)
                Arch. Esp. Urol.
                INIESTARES, S.A. (, , Spain )
                0004-0614
                May 2006
                : 59
                : 4
                : 325-331
                Affiliations
                [01] Soria orgnameHospital Santa Bárnara orgdiv1Servicio de Urología España
                Article
                S0004-06142006000400002
                10.4321/s0004-06142006000400002
                1610ebff-651b-4810-b1c0-d02d0c48d33a

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 20, Pages: 7
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                SciELO Spain


                Ecografía,Rendimiento,Eficacia,Tasa de utilización Coste-beneficio,Variabilidad,Ecografía urológica,Ultrasound,Cost effectiveness,Efficacy,Use rate,Cost benefit,Variability,Urological ultrasound

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