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Eficacia y seguridad de la ureteroscopia y la cirugía retrógrada intrarrenal sin fluoroscopia para el tratamiento de la urolitiasis: estudio comparativo
Efficacy and safety of fluoroless ureteroscopy and retrograde intrarenal surgery for the treatment of urolithiasis: A comparative study
C. Laranjo Tinocoa,
Autor para correspondencia
cat.tinoco@gmail.com

Autor para correspondencia.
, A. Coutinhoa, A. Cardosoa, A.S. Araújoa, R. Matosa, S. Anacletoa, P. Motaa,b,c
a Servicio de Urología, Hospital de Braga, Braga, Portugal
b Escuela de Medicina, Universidad de Minho, Braga, Portugal
c Centro Clínico Académico (2CA-Braga), Braga, Portugal
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De ah&#237; ha surgido la aplicaci&#243;n de principios como ALARA &#40;acr&#243;nimo de <span class="elsevierStyleItalic">As Low As Reasonably Achievable</span>&#41; y la creaci&#243;n de protocolos destinados a reducir el uso de radiaci&#243;n&#46; Los pacientes con c&#225;lculos urinarios suelen estar expuestos a radiaci&#243;n ionizante tanto durante el diagn&#243;stico como durante el tratamiento&#44; adem&#225;s de m&#250;ltiples veces a lo largo del curso de la enfermedad debido a su tasa de recurrencia de cerca del 50&#37; a los 10<span class="elsevierStyleHsp" style=""></span>a&#241;os<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a>&#46; Los efectos de la radiaci&#243;n pueden clasificarse como deterministas&#44; los cuales se producen de forma predecible por encima de un umbral de radiaci&#243;n espec&#237;fico y cuya gravedad es dependiente de la dosis&#44; y como estoc&#225;sticos&#44; tales como la carcinog&#233;nesis&#44; que pueden producirse de forma impredecible con cualquier grado de exposici&#243;n a la radiaci&#243;n&#46; Aunque la frecuencia de los efectos deterministas es bastante baja en los procedimientos urol&#243;gicos debido a la poca radiaci&#243;n aplicada en cada procedimiento&#44; los pacientes podr&#237;an sufrir un mayor riesgo de efectos estoc&#225;sticos&#46; Los endour&#243;logos que realizan un alto volumen de procedimientos guiados por fluoroscopia a lo largo de su carrera parecen tener tambi&#233;n un mayor riesgo de sufrir estas complicaciones&#44; a pesar del equipo de protecci&#243;n&#44; aunque algunos estudios informan bajas tasas de exposici&#243;n a la radiaci&#243;n para los ur&#243;logos<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Teniendo en cuenta estas preocupaciones&#44; en este estudio nos propusimos comparar la eficacia y la seguridad de la URS y la CRIR sin fluoroscopia frente a las t&#233;cnicas convencionales guiadas por fluoroscopia en el tratamiento de las litiasis ureterales y renales&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materiales y m&#233;todos</span><p id="par0015" class="elsevierStylePara elsevierViewall">Se trata de un estudio observacional retrospectivo que incluy&#243; adultos con litiasis ureterales y&#47;o renales tratados con URS o CRIR entre agosto de 2018 y diciembre de 2019 en el Hospital de Braga &#40;Portugal&#41;&#46; Los criterios de exclusi&#243;n fueron la ausencia de c&#225;lculos durante la cirug&#237;a&#59; procedimientos bilaterales&#59; anomal&#237;as anat&#243;micas &#40;estenosis ureteral que impidiera el paso del ureteroscopio&#44; sistema colector duplicado&#41;&#59; neoplasia urotelial&#59; di&#225;metro del c&#225;lculo superior a 3<span class="elsevierStyleHsp" style=""></span>cm&#44; y datos insuficientes en las historias cl&#237;nicas de los pacientes&#46; Los pacientes incluidos se clasificaron en dos grupos seg&#250;n el uso de fluoroscopia&#58; el grupo tratado de manera convencional con fluoroscopia &#40;grupo<span class="elsevierStyleHsp" style=""></span>F&#43;&#41; y el grupo tratado sin fluoroscopia &#40;grupo<span class="elsevierStyleHsp" style=""></span>F&#8722;&#41;&#46; El uso de fluoroscopia se determin&#243; seg&#250;n el d&#237;a de la semana&#44; y los casos quir&#250;rgicos de cada d&#237;a se seleccionaron independientemente de la t&#233;cnica preestablecida&#46; En los d&#237;as programados para tratamiento sin fluoroscopia no se planific&#243; la presencia de un t&#233;cnico radi&#243;logo en el quir&#243;fano&#46; No obstante&#44; el equipo de fluoroscopia siempre estuvo disponible en el quir&#243;fano&#44; por lo que&#44; en caso de requerir el uso de fluoroscopia urgente durante la cirug&#237;a&#44; se contactaba en el momento con el t&#233;cnico de radiolog&#237;a del servicio de urgencias&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Este estudio fue aprobado por el Comit&#233; de &#201;tica del Hospital de Braga &#40;n&#250;mero de aprobaci&#243;n 160&#95;2020&#41;&#46; Los datos se recogieron de las historias cl&#237;nicas individuales de los pacientes&#46; Se garantiz&#243; el anonimato de los pacientes y la confidencialidad de sus datos&#46; Los datos recogidos incluyeron las caracter&#237;sticas demogr&#225;ficas de los pacientes&#44; los datos cl&#237;nicos&#44; las variables quir&#250;rgicas&#44; la tasa libre de c&#225;lculos &#40;TLC&#41;&#44; las complicaciones y la duraci&#243;n de la estancia hospitalaria&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas de los c&#225;lculos se obtuvieron a partir de una tomograf&#237;a computarizada &#40;TC&#41; preoperatoria&#59; las TC tambi&#233;n se utilizaron para comprobar la presencia de variaciones anat&#243;micas&#44; aunque en la mayor&#237;a de casos se realizaron sin contraste intravenoso&#46; Para el tama&#241;o de los c&#225;lculos se consider&#243; el di&#225;metro m&#225;ximo del c&#225;lculo m&#225;s grande en cualquier plano anat&#243;mico&#46; El estado libre de c&#225;lculos fue evaluado por el cirujano al finalizar el procedimiento endosc&#243;pico mediante una inspecci&#243;n sistem&#225;tica de las v&#237;as urinarias y confirmado por imagen &#40;TC o ecograf&#237;a&#41; en los 3<span class="elsevierStyleHsp" style=""></span>meses posteriores a la cirug&#237;a&#44; seg&#250;n la disponibilidad&#46; El estado libre de c&#225;lculos se defini&#243; como la ausencia de c&#225;lculos residuales de m&#225;s de 4<span class="elsevierStyleHsp" style=""></span>mm y de s&#237;ntomas que requirieran reintervenci&#243;n&#46; En los casos en que no se realizaron pruebas de imagen&#44; generalmente por falta de disponibilidad&#44; el estado libre de c&#225;lculos se determin&#243; mediante la evaluaci&#243;n final del cirujano y la ausencia de s&#237;ntomas&#46; Se tuvieron en cuenta las complicaciones intraoperatorias y postoperatorias hasta un mes despu&#233;s de la intervenci&#243;n&#46; Todas las complicaciones se clasificaron seg&#250;n la clasificaci&#243;n de Clavien-Dindo<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a>&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">T&#233;cnica quir&#250;rgica</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se administr&#243; tratamiento profil&#225;ctico preoperatorio con cefoxitina&#46; Tras la colocaci&#243;n del paciente en posici&#243;n de litotom&#237;a&#44; se introdujo un ureteroscopio semirr&#237;gido y se inspeccion&#243; la vejiga&#46; De forma rutinaria&#44; se pas&#243; una gu&#237;a hidrof&#237;lica de seguridad&#44; y en casos de dif&#237;cil acceso se confirm&#243; la colocaci&#243;n correcta bajo visi&#243;n directa con ayuda del ureteroscopio&#46; Se realiz&#243; ureterorrenoscopia semirr&#237;gida o flexible seg&#250;n la localizaci&#243;n del c&#225;lculo&#46; Durante la CRIR flexible se inspeccionaron todos los c&#225;lices de forma sistem&#225;tica&#44; independientemente del uso de fluoroscopia&#46; Se utiliz&#243; l&#225;ser Holmium&#58;YAG &#40;Dornier&#174;&#44; Alemania&#41; para la fragmentaci&#243;n de los c&#225;lculos con t&#233;cnica de pulverizaci&#243;n <span class="elsevierStyleItalic">&#40;dusting&#41;</span>&#59; no se utilizaron cestas ni otros instrumentos para la extracci&#243;n de los c&#225;lculos fragmentados&#46; Se opt&#243; por realizar un cateterismo ureteral al finalizar el procedimiento con cat&#233;ter doble<span class="elsevierStyleHsp" style=""></span>J o uniJ &#40;Coloplast&#174;&#44; Reino Unido&#41; seg&#250;n el tama&#241;o del fragmento de c&#225;lculo&#44; el traumatismo ureteral o la inflamaci&#243;n&#44; y la experiencia del cirujano&#59; en los casos sin fluoroscopia&#44; la gu&#237;a fue mediante visualizaci&#243;n directa&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El equipo fluorosc&#243;pico siempre estuvo disponible en el quir&#243;fano&#44; pero solo se utiliz&#243; en el grupo<span class="elsevierStyleHsp" style=""></span>F&#43;&#46; La fluoroscopia se utiliz&#243; para confirmar la colocaci&#243;n correcta de las gu&#237;as y cat&#233;teres&#44; visualizar la anatom&#237;a del sistema colector e identificar la localizaci&#243;n de los c&#225;lculos &#40;cuando se trataba de c&#225;lculos radioopacos&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">An&#225;lisis estad&#237;stico</span><p id="par0040" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se realiz&#243; con IBM&#174; SPSS&#174; Statistics&#44; v&#46;27&#46;0&#46; La comparaci&#243;n de grupos se realiz&#243; con la prueba de chi cuadrado &#40;&#967;<span class="elsevierStyleSup">2</span>&#41; para variables categ&#243;ricas&#44; la prueba t de Student &#40;t&#41; para variables continuas con distribuci&#243;n normal y la prueba U de Mann-Whitney &#40;U&#41; para variables continuas sin distribuci&#243;n normal&#46; La normalidad se evalu&#243; mediante el histograma&#44; los valores de asimetr&#237;a y curtosis y la prueba de Kolmogorov-Smirnov&#46; Se realiz&#243; un an&#225;lisis de subgrupos de acuerdo con el tipo de procedimiento &#40;URS o CRIR&#41;&#46; Se utiliz&#243; un an&#225;lisis multivariante con regresi&#243;n log&#237;stica para identificar los predictores de c&#225;lculos residuales&#46; Se rechaz&#243; la hip&#243;tesis nula para valores de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Caracter&#237;sticas de los pacientes</span><p id="par0045" class="elsevierStylePara elsevierViewall">Este estudio incluy&#243; a 231 pacientes&#58; 132 varones &#40;57&#44;1&#37;&#41; y 99 mujeres &#40;42&#44;9&#37;&#41;&#44; con una edad media de 55<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;DE<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#41;&#46; Los pacientes se agruparon seg&#250;n el uso de fluoroscopia durante la URS o la CRIR&#58; 120 pacientes &#40;51&#44;9&#37;&#41; en el grupo de t&#233;cnica convencional con fluoroscopia &#40;grupo<span class="elsevierStyleHsp" style=""></span>F&#43;&#41; y 111 pacientes &#40;48&#44;1&#37;&#41; en el grupo sin fluoroscopia &#40;grupo<span class="elsevierStyleHsp" style=""></span>F&#8722;&#41;&#46; Las caracter&#237;sticas de los pacientes se resumen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">No se encontraron diferencias estad&#237;sticamente significativas entre los grupos en cuanto al sexo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;692&#41;&#44; la edad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;295&#41; y el cat&#233;ter ureteral o nefrostom&#237;a previos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;672&#41;&#46; El grupo<span class="elsevierStyleHsp" style=""></span>F&#43; ten&#237;a m&#225;s pacientes con antecedentes de tratamiento liti&#225;sico que el grupo<span class="elsevierStyleHsp" style=""></span>F&#8722; &#40;24&#44;2&#37; vs&#46;12&#44;6&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;028&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En el grupo sin fluoroscopia hab&#237;a m&#225;s pacientes con c&#225;lculos &#250;nicos &#40;77&#44;5&#37; vs&#46; 61&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41; y con c&#225;lculos ureterales &#40;70&#44;8&#37; vs&#46; 33&#44;3&#37;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; y menos pacientes con c&#225;lculos renales &#40;33&#44;3&#37; vs&#46; 70&#44;8&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; El tipo de cirug&#237;a &#40;URS vs&#46; CRIR&#41; tambi&#233;n fue significativamente diferente entre los grupos &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#58; la frecuencia de CRIR fue mayor en el grupo<span class="elsevierStyleHsp" style=""></span>F&#43; &#40;70&#44;8&#37;&#41; y la de URS fue mayor en el grupo<span class="elsevierStyleHsp" style=""></span>F&#8722; &#40;66&#44;7&#37;&#41;&#46; Las variables intra y postoperatorias se describen en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">El tiempo quir&#250;rgico fue significativamente mayor en el grupo tratado con t&#233;cnica convencional con fluoroscopia &#40;Md<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#44;5<span class="elsevierStyleHsp" style=""></span>min vs Md<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#44;0<span class="elsevierStyleHsp" style=""></span>min&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Ning&#250;n paciente del grupo<span class="elsevierStyleHsp" style=""></span>F&#8722; necesit&#243; fluoroscopia de urgencia&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">La tasa libre de c&#225;lculos no present&#243; una diferencia significativa entre los grupos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;127&#41;&#58; el grupo<span class="elsevierStyleHsp" style=""></span>F&#43; obtuvo una tasa libre de c&#225;lculos del 82&#44;5&#37; y el grupo<span class="elsevierStyleHsp" style=""></span>F&#8722;&#44; del 90&#44;1&#37;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Solo se describieron 3 complicaciones intraoperatorias&#46; No hubo diferencias estad&#237;sticamente significativas entre los grupos en cuanto a la tasa de complicaciones postoperatorias &#40;35&#44;0&#37; vs&#46; 31&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;675&#41; ni en cuanto al grado de las complicaciones seg&#250;n la clasificaci&#243;n de Clavien-Dindo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;981&#41;&#46; El dolor fue la complicaci&#243;n postoperatoria m&#225;s frecuente en ambos grupos&#46; Las complicaciones de grado<span class="elsevierStyleHsp" style=""></span>I fueron las m&#225;s notificadas&#44; y no se observ&#243; ninguna complicaci&#243;n de grado<span class="elsevierStyleHsp" style=""></span>IV o<span class="elsevierStyleHsp" style=""></span>V&#46; La duraci&#243;n media de la estancia hospitalaria fue de 1<span class="elsevierStyleHsp" style=""></span>d&#237;a en ambos grupos&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">An&#225;lisis de subgrupos por tipo de procedimiento</span><p id="par0080" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis de subgrupos seg&#250;n el tipo de procedimiento&#58; URS &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>109&#41; vs&#46; CRIR &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>122&#41;&#46; No hubo diferencias estad&#237;sticamente significativas entre los grupos con o sin fluoroscopia en cuanto a las caracter&#237;sticas demogr&#225;ficas&#46; Las variables relativas a los subgrupos se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">En el subgrupo URS&#44; la TLC fue similar entre los subgrupos con fluoroscopia y sin fluoroscopia &#40;91&#44;4&#37; vs 94&#44;6&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;678&#41;&#46; No hubo diferencias significativas en la tasa de complicaciones &#40;31&#44;4 vs&#46; 28&#44;4&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;823&#41; ni en el grado de Clavien-Dindo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;874&#41;&#46; El tiempo quir&#250;rgico fue significativamente mayor en la URS guiada por fluoroscopia &#40;Md<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#44;0<span class="elsevierStyleHsp" style=""></span>min vs Md<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#44;5<span class="elsevierStyleHsp" style=""></span>min&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">El subgrupo de CRIR mostr&#243; resultados similares&#58; ninguna diferencia estad&#237;sticamente significativa en la TLC &#40;78&#44;8&#37; vs&#46; 81&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;814&#41;&#44; complicaciones &#40;36&#44;5&#37; vs&#46; 37&#44;8&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;00&#41; y grado &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;00&#41;&#44; y un tiempo quir&#250;rgico significativamente mayor en el grupo de fluoroscopia &#40;Md<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55&#44;0<span class="elsevierStyleHsp" style=""></span>min vs&#46; Md<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#44;0<span class="elsevierStyleHsp" style=""></span>min&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lisis multivariante</span><p id="par0095" class="elsevierStylePara elsevierViewall">En el an&#225;lisis multivariante con regresi&#243;n log&#237;stica&#44; la cirug&#237;a sin fluoroscopia no fue un predictor independiente de c&#225;lculos residuales &#40;OR&#58; 0&#44;991&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;407-2&#44;411&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;983&#41;&#46; Solo el tama&#241;o &#40;OR&#58; 1&#44;167&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;069-1&#44;274&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y el n&#250;mero &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>c&#225;lculos&#41; &#40;OR&#58; 2&#44;889&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;268-6&#44;586&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;012&#41; de los c&#225;lculos fueron predictores independientes de c&#225;lculos residuales&#46; El aumento de 1<span class="elsevierStyleHsp" style=""></span>mm en el di&#225;metro del c&#225;lculo supon&#237;a un incremento de la probabilidad de c&#225;lculos residuales del 16&#44;7&#37;&#46; Los pacientes con m&#225;s de un c&#225;lculo ten&#237;an 2&#44;9 veces m&#225;s probabilidades de fragmentaci&#243;n incompleta&#46; Estos resultados se ilustran en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">Los pacientes con urolitiasis est&#225;n expuestos a una cantidad considerable de radiaci&#243;n ionizante durante el diagn&#243;stico y el tratamiento&#44; la cual puede aumentar teniendo en cuenta el car&#225;cter recurrente de esta enfermedad&#46; Casi el 20&#37; de los pacientes de este estudio hab&#237;a recibido tratamiento liti&#225;sico previo&#46; Esta incidencia acumulada puede suponer un riesgo importante y justifica la creaci&#243;n de protocolos de dosis reducidas de radiaci&#243;n y t&#233;cnicas totalmente libres de fluoroscopia&#46; Los resultados de este estudio demuestran que tanto la URS como la CRIR pueden realizarse sin gu&#237;a fluorosc&#243;pica&#44; con tasas libres de c&#225;lculos comparables a las de los procedimientos convencionales y sin un mayor porcentaje o grado de complicaciones&#46; En el an&#225;lisis multivariante con regresi&#243;n log&#237;stica&#44; los &#250;nicos factores predictivos de c&#225;lculos residuales fueron el tama&#241;o del c&#225;lculo y la presencia de c&#225;lculos m&#250;ltiples&#46; Estos resultados coinciden con la bibliograf&#237;a disponible<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6-11</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Una de las principales fortalezas de este estudio es el n&#250;mero de pacientes incluidos&#46; Dos estudios retrospectivos comparativos realizados por Olgin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a> y Manzo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> con un menor n&#250;mero de pacientes tampoco identificaron diferencias significativas entre los procedimientos con fluoroscopia y sin fluoroscopia&#44; en cuanto a la tasa libre de c&#225;lculos y a las complicaciones&#46; Un estudio aleatorizado de G&#252;ner y G&#252;nayd&#305;n<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a> mostr&#243; tasas de complicaciones y TLC similares entre la CRIR con fluoroscopia y sin fluoroscopia&#46; Una revisi&#243;n sistem&#225;tica y metaan&#225;lisis de Subiela et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a> tampoco mostr&#243; diferencias estad&#237;sticamente significativas en la TLC y las complicaciones de los pacientes tratados con gu&#237;a fluorosc&#243;pica o con una t&#233;cnica sin fluoroscopia&#46; Los protocolos sin fluoroscopia se estudiaron en otras poblaciones m&#225;s sensibles a los efectos de la radiaci&#243;n&#44; como la pedi&#225;trica&#44; con resultados favorables<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">12&#44;13</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Manzo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> informaron de una TLC global m&#225;s baja en ambos grupos&#44; en torno al 64&#37;&#44; y los autores la asocian a la confirmaci&#243;n de c&#225;lculos residuales &#40;&#62;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mm&#41; en la TC&#44; debido a su alta sensibilidad&#46; La elevada TLC en nuestro estudio puede estar relacionada con la definici&#243;n de TLC utilizada &#40;c&#225;lculos asintom&#225;ticos de 4<span class="elsevierStyleHsp" style=""></span>mm o inferiores&#41; y la ausencia de confirmaci&#243;n de c&#225;lculos residuales mediante TC en algunos pacientes&#46; No obstante&#44; nuestra TLC de m&#225;s del 90&#37; concuerda con el estudio prospectivo de G&#252;ner y G&#252;nayd&#305;n<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a> y con la TLC combinada del metaan&#225;lisis realizado por Subiela et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a> &#40;89&#37;&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">El tipo de cirug&#237;a difiri&#243; significativamente entre los grupos&#44; realiz&#225;ndose m&#225;s CRIR en el grupo con fluoroscopia y m&#225;s URS en el grupo sin fluoroscopia&#46; Esto se relacionaba con las diferencias en la carga liti&#225;sica y la localizaci&#243;n de los c&#225;lculos entre los grupos&#44; lo cual no pudimos controlar debido a la naturaleza retrospectiva del estudio&#44; aunque no hubo una selecci&#243;n deliberada de casos menos complejos para los d&#237;as sin fluoroscopia&#46; Para superar esta limitaci&#243;n&#44; se realiz&#243; un an&#225;lisis de subgrupos&#44; que no mostr&#243; diferencias en la TLC ni en la tasa de complicaciones entre los procedimientos con y sin fluoroscopia en el subgrupo de CRIR y en el de URS&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Nuestros resultados de un tiempo quir&#250;rgico mayor en el grupo de fluoroscopia &#8212;tanto en el an&#225;lisis principal como en el an&#225;lisis de subgrupos&#8212; son contrarios a la literatura publicada<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6-8</span></a>&#46; La colocaci&#243;n y la movilizaci&#243;n del equipo de fluoroscopia&#44; que en nuestro centro suelen realizarse despu&#233;s de pasar la primera gu&#237;a&#44; y el tiempo empleado en interpretar las im&#225;genes fluorosc&#243;picas&#44; pueden contribuir de forma significativa a esta diferencia&#46; Se podr&#237;a reducir el tiempo quir&#250;rgico en estos casos colocando el equipo fluorosc&#243;pico antes de iniciar la intervenci&#243;n&#46; Otras posibles causas son las diferencias en la carga liti&#225;sica y en el equipo quir&#250;rgico&#44; que no se controlaron&#46; Estas intervenciones fueron realizadas por al menos diez cirujanos distintos con diferentes niveles de experiencia&#44; algunos de los cuales eran residentes en formaci&#243;n&#46; Es posible que los cirujanos m&#225;s experimentados eligieran procedimientos sin fluoroscopia con m&#225;s frecuencia&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Estos procedimientos se realizaron sin vaina de acceso ureteral &#40;VAU&#41;&#44; como es habitual en nuestro centro&#46; La ausencia de VAU simplifica el procedimiento sin fluoroscopia&#44; ya que uno de los principales usos de la fluoroscopia es ayudar a su correcta colocaci&#243;n&#46; No obstante&#44; tambi&#233;n se han descrito t&#233;cnicas para su colocaci&#243;n sin ayuda de la fluoroscopia<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">10&#44;11&#44;13</span></a>&#46; Emiliani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> suelen realizar una ureteroscopia semirr&#237;gida para confirmar la colocaci&#243;n adecuada de la gu&#237;a y determinar la longitud de la vaina de acceso&#59; primero introducen el obturador y luego avanzan la VAU sobre la gu&#237;a hasta alcanzar la longitud predeterminada&#44; si no hay resistencia&#46; Los cirujanos experimentados aconsejan actuar con precauci&#243;n si se produce alguna resistencia durante el procedimiento&#46; En tales casos&#44; algunos autores sugieren retirar la VAU e inspeccionar el ur&#233;ter para comprobar la presencia de lesiones o estenosis&#46; Ante la dificultosa colocaci&#243;n de la VAU&#44; se recomienda posponer la intervenci&#243;n y dejar un cat&#233;ter ureteral en su lugar<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a>&#46; Peng et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a> describen su t&#233;cnica consistente en utilizar vainas ureterales de menor di&#225;metro &#40;9&#44;5&#47;11&#44;5<span class="elsevierStyleHsp" style=""></span>Ch&#41; si el paciente no era portador de un cat&#233;ter previamente&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Nos gustar&#237;a resaltar que el objetivo de este estudio no es eliminar el uso de la gu&#237;a fluorosc&#243;pica en la URS y la CRIR&#46; Su uso debe sopesarse en cada caso&#44; seg&#250;n las caracter&#237;sticas espec&#237;ficas y la complejidad de cada paciente&#44; y la fluoroscopia es probablemente indispensable en pacientes con malformaciones anat&#243;micas &#40;como los ri&#241;ones en herradura&#41;&#44; por ejemplo&#46; Sin embargo&#44; es posible reducir la radiaci&#243;n utilizada&#44; y algunos estudios revelan que la simple medida de alertar a los cirujanos de los efectos de la radiaci&#243;n conduce a una menor utilizaci&#243;n de la fluoroscopia<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a>&#46; Seg&#250;n nuestra experiencia&#44; navegar por todos los c&#225;lices con visi&#243;n directa en pacientes con anatom&#237;a normal es sencillo en la mayor&#237;a de los casos&#44; pudiendo descartar la fluoroscopia en estas situaciones&#46; Aunque el equipo fluorosc&#243;pico estuvo siempre disponible en el quir&#243;fano como medida de seguridad&#44; ninguno de nuestros pacientes tratados sin fluoroscopia necesit&#243; su uso de forma urgente&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">La principal limitaci&#243;n de este estudio es su dise&#241;o retrospectivo&#44; sin un registro de datos uniforme&#44; y la notificaci&#243;n subjetiva de las complicaciones&#46; Esto condujo a un sesgo significativo en la selecci&#243;n de los pacientes y a la disparidad entre grupos&#44; el cual minimizamos con un an&#225;lisis de subgrupos&#46; Tambi&#233;n puede considerarse una limitaci&#243;n el hecho de que no todos los pacientes fueron sometidos a una tomograf&#237;a computarizada para confirmar la tasa libre de c&#225;lculos&#44; que en ocasiones se comunicaba con base en otras pruebas de imagen o en la evaluaci&#243;n del cirujano&#46; Estas limitaciones deben tenerse en cuenta a la hora de dise&#241;ar futuros estudios prospectivos&#46; Creemos que&#44; a pesar de estas limitaciones&#44; nuestro estudio demuestra la eficacia y la seguridad de la URS y la CRIR sin fluoroscopia para el tratamiento de las litiasis ureterales y renales&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusiones</span><p id="par0140" class="elsevierStylePara elsevierViewall">Los resultados de este estudio muestran que la URS y la CRIR sin fluoroscopia son t&#233;cnicas factibles&#44; eficaces y seguras para el tratamiento de los c&#225;lculos ureterales y renales en casos seleccionados &#40;pacientes sin anomal&#237;as anat&#243;micas con c&#225;lculos de menos de 3<span class="elsevierStyleHsp" style=""></span>cm en los que es posible una visi&#243;n endosc&#243;pica directa&#41;&#46; Esto es especialmente importante a la hora de reducir la exposici&#243;n a la radiaci&#243;n de pacientes y profesionales&#46; Sin embargo&#44; la gu&#237;a fluorosc&#243;pica se debe seguir utilizando en casos complejos y siempre que el cirujano lo considere necesario&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Se requieren m&#225;s estudios&#44; concretamente ensayos prospectivos aleatorizados&#44; para confirmar estos hallazgos y apoyar el dise&#241;o de protocolos de t&#233;cnicas endourol&#243;gicas sin fluoroscopia&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Financiaci&#243;n</span><p id="par0150" class="elsevierStylePara elsevierViewall">Esta investigaci&#243;n no recibi&#243; ninguna subvenci&#243;n espec&#237;fica de organismos de financiaci&#243;n de los sectores p&#250;blico&#44; comercial o de entidades sin &#225;nimo de lucro&#46;</p></span></span>"
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              "titulo" => "Caracter&#237;sticas de los pacientes"
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            1 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "An&#225;lisis de subgrupos por tipo de procedimiento"
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              "titulo" => "An&#225;lisis multivariante"
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    "fechaRecibido" => "2023-01-24"
    "fechaAceptado" => "2023-03-26"
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          "palabras" => array:4 [
            0 => "Litiasis urinaria"
            1 => "Ureteroscopia"
            2 => "Fluoroscopia"
            3 => "Exposici&#243;n a la radiaci&#243;n"
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Urolithiasis"
            1 => "Ureteroscopy"
            2 => "Fluoroscopy"
            3 => "Radiation exposure"
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    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Las t&#233;cnicas convencionales de ureteroscopia &#40;URS&#41; y cirug&#237;a retr&#243;grada intrarrenal &#40;CRIR&#41; requieren el uso de gu&#237;a fluorosc&#243;pica&#44; pero los riesgos derivados de la exposici&#243;n a radiaciones ionizantes constituyen un motivo de preocupaci&#243;n entre pacientes y ur&#243;logos&#46; El objetivo de este estudio fue evaluar la eficacia y la seguridad de la URS y la CRIR sin fluoroscopia y compararlas con los procedimientos convencionales guiados por fluoroscopia para el tratamiento de litiasis ureterales y renales&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los pacientes tratados con URS o CRIR para litiasis urinaria entre agosto de 2018 y diciembre de 2019 fueron evaluados retrospectivamente y agrupados seg&#250;n el uso de o la ausencia de fluoroscopia&#46; Los datos se recopilaron de las historias individuales de los pacientes&#46; Los criterios de valoraci&#243;n principales fueron la tasa libre de c&#225;lculos &#40;TLC&#41; y las complicaciones&#44; comparadas entre los grupos con fluoroscopia y sin fluoroscopia&#46; Se realiz&#243; un an&#225;lisis de subgrupos por tipo de procedimiento &#40;URS y CRIR&#41; y un an&#225;lisis multivariante para identificar los factores predictivos de litiasis residual&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Un total de 231 pacientes cumplieron los criterios de inclusi&#243;n&#58; 120 &#40;51&#44;9&#37;&#41; en el grupo tratado con fluoroscopia convencional y 111 &#40;48&#44;1&#37;&#41; en el grupo tratado sin fluoroscopia&#46; No se hallaron diferencias significativas entre los grupos en cuanto a la TLC &#40;82&#44;5&#37; vs&#46; 90&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;127&#41; o de complicaciones postoperatorias &#40;35&#44;0&#37; vs&#46; 31&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;675&#41;&#46; No se hallaron diferencias significativas entre estas variables en el an&#225;lisis de subgrupos&#44; independientemente del procedimiento considerado&#46; En el an&#225;lisis multivariante&#44; la t&#233;cnica realizada sin fluoroscopia no fue un predictor independiente de litiasis residual &#40;OR&#58; 0&#44;991&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;407-2&#44;411&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;983&#41; cuando se ajust&#243; por tipo de procedimiento&#44; tama&#241;o y n&#250;mero de c&#225;lculos&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La URS y la CRIR pueden realizarse sin gu&#237;a fluorosc&#243;pica en casos seleccionados&#44; sin afectar la eficacia ni la seguridad del procedimiento&#46;</p></span>"
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            "titulo" => "Introducci&#243;n"
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            "titulo" => "Material y m&#233;todos"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Ureteroscopy &#40;URS&#41; and retrograde intrarenal surgery &#40;RIRS&#41; are traditionally guided by fluoroscopy&#44; but the risks of exposure to ionizing radiation may present a matter of concern for patients and urologists&#46; The aim of this study was to evaluate the efficacy and safety of fluoroless URS and RIRS compared with conventional fluoroscopy-guided procedures for the treatment of ureteral and renal stones&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Patients treated with URS or RIRS for urolithiasis between August 2018 and December 2019 were retrospectively evaluated and grouped according to the use of fluoroscopy&#46; Data was collected from individual patient records&#46; The main outcomes were stone-free rate &#40;SFR&#41; and complications&#44; compared between the fluoroscopy and fluoroless groups&#46; A subgroup analysis by type of procedure &#40;URS and RIRS&#41; and a multivariate analysis to identify predictors of residual stones were conducted&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 231 patients met the inclusion criteria&#58; 120 &#40;51&#46;9&#37;&#41; in the conventional fluoroscopy group and 111 &#40;48&#46;1&#37;&#41; in the fluoroless group&#46; No significant differences were found between groups regarding SFR &#40;82&#46;5&#37; vs 90&#46;1&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;127&#41; or postoperative complication rate &#40;35&#46;0&#37; vs 31&#46;5&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;675&#41;&#46; In the subgroup analysis these variables did not present significant differences&#44; regardless of the procedure considered&#46; In the multivariate analysis the fluoroless technique was not an independent predictor of residual lithiasis &#40;OR&#58; 0&#46;991&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>IC&#58; 0&#46;407-2&#46;411&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;983&#41;&#44; when adjusted for procedure type&#44; stone size and stone number&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">URS and RIRS can be done without fluoroscopic guidance in selected cases&#44; without affecting the efficacy or safety of the procedure&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0065">Presentaci&#243;n en el Congreso Mundial de Endourolog&#237;a y Uro-Tecnolog&#237;a 2021&#46;</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CRIR&#58; cirug&#237;a retr&#243;grada intrarrenal&#59; DE desviaci&#243;n est&#225;ndar&#59; LOCh&#59; litotricia por ondas de choque&#59; M&#58; media&#59; Md&#58; mediana&#59; NLPC&#58; nefrolitotom&#237;a percut&#225;nea&#59; RIC&#58; rango intercuart&#237;lico&#59; URS ureteroscopia&#46;</p>"
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                  \t\t\t\t">67 &#40;55&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">65 &#40;58&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Edad &#40;a&#241;os&#41;&#44; M &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">54&#44;1 &#40;13&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;295<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Cat&#233;ter previo&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">65 &#40;54&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66 &#40;59&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;429<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cat&#233;ter ureteral</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">60 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">62 &#40;55&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nefrostom&#237;a percut&#225;nea</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Tratamiento liti&#225;sico previo&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;5&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Lateralidad c&#225;lculos&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;595<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Izquierdo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">68 &#40;56&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">67 &#40;60&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Derecho</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52 &#40;43&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44 &#40;39&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">N&#250;mero de c&#225;lculos&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;010<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">1</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">74 &#40;61&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">86 &#40;77&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#8805; 2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#40;38&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;22&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Localizaci&#243;n de los c&#225;lculos&#44; n &#40;&#37;&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ur&#233;ter</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#40;38&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79 &#40;71&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Distal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;39&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Proximal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;27&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;31&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ri&#241;&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85 &#40;70&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Pelvis renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;21&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;13&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>C&#225;liz inferior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;42&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;18&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>C&#225;liz medio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;5&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>C&#225;liz superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;3&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Di&#225;metro m&#225;ximo del c&#225;lculo &#40;mm&#41;&#44; Md &#40;RIC&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;0 &#40;6&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;0 &#40;6&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Tipo de procedimiento&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">URS</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;29&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;66&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">CRIR</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85 &#40;70&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3295092.png"
              ]
            ]
          ]
          "notaPie" => array:4 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Prueba de chi-cuadrado&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Prueba t de Student&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">La suma de estas localizaciones es mayor que el n&#250;mero de pacientes debido a que algunos pacientes ten&#237;an m&#250;ltiples c&#225;lculos&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Prueba U de Mann-Whitney&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Datos demogr&#225;ficos y cl&#237;nicos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>231&#41;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; M&#58; media&#59; Md&#58; mediana&#59; OM&#58; orden medio&#59; RIC&#58; rango intercuart&#237;lico&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FluoroscopiaGrupo F&#43; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>120&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sin fluoroscopiaGrupo F&#8722; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>111&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tiempo quir&#250;rgico &#40;min&#41; Md &#40;RIC&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">52&#44;5 &#40;30&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27&#44;0 &#40;20&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tiempo de fluoroscopia &#40;s&#41;&#44; Md &#40;RIC&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;0 &#40;11&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Kerma en aire &#40;mGy&#41;&#44; Md &#40;RIC&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;49 &#40;1&#44;27&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Producto dosis &#225;rea &#40;Gy&#183;cm</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;&#44; Md&#40;RIC&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;081 &#40;0&#44;248&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;048<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Doble J&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;50&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;60&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>UniJ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;48&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;35&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estado libre de c&#225;lculos&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99 &#40;82&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;90&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;127<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Complicaciones intraoperatorias&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;00<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemorragia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V&#243;mitos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Complicaciones postoperatorias&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;35&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;31&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;675<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dolor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;10&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;13&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>C&#243;lico renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#225;useas &#47; v&#243;mitos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;3&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">3 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fiebre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ITU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;5&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hematuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;10&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>STUI de almacenamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;9&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estado mental alterado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Migraci&#243;n del cat&#233;ter&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Clavien-Dindo&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;981<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sin complicaciones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 &#40;65&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75 &#40;67&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">31 &#40;25&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27 &#40;24&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;7&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IIIb&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Duraci&#243;n estancia hospitalaria &#40;d&#237;as&#41;&#44; Md &#40;RIC&#41; &#91;OM&#93;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;0 &#40;1&#44;0&#41; &#91;126&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;0 &#40;0&#44;0&#41; &#91;105&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">URS &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>109&#41;</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CRIR &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>122&#41;</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FluoroscopiaGrupo F&#43;&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sin fluoroscopiaGrupo F&#8722;&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>74&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FluoroscopiaGrupo F&#43;&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sin fluoroscopiaGrupo F&#8722;&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tiempo quir&#250;rgico &#40;min&#41; Md&#40;RIC&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">40&#44;0 &#40;25&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">22&#44;5 &#40;15&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;0 &#40;31&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#44;0 &#40;22&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estado libre de c&#225;lculos&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;91&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">70 &#40;94&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;678<a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;78&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;81&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;814<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Complicaciones intraoperatorias&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;00<a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;00<a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Complicaciones postoperatorias&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">11 &#40;31&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;28&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;823<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">31 &#40;36&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">14 &#40;37&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;00<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Clavien-Dindo&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">0&#44;874<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;00<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sin complicaciones&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">54 &#40;63&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23 &#40;62&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>I&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;28&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;24&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;24&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;9&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;10&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IIIb&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                      "doi" => "10.7326/0003-4819-111-12-1006"
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                            3 => "S&#46;R&#46; Shim"
                            4 => "H&#46;K&#46; Chang"
                            5 => "C&#46;H&#46; Kim"
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