ABSTRACT
Resumen La fístula uro-entérica es una comunicación patológica entre la vía urinaria y digestiva. El compromiso del apéndice es infrecuente y son pocos los casos de fístulas reno-apendiculares en la literatura. Se presenta el caso de un paciente con clínica de fiebre, dolor lumbar e hidronefrosis derecha severa secundaria a cálculo coraliforme en la tomografía de vías urinarias. Manejado inicialmente con antibióticos y nefrostomía bajo fluoroscopia, posteriormente suspendida por paso de contraste al intestino. Se realizó una tomografía contrastada que reportó fístula del riñón al intestino. Se llevó a nefrectomía y se encontró fistula hacía el apéndice, por lo cual se realizó apendicectomía concomitante con mejoría clínica evidente. La patología reportó pielonefritis xantogranulomatosa y apendicitis secundaria. La fístula reno-apendicular posee una clínica inespecífica, la tomografía contrastada es una herramienta diagnóstica y la mayoría se detectan como un hallazgo intraoperatorio. El tratamiento usualmente es quirúrgico, con nefrectomía y reparación del segmento intestinal. MÉD. UIS.2021;34(3): 79-84.
Abstract Uro-enteric fistula is a pathological communication between the urinary and digestive tract. Compromise of the appendix is infrequent and few cases of reno-appendicular fistulas have been described in the literature. The case of patient with symptoms of fever, low back pain and severe right hydronephrosis secondary to staghorn calculus on urinary tract tomography is presented. Initially managed with antibiotics and nephrostomy under fluoroscopy, subsequently suspended by passing contrast to the intestine. A contrasted tomography was performed which reported a fistula from the kidney to the intestine. A nephrectomy was carried out and a fistula was found to the appendix, for which a concomitant appendectomy was performed with evident clinical improvement. The pathology reported xanthogranulomatous pyelonephritis and secondary appendicitis. Reno-appendicular fistula has nonspecific symptoms, contrasted tomography is a diagnostic tool and most are detected as an intraoperative finding. Treatment is usually surgical, with nephrectomy and intestinal segment repair. MÉD.UIS.2021;34(3): 79-84.
Subject(s)
Humans , Adult , Appendix , Pyelonephritis, Xanthogranulomatous , Urinary Fistula , Staghorn Calculi , Kidney , NephrectomyABSTRACT
La formación de cálculos en el sistema urinario es característica de la urolitiasis. Cuando los cálculos son mayores de 20 mm de largo se consideran voluminosos y coraliformes cuando llenan la pelvis renal y se ramifican en uno o más cálices. Los cálculos urinarios frecuentemente pueden comprometer la integridad y funcionalidad renal. Este estudio descriptivo y retrospectivo tiene como objetivo describir la composición de cálculos voluminosos y coraliformes obtenidos de 67 pacientes que concurrieron al IICS de marzo del 2007 a abril del 2011 y cumplieron con los criterios de inclusión. El análisis morfológico de los cálculos se realizó aplicando criterios mineralógicos y morfológicos descritos por Daudon et al. dando diferentes tipos morfológicos, cada uno con una composición dominante y una causa etiológica probable para la formación del cálculo. Los tipos más frecuentes en el núcleo fueron IVa1 y IIa compuestos respectivamente de carbapatita (fosfato de calcio) y Weddellita (oxalato de calcio dihidratado), mientras que Ia compuesto por Whewhellita (oxalato de calcio monohidratado) fue el tipo más frecuente en sección y superficie. En el 87% de los cálculos se detectó la presencia de 2 o más tipos morfológicos asociados, mostrando la etiología multifactorial de la urolitiasis. La cirugía abierta fue la técnica más frecuentemente empleada para remover el cálculo, 5 pacientes perdieron un riñón como consecuencia de la litiasis. Estos resultados apuntan a la importancia de la identificación correcta de la causa que genera los cálculos para seleccionar medidas apropiadas para evitar la recurrencia y las complicaciones severas.
The formation of stones in the urinary system is characteristic of urolithiasis. When thestones are bigger than 20 mm long they are considered voluminous and staghorn whenthey fill the renal pelvis and branch into one or more of the calices. Urinary stones could frequently compromise renal integrity and functionality. This descriptive and retrospective study aimed to describe the composition of voluminous and staghorn stones obtained from 67 patients who attended IICS from March, 2007 to April, 2011 and complied with the inclusion criteria. Morphological analysis of kidney stones was made by applying mineralogical and morphological criteria described previously by Daudon et al. giving different morphological types, each one with a dominant composition and a probable etiological cause of the stone formation. The more frequent types in the nucleus were IVa1 and IIa composed respectively of carbapatite (calcium phosphate) and weddellite (calciumoxalate dihidrated) while Ia composed of Whewhellite (calcium oxalate monohydrated) wasthe more frequent type in section and surface. The presence of 2 or more morphological types associated was detected in 87% of the stones, showing the multifactorial etiology of urolithiasis. Open surgery was the more frequent technique to remove the stones 5 patientslost one kidney as an outcome of lithiasis. This results point the importance of the correct identification of the cause that generates the stones to select proper measures to avoid recurrence and severe complications.
Subject(s)
Humans , Adult , Child , Middle Aged , Urinary Calculi , Urolithiasis , NephrolithiasisABSTRACT
Objective To access the safety and efficacy of balloon dilation in percutaneous nephrolithotomy for staghorn stones.Methods Clinical data of 64 patients with staghorn stone according to the inclusion criteria in our institution from April 2013 to April 2014 were collected and analyzed retrospectively.According to the dilation methods,the patients were divided into balloon dilation group (dilated to 24 F by balloon dilator,31 cases) and fascial dilation group (dilated to 16 F by Amplatz fascial dilator,33 cases).There was no significant difference in sex,age,body mass index between the 2 groups.The data of duration of percutaneous access,one-attempt success rate of dilation,puncture complications (kidney calices fracture,perinephric fluid collection and postoperative delayed hemorrhage etc.),removing stones time,stone free rate,hemoglobin drop after surgery and number of patients who experienced postoperative fever ＞37.5 ℃ were recorded.Results Compare to fascial dilation group,balloon dilatation group had significant differences in terms of duration of percutaneous access [(5.6± 2.1) min versus (9.4± 1.7) min],oneattempt success rate of dilation[100％ (31/31) versus 88％ (29/33)],removing stone time[(32.4±3.4) min versus (49.5±3.7) min],stone free rate [84％ (26/31) versus 61％ (20/33)],hemoglobin drop after surgery [(16.7±3.3) g/L versus (28.4±2.6) g/L],renal intrapelvic pressure[(19±3) mmHg versus (25±6) mmHg] and rate of patients who experienced postoperative fever ＞37.5 ℃ [16％ (5/31) versus 39％(13/33)] (P＜0.05).No injury of adjacent organs,including pleura,liver,spleen,or bowel was noted in all patients.Conclusions Balloon dilation is quick and safe with less hemorrhage when building percutaneous renal channel.And it has higher stone free rate and less complication rate in percutaneous nephrolithotomy with staghorn stones.
ABSTRACT
Objective To evaluate the efficacy and advantages of the technique by combined PCNL and retrograde intrarenal surgery (RIRS) in a second stage to treat the complex renal stones in solitary kidney cases.Methods PCNL most with a single 18-24 F tract was performed first and RIRS was carried out at a second stage in solitary kidneys of 21 patients,of which congenital in 14.3％ (3 cases),contralateral nephrectomy in 42.8％ (9 cases),and functional solitry kidneys in 42.8％ (9 cases).Of the 21 patients,the average age was 45 years with 15 males and 6 females.The stones were 8 multiple,6 partial staghorn,and 7 complete staghorn with a mean size of 4.6 (3.8-6.8) cm.Results Of the 21 PCNL cases,a single tract,double,triple tracts were established in 18 (85.7％),2 (9.5％),1 (4.8％) cases,respectively.Mean operation time of PCNL was 95 (45-175) min.After 1 day of PCNL,all case had residual stones with a mean size of 1.9 (1.0-3.5) cm.Two case occurred fever after PCNL and one case presented bleeding resolved by selective renal artery embolization.The mean operation time of RIRS was 72 (35-95) min.Stone-free rate after RIRS was 85.7％ (18/21).The final stone free rate increased to 95.2％ (20/21) after one case received a second-look PCNL and two cases accepted ESWL.Two cases occurred fever and steinstrasses after RIRS resolved by rigid ureteroscopy.At the 3 months follow-up,renal function became stable,improved and worse in 71.4％ (n=15),23.8％ (n=5),and 4.8％ (n=l) of patients.Conclusions PCNL combined with RIRS could be an effective and safe option for complex stones in solitary kidneys with less bleeding,reduced tracts,minor complications and good renal function preservation.
ABSTRACT
Objective To evaluate the clinical effects and safety of percutaneous nephrolithotomy (PCNL) by middle renal calice used as the main target for the treatment of staghorn stones with the combination of pneumatic and ultrasonic lithotrite.Methods Clinical data of 73 patients underwent PCNL by middle renal calices as main access with 57 incomplete staghorn stones and 35 complete staghorn stones.To observe the situation calculus removal rate and complications.Results Seventy cases (88 sides) underwent one session PCNL by single access tract (middle caliees),3 cases (4 sides) underwent one session PCNL by double access tracts (2 cases by middle and low calices,1 case by up and middle caliees).After the first period of lithoclasty,17 patients (25 sides) residual stones and the stone removal rate 72.8％ (67/92),among these patients,1 case (1 side) had fragments of lateral renal calyeeal stones with no further treatment.Other 16 cases (24 sides)underwent second session PCNL,all were treated by single access tract (middle calices) and 2 cases (2 sides)had extracorporeal shock wave lithotripsy before the second PCNL.After the second period of lithoclasty,76 sides composed of 27 complete staghorn stones and 49 incomplete staghorn stones had no residual fragments with the stone removal rate 82.6％ (76/92).The operative time lasted 120-320 min.Hemoglobin dropped 1-4 g/L,11 cases in the operation procedure and 3 cases after operation needed blood transfusion respectively.One case of renal pelvic infection after operation and 1 case had split renal dysfunction with peri-parenchyma infection.The hospitalization time was 9-18 days.Conclusion It is effective and safe to perform PCNL for staghorn stone by middle calices as a main access.Combining pneumatic and ultrasonic lithotrite will be very useful with high stone clearance,short procedure time and less complications.