Urolitiasis en lactantes: un reto diagnóstico y terapéutico. Reporte de un caso

La litiasis urinaria en niños obedece a cambios nutricionales, ambientales, climáticos, predisposición genética, infecciones del tracto urinario, anomalías metabólicas y/o anatómicas subyacentes, su incidencia es de 1-3%, la cual se ha incrementado en la última década. Se presenta lactante masculino de 22 meses, con presencia de cálculos a nivel uretral con proceso infeccioso asociado, quien requirió procedimiento invasivo para la extracción de un cálculo y documentaron hiperuricosuria, hipomagneseuria e hipercalciuria, sin antecedente familiar de litiasis renal. La urolitiasis en lactantes es relevante dado el papel que puede tener en la etiología de la infección urinaria y en el deterioro progresivo de la función renal, abarca un manejo integral multidisciplinario debido a su carácter recurrente y que aún no existe un tratamiento curativo, es importante establecer los factores de riesgo, definir estrategias para el diagnóstico temprano y acciones para su prevención y procedimientos menos invasivos para la extracción de los cálculos.

Urinary lithiasis in children are due to nutritional, environmental, climatic changes, genetic predisposition, urinary tract infections, underlying metabolic and/or anatomical anomalies. Its incidence is 1-3%, which has increased in the last decade. We present the case of a 22-month-old male infant, who presented with stones at the urethral level with an associated infectious process, and who required an invasive procedure for the extraction of a stone. The patient had documented hyperuricosuria, hypomagneseuria and hypercalciuria, without a family history of kidney stones. Urolithiasis in infants is relevant given the role it can play in the etiology of urinary infection and the progressive deterioration of kidney function. Its treatment encompasses comprehensive multidisciplinary management due to its recurrent nature and the fact that there is still no curative treatment. It is important to identify risk factors, define strategies for early diagnosis, preventive measures and less invasive procedures for stone extraction.

Cistotomía asistida por laparoscopia en un caballo de Paso Fino con cálculo vesical / Laparoscopic assisted cystotomy in a Paso Fino horse with a cystic calculus / Cistotomia assistida por laparoscopia em um cavalo de Paso Fino com cálculo na bexiga

Resumen La urolitiasis es la presencia de concreciones minerales de los cristales de orina en las vías urinarias. En los equinos esta patología tiene una prevalencia baja (0,4% a 0,5%), su presentación se da en riñones y vejiga generalmente, siendo ésta última el sitio de mayor frecuencia. Los urolitos más reportados en caballos se encuentran compuestos por carbonato de calcio. El diagnóstico se realiza comúnmente relacionando los hallazgos del examen clínico junto con la ecografía. Para el tratamiento se realiza abordaje quirúrgico. Un equino macho castrado, criollo colombiano, de doce años y un peso de 350 kg fue remitido para interconsulta por la presentación histórica de dos meses de pigmenturia y disuria, a la palpación transrectal se encontró una estructura redonda y compacta de aproximadamente 7 cm de diámetro ubicada en la vejiga, lo cual fue confirmado mediante ecografía vesical y cistoscopia, a su vez, se realizó citología del sedimento urinario. El abordaje terapéutico se hizo mediante manejo médico y quirúrgico por la técnica de cistotomía asistida por laparoscopia. El objetivo de este artículo es describir el primer reporte de caso de un urolito y de una cistotomía asistida por laparoscopia en un Caballo Criollo Colombiano.

Abstract Urolithiasis is the presence of mineral concretions or urine crystals at the urinary tract. In horses, urolithiasis has a relatively low prevalence (​0.4% to 0.5%), its presentation occurs at the level of the kidneys and the urinary bladder, the last one is the site of the greatest presentation. Most of the uroliths in horses are constituted for calcium carbonate. The diagnosis is commonly made by relating the findings of the clinical examination along with the ultrasound. Surgical resolution is the election for treatment. The patient was a 350 kg, twelve years old Colombian creole gelding referred with historical presentation of two months of pigmenturia and dysuria, to the transrectal palpation a round structure of approximately 7 cm of diameter was located in the urinary bladder, which was confirmed by ultrasound and cystoscopy, in addition, cytology of the urinary sediment was performed. The therapeutic approach was made with medical and surgical management by assisted laparoscopic approach. The aim of this case report is to describe for the first time a case of urolithiasis and its resolution by assisted laparoscopy in a Colombian Creole Horse.

Resumo A urolitíase é a presença de concreções minerais macroscópicas de cristais de urina no trato urinário. A prevalência desta afeccão em equinos é relativamente baixa (0,4% a 0,5%), geralmente acomete rins e vesicula urinária, sendo esta última o principal local de apresentação. A maior porcentagem dos urólitos de equinos é composta de carbonato de cálcio. O diagnóstico é comumente feito pela associacão dos achados do exame clínico e ultrassonográficos. A abordargem cirurgica é normalmente o tratamento de escolha, sendo realizada por meio de laparocistotomia. O paciente deste relato era um cavalo crioulo colombiano, com doze anos e pesando 350 kg, que foi encaminhado com histórico de dois meses de pigmenturia e disúria. A palpação transretal revelou uma estrutura esférica de cerca de 7 cm de diâmetro dentro bexiga, o foi confirmado por ultrassonografia e cistoscopia, seguido por citologia do sedimento urinário . A abordagem terapêutica foi realizada com manejo médico e cirúrgico, que consistiu de técnica de cistotomia assistida por videolaparoscopia. O objetivo deste relato de caso é descrever o primeiro caso de um urólito e uma cistotomia assistida por laparoscopia em um Cavalo Crioulo Colombiano.

Purple urine bag syndrome: case report / Síndrome do saco coletor de urina roxo: relato de caso

ABSTRACT A 65-year-old male with a history of urinary tract trauma requiring cystotomy and chronic bladder catheterization, presenting with chronic and uninvestigated changes in the color of the urine bag system, with no urine color change, and positive urine culture for Proteus mirabilis . These characteristics refer to the purple urine bag syndrome, a not weel-known condition, with a benign course in most cases, and associated with urinary tract infection in patients with chronic bladder catheterization. Although it is characterized by marked changes, it is underdiagnosed by healthcare professionals.

RESUMO Homem de 65 anos com história de trauma do sistema urinário, sendo necessário cistotomia e sondagem vesical crônica, apresentando alterações crônicas e não investigadas da cor do sistema coletor de urina, sem alteração da cor da urina, e urocultura positiva para Proteus mirabilis . Tais características remetem à síndrome do saco coletor de urina roxo, uma entidade pouco conhecida, de curso benigno na maioria da vezes, associada à infecção urinária em paciente com cateterismo vesical de demora. Embora seja caracterizada por alterações marcantes, é subdiagnosticada pelos profissionais de saúde.

A twisted tale of a transurethrally inserted foreign body

@#A transurethrally-inserted foreign body is a rare urologic case that may be brought about by deviant sexual behavior or mental disability. This is a case of a 42-year old male presenting with repeated episodes of inserting a twisted electrical wire into his urethra. He already underwent open transvesical extraction of intravesical screw two years prior. A pre-operative pelvic x-ray confirmed the length of the intravesical component of the electrical wire. Open transvesical extraction of the wire was done followed by urethroscopy to ensure the absence of a urethral injury. An open approach was chosen over an endoscopic one because of the significant intravesical component of the foreign body. The patient did not experience any post-operative complications such as fever and superficial wound infections. He was referred to psychiatry service cleared for any deviant behavioral or psychiatric conditions.

Clinical value of suprapubic Trocar puncture lithotripsy in the treatment of benign prostatic hyperplasia and bladder stones / 中国基层医药

Objective@#To evaluate the clinical value of suprapubic Trocar puncture lithotripsy in the treatment of benign prostatic hyperplasia and bladder stones.@*Methods@#From February 2016 to August 2018, 60 patients with benign prostatic hyperplasia and bladder stones in the Second Hospital of Pujiang County were randomly selected.The patients were divided into transurethral prostatic bipolarplasma electrotomy group(control group, 30 cases) and transurethral prostatic bipolar excision procedure combined with suprapubic Trocar puncture cystinolithotomy group(study group, 30 cases) according to the operation methods.The operation time, stone extraction time, removal of bladder fistula time, catheter extraction time, success of one stone extraction, postoperative complications of the two groups were statistically analyzed.@*Results@#The operation time, stone removal time, bladder fistula removal time and catheter removal time of the study group were significantly shorter than those of the control group(t=6.965, 4.541, 3.365, 3.306, all P<0.05). The success rate of the first stone extraction in the study group was 100.0%(30/30), which was significantly higher than 86.7%(26/30) in the control group (χ2=12.83, P<0.05). The incidence rate of postoperative complications in the study group was 10.0%(3/30), which was significantly lower than 23.3%(7/30) in the control group(χ2=13.34, P<0.05).@*Conclusion@#Suprapubic Trocar puncture lithotripsy has high value in the treatment of benign prostatic hyperplasia and bladder stones.

Clinical value of suprapubic Trocar puncture lithotripsy in the treatment of benign prostatic hyperplasia and bladder stones / 中国基层医药

Objective To evaluate the clinical value of suprapubic Trocar puncture lithotripsy in the treatment of benign prostatic hyperplasia and bladder stones.Methods From February 2016 to August 2018,60 patients with benign prostatic hyperplasia and bladder stones in the Second Hospital of Pujiang County were randomly selected.The patients were divided into transurethral prostatic bipolarplasma electrotomy group (control group,30 cases) and transurethral prostatic bipolar excision procedure combined with suprapubic Trocar puncture cystinolithotomy group (study group,30 cases) according to the operation methods.The operation time,stone extraction time,removal of bladder fistula time,catheter extraction time,success of one stone extraction,postoperative complications of the two groups were statistically analyzed.Results The operation time,stone removal time,bladder fistula removal time and catheter removal time of the study group were significantly shorter than those of the control group(t =6.965,4.541,3.365,3.306,all P ＜0.05).The success rate of the first stone extraction in the study group was 100.0％ (30/30),which was significantly higher than 86.7％ (26/30) in the control group (x2 =12.83,P ＜0.05).The incidence rate of postoperative complications in the study group was 10.0％ (3/30),which was significantly lower than 23.3％ (7/30) in the control group(x2 =13.34,P ＜ 0.05).Conclusion Suprapubic Trocar puncture lithotripsy has high value in the treatment of benign prostatic hyperplasia and bladder stones.

Pseudotumor vesical a causa de un dispositivo intrauterino / Vesical pseudotumor due to an intra-uterine device

Se describe el caso clínico de una paciente atendida en el Hospital Oncológico Docente Provincial Conrado Benítez García de Santiago de Cuba por presentar una perforación en la vejiga y desplazamiento de un dispositivo intrauterino hacia la cavidad vesical, lo cual generó la formación de litiasis y, consecuentemente, la aparición de frecuentes infecciones urinarias y dolor en bajo vientre, sin mejoría alguna ante la terapéutica aplicada. Se decidió realizar una cistotomía para extraer la litiasis compacta junto con la T de cobre; la paciente evolucionó favorablemente y los síntomas desaparecieron

The case report of a patient assisted in Conrado Benítez García Teaching Provincial Cancer Hospital in Santiago de Cuba is described, due to a bladder perforation and displacement of an intra-uterine device toward the vesical cavity, which generated the lithiasis formation and, consequently, emergence of frequent urinary infections and pain in lower abdomen, without any improvement with therapy. It was decided to carry out a cystotomy to extract the lithiasis compacted with the copper T; the patient had a favorable clinical course and the symptoms disappeared

Efficacy and safety of modified transurethral plasmakinetic enucleation of prostate combined with cystolithectomy in elderly patients with high risk of large volume benign prostatic hyperplasia complicated with large urinary bladder calculi / 中国医师进修杂志

Objective To evaluate the efficacy and safety of modified transurethral plasmakinetic enucleation of prostate (M-TPEP) combined with cystolithectomy in elderly patients with high risk of large volume benign prostatic hyperplasia (BPH) complicated with large urinary bladder calculi. Methods Seventy-one patients with high risk of large volume BPH complicated with large urinary bladder calculi were selected, and the patients were treated with M-TPEP combined with cystolithectomy. The operation time, intraoperative blood loss, hospitalization time, complications, and the maximum urinary flow rate (Qmax), post-void residual volume (PVR), serum potassium, international prostate symptom score (IPSS), quality of life (QOL) score preoperative and postoperative 3 months were recorded. Results Seventy-one patients successfully completed the operation, and no death occurred. The operation time was (75.48 ± 6.51) min, intraoperative blood loss was (82.63 ± 10.08) ml, and postoperative hospitalization time was 5-7 d. Incidence of intraoperative capsule perforation was 2.82% (2/71), incidence of postoperative temporary urinary incontinence was 7.04% (5/71), incidence of urethral and bladder irritation after operation was 8.45% (6/71), and incidence of postoperative wound infection was 2.82% (2/71). The PVR, IPSS and QOL score 3 months after operation were significantly lower than those before operation: (6.89 ± 0.74) ml vs. (205.13 ± 40.08) ml, (2.71 ± 0.45) scores vs. (28.62 ± 3.57) scores and (1.36 ± 0.24) scores vs. (4.93 ± 0.38) scores, the Qmaxwas significantly higher than that before operation: (22.46 ± 2.97) ml/s vs. (5.24 ± 0.43) ml/s, and there were statistical differences (P＜0.01);there was no statistical difference in serum potassium between before operation and 3 months after operation (P＞0.05). Conclusions M-TPEP combined with cystolithectomy has short operation time, quick recovery after operation and low complication rate. It is a proper operative method for the elderly patients with high risk of large volume BPH and large urinary bladder calculi.

Novel laparoscopic repair of VVF with limited cystotomy

Background: A Fistula is an extra anatomic communication between two or more epithelial lined body cavities or skin surface. Most of the vesicovaginal fistulas in industrialized and well developed countries are iatrogenic and most of the vesicovaginal fistulas in underdeveloped and developing countries are obstetric. Materials and methods: 10 cases of VVF presented to OGH OPD from October 2013 till September 2016 with age range 22 years to 43 years were included in study. Radiation fistulas, malignant fistulas, complex obstetric fistulas were excluded. Eight of the Ten cases were post hysterectomy (TAH) supra trigonal fistulas (7 single fistulas 1 case had two fistulas side by side), One case was post obstetric trigonal fistula, One case was post caesarean section where the fistula was in the anterior fornix close cervix. Results: Out of 10 patients, we had 1 port site infection, fever in 2 cases, increased drain for initial 2 days in 1 case. None of the 10 cases required blood transfusion, and there was no leak per vagina in all cases before and after catheter removal. All the patients were working patients, and resumed their work as early as 12 days after surgery. Conclusion: Conventional open repair with bivalving of bladder is associated with morbidity in the form of higher pain scores, higher HB % drop, prolonged hospitalization, prolonged catheterizations, and delayed resumption of work. Laparoscopic repair with limited cystotomy overcomes all the disadvantages of the conventional repair with equal results

Mitomicina C: Una Nueva Alternativa para la Estenosis de Cuello Vesical / Mitomycin C: A New Alternative for Bladder Neck Stenosis

Introducción: La mitomicina C es un agente quimiotera-péutico en virtud a su actividad antiproliferativa y anti-biótica. Se evalúa el resultado de la cervicotomía radial endoscópica combinada con la inyección intralesional de mitomicina C para el tratamiento de las estenosis severas de cuello vesical luego del fracaso del trata-miento tradicional. Materiales y método: Revisión retrospectiva de los pa-cientes con estenosis severa de cuello vesical intervenidos entre julio de 2013 y agosto de 2015 con la utilización de mitomicina C. El 54.5% de los pacientes había fracasado al menos una vez con la realización de cervicotomía interna y/o resección endoscópica de cuello vesical. En nuestra intervención se realizaron tres o cuatro incisiones endoscópicas con corte frío en el cuello de la vejiga, seguido por la inyección intralesional de 0.3 a 0.4 mg/ml de mitomicina C en cada sitio de incisión. Resultados: Un total de 11 pacientes fueron tratados con incisión endoscópica con corte frío en el cuello de la vejiga combinado con la inyección de mitomicina C. Antes de la operación, 4 pacientes (36%) eran usuarios de cistotomía. En un seguimiento medio de 9 meses (rango 1-20) 9 pacientes (82%) se encuentran con micción espontánea posterior a un procedimiento, mientras que 2 pacientes (18%) lograron dicho objetivo después de 2 procedimientos con utilización de mitomicina C. Conclusiones: El tratamiento para la estenosis del cuello vesical con cervicotomía radial endoscópica con corte frío combinada con inyección intralesional de mitomicina C, resultó en la permeabilidad del cuello vesical en el 82% de los pacientes después de 1 procedimiento y en el 100% después de 2 procedimientos. Aunque los primeros resultados son prometedores, se requiere de estudios prospectivos y aleatorizados con seguimiento prolongado en el tiempo para validar estos hallazgos.

Introduction: The mitomycin C is a chemotherapeutic agent by virtue of its antiproliferative and antibiotic ac-tivity. We evaluated the outcome of endoscopic radial cervicotomy combined with intralesional mitomycin C injection for the treatment of severe bladder neck ste-nosis after traditional treatment failure.Materials and methods: It was a retrospective review of patients with severe bladder neck stenosis who had a surgery between July 2013 and August 2015 with mi-tomycin C. The 54.5% of patients had failed at least 1 time with internal cervicotomy and/or endoscopic re-section of the bladder neck. In our intervention, three or four endoscopic incisions were performed with a cold cut in the neck of the bladder, followed by intralesio-nal injection of 0.3 to 0.4 mg / ml of the mitomycin C at each incision site.Results: A total of 11 patients were treated with endos-copic incision with a cold cut in the neck of the bladder combined with mitomycin C injection. Before the sur-gery 4 patients (36%) were cystostomy users. At a mean follow-up of 9 months (range 1-20), 9 patients (82%) had spontaneous urine after 1 procedure, while 2 patients (18%) achieved this goal after 2 procedures using mi-tomycin C.Conclusions: The treatment for bladder neck stenosis with endoscopic radial cervicotomy with cold cut com-bined with intralesional mitomycin C injection resulted in bladder neck permeability in 82% of patients after 1 procedure and 100% after 2 procedures. Although the first results are promising, some prospective and rando-mized studies with long-term monitoring are required to validate these findings.

Treatment of Recurred Iris Cyst with Laser Photocoagulation and Cystotomy

PURPOSE: To report a case of recurred iris cyst 11 years after treatment with endodiathermy, which was treated with laser photocoagulation and cystotomy followed by intraocular pressure elevation and underwent anterior chamber irrigation. CASE SUMMARY: A 46-year-old female presented to our department with decreased vision in her left eye that had persisted for several months. The patient had a history of surgical removal of an iris cyst with endodiathermy 11 years ago. Slit lamp examination showed an iris cyst adjacent to the nasal corneal limbus. The cyst was filled with turbid fluid. It distorted the pupil and threatened visual axis. Iris cystotomy (diameter larger than 500 microm) was done with diode laser photocoagulation and a neodymiumdoped yttrium aluminium garnet laser. At the same day, the patient's intraocular pressure elevated to 50 mm Hg in spite of maximal conservative treatment and went through anterior chamber irrigation. After six months, the iris cyst was adhered to corneal endothelium and disappeared. Visual acuity and intraocular pressure was within normal range. CONCLUSIONS: An iris cyst can recur after treatment with endodiathermy. Recurred iris cyst can be successfully treated with laser photocoagulation and cystotomy. However, turbid fluid inside the cyst may outflow to the anterior chamber and cause secondary ocular hypertension after treatment, so careful observation is needed.

Evaluation of intraluminal pressure in cystorrhaphies with and without intestinal serosal patch supplementation from canine cadavers

PURPOSE:To evaluate the maximal intraluminal pressure (MIP) supported by canine cadaveric urinary bladders that underwent cystotomy followed by cystorraphy, with and without serosal patching-supplementation.METHODS:Two groups (n=8 each) were formed, and in one (conventional) the cystotomy was closed with cushing pattern. In the other group (serosal), the same procedure was performed, and a piece of jejunum was used for the construction of the serosal patching over the cystorraphy. MIP was measured by means of an invasive blood pressure transducer with closed stopcock attached to a multiparameter monitor. At the end of each measurement, the bladder body circumference was assessed.RESULTS:Mean±SD MIP sustained for the conventional and serosal groups were 28.88±5.08 and 65.38±10.99 mmHg, respectively (p<0.0001). Bladder circumference did not change significantly between groups (p=0.35) and did not correlate with MIP assessed in conventional (p=0.27; r=0.4379) and serosal groups (p=0.37; r=-0.3637).CONCLUSION:Serosal patch-supplemented cystorraphies were able to sustain intraluminal pressures 55.8% higher, than nonsupplemented cystorraphies in specimens from canine cadavers.

Endometriosis de debut con manifestaciones urinarias: a propósito de dos casos / Debut endometriosis with urinary manifestations: report of two cases

FUNDAMENTO: la endometriosis es una condición benigna que afecta del 15 al 20 % de las mujeres en estado fértil. Generalmente afecta órganos como los ovarios, los ligamentos uterinos, las trompas de Falopio, el recto y la región cérvico-vaginal. Sin embargo, la probabilidad de que afecte el tracto urinario es poco común y sucede solo en el 1% de los pacientes. CASOS CLÍNICOS: se presentan dos casos con endometriosis, una localizada en la trompa derecha y otra en la vejiga, el primero comprometió de forma grave la función renal; el ultrasonido y la cistoscopia fueron fundamentales en el diagnóstico. La Laparotomía exploradora y la anatomía patológica fueron concluyentes se le realizó tumorectomía con Ooforectomía a uno de los casos que necesitó además una remodelación del diámetro ureteral y reimplantación con técnica anti reflujo, al segundo caso se le realizó cistotomía exploradora con exéresis de tumoración en hemitrígono izquierdo y conservación del meato ureteral en su posición anatómica, ambos pacientes egresaron, el primero a los 19 días y el segundo a las 72 horas con seguimiento por la consulta externa. CONCLUSIONES: la Endometriosis afectando las vías urinarias es poco frecuente pero puede presentarse con manifestaciones urinarias inespecíficas, dismenorrea y hematuria, puede diagnosticarse con los estudios imaginológicos y endoscópicos del tracto urinario y puede llegar a ocasionar lesiones irreversibles de la función renal y reproductiva.

BACKGROUND: endometriosis is a benign condition that affects 15 to 20 % of women in fertile state. It generally affects organs like ovaries, uterine ligaments, fallopian tubes, rectum, and the cervico-vaginal region. However, the probability of it affecting the urinary tract is uncommon and happens only in the 1 % of the patients. CLINICAL CASES: two cases of endometriosis are presented. One of the cases presented the endometriosis in the right fallopian tube and the other one in the bladder. In the first case the renal function was compromised; the ultrasound and cytoscopy were essential in the diagnosis. The exploratory laparotomy and pathological anatomy were conclusive. One of the patients underwent a tumorectomy, an oophorectomy, a remodeling of the urethral diameter, and a reimplantation with anti reflux technique. The second case underwent an exploratory cystotomy with exeresis of a tumor in the left hemitrigono and conservation of the ureteral meatus in its anatomical position. Both patients were discharged from hospital; the first patient 19 days later and the second one 72 hours later. A follow-up care was established. CONCLUSIONS: the endometriosis that affects urinary tracts is not very frequent but it can appear with non-specific urinary manifestations, dysmenorrhea and hematuria. It can be diagnosed through endoscopic and imaging studies of the urinary tract and can even