Fibrosis retroperitoneal como causa de uropatía obstructiva. Reporte de caso / Retroperitoneal fibrosis as a cause of obstructive uropathy. Case report

Resumen La fibrosis retroperitoneal es una patología rara, en la mayoría de los casos idiopática, aunque se ha asociado a medicamentos, neoplasias y otras enfermedades de tejido conectivo. Histopatológicamente se evidencia inflamación y depósito de tejido fibrótico en el retroperitoneo y se caracteriza por cubrir los uréteres provocando lesión renal aguda obstructiva siendo ésta, la manifestación más frecuente; el diagnóstico definitivo se obtiene únicamente con biopsia y la base del tratamiento es la corticoterapia, aunque en casos severos y en resistencia a los corticoides se han usado otras terapias como los inmunomuladores. En ocasiones son necesarias las intervenciones quirúrgicas para el manejo de las complicaciones. Se presenta el caso de un hombre de 50 años que ingresó al servicio de urgencias del Hospital San José por dolor abdominal, los paraclínicos demostraron elevación de los azoados y en las imágenes diagnósticas hidronefrosis izquierda con componente de tejido blando interaortocava y periaórtico, se realizó biopsia retroperitoneal y se hizo diagnóstico de fibrosis retroperitoneal idiopática, se instauraron nefrostomías bilaterales y se inició manejo con corticoide.

Abstract Retroperitoneal fibrosis is a rare, in most cases idiopathic, pathology, although it has been associated with medications, neoplasms and other connective tissue diseases. In terms of histopathology, inflammation and deposits of fibrotic tissue in the retroperitoneum are observed and, characteristically, this covers the urethra, provoking acute obstructive kidney damage, the most frequent manifestation of the disease. The definitive diagnosis is obtained solely via biopsy, and the basis of treatment is corticotherapy, although in severe cases, and where resistance to corticosteroids exists, other treatments have been used, such as immunomodulators. Occasionally, surgical interventions are necessary to manage complications. The case of a 50-year-old man who came to the Hospital emergency service due to abdominal pain is presented. Paraclinical studies showed azotemia, and diagnostic images showed left hydronephrosis with a component of interaortocaval and periaortic soft tissue. A retroperitoneal biopsy was conducted, and a diagnosis of idiopathic retroperitoneal fibrosis was made. Bilateral nephrostomies were put in place and treatment with corticosteroids was initiated.

Comparison of the outcomes of laparoscopic pyeloplasty with and without concomitant pyelolithotomy

ABSTRACT Objective We aimed to evaluate the results of laparoscopic pyeloplasty with concomitant pyelolithotomy and compare results with a cohort of patients undergoing laparoscopic pyeloplasty without pyelolithotomy. Materials and Methods We retrospectively reviewed records of 43 patients undergoing transperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty between December 2012 and July 2018 at our department. Eighteen patients (42%) underwent laparoscopic pyeloplasty with concomitant pyelolithotomy. The results of patients with renal stones were compared with 25 matched patients undergoing laparoscopic pyeloplasty without concomitant renal stones. Demographic data, operative and stone parameters were compared between the groups. Results The groups were similar regarding to demographic characteristics. All operations were completed laparoscopically with no conversions to open surgery. In 3 cases without renal stones and 15 cases with renal stones, transposition of the ureter due to crossing vessels was performed. The mean stone size was 13±5.24 mm, and the median number of stones was 1 (1-18). The success of laparoscopic pyeloplasty with and without pyelolithotomy was 93.3% and 92.9%, respectively, as confirmed by negative diuretic renogram at postoperative 3rd months. Overall stone-free rate after laparoscopic pyelolithotomy was 93.3%. Mean operative time was 222.6765.71 minutes vs. 219.11±75.63 minutes for the pyeloplasty with concomitant pyelolithotomy vs. pyeloplasty, respectively (p=0.88). Conclusions Laparoscopic pyeloplasty with concomitant pyelolithotomy is a safe and effective intervention with associated good cosmetic results and high stone-free rates without significant increase in operative time or complications.

Tumor de Wilms: experiencia de 15 años en un Hospital de niños, Córdoba, Argentina / Wilms tumor: 15 years of experience at a children's hospital in Córdoba, Argentina

El objetivo de este trabajo fue describir la epidemiología, la presentación, el tratamiento y el seguimiento nefrológico de niños con tumor de Wilms. Se recopilaron datos de 46 pacientes. Se encontró baja edad de presentación (< 40 meses), con síntomas iniciales de dolor, masa abdominal y fiebre. La histología prevalente fue nefroblastoma tipo mixto. Todos los pacientes recibieron quimioterapia prequirúrgica seguida, en la mayoría de los casos, de nefrectomía unilateral. Los pacientes con alto riesgo histológico tuvieron un riesgo relativo de morir de 7,2 (IC 75 %: 1,5-33,7) con respecto al resto y de recidiva de 2,5 (IC 75 %: 1,0-6,4). La sobrevida libre de enfermedad a 5 años fue del 70 %. El 80 % mantuvo la función renal en estadio I al completar el tratamiento oncológico. El factor pronóstico más importante fue la histología. Estos pacientes requieren seguimiento nefrológico prolongado.

The objective of this study was to describe the epidemiology, clinical presentation, treatment and nephrology follow-up of children with Wilms tumor. Data from 46 patients were collected. The clinical presentation occurred at a young age (< 40 months old), with initial symptoms of pain, abdominal mass, and fever. The prevalent histology type was mixed nephroblastoma. All patients received pre-surgery chemotherapy followed by, in most cases, unilateral nephrectomy. Patients with a high histological risk had a 7.2 relative risk of death (75 % confidence interval: 1.5-33.7) compared to the rest, and a 2.5 relative risk of recurrence (75 % confidence interval: 1.0-6.4). Disease-free survival at 5 years was 70 %. Once cancer treatment was completed, 80 % of patients maintained a stage-I kidney function. The most important prognostic factor was histology. These patients required a long-term nephrology follow-up.

Fístula arteriovenosa renal pós-biópsia renal: relato de caso e revisão de literatura / Renal arteriovenous fistula after renal biopsy: a case report and literature review

Fístulas arteriovenosas (FAVs) renais adquiridas são raras, correspondendo a uma conexão anômala entre o sistema arterial e o sistema venoso. As FAVs renais se dividem em três grandes grupos: idiopáticas, congênitas e adquiridas, sendo as últimas as mais comuns. Atualmente, têm incidência aumentada em decorrência do crescente número de biópsias renais. Apesar de, atualmente, o procedimento de biópsia renal ser relativamente seguro, ele carrega como complicação a formação de FAV no território vascular renal. O tratamento de FAV renal é amplamente discutido na literatura e diversas modalidades terapêuticas podem ser aplicadas. Apresentamos um caso de FAV pós-biópsia renal que foi submetida a tratamento endovascular com sucesso mediante embolização com molas

Acquired renal arteriovenous fistulas (AVF) are rare conditions in which an anomalous connection arises between the arterial and venous systems. Renal AVFs can be classified into three main groups: idiopathic, congenital, and acquired, the last of which are the most common. Incidence has been increasing, due to the growing number of renal biopsies. Although the renal biopsy procedure is relatively safe nowadays, one possible complication is formation of an AVF in the renal vascular territory. Treatment of renal AVF is widely discussed in the literature and a variety of treatment methods can be employed. We report a case of arteriovenous fistula after renal biopsy that was successfully treated with endovascular coil embolization

Experiencia en nefrolitotomía percutánea modificada en un centro urológico / Experience in modified percutaneous nephrolithotomy in a urology centre

Introducción Recientemente se ha descrito la técnica quirúrgica para la realización de nefrolitotomías percutáneas modificadas que permite obtener punciones de diámetro reducido, con buena visibilidad y éxito sin la necesidad de adquirir nuevos instrumentos. Objetivo Establecer el comportamiento de los pacientes tratados con nefrolitotomía percutánea modificada en un centro urológico de Pereira (Colombia), 2015­2016. Métodos Estudio observacional descriptivo de un grupo de pacientes que han sido tratados con nefrolitotomía percutánea modificada, donde se eliminó la camisa metálica del nefroscopio estándar para permitir menor diámetro del tracto de entrada (22-F). Se revisaron datos de registros clínicos incluyendo variables sociodemográficas, de comorbilidades, quirúrgicas y complicaciones. Se realizó seguimiento de variables adicionales del postoperatorio. Estadística descriptiva empleando STATA 11. Resultados En total se revisaron datos de 21 pacientes intervenidos con nefrolitotomía percutánea modificada. La edad media fue de 51,5 años y el 57,1% fueron hombres. El tamaño promedio de las litiasis fue de 32,8 mm y el 57,1% de las punciones fueron en cáliz inferior. La duración promedio del procedimiento fue de 91 min con una mediana de sangrado de 50 mL. La tasa libre de cálculos fue del 90,5% y ningún paciente tuvo sonda de nefrostomía (tubeless). La mayoría de los pacientes (95,2%) fueron manejados de manera ambulatoria, sin mayores complicaciones intra- o posquirúrgicas, aunque el nivel de dolor a la semana siguiente del procedimiento fue en promedio de 4,1. Conclusiones La técnica de nefrolitotomía percutánea modificada descrita mostró ser segura, efectiva y factible de realizar, incluso en pacientes con grandes litiasis y tubeless ambulatoria.

Introduction A surgical technique has been recently described for performing modified percutaneous nephrolithotomy that enables small diameter punctures to be made, with good visibility and success and without the need to purchase new instruments. Objective To establish the outcomes of patients treated with modified percutaneous nephrolithotomy in a Urology Centre in Pereira (Colombia), 2015­2016. Methods Observational study of a group of patients who were treated with modified percutaneous nephrolithotomy, where the outer sheath of the standard nephroscope was removed to give a smaller tract diameter (22-F). The data from clinical records were recorded, including socio-demographics, comorbidities, and surgical and other complications. Additional post-operative variables were monitored during follow-up. Descriptive statistics were performed using STATA 11. Results The data from a total of 21 patients who underwent modified percutaneous nephrolithotomy were reviewed. The mean age was 51.5 years, and 57.1% were men. The mean size of the stones was 32.8 mm, and 57.1% of punctures were in lower calyx. The mean duration of the procedure was 91 minutes, with a median bleeding of 50 mL. The stone-free rate was 90.5%, and no patient had a nephrostomy tube (tubeless). Most patients (95.2%) were managed on an outpatient basis, without major intra- or post-operative complications, although the mean pain level was 4.1 in the week following the procedure. Conclusions The modified percutaneous nephrolithotomy technique showed to be safe, effective, and feasible to perform, as well as tubeless in ambulatory patients and with large stones.

Effect of administering a diet contamined with fumonisins on the kidneys of wistar rats / Efeito da administração de ração contaminada com a micotoxina fumonisinas sobre os rins de ratos wistar

Fumonisins (FBs) are mycotoxins produced by Fusarium molds. Several works have shown contamination of maize by this toxin. Fumonisin B1 (FB-1) is found in greatest proportion (about 70%), resistant to several industrialization processes. In that context, the objective of this work was to analyze the effect of administering a diet contaminated with FB- 1 on the morphophysiology of the kidneys of 21-day old male Wistar rats. The animals were divided into 2 groups: G0 (with animals receiving feed free of FBs) and G6 (6mg of FB1 kg-1 of feed). The diet was administered during 42 days. After that period, the animals were placed in metabolic cages for urine collection, blood was collected for analysis of plasma creatinine, and the kidneys were fixed and stained with Masson's trichrome. We observed that FB1 administration did not affect feed intake, body weight gain and animal growth. The normal levels of plasma creatinine suggest that the toxin did not lead to glomerular lesion. There was also no change in water intake, osmolarity and excretion of sodium in urine. However, there was a significant increase in urine volume and potassium excretion in urine, with mild tubulointerstitial changes in the outer cortex for the group receiving the mycotoxin.

Fumonisinas (FBs) são micotoxinas produzidas por fungos do gênero Fusarium. Diversos trabalhos demonstraram a contaminação do milho por essa toxina. A fumonisina B1 (FB-1) é encontrada em maior proporção (cerca de 70%), sendo resistente a vários processos de industrialização. De acordo com este contexto, o trabalho em foco teve como objetivo analisar o efeito da administração de dieta contaminada com FB-1 sobre a morfofisiologia renal de ratos Wistar machos, com 21 dias de idade. Os animais foram divididos em 2 grupos: G0 (ração isenta de FBs) e G6 (alimentados com 6mg de FB1 kg-1 de ração). A dieta foi administrada por 42 dias. Após esse período, os animais foram colocados em gaiolas metabólicas para coleta da urina, o sangue foi coletado para análise da creatinina plasmática, e os rins fixados e corados pelo Tricrômico de Masson. Observou-se que a administração de FB1 não afetou o consumo de ração, o ganho de peso e crescimento dos animais. A normalidade nos níveis da creatinina plasmática sugere que a toxina não induziu lesão glomerular. Não houve alteração na quantidade de água ingerida, na osmolaridade e na excreção urinária do sódio. No entanto houve aumento significativo no volume urinário e na excreção urinária do potássio e presença de alterações tubulointersticiais de intensidade leve no córtex externo, no grupo que recebeu a micotoxina.

Audit of Percutaneous Nephrostomy in Rabat Urological Centre

Objectives: To audit and compare the different techniques for percutaneous nephrostomy (PCN) and assess the indication of each. Methods: Between March 2009 and November 2009; the records of 27 patients who underwent percutaneous nephrostomy were retrospectively reviewed. PCN procedures were performed under ultrasonography (US); computed tomography (CT) guidance or blindly according to the grade of hydronephrosis. Results: US guided PCN were done for 15; CT guided PCN for 10 and blindly PCN for two patients. Overall success rate was 25 (92.6). US guided PCN had success rate of 13 (86.6); CT guided PCN eight (80) while blindly PCN 2(100). The overall complications were minimal. Conclusions: The success of PCN procedures depend mainly on the degree of hydronephrosis and selection of the appropriate image guidance

Giant hydronephrosis in children: diagnosis and therapeutic aspects

To evaluate the clinical aspects, diagnostic and therapeutic problems of giant hydronephrosis in children managed at the Department of Urology of the University Hospital of Dakar, Senegal. In this retrospective -study all cases of giant hydronephrosis in children managed at the Department of Urology of Aristide Le Dantec Hospital, Dakar, between February 2000 and February 2007 were reviewed. The parameters studied were the epidemiological and clinical aspects, laboratory and imaging investigations and therapy, as well as the short, medium and long-term outcome. Our series included 7 patients with a mean age of 6.1 years [range 8 months - 12 years]. In 5 out of 7 cases, giant hydronephrosis was found on the left side. Ultrasonography was performed in all cases, and the giant hydronephrosis was first misdiagnosed as cystic renal disease in 6 cases. Intravenous urography revealed a non-functioning kidney in 4 cases. CT scan, performed in 6 cases, confirmed the diagnosis and provided further information about the remaining parenchyma. Nephrostomy was performed pre-operatively in 4 cases. Three patients underwent pyeloplasty, while nephrectomy was performed in 4 cases. At follow-up, a pelvi-ureteric stenosis associated with a colonic fistula was noted in one patient. Long-term follow up was uneventful in all patients. CT scan is the method of choice for the diagnosis of hydronephrosis. Nephrostomy allows an evaluation of the renal function and facilitates the extraperitoneal approach to the kidney

Percutaneous calyceal irrigation calculi during percutaneoius nephrolithotomy

Objectives: Percutaneous nephrolithotomy performed for the management of complex renal calculi is a challenging endourological procedure. In complex situations multiple tracks and Y tracks may be needed to achieve complete stone clearance. These maneuvers carry a risk of complications especially bleeding. This study was carried out to evaluate the efficacy of the use of percutaneous calyceal irrigation (PCI) for small calyceal calculi during percutaneous nephrolithotomy. Patients and Methods: Fifty patients; in whom percutaneous calyceal irrigation (PCI) was attempted; were retrospectively evaluated. Results: Complete stone clearance was achieved with the help of PCI in 62renal units. There were no complications attributable to PCI. Conclusion: Our results encourage the use of PCI as a simple technique for clearance of small calyceal calculi thus preventing the need for a second track or Y track