The impact of surgical intervention on renal function in cystinuria / O impacto da intervenção cirúrgica sobre a função renal na cistinúria

ABSTRACT Introduction: Cystinuria is an autosomal recessive disorder due to intestinal and renal transport defects in cystine and dibasic amino acids, which result in recurrent urolithiasis and surgical interventions. This study aimed to assess the impact of surgical interventions on renal function by analyzing estimated glomerular filtration rates. Methods: Thirteen pediatric patients with cystinuria, who were followed-up in a single tertiary institution between 2004 and 2016, were included in the study. Medical records were reviewed to collect data on clinical presentation of patients, urine parameters, stone formation, medical treatment, surgical intervention, stone recurrence after surgical procedure, stone analysis, ultrasonography, 99m-technetium dimercaptosuccinic acid (99mTc-DMSA) radionuclide imaging results, and follow-up time. Creatinine clearances estimated by modified Schwartz (eGFR) formula before and after surgery were used to assess renal function and compared statistically. Results: Nine patients (69.2%) had renal scarring which were detected with 99mTc-DMSA radionuclide imaging. In ten patients (76.9%), open surgical intervention for stones were needed during follow-up. Significant difference was not detected between eGFR before and after surgical intervention (mean 92 versus 106, p = 0.36). Nine of the patients (69.2%) were stone free in the last ultrasonographic examination. Relapses of stone after surgery were seen in 66.6% of patients who underwent surgical intervention. Conclusions: Surgical interventions for urinary stones are commonly required in patients with cystinuria. Renal scarring is a prevalent finding in cystinuric patients. Surgical interventions have no negative impact on eGFR in patients with cystinuria according to the present study.

RESUMO Introdução: A cistinúria é um distúrbio autossômico recessivo causado por defeitos de transporte intestinal e renal da cistina e aminoácidos dibásicos que resultam em urolitíase recorrente e necessidade de intervenção cirúrgica. O presente estudo teve por objetivo avaliar o impacto das intervenções cirúrgicas sobre a função renal por meio da análise da taxa de filtração glomerular estimada. Métodos: Treze pacientes pediátricos com cistinúria acompanhados em uma instituição terciária entre 2004 e 2016 foram incluídos no estudo. Os prontuários médicos foram analisados e utilizados como fonte de dados sobre a apresentação clínica dos pacientes, parâmetros urinários, formação de cálculos, tratamento clínico, intervenção cirúrgica, recidiva de cálculos após procedimento cirúrgico, análise de cálculos, ultrassonografia, resultados de imagens com ácido dimercaptossuccínico marcado com tecnécio metaestável (99mTc-DMSA) e tempo de seguimento. A depuração de creatinina estimada pela fórmula modificada de Schwartz (TFGe) antes e após a cirurgia foi utilizada para avaliar e comparar estatisticamente os níveis de função renal. Resultados: Nove pacientes (69,2%) apresentaram cicatrizes renais detectadas por exame de imagem com 99mTc-DMSA. Dez pacientes (76,9%) necessitaram intervenção cirúrgica aberta por cálculo renal durante o seguimento. Não foram detectadas diferenças significativas entre os valores de TFGe anteriores e posteriores à intervenção cirúrgica (média de 92 vs. 106, p = 0,36). Nove pacientes (69,2%) não apresentaram cálculos no último exame ultrassonográfico. Recidivas de cálculos renais após cirurgia foram observadas em 66,6% dos pacientes submetidos a cirurgia. Conclusões: Intervenções cirúrgicas relativas a cálculos renais são frequentemente necessárias em pacientes com cistinúria. Cicatrizes renais são um achado prevalente em pacientes com cistinúria. De acordo com o presente estudo, cirurgia não afeta negativamente a TFGe de pacientes com cistinúria.

Endourologic strategies for a minimally invasive management of urinary tract stones in patients with urinary diversion

ABSTRACT Objective To present our experience in minimally invasive management of urinary tract stones in patients with urinary diversion. Materials and Methods We retrospectively reviewed 26 patients with urinary tract stones after cystectomy and urinary diversion. The types of urinary diversion were ileal conduit, colon conduit, ileal orthotopic neobladder in 19, 4, and 3 patients, respectively. At postoperative days 2, a plain KUB and urinary ultrasonography were performed in order to assess stone fragmentation or hydronephrosis. According to postoperative imaging, stone free rate (SFR) was defined as complete absence of fragments or residual stones less than 4mm. Results 19 patients were treated with minimally invasive percutaneous lithotripsy (MPCNL) and 2 patients required second-look MPCNL. Anterograde flexible ureteroscopy was performed in 2 patients, while in 2 patients a combined anterograde and retrograde approach was required. Three reservoir stones were treated by transurethral neo-bladder lithotripsy. Postoperative significant complications occurred in 2 patients (7.7%). The highest percentage of stone composition was struvite, as a result of chronic urinary tract infection (UTI). SFR was 88.5% (23 of 26). Conclusions Our experience showed that MPCNL is a safe and effective treatment modality with little morbidity for renal and upper ureteral stones in patients with urinary diversion. For middle and lower ureteral stones, an anterograde approach could be also considered as a first line treatment, but a combined anterograde and retrograde approach was required when the anterograde access alone cannot provide acceptable results.

Analgesia for patients undergoing shockwave lithotripsy for urinary stones – a systematic review and meta-analysis

ABSTRACT Background Shock wave lithotripsy (SWL) is the first line treatment modality for a significant proportion of patients with upper urinary tracts stones. Simple analgesics, opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are all suitable agents but the relative efficacy and tolerability of these agents is uncertain. Objectives To determine the efficacy of the different types of analgesics used for the control of pain during SWL for urinary stones. Materials and Methods We searched the Cochrane Renal Group’s Specialised Register, MEDLINE, EMBASE and also hand-searched reference lists of relevant articles (Figure-1). Randomised controlled trials (RCT’s) comparing the use of any opioid, simple analgesic or NSAID during SWL were included. These were compared with themselves, each-other or placebo. We included any route or form of administration (bolus, PCA). We excluded agents that were used for their sedative qualities. Data were extracted and assessed for quality independently by three reviewers. Meta-analyses have been performed where possible. When not possible, descriptive analyses of variables were performed. Dichotomous outcomes are reported as relative risk (RR) and measurements on continuous scales are reported as weighted mean differences (WMD) with 95% confidence intervals. Results Overall, we included 9 RCTs (539 participants from 6 countries). Trial agents included 7 types of NSAIDs, 1 simple analgesic and 4 types of opioids. There were no significant differences in clinical efficacy or tolerability between a simple analgesic (paracetamol) and an NSAID (lornoxicam). When comparing the same simple analgesic with an opioid (tramadol), both agents provided safe and effective analgesia for the purpose of SWL with no significant differences. There were no significant differences in pain scores between NSAIDs or opioids in three studies. Adequate analgesia could be achieved more often for opioids than for NSAIDs (RR 0.358; 95% CI 043 to 0.77, P=0.0002) but consumed doses of rescue analgesia were similar between NSAIDs and opioids in two studies (P=0.58, >0.05). In terms of tolerability, there is no difference in post-operative nausea and vomiting (PONV) between the groups (RR 0.72, 95% CI 0.24 to 2.17, P=0.55). One study compared outcomes between two types of NSAIDs (diclofenac versus dexketoprofen). There were no significant differences in any of our pre-defined outcomes measures. Conclusion Simple analgesics, NSAIDs and opioids can all reduce the pain associated with shock wave lithotripsy to a level where the procedure is tolerated. Whilst there are no compelling differences in safety or efficacy of simple analgesics and NSAIDs, analgesia is described as adequate more often for opioids than NSAIDs.

Minimally invasive percutaneous nephrolithotomy guided by ultrasonography to treat upper urinary tract calculi complicated with severe spinal deformity

ABSTRACT Objective: To report our experience of minimally invasive percutaneous nephrolithotomy(MPCNL) in managing upper urinary tract calculi complicated with severe spinal deformity. Materials and Methods: Between August 2001 to December 2012, 16 upper urinary calculi in 13 patients with severe spinal deformity were treated by MPCNL. Preoperative investigation of the respiratory function, evaluation of anatomy by intravenous urography (IVU) and CT scan, and preoperative kidney ultrasonagraphy with simulation of the percutaneous puncture were performed in all patients. The percutaneous puncture was guided by ultrasonography. Results: A total of 19 MPCNL procedures were performed in 16 kidneys, with an average 1.2 procedures in each kidney. Three kidneys needed two sessions of MPCNL, and 2 kidneys needed combined treatment with retrograde flexible ureterscopic lithotripsy. All procedures were successfully completed with no major complications during or after surgery. The mean (range) operative duration was 67 (20-150) min and the mean postoperative haemoglobin drop was 1.0 (0.2-3.1) g/dL. Complete stone-free status was achieved in 14 kidneys. At a mean follow-up of 48(3-86) months, recurrence of small lower calyx stone was detected in one patient. Recurrent UTI was documented by urine culture in two patients and managed with sensitive antibiotics. Conclusion: PCNL for patients with severe spinal deformities is challenging. Ultrasonography-assisted puncture can allow safe and successfully establishment of PCN tract through a narrow safety margin of puncture and avoid the injury to the adjacent organs. However, the operation should be performed in tertiary centers with significant expertise in managing complex urolithiasis.

Predicting calyceal access for percutaneous nephrolithotomy with computed tomography multiplanar reconstruction

OBJECTIVES: Objective parameters in computed tomography (CT) scans that could predict calyceal access during percutaneous nephrolithotomy have not been evaluated. These parameters could improve access planning for percutaneous nephrolithotomy. We aimed to determine which parameters extracted from a preoperative multiplanar reconstructed CT could predict renal calyceal access during a percutaneous nephrolithotomy. METHODS: From January 2009 through April 2011, 230 patients underwent 284 percutaneous nephrolithotomies at our institution. Sixteen patients presented with complete staghorn calculi, and 11 patients (13 renal units) were analyzed. Five parameters were extracted from a preoperative reconstructed CT and compared with the surgical results of percutaneous nephrolithotomy. RESULTS: Fifty-eight calyces were studied, with an average of 4.4 calyces per procedure. A rigid nephroscope was used to access a particular calyx, and a univariate analysis showed that the entrance calyx had a smaller length (2.7 vs. 3.98 cm, p = 0.018). The particular calyx to be accessed should have a smaller length (2.22 vs. 3.19 cm, p = 0.012), larger angles (117.6 vs. 67.96, p<0.001) and larger infundibula (0.86 vs. 0.61 cm, p = 0.002). In the multivariate analysis, the only independent predictive factor for accessing a particular calyx was the angle between the entrance calyx and the calyx to be reached (OR 1.15, 95% confidence interval [CI], 1.053-1.256, p = 0.002). CONCLUSION: The angle between calyces obtained by multiplanar CT reconstruction is the only predictor of calyx access. .

Is ureteral stenting after ureteroscopy really necessary?

To evaluate the use of a Double J stent catheter after uncomplicated ureteroscopy regarding the need for pain killers, lower urinary tract symptoms, fever and the recurrence of stones. Over a period of one year from January 2007 through January 2008, all patients who underwent uncomplicated ureteroscopies at Prince Hussein Urology Center, King Hussein Medical Center were studied. Group A were not stented and group B were stented. The need for pain killers, lower urinary tract symptoms, onset of fever and recurrence of stones were analyzed. A total of 187 patients had uncomplicated ureteroscopies. Seventy-eight [41.7%] patients were stented [Group A] and 109 [58.3%] patients were not stented [Group B]. In the recovery room there was no difference in the need for pain killers but there was a great difference in the first four weeks postoperatively where only 20.2% needed pain killers in group B compared to 62.8% in group A. Only 14.6% of patients in group B had lower urinary tract symptoms while 79.5% in group A were symptomatic. The onset of urinary tract related fever was lower in group B compared to group A [0.91% compared to 3.8%]. There was no difference in stone recurrence at three months between the two groups. Stent placement after uncomplicated ureteroscopy is unnecessary, has no added benefit and is associated with increased morbidities. Good clinical judgment is needed for intraoperative patient evaluation and the decision for the need of ureteric stent

Vias de acesso para tratamento de cálculos urinários: influência da introdução da videolaparoscopia / Access way for treatment of urinary calculi: impact of the introduction of laparoscopy

Avaliar a influência da laparoscopia na rotina cirúrgica do Serviço de Urologia do HC-UFMG. Métodos: Foi feita uma análise retrospectiva de todas as cirurgias, para tratamento de cálculos, realizadas no HC-UFMG entre janeiro de 2004 e outubro de 2008. Resultados: No total foram realizados 613 procedimentos e 4.850 litotripsias extracorpóreas (LECOs). Ao estratificarmos o tipo de procedimento cirúrgico realizado em função do tempo, temos que: no período inicial do estudo (2004), houve apenas seis (4,7%) casos de litíase tratados pela via laparoscópica, já no ano de 2008, os procedimentos laparoscópicos corresponderam a 17 (15,2%) casos. Conclusões: As principais modalidades no tratamento de cálculos urinários são os procedimentos endoscópicos e a LECO. A laparoscopia, apesar de ter indicações limitadas, vem ganhando espaço frente à cirurgia aberta, principalmente nos casos refratários a tratamentos menos invasivos.

This paper aims to determine the influence of the laparoscopy in the treatment of urinary stones in a tertiary hospital (HC-UFMG). Methods: We reviewed our data from January 2004 to October 2008. All patients, who underwent surgery in our institution for the treatment of urinary calculi, were enrolled. Results: Six hundred and thirteen procedures and 4,850 shock wave lithotripsy (SWL) were performed. In the first year of the study (2004), only six (4.7%) cases were done by laparoscopic approach, whereas in the last year (2008) a total of 17 (15.2%) cases were performed using the laparoscopic technique. Conclusion: The SWL and the endoscopic surgery remained as the first line treatment of urinary stones, during the whole period studied. The laparoscopic technique, despite its limitations, is getting acceptance (over the traditional open procedure) and is indicated in those cases where minimally invasive techniques have failed.

Percutaneous nephrostomy for the relief of upper urinary tract obstruction: an experience with 200 cases

To assess the role of Percutaneous Nephrostomy in upper obstructive uropathy. This was a descriptive study, conducted at Department of Urology, Lady Reading Hospital and Institute of Kidney Diseases, Hayatabad Medical Complex Peshawar from January 2006 to December 2008 on 200 patients of upper obstructive uropathy undergoing Percutaneous Nephrostomy. Fluoroscopy and Ultrasonography were used as guiding tools for accurate puncture of the renal tract. The patients were kept in the ward and their renal function tests were checked daily. All the data was collected on a structured proforma and analysis was done on SPSSv 10. A total of 200 Percutaneous Nephrostomy were attempted in 200 patients. The mean age of the sample was 41.6 +/- 12.68 years. Male to female ratio was 2.3:1. The causes included Stone disease in 104 [52%], Pyonephrosis in 52 [26%], Malignancy in 20 [10%], Renal tract tuberculosis in 12 [6%], Obstetrical trauma in 8 [4%] and Ureteric Injury due to Fire Arm in 4 [2%] patients. It was successful in 192 patients, while there was a failure in 8 cases [4%]. Considerable relief in terms of symptoms and renal biochemistry was observed with in a week. The mean blood urea level of 265 mg/dl before PCN dropped to 37 mg/dl and mean serum creatinine of 10.5 mg/dl dropped to 1.2 mg/dl respectively in all patients except 12 who were declared to have End Stage Renal Disease [ESRD]. Percutaneous Nephrostomy improves the patient's condition both in terms of urinary output and renal parameters

Chemical composition of urinary tract stones at the University Hospital of the West Indies / Composición química de las piedras del tracto urinario en el Hospital Universitario de West Indies

Urinary tract stones occur frequently with the incidence being about one to fifteen per cent worldwide. Patients may be asymptomatic or sometimes they may present with haematuria. Severe lumbar pain radiating to the loin requiring immediate analgesic treatment may occur. Stones generally consist of organic and inorganic material. The organic material may be present in the nidus and can contribute up to about 2.5% of the total weight. Inorganic minerals make up the bulk of the stone. Data are presented for the inorganic minerals present in the stones seen at the University Hospital of the West Indies over a 25-year period. Six hundred and forty-one (445 males and 196 females) stones were analyzed by routine chemical methods. Calcium was the main constituent, being seen in 93.9% of the stones. This was followed by oxalate 60.1%, urate 37.0%, bicarbonate 16.5% and magnesium 8.6%. There were four cystine containing stones. Treatment includes medical management for the underlying cause and surgical methods for the removal of the stones. Chemical methods of analysis of the stones has its limitations and should be replaced by more sophisticated methods eg X-ray diffraction crystallography which would give more accurate details of the structure of the stones.

Las piedras del tracto urinario se presentan frecuentemente con una incidencia de aproximadamente uno a quince por ciento a nivel mundial. Los pacientes pueden ser asintomáticos o presentarse con hematuria. Puede producirse dolor lumbar severo que se irradia a toda la región lumbar y que requiere tratamiento analgésico inmediato. Las piedras generalmente están formadas por material orgánico e inorgánico. El material orgánico puede estar presente en el nido y puede contribuir hasta aproximadamente 2.5% del peso total. Los minerales inorgánicos constituyen la mayor parte de las piedras. Se presentan datos de los minerales inorgánicos presentes en las piedras vistas en el Hospital Universitario de West Indies en un periodo de 25 años. Seiscientos cuarenta y una (445 varones y 196 hembras) piedras fueron analizadas mediante métodos químicos de rutina. El calcio fue el constituyente principal, observándosele en el 93.9% de las piedras. El mismo fue seguido por el oxalato (60.1%), el urato (37.0%), el bicarbonato (16.5%) y el magnesio (8.6%). Había cuatro cistinas que contenían piedras. El tratamiento incluye el manejo médico de la causa subyacente y los métodos quirúrgicos para la eliminación de las piedras. Los métodos químicos de análisis de las piedras tienen sus limitaciones y deben reemplazarse por métodos más sofisticados, tales como la cristalografía por difracción de rayos X. que daría detalles más exactos de la estructura de las piedras.

Ureteroscopia flexible y láser holmium: yag para el manejo simultáneo de litiasis intrarrenal y ureteral proximal, primer caso reportado en Colombia / Flexible Urethersocopy and Holmium: Yag Laser for the simultaneous treatment of kidney and proximal ureteral stones, first case report

La eficacia y la seguridad que ofrece el Holmium Láser, han convertido este instrumento en una herramienta muy útil para el tratamiento de una gran variedad de patologías de la vía urinaria. La litotricia endoscópica es esencial en cualquier centro especializado que maneje patología litiasica. La litotricia con láser, es una alternativa de tratamiento de primera línea para el manejo de cálculos de la vía urinaria, en especial aquellos en los que falla la litotricia extracorpórea o no tienen indicación para una nefrolitotomía percutánea. Además es una tecnología superior a la litotricia neumática en lo que respecta a efectividad y complicaciones, especialmente para cálculos por encima de los vasos ilíacos

Is there a difference in the peri-operative morbidity between patients undergoing transurethral resection of the prostate alone compared with patients undergoing transurethral resection combined with treatment of bladder stones?

To compare the peri-operative morbidity in patients undergoing transurethral resection of the prostate [TURF] for obstructing benign prostatic hyperplasia [BPH] alone with patients undergoing optical cystolitholapaxy for the treatment of moderately sized bladder calculi followed by TURF for obstructing BPH. Over a 10-year period, 25 patients with obstructing BPH associated with moderately sized bladder stones underwent optical cystolitholapaxy aiming at total stone clearance followed by TURP under the same anesthesia. They were retrospectively compared with a second group of 25 randomly selected patients matched for age and prostate size who had undergone TURF only. The parameters studied were the duration of surgery, the need for post-operative urethral catheterization / irrigation, post-operative hospitalization and post-operative morbidity. Complete stone clearance was achieved in all patients before the performance of TURF. In the study group the operative time was 47 +/- 21 minutes longer than in the control patients who had TURF alone. None of the patients required catheterization or post-operative bladder irrigation. There was no difference between the groups regarding the duration of post-operative hospitalization. A single case of lower urinary tract infection occurred in each group; it resolved with appropriate antibiotic treatment. None of the patients had associated fever, and mortality was nil. The combination of optical cystolitholapaxy with TURF under the same anesthesia in patients with small and moderately sized bladder calculi associated with obstructing BPH did not lead to any significant increase in peri-operative morbidity when compared with patients who underwent TURF only

Ureteroscopy under spinal versus general anaesthesia: morbidity and stone clearance

To compare morbidity and stone clearance by ureteroscopy carried out under spinal anaesthesia with that carried out under general anaesthesia. Quasi-experimental study. The study was conducted at the Kidney Centre, Postgraduate Training Institute, Karachi, from September 2005 to December 2006. A total number of 60 patients were enrolled for the study. All patients underwent ureteroscopic procedure for a calculus disease, using a semi-rigid ureteroscope of 10 Fr. These patients were divided in 2 groups of 30 patients, receiving general or spinal anaesthesia. Operative time, stone clearance, hospital stay, intra- and postoperative complications and visual analogue score for pain were noted in each case. There were 30 patients each in both groups, with 73% males and 27% females in group A [general anaesthesia] and 93% males and 7% females in group B [spinal anaesthesia]. Mean age of the patients were 33.9 and 36.9 years in groups A and B respectively. The average stone size was 0.79 cm in group A and 1.14 cm in group B [p=0.001]. Duration of surgery was 41.4 +/- 1.29 minutes in group A and 30.5 +/- 2.13 minutes in group B [p=0.033]. Mean hospital stay was 21.6 and 18.1 hours in group A and B respectively [p= 0.073]. Mean visual analogue score for pain in group A was 3.1 and group B was 1.8. Ureteroscopy under spinal anaesthesia resulted in decreased length of operative time and shortened hospital stay in this series and did not carry any additional risk of major complications

Survey of frequency and outcome of PCNL operations in Kurdistan province

Surgery for removal of urinary system stones has improved very much. At the present time standard therapy for stones which do not respond to ESWL, and also for large or multiple stones is PCNL. In this method the stones are broken into small pieces and taken out. This method has a better outcome and minimal morbidity rate. The aim of this study was to assess the outcome of PCNL operations in Kurdistan province since 1383. This was a cross sectional descriptive analytic study. The study group comprised all the patients who had undergone PCNL from 1383 to 1385 [100 patients]. Sampling method was census. Data collected by reviewing the patients medical records and were registered in check lists. The collected data were analyzed by means of alpha and T-test using SPSS win soft ware. From 1383 to 1385, 100 PCNL operations had been done on 66 [66%] men and 34 [34%] women. The mean age of the patients was 38.33 +/- 12.81 [age range: 17-72 years old]. The mean operation time was 86.91 +/- 24.12 minutes and the mean size of the stones was 33.72 +/- 9.81mm. The mean hospitalization time was 2.33 +/- 0.65 days and the mean narcotic [petidin] dose was 57.6 +/- 24. 17% of the patients developed some kind of complication, but no problem observed in the other 83%. In general 91% of the operations were successful. 2% of the patients needed another surgery and in 7% of the patients, the remaining stones were treated by use of ESWL. The most common type of stones were calcium oxalate. There was a significant relationship between the operation time, dose of narcotic and duration of hospitalization [p=0.000]. The result of this study were compatible with previous studies and confirms PCNL as a successful surgical method for treatment of the urinary system stones

Nefrolitotomia percutânea no tratamento minimamente invasivo da litíase urinária / Nefrolitotomia percutaneous in treatment minimally invasive of lithiasis urinary

Os autores fazem uma revisão da técnica, equipamentos e indicações da nefrolitotomia percutânea no tratamento cirúrgico da litíase urinária.

Urolithiasis associated with topiramate

OBJECTIVE: Topiramate is a sulfamate-substituted monosaccharide anticonvulsant used as adjunctive therapy for intractable refractory seizures. It is report a case of topiramate-induced urolithiasis. CASE REPORT: A 35-year-old man presented with acute, right-sided, colicky flank pain. He denied hematuria or dysuria. He was in use of phenytoin, risperidone, phenobarbital, and topiramate. The total daily dose of topiramate was 375 mg. A CT scan showed a 7 x 1 mm curvilinear density at the right ureterovesical junction with proximal hydrouretronephrosis. He was managed with rigid ureteroscopic stone extraction and the calculus metabolic analysis revealed the stone was composed of carbonate apatite (70 percent), calcium oxalate dihydrate (20 percent), and calcium oxalate monohydrate (10 percent). COMMENTS: The present case typifies many features of topiramate-induced urolithiasis. Those who care for patients with urinary stone disease should be aware of this association.

Tratamiento quirúrgico de la litiasis urinaria mediante laparoscopía / Surgical treatment of the urinary lithiasis using laparoscopy

Este trabajo muestra la experiencia en el tratamiento quirúrgico de los cálculos de la vía urinaria mediante cirugía laparoscópica con el uso de sutura intracorpórea. En un período de 11 meses se operaron 16 pacientes con cálculos mayores a 1 cm. Ubicación pelvis renal 7, uréter lumbar 6, uréter medio 1, uréter distal 1, vesical 1. La tasa de éxito fue 88 por ciento (14/16). El tiempo quirúrgico promedio fue de 118 (73-180) min. Hubo dos complicaciones; neuropraxia del nervio génitofemoral y sangramiento de la pared abdominal. Es factible realizar un manejo laparoscópico de la litiasis urinaria cuando han fallado los tratamientos de primera línea o cuando no se dispone de ellos.

Urología laparoscópica: experiencia inicial del Hospital Regional de Rancagua / Laparoscopic urology: initial experience at the Hospital Regional de Rancagua

Este trabajo muestra todas las cirugías laparoscópicas realizadas entre diciembre de 2002 y octubre de 2003, lo que representa nuestra primera experiencia con la urología laparoscópica. En un período de 11 meses se efectuaron 63 procedimientos laparoscópicos: Ligadura de vena espermática n=19 (3 bilaterales), tiempo quirúrgico promedio 27,8 min, 84 por ciento ambulatorios. Sin complicaciones. Litiasis urinaria n=16, tiempo quirúrgico promedio 118 (75-180) min, éxito en 88 por ciento (14/16). Complicaciones 2: neuropraxia del nervio génitofemoral y sangramiento de pared abdominal. Nefrectomías n=14, 3 por cáncer. Mano asistidas en 6 casos. Tiempo quirúrgico promedio 134 (100-205) min. Sangramiento promedio 251 (50-900) cc. Hospitalización promedio 2,2 días. No hubo conversiones a cirugía abierta. Complicaciones: 1 paciente (N°12 de la serie) fallecido a las 48 horas por pancreatitis post quirúrgica. Linfadenectomía lumboaórtica n=9, tiempo quirúrgico promedio 140 (100-215) min. No hubo conversiones a cirugía abierta. Número de ganglios promedio 12 (5-18). Hospitalización promedio 2,5 días. Sin complicaciones. Linfadenectomía pelviana en cáncer vesical n=1, tiempo 60 min, sin complicación. Quistectomía renal n=2, tiempo quirúrgico promedio 72 min, sin complicaciones. Vaciamiento de urinoma n=1, tiempo 35 min. sin complicación. Laparoscopía diagnóstica n=1, tiempo 25 min, sin complicación. La cirugía laparoscópica en urología es posible de realizar. Tiene una curva de aprendizaje considerable. Se debe realizar un entrenamiento escalonado y una vez iniciada, se requiere de continuidad y un ascenso gradual en la complejidad de las cirugías.

La nueva y vieja tecnologia en el tratamiento de la litiasis urinaria / Old and new tecnology in treatment of urinary lithiasis

Se presenta una revisión del manejo de la urolitiasis a la luz de las diferentes tecnologías disponibles. El autor expresa su aproximación y experiencia personal en el manejo del paciente con litiasis, enfatizando en la disponibilidad de las diversas tecnologías, especialmente en ciudades intermedias y hace una invitación a los colegas al trabajo en equipo, optimizando los conocimientos individuales para beneficio del paciente