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.

Obesity and kidney disease: hidden consequences of the epidemic / Obesidad y enfermedad renal: las consecuencias ocultas de una epidemia

Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease and also for Chronic kidney disease. A high body mass index is one of the strongest risk factors for new-onset Chronic kidney disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing Chronic kidney disease in the long-term. The incidence of obesity-related glomerulopathy has increased ten-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that makes preventive behaviors an affordable option.

La obesidad se ha convertido en una epidemia mundial, y se ha proyectado que su prevalencia se incrementrá en 40% en la próxima década. Esta creciente prevalencia supone implicaciones tanto para el riesgo de desarrollo de diabetes mellitus y enfermedades cardiovasculares como para el desarrollo de Enfermedad renal crónica. Un elevado índice de masa corporal es uno de los factores de riesgo más importantes para el desarrollo de enfermedad renal crónica. En individuos afectados por la obesidad, tiene lugar una hiperfiltración compensatoria necesaria para alcanzar la alta demanda metabólica secundaria al aumento del peso corporal. El incremento de la presión intraglomerular puede generar daño renal y elevar el riesgo de desarrollar enfermedad renal crónica a largo plazo. La incidencia de glomerulopatía asociada a obesidad se ha incrementado 10 veces en los últimos años. Asimismo se ha demostrado que la obesidad es un factor de riesgo para el desarrollo de nefrolitiasis y un número de neoplasias, incluyendo cáncer renal. Este año, el Día Mundial del Riñón promueve la educación acerca de las consecuencias nocivas de la obesidad y su asociación con la enfermedad renal, abogando por un estilo de vida saludable y la implementación de políticas públicas de salud que promuevan medidas preventivas alcanzables.

Effect of mitochondrial potassium channel on the renal protection mediated by sodium thiosulfate against ethylene glycol induced nephrolithiasis in rat model

Purpose: Sodium thiosulfate (STS) is clinically reported to be a promising drug in preventing nephrolithiasis. However, its mechanism of action remains unclear. In the present study, we investigated the role of mitochondrial KATP channel in the renal protection mediated by STS. Materials and Methods: Nephrolithiasis was induced in Wistar rats by administrating 0.4% ethylene glycol (EG) along with 1% ammonium chloride for one week in drinking water followed by only 0.75% EG for two weeks. Treatment groups received STS, mitochondrial KATP channel opener and closer exclusively or in combination with STS for two weeks. Results: Animals treated with STS showed normal renal tissue architecture, supported by near normal serum creatinine, urea and ALP activity. Diazoxide (mitochondria KATP channel opening) treatment to the animal also showed normal renal tissue histology and improved serum chemistry. However, an opposite result was shown by glibenclamide (mitochondria KATP channel closer) treated rats. STS administered along with diazoxide negated the renal protection rendered by diazoxide alone, while it imparted protection to the glibenclamide treated rats, formulating a mitochondria modulated STS action. Conclusion: The present study confirmed that STS render renal protection not only through chelation and antioxidant effect but also by modulating the mitochondrial KATP channel for preventing urolithiasis.

Nefrolitíase em pacientes pediátricos: investigação metabólica e anatômica / Nephrolithiasis in pediatric patients: metabolic and anatomical investigation

Desordens metabólicas são frequentes em pacientes com nefrolitíase pediátrica. OBJETIVOS: Estudar as alterações metabólicas e anatômicas e a análise química dos cálculos encontrados em pacientes da nossa região. MÉTODOS: Este é um estudo retrospectivo em 158 crianças com evidência de formação recente de cálculos, destes apenas 109 concluíram a investigação metabólica. A investigação laboratorial consistiu de duas amostras de urina de 24 horas com dosagem de cálcio, ácido úrico, citrato, oxalato, sódio e creatinina, cistinúria qualitativa, pH urinário seguido de 12 horas de jejum e restrição hídrica, cultura da urina e análise química quando os cálculos foram disponíveis. As técnicas de imagem incluíram ultrassonografia do trato urinário e urografia excretora. RESULTADOS: Em 96,3 por cento das crianças alguma causa foi detectada. A principal alteração metabólica encontrada foi a hipercalciúria (73,4 por cento). Análise química dos cálculos mostrou oxalato de cálcio em 90,9 por cento dos casos. Alterações anatômicas foram encontradas em 18,0 por cento dos pacientes investigados, e a mais frequente foi a duplicação pieloureteral (28,6 por cento). CONCLUSÕES:Hipercalciúria foi a desordem mais encontrada, a alteração anatômica mais comum foi a duplicação pieloureteral e oxalato de cálcio foi o constituinte químico mais frequente. Este trabalho serviu para o conhecimento das características dos pacientes pediátricos portadores de nefrolitíase em nossa região.

Metabolic disorders are frequently observed in pediatric patients with renal lithiasis. OBJECTIVES: Study the metabolic and anatomical alterations and perform the chemical analysis of stones found in children with nephrolithiasis in our region. METHODS: A retrospective study on 158 children with evidence of recent renal stone formation was performed. One hundred and nine children concluded the metabolic study. Laboratory investigation consisted in two samples of 24-hour urine for calcium, uric acid, citrate, oxalate, sodium and creatinine; qualitative cystinuria, urinary pH following 12-hour fasting and water restriction, urine culture and chemical analysis when the stones were available. Renal imaging techniques included, at least, renal ultrasound and excretory urogram. RESULTS: A cause for nephrolithiasis was identified in 96.3 percent of children. The main metabolic alteration was hypercalciuria (73.4 percent). Chemical analysis of stones showed calcium oxalate in 90.9 percent of the cases. Anatomical alterations were found in 18.0 percent of the investigated cases and the most frequently found alteration was pyelo-ureteral duplication (28.6 percent). CONCLUSIONS: Hypercalciuria was the most frequently found disorder and pyelo-ureteral duplication was the most common anatomical alteration; moreover, calcium oxalate was the most frequent chemical constituent. The present study showed the characteristics of pediatric patients with nephrolithiasis in our region.

Alterações anatômicas em pacientes com nefrolitíase / Anatomical alterations in patients with nephrolithiasis

Introdução: Nefrolitíase é uma doença multifatorial e tem relação com desordens genéticas e fatores ambientais. Cálculos renais são mais comuns em adultos e são associados com várias desordens metabólicas e anatômicas. As principais anormalidades anatômicas como obstrução da junção ureteropélvica, rim em ferradura, ureter duplicado completa ou incompletamente, pelve bífida e rim esponja medular são conhecidas como responsáveis pela formação dos cálculos. O objetivo deste estudo é avaliar alterações anatômicas em pacientes com nefrolitíase em nossa região. Métodos: estudo retrospectivo em 1.378 pacientes com evidência de formação recente de cálculos renais. investigação laboratorial e análise disponibilidade. Técnicas de imagens renais incluíram pelo menos ultrassonografia renal e urografia excretora. Resultados: 1.378 pacientes com nefrolitíase foram atendidos, dentre os quais somente 367 (26,5%) foram submetidos à investigação anatômica e 132 (36,0%) tiveram pelo menos uma alteração anatômica. a idade média dos pacientes investigados foi de 36,8 +- 4,3 anos e 198 (54,5%) eram do sexo feminino. As alterações anatômicas mais frequentemente encontradas foram cisto renal, ureter duplicado completa ou incompletamente e obstrução da junção ureteropélvica. Conclusões: Alterações anatômicas foram encontradas em 36% dos pacientes investigados. Cisto renal, duplicação ureteral e obstrução da junção ureteropélvica foram alterações anatômicas mais comuns neste grupo.

Introduction: Nephrolithiasis is a multifactorial disease and is related to genetic disorders and environmental factors. Gallstones are more common in adults and are associated with various anatomical and metabolic disorders. The major anatomical abnormalities such as ureteropelvic junction obstruction, horseshoe kidney, ureter duplicated completely or incompletely, pelvis bifida and medullary sponge kidney are known to be responsible for gallstone formation. The aim of this study is to assess anatomical changes in patients with nephrolithiasis in our region. Methods: A retrospective study of 1378 patients with evidence of recent formation of kidney stones. laboratory research and analysis available. Imaging techniques included renal ultrasonography at least kidney and excretory urography. Results: 1378 patients with nephrolithiasis were treated, of whom only 367 (26.5%) underwent anatomical study and 132 (36.0%) had at least one anatomic change. the average age of patients studied was 36.8 + - 4.3 years and 198 (54.5%) were female. Anatomical abnormalities were most frequently encountered renal cyst, completely or incompletely duplicated ureter and ureteropelvic junction obstruction. Conclusions: Anatomical changes were found in 36% of the cases. Renal cyst, ureteral duplication and ureteropelvic junction obstruction were the most common anatomical changes in this group.

Fístula arteriovenosa pós-nefrolitotripsia percutânea / Arteriovenous fistula after percutaneous nephrolithotomy

Fístula arteriovenosa (FAV) é uma rara complicação pós-nefrolitotripsia percutãnea (NLP). Apresentamos o caso de um paciente de 70 anos, sexo masculino, que apresentou sangramento maciço após NLP, tratado por angioembolização renal superseletiva com implante de stent. Após a embolização, houve resolução do sangramento. FAV é uam complicação incomum da NLP, que pode ser tratada com sucesso com angioembolização.

Arteriovenous fistula (AVF) is a rare complication after percutaneous nephrolithotomy (PNL). We present the case of a 70-year-old male who had massive bleeding after NLP, angioembolização treated by superselective renal stent implantation. After embolization, there was resolution of bleeding. AVF is uam uncommon complication of NLP, which can be treated successfully with angioembolização.

Tratamiento a largo plazo con citrato de potasio en pacientes nefrolitiásicos adultos con hipocitraturia o diátesis gotosa / Long-Term treatment of adult nephrolithiasis patients with hypocitraturia or gouty diathesis with potassium citrate

Pocos estudios han evaluado el tratamiento a largo plazo con citrato de potasio en pacientes con nefrolitiasis por oxalato de calcio o ácido úrico cuyos factores de riesgo metabólico urinario son hipocitraturia o diátesis gotosa. Nosotros evaluamos retrospectivamente las historias clínicas de 92 pacientes adultos con litiasis renal recurrente cuyos factores de riesgo metabólico eran hipocitraturia aislada o diátesis gotosa que fueron tratados con citrato de potasio 30 a 60 meq/día, una a dos veces por día, por más de 3 meses.... Concluimos que el tratamiento con citrato de potasio efectivamente corrige los trastornos metabólicos en pacientes con hipocitraturia y diátesis gotosa con una disminución asociada en el calcio urinario y que estos efectos son sostenidos en el tiempo.

Few studies have evaluated the long term treatmente with potassium citrate in patients with calcium oxalate o uric acid nephrolithiasis whose urine metabolic risk factores were hypocitraturia or gouty diathesis. We retrospectively reviewed the charts of 92 adult patients with recurrent renal stones whose urine metabolic risk factores were either hypocitraturia or gouty diathesis who were treated with potassium citrate 30 at 60 meq/d one or two times daily, for more than 3 months... We conclude that potassium citrate effectively corrects metabolic derangements in patients with hypocitraturia and couty diathesis with an associated decrease in urinary calcium and these effects were sustained in time.