Comparison of safety and effectiveness of active migration technique and in situ lithotripsy technique in the treatment of 1-2 cm upper ureteral calculi by flexible ure-teroscopy / 北京大学学报(医学版)

OBJECTIVE@#To compare the safety and effectiveness of active migration technique and in situ lithotripsy technique in the treatment of 1-2 cm upper ureteral calculi by retrograde flexible ureteroscopy.@*METHODS@#A total of 90 patients with 1-2 cm upper ureteral calculi treated in the urology department of Beijing Friendship Hospital from August 2018 to August 2020 were selected as the subjects. The patients were divided into two groups using random number table: 45 patients in group A were treated with in situ lithotripsy and 45 patients in group B were treated with active migration technique. The active migration technique was to reposition the stones in the renal calyces convenient for lithotripsy with the help of body position change, water flow scouring, laser impact or basket displacement, and then conduct laser lithotripsy and stone extraction. The data of the patients before and after operation were collected and statistically analyzed.@*RESULTS@#The age of the patients in group A was (51.6±14.1) years, including 34 males and 11 females. The stone diameter was (1.48±0.24) cm, and the stone density was (897.8±175.9) Hu. The stones were located on the left in 26 cases and on the right in 19 cases. There were 8 cases with no hydronephrosis, 20 cases with grade Ⅰ hydronephrosis, 11 cases with grade Ⅱ hydronephrosis, and 6 cases with grade Ⅲ hydronephrosis. The age of the patients in group B was (51.8±13.7) years, including 30 males and 15 females. The stone diameter was (1.52±0.22) cm, and the stone density was (964.6±214.2) Hu. The stones were located on the left in 22 cases and on the right in 23 cases. There were 10 cases with no hydronephrosis, 23 cases with grade Ⅰ hydronephrosis, 8 cases with grade Ⅱ hydronephrosis, and 4 cases with grade Ⅲ hydronephrosis. There was no significant diffe-rence in general parameters and stone indexes between the two groups. The operation time of group A was (67.1±16.9) min and the lithotripsy time was (38.0±13.2) min. The operation time of group B was (72.2±14.8) min and the lithotripsy time was (40.6±12.6) min. There was no significant difference between the two groups. Four weeks after operation, the stone-free rate in group A was 86.7%, and in group B was 97.8%. There was no significant difference between the two groups. In terms of complications, 25 cases of hematuria, 16 cases of pain, 10 cases of bladder spasm and 4 cases of mild fever occurred in group A. There were 22 cases of hematuria, 13 cases of pain, 12 cases of bladder spasm and 2 cases of mild fever in group B. There was no significant difference between the two groups.@*CONCLUSION@#Active migration technique is safe and effective in the treatment of 1-2 cm upper ureteral calculi.

Hidronefrosis como causa de poliglobulia secundaria / Hydronephrosis as a cause of secondary polyglobulia

La policitemia primaria es producida por una mutación adquirida o heredada en las células progenitoras de los glóbulos rojos, mientras que la poliglobulia secundaria está relacionada con un aumento de la eritropoyetina sérica como respuesta a la hipoxia tisular o a la producción autónoma tumoral. Hace más de medio siglo que se conoce que la hidronefrosis puede actuar como una rara causa de eritrocitosis debido al aumento de producción de eritropoyetina por un riñón que censa una disminución de oxígeno, mecanismo también observado en la estenosis de la arteria renal y en los quistes renales. Se describe a continuación el caso de un paciente de 38 años con poliglobulia atendido en el Hospital Italiano de San Justo (Argentina), que presenta como hallazgo una hidronefrosis unilateral severa y cuya resolución quirúrgica a través de una nefrectomía revierte el cuadro hematológico de base. (AU)

Primary polycythemia is produced by an acquired or inherited mutation in progenitor cells of red blood cells, while secondary polyglobulia is related to an increase in serum erythropoietin in response to tissue hypoxia or autonomous tumor production. Since the middle of the twentieth century, the hydronephrosis is known to be a rare etiology of secondary polycythemia, with increased erythropoietin production caused by diminished oxygen sensing by the kidney, also seen in renal artery stenosis and kidney cysts. We describe a case of a 38 year old patient with polycythemia studied in the "Hospital Italiano de San Justo" (Argentina) that presented an incidental severe unilateral hydronephrosis, and nephrectomy was carried out as a final resolution of the hematological disorder. (AU)

Forming a stone in pelviureteric junction obstruction: cause or effect?

ABSTRACT Objectives To investigate a possible causal relationship for stone formation in pelviureteric junction obstruction and to outline management options. Materials and Methods A literature search and evidence synthesis was conducted via electronic databases in the English language using the key words pelviureteric junction obstruction; urolithiasis; hyperoxaluria; laparoscopic pyeloplasty; flexible nephroscopy; percutaneous nephrolithotomy, alone or in combination. Relevant articles were analysed to extract conclusions. Results Concomitant pelviureteric junction obstruction (PUJO) and renal lithiasis has been reported only scarcely in the literature. Although PUJO has been extensively studied throughout the years, the presence of calculi in such a patient has not received equal attention and there is still doubt surrounding the pathophysiology and global management. Conclusions Metabolic risk factors appear to play an important role, enough to justify metabolic evaluation in these patients. Urinary stasis and infection are well known factors predisposing to lithiasis and contribute to some extent. The choice for treatment is not always straightforward. Management should be tailored according to degree of obstruction, renal function, patient symptoms and stone size. Simultaneous treatment is feasible with the aid of minimally invasive operative techniques and laparoscopy in particular.

Anesthetic management of nephrectomy in a chronic obstructive pulmonary disease patient with recurrent spontaneous pneumothorax / Controle anestésico de nefrectomia em paciente com doença pulmonar obstrutiva crônica e pneumotórax espontâneo recorrente

Abstract Nephrectomies are usually performed under general anesthesia alone or in combination with regional anesthesia and rarely under regional anesthesia alone. We report the management of a patient with chronic obstructive pulmonary disease with a history of recurrent spontaneous pneumothorax undergoing nephrectomy under regional anesthesia alone.

Resumo Geralmente, as nefrectomias são feitas sob anestesia geral, isoladamente ou em combinação com anestesia regional, e raramente sob anestesia regional sozinha. Relatamos o tratamento de um paciente com doença pulmonar obstrutiva crônica e história de pneumotórax espontâneo recorrente submetido à nefrectomia sob anestesia regional isolada.

Signs and symptoms of developmental abnormalities of the genitourinary tract / Sinais e sintomas das anormalidades do desenvolvimento do trato geniturinário

Abstract Objective: The abnormalities of the genitourinary tract development are the leading cause of chronic kidney disease (CKD) in children. The diagnosis of this disease in Brazil is late and incomplete, which results in increased morbidity and mortality in this age group. Early diagnosis of this condition is the prerogative of generalist pediatricians, and the aim of this study was to review the clinical signs and symptoms associated with developmental abnormalities of the genitourinary tract. Data sources: Based on the description of a symbolic clinical case, the authors conducted a non-systematic review of medical literature. Data synthesis: The results suggest that the following data should be used as a warning for early diagnosis of affected children: (a) combined urinary tract abnormalities (chromosomal abnormalities; sequence of malformations [VACTERLand Prune-Belly]; and musculoskeletal, digestive tract, heart, and nervous system malformations); (b) previous history (congenital anomalies of the kidney and urinary tract [CAKUT] in the family, low birth weight, and oligoamnios); (c) clinical signs (polyuria/nocturia, urinary tract infection, systemic arterial hypertension, failure to thrive, weak urinary stream, difficulty to start urination, distended bladder, non-monosymptomatic enuresis, urinary/urge incontinence, and bowel and bladder dysfunction); and (d) pre- and postnatal ultrasonographic alterations (increased anteroposterior diameter of the renal pelvis, mainly in the third trimester of pregnancy; single kidney; hydronephrosis associated with other abnormalities; and hydronephrosis with parenchymal involvement in the post-neonatal assessment). Conclusion: The suggestions shown here can help the pediatrician to establish clinical hypotheses for the early diagnosis of developmental abnormalities of the genitourinary tract without resorting to expensive and invasive procedures.

Resumo Objetivo: As anormalidades do desenvolvimento do trato geniturinário são a principal causa de doença renal crônica (DRC) em crianças. O diagnóstico dessa doença no Brasil é formulado de maneira incompleta e tardia, o que resulta em aumento na morbimortalidade nessa faixa etária. O diagnóstico precoce dessa condição é prerrogativa dos pediatras generalistas e o objetivo deste trabalho foi revisar os sinais e sintomas clínicos associados às anormalidades do desenvolvimento do trato geniturinário. Fontes dos dados: A partir da descrição de um caso clínico simbólico, fizemos uma revisão não sistemática da literatura médica. Síntese dos dados: Os resultados sugerem que os seguintes dados devem ser usados como alerta para o diagnóstico precoce das crianças acometidas: a) anomalias do trato urinário compostas (anomalias cromossômicas, sequências de malformações – Vacterl e Prune-Belly, malformações musculoesqueléticas, do trato digestivo, cardíacas e do sistema nervoso); b) antecedentes (anomalias congênitas do rim e trato urinário (CAKUT) na família, baixo peso ao nascer e oligoâmnio); c) sinais clínicos (polaciúria/noctúria, infecção urinária, hipertensão arterial sistêmica, baixo ganho de peso, jato urinário fraco, dificuldade para iniciar a micção, bexigoma, enurese não monossintomática, urge/incontinência urinária, disfunção do intestino e da bexiga) e d) alterações ultrassonográficas ante e pós-natais (diâmetro anteroposterior da pélvis renal aumentado principalmente no terceiro trimestre da gestação, rim único, hidronefrose associada a outras anomalias e hidronefrose com comprometimento de parênquima na avaliação pós-neonatal). Conclusão: As sugestões apresentadas podem ajudar o pediatra a estabelecer hipóteses clínicas para o diagnóstico precoce das anormalidades do desenvolvimento do trato geniturinário sem metodologias caras e invasivas.

Pyeloduodenal Fistula Successfully Treated By Endoscopic Ligation without Surgical Nephrectomy: Case Report

A 74-yr-old woman presented with fever and abdominal discomfort. She was in a septic condition caused by urinary tract infection. Her computed tomogram of the abdomen revealed features of hydronephrosis with ureteral stones in both kidneys. During percutaneous nephrostomies, right pyeloduodenal fistula (PDF) was diagnosed. Elective surgery was originally planned but the patient was in a poor condition to undergo surgery. Instead, 2 times endoscopic clipping and ligation by endoloop were applied with parenteral antibiotics for the fistula lesion. On admission day 30, she was discharged from the hospital after confirmation of no more contrast leakage on fistulography. We reviewed the literature and discuss the etiologies, clinical presentations, diagnosis, and treatment of PDF.

Exames de imagem na avaliação de anomalias urológicas em lactentes com hidronefrose fetal: avanços e controvérsias / Imaging for evaluation of urologic abnormalities in infants with fetal hydronephrosis: advances and controversies

Avanços recentes no diagnóstico pré-natal têm permitido o aprimoramento da detecção e o manejo das anormalidades do trato urinário. A ultrassonografia pré-natal permite o reconhecimento de anormalidades urológicas que somente seriam identificadas tardiamente, após o aparecimento de sintomas ou complicações. A uretrocistografia miccional pode ser reservada para casos selecionados. Exames de medicina nuclear devem ser realizados em casos de hidronefrose moderada e grave. O estudo consistiu de uma revisão da literatura atual sobre a abordagem pós-natal da hidronefrose fetal. Os dados obtidos foram confrontados com a experiência da Unidade de Nefrologia Pediátrica do HC/UFMG na conduta e no seguimento de crianças com diagnóstico de uropatias detectadas na investigação de hidronefrose fetal.

Recent advances in prenatal diagnosis resulted in an improvement of detection and management of urinary tract abnormalities. Prenatal ultrasonography allows to identify urological abnormalities that otherwise would not be seen until later in life, when complications occur. The voiding cystourethrogram can be reserved for selected patients. Nuclear medicine exams should be performed in cases of moderate and severe hydronephrosis. A review of the current literature on postnatal approach of prenatal hydronephrosis was performed. Data obtained were compared with the records of the Pediatric Nephrology Unit HC/UFMG regarding management and follow-up of children with uropathies detected while investigating for fetal hydronephrosis.

Is there any relationship between hyperbilirubinemia and pelvicaliceal dilatation in newborn babies?

A recent study reported association of high bilirubin concentrations with decrease in basal vesical tonicity and relaxation of pre-contracted ureteral and vesical smooth muscles in vitro, and authors discussed that recovery of antenatal hydronephrosis might partly be associated with decreased bladder resistance to the urine flow due to hyperbilirubinemia. We aimed to investigate whether any relationship between serum bilirubin levels and antero-posterior renal pelvic diameters or pelvicaliceal dilatations exist during newborn period. Neonates with hyperbilirubinemia [group 1] and healthy neonates [group 2] were randomly selected to the study. Capillary blood samples were used to measure micro-bilirubin. Urinary system ultrasound [US] was performed in both groups by an experienced radiologist. Group 1 [31 neonates, 16 males, 15 females] and group 2 [22 neonates, 11 males, 11 females] were identical by means of postnatal age, gender and weight [P>0.05]. Mean serum bilirubin levels were 11.1 +/- 3.1 mg/dl and 1.4 +/- 0.2 mg/dl in group 1 and 2, respectively. Renal length and renal pelvis antero-posterior [AP] diameters were not different between study groups. Pelvis AP diameters of right kidney were 2.110.7 mm in group 1 and 1.9 +/- 0.7 mm in group 2, and of left kidney were 2.4 +/- 0.8 mm in group 1 and 2.310.6 mm in group 2. There was no correlation between bilirubin levels and renal length and renal pelvis AP diameters [P>0.05]. In this study we were not able to demonstrate any relationship between serum bilirubin levels and renal pelvic diameters and pelvicaliceal dilatation in hyperbilirubinemic neonates. So, it is thought that hyperbilirubinemia might not have a direct effect on outcome of the pelvicaliceal dilatation

Ecografía doppler en pacientes con riñón trasplantado Hospital Infantil Manuel de Jesús Rivera LA MASCOTA período 2005-2009 / Doppler ultrasound in patients with transplanted kidney Hospital Infantil Manuel de Jesus Rivera

Es bien conocida la importancia de realizar estudios de imagen en el trasplante renal. En Nicaragua se realizan trasplantes renales desde hace una década, en el hospital “la Mascota”, desde hace 5 años. El objetivo del presente estudio fue conocer cómo ha sido el seguimiento post transplante renal durante las primeras 72 horas , con ecografía doppler y cuáles han sido los principales hallazgos reportados, en pacientes que recibieron transplante renal y que fueron atendidos en el Departamento de Nefrología del Hospital Infantil Manuel de Jesús Rivera-“Mascota”, durante el periodo 2005 a 2009. Se llevó a cabo un estudio tipo serie de casos, en que se evaluaron registros de estudios de ecografia Doppler de pacientes 17 pacientes que recibieron transplante renal. En general, en las primeras 72 horas post transplante, observamos que los vasos explorados en el injerto renal, así como la morfología del injerto fueron evaluados de forma no homogénea en los diferentes momentos. A las 24 horas sólo 11 pacientes (64.7%), fueron evaluados por ecografía doppler. Fue notorio que no se realizara seguimiento ecografico a las 72 horas en 9 pacientes (52.95% de los casos). Al evaluar el flujo, la arteria renal principal y la segmentaria media fueron las arterias mas evaluadas al igual que el parámetro conocido como índice de resistencia. La mortalidad general reportada fue 35.3%. Los resultados aquí presentados representan un primer paso dirigido a crear la base para la implementación de un manejo protocolizado desde el punto de vista ecográfico del paciente post-trasplante renal, en coordinación con clínicos, radiologos, autoridades hospitalarias y del Ministerio de Salud...

Ecografía doppler en pacientes con riñón trasplantado Hospital Infantil Manuel de Jesús Rivera La Mascota período 2005-2009 / Doppler ultrasound in patients with transplanted kidney Hospital Infantil Manuel de Jesus Rivera

Es bien conocida la importancia de realizar estudios de imagen en el trasplante renal. En Nicaragua se realizan trasplantes renales desde hace una década, en el hospital “la Mascota”, desde hace 5 años. El objetivo del presente estudio fue conocer cómo ha sido el seguimiento post transplante renal durante las primeras 72 horas , con ecografía doppler y cuáles han sido los principales hallazgos reportados, en pacientes que recibieron transplante renal y que fueron atendidos en el Departamento de Nefrología del Hospital Infantil Manuel de Jesús Rivera-“Mascota”, durante el periodo 2005 a 2009. Se llevó a cabo un estudio tipo serie de casos, en que se evaluaron registros de estudios de ecografia Doppler de pacientes 17 pacientes que recibieron transplante renal. En general, en las primeras 72 horas post transplante, observamos que los vasos explorados en el injerto renal, así como la morfología del injerto fueron evaluados de forma no homogénea en los diferentes momentos. A las 24 horas sólo 11 pacientes (64.7%), fueron evaluados por ecografía doppler. Fue notorio que no se realizara seguimiento ecografico a las 72 horas en 9 pacientes (52.95% de los casos). Al evaluar el flujo, la arteria renal principal y la segmentaria media fueron las arterias mas evaluadas al igual que el parámetro conocido como índice de resistencia. La mortalidad general reportada fue 35.3%. Los resultados aquí presentados representan un primer paso dirigido a crear la base para la implementación de un manejo protocolizado desde el punto de vista ecográfico del paciente post-trasplante renal, en coordinación con clínicos, radiologos, autoridades hospitalarias y del Ministerio de Salud...

Síndrome megabexiga microcólon hipoperistaltismo intestinal: sobrevida até a adolescência / Megacystis-microcolon-intestinal hypoperistalsis syndrome: survival to adolescence

A síndrome megabexiga microcólon hipoperistaltismo intestinal (SMMHI) é uma doença rara, de provável herança genética, com prognóstico reservado, já no primeiro ano de vida. Relata-se um caso de SMMHI em criança do sexo feminino, atualmente com 16 anos de idade, com o objetivo de ressaltar o prognóstico favorável, não esperado, com sobrevida até a adolescência, de uma síndrome rara. Chama-se a atenção para a possibilidade de estabelecer o diagnóstico no período perinatal e para a importância de realizar o estudo urodinâmico.

Utilización de la nefrostomía percutánea en la práctica urológica / Percutaneous nephrostomy in clinical practice

Objetivo: Presentar una serie de nefrostomías percutáneas realizadas únicamente por urólogos de un mismo servicio. Se describen las indicaciones y se detallan las complicaciones y los resultados obtenidos. Material y métodos: La serie esta constituida por 53 pacientes, 29 hombres y 24 mujeres, con una edad promedio de 64,2 años (rango 10 a 83 años). Se excluyen de este análisis las nefrostomías efectuadas para una nefrolitectomía percutánea. Resultados: La indicación primaria de la nefrostomía percutánea fue: obstrucción ureteral en 36 casos, pionefrosis en 13 e hidronefrosis secundaria a litiasis en 4 casos. La patología de base fue una obstrucción ureteral maligna en 31 pacientes, litiasis obstructiva en 13 casos, estenosis ureteral en derivación urinaria en 8 casos y 1 caso de estenosis pieloureteral. El procedimiento de nefrostomía fue unilateral en 26 casos (derecho en 27 e izquierdo en 17) y bilateral en 9 casos, para un total de 62 nefrostomías en 53 pacientes. La única complicación observada fue una obstrucción de la nefrostomía en un caso de derivación por obstrucción maligna, la cual requirió cambio sin inconvenientes. Conclusiones: La nefrostomía percutánea es un procedimiento de amplia difusión, de resultados satisfactorios, con baja morbilidad y con capacidad de poder ser realizada en forma ambulatoria. Recalcamos la importancia de que la colocación de la misma sea efectuada por el urólogo.

Objective: To report a series of percutaneous nephrostomies solely performed by urologist of a single institution. Indications, complications and results are presented. Material and methods: A total of 53 patiens, 29 male and 24 female with a mean age of 64.2 years (range 10 to 83 years) underwent percutaneous nephrostomy placement at our institution. Nephrostomies associated with lithotomy are excluded. Results: Primary indication for nephrostomy tube placement was: ureteral obstruction 36 cases, pyonephrosis 13 cases, hydronephrosis secondary to stone 4 cases. Malign ureteral obstruction was seen in 31 patients, obstructive calculi in 13 patients and ureteral malign stenosis in 8 patients. One patient presented with ureteropelvic junction obstruction. A total of 62 nephrostomies were placed, unilateral nephrostomy was performed in 26 cases and bilateral in 9 cases (27 right and 17 left). One patient with a ureteral obstruction secondary to malign pathology required nephrostomy tube replacement. Conclusions: Percutaneous nephrostomy is wide spread procedure with satisfactory results, low morbidity and it can be performed in an ambulatory basis. We emphasize the importance of the urologist being carried out by the urologist.

Hypertensive encephalopathy treated by percutaneous nephrostomy

Although hypertension is a known complication of hydronephrosis, it is never severe enough to cause encephalopathy. Here we report a baby boy with unilateral hydronephrosis who presented with hypertensive encephalopathy and whose condition was cured by the insertion of percutaneous nephrostomy followed by pyeloplasty

Eggshell calcification of kidney in ureteropelvic junction obstruction

Eggshell calcification of kidney in case of ureteropelvic junction obstruction (UPJO) is an uncommon finding with only a few cases reported in literature. We report a thirty-year-old symptomatic man with curvilinear calcification in hydronephrotic right kidney. Thorough investigations to rule out genitourinary tuberculosis and hydatid disease of kidney were performed prior to the definitive management by laparoscopic approach.

Dietl's crisis: an under-recognized clinical entity in the pediatric population

OBJECTIVE: To characterize and determine whether patients with recurrent abdominal symptoms and associated ureteropelvic junction obstruction (UPJO) (Dietl's crisis) are effectively treated by pyeloplasty and to determine criteria for evaluating UPJO in childhood abdominal pain. MATERIALS AND METHODS: A retrospective chart review from 1998 to 2001 was performed to identify patients with Dietl's crisis and associated UPJO. Chart review included presenting symptoms, location of lesion, condition of the affected renal unit, referral method, and surgery success. RESULTS: Eight patients (7 male and 1 female) were identified with Dietl's crisis. All eight were initially misdiagnosed and spent at least a year with significant pain symptoms before being properly diagnosed. Only one patient had associated urologic complaints. Renal scan split functions of the affected renal unit ranged from 34 percent to 51 percent. One nephrectomy and seven pyeloplasties were performed and resolution of all patients' abdominal symptoms, including pain, resolved. CONCLUSIONS: Children with Dietl's crisis often suffer a delay in diagnosis; the clinical entity appears to be under-diagnosed. Renal parenchyma is typically preserved, and there is a paucity of associated urologic complaints. Once properly diagnosed, patients are well served by a pyeloplasty. Children with periumbilical pain and vomiting, particularly males, would benefit from ultrasound imaging.