Implantación de un programa de mininefrolitotomía percutánea ambulatoria: presentación del protocolo y resultados iniciales / Initial results of the implementation of an ambulatory mini percutaneous nephrolithotomy program

Objetivo Presentar nuestro protocolo de nefrolitotomía percutánea ambulatoria y evaluar los resultados iniciales del programa. Material y métodos Se analiza la implantación clínica del protocolo con los 30 primeros casos de mininefrolitotomía percutánea ambulatoria realizados en nuestro centro entre abril de 2021 y septiembre de 2022. Se recogen datos demográficos, variables perioperatorias, complicaciones y necesidad de atención médica no planificada, stone-free rate, tipología litiásica y parámetros de satisfacción con el proceso de cirugía mayor ambulatoria. Resultados Con una edad media de 60,2±11,6 años se intervinieron un total de 30 pacientes que cumplían los criterios de inclusión. El tamaño medio de la litiasis fue de 15mm [rango: 5-20]. No se registró ninguna complicación intraoperatoria. Todos los pacientes excepto uno fueron dados de alta el mismo día de la intervención, según lo planificado. El mes posterior al alta, la tasa de complicaciones, reconsulta a urgencias o reingreso hospitalario ha sido del 0%. La stone-free rate a los 3 meses ha sido del 83%. La satisfacción global de todo el proceso perioperatorio, valorada a través del cuestionario EVAN-G, fue de 124,3 puntos sobre un máximo de 150, equivalente a un 78,6% de grado de satisfacción. Conclusión La mininefrolitotomía percutánea en régimen ambulatorio puede instaurarse como una opción de asistencia en centros con experiencia en endourología, una unidad establecida de cirugía mayor ambulatoria y mediante una selección estricta de los pacientes. Nuestros resultados iniciales muestran un perfil de seguridad adecuado y un grado de satisfacción global elevado de los pacientes intervenidos en esta modalidad (AU)

Objective To present our program for ambulatory mini percutaneous nephrolithotomy and evaluate its initial results. Material and methods We analyzed the implementation of the protocol into the clinical practice with the first 30 outpatient mini percutaneous nephrolithotomy cases performed in our center between April 2021 and September 2022. Demographic characteristics, perioperative variables, complications and need for unplanned health care, stone-free rate, stone type and patient satisfaction with the major ambulatory surgery process were collected. Results A total of 30 patients with a mean age of 60.2±11.6 years who met the inclusion criteria underwent surgery. The mean stone size was 15mm [range: 5-20]. No intraoperative complications were recorded. All patients except one were discharged the same day of surgery as planned. In the month following discharge, the rate of complications, emergency department revisits or hospital readmissions rates were 0%. Stone-free-rate at 3 months was 83%. Overall satisfaction with the whole perioperative process was assessed with the EVAN-G questionnaire, obtaining 124.3 points out of a maximum of 150, which is equivalent to a 78.6% level of satisfaction. Conclusion Ambulatory mini percutaneous nephrolithotomy can be implemented as a treatment option in centers with experience in endourology, an established major ambulatory surgery unit, and strictly selected patients. Our initial results show an adequate safety profile and high overall satisfaction perceived by patients undergoing the ambulatory approach (AU)

Initial results of the implementation of an ambulatory mini percutaneous nephrolithotomy program.

OBJECTIVE: To present our program for ambulatory mini percutaneous nephrolithotomy (mini-PCNL) and evaluate its initial results. MATERIAL AND METHODS: We analyzed the implementation of the protocol into the clinical practice with the first 30 outpatient mini-PCNL cases performed in our center between April 2021 and September 2022. Demographic characteristics, perioperative variables, complications and need for unplanned health care, stone-free rate (SFR), stone type and patient satisfaction with the major ambulatory surgery (MAS) process were collected. RESULTS: A total of 30 patients with a mean age of 60.2 ±â€¯11.6 years who met the inclusion criteria underwent surgery. The mean stone size was 15 mm [range: 5-20]. No intraoperative complications were recorded. All patients except one were discharged the same day of surgery as planned. In the month following discharge, the rate of complications, emergency department (ED) revisits or hospital readmissions rates were 0%. Stone-free-rate (SFR) at 3 months was 83%. Overall satisfaction with the whole perioperative process was assessed with the EVAN-G questionnaire, obtaining 124.3 points out of a maximum of 150, which is equivalent to a 78.6% level of satisfaction. CONCLUSION: Ambulatory mini-PCNL can be implemented as a treatment option in centers with experience in endourology, an established MAS Unit, and strictly selected patients. Our initial results show an adequate safety profile and high overall satisfaction perceived by patients undergoing the ambulatory approach.

Flexible Ureteroscopy as a Major Ambulatory Surgery Procedure. Single Center Experience and Analysis of Variables Related to Hospital Readmission

Objective: To assess our experience in flexible ureteroscopy (fURS) in major ambulatory surgery (MAS) and to detect variables related to unplanned medical assistance after surgery. Material & Methods: We conducted a retrospective study among patients with renal stones undergoing a fURS from 2014 to 2019 in MAS at our hospital. Variables: Age, gender, ASA physical status, type of anesthetic technique performed, stone characteristics, influence of double J stent before or after surgery, and postoperative complications according to the Clavien-Dindo modified classification. We evaluated variables related to hospital readmission or visit to the emergency room after surgery. Results: A total of 222 consecutive fURS for stone disease were performed in MAS. Patients’ average age was 52.9 ± 13.91 years old. The mean operating time was 57.86 ± 21.11 minutes. The mean stone size was 1.92 ± 1.43 with a diameter of 10.01 ± 4.24 mm. 47.3% of patients had a double J stent before fURS, and in 35.14% of cases, a stent was placed after surgery. 7.65% of patients required unplanned hospitalization. 14.86% of patients presented to the emergency room in the following month after surgery. Among them, one-third consulted for symptoms related to the double J. Patients who carried a double J stent before the fURS had 64% less risk of visiting the emergency department in the following month after surgery [OR = 0,363; IC95% (0.153-0.798)]. All other variables (age, gender, operating time...) did not modify the risk of unplanned medical assistance. Conclusion: The low complication rate following flexible ureteroscopy allows its performance as an ambulatory surgery. Patients who carry double J stent before the procedure have less risk of requiring unplanned medical assistance after the surgery (AU)

Objetivos: Evaluar nuestra experiencia con laureterorrenoscopia flexible (Uflex) en régimen de cirugíamayor ambulatoria (CMA) e identificar variables predictoras de asistencia médica no programada en el postoperatorio.Material y Métodos: Estudio retrospectivo de los pacientes afectos de litiasis renal intervenidos mediante Uflexen régimen de CMA entre 2014 y 2019 en nuestro centro.Variables: Edad, género, medicación antitrombótica, categoría del paciente según la clasificación de la SociedadAmericana de Anestesistas (ASA), tipo de anestesia empleada, características de la litiasis, influencia del cateterismo doble J y pre y postcirugía y complicaciones postoperatorias según la clasificación Clavien-Dindo modificada.Investigamos que variables puedan asociarse a requerir ingreso o consulta a urgencias tras la intervención quirúrgica.Resultados: Un total de 222 pacientes consecutivosafectos de litiasis renal fueron intervenidos mediante Uflexen régimen de CMA. La edad de los pacientes fue de 52,9 ±13,91 años. El tiempo quirúrgico fue de 57,86 ± 21,11 minutos. El número de litiasis fue de 1,92 ± 1,43 y el tamañode la litiasis fue de 10,01 ± 4,24 mm. El 47,3% de los pacientes tenían un catéter doble J previo a la Uflex y se dejóposteriormente a la misma en un 35,14% de los casos. Un7,65% de los pacientes requirieron ingreso hospitalario. El14,86% de los pacientes acudió a urgencias en el mes siguiente a la cirugía. De ellos, un tercio consultó por sintomatología relacionada con el doble J. Los portadores de dobleJ previo a la cirugía tuvieron un 64% menos de probabilidadde consultar en urgencias en el mes siguiente [OR = 0,363;IC95% (0.153-0.798)]. El resto de variables (edad, sexo,tiempo quirúrgico…) no modificaron el riesgo de consultaen urgencias ó de ingreso hospitalario... (AU)

[Incidence and treatment of urinary lithiasis in renal transplantation]. / Incidencia y tratamiento de la litiasis urinaria en el injerto renal.

INTRODUCTION: Urinary calculi is an uncommon complication in kidney transplantation; several stone risk factors are found in transplanted patients, but in most cases there is not a relationship between these risk factors and stone formation. The treatment of these patients is complex due to their both immunosuppressive status and border-line renal function. MATERIAL AND METHOD: From 1980 to February 2000, 1198 kidney transplant have been performed in our institution. We describe our series consisting in 22 urinary calculi (15 in the graft, 3 in the urether and 4 in the bladder) in 18 patients, including 7 stones detected in cadaveric donor patients. RESULTS: We performed external shock wave lithotripsy in 7 patients, bench surgery in 4, endoscopic mechanic lithotripsy in 5, open surgery in 1 and observation in 6. Calcium oxalate (mono and dihidrate) was found in 9 of 13 calculi. Metabolic changes were found in 15 of the 18 patients, the most common was hiperuricemia. There were not complications of every treatment applied and 9% of them needed a savage treatment. We found recurrence in 4 cases (22.2%). Now 12 of the patients are stone-free (66.7%) and three have non-significative stones (83.3% without symptoms). CONCLUSIONS: Detection of renal calculi in cadaveric renal donors is not a reason to refuse the graft for further transplantation. In both renal calculi up to 2 cm and uretheric calculi surgical treatment is assessed as first option. In caliceal stones smaller than 5 mm observations is the best treatment.

Incidencia y tratamiento de la litiasis urinaria en el injerto renal / Incidence and treatment of urinary calculi in the renal graft

INTRODUCCIÓN: La litiasis urinaria es una complicación infrecuente del trasplante renal; diversos factores de riesgo se han encontrado en pacientes trasplantados renales, pero en muchos casos no hay una relación entre estos factores de riesgo y la formación del cálculo. El tratamiento de estos pacientes es complejo debido a su estado de inmunosupresión y su función renal límite. MATERIAL Y MÉTODO: Desde 1980 hasta febrero de 2000 se han llevado a cabo 1.198 trasplantes renales en nuestro centro. Describimos nuestra serie, que consiste en 22 cálculos (15 en el injerto, 3 en el uréter y 4 en la vejiga) en 18 pacientes, incluyendo 7 litiasis diagnosticadas en el donante cadáver. RESULTADOS: Se practicó litotricia extracorpórea por ondas de choque (LEOC) en 7 ocasiones, cirugía en banco en 4, litotricia mecánica endoscópica en 5, cirugía abierta en 1 y actitud expectante en 6. Los cálculos contenían oxalato cálcico (mono o dihidrato) en 9 de los 13 analizados. Aparecieron alteraciones metabólicas en 15 de los 18 pacientes, la más común fue la hiperuricemia. No han aparecido complicaciones del tratamiento y en dos litiasis (9 por ciento) fue necesario un tratamiento de rescate. Cuatro cálculos recidivaron (22,2 por ciento). Están libres de litiasis 12 pacientes (66,7 por ciento) y 3 con litiasis clínicamente no significativas (83,3 por ciento asintomáticos). CONCLUSIONES: La presencia de litiasis en el donante renal cadáver no es una razón para rechazar el injerto para el trasplante. En el tratamiento de los cálculos renales mayores de 2 cm y ureterales, debe valorarse el tratamiento quirúrgico como primera opción. En los cálculos calicilares menores de 5 mm la abstinencia terapéutica es la actitud recomendable (AU)

[Treatment of lithiasis in horseshoe kidney with extracorporeal shock-wave lithotripsy]. / Tratamiento de la litiasis en el riñón en herradura mediante litotricia extracorpórea por ondas de choque.

UNLABELLED: The horseshoe kidney is the most frequent renal anomaly. As a consequence of impaired urinary drainage, urolithiasis is present in 20% of the cases. Indications for extracorporeal shock wave lithotripsy (ESWL) in the treatment of patients with anomalous kidneys is still the subject of controversy. OBJECTIVE: To evaluate ESWL efficacy in the treatment for lithiasis in horseshoe kidney. MATERIAL AND METHODS: Between april 1988 and december 1999 a total of 32 symptomatic lithiasis in 30 patients with horseshoe kidneys were managed by 65 sessions with ESWL. Until march 1999 a Dornier HM-4 electrohydraulic lithotripter was used. Posteriorly, two treatments was performed with an electromagnetic Dornier Lithotripter S. These procedures have been performed without anaesthesia or sedation for the Dornier HM-4 equipment. Analgesia with Meperidine was used for the Dornier Lithotripter S. Diuresis was not forced during or after treatment with diuretics or serotherapy. Treatments was conducted in an outpatient clinic in all cases. RESULTS: Treatment/lithiasis rate was 2.03. Following treatment 16 patients (54%) were stone-free by X-ray, 9 patients (30%) had residual fragments and in 5 patients (16%) no sign of stone disintegration was observed. Open surgery was performed in three of this patients. Better results was achieved in stones located in the renal pelvis and stone size is 10 mm or less. Clinical evolution: free of symptoms in 20 patients; chronic vague flank pain in 5 patients and acute renal colic with or without hematuria in 5 patients. No major complication was observed in our compilation. CONCLUSIONS: These results suggest that ESWL is the method of primary choice in the treatment for small lithiasis (10 mm or less) in horseshoe kidney.

Tratamiento de la litiasis en el riñón en herradura mediante litotricia extracorpórea por ondas de choque / Extracorporeal shock wave lithotripsy in the treatment for lithiasis in horseshoe kidney

El riñón en herradura constituye la anomalía congénita más frecuente del riñón. La dificultad en el drenaje urinario influye en que un 20 por ciento de los mismos desarrollan litiasis renal. El papel de la litotricia extracorpórea por ondas de choque (LEOC) en el tratamiento de la litiasis en pacientes afectos de malformaciones congénitas renales es todavía motivo de controversia. OBJETIVO: Evaluar la eficacia de la LEOC en el tratamiento de la litiasis en el riñón en herradura. MATERIAL Y MÉTODOS: Entre abril de 1988 y diciembre de 1999 hemos tratado a 30 pacientes con riñón en herradura portadores de 32 litiasis sintomáticas que han requerido de 65 sesiones de LEOC para su resolución. Hasta marzo de 1999 hemos utilizado un equipo Litotriptor Dornier HM-4 de energía electrohidráulica. Posteriormente dos tratamientos se han realizado con equipo Dornier Lithotripter S de energía electromagnética. Todos los tratamientos han sido realizados sin anestesia ni sedación con el equipo Dornier HM-4 y utilizamos analgesia con meperidina con el Dornier Lithotripter S. En ningún caso se ha forzado diuresis con diuréticos ni sueroterapia. Todos los tratamientos se han realizado de forma ambulatoria. RESULTADOS: El índice tratamiento/litiasis ha sido de 2.03. El número de pacientes libres de litiasis tras el tratamiento es de 16 lo que supone un 54 por ciento. En 9 pacientes (30 por ciento) se consiguió fragmentación de la litiasis y en 5 pacientes (16 por ciento) no se produjeron cambios tras el tratamiento. En tres de los casos se recurrió a la cirugía convencional para la resolución de su litiasis. Se ha producido recidiva en 2 pacientes lo que supone un 6 por ciento. Obtenemos mejor o total eliminación de la litiasis cuando ésta está alojada a nivel piélico y es de un tamaño igual o inferior a 10 mm. Evolución clínica: asintomáticos 20 pacientes; lumbalgia 5 pacientes; cólico nefrítico con o sin hematuria: 5 pacientes. No hemos asistido a ninguna complicación mayor en esta serie. CONCLUSIONES: Estos resultados sugieren que la LEOC es la primera opción terapéutica a utilizar ante una litiasis renal de pequeño tamaño (=10 mm) alojada en un riñón en herradura (AU)

[Current treatment of lithiasis in congenital renoureteral malformations]. / Tratamiento actual de la litiasis en malformaciones congénitas renoureterales.

OBJECTIVE: To evaluate the treatment of urinary calculi in renoureteral malformations. METHODS: From April 1988 to December 2000, we have treated 158 patients with renoureteral malformations (36 horseshoe kidneys, 32 caliceal diverticula, 2 megacaliosis, 2 crossed renal ectopy, 3 polycystosis, 7 hydrocalyx, 24 complete duplex ureter, 18 incomplete duplex ureter, 22 ureterocele, 2 segmental megaureter). RESULTS: Renoureteral malformations were diagnosed in 158 of 19,000 patients that were treated in our stone unit from April 1988 and December 2000. Horseshoe kidney: 54% of the patients treated by ESWL are stone-free; PNL was performed in 2 patients and conventional surgery in another 2 patients. Caliceal diverticulum: 42% of the patients treated by ESWL are stone-free; 3 patients underwent conventional surgery. Other renal malformations: 62% of the patients treated by ESWL are stone-free. Ureteral malformations: duplex ureter and megaureter: 82% of the patients treated by ESWL are stone-free. Ureterocele: due to the poor results achieved by ESWL, we performed endoscopic transurethral meatotomy. CONCLUSIONS: These results indicate that ESWL alone can be considered to be the treatment of choice for small calculi in patients with renal malformations, although we consider it to be mandatory to perform individual assessment of the urinary tract and stone size in these patients in order to choose the best therapeutic option. The same criteria for the normal urinary tract can be applied in ureteral malformations except ureteroceles, for which we advocate performing endoscopic surgery for stone removal.

[Preservation by pulsatile perfusion machine: the initial experience]. / Preservación mediante maquina de perfusión pulsátil: experiencia inicial.

The increasing numbers of patients in a waiting list for a renal transplantation together with the epidemiological changes in donor's characteristics have given rise to a growing interest in preservation with pulsatile perfusion machines. The availability of objective predictive parameters of renal functioning after transplantation as well as of improving preservation to reduce the incidence of acute tubular necrosis (ATN) are the major features of this preservation technique. This paper presents our experience in preservation with pulsatile perfusion machines which have allowed us to have objective parameters to assess an organ's future functioning and to improve, as far as possible, the quality of treated kidneys preservation.

[Diverticulum of the female urethra: presentation of 3 cases]. / Divertículo de uretra femenino: presentación de tres casos.

Contribution of three cases of female urethral diverticulum diagnosed and treated in our Service. Presence in women presenting to the practice with chronic signs and symptoms of the lower urinary tract unresponsive to conventional medical management should be ruled out. A review is made of the most significant aspects in terms of clinical presentation, diagnosis and therapeutic options.