Microureteroscopy in Children: Two First Cases.

BACKGROUND: Urinary stones disease is becoming more common not only in adults but also in children. Most cases are resolved with extracorporeal shock wave lithotripsy, but miniaturization of endoscopes has increased the use of ureteroscopy in resolving ureteral stones, most notably in children. CASE PRESENTATION: This presentation focuses on two cases of microureteroscopy. In both cases, the presence of lithiasis in the pelvic ureter was suspected to be the cause of ureter hydronephrosis, and a microureteroscopy was performed for treatment purposes. MicroPerc set 4.85F sheath was used to explore the pelvic ureter, thus avoiding the need to dilate the ureteral meatus or having to use the safety guide. Patients did not require a postoperative stent and were discharged within 24 hours of the procedure. CONCLUSION: Use of microureteroscopy proved satisfactory in the two cases of children and it allows diagnosis and treatment of ureteral pathology in pediatric patients.

Calidad de Vida en pacientes con hiperplasia benigna de próstata (HBP): cirugía endoscópica (RTU bipolar) versus cirugía láser (LBO 120 W) / Quality of life of patients with benign prostatic hyperplasia (BPH): endoscopic surgery versus laser therapy

OBJETIVO: Contrastar los resultados observados en la calidad de vida de los pacientes intervenidos mediante resección transuretral de próstata (RTU bipolar) o mediante la cirugía láser. MÉTODO: Se trata de un estudio observacional, retrospectivo, de cohortes: una constituida por los pacientes intervenidos con cirugía endoscópica y otra por aquellos sometidos a cirugía láser (vaporización). En total 106 pacientes distribuidos en dos cohortes. A todos aquellos que cumplían los criterios de inclusión se les realizó dos cuestionarios, el International Prostate Sympton Score (IPSS), dos meses antes y seis meses después de la fecha de intervención y el Benign Prostate Hyperplasia Patient Impact Measure (HBP -PIM) seis meses después del acto quirúrgico. Se considera un nivel de significación estadística una p < 0.05% y un intervalo de confianza (IC) del 95 % RESULTADOS: La media del tamaño de próstata es de 55 centímetros cúbicos (cc) en los intervenidos con cirugía endoscópica frente a 40 cc en los operados mediante cirugía láser (p = 0,02). El 35,8% de los pacientes intervenidos con cirugía láser presentaron una clínica irritativa miccional frente al 6,2% de los intervenidos con cirugía endoscópica (p = 0,01). Dentro del grupo intervenido con láser, el 26,4% de los pacientes padecieron fuga de orina frente al 4,4% de los intervenidos mediante RTU bipolar (p = 0,03). El 86,7% de los pacientes de la cohorte de RTU bipolar dicen encontrarse muy felices tras la intervención frente al 53,6 % de la cohorte con cirugía láser (p = 0,03). CONCLUSIONES: En este estudio observacional retrospectivo los pacientes intervenidos mediante cirugía láser con láser LBO (LBO = triborato de litio) presentaron un empeoramiento de la calidad de vida en los seis meses posteriores de la intervención con respecto a los que fueron intervenidos mediante resección transuretral bipolar

OBJETIVE: To compare the results observed in the quality of life of patients after transurethral prostate resection (bipolar TUR) or laser therapy. METHODS: This is a retrospective observational cohort study: one cohort includes patients who underwent endoscopic surgery, and the other patients undergoing laser therapy (vaporization). A total of 106 patients were included, divided into two cohorts. Two questionnaires were prepared for those who fulfilled inclusion criteria, the International Prostate Symptom Score (IPSS), two months before and six months after the date of surgery, and Benign Prostate Hyperplasia Patient Impact Measure (BPH - PIM) six months after surgery. We consider a statistical significance level, p < 0.05% and a confidence interval (CI) of 95 %. RESULTS: Mean prostate size was 55 cc in the endoscopic surgery cohort versus 40 cc in the laser therapy cohort (p = 0.02). 35.8 % of patients treated with laser therapy had urinary irritative symptoms compared with 6.3 % in the endoscopic surgery group (p = 0.01). Within the laser group, 26.4 % of patients had urine leakage compared to 4.4 % among those operated by bipolar TUR (p = 0,03). 86.7 % of patients in the cohort of bipolar TUR were fully satisfied after surgery compared to 53.6 % of the laser therapy cohort (p = 0.03). CONCLUSION: In this retrospective observational cohort study, the patients of LBO laser therapy cohort had a worse quality of life the following six months after surgery compared to those who underwent bipolar transurethral resection

Incidence of infectious complications after extracorporeal shock wave lithotripsy in patients without associated risk factors.

PURPOSE: We determined the incidence of infectious complications (asymptomatic bacteriuria, urinary tract infection and urosepsis) in patients without associated risk factors treated with extracorporeal shock wave lithotripsy. MATERIALS AND METHODS: We performed an observational, prospective cohort study between October 2010 and June 2013. We included all patients without risk factors who were treated with extracorporeal shock wave lithotripsy for kidney or ureteral lithiasis. All patients underwent urine culture 5 days before the procedure. Another urine culture was performed 7 days after lithotripsy. No patient received antibiotics. RESULTS: Initially 366 patients with a mean ± SD age of 53 ± 13 years were enrolled in the study. A total of 64 patients (17.5%) underwent extracorporeal shock wave lithotripsy with a previously placed Double-J® stent. After lithotripsy urine culture was positive in 20 patients (5.8%), of whom 4 (1.2%) presented with symptomatic urinary infection and the remaining 4.6% showed no symptoms. Urosepsis did not develop in any case. In our study patient age was an independent risk factor for bacteriuria after lithotripsy. CONCLUSIONS: The incidence of infectious complications after extracorporeal shock wave lithotripsy in patients without risk factors is low. This leads us to conclude that without defined risk factors antibiotic prophylaxis is not justified. Also, elderly patients were more at risk for bacteriuria after extracorporeal shock wave lithotripsy and, thus, for a possible infectious complication.

Quality of life of patients with benign prostatic hyperplasia (BPH): endoscopic surgery versus laser therapy.

OBJECTIVE: To compare the results observed in the quality of life of patients after transurethral prostate resection (bipolar TUR) or laser therapy. METHODS: This is a retrospective observational cohort study: one cohort includes patients who underwent endoscopic surgery, and the other patients undergoing laser therapy (vaporization). A total of 106 patients were included, divided into two cohorts. Two questionnaires were prepared for those who fulfilled inclusion criteria, the International Prostate Symptom Score (IPSS), two months before and six months after the date of surgery, and Benign Prostate Hyperplasia Patient Impact Measure (BPH - PIM) six months after surgery. We consider a statistical significance level, p 〈 0.05% and a confidence interval (CI) of 95%. RESULTS: Mean prostate size was 55 cc in the endoscopic surgery cohort versus 40 cc in the laser therapy cohort (p = 0.02). 35.8% of patients treated with laser therapy had urinary irritative symptoms compared with 6.3% in the endoscopic surgery group (p = 0.01). Within the laser group, 26.4% of patients had urine leakage compared to 4.4% among those operated by bipolar TUR (p = 0,03). 86.7% of patients in the cohort of bipolar TUR were fully satisfied after surgery compared to 53.6% of the laser therapy cohort (p = 0.03). CONCLUSION: In this retrospective observational cohort study, the patients of LBO laser therapy cohort had a worse quality of life the following six months after surgery compared to those who underwent bipolar transurethral resection.

[Renal allograft rupture: case report and bibliographic review]. / Estallido renal. Caso clínico y revisión de literatura.

OBJECTIVE: To improve the knowledge about complications of renal transplantation and, in particular, graft rupture. METHODS: Case report and literature review. OUTCOME: We present the case of a 37 year-old patient receiving a second renal transplant. In the third postoperative day, he suffered an abrupt change from the correct evolution, with intense pain in the left iliac fossa (the side of the implant) and hemodynamic instability. Imaging tests suggested retroperitoneal collection and adjacent to the implant. In this situation we decided reoperation, we found a ruptured renal unit and transplant nephrectomy was carried out. The pathologic study confirmed that the cause of this rupture was acute rejection of the implant. CONCLUSION: The rupture of the graft is one of the most serious complications in renal transplantation. Rapid diagnosis and surgical treatment are required. Conservative management is the treatment of choice for possible preservation of the renal unit, but there are some situations in which it is dangerous and removal of the graft must be carried out.

Estallido renal. Caso clínico y revisión de literatura / Renal allograft rupture: case report and bibliographic review

OBJETIVO: Mejorar el conocimiento acerca de las complicaciones del transplante renal y en concreto la rotura del injerto. MÉTODO: Presentación de caso clínico y revisión de la literatura. RESULTADO: Presentamos un caso de una paciente de 37 años de edad sometida a su segundo injerto renal. En el tercer día del postoperatorio, sufrió un cambio brusco en la correcta evolución, con dolor intenso en fosa iliaca izquierda (donde se había instaurado el injerto) e inestabilidad hemodinámica. Las pruebas de imagen sugieren colección retroperitoneal y adyacente al injerto. En esta situación se decide reintervención donde se objetiva la ruptura de la unidad renal practicándose transplantectomía. El estudio anatomopatológico confirma que la causa de dicha ruptura viene establecida por un rechazo agudo del injerto. CONCLUSIONES: La ruptura del injerto es una de las complicaciones más graves en un transplante renal. Ante este acontecimiento se precisa un diagnóstico rápido y tratamiento quirúrgico. El manejo conservador es la medida a tomar para la posible preservación de la unidad renal, pero existen algunas situaciones en las que la conservación es peligrosa y se debe llevar a cabo la extirpación del injerto (AU)

OBJECTIVE: To improve the knowledge about complications of renal transplantation and, in particular, graft rupture. METHODS: Case report and literature review. OUTCOME: We present the case of a 37 year-old patient receiving a second renal transplant. In the third postoperative day, he suffered an abrupt change from the correct evolution, with intense pain in the left iliac fossa (the side of the implant) and hemodynamic instability. Imaging tests suggested retroperitoneal collection and adjacent to the implant. In this situation we decided reoperation, we found a ruptured renal unit and transplant nephrectomy was carried out. The pathologic study confirmed that the cause of this rupture was acute rejection of the implant. CONCLUSION: The rupture of the graft is one of the most serious complications in renal transplantation. Rapid diagnosis and surgical treatment are required. Conservative management is the treatment of choice for possible preservation of the renal unit, but there are some situations in which it is dangerous and removal of the graft must be carried out (AU)