Tratamiento de la litiasis con láser en condiciones especiales / Treatment of urinary stones with laser in special conditions

Durante la última década, se ha producido un rápido desarrollo en la nefroscopia y la ureterorrenoscopia flexible, litotricia láser y diferentes instrumentos para manejar las litiasis. Realizaremos una revisión del empleo del láser en distintas situaciones. Se deben hacer esfuerzos para minimizar el daño renal y el láser juega un papel importante en el tratamiento de pacientes con urolitiasis y riñones en herradura, insuficiencia renal crónica, pacientes neurológicos (AU)

During the last decade there has been a rapid development in flexible nephroscopy, flexible ureterorenoscopy, laser lithotripsy and instruments for stone manipulation. We are going to review the use of Laser in the management of lithiasis in different situations. Efforts should be made to minimize renal injury and lasers play a significant role in patients with urolithiasis and horseshoe kidneys, chronic renal failure, neurological patients (AU)

[Treatment of urinary stones with laser in special conditions]. / Tratamiento de la litiasis con láser en condiciones especiales.

During the last decade there has been a rapid development in flexible nephroscopy, flexible ureterorenoscopy, laser lithotripsy and instruments for stone manipulation. We are going to review the use of Laser in the management of lithiasis in different situations. Efforts should be made to minimize renal injury and lasers play a significant role in patients with urolithiasis and horseshoe kidneys, chronic renal failure, neurological patients.

[Retroperitoneal laparoscopic surgery; initial experience in the Hospital La Paz]. / Cirugía retroperitoneal laparoscópica; experiencia de los 6 primeros meses del Hospital La Paz.

We present the initial results of retroperitoneal laparoscopic surgery in the Hospital Universitario La Paz from July 2004 to December 2004. The program started after 2 years of pelvic laparoscopy surgery practice. The initial experience has been so good that we have reduced the contraindications for this technique and we have increased the number of laparoscopic surgery cases.

Cirugía retroperitoneal laparoscópica; experiencia de los 6 primeros meses del Hospital la Paz / Retroperitoneal laparoscopic surgery; initial experience in the Hospital La Paz

Presentamos los resultados iniciales del programa de cirugía laparoscópica retroperitoneal del Hospital Universitario La Paz desde julio de 2004 hasta diciembre de 2004. El programa se inició tras 2 años de experiencia en cirugía laparoscópica pélvica. La experiencia inicial ha sido lo suficientemente buena como para reducir progresivamente las contraindicaciones y aumentar el número de cirugías realizadas con dicha técnica (AU)

We present the initial results of retroperitoneal laparoscopic surgery in the Hospital Universitario La Paz from july 2004 to december 2004. The program started after 2 years of pelvic laparoscopy surgery practice. The initial experience has been so good that we have reduced the contraindications for this technique and we have increased the number of laparoscopic surgery cases (AU)

[Percutaneous endourologic treatment of obstructive ureteral lithiasis in renal transplant]. / Tratamiento endourológico percutáneo de litiasis ureteral obstructiva en injerto renal.

Donor graft lithiasis is a unusual complication of renal transplantation, however, it is associated to a high morbidity. This pathology is due to several causes such us: metabolic factors, infectious disease, drugs, foreign bodies or transferred in the donor graft. The objective of the treatment is to remove the lithiasis without damaging the renal unit. We report the successful percutaneous anterograde treatment of an ureteral obstructive hard calculi, in renal allograft.

Tratamiento endourológico percutáneo de litiasis ureteral obstructiva en injerto renal / Endourological management of ureteral obstructive calculi after renal transplantation

En el riñón trasplantado la aparición de litiasis representa una de las complicaciones menos frecuentes, sin embargo, dadas las características de estos pacientes, se asocia a una elevada morbilidad. Varias son las causas responsables de esta enfermedad: se han identificado factores metabólicos, infecciosos, fármacos, cuerpos extraños, así como la presencia previa de litiasis en el propio injerto. Desde el punto de vista del tratamiento, dado que son pacientes con un riñón único funcionante, la agresión a que éste sea sometido debe ser lo menor posible. Presentamos un caso de litiasis ureteral obstructiva de gran dureza, en un injerto renal, resuelta mediante acceso percutáneo anterógrado con ureteroscopio flexible, con éxito (AU)

Donor graft lithiasis is a unusual complication of renal transplantation, however, it is associated to a high morbidity. This pathology is due to several causes such us: metabolic factors, infectious disease, drugs, foreign bodies or transferred in the donor graft. The objetive of the treatment is to remove the lithiasis without damaging the renal unit. We report the succesful percutaneous anterograde treatment of an ureteral obstructive hard calculi, in renal allograft (AU)

[Iatrogenic injury of the lumbar ureter and iliac vessels after lumbar discectomy: urologic treatment using kidney autotransplantation]. / Lesión iatrogénica de uréter lumbar y vasos ilíacos tras discectomía lumbar: tratamiento urológico mediante autotrasplante renal.

We report a case of a patient with a secondary injury of external iliac artery and vein in the L4-L5 laminectomy and discectomy course. An immediately vein suture and ilio-iliac by-pass with Dacron was made. In the postoperative a iatrogenic lumbar ureter section was discovered and treated with renal autotransplantation. We review the options described in the literature in the management of these complex ureteral injuries.

Trasplante renal pediátrico de donante vivo relacionado / Living related donor in pediatric renal transplantation

El donante vivo relacionado (DVR) tiene importantes ventajas cuando se compara con el donante cadáver (DC) en términos de mejor supervivencia del paciente y del injerto, así como de un tiempo de espera menor. Desde 1985 hemos realizado en nuestro Centro 176 trasplantes renales (TR), de los cuales 156 (89 por ciento) son de DC y 20 (11 por ciento) de DVR en primer grado. El objetivo de este trabajo es presentar nuestra experiencia de 5 años con el DVR. A todos los donantes se les realizó un estudio protocolizado de función renal, bioquímico, metabólico y angiográfico. Doce niños recibieron su primer trasplante y 8 fueron retrasplantes ( 6 segundos, 1 tercero y 1 cuarto). El tratamiento inmunosupresor consistió en terapia clásica (azatioprina, ciclosporina prednisona) con inducción de suero antitimocítico. El FK506 y el micofenolato mefetil también se han empleado en alguno de ellos. En cuatro injertos fue necesario reaizar cirug´´ia arterial de banco debido a a presencia de anomalías vasculares. La complicación más signifiativa ha sido a pérdida de un injerto debida a una microangiopatía trombótica asociada al FK506. La supervivencia tanto del donante como del receptor es del 100 por ciento y la supervivencia actuarial del injerto a los 5 años es del 95 por ciento, con un infiltrado glomerular medio de 81,33 ml/min/1,73 m2 (AU)

[Pediatric renal transplantation from related living donor]. / Trasplante renal pediátrico de donante vivo relacionado.

Living related donor (LRD) provides significant advantages when compared with cadaveric donor (CAD) in term of improved patient and graft survival and shorten waiting time. From 1985, 176 kidney transplants were performed at our Center. Of these, 156 (89%) were from CAD and 20 (11%) were from LRD, first degree. The purpose of this paper is to show our experience at 5 years with use of LRD. All donors underwent standardized metabolic workup, angiography assessed and renal function test. Twelve children received their first transplant and 8 were retransplant (6-second, 1-third and 1-fourth). Immunosuppressive therapy consisted of globulin antithymocyte, azathioprine, cyclosporine and prednisolone, using FK506 and mycophenolate mofetil in some of them. Four kidneys with multiple renal arteries were reconstructed ex vivo with microsurgical technique before transplantation. The most significant morbidity was due to FK506-associated thrombotic microangiopathy (TMA) with graft lost. All patients (donor and recipient) survived. Five years graft survival rate is 95% and mean glomerular filtration rate is 81.33 ml/min/1.73 m2.

[Inferior vena cava leiomyosarcoma: report of a new case and review of the literature]. / Leiomiosarcoma de vena cava inferior: aportación de un nuevo caso y revisión de la literatura.

OBJECTIVE/METHODS: To present an additional case of leiomyosarcoma of the inferior vena cava and review the literature, with special reference to the etiology, diagnosis and treatment of this rare tumor. RESULTS: The patient was submitted to radical surgery and short course radiotherapy. Twelve months thereafter, the patient is asymptomatic and disease-free. CONCLUSIONS: Leiomyosarcoma of the inferior vena cava is a rare and aggressive tumor. Treatment is by aggressive and radical surgery.

[Bladder leiomyoma during pregnancy]. / Leiomioma vesical durante el embarazo.

OBJECTIVE: To describe an additional case of rapidly growing leiomyoma of the bladder in a pregnant woman. METHODS: A case of leiomyoma of the bladder in a woman at 8 months of pregnancy is presented. Transurethral resection was performed, but the tumor recurred a few weeks later. The tumor was resected by partial cystectomy after delivery. CONCLUSIONS: Leiomyoma of the bladder is an uncommon benign lesion that is successfully managed by surgical resection. The rapid recurrence of the tumor in our patient can be ascribed to the hormonal changes during pregnancy.

[Incidence of the different types of hypercalciuria in Spain]. / Incidencia de los diferentes tipos de hipercalciuria en España.

OBJECTIVE: To carry out a comparative biochemical study of primary hyperparathyroidism, the different types of hypercalciuria and a healthy population. METHODS: Fourteen patients with primary hyperparathyroidism and 103 patients with idiopathic hypercalciuria were studied under conditions of restricted calcium intake and following a calcium load; the results were compared to those of 18 healthy controls. RESULTS: The patients with hyperparathyroidism showed high parathormone concentrations. Sixty-nine patients with idiopathic hypercalciuria had normal parathormone levels and were considered suffering from absorptive hypercalciuria. Those patients with high urinary calcium excretion under restricted calcium intake and normal urinary phosphate threshold were considered as being absorptive hypercalciuria type I, those with normal urinary calcium as absorptive hypercalciuria type II, and those with low urinary phosphate threshold constituted a renal phosphate leakage group. Thirty-four patients had normal serum calcium, elevated parathormone, hypophosphatemia and high calcium excretion under all dietary conditions, and were considered undergoing renal hypercalciuria. Patients with renal hypercalciuria had increased urine hydroxyproline and low serum calcium compared with the controls after an oral calcium load. This biochemical behaviour is compatible with secondary hyperparathyroidism caused by renal calcium leakage. CONCLUSIONS: In summary, the biochemical parameters: parathormone, urinary phosphate threshold and urinary calcium excretion, measured in fasting conditions, allowed classification of patients with idiopathic hypercalciuria.

[Ureteral tamponade in the treatment of urinary fistula: our experience]. / Taponamiento ureteral en el tratamiento de las fístulas urinarias: nuestra experiencia.

Surgical correction is the treatment of choice for urinary fistulas. However, there are circumstances that advise against the use of this approach, basically when patient general condition is poor or life expectancy short; i. e., in the presence of an underlying malignant pelvic disease. In these cases, urinary diversion by percutaneous nephrostomy will suffice, although sepsis or derangement of electrolyte balance may sometimes develop due to the fistulous defect. Occlusion of the pyelo-ureteric junction and percutaneous drainage is a solution that causes no major complications. Two patients who could not be submitted to conventional surgery were treated by the foregoing procedure. Both patients have been followed for more than two years. The first case was a male who had undergone abdominoperineal resection due to carcinoma of the sigmoid colon. He developed stress ulcers, pulmonary thromboembolism, sepsis, paralytic ileus and bilateral ureteral fistula. The second case was an insulin-dependent female diabetic who had previously received radiotherapy to the pelvis. She developed a large vesicocutaneous fistula and public osteomyelitis after drainage of an inguinal abscess. Patient tolerance was good and no major complications were observed. In our view this palliative procedure should be considered in the management of patients with urinary fistula whose life expectancy is short. Its application can be extended to patients with inoperable carcinoma of the bladder or prostate and important symptoms.

[Giant lithiasis in left ureterocele. Its endoscopic resolution]. / Litiasis gigante en ureterocele izquierdo. Resolución endoscópica.

Herein we describe a case of giant calculus in an orthotopic ureterocele in a female patient who had consulted for recurrent left-sided nephritic colic. A plain film of the urinary tract prompted us to suspect a giant calculus, which was confirmed by IVP. Treatment was by endoscopic surgery. The patient has remained asymptomatic one year postoperatively.

[Our experience with the diagnosis and treatment of 429 renal traumatisms]. / Nuestra experiencia en el diagnóstico y tratamiento de 429 traumatismos renales.

We studied 429 cases (3 bilateral) of renal injuries in 426 patients diagnosed and treated at our service from 1965 to 1990. Four-hundred twenty (98.59%) were blunt and 6 (1.41%) were penetrating injuries. In 313 the renal lesions were grade I (72.96%), 69 grade II (16.08%), 27 grade III (6.29%) and 20 were traumatic injuries to pathologic kidney (4.66%). Surgery was performed immediately in 67 cases (15.61%) (35 grade II, 21 grade III, and 11 previously pathological kidneys). Surgery was delayed in 34 cases (7.92%) (1 grade I, 23 grade II, 5 grade III and 5 pathological kidneys). Three-hundred twenty-eight cases (76.45%) were managed conservatively (312 grade I, 11 grade II, 1 grade III and 4 cases of traumatic injury to previously pathological kidney). Preservation of the renal unit was achieved in 100% of those with grade I lesions and in 91.17% of those with grade II that had been treated conservatively or submitted to delayed surgery. Of the grade II lesions that were immediately treated, 22.58% required a nephrectomy procedure. Of the grade III lesions and the cases of traumatic injury to previously pathological kidney, nephrectomy was required in 72% and 65%, respectively, although delayed surgery permitted more precise indication in a hemodynamically stable patient. The mortality rate in our series was 1.87 (8/426).

[Renal oncocytoma: diagnosis and treatment. Report of 4 cases]. / Oncocitoma renal: diagnóstico y tratamiento. A propósito de cuatro casos.

Four cases of renal oncocytoma that had been treated at our service from 1985 to 1990 are presented herein. The renal mass had been incidentally disclosed on the IVP (2 cases), abdominal ultrasound (1), and on palpation (1). An abdominal CT scan complemented the diagnostic work up. The diagnoses of oncocytoma (1 case) and renal carcinoma (3 cases) were made based on the scan findings. The 3 patients that had been diagnosed as having renal carcinoma were submitted to radical nephrectomy. The patient diagnosed as having oncocytoma underwent surgical enucleation of the tumor. Subsequent histological examination was diagnostic of oncocytoma in all four cases. Follow-up ranging from 15 to 55 months revealed all patients are asymptomatic and tumor-free. Currently attention has been focussed on this tumor type. The diagnostic and therapeutic controversies are discussed.

[Endo-urologic surgery of urothelial tumors of the upper urinary tract]. / Cirugía endourológica de los tumores uroteliales del aparato urinario superior.

The endourological approach for utothelial tumors of the upper urinary tract (UUT) is a controversial issue of which there is little experience to date. However, the data reported in the series of other authors as well as our own series support its utilization. Of a total of 137 patients suspected of having UUT tumor, 66 patients underwent endourological management: 56 by ureteroscopy (URS) and 10 by percutaneous nephroscopy (PN). The presence of tumor was discarded in 26 patients, 10 underwent open surgery to treat the tumor, and the remaining 30 patients were primarily treated by URS (20), PN (9), or combined treatment (1). Overall, 30 of 111 patients (27%) were treated by endoscopy; 28 attempted cure and 2 were palliative procedures. Twenty-six of these 30 patients had a previous history of urothelial tumor, 7 had a single kidney, and in 5 patients the tumor had presented following cystectomy. Except for the T2 tumor submitted to palliative treatment and one case with diffuse carcinoma in situ, all tumors were TA-1, 20 were G1, 8 were G2, and were G3. Seven of the 30 patients had died after a mean follow-up of 28.4 months (range 3-117 months: 2 immediately postoperatively from pathological conditions unrelated to the operation (acute CVA, biliary sepsis), 1 from conditions unrelated to the urinary tract or tumor, 2 from disseminated bladder urothelial tumor, and 1 from disseminated primary adenocarcinoma of unknown origin. Currently, 23 patients (76.6%) are alive; of these, 7 (23.3%) have had tumor recurrence: 2 required treatment by nephroureterectomy but the remaining 5 patients were also treated endourologically with success. The progression index was 7% (2/28). Analysis of prognostic factors revealed a close correlation between the histologic grade of malignancy, malignant urinary cytology, and the frequency of tumor recurrence. Tumor recurrence was observed to be 60% in those with a positive cytology and only 17.6% in those with a negative cytology. G3 tumors recurred 50% of the time, G2 37.5%, and Go-1 22%. The frequency of tumor recurrence was also different in patients who had received adjuvant topical BCG or MMC therapy (20%) in comparison to those who received no adjuvant therapy (40% recurrence). On the other hand, no significant difference was observed relative to the technique utilized to treat the tumor: 3/12 (25%) of those who underwent electroresection or electrocoagulation and 6/16 (37.5%) of those submitted to Nd:YAG laser.(ABSTRACT TRUNCATED AT 400 WORDS)

[Kidney injuries in childhood: our experience in 64 cases]. / Traumatismos renales en la infancia: nuestra experiencia en 64 casos.

From 1969 to 1988, 64 children under 5 years of age with renal trauma were treated at our Urology service. Trauma was classified as grade I in 34, grade II in 23, grade III in 3, and 4 patients presented with trauma to pathologic kidney. Eight patients were submitted to immediate surgery (3 grade II, 3 grade III, and 2 with trauma to pathologic kidney). Twelve were initially treated conservatively and were deferred for surgery (11 with grade II trauma and 1 with trauma to pathologic kidney). The remaining 44 patients (34 grade 1, 9 grade II, and 1 with trauma to pathologic kidney) only received medical treatment. The renal unit could be salvaged in 34 cases with grade I trauma (100%) and in 2 of 3 (66.6%) with grade III trauma who underwent immediate surgery. In patients with grade II trauma submitted to immediate surgery, 1 out of 3 patients (33.3%) required a nephrectomy procedure, whereas in those patients submitted to conservative treatment and or deferred surgery, only 1 out of 20 (5%) required a nephrectomy procedure. The results reported in the literature are discussed and compared with our results.

[Renal candidiasis: percutaneous endoscopic treatment of the pyeloureteral fungus-ball]. / Candidiasis renal: tratamiento endoscópico percutáneo del fungus-ball pieloureteral.

We report three cases of pyelic fungus ball from Candida albicans in two patients (one bilateral) with lithiasic urinary obstruction that were treated endo-urologically by percutaneous nephroscopy and with adjuvant antifungal medication. The infection mechanism, nephroscopy procedure and results obtained are discussed.

[Endo-urologic treatment of the uretero-intestinal stenoses in patients subjected to diversion]. / Tratamiento endourológico de las estenosis ureterointestinales en pacientes derivados.

Surgical repair of uretero-enteric strictures in patients with enteric conduit urinary diversion (incidence rate 4-8%) is difficult and has a high morbidity. With the development of endo-urologic techniques and ureteral catheters, long-term insertion of stents in the treatment of strictures has become possible and safe. We have performed long-term uretero-enteric stenting with 7-8 Fr double-J catheters in 5 patients with 6 strictures: 3 ureteroileal and 3 uretero-colic. In three cases (2 colonic conduits, 1 ileal conduit) the stent was inserted anterogradely following intercostal renal percutaneous punctures and dilatation of the stricture with teflon dilators (1 case), balloon catheter (1 case), or following the incision of the stricture (1 case). In one patient with a double uretero-enteric stricture of the ileal conduit, guide-wires were successfully inserted retrogradely which permitted subsequent high pressure dilatation of the uretero-ileal strictures with a 15 Fr balloon catheter. We used the same approach in another patient with a right uretero-colic stricture. The catheters were left indwelling for 7 to 35 months and were changed every 3 months with no remarkable observations other than 3 episodes of fever which quickly resolved with antibiotic treatment. Although is has been reported that uretero-enteric strictures are particularly refractory to endo-urologic treatment and a significant morbidity rate has been associated with long-term ureteral stenting, our results show that the approach was well-tolerated by all of the patients.