[Treatment of bladder lithiasis with shock-wave extracorporeal lithotripsy]. / Tratamiento de la litiasis vesical mediante litotricia extracorpórea por ondas de choque.

PURPOSE: To evaluate the effectiveness and the prognostic factors of the bladder stones (BS) treatment by means of extracorporeal shock wave lythotripsy (ESWL). METHODS: 183 patients with BS treated using ESWL were retrospectively analysed. Independent variables were: gender, age, obstruction, BS size, BS number and amount of waves. Dependent variable was total BS resolution. Statistical analysis was provided by Cox's regression multivariate analysis, Kaplan-Meier analysis and the t Student test. RESULTS: Total effectiveness of the treatment was 73%. Initial BS size was the only prognostic factor on multivariate analysis (p = 0.0035) with smaller stones obtaining the best results (log rank p = 0.00001): 92% of effectiveness in BS smaller than 1 cm2, 73% in 1-2 cm2, 57% in 2-3 cm2 and 42% in larger than 3 cm2. BS mean size decreased 2 cm2 after the first ESWL (p = 0.00001). CONCLUSIONS: Initial BS size was the only prognostic factor of resolution. Total effectiveness was 73% and it highly increased in BS smaller than 2 cm2.

[Ureteral stenosis and pneumatic dilatation]. / Estenosis ureteral y dilatacion neumática.

OBJECTIVE: To determine the efficacy of balloon dilatation in the treatment of ureteral strictures and analyze the outcome according to its etiology. METHODS: 77 ureteral dilatations were performed in 74 patients. Most of the strictures were postoperative sequelae and the other cases were due to chronic inflammatory conditions. RESULTS: The overall success rate was 47%, partial improvement was achieved in 17% and the failure rate was 36%. In our series, the postoperative strictures responded slightly better to balloon dilatation than those arising from chronic inflammatory conditions. CONCLUSION: Endourologic techniques based on the percutaneous methods of interventional radiology have reduced the usage of invasive conventional surgery in the treatment of strictures. Although the proportion of unsatisfactory results is not negligible, balloon dilatation should be the first treatment option for ureteral strictures because it is less invasive, carries a low morbidity and requires a shorter hospitalization. If the results are unsatisfactory, re-dilatation can be attempted or conventional open surgery can be performed.

Tratamiento de la litiasis vesical mediante litotricia extracorpórea por ondas de choque / Bladder stone treatment with extracorporeal shock wave lithotripsy

FUNDAMENTO: Valorar la eficacia y los factores pronósticos de éxito del tratamiento de la litiasis vesical (LV), mediante litotricia extracorpórea por ondas de choque (LEOC). MÉTODOS: Estudio retrospectivo de 183 pacientes afectos de LV tratados mediante LEOC. Las variables independientes estudiadas fueron sexo, edad, obstrucción, tamaño de la LV, número de LV y número de ondas. La variable dependiente fue la desaparición total de la LV. Estudio de los factores pronósticos mediante análisis multivariante por regresión de Cox, y análisis de Kaplan-Meier. Variación del tamaño de la LV estudiada mediante la prueba t de Student. RESULTADOS: Eficacia global del 73 por ciento. El análisis multivariante mostró que el único factor pronóstico fue el tamaño inicial de la litiasis (p = 0,0035). A menor tamaño de la LV mejor resultado (log rank p = 0,00001): eficacia del 92 por ciento en las LV menores de 1 cm 2 , 73 por ciento entre 1-2 cm 2 , 57 por ciento de 2-3 cm 2 y 42 por ciento en mayores de 3 cm 2 . Disminución media del tamaño de la LV tras la primera sesión de LEOC de 2 cm 2 (p = 0,0001). CONCLUSIONES: El único factor pronóstico fue el tamaño inicial de la LV. La eficacia global de la técnica es del 73 por ciento, aumentando considerablemente en LV menores a 2 cm 2 (AU)

[Analysis and clinical course of residual lithiasis after shock wave renal treatment]. / Análisis y evolución de la litiasis residual tras la aplicación renal de ondas de choque.

OBJECTIVE: Although residual lithiasis after the application of shock waves is a situation that coexists with the procedure, in some cases it can be considered to be a failure of ESWL. The natural history and outcome of 244 cases of residual renal stone followed over a 5-year period are analyzed, and the approach based on a pre-established classification is discussed. METHODS: Of 1,407 patients treated by ESWL for renal lithiasis during 1995, 244 cases with a renal calculus larger than 3 mm were followed for a period of 5 years after treatment and evaluated by clinical, radiological, ultrasound and analytical methods. RESULTS: At 3 months post-ESWL, 1,013 cases (72%) were completely stone-free and 394 (28%) showed residual stone; of these, 244 (62%) had residual stone fragments greater than 3 mm. At 5 years, 190 (78%) remained stable and the remaining 54 (22%) showed stone regrowth that warranted additional treatments: 52 ESWL, 1 PNL and 1 partial nephrectomy. Despite the retreatments, only 42% became completely stone-free. CONCLUSIONS: A classification of residual renal stone can be established based on the data obtained to orient the approach in each case, although the frequency of residual stone can be reduced by the appropriate indication of ESWL. Once a renal stone has formed retreatments with ESWL cannot ensure complete elimination of the stone.

[Intracranial metastasis in prostatic cancer]. / Metástasis intracraneales en cáncer de próstata.

The intracranial metastasis due to prostatic adenocarcinoma are quite rare, inside them, the ones placed in the parasellar region on the cranial base are exceptional. There are only 3 clinical cases found in the literature consulted, now we report here two more cases and we review the etiopathogenia, clinic presentation, diagnosis and treatment for this type of lesions. Usually there are very undifferentiated neoplasms, developed stages and with multiple metastasis at others levels. A patient with prostatic carcinoma known and neurological signs we should suspect the presence of intracranial metastasis. The diagnosis is made with image tests (basically with CT and MRI), being necessary in some cases the histological confirmation with a biopsy. Although the prognostic of these patients (less than 6 months in our cases) depends more of the evolutive stage of the illness than the type of treatment that the patients will be someated, we should establish it rapidly, on this way we can revert the neurological status and we will improve the quality of life of these patients.

Metástasis intracraneales en cáncer de próstata / Intracranial metastasis due to prostatic carcinoma

Las metástasis intracraneales por adenocarcinoma de próstata son poco frecuentes, dentro de éstas, las localizadas en la región paraselar de la base craneal son excepcionales, existiendo tres casos clínicos descritos en la literatura consultada; a continuación aportamos dos casos más y revisamos la etiopatogenia, clínica, diagnósticos diferenciales y tratamiento de este tipo de lesiones.Habitualmente se trata de neoplasias muy indiferenciadas, estadios evolucionados y con múltiples metástasis a otros niveles. Ante un paciente con neoplasia prostática conocida y clínica de focalidad neurológica, debe sospecharse una metástasis intracraneal. El diagnóstico se realiza con pruebas de imagen (fundamentalmente TC y RMN), siendo en ocasiones necesario la confirmación histológica por biopsia.Aunque el pronóstico de estos pacientes (inferior a 6 meses) depende más del estadio evolutivo de la enfermedad que del tipo de tratamiento al que le sometamos, éste debe instaurarse precozmente, ya que tiene más posibilidades de revertir el cuadro neurológico y mejorar la calidad de vida del paciente (AU)