[Endourological treatment of pelviureteric junction obstruction in paediatric patients: our experience]. / Tratamiento endourológico de la estenosis pieloureteral en la edad pediátrica: nuestra experiencia.

UNLABELLED: Endourological treatment of pelviureteric junction obstruction in paediatric patients: our experience. INTRODUCTION: Pelviureteric junction (PUJ) obstruction is the most common cause of hydronephrosis in the infancy. The gold standard of treatment is open pyeloplasty, but there is an ever greater tendency towards minimally invasive procedures. We present our serie of paediatric patients with endourologically treated PUJ obstruction, together with a review of the literature. MATERIAL AND METHODS: Retrospective, descriptive study of the children diagnosed of PUJ obstruction who were treated by an endourological technique in our centre between January 1988 and January 2005. We gathered data on 3 periods of time: 1st. Presurgical: age, sex, previous treatment, ultrasound (USS) and nuclear medicine (MAG-3) studies; 2nd. Surgical: type of procedure; 3rd. Surgical: recurrence or not and its treatment, and the current state of the patient. RESULTS: Seven children, with an age range of 13 months to 14 years, underwent operation using an endourological technique. The treatment was secondary in five of these patients, after open pyeloplasty, and was primary in 2 cases. The preoperative USS showed grade III dilatation in 3 and grade IV dilatation in 4, and the MAG-3 study showed type II curves in 6 and a type IIIb curve in 1. Three percutaneous endopyelotomies were performed and, by the retrograde approach, 3 balloon dilatations and one Acucise. With a mean follow-up of 37 months, 2 cases of recurrence (both in patients receiving secondary treatment) have been observed, one in whom a retrograde technique (balloon dilatation) was used and the other in a patient treated by an antegrade technique. The remaining five patients are asymptomatic and show no evidence of recurrence (71% of the patients). CONCLUSION: The endourological treatment of PUJ obstruction in paediatric patients is possible but must be individualised in each case. Larger, prospective studies need to be performed in order to reach conclusions.

Tratamiento endourológico de la estenosis pieloureteral en la edad pediátrica: nuestra experiencia / Endourological treatment of pelviureteric junction obstruction in paediatric patients: our experience

Introducción. La estenosis de la unión pieloureteral (EPU) es la causa más frecuente de hidronefrosis en la infancia. El 'patrón oro' para su tratamiento es la pieloplastia a cielo abierto, pero cada vez están más en auge los procedimientos mínimamente invasivos. Presentamos nuestra serie de EPU en edad pediátrica tratados endourológicamente y revisamos la literatura. Material y métodos. Estudio retrospectivo y descriptivo de los niños diagnosticados de EPU, que han recibido tratamiento vía endourológica en nuestro centro, en el intervalo de tiempo comprendido de enero1998-enero2005. Recogemos las variables en 3 periodos según un criterio cronológico: 1º Prequirúrgico: edad, sexo, tratamiento previo o no, ecografía (ECO) y renograma isotópico diurético con mercaptoacetiltriglicina (MAG-3) previos a la intervención. 2º Quirúrgico: tipo de procedimiento. 3º Postquirúrgico. tiempo de evolución, recidiva o no y tratamiento de la misma y estado actual valorando estado clínico, ECO y MAG3. Resultados: 7 niños han sido intervenidos mediante técnica endourológica en este periodo, con un rango de edad de 13 meses-168 meses. En 5 de ellos se realizó como tratamiento secundario tras pieloplastia abierta, y en dos como tratamiento primario. La ECO previa mostraba: hidronefrosis grado III en 3, y IV en 4(según clasificación de la Sociedad de Urología Fetal) y en el renograma isotópico las curvas de eliminación según el patrón de O´Reilly eran 6 tipo II y 1 tipo IIIb. Se realizaron: 3 endopielotomías percutáneas. Vía retrógrada 3 dilataciones con balón y un Acucise. Con un tiempo medio de seguimiento de 37 meses, se han evidenciado que 5 están asintomáticos y sin evidencia de recidiva (71% de éxito). Existen 2 recidivas (ambos tratamientos secundarios), uno vía retrógrada (dilatación con balón) y el otro anterógrada. Conclusión. El tratamiento de la EPU en la edad pediátrica vía endourológica, es factible pero se debe individualizar en cada caso. Estudios prospectivos de mayor tamaño deben ser realizados para poder extraer conclusiones

Endourological treatment of pelviureteric junction obstruction in paediatric patients: our experience. Introduction. Pelviureteric junction (PUJ) obstruction is the most common cause of hydronephrosis in the infancy. The gold standard of treatment is open pyeloplasty, but there is an ever greater tendency towards minimally invasive procedures. We present our serie of paediatric patients with endourologically treated PUJ obstruction, together with a review of the literature. Material and methods. Retrospective, descriptive study of the children diagnosed of PUJ obstruction who were treated by an endourological technique in our centre between January 1988 and January 2005. We gathered data on 3 periods of time:1st. Presurgical: age, sex, previous treatment, ultrasound (USS) and nuclear medicine (MAG-3) studies; 2nd. Surgical: type of procedure; 3rd. Surgical: recurrence or not and its treatment, and the current state of the patient. Results. Seven children, with an age range of 13 months to 14 years, underwent operation using an endourological technique. The treatment was secondary in five of these patients, after open pyeloplasty, and was primary in 2 cases. The preoperative USS showed grade III dilatation in 3 and grade IV dilatation in 4, and the MAG-3 study showed type II curves in 6 and a type IIIb curve in 1. Three percutaneous endopyelotomies were performed and, by the retrograde approach, 3 balloon dilatations and one Acucise. With a mean follow-up of 37 months, 2 cases of recurrence (both in patients receiving secondary treatment) have been observed, one in whom a retrograde technique (balloon dilatation) was used and the other in a patient treated by an antegrade technique. The remaining five patients are asymptomatic and show no evidence of recurrence (71% of the patients). Conclusion. The endourological treatment of PUJ obstruction in paediatric patients is possible but must be individualised in each case. Larger, prospective studies need to be performed in order to reach conclusions

[Bone lithiasis in the period of the Enlightenment: D.F.J.B. Trehet]. / La litiasis ósea en el periodo de la ilustración: D.F.J.B. Trehet.

OBJECTIVE: To briefly describe the life and works of D.F.J.B. Trehet, a physician of the city of Rouen (France), who was the first to describe the "osseous points" in a renal calculus. Trèhet has not been recognized or referenced for this original observation in the urological publications. METHODS: Trehet lived in the period of the Enlightenment and endured the upheavals of the French Revolution. Data gleaned from several sources have permitted and elaborate description of this French physician from both the social and professional perspectives. RESULTS: After completing his studies at the Hôtel Dieu in Rouen, D.F.J.B. Trehet pursued his education at the School of Health in Paris. He read his doctorate's thesis at the Paris School of Medicine in 1803 and published his observation of a renal calculus "with osseous points" in 1812. Other studies by D.F.J.B. Trehet were also published in Le Journal de Médecine, Chirurgie et Pharmacie. CONCLUSIONS: D.F.J.B. Trehet should be recognized as the first to describe an osseous renal calculus.

[Pyelocalicial diverticula]. / Divertículos pielocaliciales.

OBJECTIVE: To review the embryological and clinical aspects of the different types of pyelocaliceal diverticula, with special reference to the differential diagnosis and treatment. METHODS: Images of type I and II pyelocaliceal diverticula are shown. The conditions that cause difficulty in making the differential diagnosis are discussed. RESULTS: Urography continues to be the diagnostic method preferred and is sometimes aided by retrograde ureteropyelography. CONCLUSIONS: Pyelocaliceal diverticula are cystic eventrations of the upper urinary tract lying within the renal parenchyma that communicate through a narrow channel into the main collecting system. They occur in 0.2 to 0.5% of the population and are congenital in origin. Calyceal diverticula are frequently found incidentally on routine excretory urograms, but patients may complain of flank pain, hematuria or recurrent urinary infections. In the past, treatment required open renal surgery. Endourologic procedures are widely utilized today.

[Nanobacteria. An experimental neo-lithogenesis model]. / Nanobacteria. Un modelo de neo-litogénesis experimental.

OBJECTIVE: To study the phenomenon of biomineralization in an experimental model of lithogenesis by percutaneous renal punction without laparotomy and no antibiotics. METHODS/RESULTS: The study comprised 4 Brown-Norway rats. Nanobacteria inoculum (X, 2X and 4X) was administered to three rats and the remaining one was used as control. The analytical and radiological findings showing the development of obstructive pyelocaliceal lithiasis in the kidneys of rats no. 2 and 3 are presented. CONCLUSIONS: Translumbar percutaneous renal puncture has permitted performing laparotoy without antibiotic coverage, which was the main difficulty of the experimental model of lithogenesis. Nanobacteria were cultured successfully, but not without difficulty, and formation of calculi in the rat pyelocaliceal system was achieved. This experimental model will provide further insight into lithogenesis and will allow us to find the answers to some of the many questions concerning this condition that remain.

[Silica urolithiasis: report of a new case]. / Litiasis urinaria de sílice: aportación de un nuevo caso.

We report a new case of silica urolithiasis in a 71-year-old patient with background of medicament ingesta (antacid) which could justify the formation of these calculi with so uncommon composition. Medicament calculi amounts about 1% from total urinary calculi. Among them, silica ones (silicon dioxide or Si O2) have been relate din their etiology to chronical ingest of antacid drugs, specially those with magnesium trisilicate. Silica formation in urine is facilitated and conditioned by an acid pH of it. Diagnosis and therapeutical approach does not change in relation to other lithiasis with similar dimension or location. After its composition report, and ruling out the possibility for patient's malingering, urine alkalinization was applied, with an excellent follow-up afterwards. The antacid was substituted by other drug. We analyze the most important aspects about this case. We also make reference to the main related bibliography.

[Partial nephrectomy in lithiasis]. / Nefrectomía parcial en la patología litiásica.

OBJECTIVE: To analyze our series of patients with renal lithiasis who underwent partial nephrectomy from 1980-1999. METHODS: 28 patients who underwent partial nephrectomy were analyzed (22 females; mean age 48.09 years, and 6 males; mean age 60 years). Surgery for lithiasis had been previously performed in 5 renal units. Nine patients had previously undergone ESWL (more than 3 sessions), all of whom subsequently developed multiple residual calculi. Twelve patients had a microbiologically confirmed positive urine culture. The renal lithiasis amenable to treatment by partial nephrectomy was frequently localized in the lower calyces (17 cases). RESULTS: Histopathological analysis of the nephrectomy specimen showed a prevalence of signs of chronic parenchymal atrophy (25 cases). Three cases showed segmental renal dysplasia (those in whom a superior heminephrectomy was performed for duplex excretory system). Fifty percent of the stone fragments analyzed showed calcium phosphocarbonate. Eight patients had postoperative complications; the most important were two cases of renal cutaneous fistula and one subphrenic abscess. At 9 1/2 years' mean follow-up, renal function is normal in 25 patients. Lithiasis developed in the contralateral unit in 6 cases and in the same renal unit in one case. CONCLUSIONS: Partial nephrectomy continues to be a therapeutic option for lithiasis. Its indication depends on the morphological and functional characteristics of the compromised renal unit, especially in those cases in whom renal preservation can be obviated due to its scanty significance.

[The historical setting of cystine lithiasis]. / Entorno histórico de la litiasis cistínica.

W. H. Wollaston, who first described cystine stones, as well as the most outstanding contemporary figures and their contribution to the understanding of this uncommon type of lithiasis are described.

[Adult renal polycystosis as the causal entity of an intercostal hernia containing an intestinal loop: an unusual clinical case]. / Poliquistosis renal del adulto como entidad causante de hernia intercostal que contiene asa intestinal: caso clínico excepcional.

OBJECTIVE: To describe a case of adult renal polycystosis causing intercostal hernia with intestinal segment. To our knowledge, no such case has been previously reported in the literature. METHODS/RESULTS: Diagnosis was by abdominal CT. Treatment was by bilateral nephrectomy and surgical repair of the diaphragmatic and intercostal hernia. CONCLUSIONS: Surgery is indicated in adult renal polycystosis if kidney size causes gastrointestinal involvement and above all, if the lungs are compromised by the intercostal diaphragmatic hernia.

[Saint Liborius, patron of European urology. Iconography found in Croatia and Spain]. / San Liborio, patrón de la Urología Europea. La iconografía hallada en Croacia y España.

The discovery made by the group of Dr. Stella Fatovic-Ferencic in Varazdin (Croatia) of a painting of St. Liborius, patron saint invoked for calculi, and the painting of the Sevillian school (circa 1700) discovered by another group in Spain have led to the retrieval of part of the history of European Urology forgotten 250 years ago. Saint Liborius, bishop of Le Mans (France), died in 397, at the time the barbarian hordes were ravaging the Roman Empire, which had been divided into a Western and an Eastern Empire on the death of Theodosius I. Learning more about St. Liborius is of interest. Here is an example of the Graeco-Roman culture of antiguity that is passed on to the present time. The significance of both paintings and their differences are described. The article concludes that on the basis of his biography, St. Liborius should be considered the patron saint of Urology.

[Amino acid sequence of the protein in a pure proteinic calculus]. / Secuencia de aminoácidos de la proteína de un cálculo proteico puro.

OBJECTIVE: The fact that for an equivalent oversaturation of solutes, urine of lithiasic patients has a greater tendency to form crystals, indicate that urine of stone-formers may contain substances that promote crystallization. METHODS: A renal calculus was analyzed by infra-red spectrophotometry, x-ray dispersion energy spectrophotometry, ultraviolet absorption spectrophotometry, acid hydrolysis cationic exchange chromatography, SDA-Page gel electropheresis with Coomassie Blue and amino acid sequence. RESULTS: It was a pure protein calculus formed by a beta 2-microglobulin anomaly. It was a residue that had lost its first 19 amino acids and phenylalanine replaced serine in position 19 CONCLUSIONS: Changes in the amino acid sequence of urinary proteins can cause these to behave like urinary calculus-promoting substances.

[Endometriosis: the cause of hematuria in the dysfunctional ureter]. / Endometriosis: causa de hematuria en uréter desfuncionalizado.

OBJECTIVES: To review the diagnosis and treatment of ureteral stenosis arising from endometriosis and describe a case of mixed (intrinsic and extrinsic) ureteral endometriosis. METHODS: The diagnostic and therapeutic aspects of ureteral stenosis due to endometriosis are reviewed. The case of a patient with a nonfunctioning right kidney and hematuria is described. The patient had previously undergone hysterectomy and double adnexectomy for uterine leiomyofibromas and a right ureteral lesion that warranted cuff ureterocystoneostomy leaving the extreme distal third of the pelvic ureter. CT evaluation disclosed a right retrovesical mass. The therapeutic strategy consisted in performing percutaneous nephrostomy, ureteroscopy of nonfunctioning ureter and determining the nature of the retrovesical mass by fine needle punction aspiration biopsy. RESULTS: Percutaneous nephrostomy achieved functional recovery of the renal unit. Endoscopic incision of the stricture with intravesical invagination of the compromised segment was performed with the combined antegrade and retrograde approach. The anatomopathological findings of ureteroscopic biopsy of an intraureteral lesion in the nonfunctioning ureter disclosed ureteral endometriosis. This finding obviated fine needle punction aspiration biopsy and the patient was treated with danazol for 6 months. CONCLUSIONS: Diagnosis by ureteroscopy should be considered in intrinsic and mixed forms of ureteral endometriosis. Endoscopic incision of the ureteral stricture combined with hormone therapy is a valid therapeutic option.

[Treatment of ureteral stenoses with the Acucise catheter]. / Tratamiento de las estenosis ureterales con el catéter Acucise.

OBJECTIVES: A new form of minimally invasive treatment of ureteral stricture with the Acucise catheter is described herein. METHODS: The method for catheter use for the ureteral incision using radiological control alone is described. RESULTS: The technique is easy to perform. There were no early postoperative complications in strictures at the juxtavesical or upper lumbar ureter. CONCLUSIONS: The availability of balloon dilatation catheters equipped with an electrocautery device permits incision of the ureteral stricture using radiological control alone, preferably those in the juxtavesical or upper lumbar ureter. Those localized to other levels of the ureter are not free from vascular or visceral lesions.

[Assessment of double-J ureteral catheters at a lithotripsy unit: our experience]. / Evaluación de los catéteres ureterales tipo doble J en una unidad de litotricia: nuestra experiencia.

The present study evaluated a total of 350 patients who underwent placement of double-J catheters as a result of their lithiasic condition. The work includes a review of the patients' urological background, indication for the double-J placement, tolerance to catheter, time of permanence, reason for withdrawal, presence of encrustations in the catheter and relationship between all these parameters. A significant increase of adverse symptoms was observed when permanence of the double-J catheter lasted longer than 6 weeks. Likewise, there was a significant increase in the number of encrustations in catheters retained longer than 6 weeks, as well as when the lithiasic mass was meaningful and urine cultures were positive. The authors consider that double-J catheters effectively prevent the complications of the lithiasic condition but an excessively long permanence, more than 6 weeks, increases occurrence of side-effects significantly.

[Endourologic treatment of uretero-ileal stenosis]. / Tratamiento endourológico de las estenosis ureteroileales.

OBJECTIVES: Ureterointestinal stricture represents a serious problem whose management has traditionally been by open surgery. Endourological treatment is an alternative that is generally free from the complications of open surgery, but with a lower success rate. The efficacy of endourological treatment is analyzed in 14 cases of ureteroileal stricture (12 patients) and the different treatment options are discussed. METHODS: Ureteroileal stricture was managed endourologically in 9 of 13 cases (69%) by dilatation (6 cases), incision+dilatation (2 cases) and stenting (1 case). RESULTS: Of the 6 cases submitted to dilatation, 3 recurred at 6 months, 2 remained patent at 18 and 24 months, respectively, and 1 was lost to follow up because the patient underwent reimplantation (40% success rate). The two cases submitted to incision are patent at 18 and 19 months, respectively. CONCLUSIONS: The overall success rate for endourological treatment of ureteroileal stricture is 28% (4/14 cases) at 19 months mean follow up.

[Hydrodynamic behavior of endourologic catheters]. / Comportamiento hidrodinámico de los catéteres endourológicos.

OBJECTIVE: The present study analyzed the hydrodynamic behaviour of the double-J stent. METHODS: Thirty-two double-J stents of different sizes and biomaterials (16 new and 16 removed from patients) were hydrodynamically evaluated using two models: a) nephroureterocystectomy surgical blocks harvested from pigs and b) an in vitro experimental model of the upper urinary tract. The following parameters were measured: initial and final weights, encrusted material weight, inside and outside diameters, number, size and distribution of sideholes, wall thickness, drainage area and length of time the catheter was indwelling in the patient. RESULTS: Double-J stent placement in a normal upper urinary tract constitutes a partial obstruction that is proportional to the caliber of the catheter. Ureteral-flow reduction is 83%, 61% and 58% for 5FR, 6FR, and 7FR catheters, respectively. Extraluminal obstruction of the catheter reduces ureteral flow more than intraluminal obstruction (74%, 43% and 25% for extraluminal versus 83%, 66%, 57% for intraluminal for 5FR, 6FR and 7FR, respectively). Vesicoureteral and vesicorenal reflux pressures were 6.2 +/- 0.3 cm H2O and 35.2 +/- 2 cm H2O, respectively. CONCLUSION: Selection of a double-J stent must be individualized on the basis of indication, time indwelling, sex and route of insertion.

[Intraluminal invagination technic for the incision of ureterointestinal stenosis]. / Técnica de invaginación endoluminal para la sección de las estenosis ureterointestinales.

OBJECTIVE: This paper describes the endoscopic incision of uretero-ileal anastomotic strictures by a combined approach (percutaneous antegrade and endoscopic retrograde) using the intraluminal invagination technique over a balloon dilatation catheter. METHODS: The different steps of the surgical procedure of incision of the stenotic segment of different techniques of ureteroileal diversion (Bricker, Camey, ureterosigmoidostomy) are described in detail. Endoscopic images and those from the image intensifier are shown. RESULTS: Of the 6 cases described herein, incision was achieved in 5 and in 1 case stenting of the stenotic segment could not be achieved. CONCLUSIONS: Intraluminal invagination of the stenotic segment considerably facilitates endoscopic incision.

[The endoscopic section of ureterosigmoid stenosis]. / Sección endoscópica de la estenosis ureterosigmoidea.

OBJECTIVES: Herein we describe the technique of endoscopic incision in the treatment of ureterointestinal stricture. METHODS: A teflon sheathed stent is placed in the stenotic ureterointestinal segment utilizing a combined approach (percutaneous antegrade endoscopic transrectal) and a balloon is passed over the stent retrogradely. The balloon is then inflated and is pulled retrogradely to invaginate the anastomosis into the rectal lumen. Thereafter, endoscopic incision of all the layers and the entire length of the stricture is performed by electrocautery. RESULTS: The radiological evaluation three months postoperatively show marked morphological and functional improvement of the compromised renal unit. CONCLUSIONS: In patients with a ureterointestinal urinary diversion, endoscopic incision of the stricture at the site of the anastomosis is a valid therapeutic technique, after discarding the presence of urinary infection or tumor at this site. Furthermore, open surgery can be done in the event this technique fails to achieve the desired results.