Initial results of endourological treatment of renoureteral lithiasis by means of flexible ureteroscopy and percutaneous surgery in an outpatient procedure in a tertiary care center.

OBJECTIVE: Urinary lithiasis is a prevalent disease with a high socioeconomic impact, where endourological surgery has shown excellent results with minimal complications. For its part, outpatient surgery is an efficient, safe and quality care model. We present our experience in the outpatient endourological treatment of lithiasis and a review of the main series. MATERIAL AND METHODS: Prospective analysis of 85 flexible or percutaneous procedures for the treatment of lithiasis, carried out in our center between January 2021 and April 2022. The main objective was to analyze the rate of unplanned admission and the success and incidence of complications as secondary objectives. The patients were selected following the inclusion criteria of the care process. RESULTS: The mean age was 56 ± 14 years. Urine culture was positive in 13.9% of the patients, 38% had a pre-surgical double-J catheter. Median stone surface was 55 mm 2 (961 ± 323 Hounsfield Units). 73 flexible and 12 percutaneous procedures were performed. 8 patients required immediate unplanned admission and another 2 during the first month. 94% were stone-free at the third month. No intraoperative complications were detected, although 16.5% of the patients presented some type of postoperative complication. CONCLUSION: In our experience, with a strict selection of patients and following a care process with multidisciplinary participation, endourological procedures are feasible and safe in the outpatient setting. Periodic monitoring of the results is essential for the sake of a constant improvement of the process.

Resultados iniciales del tratamiento endourológico de la litiasis renoureteral mediante ureteroscopia flexible y cirugía percutánea en régimen de cirugía mayor ambulatoria en un centro de tercer nivel / Initial results of endourological treatment of renoureteral lithiasis by means of flexible ureteroscopy and percutaneous surgery in an outpatient procedure in a tertiary care center

Objetivo La litiasis urinaria es una enfermedad prevalente y con elevado impacto socioeconómico, donde la cirugía endourológica ha demostrado excelentes resultados con mínimas complicaciones. Por su parte, la cirugía ambulatoria es un modelo asistencial eficiente, seguro y de calidad. Presentamos nuestra experiencia en el tratamiento endourológico ambulatorio de la litiasis renoureteral y una revisión de las principales series. Material y métodos Análisis prospectivo de 85 procedimientos flexibles o percutáneos para el tratamiento de la litiasis, llevados a cabo en nuestro centro entre enero de 2021 y abril de 2022. Se estableció como objetivo principal analizar la tasa de ingreso no planificado y como objetivos secundarios el éxito e incidencia de complicaciones. Los pacientes fueron seleccionados siguiendo los criterios del proceso asistencial. Resultados La edad media fue de 56±14 años. El urocultivo fue positivo en 13,9% de los pacientes, siendo portadores de doble J prequirúrgico 38%. Mediana de superficie litiásica de 55 mm2, con 961±323 Unidades Hounsfield. Se realizaron 73 procedimientos flexibles y 12 percutáneos. Ocho pacientes requirieron ingreso no planificado inmediato y otros dos durante el primer mes. Al tercer mes, 94% se encontraban libre de litiasis. No se detectaron complicaciones intraoperatorias, aunque 16,5% de los pacientes presentaron algún tipo de complicación postoperatoria. Conclusión En nuestra experiencia, con una estricta selección de los pacientes y siguiendo un proceso asistencial con participación multidisciplinar, los procedimientos endourológicos son factibles y seguros en el ámbito ambulatorio. La monitorización periódica de los resultados es fundamental en aras de una mejora constante del proceso (AU)

Objective Urinary lithiasis is a prevalent disease with a high socioeconomic impact, where endourological surgery has shown excellent results with minimal complications. For its part, outpatient surgery is an efficient, safe and quality care model. We present our experience in the outpatient endourological treatment of lithiasis and a review of the main series. Material and methods Prospective analysis of 85 flexible or percutaneous procedures for the treatment of lithiasis, carried out in our center between January 2021 and April 2022. The main objective was to analyze the rate of unplanned admission and the success and incidence of complications as secondary objectives. The patients were selected following the inclusion criteria of the care process. Results The mean age was 56±14 years. Urine culture was positive in 13.9% of the patients, 38% had a pre-surgical double-J catheter. Median stone surface was 55 mm2 (961±323 Hounsfield Units). 73 flexible and 12 percutaneous procedures were performed. 8 patients required immediate unplanned admission and another 2 during the first month. 94% were stone-free at the third month. No intraoperative complications were detected, although 16.5% of the patients presented some type of postoperative complication. Conclusion In our experience, with a strict selection of patients and following a care process with multidisciplinary participation, endourological procedures are feasible and safe in the outpatient setting. Periodic monitoring of the results is essential for the sake of a constant improvement of the process (AU)

[Utility of heliox during treatment of upper airway obstruction secondary to bilateral vocal cord paralysis after thyroidectomy]. / Utilidad del heliox en la obstrucción de vía aérea superior secundaria a disfunción bilateral de cuerdas vocales postiroidectomía.

Helium is a noble gas whose low density decreases airway resistance. This property is utilized when a mixture of helium and oxygen (heliox) is employed in certain clinical situations, particularly in the context of airway obstruction. We report the case of a woman with severe upper airway obstruction due to bilateral vocal cord paralysis after thyroidectomy. Heliox was used temporarily to reduce respiratory effort and avoid the need for tracheal intubation while the obstruction was being treated with antiinflammatory drugs.

Utilidad del heliox en la obstrucción de vía aérea superior secundaria a disfunción bilateral de cuerdas vocales postiroidectomía / Utility of heliox during treatment of upper airway obstruction secondary to bilateral vocal cord paralysis after thyroidectomy

El helio es un gas noble que por su baja densidad disminuyela resistencia de la vía aérea. Esta propiedad,empleando una mezcla de helio y oxígeno (heliox), permiteque sea útil en determinadas situaciones clínicas,especialmente en las obstrucciones de vía aérea. Describimosel caso de una paciente que presentó un cuadro deobstrucción grave de la vía aérea superior debido a laparálisis bilateral de cuerdas vocales después de unatiroidectomía. El heliox se usó temporalmente para disminuirel esfuerzo respiratorio y evitar la intubaciónendotraqueal mientras mejoraba la obstrucción conantiinflamatorios(AU)

Helium is a noble gas whose low density decreasesairway resistance. This property is utilized when amixture of helium and oxygen (heliox) is employed incertain clinical situations, particularly in the context ofairway obstruction. We report the case of a woman withsevere upper airway obstruction due to bilateral vocalcord paralysis after thyroidectomy. Heliox was usedtemporarily to reduce respiratory effort and avoid theneed for tracheal intubation while the obstruction wasbeing treated with antiinflammatory drugs(AU)