[Effect of potassium citrate in the prophylaxis of urinary lithiasis]. / Efecto del citrato potásico en la profilaxis de la litiasis urinaria.

OBJECTIVE: The physiologic effects of potassium citrate on urinary solubility have led to their use to facilitate stone passage after lithotripsy. The aim of our study is to evaluate the foregoing effects and the efficacy of long-term treatment with potassium citrate to prevent stone recurrence in patients undergoing extracorporeal shock wave lithotripsy. METHODS: A prospective study was conducted on 100 patients with calcium oxalate or calcium phosphate nephrolithiasis that had undergone treatment by extracorporeal shock wave lithotripsy (ESWL). The patients were divided into 4 groups: patients that were stone-free treated with potassium phosphate (25 cases) or fluid diet (25 cases) and patients with persistent residual lithiasis treated with potassium citrate (25 cases) or fluid diet (25 cases). Calculi were classified according to the changes observed during the study compared with the pre-study status as stable (no changes from the pre-study status, with or without residual stone), increased (increase in number or size of the residual stone or recurrence), and decreased (decrease in number or size or passage of the residual stone). RESULTS: Of the 50 patients treated with potassium citrate, 35 (70%) remained stable, 10 cases (20%) showed a decrease and 5 (10%) showed an increase. Of the 50 patients on fluid diet, 19 (38%) remained stable throughout the study, 4 (8%) showed a decrease and 27 (54%) showed an increase in stone size or number. The number of stone recurrence throughout the study in the 100 patients was 25 (25%); of these, 8 were in patients treated with potassium citrate and 17 of those that did not receive potassium citrate. CONCLUSIONS: Potassium citrate therapy has been found to be statistically significantly effective in the control of post-lithotripsy residual stone and stone recurrence.

[Distal ureteral lithiasis. ESWL versus ambulatory URS]. / Litiasis ureteral distal. LEOC versus URN ambulatoria.

OBJECTIVE: To present the results achieved in the treatment of 1802 distal ureteral stones treated at the Lithotripsy Unit of the San Cecilio University Hospital over the last 10 years (1990-2000). METHODS: Stones were treated by extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy (URS). ESWL was the initial treatment in 81% of the cases (1460 calculi) and URS in the remaining 19% (342 stones). URS was performed for complication or failed ESWL (102 stones) and ESWL was performed for failed URS, basically due to stone migration (24 stones). Ureterolithotomy was required on 7 occasions. Sedation-analgesia with fentanyl and midazolam was routinely used in URS. Sedation was required in only 55% of the ESWL procedures. RESULTS: Elective ESWL resolved 93% of the cases, a percentage which is similar to that achieved with URS as first treatment. The ESWL retreatment rate was 1.3. URS was successful in 98% of the cases of failed ESWL. CONCLUSIONS: There are two treatment modalities for stones in the distal ureter: ESWL and URS. We advocate the use of outpatient URS with sedation preferably in the female patient, impacted stones, obstructive uropathy, stones larger than 2 cm and radiotransparent stones.

[Renal cell carcinoma in patient with situs inversus and Kartagener syndrome]. / Carcinoma de células renales en paciente con situs inversus y síndrome de Kartagener.

A case of a adenocarcinoma renal in a patient with situs inversus complete to which was associated bronchiectasis and chronic sinusitis (kartagener's syndrome) is reported. It is the third case described in the international literature of a renal cells carcinoma in a patient with situs inversus totalis and the first in patient the one which has the triada classic of the kartagener's syndrome plus sterility. The tumor was discovered in a way incidental upon accomplishing a TAC toracoabdominal and was solved through nefrectomia for lumbotomy approach.

[Renoureteral malformation and lithiasis. Therapeutic approach]. / Malformaciones renoureterales y litiasis. Enfoque terapéutico.

OBJECTIVE: To analyze our results in the treatment of calculi in renoureteral malformations with extracorporeal shock wave lithotripsy (ESWL) alone and the efficacy of ESWL and adjuvant methods in the resolution of calculi in different types of renoureteral malformations. METHODS: The study comprised 141 cases of renoureteral malformations with urinary calculi; 68 were renal, 69 ureteral and 4 in the Bricker urinary diversion. All patients had been diagnosed by IVP and treated by ESWL. These patients were compared with a control group of 125 patients with calculi and a normal renoureteral system that were treated similarly. RESULTS: The malformations accounted for 2.61% of the 5,400 patients that had been treated in our unit from 1990-1998. The mean number of sessions for the patients with malformations was 1.5 versus 1.2 for the control group. The results of treatment were significantly lower for the group of patients with renal malformations than for the control group (54% vs. 87.2%, respectively). Similar results were obtained for the group of patients with ureteral malformations and the control group (87% vs. 75%). CONCLUSIONS: ESWL can be the first treatment option for calculi in patients with renal malformations, although they should be individually evaluated for status of the excretory system, urinary flow dynamics and size of the calculus in order to select the best treatment option. In patients with ureteral malformations, the same criteria utilized for those with a normal excretory system should be applied.

Carcinoma de células renales en paciente con situs inversus y síndrome de Kartagener / Renal cell carcinoma in a patient with situs inversus and Kartagener's syndrome

Se presenta el caso de un adenocarcinoma renal en un paciente con situs inversus completo al que se asociaban bronquiectasias y sinusitis crónica (síndrome de Kartagener). Es el tercer caso descrito en la literatura internacional de un carcinoma de células renales en un paciente con situs inversus total y el primer en el que el paciente tiene la triada clásica del síndrome de Kartagener más esterilidad. El tumor se descubrió de forma incidental al realizar un TAC toraco-abdominal y se resolvió mediante nefrectomía por vía lumbotómica (AU)

[Efficacy of radiotherapy for upper urinary tract tumor following radical surgery]. / Eficacia de la radioterapia en los tumores del tracto urinario superior, tras cirugía radical.

OBJECTIVE: To determine the efficacy of postoperative irradiation for locoregional tumor recurrence and in the prevention of distant metastasis in patients with upper urinary tract tumor treated by radical surgery. METHODS: 51 urothelial tumors of the upper urinary tract, most of which had been treated by radical surgery (nephroureterectomy with resection of bladder cuff were analyzed. Since 1989 an adjuvant postoperative radiotherapy protocol (55 Gy) has been included for high grade and stage tumors. Tumor staging was done according to the Jewett-Marshall classification and the Mostoffi cytological grading. RESULTS: Of the total number of cases analyzed, 16 received postoperative irradiation; of these, 5 (31%) showed recurrence. The recurrence rate was 47% for those treated by radical surgery alone. In patients with stage C tumors, 5 out of 12 cases (41.6%) showed recurrence. The recurrence rate was higher (83%) for patients with stage C tumors treated by radical surgery alone. CONCLUSIONS: Adjuvant postoperative radiotherapy is advocated for high grade and stage upper urinary tract tumors. This therapeutic approach has been found to reduce the number of recurrences and, consequently, morbidity. Although the overall survival rate did not increase, a larger series may show more consistent results in this regard.

[Leiomyosarcoma and rhabdomyosarcoma: rare tumors of the kidney]. / Leiomiosarcoma y rabdomiosarcoma: tumores raros del riñón.

Renal sarcoma represents 2.8% of all renal malignant tumours. The most common kind is leiomyosarcoma while rhabdomyosarcoma is the most unusual. Clinical presentation and diagnosis of both types of tumours are unspecific. Treatment is controversial and the overall prognosis poor. The present paper presents two cases, one leiomyosarcoma and one rhabdomyosarcoma which were treated surgically and were followed by chemo- and radiotherapy. A revision of the criteria for grading these as primary tumours of the kidney is also included.

[Renal hematomas secondary to extracorporeal shockwave lithotripsy]. / Hematomas renales secundarios a litotricia extracorpórea por ondas de choque.

OBJECTIVE: 0.6% of the patients submitted to extracorporeal shock wave lithotripsy (ESWL) present symptomatic renal hematoma that can permanently alter renal function and morphology. The present study analyzes the risk factors, types of renal hematoma secondary to shock waves and treatment. METHODS: The study comprised 9 patients with ESWL-induced renal hematoma that had been diagnosed by renal ultrasound and/or urography. Patient evaluation included CT and an isotopic renogram. Two patients had associated arterial hypertension and ischemic coronary heart disease treated with antiaggregants. In 4 patients the renal calculi had produced partial obstruction of the urinary tract. RESULTS: In 4 patients the ESWL-induced renal hematoma was less than 1/3 of the renal volume and did not alter renal function. These patients have been classified as having type I renal hematoma and have been successfully managed conservatively. In 5 patients the hematoma was more than 1/3 of the renal volume and renal function was impaired. These patients have been classified as having type II renal hematoma. Spontaneous reabsorption of the hematoma facilitated recovery of renal function in one patient, two had persistent hematoma and progressive renal function impairment, and the remaining two patients underwent delayed evacuation of the hematoma on days 30-45. Decompression renal surgery preserved renal function of the two kidneys. CONCLUSION: Advanced arteriosclerosis, arterial hypertension, primary coagulation disorders or secondary to antiaggregation therapy and obstruction of the urinary tract increase the risk of ESWL-induced renal hematoma. Renal hematoma following ESWL has been classified as type I or type II. In the latter, renal decompression surgery facilitates recovery of renal function.

[Determining factors in the success of the treatment of ureteral lithiasis by ESWL]. / Factores determinantes en el éxito del tratamiento de la litiasis ureteral mediante LEOC.

Shock-wave extracorporeal lithotripsy (SWEL) is admittedly the choice method for most ureteral calculi (UC). Treatment of 1.674 UC was carried out with a Lithostar (Siemens). Endourologic support manoeuvres (ESM) were used in 11.7% patients. To determine their statistical influence on treatment's result variables such as site, size, calculus density, obstruction and functionality of the renal unit, as well as presence of ureteral malformation, were analyzed. With an average of 1.3 sessions (9100 waves) success rate was 91.8% cases. Only the variables of size, obstruction and function showed statistical significance, thus identifying through a multistep logistic regression test the subgroup of calculi less likely to succeed (calculi > 1 cm2, with severe uropathy and functional annulment or delay). Complication were rare (7.5%) and minimally relevant. We conclude than SWEL is the first choice treatment for UC regardless the location. Ureteroscopy (UR) should be considered as the first option particularly in distal (iliopelvic ureter), obstructive calculi and those of difficult radiological study.

[Premalignant and benign lesions in nodules of adenomatous hyperplasia]. / Lesiones premalignas y otras benignas en nódulos de hiperplasia adenomatosa.

OBJECTIVES: Currently, two premalignant lesions have been recognized: prostatic intraepithelial neoplasia (PIN) and atypical adenomatous hyperplasia (AAH). Due to the possible clinical implications of these lesions, we attempted to determine their incidence in specimens of benign prostatic hyperplasia (BPH), the most frequent pathology of the prostate. METHODS: A pathological and immunohistochemical study using several markers was performed to detect premalignant lesions in 156 specimens obtained by adenomectomy and TUR from 1990 to 1992. RESULTS: 20 PIN and 8 AAH (20.6%) were found. There were other equivocal prostatic lesions, not only with respect to premalignant lesions but prostatic carcinoma as well. CONCLUSIONS: Premalignant lesions within BPH nodules are frequent (20.6%). Furthermore, other lesions were also found that caused difficulty in making the differential diagnosis.

[Oxalate: its role in lithogenesis and composition of calcium oxalate lithiasis]. / Oxalato: participación en la litogenesis y composición de la litiasis oxalocálcica.

UNLABELLED: A prospective study was conducted on 374 patients with urinary lithiasis, aiming to analyze the participation of oxalate in the lithogenesis and composition of the calcium oxalate calculi, alone or associated to other factors. METHODOLOGY: Metabolic urinary study of the patient and analysis of calculi with infrared spectrography and optical microscopy. RESULTS: 26.3% patients had hyperoxaluria and 77.5% of the calculi contain calcium oxalate; these are 167 cases of calcium oxalate, 110 of oxalate and calcium phosphate and 13 cases of mixed calcium oxalate and uric acid lithiasis. 43.4% patients with pure monohydrate calcium oxalate calculi have hypercalciuria, 22.6% hyperoxaluria and 19% hyperuricosuria. Dihydrated calcium oxalate calculi are related to high hypercalciuria in 65% cases and to significant hyperoxaluria in 35% cases. 45% patients present a single lithogenic factor, either hypercalciuria (49.6%), hyperoxaluria (20.6%), hyperuricosuria (13.74%), hypocitraturia (9%), urinary infection (1.5%), A.T.R. (2.25%) or acid oliguria (3%).

[Laparoscopic treatment of the symptomatic renal cyst: the indications and a bibliographic review]. / Tratamiento por vía laparoscópica del quiste renal sintomático: indicaciones y revisión bibliográfica.

OBJECTIVES: The indications and usefulness of laparoscopic renal cystectomy are analyzed. METHODS: Five patients with symptomatic or recurrent simple renal cyst were submitted to laparoscopic cystectomy; section of the posterior peritoneum, dissection of the cyst, puncture-aspiration and resection of the cyst wall. RESULTS: Complete removal of the cyst wall was achieved with minimum morbidity, the cyst and symptoms disappeared and the hospital stay was short. There was one case of hematoma in the lumbar fossa that resolved with conservative management. CONCLUSIONS: Laparoscopic resection of the cyst wall appears to be a useful therapeutic approach for symptomatic or recurrent simple renal cysts.

[Examination of Doppler color ultrasound in patients with ESWL]. / Examen mediante US Doppler color en enfermos tratados con ESWL.

Although treatment by shock waves has been proven useful in destroying calculi, it is not free from complications and may cause lesions to the kidney whose importance has not been completely elucidated. The present study utilized color Doppler US to determine the changes produced by ESWL on the kidney and its vessels in particular. The results achieved by Doppler evaluation of 25 patients immediately before ESWL, 2, 7 and 30 days post-ESWL show an increased resistance index 2 days after treatment which tended to return to normal at 30 days. We discuss the different results obtained depending on stone location and the complications.

[Localized renal adenocarcinoma. Prognostic factors and influence of postoperative irradiation on survival]. / Adenocarcinoma renal localizado. Factores de pronóstico e influencias de la irradiación postoperatoria en la supervivencia.

Presentation of our experience and results in the treatment of localized renal adenocarcinoma with radiotherapy supplementary to surgery. The influence of post-operative radiotherapy in the subsequent occurrence of relapse and survival is analyzed. Also, the predictive value in our series of pre-surgery VSG, FA and LDH determinations is analyzed.

[Metabolic changes in the patient with recurring lithiasis. Our cases]. / Estudio de las alteraciones metabólicas en el paciente litiásico recidivante. Nuestra casuística.

Over a period spanning six months, 69 patients with lithiasis were selected for evaluation of mineral metabolism. Hypercalciuria, particularly renal, was the metabolic disorder that was commonly detected. A high incidence of altered uric acid metabolism was also observed. The importance of correct diagnosis and treatment of hyperparathyroidism is underscored because of the extraordinary benefit afforded to these patients. Correct patient selection has resulted in a lower incidence of those with normal metabolic parameters and has thus maximized the usefulness of these studies.

[Results of total androgenic blockade for the treatment of disseminated cancer of the prostate]. / Resultados obtenidos con el bloqueo androgénico total en el tratamiento del cáncer de próstata diseminado.

Following Labrie's idea, during the last three and a half years about 35 stage D patients were treated with Total Androgenic Blockade, while Radiotherapy and adjuvant TAB was used in 7 stage C patients. Subjective response rate in stage D was 86%. In 46% of the cases there was some sort of objective response (either partial or complete). After 43 months the actual survival rate is 34%. These results show no improvement from other series, but the inclusion of patients with little life expectancy should be taken into account. Results obtained in stage C, though very few patients were included in the series, were good, and patients currently alive remain free from local and metastatic illness. Since the number of patients was reduced, no conclusion can be drawn. In view of the disease progression, Estracyt was used as a second line therapy. Results have been poor showing some subjective, but no objective, response usually of short duration, in all patients (5 cases) undergoing such therapeutic procedure.

[Kidney traumatism. Evaluation using computerized axial tomography]. / Traumatismos renales. Valoración mediante tomografía axial computarizada.

Evaluation of kidney injuries has been controversial for a long time and urography, chiefly, and angiography were the most widely used explorations previously. We have evaluated 21 patients suffering from different degrees of renal injury by means of CAT, in conjunction with other explorations. We diagnosed nine renal contusions, five subcapsular hematomas, laceration with perirenal hematoma in three cases and we detected extravasation of the contrast in five patients. CAT showed itself to be the best method in the study of kidney injuries through giving a clearer anatomic definition of the lesions, whilst also carrying out a functional evaluation of the viscera. Obviously, in severe haemodynamically unstable injuries intraoperative evaluation of the lesions is the best diagnostic and therapeutic method.