Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position.

PURPOSE: Percutaneous nephroscopy is usually performed with the patient prone, which is uncomfortable for the patient and does not prevent damage to the colon. We assess the possibility of performing percutaneous nephroscopy using local anesthesia with the patient supine, and evaluate the advantages and complications. MATERIALS AND METHODS: A total of 557 consecutive percutaneous nephroscopies were attempted in 221 men and 242 women in the supine position. Patient age ranged from 8 to 87 years (mean 55.1). Patients are supine with a 3 l. serum bag below the ipsilateral flank. We catheterize the affected uretheral meatus with a 5F catheter through a flexible cystoscope. The tract is infiltrated with local anesthesia. The skin is punctured in the posterior axillary line which corresponds to approximately 1 cm. above the bag. We use an Alken set to dilate the tract to 30F, which is the size of the Amplatz sheath we commonly use. RESULTS: Nephroscopy was performed in 519 cases (93.1%). Mean operation time was 85 minutes (range 15 to 240). Serious bleeding occurred in 3 cases. The colon was never damaged in patients treated in the supine position. CONCLUSIONS: Percutaneous nephroscopy using local anesthesia with the patient supine is safe and easy. According to our experience the advantages in comfort to the patient and feasibility to the surgeon justify its use.

[Rectal hemorrhage as a first sign of renal cell adenocarcinoma]. / Rectorragia como primera manifestación de adenocarcinoma de células renales.

Renal cell carcinoma accounts for 85% of all renal primary tumours, the remaining 15% tumours originating either in the renal pelvis or the renal capsule. Clinical signs and symptoms of renal adenocarcinoma can be classified in four groups: specifically urological signs and symptoms, unspecific general symptoms, paraneoplastic syndromes, and metastasis-derived symptoms. The classical triad consists of haematuria, pain and palpable abdominal mass; at present this triad appears in a minority of cases, and is usually a late finding. The number of cases diagnosed from unspecific signs and symptoms is increasingly larger. Routine use of ultrasound and CAT allows a higher number of diagnosis, which frequently occur in the less advanced stages. The present paper presents a case report of renal cell adenocarcinoma, diagnosed from an infrequent early symptom such as rectal bleeding.