Actualización en el manejo de la litiasis pediátrica / Update in the management of pediatric lithiasis

Entre el 5% y el 10% de la población mundial sufre litiasis pero solo del 0,5 al 5% son niños. Es poco frecuente en países desarrollados, y endémico en países en vías de desarrollo. Puede afectar a cualquier edad y localización, pero la mayoría se presenta en el tramo urinario superior, exepto en los países en vías de desarrollo que se ubica más frecuentemente en la vejiga. En un proceso multifactorial, pero los cambios en la alimentación, la obesidad infantil y la disminución en la ingesta hídrica pueden aumentar su prevalencia en edad pediátrica. La clínica es variable según la edad. La microhematuria es más constante , sobre todo en niños pequeños. La ecografía y la TAC son los métodos auxiliares más utilizados para su diagnóstico y localización. El manejo ha cambiado con los avances tecnológicos, la elección del tratamiento depende de la edad, el número, tamaño , localización, composición de la litiasis y posibilidades de cada centro. La mayoría de las litiasis pueden ser tratadas con procedimientos mínimamente invasivos, como LEOC o ureteroscopia. La NLP es de elección para las litiasis renales de gran tamaño o refractarias a LEOC. La cirugía abierta se deja para casos muy seleccionados (AU)

It is uncommon in developed countries and endemic in developing countries. It can occur at any age and localization, but mostly occurs in the upper urinary trat with the exeption of in developing countries where the most frequent location is in the bladder. It is a multifactorial process, however changes in nutrition, childhood obesity and decrease in water intake may increase its prevalence in the pediatric age. Symptoms vary according to aged. Microhematuria is the most constant, above all in small children. Ultrasonography and CT scan are the most used auxiliary methods for its diagnoses and localization. Its management has changed with technological advances, the choice of treatment depends on age, number, size, localization, composition of the lithiasis and possibilities of each center. Most lithiases can be treated with minimally invasive procedures such as the extracorporeal shockwave lithotripsy (ESWL) or ureteroscopy. The percutaneous nephrolithotomy (PCNL) or ureteroscopy. The percutaneous nephrolithotomy (PCNL) is of choice for large sized renal lithiasis or those refractory to ESWL. Open surgery is reserved for very select cases (AU)

[BCG and radiotherapy: the compatibility of 2 conservative treatments for cancer of the urinary bladder]. / BCG y radioterapia: compatibilidad de dos tratamientos conservadores frente al cancer de vejiga urinaria.

OBJECTIVE: To review the efficacy of radiotherapy and BCG in the treatment of transitional cell carcinoma of the urinary bladder in its different forms of presentation, with special reference to patients with infiltrating bladder tumors receiving radiotherapy and those in whom the lesion recurs as a high grade superficial bladder tumor. METHODS/RESULTS: 10 patients who previously received radiotherapy for T2-4 infiltrating bladder tumor that recurred as a high grade superficial tumor were treated with BCG. Four patients are alive and disease-free with a preserved bladder at 2-8 years follow-up. Four other patients who required cystectomy for persistence or progression of the tumor to the bladder wall, are alive and disease free at 3-7 years follow-up. The remaining two patients who were not amenable to major surgery died from the disease more than two years after treatment with BCG. BCG was well-tolerated by 70% of the patients and the rest showed minor complications. CONCLUSIONS: 28.3% of recurrences after radiotherapy are superficial tumors and 7% are carcinoma in situ. The appearance of carcinoma in situ or T1 G3 lesions following radiotherapy of the bladder questions its efficacy against these superficial forms for which cystectomy is reserved. BCG has been found to be effective in high grade superficial bladder tumors that have not been previously irradiated, therefore it would be acceptable to extend its application to those patients in whom radiotherapy has achieved control of the infiltrating tumor but not the high grade superficial tumor. The 40-70% of patients who are alive with a preserved bladder appears to be sufficient to recommend BCG salvage for high grade superficial bladder tumors post-radiotherapy. BCG therapy does not entail major complications or compromise patient survival, including those cases that will require cystectomy.