Implantación de un programa de mininefrolitotomía percutánea ambulatoria: presentación del protocolo y resultados iniciales / Initial results of the implementation of an ambulatory mini percutaneous nephrolithotomy program

Objetivo Presentar nuestro protocolo de nefrolitotomía percutánea ambulatoria y evaluar los resultados iniciales del programa. Material y métodos Se analiza la implantación clínica del protocolo con los 30 primeros casos de mininefrolitotomía percutánea ambulatoria realizados en nuestro centro entre abril de 2021 y septiembre de 2022. Se recogen datos demográficos, variables perioperatorias, complicaciones y necesidad de atención médica no planificada, stone-free rate, tipología litiásica y parámetros de satisfacción con el proceso de cirugía mayor ambulatoria. Resultados Con una edad media de 60,2±11,6 años se intervinieron un total de 30 pacientes que cumplían los criterios de inclusión. El tamaño medio de la litiasis fue de 15mm [rango: 5-20]. No se registró ninguna complicación intraoperatoria. Todos los pacientes excepto uno fueron dados de alta el mismo día de la intervención, según lo planificado. El mes posterior al alta, la tasa de complicaciones, reconsulta a urgencias o reingreso hospitalario ha sido del 0%. La stone-free rate a los 3 meses ha sido del 83%. La satisfacción global de todo el proceso perioperatorio, valorada a través del cuestionario EVAN-G, fue de 124,3 puntos sobre un máximo de 150, equivalente a un 78,6% de grado de satisfacción. Conclusión La mininefrolitotomía percutánea en régimen ambulatorio puede instaurarse como una opción de asistencia en centros con experiencia en endourología, una unidad establecida de cirugía mayor ambulatoria y mediante una selección estricta de los pacientes. Nuestros resultados iniciales muestran un perfil de seguridad adecuado y un grado de satisfacción global elevado de los pacientes intervenidos en esta modalidad (AU)

Objective To present our program for ambulatory mini percutaneous nephrolithotomy and evaluate its initial results. Material and methods We analyzed the implementation of the protocol into the clinical practice with the first 30 outpatient mini percutaneous nephrolithotomy cases performed in our center between April 2021 and September 2022. Demographic characteristics, perioperative variables, complications and need for unplanned health care, stone-free rate, stone type and patient satisfaction with the major ambulatory surgery process were collected. Results A total of 30 patients with a mean age of 60.2±11.6 years who met the inclusion criteria underwent surgery. The mean stone size was 15mm [range: 5-20]. No intraoperative complications were recorded. All patients except one were discharged the same day of surgery as planned. In the month following discharge, the rate of complications, emergency department revisits or hospital readmissions rates were 0%. Stone-free-rate at 3 months was 83%. Overall satisfaction with the whole perioperative process was assessed with the EVAN-G questionnaire, obtaining 124.3 points out of a maximum of 150, which is equivalent to a 78.6% level of satisfaction. Conclusion Ambulatory mini percutaneous nephrolithotomy can be implemented as a treatment option in centers with experience in endourology, an established major ambulatory surgery unit, and strictly selected patients. Our initial results show an adequate safety profile and high overall satisfaction perceived by patients undergoing the ambulatory approach (AU)

Initial results of the implementation of an ambulatory mini percutaneous nephrolithotomy program.

OBJECTIVE: To present our program for ambulatory mini percutaneous nephrolithotomy (mini-PCNL) and evaluate its initial results. MATERIAL AND METHODS: We analyzed the implementation of the protocol into the clinical practice with the first 30 outpatient mini-PCNL cases performed in our center between April 2021 and September 2022. Demographic characteristics, perioperative variables, complications and need for unplanned health care, stone-free rate (SFR), stone type and patient satisfaction with the major ambulatory surgery (MAS) process were collected. RESULTS: A total of 30 patients with a mean age of 60.2 ±â€¯11.6 years who met the inclusion criteria underwent surgery. The mean stone size was 15 mm [range: 5-20]. No intraoperative complications were recorded. All patients except one were discharged the same day of surgery as planned. In the month following discharge, the rate of complications, emergency department (ED) revisits or hospital readmissions rates were 0%. Stone-free-rate (SFR) at 3 months was 83%. Overall satisfaction with the whole perioperative process was assessed with the EVAN-G questionnaire, obtaining 124.3 points out of a maximum of 150, which is equivalent to a 78.6% level of satisfaction. CONCLUSION: Ambulatory mini-PCNL can be implemented as a treatment option in centers with experience in endourology, an established MAS Unit, and strictly selected patients. Our initial results show an adequate safety profile and high overall satisfaction perceived by patients undergoing the ambulatory approach.

Flexible Ureteroscopy as a Major Ambulatory Surgery Procedure. Single Center Experience and Analysis of Variables Related to Hospital Readmission

Objective: To assess our experience in flexible ureteroscopy (fURS) in major ambulatory surgery (MAS) and to detect variables related to unplanned medical assistance after surgery. Material & Methods: We conducted a retrospective study among patients with renal stones undergoing a fURS from 2014 to 2019 in MAS at our hospital. Variables: Age, gender, ASA physical status, type of anesthetic technique performed, stone characteristics, influence of double J stent before or after surgery, and postoperative complications according to the Clavien-Dindo modified classification. We evaluated variables related to hospital readmission or visit to the emergency room after surgery. Results: A total of 222 consecutive fURS for stone disease were performed in MAS. Patients’ average age was 52.9 ± 13.91 years old. The mean operating time was 57.86 ± 21.11 minutes. The mean stone size was 1.92 ± 1.43 with a diameter of 10.01 ± 4.24 mm. 47.3% of patients had a double J stent before fURS, and in 35.14% of cases, a stent was placed after surgery. 7.65% of patients required unplanned hospitalization. 14.86% of patients presented to the emergency room in the following month after surgery. Among them, one-third consulted for symptoms related to the double J. Patients who carried a double J stent before the fURS had 64% less risk of visiting the emergency department in the following month after surgery [OR = 0,363; IC95% (0.153-0.798)]. All other variables (age, gender, operating time...) did not modify the risk of unplanned medical assistance. Conclusion: The low complication rate following flexible ureteroscopy allows its performance as an ambulatory surgery. Patients who carry double J stent before the procedure have less risk of requiring unplanned medical assistance after the surgery (AU)

Objetivos: Evaluar nuestra experiencia con laureterorrenoscopia flexible (Uflex) en régimen de cirugíamayor ambulatoria (CMA) e identificar variables predictoras de asistencia médica no programada en el postoperatorio.Material y Métodos: Estudio retrospectivo de los pacientes afectos de litiasis renal intervenidos mediante Uflexen régimen de CMA entre 2014 y 2019 en nuestro centro.Variables: Edad, género, medicación antitrombótica, categoría del paciente según la clasificación de la SociedadAmericana de Anestesistas (ASA), tipo de anestesia empleada, características de la litiasis, influencia del cateterismo doble J y pre y postcirugía y complicaciones postoperatorias según la clasificación Clavien-Dindo modificada.Investigamos que variables puedan asociarse a requerir ingreso o consulta a urgencias tras la intervención quirúrgica.Resultados: Un total de 222 pacientes consecutivosafectos de litiasis renal fueron intervenidos mediante Uflexen régimen de CMA. La edad de los pacientes fue de 52,9 ±13,91 años. El tiempo quirúrgico fue de 57,86 ± 21,11 minutos. El número de litiasis fue de 1,92 ± 1,43 y el tamañode la litiasis fue de 10,01 ± 4,24 mm. El 47,3% de los pacientes tenían un catéter doble J previo a la Uflex y se dejóposteriormente a la misma en un 35,14% de los casos. Un7,65% de los pacientes requirieron ingreso hospitalario. El14,86% de los pacientes acudió a urgencias en el mes siguiente a la cirugía. De ellos, un tercio consultó por sintomatología relacionada con el doble J. Los portadores de dobleJ previo a la cirugía tuvieron un 64% menos de probabilidadde consultar en urgencias en el mes siguiente [OR = 0,363;IC95% (0.153-0.798)]. El resto de variables (edad, sexo,tiempo quirúrgico…) no modificaron el riesgo de consultaen urgencias ó de ingreso hospitalario... (AU)

Complicaciones hemorrágicas de la nefrolitotomía percutánea: valor del tratamiento endovascular precoz / Hemorrhagic complicationes after percutaneous nephrolithotomy: The importance of an early endovascular management

Introducción y objetivos: La hemorragia secundaria a la fístula arteriovenosa (FAV) o al pseudoaneurisma (PA) es una complicación poco frecuente de la nefrolitotomía percutánea (NLPC). El objetivo de este estudio es evaluar las complicaciones hemorrágicas (CH) tras la NLPC y los resultados del tratamiento endovascular.Materiales y métodosEntre mayo de 2009 y diciembre de 2019 se realizaron en nuestro centro 1.335 NLPC por litiasis renal. Analizamos la incidencia de CH tempranas y tardías, el tratamiento administrado, la necesidad de embolización posterior y los datos clínicos y analíticos de los pacientes.ResultadosUn total de 59 (4,4%) pacientes presentaron CH, y todos fueron tratados con arteriografía y embolización selectiva (AES) para controlar el sangrado. Se observó hematoma perirrenal en 38 pacientes (64%).En cuanto a los hallazgos angiográficos, hubo 32 (54%) PA, 8 (14%) FAV, 4 (7%) extravasaciones por laceración vascular y 15 (25%) PA combinadas con FAV. En un caso, fueron necesarios 3 procedimientos para controlar la hemorragia. En 30 pacientes (51%) no se requirió transfusión de sangre, mientras que en 29 (49%) se transfundió una media de 1,3 unidades. La mediana de seguimiento fue de 24±21 meses.El intervalo de tiempo medio entre la NLPC y la AES fue de 7,3±4,9 días. Un total de 24 (41%) pacientes reingresaron tras el alta debido a una CH tardía que requería AES. La demora entre el reingreso y la AES fue de 4,8±4,6horas de media.ConclusiónLas CH tempranas y tardías tras la NLPC pueden ser mayores. El tratamiento con AES tras la detección precoz es un método efectivo y mínimamente invasivo que evita múltiples transfusiones de sangre, en muchos casos insuficientes. (AU)

Introduction and objectives: Hemorrhage due to arteriovenous fistula (AVF) or pseudoaneurysm (PA) is a rare complication after percutaneous nephrolithotomy (PCNL). The objective of this study is to evaluate hemorrhagic complications (HC) after PCNL and the results of their endovascular treatment.Materials and methodsBetween May 2009 and December 2019, 1335 PCNL were performed in our center for kidney stone disease. We analyzed the incidence of early and late HC, their management, the need for subsequent embolization, as well as clinical and analytical data of these patients.ResultsA total of 59 (4.4%) patients presented HC. Bleeding was managed with arteriography and selective embolization (ASE). Perirenal hematoma was seen in 38 patients (64%).Regarding angiographic findings, there were 32 (54%) PA, 8 (14%) AVF, 4 (7%) extravasations due to vascular laceration and 15 (25%) PA combined with AVF. In one case, 3 procedures were required to control the bleeding. In 30 patients (51%) blood transfusions were not necessary, while in 29 (49%), a mean of 1.3 units were transfused. Median follow-up was 24±21 months.Mean time interval between PCNL and ASE was 7.3±4.9 days. A total of 24 (41%) patients were readmitted after discharge due to late HC requiring ASE. Delay between readmission and ASE was 4.8±4.6hours in average.ConclusionEarly and late HC after PCNL can be severe. Rapid identification and treatment with ASE is an effective and minimally invasive and avoids multiple blood transfusions which in many cases constitute an insufficient treatment. (AU)

Hemorrhagic complicationes after percutaneous nephrolithotomy: The importance of an early endovascular management.

INTRODUCTION AND OBJECTIVES: Hemorrhage due to arteriovenous fistula (AVF) or pseudoaneurysm (PA) is a rare complication after percutaneous nephrolithotomy (PCNL). The objective of this study is to evaluate hemorrhagic complications (HC) after PCNL and the results of their endovascular treatment. MATERIALS AND METHODS: Between May 2009 and December 2019, 1335 PCNL were performed in our center for kidney stone disease. We analyzed the incidence of early and late HC, their management, the need for subsequent embolization, as well as clinical and analytical data of these patients. RESULTS: A total of 59 (4.4%) patients presented HC. Bleeding was managed with arteriography and selective embolization (ASE). Perirenal hematoma was seen in 38 patients (64%). Regarding angiographic findings, there were 32 (54%) PA, 8 (14%) AVF, 4 (7%) extravasations due to vascular laceration and 15 (25%) PA combined with AVF. In one case, 3 procedures were required to control the bleeding. In 30 patients (51%) blood transfusions were not necessary, while in 29 (49%), a mean of 1.3 units were transfused. Median follow-up was 24 ±â€¯21 months. Mean time interval between PCNL and ASE was 7.3 ±â€¯4.9 days. A total of 24 (41%) patients were readmitted after discharge due to late HC requiring ASE. Delay between readmission and ASE was 4.8 ±â€¯4.6 h in average. CONCLUSION: Early and late HC after PCNL can be severe. Rapid identification and treatment with ASE is an effective and minimally invasive and avoids multiple blood transfusions which in many cases constitute an insufficient treatment.

Hemorrhagic complicationes after percutaneous nephrolithotomy: The importance of an early endovascular management. / Complicaciones hemorrágicas de la nefrolitotomía percutánea: valor del tratamiento endovascular precoz.

INTRODUCTION AND OBJECTIVES: Hemorrhage due to arteriovenous fistula (AVF) or pseudoaneurysm (PA) is a rare complication after percutaneous nephrolithotomy (PCNL). The objective of this study is to evaluate hemorrhagic complications (HC) after PCNL and the results of their endovascular treatment. MATERIALS AND METHODS: Between May 2009 and December 2019, 1335 PCNL were performed in our center for kidney stone disease. We analyzed the incidence of early and late HC, their management, the need for subsequent embolization, as well as clinical and analytical data of these patients. RESULTS: A total of 59 (4.4%) patients presented HC. Bleeding was managed with arteriography and selective embolization (ASE). Perirenal hematoma was seen in 38 patients (64%). Regarding angiographic findings, there were 32 (54%) PA, 8 (14%) AVF, 4 (7%) extravasations due to vascular laceration and 15 (25%) PA combined with AVF. In one case, 3 procedures were required to control the bleeding. In 30 patients (51%) blood transfusions were not necessary, while in 29 (49%), a mean of 1.3 units were transfused. Median follow-up was 24±21 months. Mean time interval between PCNL and ASE was 7.3±4.9 days. A total of 24 (41%) patients were readmitted after discharge due to late HC requiring ASE. Delay between readmission and ASE was 4.8±4.6hours in average. CONCLUSION: Early and late HC after PCNL can be severe. Rapid identification and treatment with ASE is an effective and minimally invasive and avoids multiple blood transfusions which in many cases constitute an insufficient treatment.

Nuestra experiencia en el priapismo de alto flujo por fístula arterio-lacunar uni y bilateral / Our experience in high-flow priapism due to uni-or bilateral arterio-lacunar fistula

Objetivo: Presentar nuestra experiencia en el priapismo de alto flujo tanto uni como bilateral, resaltando los buenos resultados obtenidos con la embolización supraselectiva. Material y método: Presentamos 5 casos de priapismo de alto flujo secundarios a traumatismo perineal, con una edad media de 31 años (24-43 a). El tiempo medio de consulta desde el momento del traumatismo fue de 18,6días (1-60 d). El diagnóstico se confirmo mediante gasometría de los cuerpos cavernosos, eco-doppler peneano (2 casos) y arteriografía selectiva de la pudenda. En todos los casos el tratamiento fue la embolización supraselectiva con esponja de gelatina. En los dos casos bilaterales la embolización se realizo en el mismo acto. Resultados: A corto plazo fueron la recuperación de la flacidez y a largo plazo (3-4 meses) la recuperación de la erección sin secuelas fibróticas de los cuerpos cavernosos en todos los casos. Conclusiones: La embolización de la arteria lacerada, y en caso de que sea bilateral en un solo tiempo, reporta excelentes resultados

Objective: To present our experience in both uni-and bilateral priapism, highlighting good results obtained with supraselective embolisation. Material and methods: We present 5 cases of high-flow priapism secondary to perineal trauma, with a mean age of 31 years (24-43 years). The mean time to presentation from the moment of the trauma was 18,6 days (1-60 days). Diagnosis was confirmed through gasometry of the corpora cavernosa, penile doppler ultrasound (2 cases) and selective arteriography of the pudendal artery. In all cases treatment was by supralective embolisation with gelatin sponge. In the two bilateral cases, embolisation was performed in the same act. Results: In the short term was a recovery of flaccidity and in the long term (3-4 months) a recovery of erection with no fibrotic sequelae of the corpora cavernosa. Conclusions: Embolisation of the lacerated artery, in a single procedure in cases of bilateral lacerations, provides excellent results

Tratamiento del priapismo recurrente de bajo flujo mediante autoinyección intracavernosa domiciliaria de metoxamina / Intracavernosal methoxamine self-injection for the treatment of low-flow recurrent priapism

Presentamos un caso de priapismo recurrente de bajo flujo de etiología desconocida; comprobado durante su ingreso hospitalario la eficacia y buena tolerancia a la administración intracavernosa de metoxamina, se aleccionó al paciente en la autoinyección domiciliaria, realizando ésta durante aproximadamente un mes, con desaparición del priapismo recurrente. El paciente conservó su función eréctil

We report the case of a young man with a recurrent idiopathic priapism, successfully treated with methoxamine intracarvenosal self-injections. The patient was instructed in intracorporeal self-injection of this pure alpha-1 adrenergic agonist, which provided complete detumescence. The patient became asymptomatic after one month of domiciliary treatment. We conclude that intracavernosal self-administered methoxamine can be a useful treatment of recurrent idiopathic priapism

Duplicidad uretral incompleta / Incomplete urethral duplication

La duplicidad uretral masculina es una malformación congénita poco frecuente. Presentamos el caso de un varón de 25 años con infecciones urinarias de repetición que fue diagnosticado mediante uretrografía retrógrada y cistouretrografía miccional de duplicidad uretral incompleta. El tratamiento consistió en la resección quirúrgica por vía perineal de la uretra duplicada incompleta. El resultado clínico fue excelente, quedando el paciente asintomático con funcionalidad uretral dentro de la normalidad (AU)

Urethral duplicity is a rare congenital malformation. We report a case of one 25 years old male suffering recurrent urinary infections. The diagnostic of uncompleted urethral duplicity was performed by retrograde urethrography and micturating cystourethrogram. The accessory channel was excised by a perineal approach. Clinical results were satisfactory, remaining an asintomatic patient two years after surgery, with normal mictional behavior (AU)