[Ureteral stenosis and pneumatic dilatation]. / Estenosis ureteral y dilatacion neumática.

OBJECTIVE: To determine the efficacy of balloon dilatation in the treatment of ureteral strictures and analyze the outcome according to its etiology. METHODS: 77 ureteral dilatations were performed in 74 patients. Most of the strictures were postoperative sequelae and the other cases were due to chronic inflammatory conditions. RESULTS: The overall success rate was 47%, partial improvement was achieved in 17% and the failure rate was 36%. In our series, the postoperative strictures responded slightly better to balloon dilatation than those arising from chronic inflammatory conditions. CONCLUSION: Endourologic techniques based on the percutaneous methods of interventional radiology have reduced the usage of invasive conventional surgery in the treatment of strictures. Although the proportion of unsatisfactory results is not negligible, balloon dilatation should be the first treatment option for ureteral strictures because it is less invasive, carries a low morbidity and requires a shorter hospitalization. If the results are unsatisfactory, re-dilatation can be attempted or conventional open surgery can be performed.

[Analysis and clinical course of residual lithiasis after shock wave renal treatment]. / Análisis y evolución de la litiasis residual tras la aplicación renal de ondas de choque.

OBJECTIVE: Although residual lithiasis after the application of shock waves is a situation that coexists with the procedure, in some cases it can be considered to be a failure of ESWL. The natural history and outcome of 244 cases of residual renal stone followed over a 5-year period are analyzed, and the approach based on a pre-established classification is discussed. METHODS: Of 1,407 patients treated by ESWL for renal lithiasis during 1995, 244 cases with a renal calculus larger than 3 mm were followed for a period of 5 years after treatment and evaluated by clinical, radiological, ultrasound and analytical methods. RESULTS: At 3 months post-ESWL, 1,013 cases (72%) were completely stone-free and 394 (28%) showed residual stone; of these, 244 (62%) had residual stone fragments greater than 3 mm. At 5 years, 190 (78%) remained stable and the remaining 54 (22%) showed stone regrowth that warranted additional treatments: 52 ESWL, 1 PNL and 1 partial nephrectomy. Despite the retreatments, only 42% became completely stone-free. CONCLUSIONS: A classification of residual renal stone can be established based on the data obtained to orient the approach in each case, although the frequency of residual stone can be reduced by the appropriate indication of ESWL. Once a renal stone has formed retreatments with ESWL cannot ensure complete elimination of the stone.

Renal hematoma as a complication of extracorporeal shock wave lithotripsy.

OBJECTIVE: To evaluate risk factors, clinical presentation, therapeutic management, and treatment of residual stones and subsequent development of renal hematoma following Extracorporeal Shock Wave Lithotripsy (ESWL). MATERIAL AND METHODS: A retrospective review was made of 31 post-ESWL renal hematoma cases diagnosed between May 1987 and June 1996. Lithotripsy treatments were outpatient procedures without anaesthesia. Our center has three electromagnetic sources, two with biplane X-ray centering and one ultrasound-guided (SIEMENS Lithostar II, SIEMENS Lithostar System C and SIEMENS Lithostar Ultra, respectively). We analysed findings from patient history, physical examination, blood analysis, and renovesical sonographs. Follow-up involved periodical checks, blood analyses and renovesical sonographs, scheduled first at three-month intervals and later at six-month intervals. RESULTS: Our center performed 21 699 lithotripsies on a total of 10 953 patients in this period. Thirty-one renal hematomas were diagnosed, giving an incidence rate of 0.28%. Twenty-four patients presented clinical onsets and the commonest symptom for consultation was low back pain (74%). Eleven patients of this group (46%) were hypertensive. All patients received conservative treatment. With a mean follow-up time of 18 months, ultrasound showed persistent hematoma in 11 patients (36%). There were residual stones in 71% of patients; further lithotripsy was performed on seven patients with no clinical or ultrasonographic signs of change in the hematoma. CONCLUSIONS: Renal hematoma post-ESWL is a rare complication. Main risk factors are hypertension, clotting disorders and previous ESWL sessions. Flank pain is the main symptom at presentation. Elective management is conservative. Presence of hematoma is not a contraindication for further treatments of residual stones.

[Intraprostatic prostheses]. / Prótesis intraprostáticas.

We evaluated the usefulness of the intraprostatic spiral prosthesis as an alternative to surgical treatment of benign prostatic hyperplasia (BPH) (40 cases), cancer of the prostate (7 cases), and cervico-prostatic sclerosis (2 cases). These 49 prostheses were placed in elderly patients (mean age 79 years) who had a long indwelling urethral catheter (mean 6.2 months) and were at high risk for surgery (ASA IV 83.6%). In 17% of the cases, placement of the prosthesis permitted performing curative surgery subsequently, once patient general condition had improved. Overall, good results were achieved in 63% (53 patients with BPH) of the cases who tolerated the long indwelling prosthesis well (mean 22 months). The results were assessed according to the quality of micturition (normal in 74.3%), correct placement of the stent (80%), no post-micturition residual volume (88.5%), and a flow rate of 6-12 ml/sec. (60%). Poor results (9 cases) owing to migration of the stent (7 cases) and/or complications: perforation of urethra (1 case), secondary stricture (1 case) and partial calcification of the prosthesis (1 case). The advantages and disadvantages of other currently utilized stents (Prostakath, Variospire, Wall-Stent, and Double Pezzer) are discussed.