Evaluation of the significance of radiographic density and size of calculi in the incidence and clinical manifestations of postlithotripsy renal hematomas.

OBJECTIVES: The present study is a continuation of an earlier article published on the incidence, clinical manifestations, treatment and risk factors associated with postlithotripsy renal hematomas (1). To assess the possible influence of the size and radiodensity of kidney stones on the incidence and clinical behavior of renal postlithotripsy hematomas. METHODS: Observational prospective study of 324 renal units in the same number of patients undergoing extracorporeal renal lithotripsy. The variables "calculus size" and "radiographic calculus density" were evaluaArch. ted statistically by means of the IPSS 0.15 program on the basis of 42 postlithotripsy hematomas diagnosed and grouped according to their clinical behavior. RESULTS: Higher incidence of hematomas was observed in hiperdense calculi (25%) versus medium density calculi (7,4%), this difference was significant in the asymptomatic hematoma group. CONCLUSIONS: Calculus size was unrelated to the incidence of renal hematoma, but there was a significant association between renal hematoma and radiographic calculus density, probably due to the relation of radiographic density to chemical composition and, ultimately, to hardness and ultrastructure. Ultrastructure is yet another factor, among others, to be taken into account as a potential conditioning factor for this complication.

[Upper urinary tract tumors: our experience]. / Tumores del tracto urinario superior, nuestra experiencia.

OBJECTIVES: To study the clinical, diagnostic, and therapeutic features of upper urinary tract tumors. METHODS: We perform a retrospective study of upper urinary tract tumors treated in our Department at Clinica La Luz Madrid between 1995 and 2008. RESULTS: We treated 42 tumors in 40 patients. Mean age was 64 years; there were 29 males and 11 females. Macroscopic hematuria was the most frequent clinical presentation, in 45% of the cases, and the imaging diagnostic test most frequently used was intravenous urogram (62,5%).There were more tumors on the right side (20 cases( than the left side (18 case), 2 cases were bilateral. Distal ureter was the most frequent site.27,5% of the patients presented associated bladder tumors. The most frequently used therapy was laser endoscopic resection. 5 patients required a second operation due to recurrence and 2 more a programmed second procedure due to incomplete resection; 7 cases presented postoperative complications. 70%of the tumors were superficial. 40%of the cases underwent local chemotherapy with weekly bladder instillations of Mitomycin C for 8 weeks. Recurrence rate was 20% and mortality 10%. CONCLUSIONS: Upper urinary tract tumors keep being a rare entity appearing in mid-advanced ages. Radical nephroureterectomy with excision of bladder cuff has been the treatment of choice for years, but in recent years endoscopic treatment is gaining more importance and is showing good results in selected cases.

Tumores del tracto urinario superior. Nuestra experiencia / Upper urinary tract tumours: Our experience

OBJETIVO: Estudiar la clínica, el diagnostico y el tratamiento de los tumores de tracto urinario superior.MÉTODOS: Realizamos un estudio retrospectivo de los tumores de tracto urinario superior tratados en nuestro centro, Clínica La Luz Madrid, entre el 1995 y el 2008.RESULTADOS: Tratamos 42 tumores en 40 pacientes. La edad media fue de 64 años y encontramos 29 varones frente a 11 mujeres.El debut clínico más frecuente fue la hematuria macroscópica en el 45% de los casos y el método diagnostico que más se utilizó fue la urografía intravenosa (62,5%).El lado más afectado fue el derecho (20 casos frente a 18 del lado izquierdo) y en dos casos el tumor se presentó de forma bilateral. La región más afectada fue el uréter distal. El 27,5% de los pacientes presentaron asociado tumor vesical.La terapia más utilizada fue la resección láser endoscópica, 5 pacientes precisaron una segunda intervención por recidiva y dos programada por resección incompleta, siete casos presentaron complicaciones post intervención. El 70% de los tumores fue superficial. El 40% de los casos fue sometido a quimioterapia local con instilaciones endovesicales con Mytomicina C a ritmo semanal por 8 semanas. La tasa de recidiva fue del 20% y la de mortalidad del 10%.CONCLUSIONES: Los tumores del tracto urinario superior siguen siendo una entidad poco frecuente que aparece en la edad media avanzada de la vida. Durante años el tratamiento de elección ha sido la nefroureterectomía radical con resección de rodete vesical, en estos últimos años el tratamiento endoscópico está tomando cada vez más importancia y está dando buenos resultados en casos bien selecionados(AU)

OBJECTIVES: To study the clinical, diagnostic, and therapeutic features of upper urinary tract tumors.METHODS: We perform a retrospective study of upper urinary tract tumors treated in our Department at Clinica La Luz Madrid between 1995 and 2008. RESULTS: We treated 42 tumors in 40 patients. Mean age was 64 years; there were 29 males and 11 females.Macroscopic hematuria was the most frequent clinical presentation, in 45% of the cases, and the imaging diagnostic test most frequently used was intravenous urogram (62,5%).There were more tumors on the right side (20 cases) than the left side (18 cases), 2 cases were bilateral. Distal ureter was the most frequent site.27,5% of the patients presented associated bladder tumors.The most frequently used therapy was laser endoscopic resection. 5 patients required a second operation due to recurrence and 2 more a programmed second procedure due to incomplete resection; 7 cases presented postoperative complications. 70% of the tumors were superficial. 40% of the cases underwent local chemotherapy with weekly bladder instillations of Mitomycin C for 8 weeks. Recurrence rate was 20% and mortality 10%.CONCLUSIONS: Upper urinary tract tumors keep being a rare entity appearing in mid-advanced ages. Radical nephroureterectomy with excision of bladder cuff has been the treatment of choice for years, but in recent years endoscopic treatment is gaining more importance and is showing good results in selected cases(AU)

Aplicación de la tecnología láser en el tratamiento de la litiasis ureteral / Application of laser technology in the treatment of ureteral lithiasis

Objetivo: Valorar las aportaciones del láser, fundamentalmente de holmio, en el tratamiento endourológico de la litiasis ureteral. Método: Analizamos la experiencia acumulada en 154 tratamientos endourológicos con láser holmio de litiasis ubicadas a nivel ureteral, realizado de forma continuada en nuestra Unidad desde junio 2005 a diciembre 2007. Resultados: Se consiguió la fragmentación litiásica en el 100% de los casos. El uso asociado de la pinza de rama larga al láser de holmio, nos permitió alcanzar tasas de ausencia de litiasis residual en el 91% de los pacientes. Conclusiones: El tratamiento de la litiasis ureteral se ha beneficiado de los procedimientos endoscópicos, siendo el láser de holmio la fuente de energía de elección en el momento actual. La tasa de fragmentation alcanzada fue del 100%. Las complicaciones fueron escasas y en ningún momento de importancia (AU)

Objectives: To evaluate the contribution of laser, mainly holmium laser, to the endourological treatment of ureteral lithiasis. Methods: We analyze our experience in 154 endourological treatments of ureteral lithiasis with holmium laser performed in our Unit from June 2005 to December 2007. Results: Stone fragmentation was achieved in 100% of the cases. The use of long jaw forceps associated with the holmium laser enabled us to reach a stone free rate of 91%. Conclusions: The treatment of ureteral lithiasis has benefit from the development of endoscopic procedures, being the holmium laser the energy source of choice nowadays. The fragmentation rate was 100%. Complications were rare and never important (AU)

[Application of laser technology in the treatment of ureteral lithiasis]. / Aplicación de la tecnología láser en el tratamiento de la utiasis ureteral.

OBJECTIVES: To evaluate the contribution of laser, mainly holmium laser, to the endourological treatment of ureteral lithiasis. METHODS: We analyze our experience in 154 endourological treatments of ureteral lithiasis with holmium laser performed in our Unit from June 2005 to December 2007. RESULTS: Stone fragmentation was achieved in 100% of the cases. The use of long jaw forceps associated with the holmium laser enabled us to reach a stone free rate of 91%. CONCLUSIONS: The treatment of ureteral lithiasis has benefit from the development of endoscopic procedures, being the holmium laser the energy source of choice nowadays. The fragmentation rate was 100%. Complications were rare and never important.

[MRI-spectroscopy-guided prostate biopsy]. / Biopsia de prostata dirigida por espectroscopia.

Prostate cancer is currently one of the main causes of urological practice workload. Patients with negative prostate biopsies may pose serious problems to the urologist in the decision making process for follow-up due to the lack of definitive data in the follow-up algorithm. MRI spectroscopy seems to open a diagnostic window evaluating prostatic metabolic changes. The performance of perineal prostatic biopsy with stabilizer and template enables selective biopsy of the suspect voxels following the spectroscopic study, simulating the Rubick's cube.

Biopsia de próstata dirigida por espectroscopia / MRI spectroscopy guided prostate biopsy

El cáncer de próstata supone en el momento actual, uno de los capítulos de actuación urológica mas importante. El paciente biopsiado con resultado negativo para tumor, supone un serio «problema» para el urólogo en cuanto a la toma de decisiones, para su seguimiento ante la falta de datos concluyentes en el algoritmo de seguimiento. La espectrospia asociada a RMN parece abrir una ventana diagnóstica al valorar los cambios metabólicos prostáticos. La realización de biopsia prostática mediante acceso transperineal, con sistema estabilizador y templete permite la punción selectiva de los voxels sospechosos en el estudio espectroscópico, simulando un cubo de Rubick (AU)

Prostate cancer is currently one of the main causes of urological practice workload. Patients with negative prostate biopsies may pose serious problems to the urologist in the decision making process for follow-up due to the lack of definitive data in the follow-up algorithm. MRI spectroscopy seems to open a diagnostic window evaluating prostatic metabolic changes. The performance of perineal prostatic biopsy with stabilizer and template enables selective biopsy of the suspect voxels following the spectroscopic study, simulating the Rubick's cube (AU)

[Anterograde endopyelotomy]. / Endopielotomía anterógrada.

OBJECTIVE: To analyze the results obtained with antegrade endopyelotomy and compare them with those reported in the literature. METHODS: 16 patients with ureteropelvic junction (UPJ) obstruction treated by antegrade endopyelotomy were evaluated. RESULTS: In our series the success rate was 81.3%. Avulsion of the UPJ was observed in one patient and required conversion into an Anderson-Hynes pyeloplasty. Two cases of re-stenosis were diagnosed within the first three months. CONCLUSIONS: Long-term follow-up shows that antegrade endopyelotomy can be indicated as the treatment of choice for primary and secondary UPJ strictures.

Endopielotomía anterógrada / Antegrade endopyelotomy

Objetivo: Analizar los resultados obtenidos con la endopielotomía anterógrada y comparar los datos recogidos de la literatura. Métodos: Se evaluaron 16 pacientes con estenosis de la unión pieloureteral en quienes se practicó endopielotomía anterógrada. Resultados: En nuestra serie, el porcentaje de éxito fue del 81,3 por ciento. Se constató la rotura de la unión pieloureteral en un paciente, debiendo reconvertirla en plastia de Anderson-Hynes. Se presentaron dos casos de reestenosis, ambas de aparición temprana. Conclusiones: En el seguimiento a largo plazo, la endopielotomía anterógrada puede ser propuesta como el tratamiento de elección para la resolución de estenosis primarias o secundarias de la unión pieloureteral (AU)