Más allá del nomograma de Briganti: individualización de la linfadenectomía utilizando la biopsia selectiva del ganglio centinela durante la prostatectomía radical por cáncer de próstata / Beyond the Briganti nomogram: Individualisation of lymphadenectomy using selective sentinel node biopsy during radical prostatectomy for prostate cancer

Objetivo: Validar la técnica de biopsia selectiva de ganglio centinela en el diagnóstico y estadificación del cáncer de próstata de riesgo intermedio y alto mediante comparación con la linfadenectomía extendida convencional (eLFD) en un estudio prospectivo longitudinal y comparativo. Métodos: Hemos aplicado la técnica a 45 pacientes. Previa inyección intraprostática de 99mTc-nanocoloide y SPECT-TC preoperatoria, se han extraído los ganglios centinela guiados con gammacámara portátil Sentinella® y sonda detectora de rayos gamma laparoscópica. Se completó la eLFD para establecer el valor predictivo negativo de la técnica. Resultados: La SPECT-TC mostró depósitos del radiotrazador fuera del territorio de la eLFD en el 73% de los pacientes y la gammasonda laparoscópica en el 60%. La media de focos activos por paciente en la SPECT-TC fue de 4,3 y con gammasonda laparoscópica de 3,2. La media de ganglios linfáticos centinelas extraídos fue 4,3 (0-14), el 26% fuera del territorio de la eLFD. En 10 pacientes (22%) se encontraron ganglios metastásicos, 6/40 (15%) cuando la prostatectomía fue el tratamiento primario. En todos los casos con ganglios metastásicos hubo, al menos, un ganglio centinela positivo. Se encontraron ganglios centinela metastásicos fuera del territorio de la eLFD en 3/10 pacientes (30%). La sensibilidad fue del 100%, la especificidad del 94,73%, el valor predictivo positivo del 81,81% y el valor predictivo negativo del 100%. Conclusión: La biopsia selectiva del ganglio centinela es superior a la eLFD en el diagnóstico de afectación ganglionar, y puede evitar la eLFD cuando no se encuentren ganglios centinela metastásicos (85%), con las consecuentes ventajas funcionales

Objective: To validate the technique of selective sentinel node biopsy for diagnosing and staging intermediate to high-risk prostate cancer by comparing the technique with conventional extended lymphadenectomy (eLFD) in a prospective, longitudinal comparative study. Methods: We applied the technique to 45 patients. After an intraprostatic injection of 99mTc-nanocolloid and preoperative single-photon emission computed tomography (SPECT/CT), we extracted the sentinel lymph nodes, guided by a portable Sentinella® gamma camera and a laparoscopic gamma-ray detection probe. The eLFD was completed to establish the negative predictive value of the technique. Results: SPECT/CT showed radiotracer deposits outside the eLFD territory in 73% of the patients and the laparoscopic gamma probe in 60%. The mean number of active foci per patient was 4.3 in the SPECT/CT and 3.2 in the laparoscopic gamma probe. The mean number of extracted sentinel lymph nodes was 4.3 (0-14), with 26% outside the eLFD territory. The lymph nodes were metastatic in 10 patients (22%), 6/40 (15%) when the prostatectomy was the primary treatment. In all cases with metastatic lymph nodes, there was at least one positive sentinel node. Metastatic sentinel lymph nodes were found outside the eLFD territory in 3/10 patients (30%). The sensitivity was 100%, the specificity was 94.73%, the positive predictive value was 81.81%, and the negative predictive value was 100%. Conclusion: Selective sentinel node biopsy is superior to eLFD for diagnosing lymph node involvement and can avoid eLFD when metastatic sentinel lymph nodes are not found (85%), with the consequent functional advantages

Beyond the Briganti nomogram: Individualisation of lymphadenectomy using selective sentinel node biopsy during radical prostatectomy for prostate cancer. / Más allá del nomograma de Briganti: individualización de la linfadenectomía utilizando la biopsia selectiva del ganglio centinela durante la prostatectomía radical por cáncer de próstata.

OBJECTIVE: To validate the technique of selective sentinel node biopsy for diagnosing and staging intermediate to high-risk prostate cancer by comparing the technique with conventional extended lymphadenectomy (eLFD) in a prospective, longitudinal comparative study. METHODS: We applied the technique to 45 patients. After an intraprostatic injection of 99mTc-nanocolloid and preoperative single-photon emission computed tomography (SPECT/CT), we extracted the sentinel lymph nodes, guided by a portable Sentinella® gamma camera and a laparoscopic gamma-ray detection probe. The eLFD was completed to establish the negative predictive value of the technique. RESULTS: SPECT/CT showed radiotracer deposits outside the eLFD territory in 73% of the patients and the laparoscopic gamma probe in 60%. The mean number of active foci per patient was 4.3 in the SPECT/CT and 3.2 in the laparoscopic gamma probe. The mean number of extracted sentinel lymph nodes was 4.3 (0-14), with 26% outside the eLFD territory. The lymph nodes were metastatic in 10 patients (22%), 6/40 (15%) when the prostatectomy was the primary treatment. In all cases with metastatic lymph nodes, there was at least one positive sentinel node. Metastatic sentinel lymph nodes were found outside the eLFD territory in 3/10 patients (30%). The sensitivity was 100%, the specificity was 94.73%, the positive predictive value was 81.81%, and the negative predictive value was 100%. CONCLUSION: Selective sentinel node biopsy is superior to eLFD for diagnosing lymph node involvement and can avoid eLFD when metastatic sentinel lymph nodes are not found (85%), with the consequent functional advantages.

[Factors affecting the PSA:alpha 1 antichymotrypsin/total PSA ratio]. / Factores que influencian el cociente PSA:alpha 1 antiquimotripsina/PSA-total.

OBJECTIVES: To evaluate the influence of several factors, including age, prostate volume, total PSA (PSA-T), clinical stage and Gleason on the PSA:alpha 1ACT/PSA-T (C/T) ratio. MATERIAL AND METHODS: Using in-house assays, we measured plasma levels of PSA-T and PSA:alpha 1ACT complex in 622 patients with benign prostate hyperplasia (BPH) (455 with hystological confirmation and 167 with clinical evidence of absence of malignance) and in 255 patients with prostate cancer (CaP), and determined the correlation between different parameters. RESULTS: In BPH patients, PSA-T and PSA:alpha 1ACT significantly increased with age. There was a positive correlation between age and PSA-T (r = 0.161, p < 0.0001) and PSA:alpha 1ACT (r = 0.141, p = 0.001). In contrast, the C/T ratio remained constant and below 70% in all decades. Similar results were obtained in CaP patients. In BPH patients, there was a positive correlation between prostate volume and PSA-T and PSA:alpha 1ACT, but not with the C/T ratio. In CaP patients, however, there was a negative correlation between prostate volume and the C/T ratio. An excellent correlation was found between PSA-T and PSA:alpha 1ACT, and a good correlation between PSA-T and the C/T ratio and between PSA:alpha 1ACT and C/T ratio. A multiple regression analysis showed that, in HBP and CaP patients, PSA-T and PSA:alpha 1ACT complex were the only parameters that significantly and independently influenced the C/T ratio. CONCLUSIONS: The C/T ratio is independent of age, prostate volume, Gleason and clinical stage. Therefore, these factors need not to be considered when using the C/T ratio.

[PSA:alpha 1-antichymotrypsin ratio/total PSA in the diagnosis of prostatic cancer in the range of total PSA from 4 to 10 ng/ml]. / El cociente PSA:alpha 1 antiquimotripsina/PSA total (C/T) en el diagnóstico del cáncer de próstata en el rango de PSA total entre 4 y 10 ng/ml.

OBJECTIVE: To evaluate the usefulness of the ratio PSA:alpha-1-antichymotrypsin/total PSA (C/T) in the diagnosis of prostate cancer in the range of total PSA between 4 and 10 ng/mL. MATERIAL AND METHODS: By using home-made ELISAs we have determined plasmatic concentrations of total PSA and complex PSA:alpha-1-ACT in 300 patients with total PSA between 4-10 ng/mL. All samples were obtained before any manipulation that could interfere the PSA levels. RESULTS: By prostatic biopsy 85 patients (28.3%) were diagnosed of prostate cancer (CaP) and 215 (71.6%) of benign prostatic hyperplasia (BPH). The mean values of the complex PSA:alpha-1-ACT (4.2 ng/mL in the BPH patients vs 5.0 ng/mL in the CaP patients) and of the C/T ratio (0.70 vs 0.82, respectively) showed significant differences between both groups (p = < 0.0001). The total PSA did not show differences (6.1 ng/mL vs 6.0 ng/mL; p = 0.79). From all three parameter evaluated, the ratio C/T had the biggest area under the ROC (0.884) and statistically significant differences in comparison with total PSA (0.490; p = < 0.001) and the complex PSA:alpha-1-ACT (0.696: p = < 0.001). Therefore, by using a ratio C/T > 0.62 to decide the performance of a biopsy, 27% of the patients with BPH could have avoided this procedure with a 100% sensitivity. Increasing the ratio to 0.68 the specificity is 47% and the sensitivity is 95.2%. Rectal examination did not have influence on the cut-off, sensitivity, specificity and area under the ROC of the ratio C/T. CONCLUSIONS: Our results confirm that the ratio C/T improve the diagnostic capacity of the total PSA between 4-10 ng/ml. Moreover, the rectal examination does not influence the selection of ratio C/T cut-off suggestives of CaP neither the diagnostic efficacy.

Factores que influencian el cociente PSA: alfa1 antiquimotripsina / PSA-total / Factors influencing PSA ratio: alfa1-antiquimiotrypsin / total PSA

OBJETIVOS: Evaluar la influencia que sobre el cociente C/T tiene factores como la edad, el volumen prostático, la concentración sérica de PSA total, el estadio clínico y el Gleason. MATERIAL Y MÉTODOS: Determinamos, con ensayos de desarrollo propio, los niveles plasmáticos de PSA-T y complejo PSA:α1 ACT a 877 pacientes, de los cuales en 455 tuvimos la confirmación histológica de HBP, en 167 no se obtuvo esa confirmación pero no existía la sospecha clínica de cáncer de próstata (CaP) (PSA-T < 4 ng/ml y tacto rectal no sugestivo) y 255 fueron diagnosticados de CaP. Se establecieron correlaciones entre la edad, volumen prostático y niveles de PSA total y complejo PSA:α1 ACT con el cociente C/T. RESULTADOS: En los pacientes con HBP, la concentración sérica de PSA-T y complejo PSA:α1 ACT aumenta con la edad de forma estadísticamente significativa, existiendo una correlación positiva entre la edad y los niveles de PSA-T (r = 0,161, p < 0,0001) y el complejo PSA:α1 ACT (r = 0,141, p = 0,001). El cociente C/T, sin embargo, se mantiene prácticamente constante y por debajo del 70 por ciento en todas las décadas, existiendo una muy débil correlación negativa aunque estadísticamente significativa (r = -0,094, p = 0,032). Similares resultados se obtienen en los pacientes con CaP. En relación al volumen prostático, en los pacientes con HBP existe una correlación positiva con el PSA-T y el complejo PSA:α1 ACT, pero no con el cociente C/T. En los pacientes con CaP, sin embargo, existe una correlación negativa entre el volumen prostático y el cociente C/T. Hay una buena correlación entre el PSA-T y el complejo PSA:α1 ACT, con un coeficiente de Spearman de 0,974. Esta asociación se mantiene, aunque en menor grado, entre el PSA-T y el cociente C/T, y entre el complejo PSA:α1 ACT y el cociente C/T. Finalmente, en el análisis de regresión lineal múltiple, tanto en los pacientes con HBP como con CaP, el PSA-T y el complejo PSA:α1 ACT fueron los únicos factores que mostraron una influencia significativa e independiente sobre el cociente C/T.CONCLUSIONES: El cociente C/T es independiente de la edad, el volumen prostático y el valor del PSA-T, por lo que en su aplicación clínica, no se han de considerar estos factores ni establecer mecanismos correctivos para mejorar su eficacia diagnóstica (AU)

El cociente PSA: alfa1 antiquimotripsina / PSA total (C/T) en el diagnóstico del cáncer de próstata en el rango de PSA total entre 4 y 10 ng/ml / The ratio PSA: alpha-1-antichymotrypsin / total PSA (C/T) in the diagnosis of prostate cancer in the range ot total PSA between 4 and 10 ng/mL

OBJETIVO: Evaluar la utilidad del cociente formado por el complejo PSA:alfa1 -antiquimotripsina (PSA: alfa1 -ACT) y el PSA total (cociente C/T) en el diagnóstico del cáncer de próstata (CaP), en el rango de PSA total entre 4 y 10 ng/ml. MATERIAL Y MÉTODOS: Utilizando ELISAs específicos de desarrollo propio, determinamos las concentraciones plasmáticas de PSA total y del complejo PSA: alfa1 -ACT en 300 pacientes con PSA total entre 4 y 10 ng/ml, antes de cualquier tipo de manipulación o tratamiento que pudiera interferir en los niveles de PSA. RESULTADOS: Tras biopsia prostática, 85 pacientes fueron diagnosticados de CaP (28,2 por ciento) y 215 de HBP (71,7 por ciento). Aunque el valor de la mediana del PSA total fue similar en los pacientes con CaP (6,0 ng/ml) y con HBP (6,1 ng/ml), el grupo con CaP tenía los niveles del complejo PSA: alfa1 ACT (5,0 ng/ml) y del cociente C/T (0,86) significativamente más elevados, que el grupo con HBP (4,2 ng/ml y 0,70, respectivamente). De estos 3 parámetros, el cociente C/T mostró la mayor área bajo la curva ROC (ABC) (0,884), frente a la del PSA total (0,490) y PSA: alfa1 ACT (0,696) (p 0,62 se podía haber evitado la biopsia a un 27 por ciento de los pacientes con HBP, sin dejar de diagnosticar ningún CaP (sensibilidad 100 por ciento). Subiendo el valor de corte a 0,68 la especificidad se eleva al 47 por ciento con una sensibilidad del 95,2 por ciento. Los valores de corte, la sensibilidad, especificidad y ABC del cociente C/T no se influenciaron por los hallazgos del tacto rectal, ya que no sufrieron prácticamente ninguna variación cuando se consideraron los pacientes en los que la sospecha clínica del CaP estaba motivada, exclusivamente, por unos niveles de PSA total entre 4 y 10 ng/ml. CONCLUSIONES: Nuestros resultados confirman que el cociente C/T mejora el rendimiento diagnóstico del PSA total en el rango entre 4 y 10 ng/ml. Además, la elección de los valores de corte del cociente C/T sugestivos de CaP, así como su eficacia diagnóstica, son independientes de los hallazgos del tacto rectal (AU)

[Ruptures of double-J ureteral catheter. Our experience and review of the literature]. / Roturas de catéter ureteral doble-J. Nuestra experiencia y revisión de la literatura.

Ureteral double-J stents are currently being used widely in numerous urologic indications. Side effects are infrequent and usually related to the act of insertion per se. Complications with long-term indwelling stents are mainly due to stent incrustation and more rarely to spontaneous breakage. We report 3 cases of stent multiple fragmentation after and indwelling period superior to 22 months without evidence of stent incrustation. We reviewed the literature and analyzed the different etiologic factors that are thought to be involved. We believe that radiologic control post-insertion and stent substitution after an indwelling period of three months are mandatory.

[Extracorporeal shock-wave lithotripsy in the treatment of calculi in horseshoe kidneys. Our experience]. / Litotricia extracorpórea por ondas de choque en el tratamiento de la litiasis en riñones en herradura. Nuestra experiencia.

Thirty-one (31 renal units (RU) were treated with extracorporeal shock wave lithotrity (ESWL) in 27 patients with lithiasis in horseshoe kidneys (HK). Treatment was done in an out-patients environment and in two thirds of cases the patient was placed in prone-decubitus. An average of 2.42 sessions per patient (range 1-8) were performed freeing 15 RU, 10 with removable residues, and failure in 6:3 with non-removable residues in all asymptomatic cases, 2 where fragmentation was insufficient and 1 renal annulment post-ESWL. Overall, results were "good" in 80.6% cases, with a significant relationship between size of lithiasis and therapeutical results. Thus, for < or = 2 cm calculi the result was good in 100% cases but a greater number of cleaning were required in those < 1 cm (62.5 vs 46.15%). On the contrary, "therapeutic failures" were limited to just > 2 cm calculi. It can therefore be concluded that most patients with lithiasis in HK, specifically when calculi are < 2 cm, can be treated primarily and in monotherapy with ESWL.

[Subcutaneous metastasis as the first manifestation of kidney cancer dissemination]. / Metástasis subcutáneas como primera manifestación de la diseminación del cáncer renal.

Presentation of an uncommon form of distant primary dissemination of renal adenocarcinoma (RA) 5 years after radical surgery, the subcutaneous metastasis. The patient underwent surgical resection of metastasis, and later developed early pulmonary, mediastinal and new skin metastasis. A review is made of the incidence, therapeutical approach and prognostic value of skin metastasis due to RA.

[Treatment of benign prostatic hyperplasia with finasteride. Results after 7 years of follow-up]. / Tratamiento de la hiperplasia benigna de próstata con Finasteride. Resultados a los siete años de seguimiento.

Our centre took part in an international, multicentre, Phase III trial with Finasteride (MK-906) in the treatment of BPH. In the first year, this was a double-blind, randomised, placebo-controlled study which included 25 patients who were randomly assigned: 9 to treatment with placebo, 8 to finasteride 1 mg and 8 to finasteride 5 mg. After the first year, all patients were assigned to finasteride 5 mg as a single daily dose taken before breakfast. Of the 25 patients who started the trial, 7 have completed 7 years treatment (28%): 1 from the placebo group. 1 from finasteride 1 mg, and 5 who took finasteride 5 mg throughout the study. Total symptoms score, assessed by the modified Boyarsky questionnaire, improved during the first year 4.97 points (51%) and remained unchanged up to year 7 with a final reduction of 6.2 points (64%). Percentual increase in peak urinary flow during follow-up ranged between 21 and 45.9% with an absolute increase at 7 years of 4.2 mL/seg (47.5%) and a reduction in prostate volume of 26%. Finasteride tolerance was excellent at all times, and no serious clinical reaction was seen in laboratory parameters. Two patients reported decreased libido and sexual potency and 1 decreased libido. In summary, since after 7 years of treatment efficacy is maintained in at least 30% of patients with an excellent safety profile, finasteride can be considered an alternative in the medical treatment of BPH.

[Factors influencing variability of PSA blood concentration in patients with prostate benign hyperplasia]. / Factores que influyen en la variabilidad de la concentración sérica de PSA en pacientes con hiperplasia benigna de próstata.

Study conducted in 107 patients with prostate benign hyperplasia to establish the influence that prostate volume, age, sexual activity, extent of obstruction and presence of urethral catheter have on PSA serum levels, using a linear regression model. In simple linear regression studies, a good correlation was seen between PSA serum concentration and prostate volume calculated by transrectal ultrasound (r = 0.57), which decreases when age in used as an independent variable (r = 0.40). In multiple linear regression studies where all the variables are included, correlation increases slightly (r = 0.60), and only prostate volume and sexual activity are significant. Prostate volume in the single most influential factor on PSA levels in prostate benign hypertrophy although it is not the only parameter to be taken into account in serum level variations of this marker. Age influence can be secondary to other factors such as sexual activity.

[Bladder bilharziosis]. / Bilharziosis vesical.

OBJECTIVES: We report two cases of urinary schistosomiasis that had been diagnosed and treated during the early stages of the disease. These cases are presented to provide further insight into this disease, which is uncommon in our setting. METHODS/RESULTS: The presenting features, diagnostic methods and the treatment currently available are discussed. CONCLUSIONS: Urinary bilharziasis is a parasitic disease caused by Schistosoma haematobium that may involve the entire urogenital tract. Schistosomiasis causes important lesions in the early stages and complications in the long term if treatment is not instituted early. Although it is uncommon in our area, it must be suspected in patients with GU dysfunction, particularly in those presenting with hematuria and/or have traveled to countries where this disease is endemic.

[Verrucous carcinoma of the penis]. / Carcinoma verrucoso de pene.

Verrucous carcinoma includes approximately 5% of all neoplasias of the penis and is a tumoral variety of benign behaviour and differentiated histology. Our 10-case experience of penial verrucous carcinoma is reported here. In nearly all cases, partial penectomy was the definitive approach. No dissemination, locorregional or distant, was found in any of the report cases. Since prognosis of these tumours is good, we see no justification in performing lymphadenectomy, although it is advisable to adopt and expectant attitude when faced to inguinal adenopathies.

[Burned-out testicular tumor]. / Tumor testicular fundido.

Burned-out testicular tumour is an uncommon entity defined by the spontaneous regression of the testicular tumoral site after spread to metastasis, leaving behind a scarring lesion with typical histological changes. This paper reports one case of burned-out testicular tumour diagnosed and treated initially as an embryonic carcinoma with areas of extragonadal malignant immature teratoma that after nine years of follow-up reveals the primary testicular site. Physical examination and detailed ultrasound study of the testes is of the greatest significance in stem cells tumours with extragonadal location, given the prospect of identifying the primary testicular lesion as a burned-out tumoral site and performing radical treatment of these tumours.

[Treatment of prostatic benign hyperplasia with endoscopically controlled laser fiber]. / Tratamiento de la hiperplasia benigna de próstata con fibra de láser bajo control endoscópico.

Between October 1992 and February 1993, 12 patients with benign prostate hyperplasia (BPH) were treated with Neodymium-YAG laser through an endoscopically-guided right angle fibre, and follow-up is now over 1 year. Follow-up consisted in the symptomatic assessment using I-PSS questionnaires, vesicoprostate ultrasound with flowmetry and residue measurement and urethrocystometry at least every 3 months. Mean time for suprapubic catheter withdrawal was 23.4 days (range 9-34), and one patient did not resumed micturition spontaneously. Symptomatology improved after the first month. remaining stable after 6 months, with a mean score decrease at one year of 11,2 (p < 0,001). All flowmetry parameters improved although only peak and mid-stream flow showed statistical differences, peak flow increasing at one year by an average of 5,9 ml/sec (P < 0,001). In 4 of the 12 patients surgery was performed; 1 underwent early surgery due to absence of spontaneous micturition and was excluded from the results assessment, and 3 due to persistence of symptomatology at 16, 18 and 21 months post-laser. In spite of the advantages presented by the laser when compared to conventional surgical approaches, such as short time application, absence of haemorrhage and likely used in an ambulatory setting, the major initial irritative symptomatology and the need for a suprapubic catheter during at least three weeks, are in general poorly tolerated and limit its use. The apparent improvement in symptomatology after one month is not accompanied by objective changes in flowmetry, since in our series only 1 patient presented Qmax greater than 15 ml/sec with no residues. Therefore, we consider that treatment with endoscopically-guided laser fibre in BPH has, with the technology currently available. a very limited use.

[Extracorporeal shockwave lithotripsy in single kidneys. Our experience]. / Litotricia extracorpórea por ondas de choque en monorrenos. Nuestra experiencia.

Forty patients with renal lithiasis in single kidney were treated with extracorporeal shock wave lithotrity in our unit. Nine patients required emergency urinary by-pass, because of original picture of obstructive anuria, and in another 21 cases a double-J catheterism was conducted as prophylaxis prior to lithotrity. Treatment was carried out with analgesia and ambulatory, except for 10 patients with calculi of less than 10 mm where by-pass was not performed, and who were kept in preventive hospitalization for 24 hours. Average of sessions per patients was 1.59 (range 1-7). After 6 months follow-up there are 24 free renal units (60%), 12 (30%) with debris that can be expelled, failure in 4 (10%): 2 with debris that can be expelled and 2 which were not fragmented. Renal function has not deteriorated during follow-up, except for 2 patients with obstructive uropathy, that subsequently normalized following resolution of the condition. No significant differences were found in the treatment of calculi of less than 10 mm with or without double-J. ESWL is considered to be the choice approach for lithiasis in patients with one single kidney, due to is efficacy and low morbidity, safety in the ambulatory environment, even for calculi of less than 10 mm with no urinary by-pass.

[Diverticulum of the female urethra. Review of the literature]. / Divertículo de uretra femenina. Revisión de la literatura.

Presentation of nine cases of diverticulum of the female urethra, and assessment of their specific features both clinical and diagnostic, as well as the surgical techniques used in their management. Review of the literature with regard to incidence, etiopathogeny and presentation of this condition. Analysis of the different diagnostic procedures available to show the presence of an urethral diverticulum and the various management options currently used in their resolution.

[Perirenal abscess following lithotripsy]. / Absceso perirrenal post-litotricia.

Presentation of one case of perirenal abscess secondary to lithotrity on a calcified cyst simulating a pyelic lithiasis. A pathogenic hypothesis and the importance of urography in the confirmation diagnosis of the lithiasic disease is raised.

[Extracorporeal shock-wave lithotripsy in polycystic kidneys]. / Litotricia extracorporea por ondas de choque en riñones poliquísticos.

Presentation of 6 cases (8 renal units) of lithiasis in polycystic kidneys treated with extracorporeal shockwave lithotrity (ESWL). One patient required puncture of a compressing cyst, prior to ESWL, to facilitate the stones removal. No complications were seen in any of the cases. Therefore, stones in polycystic kidneys can be safely and effectively treated by ESWL.