Tumor renal neuroectodérmico. A propósito de un caso tratado en nuestra unidad. Revisión de la literatura / Neuroectodermic renal tumor. Case report and bibliographic review

Se presenta el caso de una adolescente de 16 años de edad a la que practicamos nefrectomia radical izquierda por un tumor neuroectodérmico renal de 13,2 cm y tratada posteriormente mediante quimioterapia y radioterapia en los Hospitales Quirón de Madrid y Complejo Hospitalario de Toledo, con una supervivencia actual de 14 meses. Se revisa la literatura médica en los aspectos históricos, clínicos, etiopatogénicos, diagnósticos, pronósticos, terapéuticos y de supervivencia. Se realiza una estimación de la cantidad de casos publicados hasta la fecha. Abordamos además con una visión descriptiva y crítica el tratamiento realizado y su resultado

We report the case of a 16 year old female who underwent left radical nephrectomy for a 13,2 cm neuroectodermic renal tumor and posterior chemo and radiotherapy in the Quiron Hospitals in Madrid and Complejo Hospitalario de Toledo, with a current survival of 14 months. Medical literature was reviewed for the historical, clinical, etiopathogenic, diagnostic, prognostic, therapeutic and survival features. We estimate the number of published cases to date. We also address the treatment performed and its results under a critical view

[Neuroectodermic renal tumor. Case report and bibliographic review.] / Tumor renal neuroectodérmico. A propósito de un caso tratado en nuestra unidad. Revisión de la literatura.

We report the case of a 16 year old female who underwent left radical nephrectomy for a 13.2 cm neuroectodermic renal tumor and posterior chemo and radiotherapy in the Quiron Hospitals in Madrid and Complejo Hospitalario de Toledo, with a current survival of 14 months. Medical literature was reviewed for the historical, clinical, etiopathogenic, diagnostic, prognostic, therapeutic and survival features. We estimate the number of published cases to date. We also address the treatment performed and its results under a critical view.

Se presenta el caso de una adolescente de 16 años de edad a la que practicamos nefrectomia radical izquierda por un tumor neuroectodérmico renal de 13,2 cm y tratada posteriormente mediante quimioterapia y radioterapia en los Hospitales Quirón de Madrid y Complejo Hospitalario de Toledo, con una supervivencia actual de 14 meses. Se revisa la literatura médica en los aspectos históricos, clínicos, etiopatogénicos, diagnósticos, pronósticos, terapéuticos y de supervivencia. Se realiza una estimación de la cantidad de casos publicados hasta la fecha. Abordamos además con una visión descriptiva y crítica el tratamiento realizado y su resultado.

Tratamiento de la litiasis en niños durante 30 años en la Unidad de Litotricia y Endourología del 'Hospital La Luz'. Retrospectiva comentada de nuestra casuística / Treatment of pediatric lithiasis in the lithotripsy and endourology unit of 'Hospital La Luz'. Commented retrospective of our case series

OBJETIVO: En el presente artículo se revisa y resume nuestro quehacer en el tratamiento de niños con urolitiasis en estos 30 años y se realiza un análisis en base a los resultados y aspectos de interés de acuerdo con la experiencia nacional e internacional. MÉTODO: Estudio estadístico descriptivo restropectivo en los 30 años de nuestra unidad en los que hemos asumido el tratamiento de 178 niños aquejados de urolitiasis en los que se han realizado 221 intervenciones, incluidas Litotricias por Ondas de Choque, Ureterorrenoscopia y Nefrolitectomía Percutánea. CONCLUSIONES: De la experiencia acumulada podríamos concluir que la ESWL en niños en nuestro medio es la primera elección en litiasis renal y de uréter proximal y medio, y que aquellas de 2 a 3cm son susceptibles de ser tratadas exitosamente sin maniobras complementarias o tratamientos mixtos exceptuando las litiasis de cistina que es la que ofreció mayores problemas de fragmentación. Así mismo, la utilización de catéteres doble J aumenta la demanda de ESWL por calcificaciones del mismo e imposibilidad de extracción endoscópica y deben ser valorados individualmente tanto el beneficio de su colocación como la expectativa temporal de permanencia. La URS para nosotros es la elección en litiasis de uréter bajo y en algunos casos uréter medio y proximal, permitiendo tratamientos simultáneos, como la dilatación ureteral, o diagnósticos insospechados. Concretamente el ureteroscopio rígido permite alternativas terapéuticas coadyuvantes a la ESWL con alto poder resolutivo y de maniobrabilidad. En cuanto a la URS flexible creemos que nuestros buenos resultados con la ESWL y la URS rígida, incluso combinadas, y por ende también el balance coste-beneficio, han influido en su menor empleo para litiasis renales. En unidades de ámbito general como la nuestra la NLP combinada en niños ha tenido indicación en casos complejos excepcionales y la cirugía abierta o laparos- @ cópica no fue imperativa en ningún caso

OBJECTIVE: The aim of the present article is to summarize the results we obtained treating children with urolithiasis over the last 30 years and to perform an analysis on the basis of the these results and relevant details according to national and international experience. METHODS: Retrospective and descriptive statistical analysis of the 30 year experience in our clinics. The study was performed with a sample size of 178 children treated with urolithiasis that underwent 221 procedures. These procedures include ESWL, ureterorenoscopy (URS) and percutaneous nephrolithotomy (PCNL). CONCLUSIONS: We conclude in this study that ESWL in children was the most appropriate procedure for renal and proximal and middle-third ureteral lithiasis. Kidney stones measuring 2 to 3 cm can be treated without additional procedures or combined approaches. In contrast cystine stones caused the major problems for fragmentation. Moreover, the use of double J catheters increased the need for ESWL when catheter calcification occurred and endoscopic removal was impossible. The benefits of this method must be individually assessed both for the benefit of the temporary placement as well as for the expectation of permanence. We conclude that URS is the best choice for distal-third ureteral lithiasis and some cases of proximal and middle-third ureteral lithiasis. This enables for simultaneous treatments, ureteral dilatation and unexpected diagnoses. In particular, rigid ureteroscopy offers adjuvant options to ESWL with great therapeutic potential and easy handling. In consequence, to our good results and cost-benefit balance using ESWL and rigid URS (even combined), the use of flexible URS for renal lithiasis has been reduced. In general community units like ours, the combined PCNL has been indicated for particular complex cases, and open or laparoscopic surgery was not necessary in any case

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.

Valoración del significado de la radiodensidad y el tamaño litiásico en la incidencia y clínica de los hematomas renales / Evaluation of the significance of radiographic density and size of calculi in the incidence and clinical manifestations of postlithotripsy renal hematomas

OBJETIVO: El presente estudio se deriva de un primer artículo recientemente publicado sobre la incidencia, clínica, terapéutica y factores de riesgo asociados a los hematomas renales postlitotricia (1).Valorar la posible influencia del tamaño litiásico y su radiodensidad en la incidencia y comportamiento clínico de los hematomas renales postlitotricia.MÉTODO: Estudio prospectivo observacional en 324 unidades renales de pacientes sometidos a igual número de sesiones de litotricia renal extracorpórea en el que se evalúan estadísticamente mediante el paquete informático IPSS 0.15 las variables “tamaño litiásico” y “radiodensidad litiásica”en base a los 42 hematomas postlitotricia diagnósticados y agrupados según su comportamiento clínico.RESULTADOS: Se constató mayor incidencia de hematomas dentro de los cálculos hiperdensos (25%) en comparación con el grupo de pacientes con litiasis de densidad media o “normodensos” (7,4%) dicha diferencia básicamente se produjo a expensas del grupo de hematomas asintomáticos (16,1% hematomas en litiasis hiperdensas vs 3,1% en “normodensos”).CONCLUSIONES: El tamaño de la litiasis no implicó una mayor incidencia de hematomas renales y sí hubo asociación significativa entre estos y la radiodensidad del calculo, probablemente por su relación con la composición química y por ende con su dureza o ultraestructura, siendo este último un factor más, entre otros, a tener en cuenta como condicionante de dicha complicación(AU)

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 evaluated 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(AU)

[Renal hematoma after extracorporeal shockwave lithotripsy in a series of 324 consecutive sessions with the DOLI-S lithotripter: incidents, characteristrics, multifactorial analysis and review]. / Hematomas renales postlitotricia extracorpórea en 324 sesiones consecutivas con el litotritor DOLI-S: incidencia, características, análisis multifactorial y revisión.

OBJECTIVES: The objective is to know the prevalence of renal hematoma after lithotripsy in our unit, as well as the incidence of symptomatic and/or progressive hematomas, their clinical behavior and management, and also the factors potentially influencing those features. METHODS: A prospective study in which we analyzed various parameters from the database on 314 patients undergoing SWL on 324 renal units. SPSS 15.01 was employed for statistical analysis under supervision of biostatistics experts. The diagnosis of hematoma was obtained with clinical data (history and physical examination), blood analysis, and ultrasound, this latter with the complement of CT scan in isolated cases. All patients underwent follow-up by means of phone contacts over a period between 7-19 months after lithotripsy. RESULTS: The prevalence of hematoma was 13% but only 6.2% were symptomatic. Accumulated incidence of hematoma with progressive evolution was 2.16%, and blood transfusion requirement due to hematoma was 0.92% of all lithotripsies, which represents 7.14% or them. Factors statistically associated with the incidence of hematoma were: number of shock waves (over 2300), total energy (above 150J), number of KV (above 17.5), preoperative microhematuria, perioperative hypertension, cystine lithiasis, hydrocalyx, caliceal localizations (mainly lower calyces), the association of coronary artery disease with hypertension, or hepatic diseases, chronic hepatopathy, elevation of transaminases, usual intake of anti platelet aggregation drugs and nonsteroidal anti-inflammatory drugs (mainly with prior low-weight heparin treatment for hematoma progression), and a combination of the previous with preoperative hypertension (for symptomatic hematoma), as well as the presence of multiple stones treated in the some session, with different degrees of association for the various subgroups of hematomas. We observed differences in clinical behavior depending on the type of hematoma (subcapsular and perirenal) and 12% of the patients with hematoma remained symptomatic between 2 and six months later. CONCLUSIONS: Renal hematoma after shock wave lithotripsy is more frequent than what is believed. Hematoma's size and evolution depend on multiple factors some of them with a greater weight (hepatopathy, perioperative blood pressure behavior, usual intake of anti-aggregation drugs with need of perioperative low weight heparin) which a greater risk when three or more factors concurred. Subcapsular and perirenal hematomas have a different clinical behavior. Initial ultrasound hematoma diameters equal 24 cm were more prone to progression. The risk of symptomatic clinical presentation or progression was evident within the first five days after shockwave lithotripsy even when asymptomatic or clinically/radiologically stable over the first 24 hours, therefore, careful follow-up and physical resting is counselled over the first week in patients with high risk, and relative physical resting during at least five days in all patients undergoing treatment. Lumbar pain may persist up to six months in some patients with renal clinically significant hematoma after shockwave lithotripsy.

[Recurrent urinary tract infection in a patient with sacral agenesis and vertebral-lumbar dysraphism. Diagnostic-therapeutic scheme and clinical outcome]. / Infección urinaria recurrente en un caso de agenesia del sacro y disrafia vertebrolumbar. Conducta diagnósticoterapéutica y evolución clínica.

OBJECTIVE: To present and analyze one case of sacral agenesis with distal lumbar vertebral dysraphism, and to highlight the most relevant elements found in a bibliographic search. METHODS: We describe the clinical characteristics of an adult patient with sacral agenesis, the diagnostic-therapeutic urological management and her outcome over four years of follow-up. A bibliographic search was also performed including review of all articles published over the last 16 years; we briefly include the most relevant elements. CONCLUSIONS: Sacral agenesis, as a local regional expression of "caudal regression syndrome" almost invariably produces functional involvement of the bladder and recurrent urinary tract infection, although the evolution may be benign like present case. This does not exempt from the unavoidable need of proper initial morphological-functional diagnosis, periodic follow-up and treatment.

Infección urinaria recurrente en un caso de agenesia del sacro y disrafia vertebrolumbar. Conducta diagnosticoterapéutica y evolución clínica / Recurrent urinary tract infection in a patient with sacral agenesis and vertebral-lumbar dysraphism. Diagnostic-therapeutic scheme and clinical outcome

Objetivo: Presentación y análisis de un caso de agenesia del sacro con bifidez vertebrolumbar distal y reseñar los elementos mas relevantes encontrados en la revisión bibliográfica efectuada. Método/Resultados: Se describen las características clínicas de una paciente adulta con agenesia sacra, su manejo urológico diagnósticoterapéutico y evolución durante cuatro años de seguimiento, así mismo, se realiza búsqueda informática de artículos publicados en los últimos 16 años para su revisión, exponiéndose brevemente los elementos mas destacables. Conclusiones: La agenesia del sacro, como expresión locoregional del «Síndrome de regresión caudal» produce, casi invariablemente, afectación funcional vesical e infección urinaria recurrente, no obstante, como en nuestra paciente, la evolución puede ser benigna, lo que no exime la necesidad ineludible de un correcto diagnóstico morfofuncional inicial, el control periódico y su tratamiento consecuente (AU)

Objective: To present and analyze one case of sacral agenesis with distal lumbar vertebral dysraphism, and to highlight the most relevant elements found in a bibliographic search. Methods: We describe the clinical characteristics of an adult patient with sacral agenesis, the diagnostic-therapeutic urological management and her outcome over four years of follow-up. A bibliographic search was also performed including review of all articles published over the last 16 years; we briefly include the most relevant elements. Conclusions: Sacral agenesis, as a local regional expression of «caudal regression syndrome» almost invariably produces functional involvement of the bladder and recurrent urinary tract infection, although the evolution may be benign like present case. This does not exempt from the unavoidable need of proper initial morphological-functional diagnosis, periodic follow-up and treatment (AU)