Analysis of prognostic factors of failure in perineal urethrostomy.

PURPOSE: To identify prognostic factors of failure in patients undergoing perineal urethrostomy (PU) with Blandy technique, with inverted U-shaped perineal flap. METHODS: This is a retrospective study of PU of non-oncological causes (2001-2017). Data of age, BMI, history of diabetes mellitus, etiology of urethral stricture, type of stricture, previous surgeries, dilatation and suprapubic catheter were collected. Failure was defined as the need for any instrumentation after surgery. Variables were analyzed by Cox regression and Kaplan-Meier curves were used for survival analysis. RESULTS: A total of 115 PU were performed. Median age was 61 years (IQR 53-68) and BMI 27.9 (IQR 25-30.9). The most frequent etiologies were: lichen sclerosus (30.4%), iatrogenic (27%), and idiopathic (25.7%). 62.6% had panurethral stricture. There were no complications in 73%. Clavien I complications occurred in 25.2%, Clavien II in 0.9% and Clavien IVa in 0.9%. The overall success rate was 51.3% with a median follow-up of 71 months. In the last 8 years, it was 75%. In the multivariate analysis, we found that age (p = 0.01), BMI (p = 0.01), date of surgery (p = 0.01), and suprapubic catheter (p = 0.003) were predictive variables. The voiding satisfaction rate was 88.7%. CONCLUSIONS: PU with Blandy technique is a surgery with low morbidity. During the entire study period, it had a failure rate of 48.7% but the failure rate decreased to 25% over the last 8 years. Age, BMI, date of surgery and suprapubic catheter are the most important prognostic factor of failure.

Laparoscopic kidney transplantation.

We present the details of the first laparoscopic transplantation of a kidney from a living, related donor, performed April 16, 2009. Surgical and functional results were acceptable. Surgical time was 240 min (53 min for vascular suture), with blood loss of 300 cm(3) and a hospital stay of 14 d. Serum creatinine at discharge was 73 mmol/l. Laparoscopic kidney transplantation is a complex technique that requires previous experience in vascular and laparoscopic surgery. As with all novel procedures, technical modifications will be required to formalize its use and detailed comparisons will need to be made with standard procedures.

Traumatismo renal con urinoma / Renal traumatism with urinoma

El extravasado de orina ocurre en los traumatismos renales que interesan la vía urinaria. El mecanismo de producción del traumatismo, la clínica y la exploración física permiten limitar el diagnóstico a la región lumbar o extenderlo a otras regiones, pero la determinación de la presencia de urinoma precisa de otros métodos. La TC es la mejor prueba diagnóstica aunque en la fase inicial del traumatismo puede no demostrar fuga de contraste. En aquellos casos en que el paciente está inestable, en las lesiones penetrantes o ante una lesión vascular sangrante, debe optarse por la técnica más resolutiva

The leak out of urine occurs in renal traumatisms that affect the urinary system. The mechanism of production of the traumatism, clinic and physical exploration allow to limit the diagnosis to the lumbar region or extended it to other regions, but the determination of the presence of urinoma requires other methods. CT is the best diagnostic test although in the initial phase of the traumatism may not show leakage of contrast. In the cases where the patient is unstable, or in cases of penetrating injuries or in a vascular bleeding injury, we should adopt a more resolutive technique

Aneurisma de arteria renal / Renal artery aneurysm

No disponible

Embolization of a bleeding aneurysm in a patient with spontaneous perirenal haematoma due to Polyarteritis nodosa.

OBJECTIVE: To report a rare case of a Spontaneous perirenal haematoma due to Polyarteritis nodosa treated with a selective embolización of the bleeding aneurysm. Polyarteritis nodosa (PAN) is one of a spectrum of diseases thet belongs to the pathologic category of necrotizing vasculitis. Spontaneous perirenal haematoma (SPH) is an unusual complication of PAN. METHODS: We are introducing a patient with SPH due to PAN. RESULTS: The patient was treated with embolization of a left renal bleeding aneurysm of the upper interlobar artery. Pan is the most frequent vascular disease associated with spontaneous renal hematoma. Therefore the diagnosis may be difficult to determine. CONCLUSIONS: A selective embolization of the bleeding aneurysm is a therapeutical maneuver to be considered.

Embolization of a bleeding aneurysm in a patient with spontaneous perirenal haematoma due to polyarteritis nodosa

OBJETIVOS: Presentar un caso raro de hematoma perirenal espontáneo secundario a poliarteritis nodosa tratado mediante embolización selectiva del aneurisma sangrante. La Poliarteritis nodosa (PAN) es parte de un espectro de enfermedades que pertenece a la categoría patológica de las vasculitis necrotizantes. El hematoma perirenal espontáneo es una complicación infrecuente de la PAN. MATERIAL Y MÉTODOS: Presentamos un caso de hematoma perirenal espontáneo secundario a PAN. RESULTADOS: Se realizó embolización de un aneurisma sangrante de la arteria renal interlobar superior izquierda. La PAN es la enfermedad vascular que con mayor frecuencia se asocia con hematoma renal espontáneo. Por lo tanto, el diagnóstico puede ser difícil de establecer. CONCLUSIONES: La embolización selectiva del aneurisma sangrante es una maniobra terapéutica a considerar

Objective: To report a rara case of a Spontaneous parirenal haematoma due to Polyarteritis nodosa treated with a selective embolization of the bleeding aneurysm. Polyarteritis nodosa (PAN) is one of a spectrum of diseases that belongs to pathologic category of necrotizing vasculitis. Spontaneous perirenal haematoma (SPH) is an usual complication of PAN. METHODS: We are introducing a patient with SPH due to PAN. RESULTS: The patients was treated with embolization of a left bleeding aneurysm of the upper interlobar artery. Pan is the most frequent vascular disease associated with spontaneous renal hematoma. Therefore the diagnosis may be difficult to determine. CONCLUSIONS: A selective embolization of the bleeding aneurysm is a therapeutical maneuver to be considered

Tumor renal espúreo: nefronía lobar aguda (NLA) / Spurious renal tumor: acute lobar nephronia

OBJETIVO: Presentar un caso de una forma poco común de infección renal localizada, la nefronía lobar aguda (NLA), y describir, basándose en una revisión bibliográfica, sus características ecográficas y por TAC, destacando aquellos aspectos que, junto a la sintomatología permiten su diagnóstico diferencial con otras masas renales (abscesos, quistes infectados y carcinoma renal). MÉTODO: Presentamos un caso clínico de una paciente que acudió a urgencias con un cuadro compatible con pielonefritis en la que se realizó a su ingreso una ecografía, y una TAC por la detección de una masa renal, siendo orientado como NLA. Se realizó ecografía y TAC de control al mes de instaurar tratamiento antibiótico. RESULTADOS: La ecografía al ingreso mostró una masa de aspecto sólido en el polo inferior del riñón izquierdo, confirmándose por TAC dicha masa con captación periférica de contraste y una zona estriada central. La analítica de sangre y orina eran compatibles con un cuadro infeccioso renal, instaurándose tratamiento antibiótico al ser considerado un cuadro de NLA . Al mes de seguimiento tanto por ecografía como por TAC había desaparecido dicha masa, confirmando el diagnóstico. CONCLUSIÓN: Debe considerarse el diagnóstico de NLA en todo paciente en que se detecta una masa en el curso de una infección urinaria, siendo la correlación de la clínica con los hallazgos radiológicos y la respuesta al tratamiento las que permiten el diagnóstico diferencial (AU)