[Pulsed dye laser vs EKL-Compact lithotriptor in the treatment of distal ureteral lithiasis]. / Láser pulsado de colorante vs litotritor EKL-Compact en el tratamiento litofragmentador de la litiasis ureteral distal.

OBJECTIVES: Our results in the treatment of distal ureteral calculus with pulsed dye lasertripsy (Pulsolith) and the EKL-Compact (Olympus) electrokinetic lithotriptor are analyzed. METHODS: The time interval compared was 12 months for both cases; lasertripsy was utilized in 57 and electrokinetic energy in 61 cases. All patients underwent IVP or radiological and/or US evaluation of the urinary tree to determine the size and location of the calculus, and a complete routine presurgical assessment. Epidural anesthesia was administered in all patients, as well as prophylactic antibiotics. The approach and endoscopic technique using the 7.9-9.8 FR ureteroscopes (Olympus), stone removal with long forceps and ureteral dilatation with the Uromat hydraulic pump are described. All but 9 patients had a 5 FR catheter indwelling for 24 hours to avoid the postureteroscopy colic pain caused by perilithiasic ureteral edema. RESULTS: Our success rate was 93% for both modalities of stone fragmentation. Fragmentation with ultrasound was required in 4 cases of failed lasertripsy and 3 cases of failed lithotripsy with electrokinetic energy. There were 7 cases with mucosal laceration from ureteroscope insertion and punctate mechanical perforation of the ureteral mucosa produced by the laser fiber. There were no complications with the use of EKL-C except for small areas of petechiae. CONCLUSION: Analysis of our results for both treatment modalities, as well as their advantages and disadvantages, showed stone fragmentation with the EKL-C to be the treatment of choice. We have utilized this system in our unit since December 1994 because of its efficacy. Furthermore, it is easy to use, to transport inside and outside the hospital, easy to assemble and low-cost.

[The use of the EKL-COMPACT lithotriptor in the endoscopic treatment of ureteral lithiasis]. / Uso del litotritor EKL-COMPACT en el tratamiento endoscópico de la litiasis ureteral.

OBJECTIVE: To report on our experience with the EKL-Compact (Olympus) lithotriptor in the treatment of ureteral calculi. METHODS/RESULTS: From December, 1994 to December, 1995, we performed 192 ureteroscopy procedures for endoscopic treatment of ureteral calculi. Stone removal was achieved without necessitating fragmentation in 131 cases. In the remaining cases, stone fragmentation with the EKL-Compact (Olympus) electrokinetic lithotriptor achieved a 95% success rate. CONCLUSION: We have achieved a high success rate with the EKL-Compact lithotriptor. Its components are easily assembled, which facilitates sterilization and storage. It is compact and easily transportable.

[Triple ureter with inverted ureteral branch in "y" with ectopic ending and calculi inside]. / Triple uréter con rama ureteral en "y" invertida con desembocadura ectópica y litiasis en su interior.

OBJECTIVE: To report an uncommon case of ureteral duplication with a single intramural trajectory and a third ureter arising from the medial ureter, corresponding to the inferior pyelon, opening at the level of the bladder neck and containing a calculus measuring 10 mm along its longest axis, lodged in a saccular dilatation. The etiopathogenesis of this rare anomaly is briefly reviewed and discussed. METHODS/RESULTS: Diagnosis was established endoscopically and pyelographically. Endoscopic resolution was not possible, but stone removal was successfully achieved by conventional surgery using the least invasive approach possible. The patient is asymptomatic 24 months postoperatively. CONCLUSION: Although infrequent, this condition should be suspected in those "unclear' cases seen in day-to-day urological practice. Symptoms of the associated pathology are more common than those arising from the anomaly. Treatment should be specific to each case, as least invasive as possible and should aim at symptomatic resolution.

[Acute abdomen of urologic origin]. / Abdomen agudo de origen urológico.

Presentation of one case of bladder carcinoma which caused acute abdomen following spontaneous perforation. This presentation is extremely rare and should be taken into account when haematuria and abdominal pain appear simultaneously.

[Treatment of ureteral lithiasis with laser]. / Tratamiento de la litiasis ureteral con láser.

We present our experience in the treatment of ureteral lithiasis with pulsed dye lasertripsy (Pulsolith)**. Evaluation of the results achieved in 67 cases of lithiasis that had been treated from January, 1990 to March, 1991 revealed a success rate of 93%. The remaining cases required the use of other complementary energy to achieve stone fragmentation. The approach, the endoscopic technique using the Olympus ureteroscopes (7.2F-9F) and complementary maneuvers are described. The complications were minimal. We consider this to be the procedure of choice for calculi in the pelvic ureter. Furthermore, we discuss the cost/benefit of this therapeutic option within the context of a lithotripsy unit with a high endoscopic dedication and the possibility of using fine caliber ureteroscopes (Olympus) as well as other options for stone fragmentation (shock wave, ultrasound and electrohydraulic energy).

[Treatment of benign prostatic hypertrophy using transurethral thermotherapy. Initial experience]. / Tratamiento de la hipertrofia benigna prostática (HBP) con termoterapia transuretral. Experiencia inicial.

One hundred patients with benign prostatic hypertrophy have been treated from July 22, 1990 to April 3, 1991 (86 had been treated between July 22, 1990 and February 27, 1991) at the Department of Urology of Clínica La Luz. Measurement of residual urine with a catheter, maximum flow and index, and nocturnal frequency and urgency were determined in all patients. Patient subjective evaluation post-thermotherapy used a score from 0 to 10. Patients with improvement of 4 parameters were classed as excellent, with 3 as good, 2 fair, and 1 or 0 as poor. Of the overall patient group, 62 were evaluable. Of these, excellent or good results were achieved in 39 out of 62 patients (63%), fair in 8 patients (13%), and poor in 15 (24%). Of these 62 patients, if we exclude those with a catheter before treatment, high residual volume, middle lobe, had undergone previous urethral endoscopic surgery, or with prostates larger than 45 mm. longitudinal diameter on the ultrasound, we are left with a group of 25 patients. In this patient group excellent and good results were achieved in 21 of 25 patients (84%) and fair in 16%. We had no poor results.(ABSTRACT TRUNCATED AT 250 WORDS)

[Inverted papilloma of the ureter. Unusual presentation and review of the literature]. / Papiloma invertido de uréter. Presentación excepcional y revisión de la literatura.

A case of inverted papilloma localized in the left pelvic ureter is described. The patient was submitted to a URS procedure with excisional biopsy of the tumor and fulguration of its base using the electric ureteral resectoscope. We believe that currently available endourologic techniques are the procedure of choice in the diagnosis of upper GU tract filling defects. An endourologic procedure permits conservative treatment when indicated and direct vision of the tumor site and urothelial mucosa.

[Treatment of kidney lithiasis with extracorporeal shockwave lithotripsy in horseshoe kidney]. / Tratamiento de la litiasis renal con litotricia extracorpórea por ondas de choque en el riñón en herradura.

Following a brief overview of the general features of the horseshoe kidney, we report on ten patients diagnosed as having this anomaly and renal calculi. One patient had bilateral renal calculi. The clinical cases are described and treatment with extracorporeal shock wave lithotripsy (ESWL1) and its advantages and disadvantages relative to other treatment modalities (PCN, open surgery) are discussed. Although we do not advocate the use of a single therapeutic approach, our results show the usefulness of ESWL1 in the treatment of this frequently recurring condition.

Ureteromat. Method to facilitate ureterorenoscopy and avoid dilatation.

The history of rigid ureterorenoscopy and the development of the Ureteromat are briefly described. The technical principles of the Ureteromat, the technique for its use, and the basic principles for performing ureterorenoscopy aided by this irrigation system are described. In our experience, the average operating time diminished from 66 to 22 minutes with the Ureteromat, severe complications dropped from 4 to 0.9 per cent, and the success rate for calculi in the ureter increased from 72 to 98 per cent. Furthermore, the Ureteromat facilitates other procedures (flexible ureteroscopy and flexible percutaneous nephrolithotomy). No complications ascribable to the Ureteromat were observed.

Hydraulic hemostasis in transurethral resection of the prostate using the Iglesias continuous suction resectoscope.

An intravesicoprostatic hydrostatic pressure less than 10 mm. Hg maintains normal anatomy and physiology of the muscular and vascular prostatic structures. An increase in hydrostatic intravesicoprostatic pressure to more than 10mm. Hg produces a distortion in the musculature of the prostate, especially at the true capsule, opening the cut vessels and making possible the absorption of the irrigant free of electrolytes (transurethral resection syndrome). A low hydrostatic intravesicoprostatic pressure permits the compression of cut vessels by the inflow hydraulic pressure of 90 cm. water, achieving hydraulic hemostasis during transurethral resection of the prostate. Less electrocoagulation is necessary, resulting in more rapid patient recovery.