[Treatment of pediatric lithiasis in the lithotripsy and endourology unit of "Hospital La Luz". Commented retrospective of our case series]. / 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.

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.

Referente a "Análisis del perfil de seguridad del tratamiento con un número ampliado de ondas de choque por sesión en litotricia extracorpórea" / Refers to "Analysis of the safety profile of treatment with a large number of shock waves per session in extracorporeal lithotripsy"

No disponible

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

Objetivo: Determinar la prevalencia de los hematomas renales postlitotricia en nuestra unidad, la incidencia de los sintomáticos y/o progresivos, el comportamiento clínico, el manejo de los mismos, así como los factores potencialmente influyentes sobre dichos aspectos. Método: Estudio observacional prospectivo en el que analizamos diversos parámetros integrados en nuestra base de datos a partir de hojas recopilatorias confeccionadas en 314 pacientes sometidos a litotricia sobre 324 unidades renales en igual número de sesiones. Para el análisis estadístico se utilizó el paquete SPSS 15.0 con la asesoría de especialistas en bioestadística. Para el diagnóstico de los hematomas se utilizaron datos clínicos (interrogatorio y exploración física), hematológicos y ecográficos, estos últimos en casos aislados complementados con TAC, se realizó seguimiento mediante contacto telefónico con los pacientes durante un periodo de tiempo comprendido entre los 7 y los 19 meses después de la litotricia. Resultados: La prevalencia de hematomas fue del 13% pero sólo el 6,2 % fueron sintomáticos, la incidencia acumulada de hematomas de evolución progresiva fue de el 2,16 % y en el 0,92 % de las litotricias se requirió transfusión sanguínea a causa de los hematomas, lo que representó el 7,14% de estos. Los factores estadísticamente asociados a la incidencia de hematomas fueron el número de onda (superior a 2300), la energía total (a partir de 150J), el KV (a partir de 17,5), la microhematuria preoperatoria, la hipertensión perioperatoria, la litiasis de cistina, el hidrocáliz, la localización calicial del cálculo, (principalmente inferior), la asociación de cardiopatía isquémica con hipertensión arterial, (HTA) o hepatopatías, las hepatopatías crónicas "per se", la elevación de transaminasas, el uso habitual de antiagregantes plaquetarios y AINEs (sobre todo con pauta previa de heparina fraccionada para la progresión de los hematomas) y la combinación de estos con HTA pre-operatoria (para los hematomas síntomáticos), así como la presencia de litiasis múltiple tratadas en la misma sesión, encontrándose grados de asociación diferentes para los distintos subgrupos de hematomas establecidos. Se observó diferencias en el comportamiento clínico de los tipos de hematomas (subcapsular y perirrenal) y el 12 % de los pacientes con hematomas permanecieron sintomáticos entre 2 y 6 meses después. Conclusiones: El hematoma renal postlitotricia es mas frecuente de lo que creemos; su magnitud y evolución variables dependen de múltiples factores, algunos de los cuales tienen mayor peso específico (hepatopatías, comportamiento de la tensión arterial perioperatoria y uso habitual de fármacos antiagregantes con necesidad de heparina fraccionada perioperatoria), lo que dió lugar a pacientes con mayor riesgo de presentar hematomas cuando concurrieron 3 o mas de los factores relacionados encontrados en la presente serie. Los hematomas subcapsulares y los perirrenales difieren en su comportamiento clínico. Los hematomas con diámetros ecográficos iniciales igual o mayores de 4 cm fueron mas propensos a la progresión. El riesgo de expresión sintomática o de progresión de un hematoma se evidenció en los primeros cinco días postlitotricia aún cuando permanecieran asintomáticos o estables clínica e imagenológicamente en las primeras 24 hrs., todo lo cual aconseja un seguimiento cuidadoso y reposo físico relativo durante la primera semana en los pacientes con mayor riesgo, y considerar el reposo al menos cinco días en todos los pacientes tratados, entre otras medidas. El dolor lumbar puede persistir hasta seis meses en algunos pacientes después de padecer un hematoma postlitotricia clínicamente significativo (AU)

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 wich we analyzed various parameters from the database on 314 patients undergoing SWL on 324 renal units. SPSS 15.0l 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 2300j, 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 same 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 ≥ 4 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 (AU)

[Contact lithotripsy. Advantages and disadvantages]. / Litotricia por contacto Ventajas e inconvenientes.

OBJECTIVE: To review the different methods of contact lithotripsy by intracavitary direct contact or very close approximation of different rigid and flexible energy-transmitting devices (probes, fibers, etc.). METHODS: The systems commonly used, as well as those that have fallen into disuse or have not been developed further, are briefly described. RESULTS: Although no contact lithotripsy system is clearly superior over another, in our experience the electrokinetic system (Walz) is highly effective and simple to use. CONCLUSIONS: Contact lithotripsy permits stone disintegration and removal of fragments during the same surgical procedure. It improves the rate of completeness of stone removal and permits earlier functional recovery of the obstructed renal unit.

[Endourologic complication: endourologic resolution]. / Complicación endourológica: resolución endourológica.

OBJECTIVES: To report an uncommon endourological complication that was also resolved by endourological methods. METHODS/RESULTS: We report on a patient with a right solitary kidney, radiolucent renal stone and an indwelling double-J catheter. While removing the double-J catheter after ESWL, it broke at the level of its distal third. The proximal two thirds remaining in the ureter were successfully removed by ureteroscopy after several attempts by ureteroscopy and percutaneous nephroscopy. CONCLUSIONS: Except for special circumstances, most of the endourological complications can be resolved by an endourological procedure.

[Extracorporeal shock wave lithotripsy (ESWL) in children: our experience in 1995]. / Litotricia extracorpórea por ondas de choque (ESWL) en niños: nuestra experiencia en 1.995.

OBJECTIVES: The present study reviews our experience and analyzes the results achieved with extracorporeal shock wave lithotripsy in the treatment of urinary calculi in children. METHODS: From 1985 to 1995, 36 children, with ages ranging from 5 months to 14 years, were treated by ESWL, and in some cases by combination therapy (percutaneous nepholithectomy and/or ureteroscopy). RESULTS: Excellent results were achieved in 74.9% of the patients; of these, 52.7% were stone-free 2 to 90 days after treatment. CONCLUSIONS: Extracorporeal shock wave lithotripsy is the treatment of choice in children with urinary lithiasis, although there are some exceptions. The method of evaluation and treatment in children are the same as in the adult patients.

[Memotherm as a therapeutic device in infravesical obstruction]. / El Memotherm como medio terapéutico de la obstrucción infravesical.

OBJECTIVE: To determine the efficacy of the intraurethral mesh in the treatment of infravesical obstruction in patients at high surgical risk unamenable to other treatment modalities. METHODS: We evaluated 13 patients with obstruction and at high risk for conventional surgery (TURP) who underwent insertion of the Memotherm intraurethral prosthesis. RESULTS: The procedure was performed rapidly with scant morbidity and the patients were discharged from the hospital early. Improvement, evaluated by the IPSS-L, was referred by 84.6% of the patients at 45 weeks follow up. Post-treatment improvement was evidenced by the absence of postvoiding residual urine at ultrasound in 69.2% of the patients and improved flowmetry in 84.6% of the patients. The early post-treatment complications included hematuria with irritative symptoms (80% of the patients). The mesh prosthesis had migrated in 15%, but could be repositioned. No case required removal of the prosthesis. CONCLUSIONS: This method affords a rapid and atraumatic solution for obstructed patients at high surgical risk. The material (heat sensitive nitinol) and the design of the mesh facilitate repositioning in the few cases in whom this had been required.

[Technics of ureteral endoscopic access]. / Técnicas de acceso endoscópico ureteral.

OBJECTIVES: The present article briefly reviews the history of endoscopic access to the ureter, since visualization of the ureter was first attempted until the procedure was developed by Pérez-Castro in 1979. METHODS/RESULTS: The development of the rigid ureteroscopes, the difficulties arising from the anatomical structures during endoscopy that require ureteral dilatation, the anatomy of the juxtavesical segment of the ureter and the pathologies that may alter it, and the present and future indications of ureteral dilatation are discussed. Patient preoperative evaluation is briefly described and one of the techniques of ureteral dilatation is analyzed. Finally, a brief summary comparing the different techniques is given. CONCLUSIONS: The technique of choice for ureteral dilatation must be simple, easy to perform, low-cost and one which reduces the iatrogenic lesions and shortens the duration of hospital stay.

The use of the Dornier MPL-9000 lithotripter in the treatment of gallbladder and renal stones. Early experience.

The experience of two units (Gastroenterology and Urology) of Clínica La Luz, Madrid, in the treatment of gallbladder and renal lithiasis using the Dornier MPL-9000 lithotripter is reported herein. This lithotriptor has been utilized in the treatment of all cases of gallbladder calculi for which it is indicated and renal calculi localized high up (kidney), and in those cases that are difficult to treat with other lithotriptors such as patients with kyphoscoliosis, radiolucent calculi, elderly patients, children, etc.). During the first year the gallstone lithotripsy unit was utilized, 401 patients were referred for treatment. Of these, 180 met the criteria for patient selection. (Over 360 have been treated to date.) Sixty of these 180 patients had a single gallstone of up to 2.5 cm. These 60 patients were selected for the study since they comprised a group where the best results could be expected. The aim of studying this patient group was to evaluate the results achieved by lithotripsy and the short and medium-term outcome in this ideal group of patients. Concerning renal lithiasis, these are the first 100 cases treated with the MPL-9000 (currently over 420 have been treated). Eighty cases had a single calculus (60 caliceal and 20 pyelic), 15 had multiple calculi, and 5 had a staghorn stone. Treatment for gallbladder and renal lithiasis was exclusively by shock waves; i.e., as monotherapy with no other auxiliary procedure. The average number of shock waves used was 2,350 with a mean kV of 18 for gallbladder lithiasis.(ABSTRACT TRUNCATED AT 250 WORDS)