[Renal lithiasis, can we predict the need for retreatment in retrograde intrarenal surgery (RIRS)?] / Litiasis renales, ?podemos predecir la necesidad de retratamientos en cirugía retrógrada intrarrenal?.

OBJECTIVES: To analyze the predictive factors for retreatment in RIRS to achieve complete lithiasis resolution. METHODS: Retrospective comparative study analyzing 298 cases of RIRS performed in our center over a 3 year period. The cohort was divided in two groups: Resolution in one operation or more than one, evaluating homogeneicity for age and gender. We compared the folowing variables: Hounsfield units, body mass index (BMI), number of stones, size, (on the case of multiple stones, larger stone size), side, location in the kidney and stone biochemistry. Bivariant statistical analysis by Student's t and Chi square tests, and multivariate analysis by binary logistic regression. ROC curves were made to set cutting points for relationship between quantitative variables. RESULTS: The groups were homogeneous for both age and gender (p>0.05). 260 (87.25%) patients required one treatment only and 38 (12.75%) more than one. Among the study variables, the only one that showed differences between the groups wa stone size, being the mean size 18 mm in the single treatment group and 26 mm in the more than one treatment group (Difference between mean values -8.27, 95%CI: -5,91 - -10.63, p<0,001). CONCLUSIONS: RIRS with holmium laser is still an effective technique for the treatment of renal lithiasis. The largest stone size is related with the need of retreatments, so it must be taken into consideration specially over 2 cm. In our series, for every extra millimeter in size the probability of retreatment increased 1.14 times, demonstrating the importance of size in this context.

Litiasis renales, ¿Podemos predecir la necesidad de retratamientos en cirugía retrógrada intrarrenal? / Renal lithiasis, can we predict the need for retreatment in retrograde intrarenal surgery (RIRS)?

OBJETIVO: El objetivo de este trabajo fue analizar los factores predictivos de retratamientos para la resolución completa de la litiasis mediante cirugía retrógrada intrarrenal (CRIR). MÉTODOS: Estudio retrospectivo y analítico comparativo sobre 298 casos de CRIR realizados en nuestro centro a lo largo de 3 años. Se dividió a la muestra en dos grupos: resolución con una cirugía, o con más de una, estudiándose la homogeneidad para edad y sexo. Se compararon las siguientes variables pre e intraoperatorias entre cada grupo: Unidades Hounsfield (UHC), Índice de masa corporal (IMC), número de litiasis, tamaño de la litiasis (en caso de múltiples, tamaño mayor de la litiasis más grande), lateralidad, localización dentro del riñón, y bioquímica de la litiasis. Análisis estadístico bivariante mediante T-Student y chi-cuadrado, y multivariante mediante regresión logística binaria. Se realizaron curvas ROC para establecer puntos de corte en caso de relación con variables cuantitativas. RESULTADOS: Grupos homogéneos para edad y sexo (p > 0,05), 260 (87,25%) sujetos precisaron un solo tratamiento y 38 (12,75%) más de uno. Dentro de las variables estudiadas, la única con diferencias entre los dos grupos fue el tamaño de la litiasis, siendo la media en el grupo de un tratamiento de 18 mm, y de 26 mm en el de más de un tratamiento (diferencia de medias -8,27, IC 95%: -5,91 -- -10,63, p < 0,001). Por cada milímetro más de tamaño, la probabilidad de necesitar más de un tratamiento aumenta 1,14 veces (p < 0,001). En la curva ROC se observó que el punto con mayor sensibilidad y especificidad para el tamaño de la litiasis se estableció en 21mm, con ABC de 0,804 (IC 95%: 0,73 - 0,87, p < 0,001). CONCLUSIONES: La CRIR con láser holmio sigue siendo una técnica eficaz para el tratamiento de la litiasis renal. El tamaño mayor de la litiasis se relaciona con la necesidad de retratamientos, debiendo tenerse en cuenta este hecho sobre todo a partir de los 2 cm. En nuestra serie, por cada milímetro más de tamaño de la litiasis, aumentó 1,14 veces la probabilidad de retratamientos, lo cual demuestra la importancia e influencia del tamaño en este contexto

OBJECTIVES: To analyze the predictive factors for retreatment in RIRS to achieve complete lithiasis resolution. METHODS: Retrospective comparative study analyzing 298 cases of RIRS performed in our center over a 3 year period. The cohort was divided in two groups: Resolution in one operation or more than one, evaluating homogeneicity for age and gender. We compared the folowing variables: Hounsfield units, body mass index (BMI), number of stones, size, (on the case of multiple stones, larger stone size), side, location in the kidney and stone biochemistry. Bivariant statistical analysis by Student`s t and Chi square tests, and multivariate analysis by binary logistic regression. ROC curves were made to set cutting points for relationship between quantitative variables. RESULTS: The groups were homogeneous for both age and gender (p > 0.05). 260 (87.25%) patients required one treatment only and 38 (12.75%) more than one. Among the study variables, the only one that showed differences between the groups wa stone size, being the mean size 18 mm in the single treatment group and 26 mm in the more than one treatment group (Difference between mean values -8.27, 95%CI: -5,91 -- -10.63, p < 0,001). CONCLUSIONS: RIRS with holmium laser is still an effective technique for the treatment of renal lithiasis. The largest stone size is related with the need of retreatments, so it must be taken into consideration specially over 2 cm. In our series, for every extra millimeter in size the probability of retreatment increased 1.14 times, demonstrating the importance of size in this context

[Current results of RIRS and comparison with PCNL.] / Resultados actuales de la CRIR y comparación con NLPC.

OBJECTIVES: The objective of this article is to show the current situation regarding two surgical techniques for the treatment of renal lithiasis, RIRS (Retrograde intrarenal surgery) and PCNL (Percutaneous nephrolithotomy), specially concerning the larger size stones. We perform a literature review on the topic and add the experience with both techniques at our center. Besides, we also analyze the role of RIRS in comparison with the percutaneous techniques in smaller size lithiasis. METHODS: We review the results obtained in the literature and our experience. We offer our opinion in reference to the indications of RIRS in these cases based on such review and our experience. RESULTS/CONCLUSIONS: RIRS is a safe and effective technique, with a similar success rate to PCNL if one assumes the possibility of retreatment in stones >2cm. Its low complication rate, fast postoperative recovery and short hospital stay make this technique a therapeutic alternative to PCNL in this type of patients. Compared with percutaneous techniques less invasive than classical 24 to 30 Ch. accesses (miniperc or microperc), RIRS offers a higher stone free rate. If we also consider that RIRS is associated with shorter hospital stay and lower bleeding risk, even without significant differences in the global complication rate we could consider RIRS as the first line endourological treatment in stones <2cm.

Resultados actuales de la CRIR y comparación con NLPC / Current results of RIRS and comparison with PCNL

OBJETIVO: El objetivo del siguiente trabajo es mostrar la situación actual en lo referente a dos técnicas quirúrgicas para el tratamiento de la litiasis renal, CRIR (Cirugia Retrógrada Intrarrenal) y NLPC (Nefrolitotomía Percutánea), sobre todo en lo referente a litiasis de mayor tamaño. Para ello revisamos la literatura al respecto y añadimos la experiencia de nuestro centro en relación a ambas técnicas. Por otro lado, también se analiza el papel de CRIR frente a técnicas percutáneas en litiasis de menor tamaño. MÉTODOS: Revisión de los resultados descritos en la literatura y la experiencia de nuestro centro. Ofrecemos nuestra opinión en base a esta revisión y experiencia propia, en lo referente a las indicaciones de la CRIR en estos casos. Resultados/conclusiones: La CRIR es una técnica segura y eficaz, con una tasa de éxito similar a NLPC si se asume la posibilidad de retratamiento en litiasis >2cm. Su baja tasa de complicaciones, la rápida recuperación postoperatoria y la corta estancia hospitalaria hacen de esta técnica una alternativa terapéutica a la NLPC en este tipo de pacientes. En comparación con técnicas percutáneas de menor invasividad que los accesos clásicos de 24 ó 30 Ch. (mini o microPERC), la CRIR ofrece una mayor tasa libre de litiasis que estas técnicas. Si además, consideramos que la CRIR se acompaña de menor estancia hospitalaria, riesgo de sangrado, aún sin encontrar diferencias significativas en la tasa de complicaciones globales, podríamos considerar la CRIR como tratamiento endourológico de primera línea en las litiasis < 2 cm

OBJECTIVES: The objective of this article is to show the current situation regarding two surgical techniques for the treatment of renal lithiasis, RIRS (Retrograde intrarenal surgery) and PCNL (Percutaneous nephrolithotomy), specially concerning the larger size stones. We perform a literature review on the topic and add the experience with both techniques at our center. Besides, we also analyze the role of RIRS in comparison with the percutaneous techniques in smaller size lithiasis. METHODS: We review the results obtained in the literature and our experience. We offer our opinion in reference to the indications of RIRS in these cases based on such review and our experience. Results/conclusions: RIRS is a safe and effective technique, with a similar success rate to PCNL if one assumes the possibility of retreatment in stones >2cm. Its low complication rate, fast postoperative recovery and short hospital stay make this technique a therapeutic alternative to PCNL in this type of patients. Compared with percutaneous techniques less invasive than classical 24 to 30 Ch. accesses (miniperc or microperc), RIRS offers a higher stone free rate. If we also consider that RIRS is associated with shorter hospital stay and lower bleeding risk, even without significant differences in the global complication rate we could consider RIRS as the first line endourological treatment in stones < 2 cm

Assessment of the Effectiveness, Safety, and Reproducibility of Micro-Ureteroscopy in the Treatment of Distal Ureteral Stones in Women: A Multicenter Prospective Study.

PURPOSE: The aim of this study is to assess the effectiveness, safety, and reproducibility of the micro-ureteroscopy (m-URS) in the treatment of distal ureteral stones in women. MATERIALS AND METHODS: A multicenter, prospective observational study was designed and conducted between March and December 2015. We included women having at least one stone in the distal ureter and being a candidate for surgical treatment using the 4.85F sheath of MicroPerc®. Patients with clinical criteria and/or laboratory analysis indicating sepsis or coagulation alteration were excluded. RESULTS: Thirty-nine women were operated in eight hospitals. The profile of the patients was fairly homogeneous among hospitals. Only differences were found in age, preoperative stent, and the result of the previous urine culture. Immediate stone-free status was achieved in 88.2% and 100% 7 days after the procedure. 97.4% of patients did not present any complication in the postoperative period, with only one case with complication Clavien II. Postureteroscopic Lesion Scale (PULS) in 76.9% of patients did not show any injury, 20.5% had lesions grade 1, and grade 2 lesions 2.6%. As for the reproducibility of m-URS between hospitals, statistical analysis of the results showed differences between all the centers participating in the study. CONCLUSIONS: m-URS is an effective, safe, and reproducible technique that minimizes surgical aggression to the ureteral anatomy. Satisfactory and comparable results to "conventional" ureteroscopy were obtained in the treatment of distal ureteral stones in women, although clinical trials are needed. The reduction of the ureteral damage may reduce secondary procedures and increase the cost-effectiveness of the procedure.

[Renal hemorrhage after ESWL: From small hematoma to renal blowout]. / Hemorragia renal tras LEOC: del pequeño hematoma al estallido renal.

OBJECTIVE: To report two cases of renal hemorrhage after extracorporeal shock wave lithotripsy (ESWL) and their therapeutic management. METHODS: Description of the clinical cases, together with the diagnosis and therapeutic management of these complications. RESULTS: We present two cases of patients with renal hemorrhage after ESWL, which were performed without immediate complications. One of the cases, after detecting an important laceration of the renal parenchyma, needed two embolization sessions for its short-term resolution; however, the patient finally passed away due to the complications derived from hemorrhage. The other case was solved through conservative management. CONCLUSIONS: Even though hemorrhage is an infrequent complication after ESWL, it should be suspected when the patient presents compatible clinical symptoms, since even though most cases are resolved in a conservative manner, on some occasions specific treatments for the hemorrhage are necessary. Old age and the presence of vascular comorbidities seem to be related to a higher risk of hemorrhage after ESWL.

Nefrolitectomía micro-percutánea (NLPC-micro, Microperc): una nueva herramienta en el tratamiento de la litiasis renal. (Comentario Editorial) / Micropercutaneous Nephrolithotomy (Micro-PNL or microperc): A new tool in the treatment of renal lithiasis. (Editorial Comment)

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Intrarenal pseudoaneurysm after percutaneous nephrolithotomy. Renal angiography and selective embolization.

OBJECTIVE: We present a case of intrarrenal pseudoaneuysm after percutaneous nephrolithotomy. The treatment was selective embolization of the pseudoaneurysm. We discuss the role of computerized angiotomography and angiography in these cases. We present a review of the related literature. METHODS: A computerized angiotomography (angio CT) was performed because of suspicion of a delayed vascular lesion after percutaneous nephrolithectomy. Faced with the findings of the angio CT an selective renal artery arteriography and selective embolization was performed. RESULTS: The angiotomography shows an enhanced nodular contrast in the lower third of the left kidney with a scarred area at this level suggestive of hemorrhage due to vascular lesion.Through puncture of the right common femoral artery, arteriography was performed on the left renal artery with, objectifying an amputated artery related to the bleeding situation in the calyx. After localization of the point of hemorrhage, the vessel was embolized with a 3 mm metallic microspiral GCD, 6 cm in length After embolization, the evolution of the patient was satisfactory. CONCLUSIONS: Intrarenal pseudoaneurysm is the most frequent cause of late bleeding after percutaneous nephrolithotomy. The most common symptom is hematuria that can be severe and require active treatment in order to inhibit the hemorrhage. In these cases, computerized angiotomography and angiography take on a very important diagnostic role, the latter offering the possibility to treat the hemorrhage through selective embolization of the pseudoaneurysm.

Pseudoaneurisma intrarrenal tras nefrolitotomía percutánea. Angiografía renal y embolización selectiva / Intrarenal pseudoaneurysm after percutaneous nephrolitotomy. Renal angiography and selective embolization

OBJETIVO: Presentamos un caso de pseudoaneurisma intrarrenal tras nefrolitotomia percutánea. El tratamiento en este caso fue la embolizacion selectiva. A partir de este caso discutimos la utilidad en el dignóstico de la angiotomografia computerizada y la angiografia renal. Realizamos una revisión de la literatura al respecto. MÉTODOS: Se realizó una angitomografía computerizada (angioTC) por sospecha de lesión vascular diferida tras la nefrolitectomía percutánea. Ante los hallazgos deangioTC, se realizó una arteriografía de la arteria renal izquierda y embolización selectiva de la lesión. RESULTADOS: La angiotomografía evidencia un realce nodular de contraste en el tercio inferior del riñón izquierdo con área hipocaptante a este nivel sugestiva de hemorragia por lesión vascular. Mediante punción de la arteria femoral común derecha, se realiza arteriografía de la arteria renal izquierda objetivando una arteria amputada que corresponde a la situación del sangrado al cáliz. Tras localización del punto de hemorragia se procedió a embolizar el vaso con una microespiral metálica GDC de 3mm y 6cm de longitud Tras la embolización, la evolución del enfermo fue satisfactoria. CONCLUSIONES: El pseudoaneurisma intrarrenal constituye la causa más frecuente de sangrado tardío tras nefrolitotomía percutánea. El síntoma más habitual es la hematuria que puede ser severa y precisar de tratamiento activo para cohibir la hemorragia. En estos casos, cobran un papel muy importante en el diagnostico, la angiotomografía computerizada y la angiografía, ofreciendo esta última la posibilidad de tratar la causa de la hemorragia mediante la embolización selectiva del pseudoaneurisma(AU)

OBJECTIVE: We present a case of intrarrenal pseudoaneuysm after percutaneous nephrolithotomy. The treatment was selective embolization of the pseudoaneurysm. We discuss the role of computerized angiotomography and angiography in these cases. We present a review of the related literature. METHODS: A computerized angiotomography (angio CT) was performed because of suspicion of a delayed vascular lesion after percutaneous nephrolithectomy. Faced with the findings of the angio CT an selective renal artery arteriography and selective embolization was performed. RESULTS: The angiotomography shows an enhanced nodular contrast in the lower third of the left kidney with a scarred area at this level suggestive of hemorrhage due to vascular lesion. Through puncture of the right common femoral artery, arteriography was performed on the left renal artery with, objectifying an amputated artery related to the bleeding situation in the calyx. After localization of the point of hemorrhage, the vessel was embolized with a 3 mm metallic microspiral GCD, 6 cm in length After embolization, the evolution of the patient was satisfactory. CONCLUSIONS: Intrarenal pseudoaneurysm is the most frequent cause of late bleeding after percutaneous nephrolithotomy. The most common symptom is hematuria that can be severe and require active treatment in order to inhibit the hemorrhage. In these cases, computerized angiotomography and angiography take on a very important diagnostic role, the latter offering the possibility to treat the hemorrhage through selective embolization of the pseudoaneurysm(AU)

Importance of previous transurethral resection of the prostate before eerpe.short-term functional outcomes in a single surgeon series.

OBJECTIVES: Laparoscopic Radical Prostatectomy (LRP) is technically a very demanding procedure and potentially even more challenging in patients with previous transurethral resection (TURP). This study evaluates the impact of previous TURP on the short-term functional outcome of patients undergoing extraperitoneal LRP. METHODS: Retrospective analysis of a prospectively collected database, comprising a single-surgeon cohort of 155 consecutive LRP cases, 19 of which had previous history of TURP. Demographics, clinical and functional outcomes were evaluated and compared among patients with and without previous TURP. Multivariate analysis was performed to identify potential variables independently associated with continence outcomes. Incontinence was defined as the need of more than 1 pad/day. Potency was defined as the ability for sexual intercourse with or without the use of phosphodiesterase inhibitors. RESULTS: Demographic and clinical variables were comparable among the two study groups. Neurovascular bundle preservation was possible in 26% and 37% of patients with and without previous TURP, respectively. No major complications were recorded and the incidence of minor complications was comparable. Overall continence rate at 3 months was 82,58%, for the entire cohort. Subset analysis demonstrated a 3-month continence rate of 73.7% vs. 83.8% (p>0.05) in patients with and without TURP, respectively. Multivariate analysis demonstrated age, BMI and ASA were variables independently associated with continence outcomes. In the cohort of patients with previous TURP, 2 out of 7 undergoing preservation recovered erections, with a mean follow up of 15.5 months, comparable to the 30% achieved in patients without TURP and nerve sparing procedure. CONCLUSIONS: Laparoscopic Radical Prostatectomy in patients with previous TURP is feasible, with complication rates and short-term functional outcomes comparable to those in patients without previous resection.

Relevancia de la resección transuretral de próstata en los resultados funcionales de la prostatectomía radical laparoscópica / Importance of previous transurethral resection of the prostate before eerpe. short-term functional outcomes in a single surgeon series

OBJETIVO: La dificultad del tratamiento quirúrgico del Cáncer de próstata (caP) se acentúa en los pacientes con antecedentes de resección transuretral de próstata (RTU). En este estudio valoraremos la influencia de la RTU en los resultados funcionales a corto plazo de la prostatectomía radical laparoscópica extraperitoneal. MÉTODO: Revisión retrospectiva de una base de datos de cumplimentación prospectiva de una serie de pacientes intervenidos por un solo cirujano de manera consecutiva. Se compararon las características demográficas, clínicas y patológicas de los pacientes con y sin RTU previa, para posteriormente realizar un estudio multivariante mediante regresión logística para comprobar qué variables se asociaban de manera independiente y significativa a la incontinencia según el criterio (>1 compresa/día). Se consideró potentes a aquellos pacientes capaces de penetrar con o sin la ayuda de inhibidores de la 5 fosfodiesterasa. Se dispuso de la evaluación funcional de 155 pacientes, 19 de los cuales tenían antecedentes de RTU previa. RESULTADOS: Los subgrupos no diferían en las variables relevantes para el estudio. La conservación de haces neurovasculares se realizó en un 37% de los pacientes sin RTU previa y en un 26% del grupo contrario. No se objetivaron complicaciones mayores, la frecuencia de complicaciones menores no difería. La tasa de continencia de la serie global, evaluada en los 3 primeros meses, era del 82,58%. En el subgrupo de pacientes sin antecedentes de RTU previa era del 83,8% mientras que en el subgrupo de pacientes con RTU previa era del 73,7%, p>0,05. En el análisis multivariante, se asociaron de manera independiente y significativa a la continencia la edad, el IMC y el ASA. Tampoco se observaron diferencias significativas en la proporción de pacientes que recuperaron la erección en uno y otro grupo (28 vs 30%). CONCLUSIONES: Los resultados funcionales a corto plazo son aceptables y comparables a los de los pacientes sin resección previa (AU)

OBJECTIVES: Laparoscopic Radical Prostatectomy (LRP) is technically a very demanding procedure and potentially even more challenging in patients with previous trans-urethral resection (TURP). This study evaluates the impact of previous TURP on the short-term functional outcome of patients undergoing extraperitoneal LRP. METHODS: Retrospective analysis of a prospectively collected database, comprising a single-surgeon cohort of 155 consecutive LRP cases, 19 of which had previous history of TURP. Demographics, clinical and functional outcomes were evaluated and compared among patients with and without previous TURP. Multivariate analysis was performed to identify potential variables independently associated with continence outcomes. Incontinence was defined as the need of more than 1 pad/day. Potency was defined as the ability for sexual intercourse with or without the use of phosphodiesterase inhibitors. RESULTS: Demographic and clinical variables were comparable among the two study groups. Neurovascular bundle preservation was possible in 26% and 37% of patients with and without previous TURP, respectively. No major complications were recorded and the incidence of minor complications was comparable. Overall continence rate at 3 months was 82,58%, for the entire cohort. Subset analysis demonstrated a 3-month continence rate of 73.7% vs. 83.8% (p>0.05) in patients with and without TURP, respectively. Multivariate analysis demonstrated age, BMI and ASA were variables independently associated with continence outcomes. In the cohort of patients with previous TURP, 2 out of 7 undergoing preservation recovered erections, with a mean follow up of 15.5 months, comparable to the 30% achieved in patients without TURP and nerve sparing procedure. CONCLUSIONS: Laparoscopic Radical Prostatectomy in patients with previous TURP is feasible, with complication rates and short-term functional outcomes comparable to those in patients without previous resection (AU)

Divertículo vesical de hutch: una entidad de infrecuente presentación en el adulto / Hutch bladder diverticula: a very uncommon entity in adults

OBJETIVO: Presentamos el caso de un paciente adulto al que se le diagnosticó tras estudio realizado de divertículo de Hutch. Señalar que se trata de un tipo de divertículo vesical congénito muy infrecuente en la infancia y excepcional en el adulto, siendo muy escasos los casos en adulto comunicados en la literatura. MÉTODOS: El paciente fue estudiado mediante Urografía Intravenosa y Cistouretrografia Miccional Seriada. Una vez evaluadas las pruebas complementarias y establecido un juicio diagnóstico, se revisa la literatura y las alternativas terapeuticas. RESULTADOS: La Urografía intravenosa demostró en la fase excretora una ureterohidronefrosis sin defectos de repleción sugestivos de litiasis a nivel ureteral distal. Por otro lado se observaba un afilamiento del uréter a su entrada en vejiga debido a la presencia de un divertículo vesical yuxta-meatal. Posteriormente se realizó una cistografía retrógrada que descartó reflujo vesicoureteral y mostró que el divertículo presentaba residuo elevado tras la micción. Dadas las características de nuestro paciente y la ausencia de reflujo vesicoureteral ipsilateral asociado; se decidió un tratamiento endoscópio con apertura de la boca del divertículo. La evolución fue satisfactoria. CONCLUSIONES: El divertículo paraureteral de Hutch es una entidad infrecuente, incluso en la infancia. Para el diagnóstico en estos pacientes resulta especialmente útil la cistouretrografía miccional seriada (CUMS). Los síntomas, complicaciones asociadas así como la presencia de reflujo determinaran el tipo de tratamiento a realizar(AU)

OBJECTIVE: We present the case of an adult patient diagnosed with Hutch diverticula after examination. Indications were of a type of congenital bladder diverticula very rare in children and unusual in adults, as very few cases in adults are addressed in the literature. METHODS: Intravenous Urography and Voiding Cystourethrogram (VCUG) were realized. RESULTS: The intravenous urography revealed ureterohydronephrosis in the excretory phase that did not have repletion defects suggesting lithiasis at distal urethra. On the other hand, a narrowing of the urethra was observed at the point of bladder entry due to the presence of a juxtameatal bladder diverticulum. Next a retrograde cystography was performed which ruled out vesicourethral reflux and revealed that the diverticulum presented elevated residuals after urination. As a result of our patient’s clinical characteristics and the absence of vesico-urethral reflux, we decided to perform an endoscopic surgical opening of the diverticula’s neck. CONCLUSIONS Hutch paraurethral diverticula is an very uncommon entity, even in infancy. The Voiding Cystourethrogram (VCUG) is especially useful in diagnosing these patients. In symptomatic cases surgical correction of the diverticula is required(AU)

Hutch bladder diverticula: a very uncommon entity in adults.

OBJECTIVE: We present the case of an adult patient diagnosed with Hutch diverticula after examination. Indications were of a type of congenital bladder diverticula very rare in children and unusual in adults, as very few cases in adults are addressed in the literature. METHODS: Intravenous Urography and Voiding Cystourethrogram (VCUG) were realized RESULTS: The intravenous urography revealed ureterohydronephrosis in the excretory phase that did not have repletion defects suggesting lithiasis at distal urethra. On the other hand, a narrowing of the urethra was observed at the point of bladder entry due to the presence of a juxtameatal bladder diverticulum. Next a retrograde cystography was performed which ruled out vesicourethral reflux and revealed that the diverticulum presented elevated residuals after urination. As a result of our patient's clinical characteristics and the absence of vesico-urethral reflux, we decided to perform an endoscopic surgical opening of the diverticula's neck. CONCLUSIONS Hutch paraurethral diverticula is an very uncommon entity, even in infancy. The Voiding Cystourethrogram (VCUG) is especially useful in diagnosing these patients. In symptomatic cases surgical correction of the diverticula is required.