[Extensive ureteral lesions: management with substitution with small intestine]. / Lesiones ureterales extensas: manejo mediante sustitución por intestino delgado.

Wide ureteral injuries are unusual but not exceptional and have few conservative therapeutic options, specially those that involve the upper ureter. Autotransplantation, ureteral substitution by intestine and combined Boari bladder flap-psoas bladder hitch are basically the only chances to avoid nephrectomy. In this paper we report five cases in which ileum was used to substitute the ureter and review the most outstanding literature about this subject.

[Treatment of lithiasis in patients with one kidney by extracorporeal shock wave lithotripsy]. / Tratamiento de la litiasis en pacientes monorrenos con litotricia extracorpórea de ondas de choque.

OBJECTIVE: To describe the efficacy of extracorporeal shock wave lithotripsy in the treatment of lithiasis in patients with solitary functioning kidney. METHODS: The study comprised 56 patients with solitary kidney that had been treated by extracorporeal shock wave lithotripsy. These patients had a solitary kidney for the following reasons: 30 had undergone nephrectomy due to lithiasis, 11 had lost renal function arising from lithiasis, 9 had undergone nephrectomy for other pathologies and 6 had renal agenesis. Nine stone variables and treatment were analyzed. The same variables were analyzed and compared for statistical significance in a representative sample of 125 lithiasic patients with two kidneys who were treated by ESWL. RESULTS: Patients with solitary kidney frequently had a single calculus of < or = 1 cm located in calyces, unobstructive and did not require complementary endourological procedures. The mean number of shock waves was 8535. The psot-lithotripsy success rate was 82.1%; 98.2% had no complications. Comparison of these variables in both groups of patients showed statistically significant differences for stone location, indication for complementary endourological procedures and the number of shock waves utilized. CONCLUSIONS: In our view, ESWL is the treatment of choice in patients with lithiasis in a solitary kidney due to its high success rate and low morbidity. Stringent criteria must be employed before indicating prior endourological procedures to preserve the patency of the excretory tract and to minimize the risk of ureteral obstruction.

[Oxalate: its role in lithogenesis and composition of calcium oxalate lithiasis]. / Oxalato: participación en la litogenesis y composición de la litiasis oxalocálcica.

UNLABELLED: A prospective study was conducted on 374 patients with urinary lithiasis, aiming to analyze the participation of oxalate in the lithogenesis and composition of the calcium oxalate calculi, alone or associated to other factors. METHODOLOGY: Metabolic urinary study of the patient and analysis of calculi with infrared spectrography and optical microscopy. RESULTS: 26.3% patients had hyperoxaluria and 77.5% of the calculi contain calcium oxalate; these are 167 cases of calcium oxalate, 110 of oxalate and calcium phosphate and 13 cases of mixed calcium oxalate and uric acid lithiasis. 43.4% patients with pure monohydrate calcium oxalate calculi have hypercalciuria, 22.6% hyperoxaluria and 19% hyperuricosuria. Dihydrated calcium oxalate calculi are related to high hypercalciuria in 65% cases and to significant hyperoxaluria in 35% cases. 45% patients present a single lithogenic factor, either hypercalciuria (49.6%), hyperoxaluria (20.6%), hyperuricosuria (13.74%), hypocitraturia (9%), urinary infection (1.5%), A.T.R. (2.25%) or acid oliguria (3%).