Experiencia de traumatismo renal abierto en un Servicio de Urología / Experience of Open Renal Trauma in a Urology Service

Introducción: El traumatismo renal abierto alcanza en zonas urbanas entre un 15-20% del total de traumatismos renales. Es producido principalmente por armas blancas o de fuego; estas últimas son de alta energía y se asocian a lesiones en otros órganos. Se presenta nuestra experiencia en traumatismo renal abierto en los últimos 24 meses. Material y métodos: Estudio retrospectivo. Se evaluaron los pacientes con traumatismo torácico, abdominal y toracoabdominal ingresados entre julio de 2009 y junio de 2011. Se identificaron 14 pacientes con diagnóstico de traumatismo renal abierto con confirmación diagnóstica por imágenes o durante el intraoperatorio. Resultados: Las edades oscilan entre 16 y 37 años, con un promedio de 24,5; 13 casos de 14 fueron hombres. El mecanismo del traumatismo es en un 71% (10/14) por arma de fuego y en un 29% (4/14) por arma blanca. Se clasificó el traumatismo renal según la American Association for the Surgery of Trauma, encontrándose que 3/14 (21%) corresponden a grado II, 4/14 (29%) a grado III, 4/14 (29%) a grado IV y 3/14 (21%) a grado V. El descenso de hematocrito varió entre el 1 y 27%, con un promedio de 13,9%. Se decidió un manejo conservador en 6/14 pacientes, considerándose como tal las cirugías efectuadas por lesión de órgano no urológico. Un total de 6 pacientes (42%) requirió nefrectomía. Hubo lesiones toracoabdominales asociadas en el 79%. Conclusiones: A pesar de la baja incidencia de traumatismo renal abierto, se observa un gran número de pacientes considerando otras series nacionales. Lo anterior probablemente sea debido a las características socioculturales del centro hospitalario (AU)

Introduction: Opened renal trauma in urban areas reaches 15 to 20% of all renal traumas. It is mainly caused by gunshot wounds or knifes. Gunshot wounds are classified as high energy trauma and are usually associated to other organ injuries. We present our experience in opened renal trauma in the last 24 months. Material and methods: Retrospective study: patients with thoracic, abdominal and thoraco-abdominal trauma admitted to the emergency room between July 2009 and June 2011 were studied. Fourteen patients were identified with opened renal trauma, with diagnostic confirmation by imaging study or during surgery. Results: Ages ranged from 16 to 37 years, with a mean age of 24.5 years. Thirteen patients were males. The mechanism of injury was produced by gunshot in 71% (10/14) and by knife in 29% (4/14). The opened renal traumas were classified according to the American Association for the Surgery of Trauma. Of these, 3/14 (21%) belonged to grade II, 4/14 (29%) to grade III, 4/14 (29%) to grade IV and 3/14 to grade V (21%). Fall in hematocrit ranged from 1% to 27%, with an average of 13.9%. Expectant management was done in six patients, however, this management did not take into account those surgeries performed due to non-urologic organ injuries. Six patients (42%) required nephrectomy. Thoraco-abdominal injuries were associated in 11 patients (79%). Conclusions: Despite the low incidence of opened renal trauma, many patients are observed when other national reports are considered, probably due to the socio-cultural characteristics of this hospital (AU)

[Experience of open renal trauma in a urology service]. / Experiencia de traumatismo renal abierto en un servicio de urología.

INTRODUCTION: Opened renal trauma in urban areas reaches 15 to 20% of all renal traumas. It is mainly caused by gunshot wounds or knifes. Gunshot wounds are classified as high energy trauma and are usually associated to other organ injuries. We present our experience in opened renal trauma in the last 24 months. MATERIAL AND METHODS: Retrospective study: patients with thoracic, abdominal and thoraco-abdominal trauma admitted to the emergency room between July 2009 and June 2011 were studied. Fourteen patients were identified with opened renal trauma, with diagnostic confirmation by imaging study or during surgery. RESULTS: Ages ranged from 16 to 37 years, with a mean age of 24.5 years. Thirteen patients were males. The mechanism of injury was produced by gunshot in 71% (10/14) and by knife in 29% (4/14). The opened renal traumas were classified according to the American Association for the Surgery of Trauma. Of these, 3/14 (21%) belonged to grade II, 4/14 (29%) to grade III, 4/14 (29%) to grade IV and 3/14 to grade V (21%). Fall in hematocrit ranged from 1% to 27%, with an average of 13.9%. Expectant management was done in six patients, however, this management did not take into account those surgeries performed due to non-urologic organ injuries. Six patients (42%) required nephrectomy. Thoraco-abdominal injuries were associated in 11 patients (79%). CONCLUSIONS: Despite the low incidence of opened renal trauma, many patients are observed when other national reports are considered, probably due to the socio-cultural characteristics of this hospital.

Experiencia de trauma renal abierto en el Servicio de Urgencias Hospital Padre Hurtado / Open renal trauma experience in the emergency unit of Hospital Padre Hurtado

El trauma renal se presenta en el 10 por ciento de los pacientes traumatizados y se clasifica en abierto o cerrado de acuerdo a su mecanismo. El trauma renal abierto alcanza en zonas urbanas entre un 15-20 por ciento del total de traumas renales. Es producido principalmente por armas blancas o de fuego; estas últimas son de alta energía y se asocian a /lesiones de otros órganos. Se presenta nuestra experiencia en traumatismo renal abierto en los últimos 18 meses. Se evaluaron un total de 196 pacientes con traumatismo torácico, abdominal y toracoabdominal ingresados entre Julio de 2009 y Diciembre de 2010. Se identificaron 9 pacientes con diagnóstico de trauma renal abierta con confirmación diagnóstica por imágenes o durante el intraoperatorio. Las edades oscilan entre 16 y 30 años con un promedio de 22,7; 8 de 9 son de sexo masculino. El mecanismo de trauma es en un 55,5 por ciento (5/9) por arma de fuego y en un 44,5 por ciento (4/9) por arma blanca. Se clasificó el trauma renal según American Association for the Surgery of Trauma. Encontrándose que 2/9 (22 por ciento) corresponden a grado ll, 3/9 (33 por ciento) a grado a grado ll,3/9 (33 por ciento) a grado IV y 1/9 (11 por ciento) a grado V. La baja de hematocrito varió entre 1 y 23 por ciento, con un promedio de 11,3 por ciento. Se decidió manejo conservador en 5/9 pacientes: dentro de esto no se consideran las cirugías efectuadas por lesión de órgano no urológico. Un total de 3 pacientes (33,3 por ciento) requirió nefrectomía. Lesiones toracoabdominales asociadas se observaron en 7 de 9 pacientes, siendo las más frecuentes el Bazo (2), Hígado (2), Estómago (2), Diafragma (2) y Colon (2). No hubo muertes en el grupo de estudio en seguimiento de 6 /meses. A pesar de la baja incidencia de trauma renal abierto, se observa un gran número de pacientes considerando otras series nacionales. La anterior, probablemente debido a las características socioculturales del centro hospitalario...

Renal trauma is present in 10 percent of politraumatized patients. It’s classified into opened or closed renal trauma, according to its mechanism. Opened renal trauma in urban areas reaches 15ta 20 percent of all renal traumas. It’s mainly secondary to gunshot wounds or knifes. Gunshot wounds are classified as hi energy trauma and usually are associated to other organ lesions. We present our experience in opened renal trauma in the last 18 months. Retrospective study where 196 patients with thoracic, abdominal and thoraco-abdominal trauma admitted in the emergency room between July 2009 and December 201 0. Nine patients were identified with opened renal trauma, with diagnostic confirmation y imaging study o during surgery. The ages ranged between 16 and 30 years; with an average of 22, 7 years. Eight out of nine patients were males. The mechanism of injury was in 55.5 percent (5/9) produced by gunshot and 44.5 percent (4/9) by knife. The opened renal traumas were classified according to the American Association for the Surgery of Trauma. We found that 2/9 (22 percent) belonged to grade ll. 3/9 (33 percent) to grade lll. 3/9 (33 percent) to grade IV and 1/9 to grade V (11 percent). The drop in hematocrit ranged between 1percent and 23percent, with an average of 11.3 percent. Five out of nine patients were treated conservatively, excluding surgeries because of neurologic¡ organs. Three patients required nephrectomy. Seven out of nine patients presented association with thoraco-abdominat injuries. The most frequent were spleen (2), liver (2), stomach (2), and diaphragm (2), and colon (2). There was no mortality during a six months follow-up. Despite the low incidence of opened renal trauma, we present a large number of patients according to other national reports, probably due to socio-cultural environment of this hospital...

Nefrectomía parcial en tumores sobre 4 Cms: evolución posperatorio resultados oncológicos y complicaciones / Partial nephrectomy for tumors over 4 cms: postoperatory evolution oncological results and complications

La nefrectomía parcial (NP) es el tratamiento de elección para tumores renales malignos menores de 4 cm, ya que ha demostrado resultados oncológicos equivalentes y una sobrevida global superior a la nefrectomía radical. Esto se explica debido a la capacidad de la NP de preservar la función renal y prevenir los efectos deletéreos asociados a la disfunción renal. Existe una cantidad creciente de estudios que indican que esta ventaja seria también extensible a tumores estadio T1b (4-7 cm). Este trabajo, evalúa los resultados oncológicos de la NP en tumores mayores de 4 cms y las complicaciones con un score validado y reproducible. Material y métodos: Se identificó, de manera retrospectiva, a un total de 214 pacientes sometidos a nefrectomía parcial entre los años 2002 al 2009. De éstos, 39 presentaban tumor mayor de 4 cms. Se excluyeron aquellos pacientes que presentaban metástasis al momento del diagnóstico, los con seguimiento menor a 6 meses y/o, tumores no esporádicos. Se analizaron las variables categóricas y continuas con los test Chi cuadrado y Mann-Whitney, respectivamente. Se utilizó el análisis de Kaplan-Meier para calcular la sobrevida global y cáncer especifica. Se clasificaron las complicaciones según score de Clavien. Resultados: Se identificaron 45 tumores en 39 pacientes. La edad media fue de 61 años (110, 7). El tamaño promedio tumoral fue de 5, 7cms. En 7 pacientes la indicación de nefrectomía fue absoluta (riñón solitario o contralateral atrófico), mientras que fue electiva en 32 (82 por ciento). El estudio anátomo-patológico demostró 87,1 por ciento (34) de tumores malignos y 12, 9 por ciento (5), benignos. Luego de un seguimiento promedio de 35, 9 meses (media de 34 meses), la sobrevida fue de 92,3 por ciento, sin detectarse muertes a causa del tumor renal...

The role of nephron-sparing surgery (NSS) is well established for T1 a renal lesions (<4 cm). Renal tumor control achieved by NSS is equivalent to one achieved by Radical Nephrectomy (RN) in appropriate/y selected patients, offering the benefits of decreased renal insufficiency rate when compared to RN. Recent data for renal tumors > 4 cms have suggested that it might be possible to expand the indication of NSS, with comparable oncological and clinical outcomes. However, NSS for tumors > 4 cms has been associated with a slight/y higher rate of complications. Objectives: To evaluate the oncological and clinical outcomes of NSS for renal tumor > 4 cms and to assess the complications based in a graded, va/idated and reproducible score (Clavien grade ). Material and methods: After the approval of the institutional ethic board, we retrospectively identified 214 patients who underrnt NSS for renal tumors. Thirty nine patients had tumors over 4 cms. The study period was from 2002 to 2009. Patients with metastasis at the time of diagnosis, follow-up less than 6 months or with non-sporadic tumors were excluded from the study Continues and categorical variable were assessed with Mann- Whitney U test and chis-quare test, respectively. Kaplan-Meier analysis was used to calculate the overall survival and cancer specific survival rate. The assessment of the complication was done using the Clavien score. RESULTS Forty five tumors were identified ¡n 39 patients. The median age was 61 year r 10. 7. Median tumor size was 5. 7cms. The surgical indication was imperative in 7 patients (solitary kidney or contralateral atrophic kidney) and elective in 32 (82 percent). The final pathology report showed that 32 (87,1 percent) and 5 (12,9 percent) tumors were malignant and benign, respectively After a mean folIow- up of 35.9 months (median 34 months), the over all survival rate was 92,3 percent while none had died from renal tumors...

Inyección submucosa uretral con agente Vantris® en el manejo de la incontinencia urinaria femenina, seguimiento a un año / Submucosal ureteral inyection with vantris® bulking agent for the management of urinary incontinence, one year follow-up

El objetivo del tratamiento de la incontinencia de orina (IOE) por disfunción esfinteriana es aumentarla resistencia uretral al escape de orina. Analizamos la eficacia y seguridad del agente inyectable VANTRIS® en IOE femenina prospectivamente en 23 pacientes. Estudio urodinámico pre-operatorio y uroflujometría tres meses después del procedimiento, se aplicó cuestionario ICIQ-SF antes de lacirugía, a los 3, 6, 9 y 12 meses. Se observó una disminución del ICIQ-SF promedio de 18,0 a 8,65 puntos y el Qmáx promedio a los 3 meses fue de 22,56 ml/s. El 56,52 por ciento permanecieron secas, el 8,69 por ciento mejoraron y el 8,69 por ciento no experimentaron cambios. El uso de VANTRIS® es mínimamente invasivo y seguro, pero requiere seguimiento a largo plazo para evaluar sus resultados.

The Urinary incontinence treatment caused by sphincteric dysfuntion is focused to increase urethral outflow resistance. We made a 23 patients prospective analysis to observe the efficacy and safety of a urethral bulking agent VANTRIS®. Preoperative Urodynamic study and uroflujometry three months later from the inyection, ICIQ-SF cuestionary preoperative, 3, 6, 9 and 12 months later. Outcomes were an increase of ICIQ-SF average from 18 to 8.65 points, the Q max average at 3 month analysis was 22.56 ml/s; 56.52 percent of patients were dry; 8.69 percent healthy and a 8.69 percent without changes. VANTRIS® treatment is a safety and minimally invasive procedure, but we need more follow up for a better evaluation of it’s results.