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PURPOSE: Iatrogenic ureteral strictures (US) after endoscopic treatment for urolithiasis represent a significant healthcare concern. However, high-quality evidence on the risk factors associated with US is currently lacking. We aimed to develop a consensus statement addressing the definition, risk factors, and follow-up management of iatrogenic US after endoscopic treatment for urolithiasis. METHODS: Utilizing a modified Delphi method, a steering committee developed survey statements based on a systematic literature review. Then, a two-round online survey was submitted to 25 experts, offering voting options to assess agreement levels. A consensus panel meeting was held for unresolved statements. The predetermined consensus threshold was set at 70%. RESULTS: The steering committee formulated 73 statements. In the initial survey, consensus was reached on 56 (77%) statements. Following in-depth discussions and refinement of 17 (23%) statements in a consensus meeting, the second survey achieved consensus on 63 (86%) statements. This process underscored agreement on pivotal factors influencing US in endoscopic urolithiasis treatments. CONCLUSIONS: This study provides a comprehensive list of categorized risk factors for US following endoscopic urolithiasis treatments. The objectives include enhancing uniformity in research, minimizing redundancy in outcome assessments, and effectively addressing risk factors associated with US. These findings are crucial for designing future clinical trials and guiding endoscopic surgeons in mitigating the risk of US.
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Técnica Delphi , Obstrucción Ureteral , Ureteroscopía , Urolitiasis , Humanos , Urolitiasis/cirugía , Factores de Riesgo , Ureteroscopía/efectos adversos , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiología , Constricción Patológica , Complicaciones Posoperatorias/etiología , Enfermedad Iatrogénica , Internacionalidad , ConsensoRESUMEN
PURPOSE: We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. METHODS: We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). RESULTS: A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively. CONCLUSIONS: The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.
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Litotricia , Complicaciones Posoperatorias , Ureteroscopía , Urolitiasis , Humanos , Ureteroscopía/efectos adversos , Factores de Riesgo , Urolitiasis/cirugía , Urolitiasis/epidemiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Litotricia/efectos adversos , Litotricia/métodos , Constricción Patológica , Nefrolitotomía Percutánea/efectos adversos , Nefrolitotomía Percutánea/métodos , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugíaRESUMEN
PURPOSE: PCNL requires a lithotrite to efficiently break stones, and some devices include active suction to remove the fragments. We set out to determine the efficacy and safety of the Swiss LithoClast® Trilogy, in a prospective European multicentre evaluation and compared it to published stone clearance rates for Trilogy based on surface area (68.9 mm2/min) and using the 3D calculated stone volume (526.7 mm3/min). METHODS: Ten European centres participated in this prospective non-randomized study of Trilogy for PCNL. Objective measures of stone clearance rate, device malfunction, complications and stone-free rates were assessed. Each surgeon subjectively evaluated ergonomic and device effectiveness, on a 1-10 scale (10 = extremely ergonomic/effective) and compared to their usual lithotrite on a 1-10 scale (10 = extremely effective). RESULTS: One hundred and fifty seven PCNLs using Trilogy were included (53% male, 47% female; mean age 55 years, range 13-84 years). Mean stone clearance rate was 65.55 mm2/min or 945 mm3/min based on calculated 3D volume. Stone-free rate on fluoroscopy screening at the end of the procedure was 83%. Feedback for suction effectiveness was 9.0 with 9.1 for combination and 9.0 for overall effectiveness compared to lithotrite used previously. Ergonomic score was 8.1, the least satisfactory element. Complications included 13 (8.2%) Clavien-Dindo Grade II and 2 (1.3%) Grade III. Probe breakage was seen in 9 (5.7%), none required using a different lithotrite. CONCLUSIONS: We have demonstrated that Trilogy is highly effective at stone removal. From a user perspective, the device was perceived by surgeons to be highly effective overall and compared to the most commonly used previous lithotrite, with an excellent safety profile.
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Cálculos Renales/cirugía , Nefrolitotomía Percutánea/instrumentación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE OF REVIEW: Urologists are at significant risk due to radiation exposure (RE) from endourological procedures for stone disease. Many techniques described have shown a reduction of RE. The purpose of this article is to review available protocols to decrease RE during such procedures and provide tips and tricks for their implementation. RECENT FINDINGS: Several low-radiation and radiation-free protocols for percutaneous nephrolithotomy and flexible ureteroscopy have been described as an attempt to reduce RE during surgery. Beginning with specific checklists to ensure adequate C-arm usage, fluoroless procedures are based on endoscopic assessment, tactile guidance, and use of ultrasound to avoid fluoroscopy. A specific preoperative checklist and low radiation or complete fluoroless radiation endourological procedures have shown to be effective, feasible, and safe. It is recommended for urologists to be aware of the risks of RE and apply the "ALARA" (As Low As Reasonably Achievable) protocols.
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Nefrolitotomía Percutánea/métodos , Exposición Profesional/prevención & control , Exposición a la Radiación/prevención & control , Ureteroscopía/métodos , Cálculos Urinarios/diagnóstico por imagen , Lista de Verificación , Fluoroscopía , Humanos , Ultrasonografía , Cálculos Urinarios/cirugíaRESUMEN
OBJECTIVE: To analyze the predictive capacity of the nephrolithometry scoring systems (GSS, STONE, CROES and S-ReSC) and stone surface regarding success and complications following percutaneous nephrolithotomy (PCNL). METHODS: We studied 392 patients who had undergone PCNL in our center. Only patients with a non-contrast CT (nâ¯=â¯240) were finally included for analysis. The predictive capacities for success and complications of the different scoring systems were evaluated using ROC curves and their area under the curve (AUC). RESULTS: Regarding success, the S-ReSC system had the highest predictive capacity with an AUC of 0.681 (95% CI 0.610-0.751), followed by the CROES with 0.667 (95% CI 0.595-0.738), the STONE with 0.654 (95% CI 0.579-0.728) and finally the GSS with 0.626 (95% CI 0.555-0.698). The stone surface as a single variable had an AUC of 0.641 (95% CI 0.565-0.718). As for complications, the S-ReSC had the highest AUC with 0.664 (95% CI 0.57-0.758), followed by STONE with 0.663 (95% CI 0.572-0.755), GSS with 0.626 (95% CI 0.555).-0.698) and CROES with 0.614 (95% CI 0.518-0.7). The stone surface alone had an AUC of 0.616 (95% CI 0.522-0.715). CONCLUSION: The nephrolithometry scales analyzed show a moderate predictive capacity for success and complications in patients undergoing PCNL in our center. Moreover, stone surface as an independent variable demonstrates moderate predictive capacity for both outcomes.
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INTRODUCTION: Since 1980, extracorporeal shock wave lithotripsy (SWL) has been employed in the treatment of urolithiasis, offering noninvasive alternatives to surgical techniques. In addition to being limited by the size and location of the stones, its efficacy is influenced by several factors. Despite the advancement of other surgical techniques, SWL could maintain its position with new improvements. Our objective is to review the existing literature on the latest advances in the extracorporeal treatment of lithiasis. MATERIAL AND METHODS: A non-systematic literature review was carried out from 2017 to 2023 to obtain 26 articles on three different emerging technologies in extracorporeal lithotripsy: Burst Wave Lithotripsy (BWL), Histotripsy, and Microbubble Lithotripsy (ML). RESULTS: The BWL uses sinusoidal bursts of US waves delivered at lower and higher frequencies than conventional SWL. Its mechanism of action generates a higher quality fragmentation (fine fragments) instead of generating tensile stresses for stone fracture resulting in larger fragments, as in traditional SWL. Studies in pigs and humans have shown effective fragmentation with a good safety profile. Based on High Intensity Focused Ultrasound (HIFU) technology, histotripsy fragments tissue through cavitation. Good in vitro results have been shown, but the formation of microbubbles between the stone and ultrasound waves hinders the progress of this technique. Microbubble Lithotripsy (ML) combines microbubbles and ultrasound for safe and effective stone fragmentation. In vitro and pig results are promising. This technique can help optimize treatments and reduce energy levels. CONCLUSIONS: Technological innovation is not only being applied to endourological techniques, but also to ESWL. New techniques such as BWL, histotripsy and ML are promising, with good results in the research phase.
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Litotricia , Urolitiasis , Humanos , Animales , Porcinos , Invenciones , Urolitiasis/terapia , Litotricia/métodos , UltrasonografíaRESUMEN
In recent years, various aspects of prostate cancer (PC) management have undergone significant changes, including the implementation of therapeutic strategies such as the use of new hormonal agents like abiraterone, apalutamide, enzalutamide or darolutamide and the incorporation of next generation imaging techniques (NGI). However, the evidence regarding the role of NGI and the therapeutic decision-making based on their findings is not solid. Following the methodology of the Advanced Prostate Cancer Consensus Conference (APCCC), a multidisciplinary expert consensus was developed to address controversial questions concerning the use of NGI and clinical management in four priority scenarios: localized PC, PC after radical prostatectomy, PC after radiotherapy with curative intent, and metastatic hormone-sensitive PC. This consensus represents the opinions of medical oncology, radiation oncology and urology physicians and provides useful recommendations for clinical practice.
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OBJECTIVE: Urinary lithiasis is a prevalent disease with a high socioeconomic impact, where endourological surgery has shown excellent results with minimal complications. For its part, outpatient surgery is an efficient, safe and quality care model. We present our experience in the outpatient endourological treatment of lithiasis and a review of the main series. MATERIAL AND METHODS: Prospective analysis of 85 flexible or percutaneous procedures for the treatment of lithiasis, carried out in our center between January 2021 and April 2022. The main objective was to analyze the rate of unplanned admission and the success and incidence of complications as secondary objectives. The patients were selected following the inclusion criteria of the care process. RESULTS: The mean age was 56 ± 14 years. Urine culture was positive in 13.9% of the patients, 38% had a pre-surgical double-J catheter. Median stone surface was 55 mm 2 (961 ± 323 Hounsfield Units). 73 flexible and 12 percutaneous procedures were performed. 8 patients required immediate unplanned admission and another 2 during the first month. 94% were stone-free at the third month. No intraoperative complications were detected, although 16.5% of the patients presented some type of postoperative complication. CONCLUSION: In our experience, with a strict selection of patients and following a care process with multidisciplinary participation, endourological procedures are feasible and safe in the outpatient setting. Periodic monitoring of the results is essential for the sake of a constant improvement of the process.
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Cálculos Renales , Litiasis , Humanos , Adulto , Persona de Mediana Edad , Anciano , Ureteroscopía/métodos , Cálculos Renales/cirugía , Cálculos Renales/etiología , Litiasis/etiología , Centros de Atención Terciaria , Pacientes AmbulatoriosRESUMEN
Androgen deprivation therapy (ADT) is the mainstay treatment for metastatic hormone-sensitive prostate cancer (mHSPC). The addition of docetaxel or new hormone therapies (abiraterone, apalutamide, or enzalutamide) improves overall survival and is currently the standard of care. However, the decision on the specific regimen to accompany ADT should be discussed with the patient, considering factors such as possible associated toxicities, duration of treatment, comorbidities, patient preferences, as there is no sufficient evidence to recommend one regimen over the other in most cases. This paper summarizes the evidence on the management of mHSPC and provides consensus recommendations on the optimal treatment in combination with ADT in mHSPC patients, with special attention to the patient's clinical profile.
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Neoplasias de la Próstata , Masculino , Humanos , Neoplasias de la Próstata/patología , Antagonistas de Andrógenos/uso terapéutico , Resultado del Tratamiento , Docetaxel/uso terapéutico , Hormonas/uso terapéuticoRESUMEN
INTRODUCTION AND OBJECTIVE: Survival and quality of life (QoL) of patients with non-metastatic castration-resistant prostate cancer (nmCRPC) deteriorate significantly when they develop metastases. New generation antiandrogens (apalutamide, enzalutamide and darolutamide) can prolong metastasis-free survival (MFS) and overall survival (OS) in these patients, maintaining their QoL. MATERIAL AND METHODS: After the performance of a systematic review of the literature, a scientific committee reached a consensus on simple and practical recommendations to consolidate and improve the management of patients with nmCRPC in urology consultations. RESULTS: Recommendations are made on the frequency of PSA determination and imaging tests in patients with nmCRPC. The importance of co-morbidities in patients with nmCRPC is also highlighted, and recommendations are also made on functional and QoL assessment that can be carried out during urology consultations. The efficacy, safety, and effects on QoL of new generation antiandrogens are reviewed. CONCLUSIONS: To evaluate treatment of patients with nmCRPC, it is necessary to consider co-morbidities and QoL, in addition to age. New generation antiandrogens are a safe and effective treatment option for patients with nmCRPC. The recommendations of this review can be helpful in optimizing the management of nmCRPC patients in urology consultations.
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Neoplasias de la Próstata Resistentes a la Castración , Antagonistas de Andrógenos , Humanos , Masculino , Neoplasias de la Próstata Resistentes a la Castración/tratamiento farmacológico , Calidad de Vida , Resultado del TratamientoRESUMEN
INTRODUCTION AND OBJECTIVES: The incidence of upper urinary tract tumors is currently unknown. The aim of this study is to determine the real incidence of upper tract urothelial carcinoma (UTUC) in Spain. MATERIAL AND METHODS: A descriptive, prospective and multicenter epidemiological study was conducted in 31 Spanish facilities by means of the Platform for Multicenter Studies of the Spanish Association of Urology. Recruitment was opened from May 1st, 2017 to April 30th, 2018. The original database was exported directly from the electronic Data Collection Logbook on December 15th, 2018, with a total of 404 cases registered (402 valid cases after depuration). Statistical analysis was performed using IBM SPSS software v 23 and EPIDAT v 3.4. RESULTS: The incidence adjusted to Spanish population from raw data was 3.27 cases per 100.000 inhabitants per year (2.93 - 3.61 95% CI) and 3,3 cases per 100.000 inhabitants per year (2.96-3.66 95%CI) when adjusted to European population by age. The mean age at diagnosis was 70 years, and 77% of patients were male. Thirty-four percent of patients had an incidental diagnosis. Tumors were most commonly located in the pyelocalyceal system (54%), followed by the distal ureter (22%). Prior ureteroscopy was performed in 114 patients: this technique modified the subsequent treatment indication in 58% of cases. Radical nephroureterectomy was performed in 311 patients. Kidney-sparing surgery was the elected treatment in 76 patients (20%). Complications were found in 69% of cases, most of them classified as Clavien 1 and 2 (86% of all complications). Postoperative mortality rate was 1.7%. CONCLUSIONS: UTUC adjusted incidence rate in Spain is 3.27 and 3.3 in Europe. Prior URS modified the treatment indication in 18% of patients. We found a 69% complication rate and a 1.7% mortality rate.
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Carcinoma de Células Transicionales/epidemiología , Neoplasias Renales/epidemiología , Neoplasias Ureterales/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Estudios Epidemiológicos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , España/epidemiologíaRESUMEN
OBJECTIVE: To discover the extent of training in radiological protection (RP) of Spanish urologists who perform endourological procedures, and to analyse the use of on ionising radiation control and protection measures. MATERIAL AND METHODS: A survey conducted through the Plataforma de Investigación de Estudios Multicéntricos (PIEM) (Multicentre Study Research Platform) on the 1,894 associates of the Spanish Association of Urology, between April and October 2015. The questionnaire comprised 21 questions on endourological activity undertaken, RP training, and the use of protective measures, and personal dosimetry. Seventeen percent responded, and 238 surveys were eventually validated for study. RESULTS: Sixty-three percent of the respondents had received no type of RP training, 25% had first level accreditation, and only 12% second level. Fifty-seven percent, 27%, and 2% of the urologists used flap, wrist and crystalline dosimetry respectively. Use of radiation protection measures was insufficient. Fifty-three percent of the urologists at greatest risk of exposure had had no training in RP, 30% did not use flap dosimetry, and 40% used neither an apron or thyroid collar during the endourological procedures. CONCLUSIONS: RP training, dosis monitoring, and the use of ionising radiation protective measures are insufficient, even by practitioners most exposed to radiation. It is essential that these serious shortcomings in RP are corrected, at the level of the individual, in urology departments, scientific societies, and the health authorities.
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Protección Radiológica/métodos , Urólogos/educación , Acreditación/estadística & datos numéricos , Cateterismo , Competencia Clínica/estadística & datos numéricos , Fluoroscopía , Encuestas de Atención de la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Nefrolitiasis/diagnóstico por imagen , Nefrolitiasis/terapia , Nefrolitotomía Percutánea/efectos adversos , Nefrolitotomía Percutánea/métodos , Protección Radiológica/instrumentación , Protección Radiológica/normas , Radiación Ionizante , Radiometría/instrumentación , Radiometría/métodos , Radiometría/estadística & datos numéricos , España , Encuestas y Cuestionarios/estadística & datos numéricos , Urólogos/estadística & datos numéricosRESUMEN
In developed countries, the incidence of cardiovascular disease is increasing, therefore, anticoagulant and antiplatelet drugs are a widespread treatment nowadays. Percutaneous nephrolithotomy (PNL) is the first-line treatment for large or complex stones (> 2 cm) and remains an alternative for the smaller ones. The objective of this study is to analyze whether PNL surgery is a safe procedure in patients under a treatment discontinuation protocol for anticoagulant or antiplatelet therapies. We retrospectively studied 301 patients who underwent PNL in our hospital between 2008 and 2016 and identified 46 patients on chronic antiplatelet or anticoagulation treatment. With respect to PNL outcomes, the stone-free rate was similar (78 vs 74%, p = 0.762) in both groups, without any significant differences in the overall postoperative complications (17 vs 26%, p = 0.203). The incidence of hemorrhagic complications was similar between groups (12 vs 9%, p = 0.492), as demonstrated by the mean drop in hemoglobin (Hb), which was comparable in both cohorts (2.2 ± 1.3 vs 2.0 ± 1.4 p = 0.270) and the blood transfusion rate (14% in group A and 8% in group B, p = 0.205). No thromboembolic events were found within the year after the PNL procedure. PNL is a safe and effective intervention in patients under a treatment discontinuation protocol for anticoagulant or antiplatelet therapies. Although our study demonstrates the feasibility of this protocol, new scientific evidence aims to stratify the thromboembolic and bleeding risk of each patient to individualize the perioperative management thereafter.
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Anticoagulantes/uso terapéutico , Enfermedades Cardiovasculares/terapia , Cálculos Renales/cirugía , Nefrolitotomía Percutánea/efectos adversos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Hemorragia Posoperatoria/epidemiología , Adulto , Anciano , Estudios de Factibilidad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Nefrolitotomía Percutánea/métodos , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/prevención & control , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Introducción y objetivo: La supervivencia y calidad de vida (QoL) de los pacientes con cáncer de próstata resistente a la castración no metastásico (CPRCnm) se deteriora de forma muy significativa cuando llegan a desarrollar metástasis. Los antiandrógenos de nueva generación (apalutamida, enzalutamida y darolutamida) pueden prolongar la supervivencia libre de metástasis (SLM) y la supervivencia global (SG) en estos pacientes, manteniendo su QoL.Material y método: Tras una revisión sistemática de la literatura, un comité científico alcanzó un consenso sobre recomendaciones sencillas y prácticas que unifiquen y mejoren el manejo de los pacientes con CPRCnm en las consultas de urología.Resultados: Se dan recomendaciones sobre la frecuencia de determinación de antígeno prostático específico (PSA) y pruebas de imagen en pacientes con CPRCnm. También se destaca la importancia de las comorbilidades en el paciente con CPRCnm y se ofrecen recomendaciones sobre la valoración funcional y de la QoL que se pueden llevar a cabo en la consulta de urología. Se revisa la eficacia, seguridad y efectos sobre la QoL de los antiandrógenos de nueva generación.Conclusiones: Para la evaluación del tratamiento de pacientes con CPRCnm, es necesario tener en cuenta no solo la edad, sino también las comorbilidades y la QoL. Los antiandrógenos de nueva generación son una opción de tratamiento segura y eficaz en los pacientes con CPRCnm. Las recomendaciones de trabajo pueden servir de ayuda para optimizar su manejo de los pacientes con CPRCnm en las consultas de urología. (AU)
Introduction and objective: Survival and quality of life (QoL) of patients with non-metastatic castration-resistant prostate cancer (nmCRPC) deteriorate significantly when they develop metastases. New generation antiandrogens (apalutamide, enzalutamide and darolutamide) can prolong metastasis-free survival (MFS) and overall survival (OS) in these patients, maintaining their QoL.Material and methods: After the performance of a systematic review of the literature, a scientific committee reached a consensus on simple and practical recommendations to consolidate and improve the management of patients with nmCRPC in urology consultations.Results: Recommendations are made on the frequency of PSA determination and imaging tests in patients with nmCRPC. The importance of co-morbidities in patients with nmCRPC is also highlighted, and recommendations are also made on functional and QoL assessment that can be carried out during urology consultations. The efficacy, safety, and effects on QoL of new generation antiandrogens are reviewed.Conclusions: To evaluate treatment of patients with nmCRPC, it is necessary to consider co-morbidities and QoL, in addition to age. New generation antiandrogens are a safe and effective treatment option for patients with nmCRPC. The recommendations of this review can be helpful in optimizing the management of nmCRPC patients in urology consultations. (AU)
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Humanos , Masculino , Neoplasias de la Próstata Resistentes a la Castración/terapia , Antineoplásicos/uso terapéutico , Antagonistas de Andrógenos/uso terapéutico , Resultado del Tratamiento , Análisis de Supervivencia , Calidad de Vida , ProstatectomíaRESUMEN
OBJECTIVE: To report one case of gunshot bladder trauma and to review its diagnosis and treatment in the related literature. METHODS: We report the case of a 43-year-old-male with an abdominal firearm wound and gross haematuria. Imaging diagnosis by abdominal and pelvic CT and CT-cystography. Surgical treatment. RESULTS: CT-cystography showed extraperitoneal bladder rupture. Exploratory laparotomy to evaluate for other associated injuries. Bladder wall surgical closure and ureteroneocystostomy with transvesical technique because of complete distal ureter tear. Broad spectrum antibiotherapy. Favourable progress. The patient was discharged at 14th day. CONCLUSIONS: Firearm bladder traumas are a rare entity. Surgical exploration and closure is mandatory. In haemodynamicaly stable patients, abdomen and pelvis CT and CT-cystography allow us to rule out associated injuries and to classify the bladder trauma type. Ureteral damage associated in 5-8,9%, diagnosed during surgical exploration. Broad-spectrum antibiotherapy in all patients.
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Vejiga Urinaria/lesiones , Adulto , Humanos , Masculino , Heridas por Arma de Fuego/diagnóstico , Heridas por Arma de Fuego/cirugíaRESUMEN
The insertion of a double J catheter (DJ) has widespread, becoming a usual procedure and standard of care in urology. Despite its relative simplicity it is not free from intraoperative risks or problems during the weeks after the implant. Conversely, despite great advances in design of these catheters the ideal material has not been discovered yet, one that is perfectly biocompatible with urine and avoids completely the advent of complications. The range of problems associated with DJs is variable: from mild self-limited dysuria or hematuria to more complex situations with higher risk, such as catheter migration, complete calcification, breakage, obstruction and renal unit loss. The treatment of theses complications must combine maximal efficacy for their resolution with the least possible surgical aggression. Accordingly, the different options of endourological approach become very important and they are the cornerstone for the treatment of the complications associated with ureteral catheters. The objective of this review is to present the main complications derived from the insertion of a DJ, their diagnosis, prevention and treatment, focusing mainly in the different endourological techniques.
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Complicaciones Posoperatorias/terapia , Catéteres Urinarios/efectos adversos , Algoritmos , Diseño de Equipo , Falla de Equipo , Humanos , Procedimientos Quirúrgicos Mínimamente InvasivosRESUMEN
OBJECTIVE: To analyze the incidence of surgical complications its diagnosis and treatment after renal transplantation. METHODS: A retrospective study measuring the incidence of surgical complications and reviewing its diagnosis and treatment in 185 renal single transplants. RESULTS: 185 transplants, 27% had surgical complications. Only one patient lost the graft due to surgical complications and there was no associated mortality. Cold ischemia time 20 hours. Double J stenting in 19%, under surgeon's opinion. Vascular complications 3.2% (all of them renal artery stenosis). Urological complications 6.4%. Perinephric haematoma 7%. Lymphocele 4.9%. Peritoneum related complications 4%. Other 4%. The diagnosis was clinical and radiological in most of cases. 14% needed any kind of intervention. CONCLUSIONS: Our results are similar to those reported in other recent series. Only one surgical team involved and the same technique for vascular and vesico-ureteric anastomosis probably makes lower our complications rate. Early postoperative abdominal ultrasonography contributes to the diagnosis of surgical complications. The initial treatment approach is the endoscopic-conservative one, with exceptions.
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Trasplante de Riñón/efectos adversos , Adolescente , Adulto , Anciano , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios RetrospectivosRESUMEN
OBJECTIVE: To review in the literature atypical sites of metastatic renal cell carcinoma, its onset, clinical features, diagnosis, treatment and prognosis. METHODS: To review, using Medline database, atypical sites of metastatic renal cell carcinoma in the last five years Spanish literature. RESULTS: There have been published 15 spanish articles about atypical metastatic renal cell carcinoma in the last five years. Most patients were male with a mean age of 62,3 years and methacronous metastases. Imaging and pathological diagnosis. Main sites: ocular, renal graft, larynx, suprarenal, brain, penis, gastric and pancreatic. Surgical treatment if the surgeon is able to remove the lesion. Inmunotherapy and radiotherapy in the rest of cases. CONCLUSIONS: Renal cell carcinoma represents about 3% of all adult malignancy neoplasms. Its metastatic sites, in order of frequency, are lung, bone and liver, whether synchronic or methacronic. Its location, clinical features, onset, evolution and prognosis is very variable. Individualized diagnostic and therapeutic approach, according to prognostic factors. The knowledge of this atypical sites in patients with renal cell carcinoma in the past can lead us to an earlier diagnosis and treatment which could change the evolution of the illness.
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Carcinoma de Células Renales/secundario , Neoplasias Renales/secundario , Humanos , Metástasis de la NeoplasiaRESUMEN
OBJECTIVES: To determine the percutaneous nephrolithotomy (PCNL) effects on the tissues using the quantification of inflammatory mediators, and to assess their impact on the development of postoperative complications. PATIENTS AND METHODS: Prospective observational non-randomized study on 40 patients underwent to PCNL. 50 patients with kidney stone who were treated by extracorporeal shock wave lithotripsy (ESWL) were used as control group. Interleukin-1beta (IL-1ß), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) were determined at baseline (T0: before treatment), and at 2, 6 and 24hours after (T1, T2 and T3). RESULTS: No relevant changes on IL-1ß and TNF-α were found. IL-6 showed two peaks at 2 and 6hours post-PCNL (median 17.8 and 15.8 pg/mL, respectively). At 24hours CRP had reached its peak value (3.4mg/L). The group treated with ESWL no showed significant changes in any of the markers. The serum concentration of IL-6 and CRP at 24hours post-NLP is different depending on the occurrence of complications (P=.001 and P=.039, respectively). IL-6 showed a good predictive power for the development of complications (AUC .801). CONCLUSIONS: Tissue damage caused by the PCNL is low. This damage increases significantly in those cases showing postoperative complications. IL-6 at 24hours has been shown to be a good predictive tool for the development of complications.