Particularities and Efficacy of Extracorporeal Shock Wave Lithotripsy in Children.

BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) was first introduced in paediatric population in 1986. Given the more frequent recurrence in children, compared to adults, urinary stones treatments should require minimal invasive treatment methods. In this study, we aimed to evaluate the profile of the young patient with lithiasis who can benefit from ESWL, analysing the experience of 2 clinical departments. MATERIALS AND METHODS: We have retrospectively reviewed the medical records of 54 children who underwent ESWL for urolithiasis. ESWL success rate was defined as stone-free status or the presence of clinically insignificant residual fragments. Data were analysed using the STATA 14.2. RESULTS: In our study, the incidence of renal-ureteral calculi is significantly higher in girls (68.5%), compared to boys (31.5%). In total, 83.3% of patients showed a favourable outcome after treatment and the remaining 16.7% showed minimal complications. The presence of complications and remaining calculi was correlated to children age. The overall stone free rate was 88.9%. For calculus of 8.5 mm, only one ESWL session is recommended. CONCLUSIONS: The high percentage of cases with favourable outcome indicate that ESWL treatment is effective, considering the minimal cost, minimal invasiveness, repeatability and no need for general anaesthesia.

Is nocturnal enuresis a predisposing factor for the overactive bladder?

Background/aim: This study aimed to perform a limited observational study to ascertain whether there is statistical support that nocturnal enuresis (NE) is a predisposing factor in the development of overactive bladder (OAB). Materials and methods: The authors recruited patients diagnosed with OAB over a period of twelve months, and those who declared a history of NE were asked additional questions regarding the features of their NE. Results: A total of 285 patients were diagnosed with overactive bladder, and 98 (34.38%) of them had previously displayed NE symptoms that had diminished before reaching the median age of 9.83. Separation of patients by sex revealed a male majority (58.16%). Additionally, most patients had urban origins (75.51%). The median time span from remission of NE to diagnosis of OAB was 24.79 years, and the median age at which patients began to suffer was 31.80 years. Behavioral factors (smoking, alcohol consumption) and psychological and infectious factors (past history of urinary tract infection) were identified at varying degrees. Conclusion: The presence of NE in a third of the patients who developed over time OAB and the earlier onset of OAB for these patients suggests a causal physiopathological relationship between NE and OAB. The preponderance of urban patients confirms the existence of acquired urban triggering factors of OAB (nutritious, social, or professional).

Urothelial Bladder Carcinoma in Students at a Dental Technical College: A Report of 3 Cases.

Bladder cancer is one of the main types of neoplasia affecting men, with the highest incidence reported toward the end of the seventh decade of life. Unlike other malignancies, bladder cancer is attributable to specific widely occurring carcinogenic risk factors in 60-70% of cases, and numerous professions have been linked to higher rates of the disease. The present study includes the cases of three male graduates (mean age, 23 years) from the same dental technical college, two of whom were students at the Faculty of Dental Medicine of the Iași University of Medicine and Pharmacy (Iași, Romania) at the time of diagnosis. The individuals were occupationally exposed for a mean of 43.66 months. Histopathological examinations following resection indicated the presence of benign lesions (1 case) and malignant lesions of low aggressiveness (2 cases). The patients' outcomes were favorable, and there was no tumor recurrence over a mean observation period of 56 months. The aim of the present study was to highlight the young age at which these patients developed bladder tumors under similar etiological conditions and over short periods of exposure to known occupational risk factors. This shorter time of exposure to risk factors makes it even harder to establish causality with the occurrence of bladder tumors. However, the present cases could lead to a suspicion of a direct association between the exposure and the tumors or an entirely coincidental occurrence.

[Tracheal resection for post-intubation subglottic stenosis in a patient with granulomatosis with polyangiitis (Wegener)]. / Rezectie de trahee pentru stenoza subglotica post-intubatie la o pacienta cu granulomatoza cu poliangeita (Wegener).

Granulomatosis with polyangiitis (GPA or Wegener) is a systemic autoimmune disease with inflammation of small- and medium-size vessels. It can affect practically any organ or system, but renal, respiratory andjoint systems are most frequently damaged. Positive pANCA antibodies can raise the suspicion of diagnosis. Subglottic stenosis is relatively frequent, in a quarter of patients, especially in the third decade women. The case presented is of an 80-year-old woman, recently diagnosed with pulmonary, renal and systemic manifestations of GPA and with a subglottic stenosis rapidly evolving towards endotracheal intubation, tracheostomy with mechanical ventilation and renal failure. Further evolution has been favorable under corticoid therapy. After weaning from the mechanical ventilation and30 days after the suppression of the tracheostomy, the patient developed a tracheal stenosis with mixed etiology, secondary to vasculitis and prolonged intubation with tracheostomy. Tracheal resection with termino-terminal anastomosis was performed in emergency with simple post-operative evolution and without late complications.

[Renal colic in pregnancy]. / Colica nefretica la gravide. Experienta clinicii urologice Iasi.

UNLABELLED: Renal colic in pregnant women is a serious condition, mainly when is associated with fever. MATERIAL AND METHOD: Our retro-prospective study analyzes 111 cases managed conservatively or with endourological procedures for renal colic--insertion of JJ stents and percutaneous nephrostomy. RESULTS: Clinical evolution determined the insertion of JJ stents in 60 cases and the failure of this procedure imposed percutaneous nephrostomy in 5 cases. In 56 cases urinary tract infection was associated and in 2 cases, despite all efforts, the patients deceased due to sever sepsis. CONCLUSIONS: The immediate drainage of the upper urinary tract for renal colic in pregnancy is the recommended treatment, especially when the pain is associated with fever. JJ stens were well tolerated, even when they were replaced after 3 months. Pregnant women with a history of UTI or stone disease should be carefully followed-up.

[Five years of kidney transplantation in Iasi]. / Cinci ani de transplant renal în centrul universitar Iasi.

The activity of Renal Transplant Center Iasi started in November 2000, when we realized the first renal transplant from a live donor. Since then, 46 renal transplants were successfully realized in our center, to patients aged between 13-47 years (medium age = 30 +/- 5), M/F=27/19, 25 (56.8%) of them selected from HD, 17 (39.9%) from CAPD and 4 (8.7%) pre-emptive. Medium age of donors was 49.1 years (30-64), M/F=29/17. The donors were, in 78.3% of cases, first-degree relatives (parents, siblings). In 10 cases (21.7%) the grafts were donated by "emotionally related"donors (in most cases, spouses). An urologist-cardiovascular surgeon team, performed the transplant operations. There were no important complications during operation. We had one major vascular complication (graft artery thrombosis) in a 13 years recipient, successfully resolved after thrombectomy and stenting. Immunosuppressive therapy associated induction with monoclonal antibodies anti-Tac, cyclosporine, MMF and prednisone. Eight patients from 46 (17.39%) presented acute rejection episodes and all responded at corticosteroids. Medium values of serum creatinine were: 1.54 mg% at 1 month, 1.42 mg% at 6 months, 1.44 mg% at 1 year, 1.21 mg% at 2 years, 1.38 mg% at 3 years, 1.4 mg% at 4 years and 1.2 at 5 years. The survival of patients and donors is 100% and the survival of renal graft--97.1% (one case of chronic allograft nephropathy with lost of renal function). We also present the satisfactory evolution of the 51 renal transplanted patients addressed to our center from different other renal transplantation centers in Romania for management follow-up.

[Ureterolithotomy versus retrograde ureteroscopy for lumbar ureteral stone. A cost analysis]. / Ureterolitotomia versus ureteroscopia retrograda pentru calcul ureteral lombar o analiza a costurilor.

Ureterolithotomy is considered to be the last option for treating a lumbar ureteric stone. The authors reviewed two cases with lumbar ureteric stones treated in january 2003, one by ureterolithotomy and one by retrograde ureteroscopy regarding the costs for hospitalisation, investigations and medication. Among the certain clinical advantages for the patients, including a smaller rate of complications, ureteroscopy is considerably cheaper than open surgery. We consider that these costs criteria should be taken into consideration when the necessary equipment for-urological departments are set.

[Caliceal stones:What did we learned after 10 years of ESWL (extracorporeal shock wave lithotripsy)]. / Litiaza caliceala. Ce am învatat în 10 ani de litotritie extracorporeala?

Since its first clinical application in 1980, the indication of ESWL has rapidly extended from renal pelvis stones to almost all urinary stones. The authors discuss about their experience accumulated in the past ten years, when 476 patients with caliceal stones were treated by ESWL. The global stone free rate was 60.05%, but almost a third of the patients (where fragmentation was radiological documented after ESWL) did not returned back for control. ESWL is a good solution for superior and middle calix stones less than 1.5 cm, not very opaque, with a sufficient large caliceal width. For the stones in the lower calix, the most important criteria for success are: the stone size, the opacity and, for sure, the angle between infundibulopelvic and ureteropelvic axis.

[Transitional cell carcinoma of the upper urinary tract- staging by computed tomography]. / Stadializarea prin tomografie computerizata a carcinomului tranzitional de uroteliu superior.

PURPOSE: To determine the accuracy of computed tomography (CT) in staging transitional cell carcinoma of the renal pelvis and calyces and to identify whether hydronephrosis proximal to the tumor used as a criterion for minimal invasion may improve the overall accuracy of the method. MATERIALS AND METHODS: 24 patients with transitional cell carcinoma of the upper urinary tract underwent preoperative CT. In all cases nephroureterectomy was performed and CT and pathologic staging were compared. RESULTS: Pathologic staging revealed two stage I tumors, eight stage II tumors, five stage III tumors, and 9 stage IV tumors. The initial overall CT staging accuracy was 66.66% (16 of 24 patients). Reevaluation of the CT studies by using proximal hydronephrosis as a criterion for minimal invasion improved the overall CT staging accuracy (83.33%). CONCLUSIONS: When CT demonstrates direct tumor extension through the pelvic wall, it is a sensitive indicator of high-stage tumor. Hydronephrosis proximal to the tumor may cause overstaging of stage 0-II disease.

[The role of intravenous urography in the diagnosis of urinary tract lithiasis in the era of new therapeutical methods]. / Rolul urografiei intravenoase în diagnosticul litiazei reno-ureterale în epoca noilor metode terapeutice.

Urinary stones continue to be an interesting and major problem for both urologists and radiologists. The authors try to present the imaging diagnosis possibilities for this pathology according to the expectations of the urologists who have to deal with urinary tract lithiasis with the new methods (extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, and ureteroscopy). Helical CT has certain advantages and in different centers in Europe appear to be less expensive than intravenous urography (IVU), but unfortunately, is not available in our medical center. So, for us, IVU remains the basic investigation for urinary stones. Echography helps a lot for correct strategy, but together with KUB cannot replace IVU if we want to avoid mistakes.

[Renal cell carcinoma- diagnosis by computed tomography]. / Rolul tomografiei computerizate în diagnosticul cancerului renal chistic.

In approximately 10% of cases, renal cell carcinoma (RCC) could present as a fluid- filled cystic mass. There are three mechanisms by which RCC may become cystic: extensive cystic necrosis, intrinsic cystic growth and origin from the epithelium lining a simple renal cyst. Simple renal cysts are very common. Uncommonly these cysts are complicated by hemorrhage, infection and possibly ischemia. The goal of the radiologist in evaluating these cystic lesions is to distinguish malignant neoplastic cystic masses from non-neoplastic complicated cysts so that appropriate management can be undertaken: RCC is best treated by surgical excision while non-neoplastic complicated cysts do not require surgery. The radiologic findings in these cystic masses which must be carefully evaluated include calcification, abnormal density, septations, nodularity, wall thickening and enhancement.

[Ureteral stenting after retrograde ureteroscopy. Experience of Iasi urological department]. / Protezarea ureterului dupa ureteroscopia retrograda. Experienta clinicii urologice Iasi.

Ureteroscopy is a well-established procedure, which has proven the efficiency for diagnostic purposes, but mostly for ureteric stone removal. The authors describe their strategy after ureteroscopic lithotripsy with Wolf 8 Ch semirigid ureteroscope. Insertion of a double J stent for 2-4 weeks was the rule when there was an important bleeding during the procedure, the fragments were big and could not be extracted, some fragments migrated in upper third of the ureter or renal pelvis, a perforation occurred or it was found a ureteral stenosis. If the stone can be extracted without any problems (in one piece) and the ureter is normal there is no need for ureteral stenting. Having in mind that many patients describe problems with the double J stent (pains, polakiuria, etc) we recommend to insert a stent at the end of ureteroscopy only for selected cases.

[Role of computerized tomography in the diagnosis of transitional cell carcinoma of the upper urinary tract]. / Rolul tomografiei computerizate în diagnosticul carcinomului tranzitional de uroteliu superior.

PURPOSE: To evaluate the computed tomography (CT) semiological criteria used in the diagnosis of transitional cell carcinoma of the upper urinary tract. MATERIALS AND METHODS: 26 patients with transitional cell carcinoma of the upper urinary tract underwent preoperative CT. In all cases nephroureterectomy was performed and CT and histopathologic findings were compared. RESULTS: 16 tumors were infiltrative and 10 tumors were sessile. The smallest tumour had 7 mm diameter and the largest one 13 cm. Associated focal hydronephrosis appeared in 11 cases and diffuse hydronephrosis in 7 cases. The vast majority of these tumors (69.23%) had a 21 to 50 Hounsfield Units enhancement. CONCLUSIONS: CT is a powerful tool to diagnose transitional cell carcinoma of the upper urinary tract when data acquired in intravenous urography and echography are equivocal.