Comparison of safety and effectiveness of active migration technique and in situ lithotripsy technique in the treatment of 1-2 cm upper ureteral calculi by flexible ure-teroscopy / 北京大学学报(医学版)

OBJECTIVE@#To compare the safety and effectiveness of active migration technique and in situ lithotripsy technique in the treatment of 1-2 cm upper ureteral calculi by retrograde flexible ureteroscopy.@*METHODS@#A total of 90 patients with 1-2 cm upper ureteral calculi treated in the urology department of Beijing Friendship Hospital from August 2018 to August 2020 were selected as the subjects. The patients were divided into two groups using random number table: 45 patients in group A were treated with in situ lithotripsy and 45 patients in group B were treated with active migration technique. The active migration technique was to reposition the stones in the renal calyces convenient for lithotripsy with the help of body position change, water flow scouring, laser impact or basket displacement, and then conduct laser lithotripsy and stone extraction. The data of the patients before and after operation were collected and statistically analyzed.@*RESULTS@#The age of the patients in group A was (51.6±14.1) years, including 34 males and 11 females. The stone diameter was (1.48±0.24) cm, and the stone density was (897.8±175.9) Hu. The stones were located on the left in 26 cases and on the right in 19 cases. There were 8 cases with no hydronephrosis, 20 cases with grade Ⅰ hydronephrosis, 11 cases with grade Ⅱ hydronephrosis, and 6 cases with grade Ⅲ hydronephrosis. The age of the patients in group B was (51.8±13.7) years, including 30 males and 15 females. The stone diameter was (1.52±0.22) cm, and the stone density was (964.6±214.2) Hu. The stones were located on the left in 22 cases and on the right in 23 cases. There were 10 cases with no hydronephrosis, 23 cases with grade Ⅰ hydronephrosis, 8 cases with grade Ⅱ hydronephrosis, and 4 cases with grade Ⅲ hydronephrosis. There was no significant diffe-rence in general parameters and stone indexes between the two groups. The operation time of group A was (67.1±16.9) min and the lithotripsy time was (38.0±13.2) min. The operation time of group B was (72.2±14.8) min and the lithotripsy time was (40.6±12.6) min. There was no significant difference between the two groups. Four weeks after operation, the stone-free rate in group A was 86.7%, and in group B was 97.8%. There was no significant difference between the two groups. In terms of complications, 25 cases of hematuria, 16 cases of pain, 10 cases of bladder spasm and 4 cases of mild fever occurred in group A. There were 22 cases of hematuria, 13 cases of pain, 12 cases of bladder spasm and 2 cases of mild fever in group B. There was no significant difference between the two groups.@*CONCLUSION@#Active migration technique is safe and effective in the treatment of 1-2 cm upper ureteral calculi.

Hemorrhagic Cystitis Requiring Bladder Irrigation is Associated with Poor Mortality in Hospitalized Stem Cell Transplant Patients

Purpose: To evaluate the overall prognosis of post-stem cell transplant inpatients who required continuous bladder irrigation (CBI) for hematuria. Materials and Methods: We performed a retrospective analysis of adult stem cell transplant recipients who received CBI for de novo hemorrhagic cystitis as inpatients on the bone marrow transplant service at Washington University from 2011-2013. Patients who had a history of genitourinary malignancy and/or recent surgical urologic intervention were excluded. Multiple variables were examined for association with death. Results: Thirty-three patients met our inclusion criteria, with a mean age of 48 years (23-65). Common malignancies included acute myelogenous leukemia (17/33, 57%), acute lymphocytic leukemia (3/33, 10%), and peripheral T cell lymphoma (3/33, 10%). Median time from stem cell transplant to need for CBI was 2.5 months (0 days-6.6 years). All patients had previously undergone chemotherapy (33/33, 100%) and 14 had undergone prior radiation therapy (14/33, 42%). Twenty-eight patients had an infectious disease (28/33, 85%), most commonly BK viremia (19/33, 58%), cytomegalovirus viremia (17/33, 51%), and bacterial urinary tract infection (8/33, 24%). Twenty-two patients expired during the same admission as CBI treatment (22/33 or 67% of total patients, 22/28 or 79% of deaths), with a 30-day mortality of 52% and a 90-day mortality of 73% from the start of CBI. Conclusions: Hemorrhagic cystitis requiring CBI is a symptom of severe systemic disease in stem cell transplant patients. The need for CBI administration may be a marker for mortality risk from a variety of systemic insults, rather than directly attributable to the hematuria.

Is there a role for hyberbaric oxygen as primary treatment for grade IV radiation-induced haemorrhagic cystitis? a prospective pilot-feasibility study and review of literature

Purpose To examine the safety and efficacy of hyperbaric oxygen as the primary treatment for Grade IV radiation-induced haemorrhagic cystitis. Materials and Methods Hyperbaric oxygen was prospectively applied as a primary treatment option in 11 patients with Grade IV radiation cystitis. Primary endpoint was the incidence of complete and partial response to treatment. Secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival. Results All patients completed therapy without complications for a mean follow-up of 17.82 months (range 3 to 34). Mean number of sessions needed was 32.8 (range 27 to 44). Complete and partial response rate was 81.8% and 18.2%, respectively. However, in three patients the first treatment session was not either sufficient or durable giving a 72.7% rate of durable effect. Interestingly, all 9 patients with complete response received therapy within 6 months of the haematuria onset compared to the two patients with partial response who received therapy at 8 and 10 months from the haematuria onset, respectively (p = 0.018). The need for blood transfusion (p = 0.491) and the total radiation dose (p = 0.259) were not correlated to success-rate. One patient needed cystectomy, while all patients were alive at the end of follow-up. Conclusions Early primary use of hyperbaric oxygen to treat radiation-induced grade IV cystitis is an effective and safe treatment option. .

Enfermedad renal crónica: Clasificación, identificación, manejo y complicaciones / Clinical guidelines on identitication, management and complications of chronic kidney disease

The key messages of these guidel ines on chronic kidney disease are: • Chronic kidney disease (CKD) is a public health problem due to its wide distribution, high rate of complications and cost. • CKD is a common condition, its prevalence being about 10 percent, and is treatable if it is detected on time. • A patient with CKD has a higher risk of cardiovascular mortality than of progression of its underlying renal disease. • A new definition of CKD, based on estimated Glomerular Filtration Rate (eGFR) and kidney damage, facilitates its detection and management. • CKD is detected with three simple tests: 1) Blood pressure measurement, 2) Detection of proteinuria or albuminuria in an isolated urine sample, and 3) Estimation of renal function (eGFR), based on serum creatinine, age, gender and race. • The CKD risk groups are individuáis with diabetes, hypertension and a family history of renal disease. • The most cost-effective measures are to detect and treat diabetic and hypertensive patients in the community. • Therapy must emphasize the maximal reduction of cardiovascular risk. • The complications of CKD such as anemia and renal osteodystrophy can be identified and treated on time. • Most patients with chronic kidney disease are detected in the community, therefore their initial care must be organized at the level of primary care, along with programs for hypertension and diabetes.

Glomerulonefritis: revisión del tema / Glomerulonephritis

Las glomerulonefritis (GN) son enfermedades caracterizadas por inflamación glomerular y proliferación celular, asociada a hematuria. Los mecanismos inmunes humorales y los mediados por células, juegan un papel importante en la patogenia de la inflamación glomerular. La enfermedad glomerular tiende a producir síndromes de disfunción renal específica. Sin embargo, diferentes enfermedades glomerulares pueden producir síndromes semejantes. En este trabajo se revisa la fisiopatología, la historia natural y el tratamiento de la hematuria asintomática, la glomerulonefritis aguda y la glomerulonefritis rápidamente progresiva.

Hematuria macroscópica persistente causada por el "Síndrome de cascanueces" / Persistent macroscopic hematuria caused by the nut cracker syndrome

We report the case a fifty nine years old male patient, with the nutcraker syndrome, with clinic characteristic of persisting macroscopic hematuria, radiologic and surgical evidence of compression of the left renal vein and consequent hypertension, by compression of the left kidney produced by an inflammatory pseudotumor of spleen.

Embolization of renal artery branch pseudoaneurysm secondary to percutaneous nephrostolithotomy: case report

This is to document a case of 40- year old man who presented with persistent hematuria following percutaneous nephrostolithotomy. The patient was successfuly managed by embolization of renal artery branch pseudoaneurysm

Estudio de la hematuria en adultos / Study of the haematury in adults

La hematuria es un motivo frecuente de consulta en medicina interna, y generalmente no es un problema terapéurico sino de diagnóstico. De ella se han descrito múltiples causas, que van desde enfermedades totalmente benignas hasta cáncer. En este trabajo se exponen los signos y síntomas que debemos buscar al interrogatorio y examen físico para orientar el diagnóstico, así como los examenes de laboratorio y radiológicos existentes actualmente útiles en la búsqueda. Algunas veces la causa puede ser obvia, pero en otras nunca es encontrada.

Trauma renal: diagnóstico e tratamento / Kidney trauma: diagnosis and treatment

Baseado em extensa revisäo da literatura, apresentam-se conceitos atuais sobre a orientaçäo diagnóstica e a conduta terapêutica do traumatismo renal. Descrevem-se as interpretaçöes das alteraçöes clínicas e dos achados laboratoriais e dos métodos de imagem. Enfatizam-se por fim os critérios das indicaçöes terapêuticas expectante e cirúrgica

Haematurea in pre-eclampsia: is it due to magnesium sulfate therapy?

The study was performed on 74 in-patients, sixty two were suffering from severe pre-eclampsia who were treated by MgSO [4] [50 patients] and diazepam [12 patients]. Twelve patients with premature labour were treated by MgSO [4] as a tocolytic and served as a control group. Urine analysis and kidney functions were done to all patients. Plasma Mg concentrations were estimated as well. The study proved that MgS0 [4] magnified the sign of haematuria in severely pre-eclamptic patients but not inducing it in patients with pre-mature labour

Nuestra experiencia en embolización por cateterismo arterial percutáneo / Therapeutic embolization by percutaneous arterial catheterization

Se presenta la experiencia con 72 pacientes con diferentes patologías, en quienes se realizó tratamiento endovascular con embolización selectiva. Se discuten la técnica, diferentes materiales utilizados, resultados y complicaciones. Se concluye que la EE constituye una excelente alternativa terapéutica pre-quirúrgica, paliativa o definitiva, de fácil realización en centros especialmente entrenados

Tratamento da hematúria encoercível com alúmen / Alun treatment for incoercible hematuria

A hematúria incoercível de origem vesical é um problema de difícil resoluçäo terapêutica e de etiologia variada. Os recursos terapêuticos disponíveis säo numerosos e já se mostraram eficazes em determinadas situaçöes, embora freqüentemente se associem a aumento da morbi-mortalidade, particularmente quando o tratamento cirúrgico é empregado. A alternativa terapêutica mais recente para a resoluçäo da hematúria vesical baseia-se na irrigaçäo intravesical contínua com soluçäo de alúmen (sulfato de alumínio). Estudou-se 13 pacientes portadores de hemorragia vesical maciça, de várias etiologias, utilizando-se como tratamento a soluçäo de alúmen a 1%. Em 76,9% dos paciente houve controle do sangramenteo em intervalo de tempo que variou de 1 a 7 dias. Verificou-se que o uso do alúmen intravesical oferece maiores vantagens sobre os outros procedimentos no controle da hemorragia vesical incoercível. O método mostrou-se eficaz, de baixo custo, com poucos efeitos colaterais, näo requerendo qualquer tipo de manipulaçäo mais agressiva. Este novo e promissor recurso terapêutico poderá transformar-se no método de eleiçäo para o tratamento desta grave enfermidade

Trauma renal: presentacion de 304 casos / Renal trauma: report of 304 cases

Se presenta un estudio retrospectivo del trauma renal en el Hospital Universitario San Juna de Dios de Bogota, de enero de 1980 a junio de 1988. Se analizan 304 casos que muestran el comportamiento frente a difeentes variables como son: edad, sexo, etiologia, diagnostico y tratamiento. El porcentaje de lesiones penetrantes es de 85%; el de salvamento renal de 79% para lesiones por arma de fuego, y 30% para las lesiones por trauma renal cerrado. Se realizo tratamiento quirurgico en el 97% de los casos, con una mortalidad global del 10%. Concluimos que el tratamiento quirurgico inmediato de las lesiones renales severas reduce la morbimortalidad y aumenta la posibilidad de salvamento renal

Instilaçäo de nitrato de prata em hematúria por anemia falciforme: apresentaçäo de caso / Instillation of silver nitrate in a case of hematuria due to sickle cell disease

Os autores apresentam um caso de hematúria unilateral rebelde e grave, num paciente portador de traço de anemia falciforme. Após dois meses de hematúria ininterrupta e 20 dias de tratamento conservador e transfusöes de sangue sem resultado, foi tentada, como opçäo à lombotomia exploradora, uma instilaçäo de nitrato de prata diretamente na pelve renal, o que causou imediata cessaçäo da hemorragia, pelo menos durante três semanas de seguimento, sem seqüelas. Os autores sugerem que essa tentativa pode ser feita em casos selecionados, mesmo que näo de anemia falciforme

Hipercalciuria idiopática en la urolitiasis y hematuria asintomática del niño / Idiopatic hypercalciuria in the urolithiasis and asymptomatic hematuria in child

Entre Febrero de 1984 y Mayo del 85, se estudiaron en forma prospectiva 27 niños con hipercalciuria, quienes presentaron eliminación de calcio en orina de 24 horas mayor de 4 mg/kg con media de 5.56 ñ 1.55 y relación de Cau/Cru mayor de 0.2, con media 0.37 ñ 0.15, con valores de calcio sérico normal. Nueve pacientes (33.3%) presentaron urolitiasis y 18 (66.7%) tuvieron hematuria asintomática 74% correspondieron al sexo masculino. La edad promedio fue de 7.47 ñ 2.86. Veintidos pacientes (81.4%) fueron considerados portadores de calciuria renal, (HIR) al presentar en la prueba de sobre-carga de calcio, valores en ayuna de Cau%Cru de 0.37 ñ 0.08, es decir, mayor de 0.2. En cinco (18.6%) casos se demostró hipercalciuria absortiva (HIA), con valores normales de Cau%Cru en ayunas de 0.13 ñ 0.009 y después de la sobre-carga de calcio, valores elevados 0.46 ñ 0.18. Estos resultados muestran la prevalencia de hipercalciuria renal en niños. Dos de los pacientes con hipercalciuria renal, mostraron evidencias de hiperparatiroidismo secundario en base a la eliminación de Adenosin monofosfato cíclico en orina (AMPc). Los niveles de hormona paratiroidea en suero fueron normales en los 27 niños con hipercalciuria. Tres pacientes con hipercalciuria renal, mostraron respuesta hipercalcémica a la sobre-carga de calcio, con valores de calcio sérico > 10.8 mg/dl. Se encontró correlación positiva (r = 0.7) entre la relación Cau%Cru pre-carga y los valores de calcio sérico post-carga, en los hipercalciurios renales, lo cual sugiere aumento de absorción intestinal de calcio en la HIR y explica la baja incidencia de hiperparatiroidismo ..

La hematuria y su estrategia diagnóstica / Hematuria and its diagnostic strategy

La hematuria no es una enfermedad per se, sino que constituye un signo de enfermedad renal y consiste en la presencia de sangre en la orina, ya sea macroscópica o microscópicamente. En condiciones normales pueden existir una excreción urinaria por día, menor de 1,5 millones de eritrocitos, cantidad contenida en 0,33 mm3 de sangre. En niños asintomáticos se ha detectado hematuria como hallazgo casual en el examen general de orina, con incidencia de 0,5 a 2%

Tratamiento de la hematuria incontrolable mediante instalación vesical de formol al 5 / Treatment of intractable hematuria by intravesical installation of 5 formalin

Se realiza el análisis de 60 pacientes con hematuria incontrolable, tratados por medio de instalación vesical de formol al 5 . Se hace una valoración de las causas de la misma, así como de los resultados favorables obtenidos. Se efectúa una revisión bibliográfica para la publicación del informe preliminar de nuestra experiencia con esta modalidad terapéutica. Se comprueba la necesidad del conocimiento y aplicación de este método de tratamiento