ABSTRACT
PURPOSE: We determined the efficacy and safety of flexible ureterorenoscopy for single intrarenal calculi and further stratified efficacy by stone burden. MATERIALS AND METHODS: CROES collected prospective data on consecutive patients with urinary stones treated with ureterorenoscopy at 114 centers worldwide for 1 year. Only patients who underwent flexible ureterorenoscopy for a solitary renal stone were included in study. Preoperative and intraoperative characteristics, and postoperative outcomes were evaluated. Relationships between stone size and the stone-free rate, operative time, complications, hospital stay and need for re-treatment were determined. RESULTS: A total of 1,210 patients with a solitary kidney stone less than 10 (52.2%), 10 to 20 (43.2%) and greater than 20 mm (4.6%) were treated with flexible ureterorenoscopy. The stone-free rate negatively correlated with stone size when adjusted for body mass index. Operative time positively correlated with stone size when adjusted for body mass index. The single session stone-free rate was 90% and 80% for stones less than 10 and less than 15 mm, respectively. Patients with stones greater than 20 mm achieved a 30% stone-free rate, more often needed re-treatment and were more often rehospitalized. There was no difference in the overall complication rate by stone size. However, patients with a stone greater than 20 mm showed a higher probability of fever after flexible ureterorenoscopy than those with a smaller stone. CONCLUSIONS: Our data indicate that flexible ureterorenoscopy for a single intrarenal stone is a safe procedure. Best results after single session flexible ureterorenoscopy were obtained for stones less than 15 mm.
Subject(s)
Kidney Calculi/surgery , Ureteroscopy , Humans , Prospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: Migration of objects into the urinary tract from the digestive tract has been described. Our objective is to report the case of a patient with urosepsis and late migration of toothpick from the gastrointestinal tract into the bladder. METHODS: A 78 y/o male patient with uro-sepsis and hydronephrosis was admitted. The initial suspected etiological cause was obstructive ureteral lithiasis. CT scan showed hydronephrosis and a possible ureteral stone. However, a femoral catheter was in place near the toothpick location, which jeopardized the detection of the foreign body. Antibiotic therapy and placement of a ureteral stent were performed. Once infection subsided, ureteroscopy was carried out showing a slight extrinsic compression of the distal ureter. The patient was readmitted with urinary infection. New imaging studies showed a foreign body in the bladder, which was not evident previously. Cystoscopy showed a toothpick penetrating the bladder and it was removed. RESULTS: Retrospectively, we interpreted that the foreign body perforated the gastrointestinal tract, migrated to the retroperitoneum and caused upper urinary tract obstruction by inflammatory reaction in the periureteral tissues. Once infection was solved, ureteral manipulation by ureteroscopy may have caused the toothpick migration into the bladder. CONCLUSIONS: Migration of foreign bodies from the gastrointestinal tract into the bladder occurs rarely. They clinically present as a complicated urinary tract infection. Imaging studies make the diagnosis, and a high level of suspicion is required.
Subject(s)
Foreign-Body Migration/complications , Hydronephrosis/etiology , Urinary Bladder Diseases/etiology , Urinary Bladder/diagnostic imaging , Urinary Tract Infections/etiology , Aged , Cystoscopy , Endoscopy , Foreign-Body Migration/diagnostic imaging , Humans , Male , Parkinson Disease/complications , Tomography, X-Ray Computed , Ultrasonography , Urinary Bladder/surgery , Urinary Bladder Diseases/diagnostic imaging , Urologic Surgical ProceduresABSTRACT
La endopielotomía endoscópica alcanzó una importancia capital a partir de 1984, para el tratamiento de la obstrucción del tracto urinario superior. Primeramente por vía anterógrada y posteriormente por vía retrograda. Para simplificar estas técnicas se creó un catéter (Acucise), con el cual se realizan incisiones por vía cistoscópica, con control fluoroscópico. El mismo, incorpora un balón de tamponaje de 8mm de diámetro y un electrodo monopolar longitudinal de 100 micras de grosor. El presente trabajo es el primer reporte del uso del catéter Acucise en Venezuela. 6 pacientes con obstrucción del tracto urinario superior, (obstrucción de la unión pieloureteral), fueron tratados mediante incisiones internas con el catéter Acucise. El tiempo operatorio promedio fue de 48 min. y el período promedio de hospitazación fue de días. Se utilizó anestesia peridural en todos los casos. El seguimiento promedio fue de 12 meses. Las evaluaciones postoperatorias se realizaron en base a mejoría clínica, urogramas excretores y renogramas isotópicos. Obtuvimos resultados exitosos en el 83 por ciento de los casos (mejoría clínica y radiológica). Nuestra experiencia preliminar, aunque limitada, nos permite concluir que el tratamiento de la obstrucción del tracto urinario superior con el catéter Acucise es efectivo y seguro, pudiendo convertirse en una alternativa menos invasiva que la endopielotomía endoscópica.
Subject(s)
Humans , Endoscopy , Urethral Obstruction , Urethral Obstruction/therapyABSTRACT
Se expone la experiencia del abordaje transumbilical en reparación de hernias moldeable en una casuística de 80 casos
Subject(s)
Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Hernia, Umbilical/surgeryABSTRACT
Las hernias umbilicales ocupan un lugar importante dentro de la patología herniaria, con una alta incidencia tanto en niños como en adultos, afectando entre un 18 y 26// de la población general. La alta incidencia de complicaciones de las hernias umbilicales en el adulto, obliga la reparación de todas ellas. Tomando en consideración el efecto negativo que una cicatriz visible ocasiona en la población actual, consciente de su aspecto corporal, se describe una alternativa quirúrgica para el abordaje y reparación de las hernias umbilicales a través de una incisión transumbilical
Subject(s)
Child , Adult , Humans , Male , Female , Hernia, Umbilical/surgery , Surgical Procedures, OperativeABSTRACT
Se presenta un caso de actinomicosis abdómino-pélvica asociado a dispositivos intrauterino en una paciente de 26 años de edad con historia de síntomas abdominales y masa en fosa ilíaca derecha de dos semanas de evolución. Los exámenes de ingreso sugirieron el diagnóstico de plastrón apendicular involucrado vejiga anexo derecho. El drenaje quirúrgico seguido de tratamiento con penicilina G dio buen resultado