Prospective comparison of two methods for correct ureteral stent placement in pediatric laparoscopic pyeloplasty.

INTRODUCTION: Ureteral stent placement during laparoscopic pyeloplasty is a common procedure in pediatric patients. Although an apparently safe maneuver, ascending placement of the stent can lead to complex removal or repositioning reinterventions. OBJECTIVE: In this study we compare two methods for intraoperative verification of correct positioning. STUDY DESIGN: Prospective observational study collecting data on laparoscopic pyeloplasties in pediatric patients in our center over three years. We carried out descriptive and univariate comparative analyses. Data were compared between ultrasound and reflux visualized by the catheter after intraoperative salineinjection into the bladder through the urethral catheter. We recorded time to catheter visualization in both ultrasonography and in reflux from the start of bladder instillation, as well as bladder volume at the time of placement verification with each method. RESULTS: Data were collected from 20 patients (15 male and 5 female) with a median age of 48 months. Pyeloplasty was successful in 100% of the sample (as observed by ultrasound and MAG-3), while one patient had postoperative leak requiring nephrostomy placement. Correct distal positioning of the ureteral stent could be verified by intraoperative ultrasound and reflux in all cases. Using reflux, the bladder volume needed to verify correct positioning exceeded the age-related maximum in half the cohort, while on ultrasound, the stent was visualized in the bladder without reaching the maximum bladder capacity for age in any case (p = 0.02 comparing percentages). Likewise, mean time to verification was lower with ultrasound than with reflux (61.8 s versus 115 s), but without these differences reaching statistical significance (p = 0.14). DISCUSSION: The present study is the first to compare two methods to verify the correct positioning of the ureteral stent in laparoscopic pyeloplasties in pediatric patients. Our results show that both intraoperative ultrasound and visualization of reflux are useful methods, although ultrasound requires a lower volume of saline instilled through the bladder catheter for verification. This work can be very useful for the daily clinical practice of urologists and pediatric surgeons. CONCLUSIONS: Both intraoperative ultrasound and visualization of reflux are useful methods to verify the correct positioning of the ureteral stent in laparoscopic pyeloplasty of pediatric patients. With ultrasound, a smaller volume is required to check for reflux. Although ultrasound is faster for verification, there are no differences in procedural times.

Response to "Outcomes of infants undergoing laparoscopic pyeloplasty: A single-center experience".

Although studies such as that of Erol et al. can raise doubts to a pediatric urologist about whether or not to carry out a laparoscopic approach in a pyeloplasty in infants, especially due to the percentage of complications, meta-analyses such as the one mentioned reinforce the safety and good results of the laparoscopic approach in these patients. The laparoscopic approach provides potential benefits over open surgery, such as better visualization of polar vessels, less aggressive dissection of periureteral tissues, or smaller scars. Although many open pyeloplasty incisions can be made small, they will never be smaller than those with 3 or 5 mm ports. Thus, any urologist or pediatric surgeon with experience in laparoscopic surgery has sufficient data at their disposal to be confident in the reproducibility and safety of laparoscopic surgery for pyeloplasties in infants. It is appreciated that works such as that of Erol et al. help minimally invasive techniques expand within pediatric urology.

Metabolic analysis using HR-MAS in prostate tissue for prostate cancer diagnosis.

INTRODUCTION: In this study we used nuclear magnetic resonance spectroscopy in prostate tissue to provide new data on potential biomarkers of prostate cancer in patients eligible for prostate biopsy. MATERIAL AND METHODS: Core needle prostate tissue samples were obtained. After acquiring all the spectra using a Bruker Avance III DRX 600 spectrometer, tissue samples were subjected to routine histology to confirm presence or absence of prostate cancer. Univariate and multivariate analyses with metabolic and clinical variables were performed to predict the occurrence of prostate cancer. RESULTS: A total of 201 patients, were included in the study. Of all cores subjected to high-resolution magic angle spinning (HR-MAS) followed by standard histological study, 56 (27.8%) tested positive for carcinoma. According to HR-MAS probe analysis, metabolic pathways such as glycolysis, the Krebs cycle, and the metabolism of different amino acids were associated with presence of prostate cancer. Metabolites detected in tissue such as citrate or glycerol-3-phosphocholine, together with prostate volume and suspicious rectal examination, formed a predictive model for prostate cancer in tissue with an area under the curve of 0.87, a specificity of 94%, a positive predictive value of 80% and a negative predictive value of 84%. CONCLUSIONS: Metabolomics using HR-MAS analysis can uncover a specific metabolic fingerprint of prostate cancer in prostate tissue, using a tissue core obtained by transrectal biopsy. This specific fingerprint is based on levels of citrate, glycerol-3-phosphocholine, glycine, carnitine, and 0-phosphocholine. Several clinical variables, such as suspicious digital rectal examination and prostate volume, combined with these metabolites, form a predictive model to diagnose prostate cancer that has shown encouraging results.

Comparison between open and minimally invasive pyeloplasty in infants: A systematic review and meta-analysis.

INTRODUCTION: Ureteropelvic junction obstruction (UPJO) is the most common cause of congenital hydronephrosis. Techniques such as laparoscopic pyeloplasty (LP) have gained in popularity over recent years. Although some retrospective studies have compared minimally invasive reconstructive techniques with open surgery for treatment of UPJO in infants, results remain controversial due to the small sample size in most of these studies. OBJECTIVE: To verify whether the benefits of minimally invasive pyeloplasty (MIP) observed in adults and children over 2 years of age also apply to infants. METHODS: A systematic review of the literature was performed according to PRISMA recommendations. We searched databases of MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials. We excluded studies in which patient cohorts were outside the age range between 1 and 23 months of age (infants). Studies should evaluate at least one of the following outcomes: average hospital stay, operative time, follow-up time, complications, post-surgical catheter use, success rate and reintervention rate. The quality of the evidence was assessed with the ROBINS-I tool. RESULTS: In total, 13 studies were selected. 3494 patients were included in the meta-analysis, of whom 3054 underwent OP, while the remaining 440 were part of the group undergoing MIP. The mean difference in hospital days was -1.16 lower the MIP group (95 % CI; -1.78, -0.53; p = 0.0003). Also, our analysis showed a significantly shorter surgical time in the group who underwent OP, with a mean operative time of 119.92 min, compared to 137.63 min in the MIP group (95 % CI; -31.76, -6.27; p = 0.003). No statistically significant between-group differences were found respect to follow-up time, complications, post-surgical catheter use, success rate and reintervention rate. CONCLUSION: This systematic review with meta-analysis has shown that laparoscopic/robotic pyeloplasty in infants is a safe technique with similar success rates to open surgery. Nonetheless, randomized clinical trials with longer follow-up are needed to consolidate these results with more robust scientific evidence.

Single-Use Versus Reusable Cystoscope for Ureteral Stent Removal: A Comparative Study of Perceived Pain and Procedure Times.

INTRODUCTION: The aim of this study was to compare the IsirisTM cystoscope with a common reusable flexible cystoscope in terms of patient perceived pain and endoscopy time in the ureteral stent removal setting. MATERIALS AND METHODS: A non-randomized prospective study comparing the IsirisTM single-use cystoscope with a reusable flexible cystoscope. A visual analogue scale (VAS) was used for pain assessment and endoscopy time was recorded in seconds. Univariate and multivariate analyses were performed to assess the correlation between endoscope type and clinical variables with VAS score and endoscopy time. RESULTS: A total of 85 patients were included in the study: 53 in the disposable cystoscope group and 32 in the reusable cystoscope group. Ureteral stent extraction was successful in all cases. The mean VAS score was similar between groups (single-use group was 2.09 +/- 2.53 vs 2.53 +/- 2.14 in the reusable cystoscope group) (p = 0.13). Same was observed endoscopy time (74.92 +/- 74.45 s. in the single-use group vs 98.87 +/- 153.33 s. in the reusable group) (p = 0.07). Age (coefficient ß = -0.36, p < 0.04) and body mass index (BMI) (coefficient ß = -0.22, p < 0.02) were inversely correlated with perceived pain during ureteral stent removal, measured by VAS score. CONCLUSIONS: Ureteral catheter removal with a flexible cystoscope is a well-tolerated procedure in patients. Older age and high BMI are associated with better intervention tolerance. Use of a single-use flexible cystoscope is comparable to that of a common flexible cystoscope in terms of pain and endoscopy time.

Single-Use Versus Reusable Cystoscope for Ureteral Stent Removal: A Comparative Study of Perceived Pain and Procedure Times

Introduction: The aim of this study was to compare the IsirisTM cystoscope with a common reusable flexible cystoscope in terms of patient perceived pain and endoscopy time in the ureteral stent removal setting. Materials and Methods: A non-randomized prospective study comparing the IsirisTM single-use cystoscope with a reusable flexible cystoscope. A visual analogue scale (VAS) was used for pain assessment and endoscopy time was recorded in seconds. Univariate and multivariate analyses were performed to assess the correlation between endoscope type and clinical variables with VAS score and endoscopy time. Results: A total of 85 patients were included in the study: 53 in the disposable cystoscope group and 32 in the reusable cystoscope group. Ureteral stent extraction was successful in all cases. The mean VAS score was similar between groups (single-use group was 2.09 +/– 2.53 vs 2.53 +/– 2.14 in the reusable cystoscope group) (p = 0.13). Same was observed endoscopy time (74.92 +/– 74.45 s. in the single-use group vs 98.87 +/– 153.33 s. in the reusable group) (p = 0.07). Age (coefficient β = –0.36, p < 0.04) and body mass index (BMI) (coefficient β = –0.22, p < 0.02) were inversely correlated with perceived pain during ureteral stent removal, measured by VAS score. Conclusions: Ureteral catheter removal with a flexible cystoscope is a well-tolerated procedure in patients. Older age and high BMI are associated with better intervention tolerance. Use of a single-use flexible cystoscope is comparable to that of a common flexible cystoscope in terms of pain and endoscopy time (AU)

Renal Cyst after Heminephrectomy in a Pediatric Patient: Complication or Normality?

INTRODUCTION: In this work, we present two cases of heminephrectomies with postoperative findings of cystic lesions in the bed of the excised renal segment. MATERIAL AND METHODS: Description of the clinical cases, therapeutic management and description of the ultrasound findings. A review of the published cases was carried out. RESULTS: We present a case of open heminephrectomy due to atrophy of the upper hemirrenal in a case of ureterocele, and another case with bilateral lower heminephrectomy in a case of vesicoureteral reflux disease. In the first case, the cystic lesion disappeared during follow-up, while in the second, the cysts remained stable. In none of the cases published in the literature was it necessary to perform any intervention to resolve the cysts. CONCLUSIONS: The appearance of cystic lesions in the heminephrectomy bed in pediatric patients is a radiological finding that occurs frequently. Due to its favorable evolution, without the need for additional procedures for its resolution, we do not consider the presence of these lesions as a complication after heminephrectomy.

Microbladder due to Granulomatous Cystitis Secondary to BCG Treatment.

INTRODUCTION: Intravesical immunotherapy with bacillus Calmette-Guerin (BCG) is considered as the standard treatment for non-muscle invasive bladder cancer with high risk of recurrence and progression. OBJECTIVE: To report a case of granulomatous cystitis in a patient receiving BCG intravesical therapy for urothelial carcinoma. MATERIAL AND METHODS: A 63-year-old man underwent BCG treatment for a bladder tumor with pathological diagnosis of T1G3 urothelial carcinoma. Five months later, trans urethral resection (TUR) of bladder was performed for an erythematous lesion, with results of post-BCG cystitis. Two years later, the patient presented with hematuria and with suspicious findings in the cystoscopy (extensive fibrin-covered and calcified lesions in the bladder) and a bladder TUR was done. RESULTS: The histopathological study showed granulomatous cystitis with necrosis and the presence of BAAR compatible with post-BCG origin. In the mycobacterial culture, M. bovis grew, and treatment was initiated. A cystography was performed on suspicion of a microbladder on CT with secondary vesicoureteral reflux, confirmed in this test. It was decided to perform a radical cystectomy. Histopathology reported post-BCG granulomatous cystitis and prostatitis. CONCLUSIONS: After BCG treatment, if symptoms or images are suggestive of granulomatous cystitis, a study of mycobacterial infection should be started to avoid the development of complications, such as the microbladder as in the case we present.

Emergency Radical Nephrectomy in a Polytrauma Patient.

INTRODUCTION: The renal trauma is present in a 5% of all trauma cases. In the most common causes, conservative treatment can be performed. It is reported a case of renal trauma due to metal sick that required surgical management. It is considered that this is a rare clinical case with urgent surgical management that is not usual in this type of trauma. In addition, it is an example of quick decision-making since the patient's life depends on them. CASE REPORT: A 69-year-old man was referred to our institution for polytrauma. In contrast-enhanced computed tomography, renal, intestinal and great vessel were suspected, so an urgent surgical treatment was decided. During surgery, radical nephrectomy was performed due to perforation of the right kidney by a metal stick. CONCLUSIONS: Although conservative treatment of renal trauma can be performed in most cases, it must be taken into account that radical nephrectomy is a possible option when the kidney cannot be preserved.

Renal Cyst after Heminephrectomy in a Pediatric Patient: Complication or Normality?

Introduction: In this work, we present two cases of heminephrectomies with postoperative findings of cystic lesions in the bed of the excised renal segment. Material and Methods: Description of the clinical cases, therapeutic management and description of the ultrasound findings. A review of the published cases was carried out. Results: We present a case of open heminephrectomy due to atrophy of the upper hemirrenal in a case of ureterocele, and another case with bilateral lower heminephrectomy in a case of vesicoureteral reflux disease. In the first case, the cystic lesion disappeared during follow-up, while in the second, the cysts remained stable. In none of the cases published in the literature was it necessary to perform any intervention to resolve the cysts. Conclusions: The appearance of cystic lesions in the heminephrectomy bed in pediatric patients is a radiological finding that occurs frequently. Due to its favorable evolution, without the need for additional procedures for its resolution, we do not consider the presence of these lesions as a complication after heminephrectomy (AU)

Objetivos: En este trabajo presentamos dos casos deheminefrectomías con hallazgos en el postoperatorio de lesiones quísticas en el lecho del segmento renal extirpado.Material y Métodos: Descripción de los casos clínicos, manejo terapéutico y descripción de los hallazgosecográficos. Se realizó una revisión de los casos publicados.Resultados: Presentamos un caso de heminefrectomía abierta por atrofia de hemirriñón superior en un casode ureterocele, y otro caso con heminefrectomía inferior bilateral en un caso de enfermedad por reflujo vesicoureteral.En el primer caso, la lesión quística desapareció duranteel seguimiento, mientras que en segundo, los quistes permanecieron estables. En ninguno de los casos publicadosen la literatura se precisó realizar ninguna intervención pararesolución de los quistes.Conclusiones: La aparición de lesiones quísticas enel lecho de la heminefrectomía en pacientes pediátricos esun hallazgo radiológico que sucede con frecuencia. Debidoa su evolución favorable, sin necesidad de procedimientosadicionales para su resolución, no consideramos la presencia de estas lesiones como una complicación tras la heminefrectomía. (AU)

Early Ultrasound after Endoscopic Puncture of Ureterocele: Signs that Show Surgical Treatment Success.

INTRODUCTION: We show the ability of early ultrasound after surgery to show the success of endoscopic puncture of the ureterocele. METHOD: Description of the clinical cases, therapeutic management and description of the ultrasound findings. RESULTS: We present two infants aged 1 and 4 months who underwent endoscopic puncture of ectopic ureteroceles during a period of 3 months at our institution. The first case was operated urgently for urinary sepsis, while the second was punctured to preserve renal function. In both cases, ultrasound was performed two hours after surgery, and the ultrasound findings were recorded. In both patients, the ureterocele was considered resolved one year after the puncture. CONCLUSIONS: Findings such as puncture notch, flap-like collapse of the walls, decrease in ureterohydronephrosis, or disappearance of debris in the upper tract, are ultrasound signs that are visualized in the immediate postoperative period of endoscopic puncture of the ureterocele. Thus, early ultrasound is useful for early monitoring of endoscopic treatment of ureterocele.

Microbladder due to Granulomatous Cystitis Secondary to BCG Treatment

Introduction: Intravesical immunotherapy with bacillus Calmette-Guerin (BCG) is considered as the standard treatment for non-muscle invasive bladder cancer with high risk of recurrence and progression. Objective: To report a case of granulomatous cystitis in a patient receiving BCG intravesical therapy for urothelial carcinoma. Material and Methods: A 63-year-old man underwent BCG treatment for a bladder tumor with pathological diagnosis of T1G3 urothelial carcinoma. Five months later, trans urethral resection (TUR) of bladder was performed for an erythematous lesion, with results of post-BCG cystitis. Two years later, the patient presented with hematuria and with suspicious findings in the cystoscopy (extensive fibrin-covered and calcified lesions in the bladder) and a bladder TUR was done. Results: The histopathological study showed granulomatous cystitis with necrosis and the presence of BAAR compatible with post-BCG origin. In the mycobacterial culture, M. bovis grew, and treatment was initiated. A cystography was performed on suspicion of a microbladder on CT with secondary vesicoureteral reflux, confirmed in this test. It was decided to perform a radical cystectomy. Histopathology reported post-BCG granulomatous cystitis and prostatitis. Conclusions: After BCG treatment, if symptoms or images are suggestive of granulomatous cystitis, a study of mycobacterial infection should be started to avoid the development of complications, such as the microbladder as in the case we present (AU)

Emergency Radical Nephrectomy in a Polytrauma Patient

Introduction: The renal trauma is present in a 5% of all trauma cases. In the most common causes, conservative treatment can be performed. It is reported a case of renal trauma due to metal sick that required surgical management. It is considered that this is a rare clinical case with urgent surgical management that is not usual in this type of trauma. In addition, it is an example of quick decision-making since the patient’s life depends on them. Case Report: A 69-year-old man was referred to our institution for polytrauma. In contrast-enhanced computed tomography, renal, intestinal and great vessel were suspected, so an urgent surgical treatment was decided. During surgery, radical nephrectomy was performed due to perforation of the right kidney by a metal stick. Conclusions: Although conservative treatment of renal trauma can be performed in most cases, it must be taken into account that radical nephrectomy is a possible option when the kidney cannot be preserved (AU)

Use of Circular RNAs in Diagnosis, Prognosis and Therapeutics of Renal Cell Carcinoma.

Renal cell carcinoma is the most common type of kidney cancer, representing 90% of kidney cancer diagnoses, and the deadliest urological cancer. While the incidence and mortality rates by renal cell carcinoma are higher in men compared to women, in both sexes the clinical characteristics are the same, and usually unspecific, thereby hindering and delaying the diagnostic process and increasing the metastatic potential. Regarding treatment, surgical resection remains the main therapeutic strategy. However, even after radical nephrectomy, metastasis may still occur in some patients, with most metastatic renal cell carcinomas being resistant to chemotherapy and radiotherapy. Therefore, the identification of new biomarkers to help clinicians in the early detection, and treatment of renal cell carcinoma is essential. In this review, we describe circRNAs related to renal cell carcinoma processes reported to date and propose the use of some in therapeutic strategies for renal cell carcinoma treatment.

[The use of urokinase in urinary catheter obstructed by clots.] / El uso de urocinasa en catéteres urinarios obstruidos por coágulos.

OBJECTIVE: The objective of thisstudy is to review three cases using urokinase in patientswith urinary catheter obstructed by clots, aswell to carry out a review of the published literature. METHODS: It was done a review of three casesfrom 2019 to 2020 who required urokinase due tourinary catheters obstructed by clots in our department.In addition, a reference search was performedin Pubmed. RESULTS: The first case was a woman with metastaticbreast carcinoma who required nephrostomyplacement. The second case was a renal trauma thatrequired bladder catheterization. The third case wasa male with a benign ureteric obstruction who requirednephrostomy placement due to sepsis. After instillationswith urokinase, the first two cases respondedadequately, while the third was unsuccessful. CONCLUSIONS: Urokinase may be an effectiveand well-tolerated therapy in the treatment of coagulatedurinary catheters that does not respond toother measures.

OBJETIVO: Reportar tres casos acercadel uso de la urocinasa en pacientes portadores decatéteres urinarios obstruidos por coágulos y realizaruna revisión de la literatura publicada. MATERIAL Y MÉTODOS: Revisión de casos quehan precisado de urocinasa en nuestro servicio de2019 a 2020 en relación a pacientes con catéteresurinarios obstruidos por coágulos. Además, se realizóbúsqueda de referencias en Pubmed. RESULTADOS: El primer caso fue una mujer concarcinoma de mama metástasico que precisó colocaciónde nefrostomías. El segundo fue un paciente pediátricocon traumatismo renal que requirió sondajevesical. El último enfermo fue un varón con obstrucciónbenigna de uréter que precisó de nefrostomía porsepsis. Tras instilaciones con urocinasa, los dos primerospacientes respondieron adecuadamente, mientrasque no hubo éxito en el tercero. CONCLUSIONES: La urocinasa puede ser unaterapia eficaz y bien tolerada en el tratamiento decatéteres urinarios coagulados que no responden aotras medidas.

El uso de urocinasa en catéteres urinarios obstruidos por coágulos / The use of urokinase in urinary catheter obstructed by clots

OBJETIVO: Reportar tres casos acerca del uso de la urocinasa en pacientes portadores decatéteres urinarios obstruidos por coágulos y realizaruna revisión de la literatura publicada.MATERIAL Y MÉTODOS: Revisión de casos quehan precisado de urocinasa en nuestro servicio de2019 a 2020 en relación a pacientes con catéteresurinarios obstruidos por coágulos. Además, se realizóbúsqueda de referencias en Pubmed.RESULTADOS: El primer caso fue una mujer concarcinoma de mama metástasico que precisó colocación de nefrostomías. El segundo fue un paciente pediátrico con traumatismo renal que requirió sondajevesical. El último enfermo fue un varón con obstrucción benigna de uréter que precisó de nefrostomía porsepsis. Tras instilaciones con urocinasa, los dos primeros pacientes respondieron adecuadamente, mientras que no hubo éxito en el tercero.CONCLUSIONES: La urocinasa puede ser unaterapia eficaz y bien tolerada en el tratamiento decatéteres urinarios coagulados que no responden aotras medidas. (AU)

OBJECTIVE: The objective of thisstudy is to review three cases using urokinase in patients with urinary catheter obstructed by clots, aswell to carry out a review of the published literature.METHODS: It was done a review of three casesfrom 2019 to 2020 who required urokinase due tourinary catheters obstructed by clots in our department. In addition, a reference search was performedin Pubmed.RESULTS: The first case was a woman with metastatic breast carcinoma who required nephrostomyplacement. The second case was a renal trauma thatrequired bladder catheterization. The third case wasa male with a benign ureteric obstruction who required nephrostomy placement due to sepsis. After instillations with urokinase, the first two cases respondedadequately, while the third was unsuccessful.CONCLUSIONS: Urokinase may be an effectiveand well-tolerated therapy in the treatment of coagulated urinary catheters that does not respond toother measures. (AU)

Retrograde endoureterotomy as a treatment option for impacted calculus in the ureterointestinal junction.

INTRODUCTION: In patients with a history of radical cystectomy and with intestinal diversion, urolithiasis in the upper urinary tract is a frequent event. MATERIAL AND METHODS: We describe for the first time a case of retrograde endoureterotomy used to treat a calculus proximal to the ureterointestinal junction. RESULTS: This technique is of interest when antegrade access is not possible. In our example, after passing the guidewire percutaneously, and externalize it through the stoma, the left meatus was reached with a resectoscope inserted through the ileal duct. After the use of a balloon to prevent migration of the calculus, a retrograde endoureterotomy was performed with a Collins knife and the stone removed. The patient's progress was satisfactory. CONCLUSION: Endoscopic management of calculi in patients with intestinal diversion can be performed with different approaches. We recommend retrograde endoureterotomy as a feasible treatment option for the removal of impacted calculi at the ureterointestinal junction.