Calcified intrarenal aneurysm simulating urinary lithiasis.

We describe the case of a female patient with calcification in renal topography, initially diagnosed as lithiasis in the left kidney, and later attributed to calcification of intrarenal vascular aneurysm. Next, we discuss the relevance of considering such an entity in the differential diagnoses of intrarenal calcifications before choosing any form of specific interventional treatment.

Calcified intrarenal aneurysm simulating urinary lithiasis

ABSTRACT We describe the case of a female patient with calcification in renal topography, initially diagnosed as lithiasis in the left kidney, and later attributed to calcification of intrarenal vascular aneurysm. Next, we discuss the relevance of considering such an entity in the differential diagnoses of intrarenal calcifications before choosing any form of specific interventional treatment.

Steinstrasse predictive factors and outcomes after extracorporeal shockwave lithotripsy.

PURPOSE: Urinary stone disease is a common medical problem. Extracorporeal shockwave lithotripsy (SWL) has been applied with high success and low complication rates. Steinstrasse (SS) is a possible complication after SWL. The aim of the present study was to prospectively evaluate the factors and outcomes associated with SS after SWL. MATERIALS AND METHODS: We have prospectively evaluated 265 SWL sessions (2005-2009). Two lithotriptors were used randomly: Siemens Lithostar and Dornier Compact S. All patients had imaging exams after 30 and 90 days or according to symptoms. RESULTS: SS was observed in 14 (5.3%) out of 265 SWL procedures (n = 175 patients, 51.5% women/48.5% men, mean ± SD age = 46.3 ± 15.5 years). SS was more common after SWL for pelviureteral calculi rather than caliceal stones (p = 0.036). There was a trend toward more occurrences of SS after SWL for larger stone area (> 200 mm², p = 0.072). Preoperative ureteral stent didn't prevent SS. SWL machine, intensity, number of pulses and frequency were not associated with SS formation. Post-SWL pain, fever and gravel elimination were factors associated with SS (p = 0.021; p = 0.011; p = 0.078). When SS occurred, treatment modalities included Medical Expulsive Therapy (MET), ureteroscopy and SWL. CONCLUSIONS: Steinstrasse is an uncommon event after SWL and seems to occur more frequently with larger pelviureteral stones. Impaction of stones is more frequent in the middle ureter. All patients should be followed after SWL, but SS should be specially suspected if there is macroscopic gravel elimination, flank pain and/or fever. When SS occurs, treatment should be promptly introduced, including medical expulsive therapy, surgical approach or SWL in selected cases. Further prospective studies are awaited to evaluated preventive measures for SS occurrence.

Steinstrasse predictive factors and outcomes after extracorporeal shockwave lithotripsy

PURPOSE: Urinary stone disease is a common medical problem. Extracorporeal shockwave lithotripsy (SWL) has been applied with high success and low complication rates. Steinstrasse (SS) is a possible complication after SWL. The aim of the present study was to prospectively evaluate the factors and outcomes associated with SS after SWL. MATERIALS AND METHODS: We have prospectively evaluated 265 SWL sessions (2005-2009). Two lithotriptors were used randomly: Siemens Lithostar and Dornier Compact S. All patients had imaging exams after 30 and 90 days or according to symptoms. RESULTS: SS was observed in 14 (5.3 percent) out of 265 SWL procedures (n = 175 patients, 51.5 percent women/48.5 percent men, mean ± SD age = 46.3 ± 15.5 years). SS was more common after SWL for pelviureteral calculi rather than caliceal stones (p = 0.036). There was a trend toward more occurrences of SS after SWL for larger stone area (> 200 mm², p = 0.072). Preoperative ureteral stent didn't prevent SS. SWL machine, intensity, number of pulses and frequency were not associated with SS formation. Post-SWL pain, fever and gravel elimination were factors associated with SS (p = 0.021; p = 0.011; p = 0.078). When SS occurred, treatment modalities included Medical Expulsive Therapy (MET), ureteroscopy and SWL. CONCLUSIONS: Steinstrasse is an uncommon event after SWL and seems to occur more frequently with larger pelviureteral stones. Impaction of stones is more frequent in the middle ureter. All patients should be followed after SWL, but SS should be specially suspected if there is macroscopic gravel elimination, flank pain and/or fever. When SS occurs, treatment should be promptly introduced, including medical expulsive therapy, surgical approach or SWL in selected cases. Further prospective studies are awaited to evaluated preventive measures for SS occurrence.

Extensive ureteral stricture after percutaneous nephrolithotomy.

OBJECTIVE: To present a previously unreported long term complication of percutaneous nephrolithotomy for exclusive renal stone. METHODS/RESULTS: A 30-years-old woman underwent percutaneous nephrolithotomy for a obstructive pelvic stone, through inferior calix access achieving a stone free status. During the procedure occurred an inadvertent pelvis perforation, but the early evolution was otherwise uneventful. Patient was asymptomatic during the follow-up. However, a urinary ultrasound disclosed important pielocalyceal dilation, and further investigation demonstrated extensive proximal ureteral stricture. CONCLUSION: Ureteral stricture may rarely occur as a late complication of percutaneous nephrolithotomy. A review of the literature of this quite uncommon complication was performed and the authors discuss the possible etiology and preventive measures.

Experiência da Faculdade de Medicina do ABC em nefrolitotripsia percutânea / Experience of the Faculdade de Medicina do ABC in percutaneous nephrolithotripsy

Objetivos: Demonstrar a experiência e os resultados em nefrolitotripsia percutânea na Faculdade de Medicina do ABC. Pacientes e métodos: Entre janeiro de 2002 e janeiro de 2005, foram revisados os prontuários de 69 pacientes foram submetidos a NLPC. Resultados: A massa calcárea média foi de 850 mm2. Todos os pacientes foram tratados através de apenas uma punção renal e somente em 1 caso foi necessária transfusão peri-operatória. A taxa de sucesso após o procedimento inicial foi de 70%, sendo 39% livre de cálculo. Após tratamentos complementares a taxa de sucesso final foi de 85,5%. Conclusão: Os nossos resultados iniciais em NLPC foram um pouco inferiores aos publicados em outras séries. Tal diferença pode ser justificada pela curva de aprendizado inicial neste procedimento, envolvimento de residentes em treinamento, pelo maior volume dos cálculos em relação aos trabalhos da literatura, por ter sido realizada apenas uma punção e não disponibilidade de material flexível para exploração completa da via excretora.

Litíase ureteral gigante: relato de caso / Giant ureteral stone: case report

A cirurgia convencional para o tratamento dos cálculos urináriosestá hoje restrita a algumas situações especiais, ou quando há falha do tratamento minimamente invasivo. A litíase ureteral gigante é uma entidade patológica rara. O tratamento clássico é aureterolitotomia com ampla incisão do ureter. Relatamos um caso de um paciente de 16 anos do sexo masculino que apresentou um cálculo ureteral de 11 cm, submetido a cirurgia aberta, onde a fratura do cálculo e uma incisão de 2 cm no ponto médio do cálculopermitiram uma menor agressão ao ureter para retirada do cálculo.Não houve complicações e o paciente recebeu alta no 4º dia pósoperatório.Especulamos que a técnica utilizada pode ser perfeitamente reprodutível por laparoscopia, tornando o procedimento ainda menos invasivo.