Nefrolitotomía percutánea bilateral simultánea: Eficacia y seguridad" / Simultaneous bilateral percutaneous nephrolithotomy: Effectiveness and safety

Objetivos: Evaluar la efectividad y seguridad de la nefrolitotomía percutánea bilateral simultánea realizada en pacientes afectados de litiasis renales bilaterales. Material y métodos: Estudio prospectivo, período de septiembre de 2012 a noviembre de 2016. Se incluyeron pacientes diagnosticados de litiasis renales bilaterales por TC abdominal. Técnica quirúrgica posición en prono, punción renal guiada por fluoroscopia y dilatación del tracto hasta 24Ch. Se revisaron las características demográficas y de las litiasis, la tasa libre de litiasis, el éxito clínico, las complicaciones y el seguimiento. Resultados: Durante el período de estudio, se realizaron 732 nefrolitotomías percutáneas. Dieciocho pacientes (36 unidades renales; 2,5%), 13 hombres y 5 mujeres con una mediana de edad de 58 años y un rango intercuartílico (RIC) de 40-66. Tamaño de la litiasis mediana de 228 mm2 (RIC 134-389), tiempo operativo mediana de 150 min (RIC 97-180) y una estancia hospitalaria mediana de 5 días (RIC 5-15). La tasa libre de litiasis fue del 80%. Se reportaron litiasis residuales en 8 unidades renales (22,2%) que requirieron técnicas complementarias para su completa resolución, 4 litotricias extracorpóreas por ondas de choque, una ureterolitotomía por laparotomía, 2 ureteroscopias y un segundo procedimiento. Complicaciones mayores incluyeron 4 hemorragias manejadas mediante embolización por angiografía. Mediana de seguimiento 36 meses (rango 26-46). Conclusiones: La nefrolitotomía percutánea bilateral simultánea es un procedimiento eficaz y seguro en pacientes afectados con cálculos renales bilaterales. Es un desafío quirúrgico que debe realizarse en pacientes seleccionados y en centros con experiencia

Objectives: To evaluate the effectiveness and safety of simultaneous bilateral percutaneous nephrolithotomy performed in patients affected with bilateral renal calculi. Materials and methods: This is a prospective study from September 2012 to November 2016. Patients diagnosed of bilateral kidney stones with abdominal CT scan were included. Surgical technique prone position, renal puncture guided by fluoroscopy and tract dilation up to 24Ch. We reviewed demographic and stone characteristics, stone free rate, clinical success, complications and follow-up. Results: During the study period, 732 percutaneous nephrolithotomies were performed. Eighteen patients were included (36 renal units, 2.5%), 13 men and 5 women, with a median age of 58 years and an interquartile range (IQR) of 40-66. Median stone burden was 22 8mm2 (IQR 134-389); median operative time, 150 minutes (IQR 97-180); and median hospital stay, 5 days (IQR 5-15). Stone free rate was 80%. Residual calculi were encountered in 8 renal units (22.2%) and required other complementary techniques for their complete tesolution 4 external shockwave lithotripsies, one open ureterolithotomy, 2 ureteroscopies and one second look. Major complications included 4 cases of severe hemorrhage managed with angiographic embolization. The median follow-up was 36 months (range 26-46). Conclusions: Simultaneous bilateral percutaneous nephrolithotomy is an effective and safe procedure in patients affected with bilateral renal calculi. It is a surgical challenge that should be performed in selected patients and in centers with experience

Simultaneous bilateral percutaneous nephrolithotomy: Effectiveness and safety. / Nefrolitotomía percutánea bilateral simultánea: Eficacia y seguridad".

OBJECTIVES: To evaluate the effectiveness and safety of simultaneous bilateral percutaneous nephrolithotomy performed in patients affected with bilateral renal calculi. MATERIALS AND METHODS: This is a prospective study from September 2012 to November 2016. Patients diagnosed of bilateral kidney stones with abdominal CT scan were included. Surgical technique prone position, renal puncture guided by fluoroscopy and tract dilation up to 24Ch. We reviewed demographic and stone characteristics, stone free rate, clinical success, complications and follow-up. RESULTS: During the study period, 732 percutaneous nephrolithotomies were performed. Eighteen patients were included (36 renal units, 2.5%), 13 men and 5 women, with a median age of 58 years and an interquartile range (IQR) of 40-66. Median stone burden was 228mm2 (IQR 134-389); median operative time, 150minutes (IQR 97-180); and median hospital stay, 5 days (IQR 5-15). Stone free rate was 80%. Residual calculi were encountered in 8 renal units (22.2%) and required other complementary techniques for their complete tesolution 4 external shockwave lithotripsies, one open ureterolithotomy, 2 ureteroscopies and one second look. Major complications included 4 cases of severe hemorrhage managed with angiographic embolization. The median follow-up was 36 months (range 26-46). CONCLUSIONS: Simultaneous bilateral percutaneous nephrolithotomy is an effective and safe procedure in patients affected with bilateral renal calculi. It is a surgical challenge that should be performed in selected patients and in centers with experience.

Complicaciones de la nefrolitotomía percutánea en decúbito prono de acuerdo a la clasificación de Clavien-Dindo modificada / Complications of percutaneous nephrolithotomy in the prone position according with modified Clavien-Dindo grading system

Introducción: La clasificación de Clavien ha sido propuesta como sistema para determinar el grado de complicaciones perioperatorias en la nefrolitotomía percutánea. Comunicamos las complicaciones acaecidas en los últimos 2 años en la realización de esta técnica utilizando la clasificación estratificada de Clavien-Dindo. Materiales y métodos: Entre 2011 y 2012 se han realizado 255 nefrolitotomías percutáneas en nuestro centro por litiasis renal superior a 2 cm. A partir de los datos obtenidos se lleva a cabo un análisis estadístico para determinar la incidencia de complicaciones según la clasificación de Clavien-Dindo modificada. Resultados: Durante el período analizado se realizaron 255 nefrolitotomías percutáneas en 249 pacientes, 41% del lado derecho, 57% del lado izquierdo y 2% bilateral simultáneo, de ellos 137 fueron hombres y 112 mujeres. Entre las comorbilidades más prevalentes encontramos la HTA en 101 pacientes (40,6%), IMC > 30 en 81 pacientes (32%), diabetes mellitus 46 pacientes (18,5%) y alteraciones de la coagulación en 24 pacientes (9,6%). Encontramos 70 casos (27,4%) de complicaciones que se distribuyen según la clasificación de Clavien-Dindo en: grado i 8,4%, grado ii 8,4%, grado iiia 4,4%, grado iiib 6% y grado iva: 0,8%, grado ivb: 0% y grado v 0%. Conclusiones: Un esquema de clasificación graduada para informar las complicaciones de la nefrolitotomía percutánea es útil para el seguimiento y notificación de los resultados. Consideramos de gran utilidad estandarizar su uso para poder hacer comparables los resultados entre los distintos centros que realizan dicha técnica

Introduction:Clavien-Dindo classification system has been proposed to grade perioperative complications in percutaneous nephrolithotomy. The complications of this technique that have taken place in the last 2 years are reported in this paper according Clavien-Dindo classification. Materials and methods: Between 2011 and 2012 a total of 255 percutaneous nephrolithotomy were performed at our center for stones more than 2 cm in size. In order to determine the incidence of complications classified in the modified Clavien-Dindo system, statistical analysis of the data obtained was carried out. Results: During the period analyzed, 255 percutaneous nephrolithotomy were performed in 249 patients, 41% of the right side, 57% of the left side and 2% bilateral and simultaneous. 137 and 112 patients were males and females, respectively. The most prevalent comorbidities were: hypertension (AHT) in 101 patients (40.6%), BMI > 30 in 81 patients (32%), diabetes mellitus in 46 patients (18.5%) and coagulation abnormalities in 24 patients (9.6%). A total of 70 cases (27.4%) were distributed according to Clavien-Dindo classification: grade i, 8.4%, grade ii 8.4%, grade iiia 4.4%, grade iiib 6% grade iva .8%, grade ivb: 0% and grade v 0%. Conclusions: A graded classification scheme for reporting the complications of percutaneous nephrolithotomy is useful for monitoring and reporting outcomes. We propose a standardized use of this classification in order to make the results comparable among different centers performing the technique

Complications of percutaneous nephrolithotomy in the prone position according with modified Clavien-Dindo grading system.

INTRODUCTION: Clavien-Dindo classification system has been proposed to grade perioperative complications in percutaneous nephrolithotomy. The complications of this technique that have taken place in the last 2 years are reported in this paper according Clavien-Dindo classification. MATERIALS AND METHODS: Between 2011 and 2012 a total of 255 percutaneous nephrolithotomy were performed at our center for stones more than 2 cm in size. In order to determine the incidence of complications classified in the modified Clavien-Dindo system, statistical analysis of the data obtained was carried out. RESULTS: During the period analyzed, 255 percutaneous nephrolithotomy were performed in 249 patients, 41% of the right side, 57% of the left side and 2% bilateral and simultaneous. 137 and 112 patients were males and females, respectively. The most prevalent comorbidities were: hypertension (AHT) in 101 patients (40.6%), BMI>30 in 81 patients (32%), diabetes mellitus in 46 patients (18.5%) and coagulation abnormalities in 24 patients (9.6%). A total of 70 cases (27.4%) were distributed according to Clavien-Dindo classification: grade i, 8.4%, grade ii 8.4%, grade iiia 4.4%, grade iiib 6% grade iva .8%, grade ivb: 0% and grade v 0%. CONCLUSIONS: A graded classification scheme for reporting the complications of percutaneous nephrolithotomy is useful for monitoring and reporting outcomes. We propose a standardized use of this classification in order to make the results comparable among different centers performing the technique.

[The nutcracker phenomenon: an infrequent cause of hematuria]. / Fenómeno nutcracker o cascanueces: una infrecuente causa de hematuria.

The nutcracker phenomenon consists in the compression of the left renal vein by the aortomesenteric clamp. This is an infrequent cause of haematuria. The present paper presents one case of nutcracker phenomenon showing haematuria after mild accidental lumbar bruising, with arteriographic diagnosis. CAT assessment showed a mark in the lumbar ureter as well as peripyelic and periureteral varices.