Transperitoneal laparoscopic management of urinary tract stone disease: experience in a third level hospital.

OBJECTIVES: The aim of this paper is to describe the clinical-surgical characteristics of patients who underwent laparoscopic procedures for the management of urinary tract stone disease when performing extracorporeal, percutaneous or endourological procedures was not available. METHODS: A descriptive study based on information from the medical records of patients who underwent surgical laparoscopic management of urinary stone disease between January 2001 and May 2010 at a third level hospital. Epidemiological, clinical and procedure-related variables were taken from the medical records. Univariate analysis was performed with the statistical software STATA 10.1. RESULTS: There were 29 procedures (27 patients) for treatment of urinary stone disease in adults. The average age was 45 years. 55% of patients were men. 17 stones were found on the right side, 5 were pyelic, 19 of the proximal ureter, 4 of the medium ureter and 1 distal. All patients underwent laparoscopic surgery as first surgical option. Average operative time was 142 ± 32 minutes. Three procedures were defined as failures. Hospital stay presented a median of 2 days. There were seven complications. CONCLUSION: Laparoscopic surgery is a good surgical option for the management of urinary tract stone disease in adults.

Evaluación de la necrosis de Fournier en un hospital de alta complejidad / Evaluation of Fournier`s necrosis in a high complexity hospital

OBJETIVO: Determinar las características clínicas de la población con Necrosis de Fournier que consulto al Hospital Universitario del Valle (HUV) en Cali durante el período 2003-2008.MÉTODOS: Estudio descriptivo. Se realizo una revisión retrospectiva de los pacientes atendidos por Necrosis de Fournier en el H.U.V durante el período 2003-2008. Se recopilo información sobre la edad, antecedentes personales, tiempo de evolución de la enfermedad, estancia hospitalaria, cirugías realizadas, tiempo hasta el tratamiento quirúrgico, gérmenes aislados y mortalidad. Análisis descriptivo univariado en STATA v 10.1RESULTADOS: 42 pacientes con edad promedio de 51 anos y tiempo de evolución promedio de 12 días. 26% tenían antecedente de diabetes mellitus y 21.4% traumatismo uretral previo al ingreso. El tiempo promedio hasta el desbridamiento quirúrgico fue de 41.4 hrs. 62% requirieron cistotomía suprapúbica, 14.3% colostomía derivativa, 9.5% orquidectomía y 2.4% penectomia. El promedio de estancia hospitalaria fue de 23 días y 12% requirió manejo en UCI.59.5% de los pacientes se le aisló algún germen en escroto de los cuales 64% un único germen y 36% fueron polimicrobiano. La mortalidad reportada fue de 17%.CONCLUSIÓN: La necrosis de fournier es una entidad clínica que amenaza la vida en pacientes con múltiples comorbilidades y con requerimiento de múltiples intervenciones. El manejo antibiótico de amplio espectro, el debridamiento agresivo del tejido necrótico y el manejo integral de estos pacientes son los pilares fundamentales en el tratamiento de éstos pacientes severamente enfermos(AU)

OBJECTIVES: To determine clinical characteristics of the population with Fournier`s necrosis at Hospital Universitario del Valle (HUV) in Cali during the period 2003-2008.METHODS: We performed a retrospective review of patients with the diagnosis of Fournier´s necrosis at HUV during the period 2003-2008. We collected information on age, personal history, duration of illness, hospitalization, surgeries performed, time to surgical treatment, isolated germs, and mortality. Univariate descriptive analysis was performed in STATA v 10.1. RESULTS: 42 patients with mean age 51 years and 12 days mean disease duration. 26% had diabetes mellitus and 21.4% urethral trauma before admission. Average time to surgical debridement was 41.4 hours. 62% required suprapubic cystostomy, 14.3% derivative colostomy, 9.5% and 2.4% orchiectomy and penectomy respectively. The average hospital stay was 23 days and 12% required ICU care.Scrotal cultures were positive in 59.5%: 64% a single germ and 36% polymicrobial. Reported mortality was 17%.CONCLUSION: Fournier`s necrosis is a life-threatening clinical entity in patients with multiple comorbidities requiring multiple interventions. Broad-spectrum antimicrobial therapy, aggressive debridement of necrotic tissue and comprehensive management of these patients are the mainstays in the treatment of these severely ill patients(AU)

Utilidad de la ecografía vésico-prostática en el diagnóstico de obstrucción/hiperactividad en varones con HBP / Usefulness of bladder-prostate ultrasound in the diagnosis of obstruction/hyperactivity in males with BPH

OBJETIVO: El objetivo principal del presente artículo fue describir las características clínicoquirúrgicas de los pacientes que fueron llevados a procedimientos laparoscópicos como manejo de enfermedad litiásica del tracto urinario cuando no se dispone de equipamiento para la realización de procedimientos extracorpóreos, percutáneos ni endourológicos.MÉTODOS: Se realizó un estudio observacional descriptivo basado en la información de las historias clínicas de los pacientes que fueron llevados a cirugía laparoscópica como manejo de enfermedad litiásica entre enero de 2001 y mayo de 2010 en el Hospital Universitario del Valle. Se tuvieron en cuenta variables epidemiológicas, clínicas y relacionadas a los procedimientos. Se realizó un análisis univariado con el programa estadístico STATA 10.1.RESULTADOS: Se encontraron 29 procedimientos (27 pacientes) para manejo de enfermedad litiásica en adultos. La edad promedio fue 45 años. 55% de los pacientes fueron hombres. 17 cálculos se encontraron al lado derecho y de la totalidad de ellos 5 eran piélicos, 19 proximales, 4 en uréter medio y 1 distal. Todos los pacientes fueron llevados a cirugía laparoscópica como primera opción quirúrgica. La duración promedio del acto quirúrgico fue 142 ± 32 minutos. Tres procedimientos fueron definidos como fallidos. El tiempo de hospitalización presentó una mediana de 2 días. Se presentaron 5 complicaciones.CONCLUSION: La cirugía laparoscópica es una buena opción quirúrgica para manejo de la enfermedad litiásica del tracto urinario en adultos(AU)

OBJECTIVES: The aim of this paper is to describe the clinical-surgical characteristics of patients who underwent laparoscopic procedures for the management of urinary tract stone disease when performing extracorporeal, percutaneous or endourological procedures was not available.METHODS: A descriptive study based on information from the medical records of patients who underwent surgical laparoscopic management of urinary stone disease between January 2001 and May 2010 at a third level hospital. Epidemiological, clinical and procedure-related variables were taken from the medical urirecords.Univariate analysis was performed with the statistical software STATA 10.1.RESULTS: There were 29 procedures (27 patients) for treatment of urinary stone disease in adults. The average age was 45 years. 55% of patients were men. 17 stones were found on the right side, 5 were pyelic, 19 of the proximal ureter, 4 of the medium ureter and 1 distal. All patients underwent laparoscopic surgery as first surgical option. Average operative time was 142 ± 32 minutes. Three procedures were defined as failures. Hospital stay presented a median of 2 days. There were seven complications.CONCLUSION: Laparoscopic surgery is a good surgical option for the management of urinary tract stone disease in adults(AU)

Evaluation of Fournier's necrosis in a high complexity hospital.

OBJECTIVES: To determine clinical characteristics of the population with Fournier's necrosis at Hospital Universitario del Valle (HUV) in Cali during the period 2003-2008. METHODS: We performed a retrospective review of patients with the diagnosis of Fournier's necrosis at HUV during the period 2003-2008. We collected information on age,personal history, duration of illness, hospitalization, surgeries performed, time to surgical treatment, isolated germs, and mortality. Univariate descriptive analysis was performed in STATA v 10.1. RESULTS: 42 patients with mean age 51 years and 12 days mean disease duration. 26% had diabetes mellitus and 21.4% urethral trauma before admission. Average time to surgical debridement was 41.4 hours. 62% required suprapubic cystostomy, 14.3% derivative colostomy, 9.5% and 2.4% orchiectomy and penectomy respectively. The average hospital stay was 23 days and 12% required ICU care. Scrotal cultures were positive in 59.5%: 64% a single germ and 36% polymicrobial. Reported mortality was 17%. CONCLUSION: Fournier's necrosis is a life-threatening clinical entity in patients with multiple comorbidities requiring multiple interventions. Broad-spectrum antimicrobial therapy, aggressive debridement of necrotic tissue and comprehensive management of these patients are the mainstays in the treatment of these severely ill patients.

Testicular hemangiopericytoma, solitary fibrous tumor: a very rare case.

OBJECTIVE: To describe the case of a patient with paratesticular hemangiopericytoma and to perform a bibliographic review. METHODS: We describe the case of a patient with paratesticular hemangiopericytoma. We conducted an exhaustive literature review in different databases to support the case discussion. RESULTS: We present the case of a 64 year old male with a progressively growing mass in the right scrotum that underwent complete resection of the mass. The result of the pathology report was hemangiopericytoma / solitary fibrous tumor and we present the treatment. CONCLUSIONS: We present a rare case of paratesticular hemangiopericytoma. Most of these have a benign outcome, but one must take into account the criteria of malignancy to make decisions regarding their management.

Clinical experience in the management of penile fractures at Hospital Universitario del Valle (Cali--Colombia).

SUMMARY OBJECTIVES: The main objective of this study was to describe the clinical characteristics of patients diagnosed with penile fracture in the Hospital Universitario del Valle (Cali, Colombia). METHODS: A descriptive study, reviewing all the medical records of patients diagnosed with penile fracture from January 2001 to December 2008 at Hospital Universitario del Valle (.HUV).in Cali. It took into account variables related to urological history, etiology, diagnosis, the surgical treatment and follow-up. Univariate analysis was performed with the statistical program STATA v. 10.1 RESULTS: There were 18 cases of penile fracture with an average age of 30 years. 11 patients (.61%). had episodes related to intercourse. Patients presented swelling, pain and popping or cracking sound. The diagnosis was done by history and physical examination in 100%. Surgery was performed with a subcoronal incision in most of the patients. The right corpus cavernosum was frequently injured and corrected with absorbable suture. The patients had an average of 1.5 days of postoperative hospital stay. CONCLUSIONS: Penile fracture is an entity the diagnosis of which is straightforward and can be reliable by history and physical examination. Surgical repair is the treatment of choice preventing complications, allowing the patient to return to satisfactory sexual life.

Experiencia clínica en el manejo de fracturas de pene en el Hospital Universitario del Valle (Cali-Colombia) / Clinical experience in the management of penile fracture at Hospital Universitario del Valle (Cali-Colombia)

OBJETIVO: El objetivo principal del presente estudio fue describir las características clínicas de los pacientes con diagnóstico de fractura de pene en el Hospital Universitario del Valle (Cali, Colombia).MÉTODOS: Se realizó un estudio descriptivo, en el que se revisaron todas las historias clínicas de los pacientes con diagnóstico de fractura de pene entre enero de 2001 a diciembre de 2008 en el Hospital Universitario del Valle (HUV) en la ciudad de Cali. Se tuvieron en cuenta variables relacionadas con los antecedentes urológicos, la etiología, el diagnóstico de la fractura, el procedimiento quirúrgico y el seguimiento. Se realizó un análisis univariado con el programa estadístico STATA v. 10.1RESULTADOS: Se encontraron 18 casos de fractura de pene con un promedio de edad de 30 años. 11 pacientes (61%) presentaron el episodio secundario a la relación sexual. Se presentó edema, dolor y chasquido más frecuentemente. El diagnóstico fue clínico en el 100% de los casos. El abordaje quirúrgico se realizó con una incisión circunferencial en la mayoría de los pacientes. El cuerpo cavernoso derecho fue el más frecuentemente lesionado y en la mayoría de los casos la lesión fue corregida con una sutura absorbible de forma continua. Los pacientes tuvieron una hospitalización posquirúrgica en promedio de 1.5 días.CONCLUSIONES: La fractura de pene es una entidad cuyo diagnóstico es clínico, debe realizarse de forma precoz y la reparación quirúrgica es el tratamiento de elección para evitar complicaciones y permitir que el paciente retorne a su actividad sexual satisfactoria de manera temprana(AU)

OBJECTIVES: The main objective of this study was to describe the clinical characteristics of patients diagnosed with penile fracture in the Hospital Universitario del Valle (Cali, Colombia).METHODS: A descriptive study, reviewing all the medical records of patientsdiagnosed with penile fracture from January 2001 to December 2008 at Hospital Universitario del Valle (HUV) in Cali. It took into account variables related to urological history, etiology, diagnosis, the surgical treatment and follow-up. Univariate analysis was performed with the statistical program STATA v. 10.1. RESULTS: There were 18 cases of penile fracture with an average age of 30 years. 11 patients (61%) had episodes related to intercourse. Patients presented swelling, pain and popping or cracking sound. The diagnosis was done by history and physical examination in 100%. Surgery was performed with a subcoronal incision in most of the patients. The right corpus cavernosum was frequently injured and corrected with absorbable suture. The patients had an average of 1.5 days of postoperative hospital stay.CONCLUSIONS: Penile fracture is an entity the diagnosis of which is straightforward and can be reliable by history and physical examination. Surgical repair is the treatment of choice preventing complications, allowing the patient to return to satisfactory sexual life(AU)

[Clinical management of renal injuries at Hospital Universitario Del Valle (Cali, Colombia)]. / Experiencia clínica en el manejo del traumatismo renal en el Hospital Universitario del Valle (Cali, Colombia).

PURPOSE: The purpose of this study is to describe the clinical characteristics of patients diagnosed with renal trauma at Hospital Universitario Del Valle (HUV) in Cali, Colombia. MATERIAL AND METHODS: This is a descriptive study of patients diagnosed with renal trauma (ICD 10) at HUV between 1 January 2003 and 31 December 2007. We gathered such variables as age, sex, haemodynamic stability, type of trauma, location and effect of injury, clinical examination findings at admission, presence of renal failure, need for transfusion, diagnostic method, accompanying injuries, required treatment, duration of hospital stay and complications. Statistical analysis was performed using SPSS v. 15. RESULTS: 106 patients were evaluated, 78.3% of whom were male; mean age was 30.5 years. The majority were admitted for blunt trauma (73.6%) mainly due to motorcycle accidents and falls from heights. Minor trauma (Grades 1-3) was found in 77.3% of cases, haematuria in 90% and flank pain in 64%. A CT scan was used in 69.8% of all cases. Conservative treatment was employed in 77.4% of the cases, mainly for minor trauma (P < .0001); of these, 12% subsequently required surgery. Acute abdominal pain was the main surgical indication. Procedures were as follows: Nephropexy (32%) nephrectomy (38%) and conservative treatment (26%). The main complication was rebleeding (3.8%). CONCLUSIONS: Minor trauma is the most frequent kind of kidney injury, and is usually present with associated injuries. Conservative treatment was administered to most patients, but the failure rate was 12% and the frequency of overall complications was 10%.

Liposarcoma gigante desdiferenciado de cordón espermático / Giant dedifferenciated liposarcoma of the spermatic cord

OBJETIVOS: Describir el caso de un paciente con liposarcoma desdiferenciado de cordón espermático y realizar una revisión de la literatura.MÉTODOS: Se describió el caso clínico de un paciente con liposarcoma desdiferenciado de cordón espermático, posteriormente se realizó una búsqueda exhaustiva de la literatura en diferentes bases de datos con las que se sustentó la discusión del caso.RESULTADOS: Se presentó el caso de un varón de 65 años con una masa de crecimiento progresivo en el escroto derecho, quien fue sometido a exéresis de la masa (midió 34 x 22 x 17 cm, y pesó 5786 gramos). El resultado de la patología reportó liposarcoma desdiferenciado de cordón espermático derecho. En éste paciente llama la atención la concurrencia de un tumor papilar de tiroides.CONCLUSIONES: Los tumores paratesticulares son entidades poco frecuentes, la mayoría son benignos, sin embargo hasta un 30% pueden ser de tipo sarcomatoide. Su tratamiento se basa en la extracción completa de la masa junto a la orquidectomía radical; sin embargo por ser una patología tan poco frecuente no es claro el beneficio de tratamiento adyuvante tipo radioterapia y quimioterapia en este tipo de pacientes(AU)

OBJECTIVES: To describe a patient with dedifferentiated liposarcoma of the spermatic cord and to perform a bibliographic review.METHODS: We describe the case of a patient with dedifferentiated liposarcoma of the spermatic cord, and conducted an extensive search of literature in different databases that support the discussion of the case.RESULTS: A 65 years old male presented a right scrotal mass with progressive growth, and underwent excision of the mass (measured 34 x 22 x 17 cm and weighed 5786 grams). Pathology reported dedifferentiated liposarcoma of the spermatic cord. This patient draws attention to the re-occurrence of papillary thyroid cancer.CONCLUSIONS: Paratesticular tumors are rare entities, derived from mesenchymal tissue. Most of them are benign, but up to 30% could be of sarcomatoid type. Their treatment is based on the extraction of the mass along with radical orchiectomy, but being a very rare disease is not clear whether the benefit of adjuvant chemotherapy and radiotherapy in these patients is beneficial(AU)

Prevalencia de alteración en las pruebas de coagulación en pacientes sometidos a biopsia transrectal de próstata / Prevalence of abnormal coagulation tests in patients who undergo transrectal biopsy of the prostate

Objetivo: Determinar la prevalencia de las alteraciones en las pruebas de coagulación en pacientes sometidos a biopsia transrectal de la próstata. Material y métodos: Se realizó un estudio de corte transversal en el hospital universitario del valle (HUV) entre el 1 de junio y el 31 de diciembre de 2008. Se recolectaron variables tales como edad, valor del antígeno prostático específico (PSA), valor del PT (tiempo de protrombina), valor del PTT (tiempo parcial de tromboplastina), valor de INR (relación internacional normalizada) y la presencia de anormalidad en cada una de las variables hematológicas. No existen valores normales o máximos aceptables en realidad en la práctica clínica; sin embargo, se toman como base los valores descritos por algunos autores y diferentes protocolos de práctica clínica. Resultados: El promedio de edad fue 70 años, la mediana del PSA fue 28, el PTT fue alterado en el 2,3%, el INR fue anormal en el 3,4% (punto de corte, 1,5). No se encontraron alteraciones en los valores de PT ni en el INR (punto de corte, 2,0). Conclusiones: La prevalencia de alteraciones en las pruebas de coagulación es baja, aun cuando no existen puntos de corte claros en la literatura científica mundial para determinar anormalidad (AU)

Purpose: To determine the prevalence of abnormal coagulation tests in patients who undergo transrectal prostate biopsy. Material and methods: A cross-sectional study was performed at Hospital Universitario del Valle (HUV) between 1 June and 31 December 2008. Variables collected included age, PSA value, PT (prothrombin time), PTT (partial thromboplastin time) and INR (international normalized ratio) values and the presence of abnormalities in each of the haematological variables. There are no real normal or maximum acceptable values in clinical practice; however, the values described by some authors and different clinical practice protocols serve as a guide. Results: The average age was 70 years, the median PSA was 28, the partial thromboplastin time was altered in 2.3% of patients, and INR was abnormal in 3.4% of patients (cut-off point 1.5). There were no changes in PT or INR values (cut-off point 2.0). Conclusions: The prevalence of abnormal coagulation tests is low even when there are no clear cut-off points in worldwide literature that would determine abnormality (AU)

Experiencia clínica en el manejo del traumatismo renal en el Hospital Universitario del Valle (Cali, Colombia) / Clinical management of renal injuries at Hospital Universitario Del Valle (Cali, Colombia)

Objetivo: Describir las características clínicas de los pacientes con diagnóstico de traumatismo renal en el Hospital Universitario del Valle (HUV) en Cali, Colombia. Materiales y métodos: Se realizó un estudio descriptivo de pacientes con diagnóstico de traumatismo renal (CIE 10) en el HUV entre el 1 de enero de 2003 y el 31 de diciembre de 2007. Se recolectaron variables como: edad, sexo, estabilidad hemodinámica, tipo de traumatismo, sitio y mecanismo de la lesión, hallazgos al examen físico de ingreso, fallo renal, requerimiento de transfusión, método del diagnóstico, lesiones asociadas, manejo del traumatismo, tiempo de hospitalización y complicaciones. El análisis estadístico se realizó en SPSS v. 15.Resultados: Se evaluó a 106 pacientes, el 78,3% varones, con un promedio de edad de 30años. La mayoría ingresó por traumatismo cerrado (73,6%), principalmente por accidente en moto y caídas de altura. Se encontró traumatismo menor (grado 1-3) en el 77,3% de los casos, hematuria (90%) y dolor en el flanco (64%). La tomografía computarizada se utilizó en el 69,8% de los casos. Se realizó un manejo conservador (77,4%) principalmente en traumatismo menor (p < 0,0001); de éstos un 12% requirió cirugía posteriormente. El abdomen agudo fue la indicación quirúrgica más frecuente. Se realizó: nefrorrafia (32%), nefrectomía (38%) y manejo conservador (26%). La complicación más frecuente fue el resangrado (3,8%).Conclusiones: El traumatismo renal menor es más frecuente y usualmente se presenta con lesiones asociadas. Se hace un manejo conservador en la mayoría de los pacientes; sin embargo, la tasa de fallo es del 12% y la frecuencia de complicaciones es del 10% (AU)

Purpose: The purpose of this study is to describe the clinical characteristics of patients diagnosed with renal trauma at Hospital Universitario Del Valle (HUV) in Cali, Colombia. Material and methods: This is a descriptive study of patients diagnosed with renal trauma (ICD 10) at HUV between 1 January 2003 and 31 December 2007. We gathered such variables as age, sex, haemodynamic stability, type of trauma, location and effect of injury, clinical examination findings at admission, presence of renal failure, need for transfusion, diagnostic method, accompanying injuries, required treatment, duration of hospital stay and complications. Statistical analysis was performed using SPSS v. 15.Results: 106 patients were evaluated, 78.3% of whom were male; mean age was 30.5 years. The majority were admitted for blunt trauma (73.6%) mainly due to motorcycle accidents and falls from heights. Minor trauma (Grades 1-3) was found in 77.3% of cases, haematuria in 90% and flank pain in 64%. A CT scan was used in 69.8% of all cases. Conservative treatment was employed in 77.4% of the cases, mainly for minor trauma (P <0.0001); of these, 12% subsequently required surgery. Acute abdominal pain was the main surgical indication. Procedures were as follows: Nephropexy (32%) nephrectomy (38%) and conservative treatment (26%). The main complication was rebleeding (3.8%).Conclusions: Minor trauma is the most frequent kind of kidney injury, and is usually present with associated injuries. Conservative treatment was administered to most patients, but the failure rate was 12% and the frequency of overall complications was 10% (AU)

Lesión de la glándula suprarrenal por trauma penetrante: reporte de un caso y revisión de la literatura / Adrenal gland injury in penetrating trauma: case report and literature review

Se presenta el caso de un paciente que recibió una herida por proyectil de arma de fuego en abdomen que le ocasionó una lesión grado III de la glándula suprarrenal izquierda. Fue manejado conservadoramente con empaquetamiento perirrenal, con buena evolución clínica posquirúrgica y sin presentar signos de insuficiencia suprarrenal.El trauma suprarrenal es una patología muy poco frecuente, debida probablemente a la localización y el tamaño de la glándula. Su manejo debe estar enfocado al control de la hemorragia y la prevención de la suprarrenalectomía para preservar su función endocrina.