Microureteroscopy in Children: Two First Cases.

BACKGROUND: Urinary stones disease is becoming more common not only in adults but also in children. Most cases are resolved with extracorporeal shock wave lithotripsy, but miniaturization of endoscopes has increased the use of ureteroscopy in resolving ureteral stones, most notably in children. CASE PRESENTATION: This presentation focuses on two cases of microureteroscopy. In both cases, the presence of lithiasis in the pelvic ureter was suspected to be the cause of ureter hydronephrosis, and a microureteroscopy was performed for treatment purposes. MicroPerc set 4.85F sheath was used to explore the pelvic ureter, thus avoiding the need to dilate the ureteral meatus or having to use the safety guide. Patients did not require a postoperative stent and were discharged within 24 hours of the procedure. CONCLUSION: Use of microureteroscopy proved satisfactory in the two cases of children and it allows diagnosis and treatment of ureteral pathology in pediatric patients.

Incidence of infectious complications after extracorporeal shock wave lithotripsy in patients without associated risk factors.

PURPOSE: We determined the incidence of infectious complications (asymptomatic bacteriuria, urinary tract infection and urosepsis) in patients without associated risk factors treated with extracorporeal shock wave lithotripsy. MATERIALS AND METHODS: We performed an observational, prospective cohort study between October 2010 and June 2013. We included all patients without risk factors who were treated with extracorporeal shock wave lithotripsy for kidney or ureteral lithiasis. All patients underwent urine culture 5 days before the procedure. Another urine culture was performed 7 days after lithotripsy. No patient received antibiotics. RESULTS: Initially 366 patients with a mean ± SD age of 53 ± 13 years were enrolled in the study. A total of 64 patients (17.5%) underwent extracorporeal shock wave lithotripsy with a previously placed Double-J® stent. After lithotripsy urine culture was positive in 20 patients (5.8%), of whom 4 (1.2%) presented with symptomatic urinary infection and the remaining 4.6% showed no symptoms. Urosepsis did not develop in any case. In our study patient age was an independent risk factor for bacteriuria after lithotripsy. CONCLUSIONS: The incidence of infectious complications after extracorporeal shock wave lithotripsy in patients without risk factors is low. This leads us to conclude that without defined risk factors antibiotic prophylaxis is not justified. Also, elderly patients were more at risk for bacteriuria after extracorporeal shock wave lithotripsy and, thus, for a possible infectious complication.

[Renal adenocarcinoma. Prognostic factors]. / Adenocarcinoma renal. Factores pronósticos.

OBJECTIVES: To perform a descriptive analysis of 57 cases of renal adenocarcinoma treated in our department, trying to identify those variables that modify survival, and to evaluate the impact of incidental diagnosis on survival. METHODS: 57 cases of renal cell carcinoma treated in our department from 1996 to 2001 were retrospectively reviewed. Mean follow-up time was 30 months. The impact on survival of incidental diagnosis, stage, and other variables was evaluated. We used the chi-square test to study the association between qualitative variables, and the prevalence proportion with 95% confidence intervals to quantify the magnitude of the association. RESULTS: Mean age on presentation was 63 +/- 12.57 yr. The most frequent histological type was classic renal cell carcinoma (83.6%). hematuria was the presenting sign in most cases. 19.3% were incidentally diagnosed with a 24 month survival was 100% in comparison to 59% of the patients presenting with clinical signs/symptoms (p = 0.0218); 24 month survival rates for stages I-II was 95.83% in comparison to 48.48% for stage III-IV. CONCLUSIONS: Renal cell adenocarcinoma is an aggressive tumor with a variety of clinical presentations which delay its diagnosis. Tumor stage is one of the main prognostic factors. Nowadays, the greater availability of radiological tests, mainly ultrasounds, has resulted on an increase in the number of incidental diagnosis and therefore a greater number of early stages; it is advisable to perform a renal pathology screening on every patient who undergoes abdominal ultrasound for any other reason.

Adenocarcinoma renal. Factores pronósticos / Renal adenocarcinoma. Prognostic factors

OBJETIVOS: Realizar el análisis descriptivo de los 57 casos de carcinoma de células renales tratados en nuestro servicio identificando aquellas variables que modifican la supervivencia y evaluar el impacto del diagnóstico incidental en la supervivencia. MÉTODOS: Se ha llevado a cabo el estudio retrospectivo de 57 casos de car. de céls. renales, tratados en nuestro servicio en el periodo de tiempo comprendido entre 1996-2001 con un tiempo de seguimiento medio de 30 meses. Se evaluó el impacto en la supervivencia del diagnóstico incidental y el estadio así como otras variables. Utilizamos el test de la chi-cuadrado para el estudio de la asociación entre variables cualitativas y la razón de prevalencia con intervalos de confianza al 95 por ciento para cuantificar la magnitud de la asociación. RESULTADOS: La edad media de presentación fue de 63+/- 12,57 años.El tipo histológico más frecuente fue el carcinoma de céls. renales clásico (83,6 por ciento).La presentación clínica mayoritaria fue la hematuria. El 19,3 por ciento fueron incidentales y la supervivencia a los 24 meses fue del 100 por ciento frente al 59 por ciento de los que presentaron clínica (p= 0,0218); la tasa de supervivencia a los 24 meses para los estadios I-II fue del 95,83 por ciento frente al 48,48 por ciento de los estadios III-IV.CONCLUSIONES: El adenocarcinoma de céls. renales es un tumor agresivo con gran variedad de manifestaciones clínicas que demoran su diagnóstico, siendo el estadio uno de sus principales factores pronósticos. Actualmente la mayor disponibilidad de técnicas radiológicas sobre todo las ultrasónicas, ha propiciado un incremento en el diagnóstico incidental y por lo tanto un mayor número de estadios precoces; es por todo ello que sería aconsejable realizar un despistaje de patología renal a todos los pacientes a los que se realizara una ecografía abdominal por cualquier motivo (AU)