Pielonefritis xantogranulomatosa: un reto actual para la laparoscopia.

OBJECTIVE: To present the results of our case series on laparoscopic nephrectomy in xanthogranulomatous pyelonephritis (XGP). METHODS: A retrospective study was conducted that included 143 patients treated with laparoscopic nephrectomy for non-functioning kidney, of whom 15 had XGP, within the time frame of 2011 to 2019. The demographic and clinical data were collected, along with the intraoperative results, complications, and days of hospital stay. RESULTS: Transperitoneal laparoscopic nephrectomy was successfully performed on 15 patients with XGP, with no need for conversion. Mean intraoperative time was 124.4 minutes (range 70-240) and intraoperative blood loss was 148.5 ml (range 30-550), with no blood transfusion required. No intraoperative complications occurred but there was one postoperative complication (6.6%), classified as Clavien-Dindo I (surgical wound infection). Mean hospital stay was 2.85 days (range 2-7). CONCLUSIONS: Nephrectomy is the definitive management for XGP, and the laparoscopic approach should be considered a treatment modality, despite the fact that the pathology involves a severe chronic inflammatory process. Its benefits are reduced surgery duration, less blood loss, a lower complication rate, and fewer days of hospital stay, when performed by a skilled and experienced surgeon.

OBJETIVO: Presentar los resultados de nuestra serie de nefrectomía laparoscópica en pielonefritis xantogranulomatosa (PXG). MÉTODO: Se realizó un estudio retrospectivo que incluyó 143 pacientes tratados con nefrectomía laparoscópica por exclusión renal, de los cuales 15 fueron por PXG, en el periodo comprendido de 2011 a 2019. Se recolectaron datos demográficos y clínicos, resultados transoperatorios, complicaciones y días de estancia hospitalaria. RESULTADOS: Se realizó nefrectomía laparoscópica transperitoneal de forma exitosa en 15 pacientes con PXG, sin necesidad de conversión. El tiempo transoperatorio promedio fue de 124.4 minutos (rango: 70-240). El sangrado transoperatorio fue de 148.5 ml (rango: 30-550), sin requerimiento de transfusión sanguínea. No se reportaron complicaciones transoperatorias; se presentó una complicación en el posoperatorio (6.6%) clasificada como Clavien-Dindo I (infección de la herida quirúrgica). La estancia hospitalaria promedio fue de 2.85 días (rango: 2-7). CONCLUSIONES: El manejo definitivo de la PXG es la nefrectomía, y el abordaje laparoscópico debe ser considerado como una modalidad de tratamiento a pesar de ser una patología que presenta un proceso inflamatorio grave y crónico, obteniéndose beneficios como disminución en el tiempo quirúrgico, menor sangrado, menor tasa de complicaciones y menos días de estancia hospitalaria cuando es realizado por un cirujano experimentado.

Association Between Testicular Microlithiasis and Histological Subtype in Testicular Cancer.

Background There is a clear association between testicular cancer and microlithiasis when there are predisposing risk factors such as the history of germ cell tumors in first-degree relatives, testicular atrophy, Klinefelter's syndrome, and cryptorchidism. This study aimed to establish an association between microlithiasis and the histological subtype of testicular cancer by analyzing data on Hispanic population. Methods A retrospective cohort, longitudinal, comparative, and analytic study was conducted on patients with a confirmed diagnosis of primary testicular cancer. The testicular ultrasounds were checked before any surgical treatment to find microlithiasis. We performed a binary logistic regression to establish an association between microlithiasis and the type of testicular cancer. Results A total of 130 clinical files were analyzed. Binary logistic regression showed no association between testicular microlithiasis and the subtype of testicular cancer (p = 0.438, 95% CI: 0.80-1.64). The result of the Pearson chi-square test showed no association (p = 0.184). We also analyzed the association between age and microlithiasis using the one-way ANOVA test (p = 0.82) and the association between age and the dichotomic subtype of testicular cancer (seminomatous and non-seminomatous) using the ANOVA one-way test, which showed no significant association in age and testicular cancer subtype (p = 0.178). Conclusions There was no association between testicular microlithiasis and the histological subtype of testicular cancer in our study. As mentioned before, we recommend conducting a more extensive study to provide further scientific evidence to establish a reliable association between microlithiasis and the subtype of testicular cancer since there is a discrepancy in the results of our study with the information previously reported. We encourage the study of characterization of risk factors among ethnic groups as this field has not been explored yet.

Advantages and Short-Term Outcomes of Laparoscopic-Assisted Renal Surgery in Elderly Patients.

OBJECTIVE: To compare the perioperative results of adult and elderly patients undergoing laparoscopic renal surgery. METHODOLOGY: Retrospective, analytical study. 448 who underwent kidney surgery for benign or malignant pathologies between 2011-2019 were included in the General Hospital of Mexico "Dr. Eduardo Liceaga". They were categorized into two groups: Group 1 <60 years and Group 2 >60 years. Descriptive statistics and bivariate analysis were performed, the calculations were performed with 95% reliability and a value of p (<0.05). RESULTS: In the group over 60 years of age, the following was found: Age: 67.1 years (60-83). IMC 28.3 kg/m2 (19-48.7). Intra and postsurgical outcomes: intraoperative bleeding = 184.4cc (5-1700). Surgical Time = 112.6min (30-240). Days of hospital stay = 2 (1-7). Complications in 2.6% (Clavien-Dindo: I = 2; II = 1), no conversion was required in any patient. There were no statistically significant differences with group 1, an exception for intraoperative bleeding. CONCLUSIONS: Our study is a pioneer in Latin America in the evaluation of the geriatric population and outcomes with laparoscopic surgery and we recommend that renal procedures with a laparoscopic approach should be considered as the best strategy in the management of benign or malignant renal pathology in geriatric patients.

Experiencia de la plastia laparoscópica de uréter retrocavo en el Hospital General de México Dr. Eduardo Liceaga.

INTRODUCCIÓN: El uréter retrocavo es una anomalía congénita rara que requiere manejo quirúrgico. OBJETIVO: Reportar los resultados en el manejo laparoscópico para uréter retrocavo y hacer una revisión bibliográfica. MÉTODO: Estudio retrospectivo, descriptivo, transversal, en pacientes con diagnóstico de uréter retrocavo que fueron sometidos a plastia laparoscópica de uréter retrocavo. RESULTADOS: Cuatro pacientes sometidos a plastia laparoscópica por diagnóstico de uréter retrocavo, 1 hombre y 3 mujeres, con una media de edad de 40.7 años. La media del tiempo operatorio fue de 138.2 minutos. La pérdida de sangre cuantificada transoperatoria media fue de 23.7 ml. Ningún paciente presentó complicaciones transoperatorias ni posoperatorias. Los pacientes permanecieron hospitalizados hasta su egreso una media de 2.5 días. Todos los pacientes presentaron mejoría de su sintomatología. CONCLUSIONES: El uréter retrocavo es una condición rara y aún no existe un consenso sobre su diagnóstico, tratamiento y seguimiento. El manejo quirúrgico laparoscópico es una opción para el tratamiento de estos pacientes. INTRODUCTION: The retrocave ureter is a rare congenital anomaly that requires surgical management. OBJECTIVE: Report the results in laparoscopic management for retrocave ureter and literature review. METHOD: Retrospective, descriptive, cross-sectional study in patients with a diagnosis of retrocave ureter who were sometimes a laparoscopic retrocave ureter. RESULTS: Four patients sometimes underwent laparoscopic plasty for diagnosis of retrocave ureter, 1 man and 3 women, with a mean age of 40.7 years. The mean operative time was 138.2 minutes. The mean intraoperative quantified blood loss was 23.7 ml. No patient presented transoperative or postoperative complications. The patients remained hospitalized until their progress with an average of 2.5 days. All patients visualize improvement in their symptoms. CONCLUSION: The retrocave ureter is a rare condition and there is still no consensus on its diagnosis, treatment and follow-up. Laparoscopic surgical management is an option for the treatment of these patients.

Adrenal cyst: our experience in its laparoscopic management.

ANTECEDENTES: Los quistes suprarrenales son una afección rara. Su diagnóstico y su tratamiento son un desafío debido a la escasa información, lo que genera incertidumbre respecto al mejor manejo. CASOS CLÍNICOS: Presentamos tres casos de quistes suprarrenales que recibieron tratamiento de mínima invasión con cirugía laparoscópica, sin presentar complicaciones y con una evolución favorable. DISCUSIÓN: Las nuevas técnicas quirúrgicas de mínima invasión ofrecen una oportunidad terapéutica que permite preservar estructuras y obtener material necesario para su diagnóstico histopatológico, así como la resolución de la sintomatología. BACKGROUND: Adrenal cysts are a rare entity; their diagnosis and treatment are challenging due to the lack of information, generating uncertainty regarding the best management. CASE REPORTS: We present three cases of adrenal cysts that received minimally invasive treatment with laparoscopic surgery, without complications and with a favorable evolution. DISCUSSION: The new minimally invasive surgical techniques offer a therapeutic opportunity that allows preserving structures and obtaining the necessary material for histopathological diagnosis, as well as a resolution of the symptoms.

[Testicular Microlithiasis: Update on diagnosis and management.] / Actualidades sobre microlitiasis testicular.

Testicular microlithiasis (TM) is an uncommonurologic condition incidentally diagnosed byscrotal ultrasound. It has been associated with differentdiseases, such as Klinefelter`s syndrome, testicular atrophy,cryptorchidism, testicular torsion, and infertility.However, it can also present in healthy males that haveno associated risk factors. Currently, TM is most oftendetected thanks to the superior resolution of today's ultrasoundequipment, compared with former models. In the1990s, TM was considered a benign condition with noimportant clinical relevance, but later reports associatedit with the development of testicular neoplasias andinfertility. Thus, many authors recommended periodic surveillance with tumor markers and ultrasound imaging,with some even promoting the use of testicular biopsy.The aim of this article is to clearly and specifically presentcurrent information about testicular microlithiasis, toestablish both diagnostic and follow-up indications.

La microlitiasis testicular (MT) es un padecimiento urológico poco frecuente que se diagnostica de forma incidental mediante ltrasonografía escrotal. Ha sido asociado a diversas enfermedades como síndrome de Klinefelter, atrofia testicular, criptorquidia, torsión testicular e infertilidad. Sin embargo, también se puede encontrar en varones sanos sin factores de riesgo asociados. La microlitiasis testicular es detectada con mayor frecuencia en la actualidad, debido a la resolución superior de los equipos de ultrasonido actuales en comparación a los anteriores.  En la década de los  noventa la MT fue considerada una condición benigna sin gran relevancia clínica. Sin embargo, reportes posteriores asociaron este padecimiento al desarrollo de neoplasias testiculares e infertilidad. Por tal motivo muchos autores recomendaban la vigilancia periódica con marcadores tumorales y ultrasonido, e incluso algunos preconizaban el uso de la biopsia testicular. El objetivo del presente articulo de revisión es exponer de manera clara y especifica la evidencia actual de la microlitiasis testicular para así establecer las pautas tanto diagnósticas como de seguimiento.

Actualidades sobre microlitiasis testicular / No disponible

La microlitiasis testicular (MT) es un padecimiento urológico poco frecuente que se diagnostica de forma incidental mediante ltrasonografía escrotal. Ha sido asociado a diversas enfermedades como síndrome de Klinefelter, atrofia testicular, criptorquidia, torsión testicular e infertilidad. Sin embargo, también se puede encontrar en varones sanos sin factores de riesgo asociados. La microlitiasis testicular es detectada con mayor frecuencia en la actualidad, debido a la resolución superior de los equipos de ultrasonido actuales en comparación a los anteriores. En la década de los noventa la MT fue considerada una condición benigna sin gran relevancia clínica. Sin embargo, reportes posteriores asociaron este padecimiento al desarrollo de neoplasias testiculares e infertilidad. Por tal motivo muchos autores recomendaban la vigilancia periódica con marcadores tumorales y ultrasonido, e incluso algunos preconizaban el uso de la biopsia testicular. El objetivo del presente articulo de revisión es exponer de manera clara y especifica la evidencia actual de la microlitiasis testicular para así establecer las pautas tanto diagnósticas como de seguimiento

Testicular microlithiasis (TM) is an uncommon urologic condition incidentally diagnosed by scrotal ultrasound. It has been associated with different diseases, such as Klinefelter's syndrome, testicular atrophy, cryptorchidism, testicular torsion, and infertility. However, it can also present in healthy males that have no associated risk factors. Currently, TM is most often detected thanks to the superior resolution of today’s ultrasound equipment, compared with former models. In the 1990s, TM was considered a benign condition with no important clinical relevance, but later reports associated it with the development of testicular neoplasias and infertility. Thus, many authors recommended periodic surveillance with tumor markers and ultrasound imaging, with some even promoting the use of testicular biopsy. The aim of this article is to clearly and specifically present current information about testicular microlithiasis, toestablish both diagnostic and follow-up indications

Comparison of three analgesic drug regimens with twelfth subcostal nerve block for pain control during extracorporeal shock wave lithotripsy.

INTRODUCTION AND OBJECTIVE: Extracorporeal shock wave lithotripsy (ESWL) is the first-line treatment in the majority of cases of upper urinary tract stones. Since its introduction, attempts have been made to establish the ideal accompanying analgesic method to enable the application of shock waves of adequate duration and intensity for efficacious stone fragmentation. An open, randomized, prospective, longitudinal, comparative, and experimental clinical study was conducted to evaluate the efficacy of subcostal nerve block with lidocaine, comparing it in combination with tramadol or diclofenac for pain control during ESWL. MATERIALS AND METHODS: Seventy patients of both sexes were included in the study. Thirty-five were men and 35 were women, all above 18 years of age, with kidney stones or ureteral stones smaller than 20 mm. The patients were randomly assigned to one of the following groups: Group 1 (24 patients) Twelfth subcostal nerve block with 10 ml of lidocaine 2%, 5 min before ESWL. Group 2 (25 patients) Twelfth subcostal nerve block with 10 ml lidocaine 2% + intramuscular diclofenac sodium 45 min before ESWL. Group 3 (21 patients) Twelfth subcostal nerve block with 10 ml of lidocaine 2% + tramadol at 1 mg/Kg of weight, 45 min before ESWL. The visual analog scale (VAS) for pain was applied at minutes 10, 20, and 30 of the procedure. RESULTS: No statistically significant differences were reported by the ANOVA test for comparing the mean pain values between the three groups at minutes 10, 20, and 30 of the ESWL. There were no adverse effects. CONCLUSIONS: Even though there were no statistically significant differences between the three groups, the analgesic regimen of twelfth subcostal nerve block with lidocaine 2%, alone, was as efficacious as its combination with other analgesics and therefore can be used as a sole analgesic method during ESWL.

Treatment of reno-ureteral colic by twelfth intercostal nerve block with lidocaine versus intramuscular diclofenac.

INTRODUCTION AND OBJECTIVE: Renal colic is one of the most intense pains known to humans. Standard treatment usually consists of nonsteroidal anti-inflammatory drugs and opiates, but they do not always provide optimum efficacy and speed in relieving the pain. For more than 25 years, our hospital has been employing twelfth subcostal nerve block. The objective of the present study was to compare the efficacy of subcostal nerve block with lidocaine versus intramuscular diclofenac in renal colic management. METHODS: Sixty patients of both sexes, above the age of 18 years, and presenting with renal colic were randomly selected for the study. The visual analog scale was applied prior to the treatment and at minutes 1, 3, 5, 30, and 45 after the application of the twelfth nerve block or the intramuscular administration of diclofenac. RESULTS: A total of 60 patients, 35 women and 25 men, were included in the study. There were statistically significant differences in the mean scores for pain from minute 1 to minute 45. There were no adverse effects. CONCLUSIONS: Twelfth Subcostal nerve block with lidocaine is an efficacious, safe, inexpensive, and very fast-acting medication for pain control related to renal colic. These characteristics make it superior to diclofenac.

Efficacy of Tamsulosin, Oxybutynin, and their combination in the control of double-j stent-related lower urinary tract symptoms.

INTRODUCTION AND OBJECTIVE: Indwelling double J ureteral stents are used routinely in the resolution of ureteral obstruction caused by different etiologies. Evaluation of urinary symptoms related to double-J stent, indicate that these affect 73-90% of patients. We conducted a prospective, randomized study, to evaluate the efficacy of tamsulosin, oxybutinin and combination therapy in improving the urinary symptoms. METHODS: Patients who underwent ureteral stent placement after ureterolithotripsy (total 51), were randomized into three groups: Group I: Tamsulosin 0.4 mg. Once per day(17 patients), Group II: Oxybutinin 5 mg. once per day (17 patients), Group III: Tamsulosin+ oxybutynin once per day (17 patients). All the groups received the drugs for three weeks and completed a Spanish validated Ureteral Stent Symptom Questionnaire (USSQ) at day 7 and 21. RESULTS: Repeated measures ANOVA showed mean urinary symptom index score was 22.3 vs. 15.5 in group three (p<0.001) at day 7 and 21 respectively. The mean work performance index was 6.6 vs 8.1 (p=0.049) favoring tamsulosin group, the mean sexual score was 0.5 vs 1.5 (p=0.03). Among additional problems the mean was 7.2 vs 6.2 (p=0.03). No significant difference was noted among pain and general health index. No side effects were reported. CONCLUSIONS: Combination therapy with tamsulosin and oxybutynin improved irritative symptoms and work performance as well as sexual matters. Combination therapy should be considered for patients who complained of stent related symptoms.

Efficacy of Tamsulosin, Oxybutynin, and their combination in the control of double-j stent-related lower urinary tract symptoms

ABSTRACT Introduction and objective Indwelling double J ureteral stents are used routinely in the resolution of ureteral obstruction caused by different etiologies. Evaluation of urinary symptoms related to double-J stent, indicate that these affect 73-90% of patients. We conducted a prospective, randomized study, to evaluate the efficacy of tamsulosin, oxybutinin and combination therapy in improving the urinary symptoms. Methods Patients who underwent ureteral stent placement after ureterolithotripsy (total 51), were randomized into three groups: Group I: Tamsulosin 0.4 mg. once per day(17 patients), Group II: Oxybutinin 5 mg. once per day (17 patients), Group III: Tamsulosin+ oxybutynin once per day (17 patients). All the groups received the drugs for three weeks and completed a Spanish validated Ureteral Stent Symptom Questionnaire (USSQ) at day 7 and 21. Results Repeated measures ANOVA showed mean urinary symptom index score was 22.3 vs. 15.5 in group three (p<0.001) at day 7 and 21 respectively. The mean work performance index was 6.6 vs 8.1 (p=0.049) favoring tamsulosin group, the mean sexual score was 0.5 vs 1.5 (p=0.03). Among additional problems the mean was 7.2 vs 6.2 (p=0.03). No significant difference was noted among pain and general health index. No side effects were reported. Conclusions Combination therapy with tamsulosin and oxybutynin improved irritative symptoms and work performance as well as sexual matters. Combination therapy should be considered for patients who complained of stent related symptoms.

Emphysematous pyelonephritis: multicenter clinical and therapeutic experience in Mexico.

OBJECTIVE: To analyze the outcomes of emphysematous pyelonephritis (EPN), the impact of different treatment modalities, and to determine risk factors associated with mortality. METHODS: We retrospectively reviewed cases of EPN from 3 tertiary care institutions in Mexico. The diagnosis was confirmed with computed tomographic scan. Treatment was classified as follows: medical management (MM), minimally invasive, and surgical. Demographic, clinical, biochemical, and radiological characteristics were assessed and compared between survivors and nonsurvivors. Comparison was assessed using 1-way analysis of variance and chi-square. Univariate and multivariate logistic regression analyses were performed to determine prognostic factors. Main end point was mortality. RESULTS: A total of 62 patients were included (49 women and 13 men), with a mean age of 53.9 years. The most common comorbidities were diabetes (69.3%) and hypertension (40.3%). Escherichia coli was the most common isolated microorganism (62.7%). MM was provided to 24.2%, minimally invasive treatment to 51.6%, open drainage to 19.3%, and emergency nephrectomy to 4.8%. Overall mortality was 14.5% and was similar among different treatment modalities (P=.06). Survivors were younger (P=.004), had lower creatinine (P=.002), and better estimated glomerular filtration rate (P=.007). In univariate analysis, age (P=.009), creatinine (P=.009), and need for nephrectomy (P=.03) were associated with mortality. In multivariate logistic regression analysis, creatinine (odds ratio 1.56, 95% confidence interval 1.03-2.35, P=.03) and nephrectomy (odds ratio 9.7, 95% confidence interval 1.007-93.51, P=.049) remained significant predictors of mortality. CONCLUSION: EPN needs an aggressive MM and stepwise approach; nephrectomy should be the last resort of treatment. Creatinine level and need for nephrectomy are the strongest predictors of mortality according our analysis.

A comparative study on the use of tamsulosin versus alfuzosin in spontaneous micturition recovery after transurethral catheter removal in patients with benign prostatic growth.

PURPOSE: To compare the efficacy and safety of tamsulosin and alfuzosin in patients with acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH). METHODS: Ninety men with AUR due to BPH underwent urinary catheterization and were randomly assigned to treatment groups with tamsulosin 0.4 mg (37 patients), alfuzosin 10 mg (34 patients), and placebo (19 patients). After 4 days of the drug treatment, the catheters were removed, and the patients underwent trial without catheter (TWOC). A TWOC was considered successful if the patient had a voided volume >100 ml and post-void residual urine <200 ml. RESULTS: TWOC was successful in 16 patients (43.2 %) in the tamsulosin group, 12 patients (35.2 %) in the alfuzosin group, and 5 patients (26.3 %) in the placebo group. Logistic regression analysis showed that both drugs were equally effective and that the type of alpha-blocker was not a predictive factor for TWOC success (OR 1.137, 95 % CI 0.639-2.022) (p = 0.662). CONCLUSION: Even though there were no statistically significant differences when comparing the three groups, tamsulosin showed a tendency to be more effective in a successful catheter removal. The lack of objective criteria in the definition of successful micturition leads us to believe that the effectiveness of both drugs reported in the literature is overestimated.

Effect of intraprostatic epinephrine on intraoperative blood loss reduction during transurethral resection of the prostate.

OBJECTIVE: To determine whether the use of intraprostatic epinephrine during transurethral resection of the prostate reduces intraoperative blood loss. METHODS: A random, double-blind, prospective study was carried out on twenty-three patients that underwent transurethral resection of the prostate. Patients were divided into two groups: (1) group receiving intraoperative intraprostatic injection of epinephrine (thirteen patients) and (2) group receiving intraoperative intraprostatic injection of saline solution as placebo (ten patients). Blood loss was quantified with the following formula: irrigation solution hemoglobin × 1000/intraoperative presurgical serum hemoglobin. The variables analyzed were blood loss, resection time, presurgical prostate volume, and grams of resected tissue. Student´s t test and Pearson correlation were used for their analysis. RESULTS: There were thirteen patients in the epinephrine group and ten patients in the placebo group. Mean blood loss in the epinephrine group was significantly lower than in the placebo group (127.48 mL ± 77.0 mL vs. 336.63 ± 185.6 mL, 95% CI, 45-234, P < 0.001). There were no statistically significant differences in mean resected grams or mean resection time between the two groups. One patient in the epinephrine group presented with intraoperative hypertensive crisis (7.7%). CONCLUSIONS: Intraprostatic epinephrine injection can be used to reduce blood loss during transurethral resection of the prostate in selected patients. Cardiovascular monitoring should be carried out during its application. Resection time and grams of resected tissue continue to be the most influential factors in relation to blood loss in patients undergoing this treatment modality.