Validez actual de la litotricia extracorpórea como tratamiento de primera línea de la litiasis / Is extracorporeal lithotripsy a first-line treatment for urinary stones today?

Objetivo Evaluar la eficacia y complicaciones de la litotricia extracorpórea por ondas de choque (LEOCh) como tratamiento de primera línea de la litiasis renal y ureteral. Métodos Estudio observacional retrospectivo de todos los pacientes tratados con litotricia en un centro de tercer nivel entre enero de 2014 y enero de 2021. Se recogieron las características de los pacientes, de la litiasis, y las complicaciones y resultados de la LEOCh. Se realizó una regresión logística multivariante de los factores asociados a la reducción del tamaño litiásico. También se llevó a cabo un análisis estadístico de los factores asociados a la necesidad de tratamiento adicional tras la LEOCh y de los factores asociados a las complicaciones. Resultados Se incluyeron 1.727 pacientes. El tamaño litiásico medio fue de 9,5 mm. En 1.540 (89,4%) pacientes se observó la reducción del tamaño litiásico. En el análisis multivariante, el tamaño (OR=1,13; p=0,00), la localización de la litiasis en el uréter (OR=1,15; p=0,052) y el número de ondas (p=0,002; OR=1,00) utilizadas en la LEOCh son los factores asociados a la reducción del tamaño litiásico. Un total de 665 pacientes (38,5%) precisaron tratamiento adicional tras la litotricia. Los factores asociados a la necesidad de retratamiento fueron el tamaño litiásico (OR=1.131; p=0,000), el número de ondas (OR=1.000; p=0,000) y la energía administrada (OR=1.005; p=0,000). En 153 pacientes (8,8%) se produjeron complicaciones tras la LEOCh. Se encontró una asociación estadísticamente significativa entre el tamaño de la litiasis (p=0,024; OR=1.054) y la derivación urinaria previa (p=0,004; OR=0,571). Conclusión La litotricia sigue siendo eficaz como tratamiento de primera línea para la litiasis reno-ureteral, con un bajo porcentaje de complicaciones. (AU)

Objective To evaluate the efficacy and complications of extracorporeal lithotripsy (SWL) as a first-line treatment for renal and ureteral stones. Methods Retrospective and observational study of all the patients treated with lithotripsy in a third level center between January 2014 and January 2021; characteristics of the patients, the stones, complications and results of SWL is recollected. Multivariate logistic regression of the factors associated with stone size reduction was performed. A statistical analysis of the factors associated with additional treatment after SWL and factors associated with complications is also executed. Results 1727 patients are included. Stone mean size was 9,5 mm. 1540 (89.4%) patients presented reduction in stone size. In multivariate analysis, stone size (OR=1.13; P=0.00), ureteral location of the lithiasis (OR=1.15; P=0.052) and number of waves (P=0.002; OR=1.00) used in SWL are the factors associated with reduction of stone size. Additional treatment after lithotripsy was needed in 665 patients (38.5%). The factors associated with the need for retreatment were stone size (OR=1.131; P=0.000), number of waves (OR=1.000; P=0.000), energy (OR=1.005; P=0.000). 153 patients (8.8%) suffered complications after SWL. A statistically significant association was found between the size of the lithiasis (P=0.024, OR=1.054) and the previous urinary diversion (P=0.004, OR=0.571). Conclusion Lithotripsy remains an effective treatment as the first line of therapy for reno-ureteral lithiasis with a low percentage of complications. (AU)

Is extracorporeal lithotripsy a first-line treatment for urinary stones today?

OBJECTIVE: To evaluate the efficacy and complications of extracorporeal lithotripsy (SWL) as a first-line treatment for renal and ureteral stones METHODS: Retrospective and observational study of all the patients treated with lithotripsy in a third level center between January 2014 and January 2021; characteristics of the patients, the stones, complications and results of SWL is recollected. Multivariate logistic regression of the factors associated with stone size reduction was performed. A statistical analysis of the factors associated with additional treatment after SWL and factors associated with complications is also executed. RESULTS: 1727 patients are included. Stone mean size was 9,5mm. 1540 (89.4%) patients presented reduction in stone size. In multivariate analysis, stone size (OR=1.13; p=0.00), ureteral location of the lithiasis (OR=1.15; p=0.052) and number of waves (p=0.002; OR=1.00) used in SWL are the factors associated with reduction of stone size. Additional treatment after lithotripsy was needed in 665 patients (38.5%). The factors associated with the need for retreatment were stone size (OR=1.131; p=0.000), number of waves (OR=1.000; p=0.000), energy (OR=1.005; p=0.000). 153 patients (8.8%) suffered complications after SWL. A statistically significant association was found between the size of the lithiasis (p=0.024, OR=1.054) and the previous urinary diversion (P=0.004, OR=0.571). CONCLUSION: Lithotripsy remains an effective treatment as the first line of therapy for reno-ureteral lithiasis with a low percentage of complications.

Litotricia extracorpórea por ondas de choque (LEOCh) Para litiasis de grupo calicial inferior: ¿cómo predecir el éxito del tratamiento? / Extracorporeal shock wave lithotripsy for lower calyx stones: Predicting treatment success

Introducción El uso de la litotricia extracorpórea por ondas de choque (LEOCh) en litiasis de grupo calicial inferior (GCI) se asocia con una alta tasa de fragmentos residuales. Nuestro objetivo es analizar la efectividad y complicaciones del tratamiento con LEOCh en litiasis de GCI. Métodos Revisión retrospectiva de pacientes con litiasis en GCI tratadas con LEOCh entre enero 2014 y diciembre del 2020. Se determina anatomía favorable del GCI mediante longitud infundibular, ancho infundibular y ángulo infundibulopélvico. Se considera fracaso de LEOCh la presencia de fragmentos >3mm en radiografía simple, TC o ecografía a los 3 meses del procedimiento. Análisis de complicaciones, procedimientos auxiliares y factores de riesgo asociados con hematoma perirrenal. Análisis estadístico mediante software SPSS. Resultados En total, 512 pacientes con litiasis en GCI fueron tratados con LEOCh. El 80,3% de los pacientes tenía anatomía GCI favorable. La tasa libre de litiasis (TLL) fue 70,5%. Las principales complicaciones fueron: calle litiásica (5 pacientes) e infección del tracto urinario (3 casos). Se describen 10 hematomas perirrenales (2%). La toma de antiagregantes mostró asociación estadística con el riesgo de hematoma perirrenal (p=0,004). Mediante regresión logística binaria se demuestra asociación entre anatomía desfavorable del GCI (p=0,000), tamaño de litiasis (p=0,001), número de ondas de choque (p=0,003), energía aplicada (p=0,038) y necesidad de tratamiento adicional tras LEOCh. Conclusiones El tratamiento con LEOCh puede ser considerado de primera elección en litiasis de GCI. El tamaño de la litiasis, anatomía calicial desfavorable, número de ondas de choque y energía utilizadas pueden predecir la necesidad de retratamiento. (AU)

Introduction The use of extracorporeal shock wave lithotripsy (ESWL) for lower calyx stones is associated with a high rate of residual fragments. Our aim is to analyse the effectiveness and complications of ESWL for lower calyx stones. Methods Retrospective review of patients with lower renal calyx stones treated with ESWL between January-2014 and December-2020. Measurement of infundibular length, infundibular width and infundibulopelvic angle in lower renal pole to determine favourable anatomy. ESWL failure: fragments >3mm detected in plain abdominal film, CT scan and/or renal ultrasound 3 months after treatment. Complications after ESWL, auxiliary procedures along with risk factors associated with perirenal haematoma were analysed. SPSS statistical software was used. Results 512 patients with lower calyx stones were treated with ESWL. 80.3% of patients had a favourable anatomy. Overall stone-free rate was 70.5%. Regarding main complications after ESWL, stainstrasse was described in 5 patients and urinary tract infection in 3 patients. 10 perirenal haematomas (2%) were reported. Statistical association was found between antiplatelet treatment and the risk of perirenal haematoma (p=0.004). Logistic binary regression proved the association between unfavourable anatomy of the lower renal pole (p=0.000), size of the stone (p=0.001), number of shock waves (p=0.003), energy applied (p=0.038) and the need for additional treatment after ESWL. Conclusions ESWL can still be considered as the initial treatment option for lower renal pole stones. The size of the stone, an unfavourable anatomy of the lower renal calyx, number of shock waves and energy applied can help predict the need for additional treatment. (AU)

Extracorporeal shock wave lithotripsy for lower calyx stones: predicting treatment success.

INTRODUCTION: The use of extracorporeal shock wave lithotripsy (ESWL) for lower calyx stones is associated with a high rate of residual fragments. Our aim is to analyse the effectiveness and complications of ESWL for lower calyx stones. METHODS: Retrospective review of patients with lower renal calyx stones treated with ESWL between January-2014 and December-2020. Measurement of infundibular length, infundibular width and infundibulopelvic angle in lower renal pole to determine favourable anatomy. ESWL failure: fragments >3 mm detected in plain abdominal film, CT scan and/or renal ultrasound 3 months after treatment. Complications after ESWL, auxiliary procedures along with risk factors associated with perirenal haematoma were analysed. SPSS statistical software was used. RESULTS: 512 patients with lower calyx stones were treated with ESWL. 80.3% of patients had a favourable anatomy. Overall stone-free rate was 70.5%. Regarding main complications after ESWL, stainstrasse was described in 5 patients and urinary tract infection in 3 patients. 10 perirenal haematomas (2%) were reported. Statistical association was found between antiplatelet treatment and the risk of perirenal haematoma (p = 0.004). Logistic binary regression proved the association between unfavourable anatomy of the lower renal pole (p = 0.000), size of the stone (p = 0.001), number of shock waves (p = 0.003), energy applied (p = 0.038) and the need for additional treatment after ESWL. CONCLUSIONS: ESWL can still be considered as the initial treatment option for lower renal pole stones. The size of the stone, an unfavourable anatomy of the lower renal calyx, number of shock waves and energy applied can help predict the need for additional treatment.

Lecciones aprendidas sobre el manejo de la urolitiasis tras los perjuicios causados por la COVID-19: un ejemplo de adaptación en un centro de alto volumen / Lessons learned after the disruption caused by COVID-19 in the management of urolithiasis: An example of adaptation in a high-volume center

Introducción El objetivo del estudio fue analizar el impacto de la pandemia por COVID-19 en la presentación y el manejo de la enfermedad litiásica. Métodos Estudio retrospectivo comparativo de los procedimientos (urgentes y electivos) por litiasis durante los primeros 8 meses de la pandemia (01/03/2020 al 31/10/2020), comparándose con el mismo periodo de 2019, y entre olas. Las pruebas utilizadas fueron la prueba exacta de Fisher, la t de Student, la chi-cuadrado y la U de Mann-Whitney. Resultados Se analizaron 530 procedimientos. El número total de procedimientos quirúrgicos por enfermedad litiásica fue similar entre los 2 periodos. En cuanto a la cirugía electiva, se identificó un aumento en la tasa de complicaciones en el periodo de pandemia, pero no se observaron diferencias estadísticamente significativas en cuanto a tipos de procedimientos realizados y necesidad de tratamientos complementarios. El patrón de presentación del cólico renoureteral complicado fue diferente durante la pandemia, con un mayor número de días desde el inicio de los síntomas hasta la consulta y una mayor proporción de pacientes con fracaso renal agudo. Asimismo, se detectó un aumento significativo de los niveles de creatinina en la primera ola, así como un incremento en el número de procedimientos urgentes tras la primera ola debido al retraso en el tratamiento y diagnóstico de la enfermedad litiásica. Conclusiones La pandemia por COVID-19 ha impactado negativamente en el tratamiento urgente y electivo de la litiasis. Se deben aprender lecciones sobre el manejo de la litiasis en este contexto para evitar complicaciones graves y mejorar los estándares de atención (AU)

Introduction The aim was to determine the impact of COVID-19 pandemic on urolithiasis presentation and management. Methods In this retrospective study, we comparatively evaluated urgent and elective procedures due to urolithiasis during the early 8 months of the COVID-19 pandemic (March 1, 2020, to October 31, 2020) compared to the same period a year before, and between waves. Fisher's exact test, Student's t-test, chi-square test and Mann-Whitney U test were used to compare the patients’ characteristics and outcomes between the 2 periods and waves. Results Five hundred and thirty procedures were included. The overall numbers of surgical procedures due to urolithiasis were similar between pre-pandemic and pandemic periods. Regarding elective surgery, our data draw attention to the increased complication rate in the pandemic times, but no statistically significant differences in terms of types of procedures and need for complementary treatments were observed. We noted that patterns of presentation of complicated renal colic were different during COVID-19 pandemic, with a higher number of days after the onset of symptoms and a higher proportion of patients presenting acute kidney injury. Furthermore, a significant increase of creatinine levels at presentation in first wave was detected, and a growth in the number of urgent procedures after the first wave was noted, owing to the delay in urolithiasis treatment and diagnosis. Conclusions The COVID-19 pandemic has negatively affected both urgent and elective management of urolithiasis. Lessons about the management of urolithiasis in this context should be learned to avoid fatal complications and improve standards of care (AU)

Lessons learned after the disruption caused by COVID-19 in the management of urolithiasis: An example of adaptation in a high-volume center.

BACKGROUND: The aim was to determine the impact of COVID-19 pandemic on urolithiasis presentation and management. METHODS: In this retrospective study, we comparatively evaluated urgent and elective procedures due to urolithiasis during the early eight months of the COVID-19 pandemic (March 1, 2020, to October 31, 2020) compared to the same period a year before, and between waves. The student's t-test, chi-square test, Mann-Whitney U test and Fisher's exact test were used to compare the patients' characteristics and outcomes between the two periods and waves. RESULTS: Five hundred and thirty procedures were included. The overall numbers of surgical procedures due to urolithiasis were similar between pre-pandemic and pandemic periods. Regarding elective surgery, our data draw attention to the increased complication rate in the pandemic times, but no statistically significant differences in terms of types of procedures and need for complementary treatments were observed. We noted that patterns of presentation of complicated renal colic were different during COVID-19 pandemic, with a higher number of days after the onset of symptoms and a higher proportion of patients presenting acute kidney injury. Furthermore, a significant increase of creatinine levels at presentation in first wave was detected, and a growth in the number of urgent procedures after the first wave was noted, owing to the delay in urolithiasis treatment and diagnosis. CONCLUSION: The COVID-19 pandemic has negatively affected both urgent and elective management of urolithiasis. Lessons about the management of urolithiasis in this context should be learned to avoid fatal complications and improve standards of care.

[Lessons learned after the disruption caused by COVID-19 in the management of urolithiasis: An example of adaptation in a high-volume center]. / Lecciones aprendidas sobre el manejo de la urolitiasis tras los perjuicios causados por la COVID-19: un ejemplo de adaptación en un centro de alto volumen.

Introduction: The aim was to determine the impact of COVID-19 pandemic on urolithiasis presentation and management. Methods: In this retrospective study, we comparatively evaluated urgent and elective procedures due to urolithiasis during the early 8 months of the COVID-19 pandemic (March 1, 2020, to October 31, 2020) compared to the same period a year before, and between waves. Fisher's exact test, Student's t-test, chi-square test and Mann-Whitney U test were used to compare the patients' characteristics and outcomes between the 2 periods and waves. Results: Five hundred and thirty procedures were included. The overall numbers of surgical procedures due to urolithiasis were similar between pre-pandemic and pandemic periods. Regarding elective surgery, our data draw attention to the increased complication rate in the pandemic times, but no statistically significant differences in terms of types of procedures and need for complementary treatments were observed. We noted that patterns of presentation of complicated renal colic were different during COVID-19 pandemic, with a higher number of days after the onset of symptoms and a higher proportion of patients presenting acute kidney injury. Furthermore, a significant increase of creatinine levels at presentation in first wave was detected, and a growth in the number of urgent procedures after the first wave was noted, owing to the delay in urolithiasis treatment and diagnosis. Conclusions: The COVID-19 pandemic has negatively affected both urgent and elective management of urolithiasis. Lessons about the management of urolithiasis in this context should be learned to avoid fatal complications and improve standards of care.

Síndrome metabólico en los cálculos de oxalato cálcico: ¿es tan importante en este tipo de litiasis? / Metabolic syndrome in calcium oxalate stones: Is it so important in this type of lithiasis?

introducción y objetivo Se ha descrito la asociación del síndrome metabólico con la litogénesis, especialmente en cálculos de ácido úrico. El objetivo de este trabajo es analizar la importancia del síndrome metabólico en la litogénesis oxalocálcica. Materiales y métodos Evaluación metabólica de 151 pacientes: parámetros bioquímicos, hormonales y orina de 24horas; características asociadas al síndrome metabólico. Se evaluó la relación entre las características asociadas con el síndrome metabólico y las relacionadas con la litogénesis mediante el coeficiente de correlación de Spearman (CCS), «t» de Student y prueba exacta de Fisher. Resultados El índice de masa corporal promedio (IMC) fue 25,9 (DE 3,7). La mediana de edad fue de 51 años (18,6-84,8) y el 64,9% eran hombres. No hubo diferencias estadísticamente significativas entre hipertensión y estradiol, testosterona, triglicéridos o colesterol (p>0,05). Referente a la glucosa la media fue 114,5 y 93,5mg/dl en pacientes con y sin hipertensión (p=0,000). Los niveles de glucosa, estradiol, testosterona o colesterol no variaron con la proteinuria (p>0,05). La media de triglicéridos fue 185,6 y 108.2mg/dl en pacientes con y sin proteinuria (p=0,001). La hipertensión y la proteinuria no se asociaron (p=0,586). El IMC se correlacionó con el ácido úrico sérico y urinario y la creatinina urinaria. Conclusiones Existen pocas asociaciones entre las características del síndrome metabólico y las anomalías relacionadas con la litogénesis. El síndrome metabólico no parece tener un papel relevante en el desarrollo de cálculos oxalocálcicos (AU)

Introduction and objective The association of metabolic syndrome with lithogenesis has been described, especially in uric acid stones. The aim of the work was to analyze the role of the metabolic syndrome in oxalocalcic lithogenesis. Materials and methods Metabolic evaluation of 151 patients including biochemical, hormonal and 24-urine urine parameters, as well as characteristics associated with metabolic syndrome. The relationship between characteristics associated with metabolic syndrome and those related to lithogenesis was evaluated using Spearman's correlation coefficient (SCC), Student's t test and Fisher's exact test. Results The average body mass index (BMI) was 25.9 (SD 3.7). The median age was 51 years (18.6-84.8) and 64.9% were men. There were no statistically significant differences between hypertension and estradiol, testosterone, triglycerides, or cholesterol (P=.191, .969, .454, .345, respectively). Regarding glucose, mean value was 114.5 and 93.5mg/dl in patients with and without hypertension (P=.000). Glucose, estradiol, testosterone, or cholesterol levels did not vary with proteinuria (P=.518, P=.227, P=.095, P=.218, respectively). Mean triglycerides were 185.6 and 108.2mg/dl in patients with and without proteinuria (P=.001). Hypertension and proteinuria were not associated (P=.586). BMI correlated with serum and urinary uric acid and urinary creatinine. Conclusions There are few associations between the characteristics of metabolic syndrome and abnormalities related to lithogenesis. Metabolic syndrome does not seem to have a relevant role in the development of oxalocalcic stones (AU)

Metabolic syndrome in calcium oxalate stones: Is it so important in this type of lithiasis?

INTRODUCTION AND OBJECTIVE: The association of the metabolic syndrome with lithogenesis has been described, especially in uric acid stones. The aim of the work was to analyze the role of the metabolic syndrome in oxalocalcic lithogenesis. MATERIALS AND METHODS: Metabolic evaluation of 151 patients including biochemical, hormonal and 24-urine urine parameters, as well as characteristics associated with metabolic syndrome. The relationship between the characteristics associated with the metabolic syndrome and those related to lithogenesis was evaluated using Spearman's correlation coefficient (SCC), Student's t test and Fisher's exact test. RESULTS: The average body mass index (BMI) was 25.9 (SD 3.7). The median age was 51 years (18.6-84.8) and 64.9% were men. There were no statistically significant differences between hypertension and estradiol, testosterone, triglycerides or cholesterol (P=.191, .969, .454, .345, respectively). Regarding glucose, the mean was 114.5 and 93.5mg/dl in patients with and without hypertension (P=.000). The levels of glucose, estradiol, testosterone or cholesterol did not vary with proteinuria (P=.518, P=.227, P=.095, P=.218, respectively). The mean triglycerides were 185.6 and 108.2mg/dl in patients with and without proteinuria (P=.001). Hypertension and proteinuria were not associated (P=.586). BMI correlated with serum and urinary uric acid and urinary creatinine. CONCLUSIONS: There are few associations between the characteristics of the metabolic syndrome and the anomalies related to lithogenesis. Metabolic syndrome does not seem to have a relevant role in the development of oxalocalcic stones.

Xanthogranulomatous pyelonephritis: a focus on microbiological and antibiotic resistance profiles.

BACKGROUND: Xanthogranulomatous pyelonephritis (XGP) is an inflammatory condition of the kidney and its treatment most often involves a combination of antibiotics and nephrectomy. This study aimed to define the clinical features and management of XGP, focusing on microbiological aspects and antibiotic therapy. METHODS: We performed a retrospective study of 27 cases of XGP diagnosed between January 2001 and January 2020 to analyse their clinical and management characteristics. In addition, a literature review was conducted of XGP case series covering the period from 2000-2020. We searched PubMed for case series through April 2020 without language restrictions. Studies reporting case series of XGP (more than ten cases) were included if they were relevant to this study. RESULTS: Twenty-seven patients were diagnosed with XGP, and 26 of them were histologically proven to have XGP. A total of 81.5% of the patients were female and the mean age was 59.6 years (SD 19.2). The most frequent symptoms were flank pain (70.4%) and fever (59.3%), while 77.8% of patients had renal stones. Proteus mirabilis was detected in the urine culture in 18.5% of patients, followed by detection of Escherichia coli in 14.8% of patients. The computed tomography (CT) findings included perirenal (29.6%) or pararenal (29.6%) involvement in the majority of patients. Twenty-six patients underwent nephrectomy. Piperacillin/tazobactam and ceftriaxone were the most commonly prescribed antibiotics for treatment. The reported piperacillin/tazobactam and ceftriaxone resistance rates were 14.3% and 16.6%, respectively. Twenty-six case series were included in the literature review, reporting 693 cases in total. CONCLUSION: We found well-established characteristics of XGP patients among series in terms of previous history, clinical, laboratory and imaging findings, and operative and postoperative outcomes. It is important to know the clinical presentation and potential severity of XGP, as well as the most frequently involved microorganisms and their antibiotic resistance profiles, to select the most appropriate antibiotic therapy.

Intraparenchymal renal artery pseudoaneurysm following nephrostomy tube insertion in a patient with a solitary kidney: A case report.

Intraparenchymal renal artery aneurysms are uncommon and represent less than 10% of all renal artery aneurysms. They are caused by trauma or iatrogenic injury, and their rupture can lead to life-threatening hemorrhage. We report the case of a 48-year-old male with history of left solitary kidney and orthotopic neobladder, who presented with massive hematuria 7 days after nephrostomy tube placement because of obstructive uropathy and acute renal failure due to ureteroileal stricture. An abdominal CT angiography revealed an intraparenchymal renal artery aneurysm, and it was successfully treated with superselective endovascular embolization, achieving maximal parenchymal preservation.

Sepsis urinaria tras tratamiento endourológico de la litiasis por ureterorrenoscopia / Urinary sepsis after endourological ureterorenoscopy for the treatment of lithiasis

Objetivo: Evaluar la incidencia, presentación clínica y factores asociados al desarrollo de sepsis urinaria tras la realización de una ureterorrenoscopia. Material y métodos: Estudio retrospectivo de los pacientes intervenidos mediante ureterorrenoscopia para el tratamiento de la litiasis entre julio de 2015 y octubre de 2017. Se identificaron aquellos pacientes que desarrollaron sepsis urinaria en los primeros 30 días tras la intervención. Se recogieron antecedentes personales, clínicos, quirúrgicos y microbiológicos. Se realizó análisis estadístico mediante chi2 (o test exacto de Fisher), t de Student (o U de Mann-Whitney) o regresión logística según procediese. Resultados: Se realizaron 246 ureterorrenoscopias, 184 (74,8%) sobre litiasis ureterales y 62 (25,2%) sobre litiasis renales, con una edad media de 52 (44,5-59,5) años. Tras el procedimiento, 18 (7,3%) pacientes desarrollaron sepsis urinaria, 10 de ellos (55,5%) en las primeras 24h. El urocultivo mostró enterobacterias (61,1%) y enterococos (38,9%). El antibiograma mostró mayor sensibilidad a nitrofurantoínas (100%) y a quinolonas (72%). El análisis estadístico mostró que el sexo femenino, el inicio clínico de la litiasis en forma de sepsis urinaria, haber recibido antibiótico o haber precisado derivación urinaria mediante doble J en el inicio, el urocultivo prequirúrgico positivo y la persistencia de restos litiásicos tras la cirugía se asociaron de forma significativa (p<0,05) al desarrollo de sepsis urinaria tras la ureterorrenoscopia. Conclusión: La sepsis urinaria es una complicación que aparece tras la realización de una ureterorrenoscopia, especialmente en pacientes de sexo femenino, con antecedente de sepsis urinaria, antibioterapia, doble J, urocultivo previo positivo o presencia de restos litiásicos tras el procedimiento

Objective: To evaluate the incidence, clinical presentation and factors associated with the development of urinary sepsis after performing ureterorenoscopy. Material and methods: Retrospective study of patients undergoing ureterorenoscopy for the treatment of lithiasis between July 2015 and October 2017. Patients who developed urinary sepsis during the 30 days following the intervention were identified. Personal, clinical, surgical and microbiological backgrounds were collected. Statistical analysis was performed with the Chi squared test (or Fisher's exact test), Student's t (or U Mann-Whitney) or logistic regression as appropriate. Results: 246 ureterorenoscopies were performed, 184 (74.8%) on ureteral stones and 62 (25.2%) on kidney stones, with a mean age of 52 (44.5-59.5) years. After procedure, 18 (7.3%) patients developed urinary sepsis, 10 of them (55.5%) occurred in the first 24h. The urine culture showed enterobacteria (61.1%) and enterococci (38.9%). The antibiogram showed greater sensitivity to nitrofurantoins (100%) and quinolones (72%). The statistical analysis showed that female sex, the clinical debut of urolithiasis as urinary sepsis, having received antibiotic or having required urinary diversion by a double J during debut, positive presurgical uroculture and the persistence of residual lithiasis after surgery were significantly associated (p < 0.05) with the development of urinary sepsis after ureterorenoscopy. Conclusion: Urinary sepsis is a complication that appears after performing ureterorenoscopy, especially in female patients with a history of urinary sepsis, antibiotic therapy, double J, previous positive urine culture or residual lithiasis after the procedure

Urinary sepsis after endourological ureterorenoscopy for the treatment of lithiasis. / Sepsis urinaria tras tratamiento endourológico de la litiasis por ureterorrenoscopia.

OBJECTIVE: To evaluate the incidence, clinical presentation and factors associated with the development of urinary sepsis after performing ureterorenoscopy. MATERIAL AND METHODS: Retrospective study of patients undergoing ureterorenoscopy for the treatment of lithiasis between July 2015 and October 2017. Patients who developed urinary sepsis during the 30 days following the intervention were identified. Personal, clinical, surgical and microbiological backgrounds were collected. Statistical analysis was performed with the Chi squared test (or Fisher's exact test), Student's t (or U Mann-Whitney) or logistic regression as appropriate. RESULTS: 246 ureterorenoscopies were performed, 184 (74.8%) on ureteral stones and 62 (25.2%) on kidney stones, with a mean age of 52 (44.5-59.5) years. After procedure, 18 (7.3%) patients developed urinary sepsis, 10 of them (55.5%) occurred in the first 24h. The urine culture showed enterobacteria (61.1%) and enterococci (38.9%). The antibiogram showed greater sensitivity to nitrofurantoins (100%) and quinolones (72%). The statistical analysis showed that female sex, the clinical debut of urolithiasis as urinary sepsis, having received antibiotic or having required urinary diversion by a double J during debut, positive presurgical uroculture and the persistence of residual lithiasis after surgery were significantly associated (P<.05) with the development of urinary sepsis after ureterorenoscopy. CONCLUSION: Urinary sepsis is a complication that appears after performing ureterorenoscopy, especially in female patients with a history of urinary sepsis, antibiotic therapy, double J, previous positive urine culture or residual lithiasis after the procedure.

Comparación entre nefrolitotomía percutánea y ureteroscopia flexible para el tratamiento de litiasis renales de entre 2 y 3 cm / Comparison between percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of 2 and 3cm renal lithiasis

Contexto y objetivos: El tratamiento de primera elección para litiasis > 2 cm es la nefrolitotomía percutánea (NLP), dejando a la ureteroscopia flexible (URS-F) como una segunda opción. En la presente revisión se evaluaron la tasa libre de litiasis y las complicaciones de ambas técnicas en el tratamiento de litiasis de tamaño entre 2 y 3 cm. Material y métodos: Revisión sistemática de estudios que compararon las dos técnicas. Fueron excluidos aquellos estudios que no fueran comparativos, los realizados en población pediátrica o con litiasis menores de 2 cm o mayores de 3 cm. Dos investigadores realizaron independientemente la búsqueda, obteniendo 5 estudios que abarcaban un total de 815 pacientes: 252 pertenecieron al grupo de URS-F y 563 al de NLP. Cuatro fueron retrospectivos y uno fue prospectivo no aleatorizado. Resultados: La tasa libre de litiasis osciló entre el 47,0 y el 95,0% para la URS-F y entre el 87,0 y el 100% para la NLP. La tasa de complicaciones fue del 8,8-29,0% en la URS-F y del 11,9-27,0% en la NLP. La URS-F requirió un número mayor de procedimientos y tuvo un menor descenso de hemoglobina y ascenso de creatinina en comparación con la NLP. Conclusiones: La tasa libre de litiasis fue mayor en la NLP, aunque la URS-F podría alcanzar unos resultados comparables a expensas de realizar varios procedimientos. Ambas técnicas tienen una frecuencia de complicaciones similar, pero con más alteraciones analíticas posquirúrgicas en el grupo de NLP

Context and objectives: The first-line treatment for > 2 cm lithiasis is percutaneous nephrolithotomy (PNL), leaving flexible ureteroscopy (FURS) as a second option. In the present review, the stone-free rate and the complications of both techniques were evaluated in the treatment of 2-3 cm stones. Material and methods: Systematic review of studies that compared both techniques. Studies that were not comparative, as well as those carried out in the paediatric population or with < 2 cm or > 3 cm stones, were excluded. Two researchers independently performed the investigation, obtaining 5 studies that made up a total of 815 patients: 252 belonged to the FURS group and 563 to the PNL group. Four studies were retrospective, and one was non-randomised prospective. Results: Stone-free rate ranged between 47.0% and 95.0% for the FURS and between 87.0% and 100% for the PNL. The complication rate was 8.8-29.0% in the FURS and 11.9-27.0% in the PNL. FURS required a greater number of procedures, and had a lower decrease in haemoglobin and creatinine rise compared to PNL. Conclusions: The stone-free rate was higher for PNL, although the FURS could reach comparable results at the expense of performing several procedures. Both techniques have a similar frequency of complications, but the PNL has more postsurgical analytical alterations

Comparison between percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of 2 and 3cm renal lithiasis. / Comparación entre nefrolitotomía percutánea y ureteroscopia flexible para el tratamiento de litiasis renales de entre 2 y 3cm.

CONTEXT AND OBJECTIVES: The first-line treatment for >2cm lithiasis is percutaneous nephrolithotomy (PNL), leaving flexible ureteroscopy (fURS) as a second option. In the present review, the stone-free rate and the complications of both techniques were evaluated in the treatment of 2-3cm stones. MATERIAL AND METHODS: Systematic review of studies that compared both techniques. Studies that were not comparative, as well as those carried out in the pediatric population or with <2cm or>3cm stones, were excluded. Two researchers independently performed the investigation, obtaining 5 studies that made up a total of 815 patients: 252 belonged to the fURS group and 563 to the PNL group. Four studies were retrospective, and one was non-randomized prospective. RESULTS: Stone-free rate ranged between 47.0% and 95.0% for the fURS and between 87.0% and 100% for the PNL. The complication rate was 8.8-29.0% in the fURS and 11.9-27.0% in the PNL. fURS required a greater number of procedures, and had a lower decrease in haemoglobin and creatinine rise compared to PNL. CONCLUSIONS: The stone-free rate was higher for PNL, although the fURS could reach comparable results at the expense of performing several procedures. Both techniques have a similar frequency of complications, but the PNL has more postsurgical analytical alterations.

Carcinoma de células renales con invasión vascular: mortalidad y factores pronósticos / Renal cell carcinoma with vascular invasion: mortality and prognostic factors

Objetivo. Análisis de los resultados obtenidos en el seguimiento de los pacientes intervenidos de carcinoma renal con invasión vascular en nuestro centro, evaluación de los factores pronósticos y de las complicaciones. Material y métodos. Estudio observacional retrospectivo de 37 pacientes diagnosticados de carcinoma renal con invasión vascular intervenidos entre mayo de 1999 y julio de 2013. Se emplean el método de Kaplan-Meier para el análisis de supervivencias y la prueba de Mantel-Haenszel (LogRank) y el modelo de riesgos proporcionales de Cox para el análisis de los factores de riesgo de mortalidad. Resultados. La mediana de edad fue de 60 años. El tiempo de seguimiento medio de 42,1 meses. Las medianas de supervivencia global y supervivencia libre de enfermedad fueron de 53,8 y 36,3 meses respectivamente. Existe asociación estadística entre supervivencia global y el ASA (p=0,047), estadio tumoral (p=0,003), la afectación ganglionar (p=0,024), la presencia de metástasis (p=0,013), el nivel de trombo tumoral (p=0,05) y el tipo histológico (p=0,001). Catorce pacientes presentaron complicaciones grado IIIb o mayor según la clasificación de Clavien-Dindo, siendo la más frecuente el sangrado. Conclusiones. El carcinoma renal con invasión vascular es una enfermedad con alta tasa de mortalidad. La cirugía es una opción terapéutica que puede resultar curativa. El número de complicaciones es importante. La supervivencia está condicionada por el ASA, el estadio tumoral, el nivel de trombo tumoral, la afectación ganglionar, las metástasis y el tipo histológico (AU)

Objective. Analysis of the results of patients who had been operated of renal cell carcinoma with vascular invasion in our institution, evaluation of prognostic factors and complications. Methods. Retrospective observational study of 37 patients diagnosed of renal cell carcinoma with vascular invasion operated between May 1999 and July 2013. We used the method of Kaplan-Meier survival analysis and the Mantel-Haenszel's test (log rank) and the Cox's proportional hazards analysis test to analyse the risk factors of mortality. Results. The median age was 60 years. Mean follow-up period was 42.1 months. The median overall survival and disease-free survival were 53.8and 36.3 months, respectively. There was statistical association between overall survival and ASA (p=0.047), tumor stage (p=0.003), lymph node involvement (p=0.024), presence of metastases (p=0.013), level of tumor thrombus (p=0, 05) and histological type (p=0.001). 14 patients had grade IIIb complications or higher according to the Clavien Dindo classification, the most frequent was bleeding. Conclusions. Renal cell carcinoma with vascular invasion is a disease with high rate of mortality. Surgery is a therapeutic option that can be curative. The number of complications is important. Survival is conditioned by the ASA, tumor stage, the level of tumor thrombus, lymph node involvement, metastasis and histological type (AU)

Renal cell carcinoma with vascular invasion: Mortality and prognostic factors. / Carcinoma de células renales con invasión vascular: mortalidad y factores pronósticos.

OBJECTIVE: Analysis of the results of patients who had been operated of renal cell carcinoma with vascular invasion in our institution, evaluation of prognostic factors and complications. METHODS: Retrospective observational study of 37 patients diagnosed of renal cell carcinoma with vascular invasion operated between May 1999 and July 2013. We used the method of Kaplan-Meier survival analysis and the Mantel-Haenszel's test (log rank) and the Cox's proportional hazards analysis test to analyse the risk factors of mortality. RESULTS: The median age was 60 years. Mean follow-up period was 42.1 months. The median overall survival and disease-free survival were 53.8and 36.3 months, respectively. There was statistical association between overall survival and ASA (p=0.047), tumor stage (p=0.003), lymph node involvement (p=0.024), presence of metastases (p=0.013), level of tumor thrombus (p=0, 05) and histological type (p=0.001). 14 patients had grade IIIb complications or higher according to the Clavien Dindo classification, the most frequent was bleeding. CONCLUSIONS: Renal cell carcinoma with vascular invasion is a disease with high rate of mortality. Surgery is a therapeutic option that can be curative. The number of complications is important. Survival is conditioned by the ASA, tumor stage, the level of tumor thrombus, lymph node involvement, metastasis and histological type.