Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis.

PURPOSE: We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. METHODS: We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). RESULTS: A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively. CONCLUSIONS: The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.

Entrando en el manejo 2.0 de la cistinuria con una herramienta médica digital para monitorizar el pH de la orina: un estudio prospectivo y aleatorizado / Entering into 2.0 cystinuria management with a medical digital tool to monitor urine pH: A prospective, randomized study

Introducción y objetivos Las personas con cistinuria pueden experimentar eventos recurrentes de litiasis debido a la relativa insolubilidad de la cistina en el pH fisiológico de la orina, lo que resulta en deterioro de la función renal. El pHmetro Lit-Control® es un dispositivo médico que permite la automedición precisa del pH de la orina. El objetivo principal de este estudio fue comparar la usabilidad del pHmetro Lit-Control® con las tiras reactivas para la automonitorización domiciliaria del pH urinario por parte de pacientes con cistinuria, y su satisfacción general con cada herramienta.Pacientes y métodosSe incluyeron 28 pacientes (9 mujeres y 19 varones, de 19 a 76 años), que fueron asignados aleatoriamente a monitorizar su pH urinario con tiras reactivas (n=17) o el pHmetro Lit-Control® (n=11).ResultadosDespués de 6 meses de uso, la satisfacción con los 2 métodos fue similarmente alta, pero los pacientes calificaron (en una escala de 0 a 10) mejor el pHmetro en términos de facilidad de aprendizaje (media± DE, 8,11±0,60 vs. 7,06±1,18; p=0,038), facilidad de preparación (8,22±0,67 vs. 7,25±1,18; p=0,034) y facilidad de uso (8,22±0,67 vs. 7,25±1,39; p=0,062). En general, los pacientes no alcanzaron los objetivos de alcalinización (pH entre 7,0 y 8,0).ConclusionesEl pHmetro Lit-Control® demostró ser un dispositivo fácil de usar que puede facilitar el control del pH urinario en los pacientes con cistinuria. Queda justificado un estudio prospectivo para evaluar la correlación entre la monitorización del pH de la orina, una estrategia de tratamiento por objetivo y la recurrencia de los cálculos de cistina. (AU)

Background and objectives Individuals with cystinuria can experiment recurrent lithiasis events due to the relative insolubility of cystine at physiological urine pH, resulting in renal function decline. The Lit-Control® pH Meter is a medical device that accurately allows urine pH self-monitoring. The main objective of this study was to compare the usability of the Lit-Control® pH Meter with the reactive strips for self-monitoring of urinary pH at home by patients with cystinuria, and their overall satisfaction with each tool.Patients and methodsWe included 28 patients (9 females and 19 males, age 19-6 years), who were randomly assigned to monitor their urine pH with reactive strips (n=17) or the Lit-Control® pH Meter (n=11).ResultsAfter six months of use, the satisfaction with the two methods was similarly high, but the patients rated (0-10 scale) the pH meter better in terms of ease of learning (mean±SD, 8.11±0.60 vs. 7.06±1.18; P=.038), ease to prepare (8.22±0.67 vs. 7.25±1.18; P=0.034), and ease of use (8.22±0.67 vs. 7.25±1.39; P=.062). Overall, patients did not reach the alkalinization goals (pH between 7.0 and 8.0).ConclusionsThe Lit-Control® pH Meter demonstrated to be an easy-to-use device that can facilitate urinary pH control by cystinuric patients. A prospective study is warranted to assess the correlation between urine pH monitoring, a treat to target approach, and the recurrence of cystine stones. (AU)

Does gender influence retrograde intrarenal surgery (RIRS) outcomes? Data from the Flexible Ureteroscopy Outcomes Registry (FLEXOR).

INTRODUCTION AND OBJECTIVES: As well established flexible ureteroscopy (RIRS). There is still no evidence if gender can have any influence on the outcomes and complication when performing. This study aims to evaluate the role that gender has in performing flexible ureteroscopy from a large series of patients. METHODS: This study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups. RESULTS: A total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characteristics was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P < 0.001) and more residual fragments after the procedure (23.03% vs. 20.97 (P = 0.032). Overall complications were slightly significantly higher in women (15.74% vs. 14% (P = 0.042)) mainly at the expense of fever rates (6.9% vs. 5.7%) whereas the risk of sepsis was similar in both groups. A multivariate analysis showed that larger stone size, multiple and lower pole stones seem to have a negative impact in the incidence of residual stones and complications. CONCLUSION: Our real life global study reflects that female gender may have a correlation with a slightly increased residual fragment rate and overall low grade complications. However, women can safely be treated with RIRS with no increased the rate of sepsis with appropriate care.

Assessment of intrarenal temperature dynamics when using holmium and thulium: YAG lasers in an ex vivo porcine kidney model.

AIM: To measure the temperature dynamics at the renal surface and within the urinary tract when using Ho:YAG and Tm:YAG lasers for tissue ablation. MATERIALS AND METHODS: Porcine kidneys were used. Both types of lasers with different configurations and fiber sizes were used through a flexible ureteroscope. The temperature at the renal surface was recorded using a thermal camera while the intrarenal temperature was measured using two thermal probes, the first one at the ureteropelvic junction and the second one at the calyx used for lasering. Temperature was determined at 0.5-1-3-5 and 10 min. RESULTS: Recordings at the ureteropelvic junction and calyx revealed significant increases when using Tm:YAG with the 273 µm (10 W to 50 W) (p ≤ 0.02) and 550 µm (10 W) fiber (p = 0.04). With Ho:YAG there was a significant increase when using 273 µm (at 10 W and 20 W) (p ≤ 0.03) and 365 µm (10 W) fibers (p = 0.04). Regarding fiber size there was a significant difference when using Tm:YAG (at 20 W and 40 W) (p < 0.05). The thermal camera recorded a mean increase of 8 °C in the UPJ while the remaining areas of the kidney did not undergo significant changes. CONCLUSIONS: Temperature changes were greater when using the Ho:YAG laser with respect to Tm:YAG at similar power settings for tissue ablation. The greatest temperature increase was recorded at the UPJ from where the heat dissipated throughout the kidney.

Entering into 2.0 cystinuric management with a medical digital tool to monitor urine pH: a prospective, randomized study.

BACKGROUND AND OBJECTIVES: Individuals with cystinuria can experiment recurrent lithiasis events due to the relative insolubility of cystine at physiological urine pH, resulting in renal function decline. The Lit-Control® pH Meter is a medical device that accurately allows urine pH self-monitoring. The main objective of this study was to compare the usability of the Lit-Control® pH Meter with the reactive strips for self-monitoring of urinary pH at home by patients with cystinuria, and their overall satisfaction with each tool. PATIENTS AND METHODS: We included 28 patients (9 females and 19 males, age 19-76 years), who were randomly assigned to monitor their urine pH with reactive strips (n = 17) or the Lit-Control® pH-meter (n = 11). RESULTS: After six months of use, the satisfaction with the two methods was similarly high, but the patients rated (0-10 scale) the pH meter better in terms of ease of learning (mean ±â€¯SD, 8.11 ±â€¯0.60 vs. 7.06 ±â€¯1.18; P = 0.038), ease to prepare (8.22 ±â€¯0.67 vs. 7.25 ±â€¯1.18; P = 0.034), and ease of use (8.22 ±â€¯0.67 vs. 7.25 ±â€¯1.39; P = 0.062). Overall, patients did not reach the alkalinization goals (pH between 7.0 and 8.0). CONCLUSIONS: The Lit-Control® pH Meter demonstrated to be an easy-to-use device that can facilitate urinary pH control by cystinuric patients. A prospective study is warranted to assess the correlation between urine pH monitoring, a treat to target approach, and the recurrence of cystine stones.

Evaluación de la dinámica de la temperatura intrarrenal con el uso de láseres holmio y tulio YAG en un modelo exvivo de riñón porcino / Assessment of intrarenal temperature dynamics when using holmium and thulium: YAG lasers in an ex vivo porcine kidney model

Objetivo Medir la dinámica de la temperatura en la superficie renal y dentro de la vía urinaria al usar los láseres Ho:YAG y Tm:YAG para la ablación tisular. Materiales y métodos Se utilizaron riñones porcinos. Ambos tipos de láseres con diferentes configuraciones y tamaños de fibras se usaron a través de un ureteroscopio flexible. La temperatura en la superficie renal fue registrada mediante una cámara termográfica mientras que la intrarrenal fue medida a través de dos termómetros, el primero en la unión pieloureteral y el segundo en el cáliz elegido para el uso del láser. La temperatura fue determinada a los 0,5-1-3-5 y 10 minutos. Resultado Los registros en la unión pieloureteral y en el cáliz revelaron incrementos significativos al usar el Tm:YAG con la fibra de 273μm (10W a 50W) (p≤0,02) y de 550μm (10W) (p=0,04). Con el Ho:YAG se registró un incremento significativo al usar fibras de 273μm (a 10W y 20W) (p≤0,03) y de 365μm (10W) (p=0,04). Respecto al tamaño de las fibras, hubo una diferencia significativa al usar el Tm:YAG (a 20W y 40W) (p<0,05). La cámara termográfica registró un incremento medio de 8°C en la unión pieloureteral mientras que el resto del riñón no sufrió cambios significativos. Conclusione Los cambios de temperatura fueron mayores al usar el láser Ho:YAG respecto al Tm:YAG a configuraciones de poder similares para la ablación tisular. El mayor incremento de temperatura fue registrado en la unión pieloureteral desde donde el calor se disipaba al resto del riñón (AU)

Aim To measure the temperature dynamics at the renal surface and within the urinary tract when using Ho:YAG and Tm:YAG lasers for tissue ablation. Materials and methods Porcine kidneys were used. Both types of lasers with different configurations and fiber sizes were used through a flexible ureteroscope. The temperature at the renal surface was recorded using a thermal camera while the intrarenal temperature was measured using two thermal probes, the first one at the ureteropelvic junction and the second one at the calyx used for lasering. Temperature was determined at 0.5-1-3-5 and 10minutes. Results Recordings at the ureteropelvic junction and calyx revealed significant increases when using Tm:YAG with the 273μm (10W to 50W) (p≤0.02) and 550μm (10W) fiber (p=0.04). With Ho:YAG there was a significant increase when using 273μm (at 10W and 20W) (p≤0.03) and 365μm (10W) fibers (p=0.04). Regarding fiber size there was a significant difference when using Tm:YAG (at 20W and 40W) (p<0.05). The thermal camera recorded a mean increase of 8°C in the UPJ while the remaining areas of the kidney did not undergo significant changes. Conclusions Temperature changes were greater when using the Ho:YAG laser with respect to Tm:YAG at similar power settings for tissue ablation. The greatest temperature increase was recorded at the UPJ from where the heat dissipated throughout the kidney (AU)

Fluoroless Endourological Surgery for Stone Disease: a Review of the Literature-Tips and Tricks.

PURPOSE OF REVIEW: Urologists are at significant risk due to radiation exposure (RE) from endourological procedures for stone disease. Many techniques described have shown a reduction of RE. The purpose of this article is to review available protocols to decrease RE during such procedures and provide tips and tricks for their implementation. RECENT FINDINGS: Several low-radiation and radiation-free protocols for percutaneous nephrolithotomy and flexible ureteroscopy have been described as an attempt to reduce RE during surgery. Beginning with specific checklists to ensure adequate C-arm usage, fluoroless procedures are based on endoscopic assessment, tactile guidance, and use of ultrasound to avoid fluoroscopy. A specific preoperative checklist and low radiation or complete fluoroless radiation endourological procedures have shown to be effective, feasible, and safe. It is recommended for urologists to be aware of the risks of RE and apply the "ALARA" (As Low As Reasonably Achievable) protocols.

A New Simplified Biplanar (0-90°) Fluoroscopic Puncture Technique for Percutaneous Nephrolithotomy. Reducing Fluoroscopy Without Ultrasound. Initial Experience and Outcomes.

OBJECTIVE: To present our simplified biplanar fluoroscopic puncture technique, its reduction in the fluoroscopic screening time as well as outcomes and the initial experience for percutaneous nephrolithotomy. METHODS: We performed a retrospective review of 136 patients operated with our simplified 0-90° puncture technique for percutaneous nephrolithotomy between 2015 and 2018. All patients were classified by stone complexity with Guy´s nephrolithometric stone score. The stone-free rate was evaluated by nonenhanced computerized tomography, and residual stones were defined as fragments ≥2 mm. Complications were divided according to the Clavien-Dindo classification. RESULTS: One hundred and thirty-six patients were operated with our puncture technique; 121 patients were performed in supine and 15 in the prone position. Fifty-one were men, and 85 were women with an overall mean age of 44.36 ± 13.23 years. The overall stone-free rate was 62.5%, and 83.8 % after an ancillary procedure. The mean fluoroscopy screening time was 69.47 ± 7.1 and 6 ± 4.1 seconds for the total surgical procedure and the percutaneous puncture, respectively. Complications were present in 25.7%, and no grade IV and V complications were present. CONCLUSION: Our first case series with the 0-90° simplified fluoroscopic puncture technique shows a similar stone-free rate and safety profile but a low fluoroscopic screening time compared to the most common previously reported fluoroscopic puncture techniques non-focused on low radiation protocols. Further studies are required to evaluate the reproducibility, external validation, and the learning curve of our simplified 0-90° technique.

Totally fluoroless retrograde intrarenal surgery technique in prestented patients: tips and tricks.

Treatment of urolithiasis has evolved greatly as retrograde intrarenal surgery (RIRS) has gained popularity nowadays being a gold standard therapy for renal stones up to 2 cm. Endourological procedures are traditionally fluoroscopic guided; thus, an increasing concern is the harm of radiation exposure, especially in the pediatric population. Therefore, performing fluoroless RIRS should be a feasible option for pediatric urologists. Herein, we describe the technique of totally fluoroless RIRS in presented patients and the tips to avoid radiation use at most.

Hematuria macroscópica gestacional: a propósito de un caso tratado con RIRS / Gestational gross hematuria: report of a case treated with RIRS

La hematuria, durante la gestación, es debida a causas urológicas comunes como la litiasis y la infección de orina, los tumores del riñón y la vejiga, y las malformaciones vasculares renales. Anomalías de la implantación de la placenta y complicaciones obstétricas pueden ocasionar sangrado en orina. Entre las causas nefrológicas figura el síndrome hemolítico urémico. Alteraciones hematológicas asociadas a la gestación como la plaquetopenia favorecen la hematuria, en especial si existe una patología urológica subyacente. Se presenta un caso clínico de hematuria recidivante en una gestante que requirió estudio con RM y URS, resuelto después del parto con cirugía endoscópica intrarrenal (RIRS) (AU)

Hematuria during pregnancy is due to common urological causes such as stones and urinary tract infection, kidney and bladder tumors, and renal vascular malformations. Abnormalities of placenta implantation and obstetric complications are the cause of bleeding in urine. Among nephrological causes is the hemolitic-uremic syndrome. Hematologic abnormalities as a thrombocytopenia favor gestational hematuria, especially if there is an underlying urologic pathology. A case report of recurrent hematuria in a pregnant is presented. MRI and URS was required to study it. The case was resolved after birth with intrarenal endoscopic surgery (RIRS) (AU)

Can endoscopic balloon dilation for primary obstructive megaureter be effective in a long-term follow-up?

BACKGROUND: Ureteral tapering and reimplantation is an established treatment for persistent or progressive primary obstructive megaureter (POM) but may result in complications and morbidity. Use of a less invasive technique involving endoscopic balloon dilation appears very interesting. OBJECTIVE: The objective of this report is to determine if endoscopic balloon dilation for POM is effective in the long term as well as to assess complications of the procedure. MATERIAL AND METHODS: A retrospective review was done on 19 patients and 20 ureters treated with the endoscopic balloon dilation by POM from June 2000 to February 2010. Surgery was performed solely in those cases in which there was persistence of obstruction in the renogram along with one or all of the following conditions: impairment of the differential renal function <40%, worsening of the renal pelvic dilation, febrile UTI in spite of antibiotic prophylaxis or renal calculi. The patients comprised 16 boys and 3 girls with a mean age at surgery of 17 months (range 1-44 months). Ten cases were left sided, eight right sided, and one bilateral. Under endoscopic and fluoroscopic guidance, a 3-5 Fr dilating balloon was inflated to 12-14 atm, or until disappearance of the stenotic obstructive area. A double J stent was positioned and withdrawn 2 months later. Follow-up recorded the presence of symptoms, number of reintervention procedures registered, and included renal ultrasound and MAG-3 renogram. RESULTS: There were no perioperative complications. Eighteen ureters showed a non-obstructive pattern on MAG-3 renogram after the first endoscopic dilation, representing a 90% success rate. One case required a second dilation, which proved successful and two cases of recurrent lithiasis required ureterotomy without instances of obstruction. 2 patients had a febrile UTI and a vesicoureteral reflux was diagnosed in one. Renal function was preserved in 95% of patients. The mean follow-up was 6.9 years (range 3.9-13.3 years). One patient was lost after the procedure. DISCUSSION: In an era of minimally invasive techniques, the search for less invasive procedures for treatment of POM has resulted in a variety of surgical options. Angulo et al., in 1998 and our group described the first POM treatment with endoscopic balloon dilation, which is believed to be a definitive, less invasive, and safe treatment. Furthermore, should an endoscopic approach fail, reimplant surgery can be performed. Few publications have reported short series with good results in the short and medium term. Torino et al. presented five cases in children aged less than 1 year, none of these showed evidence of obstruction. García-Aparicio et al. presented a series of 13 patients treated with a success rate of 84.6%. Christman et al. added laser incision in cases of narrowed ureteral segment 2-3 cm long and used double stenting. Good outcomes were presented in 71%. Romero et al. reported improvement of drainage within the first 18 months after treatment in 69% of patients. The potential de novo onset of vesicoureteral reflux may be the source of some controversy. We consider that dilation does not significantly alter the antireflux mechanism. In VCUG is not systematically performed because it is an invasive test. This restricts the conclusions that can be drawn from our findings. Nevertheless, some groups continue to systematically perform VCUG. CONCLUSIONS: Endoscopic balloon dilation for POM is a safe, feasible, and less invasive procedure that shows good outcomes on long-term follow-up. However, multicenter studies and prospective trials should be encouraged to provide more definitive evidence on its benefits.

Uropatía incrustante por Corynebacterium urealiticum: comentarios a partir de tres casos clínicos / Fouling uropathy by Corynebacterium urealyticum: Comments from three clinical cases

La uropatía incrustante es una enfermedad infecciosa del tracto urinario causada por la bacteria urealítica Corynebacterium urealyticum (CU). En nuestra serie (datos no publicados) sólo el 15% de las infecciones por CU produce uropatía incrustante. La formación de incrustaciones de estruvita y apatita en la pared del urotelio puede afectar a pelvis renal (pielitis), uréter, vejiga (cistopatía) y próstata, incluyendo la celda prostática después de resección ("celdopatía"). La pielitis es la más frecuente. La clínica corresponde a la triada orina alcalina, piuria y cristaluria de estruvita. Los pacientes suelen ser inmunodeprimidos o multioperados. El cultivo de orina debe estar dirigido al diagnóstico de CU. La TC es la prueba de imagen de elección. Muestra típicas imágenes de calcificación laminar. El tratamiento de la uropatía incrustante es multimodal. Incluye antibioterapia, acidificación de la orina y cirugía (algunos casos) (AU)

The encrustant uropathy is an infectious disease of the urinary tract caused by urealithic bacteria Corynebacterium urealyticum (CU). In our series (unpublished data) only 15% of CU infections caused encrustant uropathy. Formation of apatite and struvite on the wall of the urothelium can affect renal pelvis (pyelitis), urether, bladder (cystophatie) and prostate, including prostate cell after resection ("cellpathy"). Pyelitis is the most common. Clinical triad corresponds to alkaline urine, pyuria and struvite crystalluria. Patients are usually immunocompromised or or multiple previous surgeries. Urine culture should be directed to the diagnosis of UC. CT is the imaging test of choice. Shows typical images of laminar calcification. Treatment of encrusted uro pathy is multimodal. Includes antibiotics, acidification of urine and surgery (sometimes) (AU)

Hemangioma papilar como causa de macrohematuria. Presentación de un caso y revisión de la literatura / Papillary hemangioma as a cause of macrohematuria. A case report and review of the literature

La hematuria recidivante unilateral supone un reto diagnóstico y terapéutico para el urólogo. El hemangioma renal (HR) figura entre las posibles causas. La localización en la papila renal es típica. Se presenta un caso de hematuria secundaria a HR que fue diagnosticado en primera instancia como síndrome del cascanueces. Tras una revaloración se realizó ureterorrenoscopia que demostró un hemangioma papilar sangrante. La lesión fue tratada con fotovaporización láser con buen resultado. Se revisa la etiopatogenia, diagnóstico y las opciones terapéuticas frente al HR sangrante (AU)

Unilateral recurrent hematuria is a diagnostic and therapeutic challenge for the urologist. The renal hemangioma (RH) is a possible cause. The location is typically the renal papilla. A case of hematuria secondary to RH who was diagnosed at first instance and nutcracker syndrome is presented. After a diagnostic reassessment ureterorenoscopy was performed which showed a bleeding papillary hemangioma. The lesion was treated with laser PVP with good results. The pathogenesis, diagnosis and therapeutic options against the bloody RH is reviewed (AU)

Litiasis úrica coraliforme bilateral de origen intestinal. Presentación de un caso tratado con la combinación quirúrgica NLP/RIRS/ECIRS / Uric bilateral staghorn lithiasis of intestinal origin. Report of a case treated with surgical combination NLP / RIRS / ECIRS

La cirugía endoscópica renal (por vía percutánea o por vía retrograda) se ha consolidado como una técnica de elección para los cálculos renales. En los más voluminosos (mayores de 2-3 cm de diámetro mayor) está indicada la nefrolitotomía percutánea (NLP) y en los menores la cirugía retrógrada intrarrenal RIRS (exceptuando los tratables con litotricia extracorpórea por ondas de choque). La ECIRS es una modalidad mixta. La litotricia endoscópica con láser es un tratamiento eficaz en las tres técnicas. En NLP es necesario usar altas energías La litiasis de AU representan un 10% del total de cálculos en España. Entre los factores etiológicosfiguran la dieta, los procesos inductores de lisis celular (ciertas neoplasias, quimioterapia) y algunos trastornos digestivos. Aunque la bilateralidad es muy frecuente es más raro encontrar coraliformes bilaterales. Presentamos un caso de litiasis renal úrica bilateral coraliforme (AU)

Renal endoscopic surgery (percutaneously or via retrograde) has become a technique of choice for kidney stones. In the more bulky (greater than 2-3 cm in diameter) is indicated percutaneous nephrolithotomy (PCNL). In smaller is indicated intrarenal retrograde surgery (RIRS), excluding those that can be treated with extracorporeal shock wave lithotripsy. The ECIRS is a mixed mode. Endoscopic laser lithotripsy is an effective treatment in the three techniques. In NLP is necessary to use high energy. The uric acid stones account for 10% of all stones in Spain. Etiologic factors include diet, conditions inducing cell lysis (certain malignancies, chemotherapy) and some digestive disorders. Although it is very frequent bilaterality is rare to find bilateral staghorn. We report a case of bilateral staghorn uric kidney stones secondary to intestinal disorder treated with a combination of three pocedures (AU)

Extracción de un cálculo vesical a un niño según el relato del médico renacentista Cristóbal Méndez / Extraction of a bladder stone in a child as described by the renaissance physician Cristóbal Méndez

Introducción: El médico renacentista español Cristóbal Méndez (1500-1553) relata en su obra Libro del exercicio y de sus provechos la extracción de un grueso cálculo de la vejiga de un niño menor de 5 años en el México colonial, siendo la primera descripción de un procedimiento quirúrgico en América. Material y métodos: Recopilación de datos biográficos sobre Cristóbal Méndez. Lectura del facsímil electrónico del Libro del exercicio y de sus provechos. Análisis de los aspectos históricos sobre la litotomía perineal y etiología de la litiasis vesical. Resultados: En el capítulo 7 del tercer tratado (página 120) Méndez narra la extracción del cálculo vesical a un niño llamado «Villaseñor». Emplea la palabra «abrir» para describir el procedimiento, correspondiente a una litotomía más que a una necropsia. Atribuye la etiología al exceso de movimientos tras la ingesta y apunta una posible etiología hereditaria. Discusión: La litotomía perineal era una práctica habitual en niños de la antigüedad por la alta incidencia de litiasis vesical. La técnica era muy cruenta y fue mejorando a lo largo de siglos. Conclusiones: La intervención descrita por Méndez al niño Villaseñor corresponde con mayor probabilidad a una litotomía perineal. En su etiología pudo intervenir una causa congénita

Introduction: In his Libro del exercicio y desus provechos (Book of exercise and profits), the Spanish Renaissance physician Christopher Mendez (1500-1553) describes extracting a bulk stone from the bladder of a child younger than 5 years in the land of colonial Mexico. This is the first description of a surgical procedure in America. Materials and methods: Biographical data were collected on Christopher Mendez. The electronic facsimile of the Book of exercise and profits was read. The historical aspects of perineal lithotomy and etiology of bladder stones were analyzed. Results: In chapter seven of the third treatise (page 120), Mendez speaks about the removal of a bladder stone in a boy named "Villaseñor". It uses the word "open" to describe the procedure, corresponding to a lithotomy more than a necropsy. It attributes the etiology of excess movements after ingestion and suggests a possible hereditary etiology. Discussion: Perineal lithotomy was a common practice in ancient times for children due to the high incidence of bladder stones. The technique was very invasive and was improved over the centuries. Conclusions: The surgery described by Mendez for the child called Villaseñor most likely corresponds to a perineal lithotomy. A congenital cause could play a role in its etiology

Versión española del cuestionario USSQ: evaluación de la tolerancia clínica al catéter ureteral doble jota / Spanish version of the USSQ questionnaire: evaluation of clinical tolerance to double J uretheral catheter

INTRODUCCIÓN: La evaluación de los síntomas debidos a catéter ureteral doble jota (CUJJ) precisa de una herramienta fiable como el cuestionario USSQ. Se presenta una versión traducida al español de este cuestionario (USSQ-E). MATERIAL Y MÉTODOS: La versión en inglés del USSQ ha sido traducida al español siguiendo una sofisticada sistemática lingüística. Una vez obtenido el USSQ-E ha sido probado en un grupo de 70 pacientes portadores de CUJJ. Como grupo control se han tomado 40 personas sin catéter. RESULTADOS: Se ha evaluado el USSQ-E con pruebas de consistencia interna, test-retest, validez convergente, sensibilidad al cambio y validez discriminatoria, siendo todas ellas satisfactorias. CONCLUSIÓN: El USSQ-E es una herramienta válida y fiable para evaluar la sintomatología derivada del CUJJ en población hispanoparlante (AU)

INTRODUCTION: The assessment of symptoms due to double J ureteral catheter (CUJJ) requires a reliable tool like USSQ questionnaire. A translation in Spanish of this questionnaire (USSQ-E) version is presented. MATERIAL AND METHODS: The English version of USSQ has been translated into Spanish language following a systematic sophisticated. After obtaining the USSQ-E has been tested in a group of 70 patients with CUJJ. A control group of 40 people have been taken without catheter. RESULTS: We evaluated the USSQ-E with evidence of internal consistency, test-retest reliability, convergent validity, sensitivity to change and discriminant validity, all of which are satisfactory. CONCLUSION: USSQ-E is a valid and reliable for assessing symptomatology derived CUJJ tool in speaking population (AU)

Extraction of a bladder stone in a child as described by the renaissance physician Cristóbal Méndez.

INTRODUCTION: in his Libro del exercicio y de sus provechos (Book of exercise and profits), the Spanish Renaissance physician Christopher Mendez (1500-1553) describes extracting a bulk stone from the bladder of a child younger than 5 years in the land of colonial Mexico. This is the first description of a surgical procedure in America. MATERIAL AND METHODS: Biographical data were collected on Christopher Mendez. The electronic facsimile of the Book of exercise and profits was read. The historical aspects of perineal lithotomy and etiology of bladder stones were analyzed. RESULTS: In chapter seven of the third treatise (page 120), Mendez speaks about the removal of a bladder stone in a boy named «Villaseñor¼. It uses the word «open¼ to describe the procedure, corresponding to a lithotomy more than a necropsy. It attributes the etiology of excess movements after ingestion and suggests a possible hereditary etiology. DISCUSSION: Perineal lithotomy was a common practice in ancient times for children due to the high incidence of bladder stones. The technique was very invasive and was improved over the centuries. CONCLUSIONS: The surgery described by Mendez for the child called Villaseñor most likely corresponds to a perineal lithotomy. A congenital cause could play a role in its etiology.

Recomendaciones dietéticas en la litiasis de oxalato cálcico / Dietary recommendations in calcium oxalate lithiasis

La dieta puede afectar a los enfermos con litiasis oxálica, aumentando los factores de riesgo para la formación. Una vez completado el estudio metabólico se deben dar algunas normas dietéticas basadas en los datos científicos disponibles. Existen pocos trabajos que hayan analizado de forma completa el contenido de oxalatos en los alimentos de la dieta humana. Se debe insistir en la ingesta hídrica abundante, la reducción de sal y de proteínas animales, manteniendo un correcto aporte de calcio. En el presente trabajo se adjuntan algunas tablas de contenidos de oxalato en diversos alimentos. Los más ricos en oxalato (acelgas, espinacas, coliflor, té, cacao, kiwis) deben ser restringidos

Diet affect oxalic lithiasis patients, increasing the risk factors for stone formation. Upon completion of the metabolic study should give some dietary guidelines based on scientific data. Few studies have analyzed completely the oxalate content in foods of the human diet. It must be emphatized abundant fluid intake, reducing salt and animal protein, maintaining proper calcium intake. In this paper, some tables about oxalate content in various foods are attached. Most rich in oxalate (chard, spinach, cauliflower, tea, cocoa, kiwis) must be restricted

Ureterolitotomía laparoscópica en litiasis ureteral proximal de gran tamaño / Laparoscopic ureterolithotomy in proximal uretheral litiasis of great size

Se presenta el caso de ureterolitotomía laparosocópica en un paciente joven con un grueso cálculo en uréter lumbar izquierdo. La operación se realizó tras el fracaso de dos sesiones de litotricia extracorpórea por ondas de choque. La técnica resulta eficaz y presenta mínimas complicaciones. Cada vez más se indican casos de laparoscopia en el tratamiento quirúrgico de la litiasis. Ello se debe a la falta de eficacia de otras técnicas menos invasivas como la LEOC, y a las limitaciones de la ureterorrenoscopia en cálculos ureterales cercanos a los 20 mm (AU)

We present a case of laparoscopic ureterolithotomy in a young patient with a thick left lumbar ureter stone. The operation was performed after the failure of two sessions of extracorporeal shock waves lithotripsy (ESWL). The technique is efficient and has minimal complications. Increasingly, The laparosocopy is increasingly recommended in cases of urolithiasis. This is due to the lack of effectiveness of other less invasive techniques such as ESWL, and the limitations of ureteroscopy against ureteral stones close to 20 mm (AU)

Coluria y pigmenturia / Choluria and pigmenturia

Orina oscura no siempre significa hematuria. Diversas situaciones clínicas y pigmentos orgánicos e inorgánicos pueden modificar el color amarillento pajizo de la orina normal. Conviene diferenciar a simple vista las diversas tonalidades cromáticas de la orina para no confundir las distintas situaciones clínicas que la provocan. La tirilla reactiva es la prueba inicial más eficaz para discriminar la hematuria de la hemoglobinuria/mioglobinuria, la bilirrubinuria y la coluria. En este trabajo se repasan las principales causas de orina oscura, coluria y pigmenturia (AU)

Dark urine does not always mean hematuria. Various clinical and organic and inorganic pigments can dye urine modifying the straw yellow color of normal urine. Should distinguish at a glance the various chromatic tones of urine in order not to confuse the different clinical situations that cause it. The dipstick test is the most effective initial test to discriminate hematuria and hemoglobinuria/myoglobinuria. This paper reviews the main causes of dark urine, choluria and pigmenturia (AU)