Factores predictivos de éxito tras una sesión única de litotricia extracorpórea de cálculos urinarios a las tres semanas de seguimiento / Single-Session Extracorporeal Shock Wave Lithotripsy for Urinary Calculi: Factors Predicting Success after Three Weeks of Follow-Up

Objetivo: Identificar factores predictivos de éxito después de una sesión única de litotricia extracorpórea por ondas de choque (LEOC) a las tres semanas de seguimiento. Material y métodos: Se revisaron los registros clínicos de 116 pacientes con cálculos urinarios únicos sometidos a LEOC entre octubre 2007 y agosto 2009. Las tomografías axiales computarizadas preoperatorias de todos los pacientes fueron revisadas por dos radiólogos en desconocimiento del desenlace clínico. El éxito fue definido como la desaparición completa del cálculo o la persistencia de fragmentos ≤ 2mm en la radiografía simple realizada durante las tres primeras semanas de seguimiento. El impacto de factores clínicos y radiológicos fue evaluado utilizando regresión logística. Resultados: La tasa de éxito de LEOC a las tres semanas de seguimiento fue del 49,1%. Tamaño < 8mm, área del cálculo < 30mm2, localización en el uréter distal, densidad < 1.000 UH y fragmentación intraoperatoria demostraron una significativa asociación con éxito en el análisis univariado (p<0,05). Área del cálculo<30mm2 (OR: 2,9), localización en uréter distal (OR: 3,4) y fragmentación intraoperatoria (OR: 4,2) fueron factores predictivos de éxito en el análisis multivariado (p<0,05). Conclusiones: El área del cálculo y la localización en el uréter distal son útiles en el momento de decidir acerca de la realización de una LEOC. Sin embargo, la resolución exitosa de solamente la mitad de los casos bajo los criterios evaluados recalca la relevancia de informar al paciente de la eventual necesidad de tratamientos adicionales después de una sesión única de LEOC (AU)

Introduction: The aim of this study was to identify predictive factors of success following a single-session of shock wave lithotripsy (SWL) at 3 weeks of follow-up in our center. Material and methods: The medical records of 116 patients with solitary urinary calculi who underwent single-session SWL in our department between October 2007 and August 2009 were reviewed. All preoperative unenhanced computed axial tomographies were reviewed by two radiologists blinded to clinical outcome. Success was defined as complete clearance or the persistence of fragments ≤ 2mm on a plain film at 3 weeks of follow-up. The impact of clinical and radiological factors on success was assessed by univariate and multivariate analyses. Results: The single-session SWL success rate at 3 weeks was 49.1%. Stone size <8mm, stone area < 30mm2, stone location (mid- and distal ureter), stone density <1000 HU and intraoperative fragmentation showed a significant association with SWL success in the univariate analysis (p<0.05). Stone area (OR 2.9), ureteral stone location (OR 3.4) and intraoperative fragmentation (OR 4.2) were the only predictors of success in the multivariate analysis. Conclusions: Stone area and ureteral stone location provide important information when deciding about the indication of a SWL in a patient with stone disease. However, successful resolution of only half of the cases after a single session at 3 weeks in our series undermines the relevance of informing patients about the potential need for additional treatment (AU)

[Single-session extracorporeal shock wave lithotripsy for urinary calculi: factors predicting success after three weeks of follow-up]. / Factores predictivos de éxito tras una sesión única de litotricia extracorpórea de cálculos urinarios a las tres semanas de seguimiento.

INTRODUCTION: The aim of this study was to identify predictive factors of success following a single-session of shock wave lithotripsy (SWL) at 3 weeks of follow-up in our center. MATERIAL AND METHODS: The medical records of 116 patients with solitary urinary calculi who underwent single-session SWL in our department between October 2007 and August 2009 were reviewed. All preoperative unenhanced computed axial tomographies were reviewed by two radiologists blinded to clinical outcome. Success was defined as complete clearance or the persistence of fragments ≤ 2 mm on a plain film at 3 weeks of follow-up. The impact of clinical and radiological factors on success was assessed by univariate and multivariate analyses. RESULTS: The single-session SWL success rate at 3 weeks was 49.1%. Stone size <8 mm, stone area < 30 mm(2), stone location (mid- and distal ureter), stone density <1000 HU and intraoperative fragmentation showed a significant association with SWL success in the univariate analysis (p<0.05). Stone area (OR 2.9), ureteral stone location (OR 3.4) and intraoperative fragmentation (OR 4.2) were the only predictors of success in the multivariate analysis. CONCLUSIONS: Stone area and ureteral stone location provide important information when deciding about the indication of a SWL in a patient with stone disease. However, successful resolution of only half of the cases after a single session at 3 weeks in our series undermines the relevance of informing patients about the potential need for additional treatment.

Láser KTP (verde) para la vaporización fotoselectiva del adenoma prostático obstructivo: una evaluación independiente / KTP Laser (green) for photoselective vaporization of the obstructive prostatic adenoma: an independent evaluation

La vaporización fotoselectiva del adenoma prostático es una técnica poco invasiva, que consiste en la vaporización y remoción del tejido usando el láser verde KTP, con una potencia de 80W. El propósito de este trabajo es informar nuestra experiencia con el uso de esta técnica. Material y Métodos: Se realizó fotovaporización selectiva con láser KTP a 18 pacientes, portadores de uropatía obstructiva baja secundaria a HNBP, entre noviembre de 2005 y abril de 2006, en el Hospital Militar de Santiago. Se registraron las características pre operatorias y los resultados post operatorios y complicaciones. Resultados: El volumen prostático promedio fue de 51 cc (rango 24 a 78). El tiempo operatorio promedio fue de 83 minutos (rango 40 a 120). Dieciséis pacientes quedaron sin sonda Foley antes de las 24 horas. El promedio del score AUA preoperatorio fue de 22 y disminuyó a 11,4 a los 30 días. El flujo máximo promedio en el pre operatorio fue de 9 ml/seg y aumentó a 18,2, 22,1, 22,5, 25,3 y 27,2 ml/seg al día 1, 7, 14, 21 y 30 respectivamente. Las complicaciones no fueron de gravedad e incluyeron demora en el retiro de la sonda Foley (11,1 por ciento), disuria (16,6 por ciento) y hematuria tardía (11,1 por ciento). Conclusiones: La vaporización fotoselectiva del adenoma prostático con láser KTP es una técnica segura, fácil de aprender, con buenos resultados funcionales a corto plazo y con bajo riesgo de complicaciones.

Prostatic adenoma photoselective vaporization is a low invasive technique. It is a tissue vaporization and removal using green KTP laser, under 80W power. The purpose of this work was to report our experience with this technique. Material and Methods: Selective photovaporization with KTP laser to 18 patients, carriers of secondary low obstructive uropathy HNBP, was carried out from November, 2005 to April 2006, in Hospital Militar of Santiago. Pre-operation characteristics and post- operation results and complications were registered. Results: The prostatic volume average was 51cc (range 24 to 78). Average operation time was 83 minutes (range 40 to 120). The Foley catheter was removed from sixteen patients before 24 hours. The AUA preoperation average score was 22, and on the 30th day it diminished to 11.4. The maximum average in the pre-operation was 9 ml/sec and it increased to 18.2, 22.1, 22.5, 25.3 and 27.2 ml/sec. at the 1st, 7th, 14th, 21st, and 30th day, respectively. Complications were not serious. They included delay in the removal of Foley catheter (11.1%), dysuria (16.6%) and late hematuria (11.1%) Conclusions: Prostatic adenoma photoselective vaporization with KTP laser is a safe, easy to learn technique, with good functional results at the short term and with low risk of complications.

[Extracorporeal lithotripsy of urinary calculi: experience with Modulith SL-20 (Storz Medical)]. / Litotricia extracorporea de calculos urinarios: experiencia con el Modulith SL-20 (Storz Medical).

The results of extracorporeal lithotripsy on 250 patients with renal and ureteral stones are reported. Stone size varied from less than 1 cm (64%), 1 to 2 cm (31%) to over 2 cm (4%). 51% of patients were treated on an ambulatory basis. Complete fragmentation was obtained in 97% of patients and 78% were free of any demonstrable stone after 90 days. lithotripsy is an effective procedure allowing ambulatory non surgical treatment of urinary stones in many patients.

Neoimplante ureterovesical en transplante renal: controversias de técnica / Ureterovesical implantation in renal transplantation

Se presenta una serie de 28 pacientes sometidos a transplante renal en quienes la reconstitución de la vía urinaria se efectuó mediante anastomosis ureter vesical directa sin técnica anti reflujo. 19 pacientes fueron sometidos tardíamente a cistografía de relleno y miccional observandose reflujo vesico ureteral en sólo 10.5% de éllos, cifra que es sensiblemente similar o inferior a la obtenida en grandes series en las que se ha pretendido expresamente evitar el reflujo efectuando el implante ureteral con túnel submucoso