[Single center experience with Siemens Lithostar Modularis for treatment of 1500 solitiary urinary stones]. / Resultado del tratamiento con Lithostar Modularis de Siemens de 1500 pacientes con litiasis unica.

OBJECTIVES: the aim of the study was to evaluate the results of extracorporeal shock wave lithotripsy (ESWL) treatment with Siemens Lithostar Modularis in urinary stones. PATIENTS AND METHODS: from May 2000 until September 2006, 1500 patients, 62% men and 38% women, ages 15 to 89 years (mean age 53), underwent ESWL as treatment of urinary stones at the Lithotripsy Unit of León. Data were analized retrospectively. More than half (56%) had left urinary stones. The most frequent ureteral localization (55%) was proximal (420 patients), and the most frecuent renal was renal pelvis (345 patients). The mean stone diameter was 1.3 cm. (1.01 ureteral and 1.7 renal). All patients received ESWL-session under i.v. analgesia with alfentanil and midazolam. RESULTS: Mean number of sessions per lithiasis was 1.5 (ureteral stones 1.4 and renal stones 1.7). The retreatment rate was 33%, 28% for ureteral stones and 39% for renal stones with a cumulative success of 86% with two sessions. 22% of the patients required auxiliary manouvers, 24% of the patients with ureteral stones and 18% of the renal stones patients. Stone free rate was 91%, 97% in ureteral stones and 82% in renal stones. CONCLUSIONS: treatment of urinary stones with Siemens Lithostar Modularis showed good results, with a stone free patient rate of more than 90%, although 33% of the patients need multiple ESWL treatment sessions and 20% of the patient required auxiliary procedures.

Resultado del tratamiento con Lithostar Modularis de Siemens de 1500 pacientes con litiasis única / Single center experience with Siemens Lithostar Modularis 1500 solitary urinary stones

Objetivos: Valoración de la eficacia de la litotricia extracorpórea en litiasis urinaria con el litotritor Lithostar Modularis de Siemens. Pacientes y Métodos: de junio del 2000 a Septiembre de 2006 se trataron 1.500 pacientes, 62% varones y 38%mujeres, con edades comprendidas entre 15 y 89 años, media 53 años, en la Unidad de Litotricia de León. Los datos se analizaron de forma retrospectiva. En el 56 % de los enfermos la localización de la litiasis fue izquierda. En el uréter, el 55% de las litiasis, la localización más frecuente fue proximal (420 pacientes) y la localización más frecuente renal fue en la pelvis (345 pacientes). El tamaño medio de las litiasis fue de 1,3 cm (1,01 cm en urétery 1,7 cm renal). Todos los pacientes se trataron con sedación con alfentanil y midazolan. Resultados: La media de sesiones por litiasis fue de 1,5 (1,4 en las ureterales y 1,7 en las renales) La tasa de retratamiento fue de 33% (28% en el caso de las litiasis ureterales y 39% en las renales. La eficacia acumulada tras 2 sesiones fue de 86%. El 22% precisó maniobras auxiliares (el 24% de las ureterales y el 18% de las renales).El porcentaje de pacientes libre de litiasis fue del 91% (97 % en el caso de las ureterales y el 82% en el caso de las renales).Conclusiones: El tratamiento de las litiasis urinarias mediante litotricia con el Lithostar Modularis de Siemens muestra unos buenos resultados, con más de un 90% de los pacientes libres de litiasis, aunque con un 33% de retratamientos y más de un 20% de los pacientes precisan maniobras auxiliares (AU)

Objectives: the aim of the study was to evaluate the results of extracorporeal shock wave lithotripsy (ESWL) treatment with Siemens Lithostar Modularis in urinary stones. Patients and Methods: from may 2000 until September 2006, 1500 patients, 62% men and 38% women, ages 15 to 89 years (mean age 53), underwent ESWL as treatment of urinary stones at the Lithotripsy Unit of León. Data were analized retrospectively. More than half (56%) had left urinary stones. The most frequent ureteral localization (55%) was proximal (420 patients), and the most frecuent renal was renal pelvis (345 patients). The meanstone diameter was 1.3 cm. (1.01 ureteral and 1.7 renal). All patients received ESWL-session under i.v. analgesia with alfentanil and midazolam. Results: Mean number of sessions per lithiasis was 1.5 (ureteral stones 1.4 and renal stones 1.7). The retreatment rate was 33%, 28% for ureteral stones and 39 % for renal stones with a cumulative success of 86% with two sessions. 22% of the patients required auxiliary man ouvers, 24% of the patients with ureteral stones and 18% of the renal stones patients. Stone free rate was 91%, 97% in ureteral stones and 82% in renal stones. Conclusions: treatment of urinary stones with Siemens Lithostar Modularis showed good results, with a stone free patient rate of more than 90%, although 33% of the patients need multiple ESWL treatment sessions and 20%of the patient required auxiliary procedures (AU)

[Bladder endometriosis. Diagnostic and treatment]. / Endometriosis vesical. Diagnóstico y tratamiento.

Endometriosis is a common gynecologic disease in which endometrial tissue is deposited outside the normal confines of the uterine cavity. Rarely endometriosis involves urinary tract. The bladder is the most frequent organ affected into this tract. A delay in detection can result in months or years of morbidity.

Endometriosis vesical. Diagnóstico y tratamiento / Bladder endometriosis. Diagnostic and treatment

La endometriosis es una enfermedad ginecológica muy frecuente en la que el tejido endometrial aparece fuera de la cavidad uterina. En raras ocasiones la endometriosis afecta al tracto urinario, siendo la vejiga el órgano más frecuentemente afectado. Un retraso en su detección puede condenar a la paciente a meses de morbilidad innecesaria (AU)

[Inflammatory aorto-iliac aneurysm. A cause of extrinsic ureteral obstruction]. / Aneurismas aorto-ilíacos inflamatorios. Una causa de obstrucción ureteral extrínseca.

OBJECTIVE: A ureteral pathology arising from inflammatory aneurysm of the abdominal aorta is described. METHODS/RESULTS: A case of inflammatory abdominal aortic aneurysm causing entrapment of both ureters, destruction of a renal unit and ureterohydronephrosis of the contralateral kidney is described. CONCLUSIONS: Treatment of inflammatory aneurysm of the abdominal aorta is by surgical repair with a prosthesis. Endourological urinary drainage is warranted prior to surgical repair, but ureterolysis to preserve renal function is unnecessary.

[Postoperative fusiform cell nodule. Relationship with other benign fibrous proliferations]. / Nódulo de células fusiformes postquirúrgico. Relación con otras proliferaciones fibrosas benignas.

We report on a patient who developed postoperative spindle cell nodule one month following TURP for prostatic adenocarcinoma. The foregoing was compared with other benign fibrous lesions from our records: one case of nodular fasciitis and one case of proliferative myositis. Although they were all well-defined and clinically distinct disease entities, a very close relationship concerning their origin was demonstrated histologically and immunohistochemically.

[Synchronous metastasis of renal adenocarcinoma to gallbladder and ipsilateral adrenal gland]. / Metástasis en vesícula biliar y suprarrenal ipsilateral sincrónica de adenocarcinoma renal.

Herein we describe a patient in whom a renal mass had been detected. He had no previous urological symptoms or signs, but had undergone laryngectomy in 1989 for well-differentiated squamous cell carcinoma of the glottic region. The radiological and ultrasound evaluations disclosed a right renal mass, a mass in the ipsilateral adrenal gland and a polypoid mass in the gallbladder. The patient underwent radical nephrectomy, adrenalectomy and cholecystectomy. The surgical specimens of the gallbladder and adrenal gland showed histological evidence of clear cell carcinoma with the same characteristics as those of the primary renal tumor.

[Renal angiomyolipoma: a cause of massive retroperitoneal hemorrhage]. / Angiomiolipoma renal: una causa de hemorragia retroperitoneal masiva.

Five patients were diagnosed as having angiomyolipoma. Evidence or signs of tuberous sclerosis were observed in no patient. In 2 patients the presenting symptoms was massive retroperitoneal hemorrhage which required emergency surgery. The kidney could be preserved in 4 cases. One underwent nephrectomy for synchronous clear cell renal tumor. CT and US afford a diagnostic accuracy of nearly 100 percent. According to the data reported in the literature, tumors larger than 4 cm are amenable to treatment by conservative surgery. Smaller tumors can be followed carefully. However, surgical exploration is warranted not only in patients with pain and hemorrhage, but also in those cases with complex lesions less than 4 cm.

[Corynebacterium D2 as a ureolytic organism: report of 5 cases]. / Corynebacterium D2 como germen ureolítico: a propósito de cinco casos.

Corynebacterium D2, a saprophytic microorganism of skin, causes alkaline encrusted cystitis in patients with a previous bladder injury. In 5 patients that had presented this nosological entity, these gram-positive rods were isolated in urine cultures and calculi. Four patients had undergone urological instrumentation maneuvers and one patient (female) had a history of recurrent cystitis from gram-negative bacteria. Corynebacterium D2 grows slowly and under certain conditions, as those described above, must be considered pathological despite counts of less than 100,000/ufc-cc. It is ureolytic and highly resistant to antibiotics. The synergistic effects of antimicrobials, acetohydroxamic acid and transurethral resection of the lithiasic plaques achieve satisfactory treatment of alkaline encrusted cystitis from Corynebacterium D2.

[Epidermoid carcinoma of the urinary tract. Immunohistochemical study]. / Carcinoma epidermoide de vías urinarias. Estudio inmunohistoquímico.

Six patients diagnosed as having urothelial carcinoma with varying degrees of squamous features are described. Four had pure squamous carcinoma. Two had transitional cell carcinoma (1 with squamous areas and the other had carcinoma in situ). The histological analyses of specimens were performed using immunohistochemical techniques to detect epithelial markers with low molecular weight monoclonal antibodies to cytokeratin. The tests were positive for pure squamous carcinoma and transitional cell carcinoma with squamous areas, and were negative for all areas of transitional cell carcinoma. We underscore the importance of the squamous component in the prognosis of urothelial carcinomas as well as the usefulness of this type of markers, particularly low molecular weight antibodies to cytokeratin, in differentiating squamous areas.

[Substitution and augmentation enterocystoplasty: long-term follow up]. / Enterocistoplatias de sustitución y ampliación: seguimiento a largo plazo.

From 1957 to 1981, nine patients (7 males and 2 females) were submitted to enterocystoplasty or bladder augmentation procedure. Patient age ranged from 19-67 years (mean = 40 yrs). Patient follow-up ranged from 9 to 31 years (mean = 19 yrs). The terminal ileum was utilized in 6 and the sigmoid in 3. Five patients had tuberculous conditions, 2 had transitional cell bladder tumor, 1 had interstitial cystitis, and 1 patient had bladder fibrosis. The ureters were directly reinserted in 2 cases. Two patients required TUR of the bladder neck; 1 patient had nocturnal incontinence. Two presented severe and 1 moderate chronic renal failure. In our view, augmentation and substitution plasty utilizing a segment of the intestine achieve good results. However, patients must be followed closely. Two patients who had been lost to follow-up presented with chronic renal failure. These patients might have benefitted from TUR of the bladder neck to correct voiding problems and avoid deterioration of the upper urinary tract.