La combinación de litotricia extracorpórea y ureterorrenoscopia flexible optimiza el tratamiento de litiasis renales / Combination of extracorporeal lithotripsy and flexible ureterorenoscopy optimize renal lithiasis therapy

Objetivos: Describir nuestra experiencia inicial en el tratamiento de las litiasis renales mediante litotricia extracorpórea controlada por ureterorrenoscopia flexible simultánea y combinada con litotricia mediante láser holmium. Material y métodos: Llevamos a cabo esta novedosa técnica en una paciente previamente seleccionada que presentaba litiasis renales izquierdas, 2 en cáliz superior, 2 en cáliz medio y 2 en cáliz inferior, la mayor de ellas en cáliz medio de 6 mm. Realizamos de forma simultánea una litotricia extracorpórea por ondas de choque y una ureterorrenoscopia flexible para un mejor control de la fragmentación de la litiasis y aplicando láser holmium. En el postoperatorio inmediato se realizó una ecografía y una tomografía computarizada (TC) de control al mes. Resultados: Se consiguió la completa fragmentación de todas las litiasis y se dejó un catéter doble J que se retiró posteriormente tras la comprobación de la ausencia de restos litiásicos mediante TC. No hubo complicaciones intraoperatorias, ni posquirúrgicas. Conclusiones: Esta técnica descrita es novedosa, segura y reproducible. El buen resultado obtenido mediante esta técnica combinada aumenta nuestro interés en seguirla empleando y considerarla como una opción de tratamiento para las litiasis renales de nuestros pacientes

Objective: Describe our initial experience in the treatment of renal lithiasis with extracorporeal lithotripsy controlled by simultaneous flexible ureterorenoscopy and combined with holmium laser lithotripsy. Material and methods: We performed this novel technique in a previously selected patient with left renal lithiasis, two in the superior calix, two in the medium calix and two in the inferior calix, the biggest of which was placed in medium calix and was 6 mm long. We proceeded to an extracorporeal shock wave lithotripsy and a simultaneous flexible ureterorenoscopy for better controlling the fragmentation of the lithiasis with the use of a holmium laser. In the immediate post-operative, an ultrasound was performed and, one month later, a computerized tomography (CT) was done. Results: The complete fragmentation of all the lithiasis was obtained and a double-J catheter was placed. After the assessment of the absence of stone fragments by CT the catheter was removed. No intra-operative or post-operative complications were described. Conclusions: The technique described is novel, safe and reproducible. The good result obtained through this combined technique increases our interest in continuing with its application and consider it as an option for the treatment of renal lithiasis in our patients

Residual tumor resection (RTR).

Residual tumor resection in patients with advanced testicular tumor plays a vital role in the multimodal treatment. Treatment indications for residual tumor resection have changed over the last two decades. While patients with advanced seminoma after chemotherapy or radiotherapy rarely need surgery, it is mandatory for most non-seminomatous tumor patients to undergo post-chemotherapy tumor resection. Due to adjunctive surgical procedures, the operation is surgically demanding and should be performed only in specialized high-volume referral centers. Additional surgical procedures such as nephrectomy, partial colectomy or vascular interventions including caval and aortic resection with grafting might be required. Consequently, several complications can be seen in the peri- and postoperative course. We aim to describe indications for residual tumor resection, operative technique, including adjunctive surgeries and the most common peri- and postoperative complications.

Combination of extracorporeal lithotripsy and flexible ureterorenoscopy optimize renal lithiasis therapy. / La combinación de litotricia extracorpórea y ureterorrenoscopia flexible optimiza el tratamiento de litiasis renales.

OBJECTIVE: Describe our initial experience in the treatment of renal lithiasis with extracorporeal lithotripsy controlled by simultaneous flexible ureterorenoscopy and combined with holmium laser lithotripsy. MATERIAL AND METHODS: We performed this novel technique in a previously selected patient with left renal lithiasis, two in the superior calix, two in the medium calix and two in the inferior calix, the biggest of which was placed in medium calix and was 6mm long. We proceeded to an extracorporeal shock wave lithotripsy and a simultaneous flexible ureterorenoscopy for better controlling the fragmentation of the lithiasis with the use of a holmium laser. In the immediate post-operative, an ultrasound was performed and, one month later, a computerized tomography (CT) was done. RESULTS: The complete fragmentation of all the lithiasis was obtained and a double-J catheter was placed. After the assessment of the absence of stone fragments by CT the catheter was removed. No intra-operative or post-operative complications were described. CONCLUSIONS: The technique described is novel, safe and reproducible. The good result obtained through this combined technique increases our interest in continuing with its application and consider it as an option for the treatment of renal lithiasis in our patients.

[Management of complications after residual tumor resection for metastatic testicular cancer]. / Komplikationsmanagement nach Residualtumorresektion bei metastasiertem Hodentumor.

Residual tumor resection (RTR) in patients with metastatic testicular cancer plays a pivotal role in a multimodal treatment. It can be performed unilaterally or as an extended bilateral RTR. Additional surgical procedures might be necessary, such as nephrectomy, splenectomy, partial colectomy, or vascular interventions with possible caval resection, cavotomy, or aortic resection with aortic grafting. Consequently, several complications can be seen in the intra- and postoperative course, most common of which are superficial wound infections, intestinal paralysis, lymphocele, and chylous ascites. We sought to describe complication management and how to prevent complications before they arise.

[Pelvic kidney in childhood. Specific features, concomitant pathologies and useful diagnostic investigations]. / Kindliche Beckenniere. Spezifika, Begleitpathologien und sinnvolle Diagnostik.

In a retrospective analysis we studied the case histories of 31 children who had been seen in our department for investigation of pelvic ectopic kidney between January 1994 and June 2005. The evaluation of each involved the medical history, ultrasound examination, VCUG, and DMSA scan or MAG3 diuresis renogram. Of the 31 children, 21 (67.7%) had initially been referred to our department for further investigation and clarification because renal agenesis was suspected. In the remaining 10 (32.3%) children the pelvic kidney was an incidental finding observed during investigation of various other conditions. Overall, 7 (22.6%) of the 31 were symptomatic (recurrent urinary tract infections, abdominal pain, hypertension, hydronephrosis), while 77.4% (24/31) were completely free of symptoms at the time of follow-up. Ultrasound revealed that the ectopic kidney was on the left in 64.5% (20/31) of these cases. Nuclear scans performed both at the time of the initial diagnosis and at follow-up were available for 11 of the 31 children and showed a mild improvement of the partial function of the pelvic kidney, from a mean of 25.6% to a mean of 34.6%. In conclusion, whenever renal agenesis is suspected on ultrasonographic examination, the investigator should first consider renal ectopia; ultrasound examination with the bladder full is the definitive diagnostic procedure. For asymptomatic cases we recommend regular ultrasound monitoring of the kidney -- at first every 6 months and later once a year. In cases with complex anatomy MRI is a suitable method for further diagnostic work-up.

[Biofeedback for urinary bladder dysfunctions in childhood. Indications, practice and the results of therapy]. / Biofeedback bei kindlichen Blasenfunktionsstörungen. Indikationen, praktische Durchführung und Therapieergebnisse.

In children, abnormal behavior during micturition, i.e. detrusor/sphincter dyscoordination, causes persistent voiding problems, urinary incontinence and/or recurrent urinary tract infections in up to 15% of cases. Contractions of the external urethral sphincter during micturition lead to functional subvesical obstruction. Nowadays, biofeedback training is the most suitable therapy. Biofeedback training for children is based on the assumption that relaxation and contraction of the urinary external sphincter is a habitual phenomenon and can be restored. With specially developed, computer-assisted biofeedback programs, sphincter contraction and relaxation can be transformed into acoustic or visual signals. Acoustic or optical feedback indicates relaxation and contraction control to the patient. The residual urine volume should subsequently be assessed. The results should be reviewed after each micturition. Poor compliance sometimes makes biofeedback training impossible. Further biofeedback training at home is a reasonable suggestion. Good results-a response rate of up to 90%-demonstrates that biofeedback training is successful in the treatment of detrusor-sphincter dyscoordination. After effective therapy, associated urinary tract infections and vesicoureterorenal reflux may disappear.