Emergency Radical Nephrectomy in a Polytrauma Patient.

INTRODUCTION: The renal trauma is present in a 5% of all trauma cases. In the most common causes, conservative treatment can be performed. It is reported a case of renal trauma due to metal sick that required surgical management. It is considered that this is a rare clinical case with urgent surgical management that is not usual in this type of trauma. In addition, it is an example of quick decision-making since the patient's life depends on them. CASE REPORT: A 69-year-old man was referred to our institution for polytrauma. In contrast-enhanced computed tomography, renal, intestinal and great vessel were suspected, so an urgent surgical treatment was decided. During surgery, radical nephrectomy was performed due to perforation of the right kidney by a metal stick. CONCLUSIONS: Although conservative treatment of renal trauma can be performed in most cases, it must be taken into account that radical nephrectomy is a possible option when the kidney cannot be preserved.

Emergency Radical Nephrectomy in a Polytrauma Patient

Introduction: The renal trauma is present in a 5% of all trauma cases. In the most common causes, conservative treatment can be performed. It is reported a case of renal trauma due to metal sick that required surgical management. It is considered that this is a rare clinical case with urgent surgical management that is not usual in this type of trauma. In addition, it is an example of quick decision-making since the patient’s life depends on them. Case Report: A 69-year-old man was referred to our institution for polytrauma. In contrast-enhanced computed tomography, renal, intestinal and great vessel were suspected, so an urgent surgical treatment was decided. During surgery, radical nephrectomy was performed due to perforation of the right kidney by a metal stick. Conclusions: Although conservative treatment of renal trauma can be performed in most cases, it must be taken into account that radical nephrectomy is a possible option when the kidney cannot be preserved (AU)

[The use of urokinase in urinary catheter obstructed by clots.] / El uso de urocinasa en catéteres urinarios obstruidos por coágulos.

OBJECTIVE: The objective of thisstudy is to review three cases using urokinase in patientswith urinary catheter obstructed by clots, aswell to carry out a review of the published literature. METHODS: It was done a review of three casesfrom 2019 to 2020 who required urokinase due tourinary catheters obstructed by clots in our department.In addition, a reference search was performedin Pubmed. RESULTS: The first case was a woman with metastaticbreast carcinoma who required nephrostomyplacement. The second case was a renal trauma thatrequired bladder catheterization. The third case wasa male with a benign ureteric obstruction who requirednephrostomy placement due to sepsis. After instillationswith urokinase, the first two cases respondedadequately, while the third was unsuccessful. CONCLUSIONS: Urokinase may be an effectiveand well-tolerated therapy in the treatment of coagulatedurinary catheters that does not respond toother measures.

OBJETIVO: Reportar tres casos acercadel uso de la urocinasa en pacientes portadores decatéteres urinarios obstruidos por coágulos y realizaruna revisión de la literatura publicada. MATERIAL Y MÉTODOS: Revisión de casos quehan precisado de urocinasa en nuestro servicio de2019 a 2020 en relación a pacientes con catéteresurinarios obstruidos por coágulos. Además, se realizóbúsqueda de referencias en Pubmed. RESULTADOS: El primer caso fue una mujer concarcinoma de mama metástasico que precisó colocaciónde nefrostomías. El segundo fue un paciente pediátricocon traumatismo renal que requirió sondajevesical. El último enfermo fue un varón con obstrucciónbenigna de uréter que precisó de nefrostomía porsepsis. Tras instilaciones con urocinasa, los dos primerospacientes respondieron adecuadamente, mientrasque no hubo éxito en el tercero. CONCLUSIONES: La urocinasa puede ser unaterapia eficaz y bien tolerada en el tratamiento decatéteres urinarios coagulados que no responden aotras medidas.

El uso de urocinasa en catéteres urinarios obstruidos por coágulos / The use of urokinase in urinary catheter obstructed by clots

OBJETIVO: Reportar tres casos acerca del uso de la urocinasa en pacientes portadores decatéteres urinarios obstruidos por coágulos y realizaruna revisión de la literatura publicada.MATERIAL Y MÉTODOS: Revisión de casos quehan precisado de urocinasa en nuestro servicio de2019 a 2020 en relación a pacientes con catéteresurinarios obstruidos por coágulos. Además, se realizóbúsqueda de referencias en Pubmed.RESULTADOS: El primer caso fue una mujer concarcinoma de mama metástasico que precisó colocación de nefrostomías. El segundo fue un paciente pediátrico con traumatismo renal que requirió sondajevesical. El último enfermo fue un varón con obstrucción benigna de uréter que precisó de nefrostomía porsepsis. Tras instilaciones con urocinasa, los dos primeros pacientes respondieron adecuadamente, mientras que no hubo éxito en el tercero.CONCLUSIONES: La urocinasa puede ser unaterapia eficaz y bien tolerada en el tratamiento decatéteres urinarios coagulados que no responden aotras medidas. (AU)

OBJECTIVE: The objective of thisstudy is to review three cases using urokinase in patients with urinary catheter obstructed by clots, aswell to carry out a review of the published literature.METHODS: It was done a review of three casesfrom 2019 to 2020 who required urokinase due tourinary catheters obstructed by clots in our department. In addition, a reference search was performedin Pubmed.RESULTS: The first case was a woman with metastatic breast carcinoma who required nephrostomyplacement. The second case was a renal trauma thatrequired bladder catheterization. The third case wasa male with a benign ureteric obstruction who required nephrostomy placement due to sepsis. After instillations with urokinase, the first two cases respondedadequately, while the third was unsuccessful.CONCLUSIONS: Urokinase may be an effectiveand well-tolerated therapy in the treatment of coagulated urinary catheters that does not respond toother measures. (AU)

Retrograde endoureterotomy as a treatment option for impacted calculus in the ureterointestinal junction.

INTRODUCTION: In patients with a history of radical cystectomy and with intestinal diversion, urolithiasis in the upper urinary tract is a frequent event. MATERIAL AND METHODS: We describe for the first time a case of retrograde endoureterotomy used to treat a calculus proximal to the ureterointestinal junction. RESULTS: This technique is of interest when antegrade access is not possible. In our example, after passing the guidewire percutaneously, and externalize it through the stoma, the left meatus was reached with a resectoscope inserted through the ileal duct. After the use of a balloon to prevent migration of the calculus, a retrograde endoureterotomy was performed with a Collins knife and the stone removed. The patient's progress was satisfactory. CONCLUSION: Endoscopic management of calculi in patients with intestinal diversion can be performed with different approaches. We recommend retrograde endoureterotomy as a feasible treatment option for the removal of impacted calculi at the ureterointestinal junction.

Ctopia ureteral en paciente pediátrico: diferentes soluciones para diferentes problemas / Ureteral ctopia in a pediatric patient: different solutions for different problems

Objetivo: El tratamiento del uréter ectópicoen el paciente pediátrico debe individualizarse en cadacaso.Método: Descripción de los casos clínicos, manejo terapéutico y evolución de los pacientes.Resultados: Presentamos cuatro pacientes pediátricoscon uréteres ectópicos sometidos a cirugía. Se describe uncaso de nefroureterectomía laparoscópica, uno de uretero-ureterostomía laparoscópica, uno de reimplante ureteralbilateral y otro de reimplante unilateral. Se profundiza enla discusión sobre el diagnóstico y diferentes tratamientosquirúrgicos de cada caso. Conclusiones: Presentamos cuatro casos de pacientes pediátricos con uréteres ectópicos, tratados mediantediferentes cirugías. Exponemos cómo fue el diagnósticopreoperatorio y la importancia de individualizar el tratamiento quirúrgico en cada caso. Aspectos descritos recientemente en el contexto de la ectopia ureteral, como laevaluación diagnóstica mediante RMN o el papel de lastécnicas mínimamente invasivas en el tratamiento, debentenerse en cuenta en su manejo.(AU)

Objetive: The treatment of the ectopic ureter in the pediatric patient must be individualized in eachcaseMethods: Description of clinical cases, therapeutic management and evolution of patients.Results: We present four pediatric patients with ectopicureters who underwent surgery. We describe a case of laparoscopic nephroureterectomy, one of laparoscopic uretero-ureterostomy, one of bilateral ureteral reimplantation andanother of unilateral reimplantation. The discussion aboutthe diagnosis and different surgical treatments of each caseis deepened.Conclusions: We present four cases of pediatric patients with ectopic ureters, treated by different surgeries.We present how was the preoperative diagnosis and theimportance of individualizing the surgical treatment in eachcase. Aspects recently described in the context of ureteralectopy, such as diagnostic evaluation by MRI or the role ofminimally invasive techniques in treatment, should be takeninto account in its management.(AU)

[Pediatric ureteral ectopia: Solutions for several issues.] / Ectopia ureteral en paciente pediátrico: diferentes soluciones para diferentes problemas.

OBJECTIVE: The treatment of the ectopic ureter in the pediatric patient must be individualized in each caseMETHOD: Description of clinical cases, therapeutic management and evolution of patients. RESULTS: We present four pediatric patients with ectopic ureters who underwent surgery. We describe a case of laparoscopic nephroureterectomy, one of laparoscopic uretero-ureterostomy, one of bilateral ureteral reimplantation and another of unilateral reimplantation. The discussion about the diagnosis and different surgical treatments of each case is deepened. CONCLUSIONS: We present four cases of pediatric patients with ectopic ureters, treated by different surgeries. We present how was the preoperative diagnosis and the importance of individualizing the surgical treatment in eachc ase. Aspects recently described in the context of ureteralectopy, such as diagnostic evaluation by MRI or the role of minimally invasive techniques in treatment, should be taken into account in its management.

OBJETIVO: El tratamiento del uréter ectópico en el paciente pediátrico debe individualizarse en cada caso.MÉTODO: Descripción de los casos clínicos, manejo terapéutico y evolución de los pacientes. RESULTADOS: Presentamos cuatro pacientes pediátricos con uréteres ectópicos sometidos a cirugía. Se describe un caso de nefroureterectomía laparoscópica, uno de uretero-ureterostomía laparoscópica, uno de reimplante ureteral bilateral y otro de reimplante unilateral. Se profundiza en la discusión sobre el diagnóstico y diferentes tratamientos quirúrgicos de cada caso. CONCLUSIONES: Presentamos cuatro casos de pacientes pediátricos con uréteres ectópicos, tratados mediante diferentes cirugías. Exponemos cómo fue el diagnóstico preoperatorio y la importancia de individualizar el tratamiento quirúrgico en cada caso. Aspectos descritos recientemente en el contexto de la ectopia ureteral, como la evaluación diagnóstica mediante RMN o el papel de las técnicas mínimamente invasivas en el tratamiento, deben tenerse en cuenta en su manejo.

Endoscopic treatment of intraluminal ureteral suture with holmium laser.

Although reconstructive surgery is the most accepted treatment for ureteral injury, there are reports of cases where endourologic treatment led to correct resolution of the problem. We present the case of a female patient aged 72-year-old who was previously underwent sacralcolpopexy because of anterior vaginal compartment prolapse. The patient underwent surgery to remove the mesh, due to the pain she had had since it was placed. A mid-line laparotomy was performed removing completely the mesh. At 48 hours after intervention, the patient started feeling an intense pain in the left renal fossa that was not relieved with anti-inflammatories and morphic drugs. In the diagnostic ureteroscopy, it was found iatrogenic suture of the ureter. Due to the availability of holmium laser, an endoureterotomy was performed in the 12h central position on the tip, with laser parameters of 1J-10Hz. A 6F ureteral stent was maintained for one month. During follow-up, the patient remained asymptomatic and without dilation of the left system on imaging tests. Although we accept that open reconstruction is the gold standard treatment for ureteral trauma, we describe holmium laser endoureterotomy as a promising technique to consider in the event of ureteral intraluminal ligation.