[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.

[Scrotal haematoma as a sign of renal hematoma after ESWL]. / Hematoma escrotal como primera manifestación de hematoma retroperitoneal tras litotricia extracorpórea.

We described the case of a patient who presented a large scrotal black discoloration 15 hours after successful extracorporeal lithotripsy of a proximal ureteral calculus. The patient did not present any other clinical symptoms as a sign of subcapsular haematoma.

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)

Hematoma escrotal como primera manifestación de hematoma retroperitoneal tras litotricia extracorpórea / Scrotal haematoma as a sign of renal hematoma after ESWL

Describimos el caso de un paciente que a las 15 horas del tratamiento y fragmentación de una litiasis en el uréter proximal mediante litotricia extracorpórea presenta un hematoma escrotal indoloro como única manifestación de hematoma subcapsular (AU)

We described the case of a patient who presented a large scrotal black discoloration 15 hours after successful extracorporeal lithotripsy of a proximal ureteral calculus. The patient did not present any other clinical symptoms as a sign of subcapsular haematoma (AU)

[Characterization of urinary tract symptoms and quality of life in patients with double-pig-tailed ureteral stents]. / Evaluación de clínica y calidad de vida con catéteres ureterales de tipo doble pig-tail.

OBJECTIVES: To prospectively assess the prevalence of urinary tract symptoms caused by indwelling ureteral stents and how they affect their quality of life using an specific questionnaire. MATERIAL AND METHODS: A total of 100 patients with unilateral indwelling ureteral stents were asked to complete an specific questionnaire that include questions on urinary symptoms: dysuria, frequency of urination, incomplete empting, urgency, incontinence, haematuria and bother or pain associated with urinary stents affecting the daily activities of the patients. They were also asked to compete International Prostate Symptoms Score questionnaire and a question on quality of life. Pain was assessed from 0 to 10 using a VAS (visual analogic scale). RESULTS: 46 men and 54 women, mean age 54 years, completed the study. Mean time after stent insertion was 6.5 weeks. The cause of the insertion was in 40% due to the size of the stone, previous to ESWL, 33% due to urinary tract obstruction, 25% due to infection, and the others after a surgical procedure. 95% of patients with stent positioning without general anesthesia complaint of pain during the procedure. 89% of patients reported bothersome urinary symptoms, named in order of frequence: nycturia, frequence voiding, incomplete empting, dysuria, urgence, haematuria and incontinence. More than 70% of patients experienced pain that impaired daily activities, in 52% pain was located at the flank and in 47% at the bladder. 60% of patients signalled that they were not satisfied with their quality of life with the indwelling catheter. CONCLUSIONS: Urinary symptoms and pain related to indwelling double pig tailed ureteral stens affect the daily activities and reduces the quality of life of 60% of patients.

Evaluación de clínica y calidad de vida con catéteres ureterales de tipo doble pig-tail / Characterization of urinary tract symptoms and quality of life in patients with double-pig-tailed ureteral stents

Objetivos: Valoración de la prevalencia de la clínica asociada a los catéteres ureterales tipo doble pig-tail y de su impacto en la calidad de vida a través de un cuestionario. Material y métodos: 100 pacientes portadores de doble pig-tail cumplimentaron el cuestionario. Este incluye preguntas sobre clínica urinaria: disuria, polaquiuria, tenesmo, urgencia, incontinencia, hematuria y dolor o malestar provocado por el catéter durante las actividades normales del paciente. También contestaron el tes IPSSy una cuestión sobre la calidad de vida. El dolor se valoró de 1 a 10 mediante una escala visual analógica. Resultados: Se valoró 46 varones y 54 mujeres, con una edad media de 54 años. El tiempo medio de colocación del catéter fue de 6,5 semanas. La colocación se debió en un 40% al tamaño de la litiasis, previo a la litotricia,en un 33% por obstrucción, en un 25% por infección y en el resto fue postquirúrgico. El dolor de la colocación sin anestesia general se produjo en el 95% de los pacientes. En un 89% de los pacientes la presencia del catéter produjo clínica, el orden de frecuencia fue: nicturia, polaquiuria, tenesmo, disuria, urgencia, hematuria e incontinencia. En un 73 % les produjo dolor, en un 52% éste se localizó en el flanco y en el 47% en la vejiga. Un 60% de los pacientes se consideraron insatisfechos con su calidad de vida con el catéter. Conclusiones: La clínica urinaria y el dolor asociados a los catéteres ureterales tipo doble pig-tail interfiere con las actividades de la vida diaria y reduce la calidad de vida en un 60% de los pacientes

Objectives: To prospectively assess the prevalence of urinary tract symptoms caused by indwelling ureteral stents and how they affect their quality of life using an specific questionnaire. Material and methods: A total of 100 patients with unilateral indwelling ureteral stents were asked to completean specific questionnaire that include questions on urinary symptoms: dysuria , frequency of urination, incomplete empting, urgency, incontinence, haematuria and bother or pain associated with urinary stents affecting the daily activities of the patients. They were also asked to compete International Prostate Symptoms Score questionnaire and a question on quality of life. Pain was assessed from 0 to 10 using a VAS (visual analogic scale). Results: 46 men and 54 women, mean age 54 years, completed the study. Mean time after stent insertion was 6.5 weeks. The cause of the insertion was in 40% due to the size of the stone, previous to ESWL, 33% due to urinary tract obstruction, 25% due to infection, and the others after a surgical procedure. 95% of patients with stent positioning without general anesthesia complaint of pain during the procedure. 89% of patients reported bother so meurinary symptoms, named in order of frequence: nycturia, frequence voiding, incomplete empting, dysuria, urgence, haematuria and incontinence. More than 70 % of patients experienced pain that impaired daily activities, in 52% pain was located at the flank and in 47 % at the bladder. 60 % of patients signalled that they were not satisfied with their quality of life with the indwelling catheter. Conclusions: Urinary symptoms and pain related to indwelling double pig tailed ureteral stens affect the daily activities and reduces the quality of life of 60% of patients

[Clinical experience and results of ESWL treatment for 1.000 consecutive patients with the Siemens Lithostar Modularis]. / Lithostar Modularis de Siemens: exposición de los resultados de los 1.000 primeros pacientes.

PATIENTS AND METHODS: We describe the outcome of the treatment of 1.000 consecutive patients treated since may 2000 to december 2003 with Siemens Lithostar Modularis to evaluate the efficacy of this new lithotripter RESULTS: 60.5% male and 39.5% female's patients were treated. Average age of 53.5 years old. 44.1% of the urinary stones were located on the right side and 55.9% on the left. The mean size of the stones was 1.22 +/- 0.74 cm with 59% lesser than 1 cm, 27.6% between 1 and 2 cm and 13.4% bigger than 2 cm. Mean number of sessions required were 1.6. There were differences in the number of sessions related to the size of the lithiasis, 1.3 session in the group of lithiasis smaller than 1 cm and 2.01 sessions in the group bigger than 1 cm. The stones that required less number of sessions were located in the ureter and upper calyx. 71.2% of the patients were stone free after one treatment. CONCLUSIONS: Siemens Lithostar Modularis has the adventages of a great confort of the patient during the procedure, better image because of a very good cuality of the fluoroscopy and the main point is a great comminution of the stone doing very easy the elimination of the fragments achieving a stone free rate of more than 90% in our experience, decreasing the need of auxiliary manoeuvres and the leng of the treatment.

Lithostar Modularis de Siemens: exposición de los resultados de los 1.000 primeros pacientes / Clinical experience and results of ESWL treatment for 1.000 consecutive patients with the Siemens Lithostar Modularis

Pacientes y Métodos: Exponemos los resultados de los 1.000 primeros tratamientos de pacientes con litiasis en el sistema urinario efectuados desde mayo 2000 a diciembre 2003 con Lithostar Modularis de Siemens en un intento de valorar la eficacia de este litotritor de nueva generación. Resultados: 60,5 % varones y 39,5% mujeres. Edad media 53,5 años. La localización de la litiasis: derecha 44,1% e izquierda 55,9%. Tamaño medio de las litiasis 1,22+0,74 cm. El 59 % 2 cm. La media de sesiones fue de 1,6 por paciente, existiendo diferencias en el número de sesiones en cuanto al tamaño, 1,3 en 1 cm, y a la localización, menor número en las litiasis en uréter lumbar y en cáliz superior. La tasa de pacientes libres de litiasis en una sola sesión fue del 71,2%. Conclusiones: las ventajas de este litotritor, además de los adelantos técnicos tanto en comodidad del paciente, localización de la litiasis y mejor calidad de la escopia, se deben sobre todo a su alta eficacia, con una fragmentación de la litiasis en pequeños fragmentos, facilitando su eliminación, consiguiendo una resolución sin restos de litiasis por encima del 90%. Además disminuye la necesidad de maniobras complementarias y acorta el tiempo de tratamiento por la fácil eliminación de los restos fragmentados (AU)

Patients and Methods: We describe the outcome of the treatment of 1.000 consecutive patients treated since may 2000 to december 2003 with Siemens Lithostar Modularis to evaluate the efficacy of this new lithotripter Results: 60.5% male and 39.5% female’s patients were treated. Average age of 53.5 years old. 44.1% of the urinary stones were located on the right side and 55.9% on the left. The mean size of the stones was 1,22+0,74 cm with 59% lesser than 1 cm, 27.6% between 1 and 2 cm and 13.4% bigger than 2 cm. Mean number of sessions required were 1.6. There were differences in the number of sessions related to the size of the lithiasis, 1.3 session in the group of lithiasis smaller than 1 cm and 2.01 sessions in the group bigger than 1 cm. The stones that required less number of sessions were located in the ureter and upper calyx. 71.2% of the patients were stone free after one treatment. Conclusions: Siemens Lithostar Modularis has the adventages of a great confort of the patient during the procedure, better image because of a very good cuality of the fluoroscopy and the main point is a great comminution of the stone doing very easy the elimination of the fragments achieving a stone free rate of more than 90 % in our experience, decreasing the need of auxiliary manoeuvres and the leng of the treatment (AU)

[Laparoscopic adrenalectomy in adrenal carcinoma]. / Adrenalectomía laparoscópica por patología maligna.

There is general agreement on the suitability of the laparoscopic approach for benign adrenal lesions against open procedures because of the efficacy and less morbidity. For suspected adrenal malignancies laparoscopic use is controversial. We report our experience in 6 cases of laparoscopic adrenalectomy in patients with the suspicion of adrenal malignancy confined in the gland. In medium a follow up of 24 months (range 12 to 48 months) we observed no recurrences. We concluded that in a suspected adrenal malignancy organ confined laparoscopic adrenalectomy presents the advantage compared with open surgery of reduced morbidity and similar results in the follow up of the patient.

Adrenalectomía laparoscópica por patología maligna / Laparoscopic adrenalectomy in adrenal carcinoma

Existe un consenso generalizado de las bondades de la adrenalectomía laparoscópica respecto a la cirugía abierta en la patología benigna de suprarrenal, por su igual eficacia y menor morbilidad. En lesiones en las que existe sospecha de patología maligna el uso de la laparoscopia es controvertido. Exponemos nuestra experiencia en 6 casos de adrenalectomía laparoscópica en pacientes con sospecha preoperatorio de malignidad, en lesiones confinadas a la glándula. La evolución de estos pacientes en un seguimiento de 24 meses de media (rango 12 a 48 meses) no indicó recidiva tumoral, indicando que cuando la sospecha preoperatoria es de malignidad, sin infiltración de órganos adyacentes el beneficio de la laparoscopia en cuanto a confort postoperatorio se mantiene y no empeora el pronóstico de estos pacientes (AU)

There is general agreement on the suitability of the laparoscopic approach for benign adrenal lesions against open procedures because of the efficacy and less morbidity. For suspected adrenal malignancies laparoscopic use is controversial. We report our experience in 6 cases of laparoscopic adrenalectomy in patients with the suspicion of adrenal malignancy confined in the gland. In medium a follow up of 24 months (range 12 to 48 months) we observed no recurrences. We concluded that in a suspected adrenal malignancy organ confined laparoscopic adrenalectomy presents the advantage compared with open surgery of reduced morbidity and similar results in the follow up of the patient (AU)

[Extracorporeal shock wave lithotripsy of urolithiasis in patients with urinary diversion]. / Litotricia extracorpórea en litiasis en pacientes con derivación urinaria.

We evaluate the efficacy of ESWL in the management of calculi in patients with urinary diversion. We treated 5 patients who suffered from urinary lithiasis after urinary diversion post cistectomy. We managed the patients with extracorporeal shock wave lithotripsy in monotherapy with a Siemens Lithostar Modularis device. Mean stone size (long axis) was 1.95 cm (range 1 to 3.5 cm). The mean shockwave number per session was 2.6 per patient. Stone free result was 100%. We conclude that ESWL technique can provide acceptable results in patients with urinary diversion and can be used as first choice treatment in these type of patients due to its minimal morbidity and excellent results, equivalent to those achieved in patients without urinary diversion.

Litotricia extracorpórea en litiasis en pacientes con derivación urinaria / Extracorporeal shock wave lithotripsy of urolithiasis in patients with urinary diversion

Exponemos nuestra experiencia en el tratamiento de litiasis en pacientes con derivación urinaria. Hemos tratado 5 pacientes con litiasis en el tracto urinario superior tras cistectomía y derivación urinaria. El tratamiento se ha hecho con monoterapia por ondas de choque con el litotritor Lithostar Modularis de Siemens. El tamaño medio de las litiasis fue de 1,95 cm (rango 1 a 3,5 cm). El número medio de sesiones ha sido 2,6, con 3961 ondas de choque de media por sesión. Hemos conseguido un 100% de pacientes libres de litiasis, indicando que la litotricia extracorpórea tiene unos buenos resultados en el tratamiento de las litiasis en pacientes con derivación urinaria, siendo el tratamiento de elección en estos pacientes, con muy baja morbilidad y alta eficacia, comparable a los pacientes sin derivación urinaria (AU)

We evaluate the efficacy of ESWL in the management of calculi in patients with urinary diversion. We treated 5 patients who suffered from urinary lithiasis after urinary diversion post cistectomy. We managed the patients with extracorporeal shock wave lithotripsy in monotherapy with a Siemens Lithostar Modularis device. Mean stone size (long axis) was 1.95 cm (range 1 to 3.5 cm). The mean shockwave number per session was 2.6 per patient. Stone free result was 100%. We conclude that ESWL technique can provide acceptable results in patients with urinary diversion and can be used as first choice treatment in these type of patients due to its minimal morbidity and excellent results, equivalent to those achieved in patients without urinary diversion (AU)

[Acute cell rejection in ex vivo model of swine-human renal xenotransplantation]. / Rechazo celular agudo en modelo ex vivo de xenotrasplante renal cerdo-hombre.

OBJECTIVE: Ex vivo perfusion model of pig-to-human kidney xenotransplantation to evaluate human antiporcine xenograft rejection once hyperacute rejection (HAR) is avoided. METHODS: Pig kidneys were perfused for 3 hours with pig blood (group 1; n = 5), human blood (group 2; n = 5), complement heat inactivated human blood (group 3; n = 5), platelet-depleted human blood (group 4; n = 5); and xenoreactive natural antibodies (XNA)-depleted human blood (group 5; n = 5). Tissue samples were studied with immunoperoxidase techniques. RESULTS: Pig kidneys perfused with human blood, group 2, showed HAR with interstitial haemorrhage, vascular thrombi and glomerular injury. Pig kidneys perfused with manipulated human blood (groups 3 to 5) had no histologic evidence of HAR, but showed signs of acute cellular rejection with different degrees of interstitial infiltrate of mononuclear cells, specially in the XNA-depleted group. CONCLUSIONS: The model may be valuable in the isolated evaluation of the elements involved in the pig-to-human xenorejection. The depletion of complement, platelets and XNA protected porcine kidneys form HAR in our study and allowed the development of an acute cellular rejection, a very unusual fact in this short time, 3 hours.

Rechazo celular agudo en modelo ex vivo de xenotrasplante renal cerdo-hombre / Cellular acute rejection pig to human in an ex vivo renal transplant model

OBJETIVOS: Desarrollo de un modelo ex vivo de perfusión de riñones de cerdo con sangre humana, intentando reproducir el xenotrasplante renal cerdo-hombre, para el estudio de las manifestaciones que se producen una vez evitado el rechazo hiperagudo. MÉTODO: Perfusión de los riñones de cerdo durante 3 horas con sangre de cerdo (grupo 1; n=5), sangre humana (grupo 2; n=5), sangre humana decomplementada por calor (grupo 3; n=5), sangre humana deplaquetada por centrifugación (grupo 4; n=5), sangre humana inmuonadsobida con proteína A estafilocócica (grupo 5; n=5). Las piezas se estudian por microscopía óptica e inmunohistoquímica. RESULTADOS: Rechazo hiperagudo con hemorragia difusa, trombosis y lesiones glomerulares en el grupo con sangre humana sin manipular. Ausencia de rechazo hiperagudo en el resto de los grupos: decomplementada, deplaquetada e inmunoadsorbida, con presencia de rechazo celular agudo con diferentes grados de infiltración intersticial de células mononucleares, en especial en el grupo con sangre inmunoadsorbida. CONCLUSIONES: El modelo que permite valorar de forma aislada elementos de la respuesta inmune xenogénica cerdo-hombre. La depleción de complemento, plaquetas y xenoanticuerpos protege a los riñones de cerdo del rechazo hiperagudo, observando por primera vez la presencia de rechazo celular agudo en 3 horas, manifestación que suele precisar para su aparición varios días (AU)

[Stevens-Johnson syndrome, unusual urologic involvement]. / Síndrome de Stevens-Johnson, una rara afectación urológica.

Stevens-Johnson Syndrome is an adverse drug reaction, considered a severe type of erythema exsudativum multiforme, fatal in about 5%. Characterized by erythema with vesiculobullous lesions in skin and mucous membranes. Implicated drugs are mainly anticonvulsivants and sulphonamides. Prompt recognition and withdrawal of the suspected drug is essential in treatment. Denuded skin areas must be treated with the same principles of burns. Systemic immunosuppression, mainly corticosteroids, remain controversial. We report a case of Stevens-Johnson Syndrome in a 43 year-old male who developed disuria and genital lesions with a detachment of foreskin and glans penis.