Litiasis urinaria. Presente y futuro / Urinary lithiasis. Present and future

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[Bladder metastasis of a stomach carcinoma. Presentation of a case]. / Metástasis de carcinoma gástrico en vejiga. Presentación de un caso.

Metastatic tumors account for a small percentage within bladder neoplastic pathology. The presence of signs of bladder neoplasm in a patient with malignancies in other location must aware us about its metastatic origin. One of the most frequent locations of the primary tumor is the stomach. Its evolution is always bad. We present a case of a woman who previously had undergone surgery for a gastric carcinoma, and later suffered a metastatic bladder affectation. We make special attention in the clinic presentation, very similar to the typical transitional cell carcinoma, its anatomopathological diagnosis after transurethral resection (T.U.R.), and its evolution. We make a brief revision of the bladder metastatic pathology.

[Multiple urinary lithiasis and nephrocalcinosis secondary to primary Sjögren syndrome]. / Litiasis urinaria múltiple y nefrocalcinosis secundaria a síndrome de Sjögren primario.

A 39 year old women with a primary Sjögren syndrome (pSS) had bilateral and multiple nephrolithiasis and nephrocalcinosis due to distal renal tubular acidosis (dRTA), hypercalciuria and hypocitraturia. She had in serum positive antinuclear antibodies with mottled pattern 1/320, totals ENA, Anti-SSA/Ro 52, Anti-SSA/Ro 60 and Anti-SSB-La antibodies. Stones were removed with extracorporeal shock wave lithotripsy satisfactory and were composed of calcium phosphate and calcium oxalate. Metabolic abnormalities were resolved with potassium citrate and hydrochlorothiazide. At two years of follow-up, the patient hadn't stone recurrence and had normal 24-hour urinary levels of citrate and calcium.

Metástasis de carcinoma gástrico en vejiga. Presentación de un caso / Gastric metastatic carcinoma to the bladder. A case report

Los tumores de origen metastático suponen un porcentaje mínimo dentro de la patología neoplásica vesical. La aparición de datos compatibles con neoplasia vesical en un paciente con antecedentes tumorales en otra localización debe hacernos pensar en un origen metastático de la lesión vesical. Una de las localizaciones más frecuentes de la neoplasia primaria es el estómago. La evolución es indefectiblemente ominosa. Presentamos el caso de una mujer operada previamente de una neoplasia gástrica que más tarde metastatiza a vejiga. Hacemos hincapié en la presentación clínica, similar a la de una neoplasia vesical de células transicionales, su diagnóstico anatomopatológico tras resección transuretral (R.T.U.), y su mala evolución. Se realiza breve revisión de la patología vesical metastática (AU)

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[Metabolic risk factors in calcium urolithiasis according to gender and age of the patients]. / Factores de riesgo metabólico en urolitiasis cálcica según el sexo y edad de los pacientes.

INTRODUCTION: Little information is available on the metabolic changes found in relation to gender and aging in patients with urolithiasis. In this study a comparison has been made of the metabolic profiles in men and women, in different groups of aging, with calcium-containing urinary stones in order to identify possibly significant differences. MATERIAL AND METHODS: In the past five years, a total of 500 patients with calcium-containing urinary stones, 226 male (45.2%) and 274 female (54.8%), have undergone comprehensive metabolic evaluation. The mean age was 47.4 years, with a range of 20 to 75 years. The patients was included in 3 groups: 151 patients aged 20-39 years, 255 patients aged 40-59 years and 94 patients aged 60-75 years. A comparison has been made of the frequency of metabolic changes, the urinary biochemical parameters and the supersaturation index (AP(CaOx)) between a group of men and a group of women and the different groups of aging. All patients carried out in an identical manner to metabolic diagnosis. The patients with morphologic and functional abnormalities were excluded. RESULTS: Hyperoxaluria, hyperuricosuria and hypocitraturia were more common in men than in women, whilst in women, hypercalciuria and a low urinary volume were more frequent with respect to men, though the differences in hypercalciuria were not statistically significant. Men excrete higher levels of calcium, phosphate, oxalate, uric acid and magnesium than women. On the other hand, women excrete higher levels of citrate than men. The AP(CaOx) index is significantly higher in men than in women. Hypercalciuria were more common in patients aged < 60 years, and low urinary volume were more frequent in patients aged < 40 years. Patients aged < 60 years excrete higher levels of calcium, phosphate and uric acid. The AP(CaOx) index is significantly higher in patients aged < 60 years. CONCLUSIONS: Differences were observed between the metabolic profiles of men and women, and in different groups of aging. Men and younger patients afford a metabolic profile of upper lithogenic risk compared with women and older patients; this is consistent with the upper reported prevalence of lithiasis and the upper tendency to recurrence in men and middle-age patients.

Litiasis urinaria múltiple y nefrocalcionosis secundaria a síndrome de Sjögren primario / Multiple urinary lithiasis and nephrocalcinosis secondary to primary Sjögren syndrome

Una paciente de 39 años de edad diagnosticada de síndrome de Sjógren primario (SSp) desarrolla litiasis reno-ureteral múltiple y nefrocalcinosis bilateral secundaria a acidosis tubular renal distal (ATRd), hipercalciuria e hipocitraturia. Resultan positivos los anticuerpos ANA moteado 1/320, ENA totales, Anti-SSA/Ro 52, Anti-SSA/Ro 60 y Anti-SSB-La. Los cálculos son tratados con litotricia extracorpórea por ondas de choque con resultado satisfactorio, correspondiendo su composición a fosfato cálcico y oxalato cálcico. Los trastornos metabólicos son corregidos con la administración de citrato potásico e hidroclorotiazida. Después de dos años de seguimiento, la paciente no ha recurrido de la litiasis y mantiene niveles normales de citrato y calcio en orina de 24 horas. (AU)

Factores de riesgo metabólico en urolitiasis cálcica según el sexo y edad de los pacientes / Metabolic risk factors on calcium urinary calculi according to age and gender of patients

INTRODUCCIÓN: Se tiene limitada información de las alteraciones metabólicas observadas en pacientes litiásicos de acuerdo al sexo y edad de los pacientes. Comparamos el perfil metabólico de hombres y mujeres con litiasis cálcica, en varios grupos de edad, para identificar posibles diferencias significativas.MATERIAL Y MÉTODOS: En los últimos cinco años han sido sometidos a estudio metabólico-mineral un total de 500 pacientes con litiasis urinaria cálcica, 226 varones (45,2 por ciento) y 274 mujeres (54,8 por ciento) con una edad media de 47,4 años (rango 75-20 años). Según la edad de realización del estudio, los pacientes se dividen en 3 grupos: de 20-39 años (151 pacientes), de 40-59 años (255 pacientes) y de 60-75 años (94 pacientes). Se compara la frecuencia de alteraciones metabólicas, los valores de parámetros bioquímicos en orina y el índice de sobresaturación (AP(CaOx)) entre varones y mujeres y los diferentes grupos etarios. En todos los pacientes se siguió la misma metodología de estudio, excluyéndose aquellos con alteraciones morfológicas y funcionales de la vía urinaria.RESULTADOS: En los varones fue más frecuente la hiperoxaluria. hiperuricosuria e hipocitraturia respecto a las mujeres, mientras que en éstas fue más frecuente la hipercalciuria y el bajo volumen de orina. Los varones eliminan mayores niveles de calcio, fosfato, oxalato, ácido úrico y magnesio que las mujeres, y éstas eliminan mayores niveles de citrato que los hombres. El índice AP(CaOx) es significativamente más alto en hombres que en mujeres. En los pacientes de edad inferior a 60 años fue más frecuente la hipercalciuria. Y en los pacientes de edad inferior a 40 años fue más frecuente un bajo volumen de orina. Los pacientes de edad inferior a 60 años eliminan mayores niveles de calcio, fosfato y ácido úrico. El índice AP(CaOx) es significativamente mayor por debajo de los 60 años.CONCLUSION: Observamos diferencias en el perfil metabólico tanto entre hombres y mujeres como a distintos grupos de edad. Los varones y los pacientes más jóvenes presentan un perfil de mayor riesgo litogenético respecto a las mujeres y enfermos más añosos respectivamente, que parece corresponderse con la mayor prevalencia poblacional de litiasis v la mayor tendencia a la recurrencia que se ha venido refiriendo a los varones jóvenes y en edades media de la vida (AU)

[Urinary lithiasis in transplanted kidney]. / Litiasis urinaria en riñón trasplantado.

OBJECTIVE: We reviewed the records of patients submitted to renal transplantation at our institution to determine the incidence and risk factors for calculus formation in these patients. METHODS: Of 794 functioning renal grafts that had been transplanted from January, 1981 to May, 1996, 16 patients (2%), 9 males and 7 females, had upper urinary tract calculi post-transplantation. All 16 patients had received kidneys from cadaver donors. Three had donor graft lithiasis. The calculi were located predominantly in the calyces, at multiple sites in 7 patients and the mean size was 8.3 mm. The composition of the calculi was predominantly uric acid. Four patients who developed sudden obstructive anuria with elevated serum creatinine, underwent percutaneous drainage. RESULTS: All patients had one or more stone-predisposing factors, such as obstructive uropathy, recurrent urinary tract infection or metabolic abnormalities (predominantly hyperuricosuria). Five patients passed their stones spontaneously, 7 patients with uric acid stones were treated with urinary alkalinization, two patients underwent open pyelolithotomy, one underwent percutaneous nephrolithotomy and one patient with a small asymptomatic caliceal stone was managed conservatively (watchful waiting). During long-term follow-up (mean 69 months), 4 patients lost the real graft [only one case was related to urinary calculi (primary hyperoxaluria)] and 4 patients had recurrent calculi. CONCLUSION: Urinary lithiasis after renal transplantation is a relatively uncommon complication. A multifactorial etiology for calculus formation has been observed. The predisposing factors and composition of the calculi, but not frequency, are identical to those of non-transplant patients. A variety of methods are used to treat posttransplant calculi. The least invasive treatment available should be utilized according to the likelihood of recurrence and the need to preserve renal function. With adequate treatment and prophylaxis, posttransplant urolithiasis does not appear to affect graft function.

[Skin metastasis from transitional cell carcinoma of the bladder]. / Metástasis cutánea de carcinoma de células transicionales de la vejiga.

OBJECTIVES: An additional case of cutaneous metastasis arising from transitional cell carcinoma of the bladder is described. Its form of presentation, dissemination pattern, pathological features, clinical course and treatment are briefly discussed. METHODS: This article reports on a 62-year-old male with bladder carcinoma stage PT3B, PN0, PMx, who underwent radical cystoprostatectomy and detubularized ileal neobladder four months earlier. RESULTS: A solid tumor with an ulcerated surface was found on the dorsal side of the left shoulder. Microscopic analysis disclosed neoplastic cells resembling transitional cells in dermis, the first manifestation of distant tumoral spread. Patient survival was only two months. CONCLUSIONS: Transitional cell carcinoma of bladder metastasizing to the skin is an uncommon finding despite the high incidence of this tumor, although more cases are being reported. Skin metastasis generally presents in the late stages of this disease and indicates a poor outcome.

[Sarcoidosis and urolithiasis]. / Sarcoidosis y litiasis urinaria.

OBJECTIVES: A retrospective study of patients with sarcoidosis and urinary lithiasis or lithogenic risk factors (hypercalcemia and hypercalciuria) was conducted to determine the degree of relationship of this disease with urinary lithogenesis. METHODS: From 1978 to 1993, 96 patients with sarcoidosis (68 females and 28 males), aged 17 to 77 years (mean 43 yrs), were evaluated. Serum and 24-hour urinary calcium were determined by the cresolphthalein complexone procedure. The presence of urinary lithiasis was determined from patient clinical data and/or the findings of the imaging techniques that had been utilized to evaluate these patients. RESULTS: 6.3% were hypercalcemic, 26.6% were hypercalciuric, 6.2% had a previous history of urolithiasis and 8.3% had a urinary calculus at the initial consultation. CONCLUSIONS: Hypercalciuria was present in about 25% of the patients with sarcoidosis, whereas approximately 15% had clinically documented urinary lithiasis.

[Kidney transplants from asystolic donors]. / Trasplante de riñón procedente de donantes en asistolia.

Review of our experience on renal transplantation with graft from removal in asystole. We have performed 31 transplantations of kidneys removed while in asystole, 25 of which were treated only with cardiocompression and assisted ventilation as support measures, the average asystole time being 45 minutes. Two donors were treated by in situ cold perfusion of the abdominal organs (time of asystole, 70 and 218 minutes). One patient was maintained with body cooling by cardiopulmonary by-pass for 90 minutes. Graft survival at three months was 77%, with a delay in the initial function of 70%, secondary to acute tubular necrosis, this being the only parameter in which a significant difference is observed when comparing them to those from a control group of 50 transplant performed over the same interval. No significant differences were seen at one year with regard to either graft survival or the recipients in both groups.

[Clinico-therapeutic classification of urinary lithiasis]. / Clasificación clínico-terapéutica de la litiasis urinaria.

Urinary lithiasis is a millenary disease for which different classifications have been developed: clinical, etiopathogenic, crystallographic, etc. The introduction of endoscopic surgery and extracorporeal lithotripsy in the last decade has created the need for a clinicotherapeutic classification as manifested by Rocco, Griffith, Tisselius, and other authors. We have developed the CEP/LTS-X classification, which evaluates the stone characteristics (C) [location and form (L), size (T), consistency (S) and number (X)], the excretory tract (E) and the renal parenchyma (P), and permits classifying the urinary calculus as LTS renal calculus types I, II, III, IV; LTS ureteral calculus types I, II, III; and LTS vesical and ureteral calculi types I and II, with related general characteristics that permit indicating treatment for each type: in situ ESWL or complementary endourological techniques, endoscopic or open surgery, alone or in combination.

[Treatment of calculi not easily seen with radiology using extracorporeal shockwave lithotripsy. Value of contrast media]. / Tratamiento de los cálculos de difícil visualización radiológica mediante litotricia extracorpórea por ondas de choque. Valor de los medios de contraste.

Currently, most calculi can be treated with shockwave extracorporeal lithotrity regardless their location within the urinary apparatus or their physico-chemical features. In order to optimize results only medical criteria for patient's selection should be taken into account. Certain type of calculi can obstruct adequate radioscopic viewing by not allowing correct centring for shockwave emission. The problem can be overcome by using echography or other contrast procedures. Of a total 514 patients treated in our Unit with ESWL, execution of contrast procedures was necessary in 18 cases (3.5%) in order to allow adequate viewing of the calculi. Calculi in 10 patients were midly radiopacque, uric acid in 4, and bone-superimposed in the remaining 4. This technical manoeuvre allowed in all cases a good centring of the calculi. After a two months follow-up. lithiasis is absent in 15 patients and only 2 present expellable lithiatic fragments. It can therefore be concluded that the use of contrast procedures, both through i.v. or a catheter, is a simple, safe and well tolerated procedure allowing convenient viewing of those calculi, also followed by good results after ESWL treatment.

[Prevention of recurrence of superficial tumors of the bladder with intravesical epirubicin]. / Profilaxis de la recidiva en tumores vesicales superficiales con epirrubicina endovesical.

Twenty-six patients with surface vesical tumor receiving epirubicin are included for prophylaxis of relapse following surgical exeresis. The dosage used was 15 endovesical instillations of 50 mg in 50 cc sterile water, one instillation a week during the first month followed by once monthly to complete a year. After an average follow-up of 14 months a percentage of 19% relapses were observed with a relapse are of 1.3. Toxic events were seen in 46.1% of cases, and were almost exclusively chemical cystitis. Due to intractable vesical intolerance 5 patients were withdrawn from the study. Epirubicin was shown to be effective in reducing the relapse rate but showed a high incidence of chemical cystitis.

[Double-J ureteral catheter: its application in patients with complex renal lithiasis as a support measure during extracorporeal lithotripsy. Analysis of 441 consecutive cases]. / Catéter ureteral doble J: su aplicación en pacientes con litiasis renal compleja como maniobra de apoyo para litofragmentación extracorpórea. Análisis de 441 casos consecutivos.

Between August, 1986 and February, 1988, double J ureteral catheters were placed in 441 renal units of 419 patients (22 were bilateral) with complex renal stones prior to ESWL. Catheter placement was achieved in all but 3.8% of the cases using several techniques, mainly via the retrograde route. Placement of the double J catheter was indicated in almost 75% of cases with a large stone mass (staghorn or pseudo staghorn). Only 11% of post-ESWL "Steinstrasse" were obstructive; of these, 80% resolved spontaneously. The complication rate was 21%. Most of these cases were mild complications. All cases were resolved satisfactorily. We believe that the double J catheter is useful in patients with complex renal stones. Placement of a double J catheter involves a simple maneuver with a low morbidity. It aids ESWL, reduces complications, and avoids more important endourologic maneuvers.

[Malignant primary lymphoma of the bladder]. / Linfoma maligno primitivo de vejiga.

We report a case of primary malignant lymphoma of the bladder in a 20-year-old female patient who consulted for recurrent urinary tract infections. Tumor type was that of a poorly-differentiated lymphocytic lymphoma with a predominantly diffuse growth pattern. The patient was put on a combined treatment modality of external radiotherapy and polychemotherapy which achieved good results. Patient follow up 20 months after treatment revealed no local recurrence or distant spread of the tumor.