Flexible ureteroscopy in extreme elderly patients (80 years of age and older) is feasible and safe.

PURPOSE: To compare the safety and efficacy of RIRS in patients ≥ 80 years to a younger population. METHODS: We retrospectively compared the data from patients ≥ 80 years of age undergoing RIRS with the data of a group of patients from 18 and < 80 years. Perioperative outcomes, complications and emergency department visits were compared between two groups. RESULTS: A total of 173 patients were included in the study. Mean age was 44 (27-79) and 81 years-old (80-94), for younger and elderly group, respectively. Elderly patients had higher ASA scores (≥ 3) (28.6% vs 75.8%; p = 0.0001) and Charlson comorbidity index (1.99 vs 7.86; p = 0.0001), more diabetes (p = 0.006) and respiratory comorbidities (p = 0.002). No statistical difference was found between two groups in stone size (p = 0.614) and number (p = 0.152). Operative time (74.48 vs 102.96 min; p = 0.0001) and duration of hospitalisation (1.7 vs 2.9 days; p = 0.001) were longer for the elderly. Intraoperative complication rate did not show differences between the two groups (p = 0.166). Postoperative complications rates were similar between the cohorts (7.7% vs 9.5%; p = 0.682). The success rates were 67.5% in the younger group and 71.4% in the elderly group (p = 0.584). No difference was seen in stone recurrence (p = 0.73). A higher rate of visits to the emergency department was found in younger cohort (23.6% vs 11.6%; p = 0.046), mostly duo to stent-related symptoms. CONCLUSIONS: Despite the higher rate of comorbidity in the elderly group, RIRS was a safe procedure with similar complication rate and outcomes at an expense of higher operative time and hospital stay.

Fragmentation targeted at preferred discontinuities: A new concept in endolithotripsy with Holmium laser:YAG. / Fragmentación dirigida a discontinuidades preferentes: un nuevo concepto en endolitotricia con láser Holmium:YAG.

INTRODUCTION: There are currently 3holmium laser, YAG (Ho:YAG) endolithotripsy procedures that are considered basic (fragmentation, pulverisation, "pop-corn" technique). We present the technique of fragmentation targeted at preferred discontinuities (FTPD), a new concept of endolithotripsy by Ho:YAG laser. MATERIAL AND METHODS: The FTPD technique is based on the selective application of energy (targeting a specific preselected point) to an area that is visually prone to the formation of a fracture line or preferred discontinuity (conditioned by the anisotropy of the urolithiasis). The ideal energy regimen (setting) is a high range of working energy (2-3J) with a very low frequency range (5-8Hz) and short pulse width. Between January 2015 to February 2017, the FTPD technique was used in 37 procedures (7 NLP, 16 RIRS, 12 URS, 2 cystolithotomies), with a Ho:YAG laser (Lumenis Pulse 120H®, Tel-Aviv, Israel). Maximum power used: 24W (3J/8Hz) with fibres of 365µ and 273µ (URS, RIRS), and 32W (4J/8Hz) with fibres of 550µ (NLP, cystolithotomy). RESULTS: Strategic improvement was achieved in all cases using the TFPD technique to continue the endolithotripsy or remove fragments. No complications were recorded after the use of this method. CONCLUSIONS: FTPD can be considered a complementary option in combination with the basic methods of fragmentation and pulverisation. In our experience, it constitutes significant progress in optimising the performance of Ho:YAG laser endolithotripsy.

Corinebacterium urealyticum: increased incidence of infection and encrusted uropathy.

INTRODUCTION: Corynebacterium urealyticum (CU) affects patients who are immunosuppressed, chronically ill or have undergone numerous operations. Obstructive uropathy (OU) is a complication of infection. STUDY OBJECTIVE: To demonstrate the growing increase in cases of infection by CU and OU in the past 5 years. MATERIAL AND METHODS: A descriptive study was conducted of urological patients with CU-positive urine cultures (January 2009-December 2014). We calculated the annual distribution and clinical characteristics of infection by CU and OU. Minimum follow-up: 6 months. We obtained the statistical means and ranges of clinical parameters pre/post-therapy. RESULTS: The total number of patients with CU was 115 (men, 87; women, 28). The mean age was 67.9 years (range, 6-95 years), and the annual distribution of cases for 2009, 2010, 2011, 2012, 2013 and 2014 was 9 (7.8%), 13 (11.3%), 9 (7.8%), 20 (17.4%), 31 (27%) and 33 (28.7%), respectively. The increase in cases for 2009-2014 was 300%. Multiple urological surgeries were performed in 89 cases (77.3%), with surgical complications in 77 cases (66.9%). Eighteen (15.6%) patients had OU (men, 13; women, 5), 12 had pyelitis (66.7%), 3 had cystopathy (16.6%), 2 had prostatic capsule disease (11.2%) and 1 had mesh calcification (5.5%). The analysis of the 18 cases with OU showed pre/postantibiotic therapy urine pHs of 8 (r, 6-9) vs. 6 (r, 5-7). All postantibiotic cultures were negative. Acidifying solution was applied in 5 cases, and surgery was performed in 13 cases (72.2%). The results from before/after the multimodal therapy showed renal impairment in 12 (66.6%) vs. 9 cases (50%) and glomerular filtration rates (GFR) of 45.8 (r, 6->90) vs. 52.7 (r, 13->90). The improvement in GFR was 6.94 points (T Wilcoxon; P=.102). The radiology results (incrustations) showed improvement in 13 patients (72.2%) and no change in 5 (27.8%). There was no specific mortality for CU. CONCLUSIONS: The prevalence of infection by CU and OU is increasing. Antibiotic treatment is highly effective. Acidifying solutions are an acceptable option for reducing calcifications.

Uropatía incrustante por Corynebacterium urealiticum: comentarios a partir de tres casos clínicos / Fouling uropathy by Corynebacterium urealyticum: Comments from three clinical cases

La uropatía incrustante es una enfermedad infecciosa del tracto urinario causada por la bacteria urealítica Corynebacterium urealyticum (CU). En nuestra serie (datos no publicados) sólo el 15% de las infecciones por CU produce uropatía incrustante. La formación de incrustaciones de estruvita y apatita en la pared del urotelio puede afectar a pelvis renal (pielitis), uréter, vejiga (cistopatía) y próstata, incluyendo la celda prostática después de resección ("celdopatía"). La pielitis es la más frecuente. La clínica corresponde a la triada orina alcalina, piuria y cristaluria de estruvita. Los pacientes suelen ser inmunodeprimidos o multioperados. El cultivo de orina debe estar dirigido al diagnóstico de CU. La TC es la prueba de imagen de elección. Muestra típicas imágenes de calcificación laminar. El tratamiento de la uropatía incrustante es multimodal. Incluye antibioterapia, acidificación de la orina y cirugía (algunos casos) (AU)

The encrustant uropathy is an infectious disease of the urinary tract caused by urealithic bacteria Corynebacterium urealyticum (CU). In our series (unpublished data) only 15% of CU infections caused encrustant uropathy. Formation of apatite and struvite on the wall of the urothelium can affect renal pelvis (pyelitis), urether, bladder (cystophatie) and prostate, including prostate cell after resection ("cellpathy"). Pyelitis is the most common. Clinical triad corresponds to alkaline urine, pyuria and struvite crystalluria. Patients are usually immunocompromised or or multiple previous surgeries. Urine culture should be directed to the diagnosis of UC. CT is the imaging test of choice. Shows typical images of laminar calcification. Treatment of encrusted uro pathy is multimodal. Includes antibiotics, acidification of urine and surgery (sometimes) (AU)

Hemangioma papilar como causa de macrohematuria. Presentación de un caso y revisión de la literatura / Papillary hemangioma as a cause of macrohematuria. A case report and review of the literature

La hematuria recidivante unilateral supone un reto diagnóstico y terapéutico para el urólogo. El hemangioma renal (HR) figura entre las posibles causas. La localización en la papila renal es típica. Se presenta un caso de hematuria secundaria a HR que fue diagnosticado en primera instancia como síndrome del cascanueces. Tras una revaloración se realizó ureterorrenoscopia que demostró un hemangioma papilar sangrante. La lesión fue tratada con fotovaporización láser con buen resultado. Se revisa la etiopatogenia, diagnóstico y las opciones terapéuticas frente al HR sangrante (AU)

Unilateral recurrent hematuria is a diagnostic and therapeutic challenge for the urologist. The renal hemangioma (RH) is a possible cause. The location is typically the renal papilla. A case of hematuria secondary to RH who was diagnosed at first instance and nutcracker syndrome is presented. After a diagnostic reassessment ureterorenoscopy was performed which showed a bleeding papillary hemangioma. The lesion was treated with laser PVP with good results. The pathogenesis, diagnosis and therapeutic options against the bloody RH is reviewed (AU)

Implications of vitamin D deficiency in lithiasic patient and in general population.

CONTEXT AND OBJECTIVE: Vitamin D deficiency causes problems in mineral metabolism but also overall health. In first place a review of the topic was carried out. Then, in order to contextualize it in lithiasic patient, a study on Vitamin D deficiency and its possible relationship with impaired PTH levels is performed. EVIDENCES ACQUISITION: A review of topics such as metabolism, epidemiology and the relationship of vitamin D deficiency with several pathologies was performed. Besides a multivariate analysis and a correlation study between vitamin D and PTH levels was conducted in 100 lithiasic patients. EVIDENCES SYNTHESIS: We present a review of Vitamin D metabolism, receptors and functions, as well as about its valuation methodology and the treatment of its deficiency. Lithiasic patients show a higher vitamin D deficiency than general population. Vitamin D deficiency has been significantly associated with increased PTH levels. In addition, there is enough literature showing a relationship between vitamin D deficiency not only with bone disease, but also with multiple diseases. CONCLUSION: vitamin D levels should be measured in all lithiasic patients, and those with vitamin D deficiency should be treated.

Infecciones de transmisión sexual en el varón: actitud práctica diagnóstico-terapéutica / STDs in men: diagnostic-therapeutic practical attitude

Las infecciones de transmisión sexual (ITS) son un grupo de enfermedades que afectan a la población que mantiene actividad sexual. Su distribución es muy amplia y afecta a ambos géneros. Para las uretritis por clamidia, ureaplasma y gonococo se utilizan cada vez más las pruebas de ampliación genómica como el test de reacción en cadena de la polimerasa (PCR). La balanitis por gardnerella y candida se diagnostican con cultivo de secreción y se tratan con terapia médica. Para el diagnóstico de la sifilis siguen en vigor las pruebas (reagínicas) como VDRL y las RPR y las treponémicas (no reagínicas) como FTA y TPHA. El tratamiento de todas ellas es antibiótico e incluye a las parejas. El herpes simple (VHS) se diagnostica clínicamente. La serología confirma el diagnóstico. El tratamiento con antivirales mejora el pronóstico. El virus del papiloma humano (VPH) se trata con eliminación química o física de las lesiones. El molusco contagioso se extirpa mecánicamente. En este trabajo se revisa el diagnóstico y el tratamiento práctico de las principales ITS que afectan al género masculino (AU)

Sexually Transmitted Infections (STIs) are a group of diseases affecting population that keeps sexual activity. Their distribution is very wide and affects both sexes. For urethritis chlamydia, ureaplasma and gonococcus genomic tests enlargement as test chain reaction (PCR) are used increasingly. The gardnerela and candida balanitis are diagnosed with secretion culture and treated with medical therapy. For the diagnosis of syphilis remain in reaginic and no reaginic tests). Treatment of these is antibiotic and includes couples. Herpes simplex virus (HSV) is diagnosed clinically. Serology confirms the diagnosis. Antiviral treatment improves prognosis. The Human Papilloma Virus (HPV) is treated with chemical or physical removal of the lesions. Molluscum contagiosum is removed mechanically. In this paper practical diagnosis and treatment of major ITS affecting male is reviewed (AU)

Litiasis úrica coraliforme bilateral de origen intestinal. Presentación de un caso tratado con la combinación quirúrgica NLP/RIRS/ECIRS / Uric bilateral staghorn lithiasis of intestinal origin. Report of a case treated with surgical combination NLP / RIRS / ECIRS

La cirugía endoscópica renal (por vía percutánea o por vía retrograda) se ha consolidado como una técnica de elección para los cálculos renales. En los más voluminosos (mayores de 2-3 cm de diámetro mayor) está indicada la nefrolitotomía percutánea (NLP) y en los menores la cirugía retrógrada intrarrenal RIRS (exceptuando los tratables con litotricia extracorpórea por ondas de choque). La ECIRS es una modalidad mixta. La litotricia endoscópica con láser es un tratamiento eficaz en las tres técnicas. En NLP es necesario usar altas energías La litiasis de AU representan un 10% del total de cálculos en España. Entre los factores etiológicosfiguran la dieta, los procesos inductores de lisis celular (ciertas neoplasias, quimioterapia) y algunos trastornos digestivos. Aunque la bilateralidad es muy frecuente es más raro encontrar coraliformes bilaterales. Presentamos un caso de litiasis renal úrica bilateral coraliforme (AU)

Renal endoscopic surgery (percutaneously or via retrograde) has become a technique of choice for kidney stones. In the more bulky (greater than 2-3 cm in diameter) is indicated percutaneous nephrolithotomy (PCNL). In smaller is indicated intrarenal retrograde surgery (RIRS), excluding those that can be treated with extracorporeal shock wave lithotripsy. The ECIRS is a mixed mode. Endoscopic laser lithotripsy is an effective treatment in the three techniques. In NLP is necessary to use high energy. The uric acid stones account for 10% of all stones in Spain. Etiologic factors include diet, conditions inducing cell lysis (certain malignancies, chemotherapy) and some digestive disorders. Although it is very frequent bilaterality is rare to find bilateral staghorn. We report a case of bilateral staghorn uric kidney stones secondary to intestinal disorder treated with a combination of three pocedures (AU)

Versión española del cuestionario USSQ: evaluación de la tolerancia clínica al catéter ureteral doble jota / Spanish version of the USSQ questionnaire: evaluation of clinical tolerance to double J uretheral catheter

INTRODUCCIÓN: La evaluación de los síntomas debidos a catéter ureteral doble jota (CUJJ) precisa de una herramienta fiable como el cuestionario USSQ. Se presenta una versión traducida al español de este cuestionario (USSQ-E). MATERIAL Y MÉTODOS: La versión en inglés del USSQ ha sido traducida al español siguiendo una sofisticada sistemática lingüística. Una vez obtenido el USSQ-E ha sido probado en un grupo de 70 pacientes portadores de CUJJ. Como grupo control se han tomado 40 personas sin catéter. RESULTADOS: Se ha evaluado el USSQ-E con pruebas de consistencia interna, test-retest, validez convergente, sensibilidad al cambio y validez discriminatoria, siendo todas ellas satisfactorias. CONCLUSIÓN: El USSQ-E es una herramienta válida y fiable para evaluar la sintomatología derivada del CUJJ en población hispanoparlante (AU)

INTRODUCTION: The assessment of symptoms due to double J ureteral catheter (CUJJ) requires a reliable tool like USSQ questionnaire. A translation in Spanish of this questionnaire (USSQ-E) version is presented. MATERIAL AND METHODS: The English version of USSQ has been translated into Spanish language following a systematic sophisticated. After obtaining the USSQ-E has been tested in a group of 70 patients with CUJJ. A control group of 40 people have been taken without catheter. RESULTS: We evaluated the USSQ-E with evidence of internal consistency, test-retest reliability, convergent validity, sensitivity to change and discriminant validity, all of which are satisfactory. CONCLUSION: USSQ-E is a valid and reliable for assessing symptomatology derived CUJJ tool in speaking population (AU)

Extraction of a bladder stone in a child as described by the renaissance physician Cristóbal Méndez.

INTRODUCTION: in his Libro del exercicio y de sus provechos (Book of exercise and profits), the Spanish Renaissance physician Christopher Mendez (1500-1553) describes extracting a bulk stone from the bladder of a child younger than 5 years in the land of colonial Mexico. This is the first description of a surgical procedure in America. MATERIAL AND METHODS: Biographical data were collected on Christopher Mendez. The electronic facsimile of the Book of exercise and profits was read. The historical aspects of perineal lithotomy and etiology of bladder stones were analyzed. RESULTS: In chapter seven of the third treatise (page 120), Mendez speaks about the removal of a bladder stone in a boy named «Villaseñor¼. It uses the word «open¼ to describe the procedure, corresponding to a lithotomy more than a necropsy. It attributes the etiology of excess movements after ingestion and suggests a possible hereditary etiology. DISCUSSION: Perineal lithotomy was a common practice in ancient times for children due to the high incidence of bladder stones. The technique was very invasive and was improved over the centuries. CONCLUSIONS: The surgery described by Mendez for the child called Villaseñor most likely corresponds to a perineal lithotomy. A congenital cause could play a role in its etiology.

Espina bífida y vejiga neurógena. Manejo de un caso complejo con esfínter artificial, ampliación vesical y derivación urinaria / Spina bifida and neurogenic bladder. Managing a complex case with artificial sphincter, bladder augmentation and urinary diversion

Se presenta caso de varón de 26 años con antecedente de espina bífida y mielomeningocele. Diagnosticado de vejiga neurógena con sistema de bajas presiones inicialmente debido a incontinencia de orina fue tratado con esfínter artificial. Después de la operación presentó un patrón de sistema de altas presiones que requirió ampliación vesical, derivación tipo Mitrofanoff y retirada del esfínter. Con ello se consiguió que la presión del detrusor se mantenga dentro de límites seguros durante las fases de llenado y vaciado para proteger la función renal. Es de gran importancia el diagnóstico y seguimiento urológico temprano de los niños y niñas con esta enfermedad mediante los estudios urodinámicos para determinar el patrón vesical y esfinteriano y decidir la mejor estrategia de tratamiento posible. La finalidad fundamental es convertir la vejiga en un sistema de baja presión, conseguir la continencia y preservar la función renal (AU)

Twenty-six years old male with a history of spina bifida and myelomeningocele is presented. Neurogenic bladder with initially low pressure system due to urinary incontinence was treated with artificial sphincter. After the operation presented a pattern of high pressure system that required bladder augmentation, Mitrofanoff diversion and removal of the sphincter. Through these measures safe limits during the phases of filling and emptying of the bladder were achieved, to protect renal function. It is very important the early diagnosis and monitoring of urological children with spina bifida with urodynamic study to determine bladder and sphincter patterns and determine the best possible treatment strategy. The main purpose is to convert the bladder in a low-pressure system, achieve continence and preserve renal function (AU)

Recomendaciones dietéticas en la litiasis de oxalato cálcico / Dietary recommendations in calcium oxalate lithiasis

La dieta puede afectar a los enfermos con litiasis oxálica, aumentando los factores de riesgo para la formación. Una vez completado el estudio metabólico se deben dar algunas normas dietéticas basadas en los datos científicos disponibles. Existen pocos trabajos que hayan analizado de forma completa el contenido de oxalatos en los alimentos de la dieta humana. Se debe insistir en la ingesta hídrica abundante, la reducción de sal y de proteínas animales, manteniendo un correcto aporte de calcio. En el presente trabajo se adjuntan algunas tablas de contenidos de oxalato en diversos alimentos. Los más ricos en oxalato (acelgas, espinacas, coliflor, té, cacao, kiwis) deben ser restringidos

Diet affect oxalic lithiasis patients, increasing the risk factors for stone formation. Upon completion of the metabolic study should give some dietary guidelines based on scientific data. Few studies have analyzed completely the oxalate content in foods of the human diet. It must be emphatized abundant fluid intake, reducing salt and animal protein, maintaining proper calcium intake. In this paper, some tables about oxalate content in various foods are attached. Most rich in oxalate (chard, spinach, cauliflower, tea, cocoa, kiwis) must be restricted

Liderazgo en medicina: Claves generales / Leadership in medicine: general keys

Introducción: El liderazgo es una de las claves para la dirección de equipos de trabajo en cualquier ámbito, incluida la medicina. El trabajo en equipo es una fórmula que mejora la productividad y genera satisfacción. El equipo debe estar motivado para conseguir sus objetivos. Material y métodos: Se realiza una somera revisión bibliográfica sobre liderazgo y motivación desde un punto general definiendo las claves conceptuales, con extrapolaciones al ámbito de la medicina. Resultados: Se define el decálogo del líder: tener un plan de acción por objetivos, conocer las habilidades para liderar, construir y dirigir un equipo, estar bien informado, conocer el talento de cada miembro del equipo, generar confianza, credibilidad e ilusión, comunicar con claridad los objetivos, conseguir pactos y compromisos, delegar tareas y demostrar empatía y honestidad, inspirando confianza. Las claves del liderazgo son: dar más que recibir, ser magnánimo, tener competencia y credibilidad, mostrar presencia y constancia, empatizar, dialogar, conocer la forma de transmitir órdenes y directivas, controlar, premiar y castigar, instruir y aportar valores. Conclusiones: El liderazgo es posible si existe un equipo motivado. El líder se hace con formación, trabajo, experiencia, solvencia y capacidad de comunicación. Generar satisfacción debe ser el objetivo final del binomio líder-equipo

Introduction: Leadership is a key to the management of teams in any field, including medicine. Teamwork is a formula that generates improved productivity and satisfaction. The team must be motivated to achieve their goals. Material and methods: We performed a review of the literature on leadership and motivation from a general point defining the key concepts, with extrapolations to the field of medicine. Results: We define the decalogue of the leader: Have a plan of action to achieve goals, learn the skills to lead, build and lead a team, be well informed, know the talent of each team member, build trust, credibility and enthusiasm, clearly communicate the goals, achieve agreements and commitments, delegate tasks and demonstrate empathy and honesty, inspiring confidence. The keys of leadership are: competence, credibility, show presence and persistence, empathy, dialogue, know how to transmit orders and directives, control, reward and punish, educate and bring values. Conclusions: Exercise leadership is only possible if there is a motivated team. The leader, above all, is done with training, work experience, reliability, credibility and ability to comunicate. Satisfaction should be the ultimate goal of the binomial leader-team

Principios físicos y aplicaciones quirúrgicas y urológicas del láser / Physical principles and surgical and urological applications of laser

El láser es una tecnología que se basa en la estimulación de fotones. Se consigue un haz de luz de gran potencia y alta precisión capaz de cortar y coagular, así como de destruir lesiones de todo tipo, incluidos los cálculos. Cada especialidad tiene sus indicaciones. En urología se utilizan para la ablación de la próstata con hiperplasia benigna (HBP) y de tumores de urotelio (superficiales) así como para destruir cálculos urinarios (litiasis). Se realiza una breve revisión de los principios del láser y su aplicación en algunas especialidades quirúrgicas (AU)

The laser is a technology based on the stimulation of photons, getting a beam of high power and high accuracy can cut and coagulate and destroy all kinds of tissues and stone. Each specialty has its indications. In urology is used to ablate benign hyperplasic prostate (BPH) and urothelial tumours (surface) as well as to destroy urinary calculi (stones). It is a brief review of the principles of the laser and its applications in some surgical specialties, particularly urology (AU)

Ureterolitotomía laparoscópica en litiasis ureteral proximal de gran tamaño / Laparoscopic ureterolithotomy in proximal uretheral litiasis of great size

Se presenta el caso de ureterolitotomía laparosocópica en un paciente joven con un grueso cálculo en uréter lumbar izquierdo. La operación se realizó tras el fracaso de dos sesiones de litotricia extracorpórea por ondas de choque. La técnica resulta eficaz y presenta mínimas complicaciones. Cada vez más se indican casos de laparoscopia en el tratamiento quirúrgico de la litiasis. Ello se debe a la falta de eficacia de otras técnicas menos invasivas como la LEOC, y a las limitaciones de la ureterorrenoscopia en cálculos ureterales cercanos a los 20 mm (AU)

We present a case of laparoscopic ureterolithotomy in a young patient with a thick left lumbar ureter stone. The operation was performed after the failure of two sessions of extracorporeal shock waves lithotripsy (ESWL). The technique is efficient and has minimal complications. Increasingly, The laparosocopy is increasingly recommended in cases of urolithiasis. This is due to the lack of effectiveness of other less invasive techniques such as ESWL, and the limitations of ureteroscopy against ureteral stones close to 20 mm (AU)

Manejo conservador de los tumores del tracto urinario superior. Revisión / Conservative management of upper urinary tract tumors. A review

El tratamiento convencional para los tumores del tracto urinario superior (TTUS) es la nefroureterectomía. En algunos casos (tumores de pequeño tamaño, no invasivos y de bajo grado) se aceptan las opciones quirúrgicas conservadoras, como la ureteroscopia (URS) y la cirugía percutánea. La URS flexible ha permitido el acceso a todos los tumores más inaccesibles. La ablación con láser es una de sus ventajas. Como tratamiento adyuvante existe la inmunoterapia o la quimioterapia, aplicadas por instilación local con buenos resultados. En este trabajo se revisan las opciones de tratamiento conservador de los TTUS y las modalidades de seguimiento (AU)

Conventional treatment for upper urinary tract tumors (UUTT) is nephroureterectomy. In some cases (small tumors, non-invasive and low grade) are accepted conservative surgical options such as ureteroscopy (URS) and percutaneous surgery. Flexible URS has allowed access to all inaccessible tumors. Laser ablation is one of its advantages. As adjuvant therapy exists immunotherapy or chemotherapy for local instillation with good results. In this paper we review the options (UUTT) of conservative treatment and monitoring procedures (AU)

Lesión en el colon como complicación de la nefrolitotomía percutánea / Injury to the colon as a complication of percutaneous nephrolithotomy

La cirugía percutánea es una opción quirúrgica efectiva y segura para el tratamiento de cálculos renales, tumores del sistema colector y para realizar endopielotomía anterógrada por síndrome de la unión pieloureteral. La lesión colónica yatrogénica es poco frecuente, pero puede tener consecuencias graves. El diagnóstico de la misma es habitualmente difícil, y las estrategias de tratamiento son controvertidas. Se presenta un caso de lesión de colon descendente durante una nefrolitotomía percutánea tratado con éxito aplicando medidas conservadoras (AU)

Percutaneous endoscopic renal surgery is usually a safe and effective treatment for patients with complex renal calculi, tumors of the collecting system, and ureteropelvic junction obstruction. A unique set of complications, however, can occur with this surgical approach that may involve the targeted kidney and surrounding structures. Iatrogenic colon injury is an uncommon but serious complication. Diagnosis is sometimes delayed, and treatment strategies are still controversial. We report a case of descending colon injury during percutaneous nefrolithotomy successfully treated using conservative measures (AU)