Tratamiento endourológico de la litiasis ureteral lumbar. ¿Qué aporta la ureterorrenoscopia flexible? / Endourological treatment for lumbar ureteral stones. What are the benefits of flexible ureterorenoscopy?

Introducción y objetivos: Actualmente, no existe un criterio claro para el tratamiento de la litiasis ureteral lumbar. El objetivo de este trabajo es presentar nuestros resultados en el tratamiento endourológico de esta patología y analizar las variables que aconsejen la utilización del ureterorrenoscopio flexible.Material y métodosRevisión retrospectiva de 103 pacientes operados mediante ureterorrenoscopia (URS) por vía retrógrada, utilizando un ureterorrenoscopio semirrígido o flexible. Se consideró localización proximal en L2-L3 y localización media en L4-L5. URS semirrígida inicial y reconversión a URS flexible cuando fue imposible finalizar la intervención o fue necesaria para completar el tratamiento. Se consideró éxito a la ausencia de fragmentos residuales (6 semanas). Se hizo un análisis de variables demográficas, litiásicas, quirúrgicas y postoperatorias inmediatas y se comparó el uso del ureterorrenoscopio flexible con algunas de ellas.ResultadosLa edad media de los pacientes fue 57,2 años (DE 15,6); 73 eran hombres (70,9%). Tamaño litiásico: 8mm (rango 4-30; RIQ 4,5). Localización proximal: 58 (56,3%). JJ previo: 44,7%. Nefrostomía previa: 10,7%. URS semirrígida con reconversión a URS flexible: 51 (49,5%). Litiasis impactada: 28,2%. Complicaciones intraoperatorias: 2 (1,9%). JJ postoperatorio: 84,5%. Complicaciones postoperatorias inmediatas: 23 (22,3%) (Clavien-Dindo I-II: 91,3%). Estenosis ureteral postoperatoria: 5,8%. Éxito: 88,4%. Restos: 12 (11,7%), expulsión espontánea 6 (50%). Mayor realización de URS flexible en litiasis proximales (p=0,001) y mayores de 11mm (p=0,02) en análisis univariante y en litiasis proximales (OR 3,5; 1,5-8,1; p=0,004) en análisis multivariante. (AU)

Introduction and objectives: Currently, there are no established criteria regarding treatment for lumbar ureteral stones. The objective of this work is to present our results in the endourological treatment of this pathology, analyzing the variables associated with the use of the flexible ureterorenoscope.Material and methodsRetrospective review of 103 patients who underwent retrograde URS with semi-rigid or flexible ureterorenoscope. Proximal location: L2-L3. Medial location: L4-L5. Semirigid URS was the initial treatment, with conversion to flexible URS when it was required to complete the procedure. Success was defined as absence of residual fragments (6 weeks). Demographic, surgical, immediate postoperative variables, and those related to the stone, were analyzed. Their correlation with the use of the flexible ureterorenoscope was evaluated.ResultsMean age: 57.2 years (SD 15.6); there were 73 men (70.9%). Stone size: 8mm (range 4-30; IQR 4.5). Proximal location: 58 (56.3%). Previous JJ: 44.7%. Previous nephrostomy: 10.7%. Semirigid URS with conversion to flexible URS: 51 (49.5%). Impacted stones: 28.2%. Intraoperative complications: 2 (1.9%). Postoperative JJ: 84.5%. Immediate postoperative complications: 23 (22.3%) (Clavien-Dindo I-II: 91.3%). Postoperative ureteral stricture: 5.8%. Success: 88.4%. Residual fragments: 12 (11.7%). Spontaneous passage: 6 (50%). Greater performance of flexible URS in proximal ureteral stones (P=0.001) of more than 11mm (P=0.02) in univariate analysis, and in proximal stones [OR 3.5; 1.5-8.1; P=0.004] in multivariate analysis.ConclusionsEndourological treatment obtained a high success rate in our sample. Size greater than 11mm and proximal ureteral location in univariate and multivariate analysis, respectively, behaved as predictors of flexible URS. (AU)

Endourological treatment for lumbar ureteral stones. What are the benefits of flexible ureterorenoscopy?

INTRODUCTION AND OBJECTIVES: Currently, there are no established criteria regarding treatment for lumbar ureteral stones. The objective of this work is to present our results in the endourological treatment of this pathology, analyzing the variables associated with the use of the flexible ureterorenoscope. MATERIAL AND METHODS: Retrospective review of 103 patients who underwent retrograde URS with semi-rigid or flexible ureterorenoscope. Proximal location: L2-L3. Medial location: L4-L5. Semirigid URS was the initial treatment, with conversion to flexible URS when it was required to complete the procedure. Success was defined as absence of residual fragments (6 weeks). Demographic, surgical, immediate postoperative variables, and those related to the stone, were analyzed. Their correlation with the use of the flexible ureterorenoscope was evaluated. RESULTS: Mean age: 57.2 years (SD 15.6); there were 73 men (70.9%). Stone size: 8 mm (range 4-30; IQR 4.5). Proximal location: 58 (56.3%). Previous JJ: 44.7%. Previous nephrostomy: 10.7%. Semirigid URS with conversion to flexible URS: 51 (49.5%). Impacted stones: 28.2%. Intraoperative complications: 2 (1.9%). Postoperative JJ: 84.5%. Immediate postoperative complications: 23 (22.3%) (Clavien-Dindo I-II: 91.3%). Postoperative ureteral stricture: 5.8%. Success: 88.4%. Residual fragments: 12 (11.7%). Spontaneous passage: 6 (50%). Greater performance of flexible URS in proximal ureteral stones (p = 0.001) of more than 11 mm (p = 0.02) in univariate analysis, and in proximal stones [OR 3.5; 1.5-8.1; p = 0.004] in multivariate analysis. CONCLUSIONS: Endourological treatment obtained a high success rate in our sample. Size greater than 11 mm and proximal ureteral location in univariate and multivariate analysis, respectively, behaved as predictors of flexible URS.

Endourological treatment for lumbar ureteral stones. What are the benefits of flexible ureterorenoscopy? / Tratamiento endourológico de la litiasis ureteral lumbar. ¿Qué aporta la ureterorrenoscopia flexible?

INTRODUCTION AND OBJECTIVES: Currently, there are no established criteria regarding treatment for lumbar ureteral stones. The objective of this work is to present our results in the endourological treatment of this pathology, analyzing the variables associated with the use of the flexible ureterorenoscope. MATERIAL AND METHODS: Retrospective review of 103 patients who underwent retrograde URS with semi-rigid or flexible ureterorenoscope. Proximal location: L2-L3. Medial location: L4-L5. Semirigid URS was the initial treatment, with conversion to flexible URS when it was required to complete the procedure. Success was defined as absence of residual fragments (6 weeks). Demographic, surgical, immediate postoperative variables, and those related to the stone, were analyzed. Their correlation with the use of the flexible ureterorenoscope was evaluated. RESULTS: Mean age: 57.2 years (SD 15.6); there were 73 men (70.9%). Stone size: 8mm (range 4-30; IQR 4.5). Proximal location: 58 (56.3%). Previous JJ: 44.7%. Previous nephrostomy: 10.7%. Semirigid URS with conversion to flexible URS: 51 (49.5%). Impacted stones: 28.2%. Intraoperative complications: 2 (1.9%). Postoperative JJ: 84.5%. Immediate postoperative complications: 23 (22.3%) (Clavien-Dindo I-II: 91.3%). Postoperative ureteral stricture: 5.8%. Success: 88.4%. Residual fragments: 12 (11.7%). Spontaneous passage: 6 (50%). Greater performance of flexible URS in proximal ureteral stones (P=0.001) of more than 11mm (P=0.02) in univariate analysis, and in proximal stones [OR 3.5; 1.5-8.1; P=0.004] in multivariate analysis. CONCLUSIONS: Endourological treatment obtained a high success rate in our sample. Size greater than 11mm and proximal ureteral location in univariate and multivariate analysis, respectively, behaved as predictors of flexible URS.

[Low-grade collecting duct carcinoma of the kidney in a patient treated by dialysis]. / Carcinoma renal de los conductos colectores de bajo grado en un paciente en tratamiento con hemodiálisis.

Patient treated by dialysis for end-stage renal disease are at increased risk of many cancers, especially those of kidney and urinary tract. A 56 years old man who undergoing chronic dialysis, presented in ultrasonography a 2 cm complex cystic mass in the left kidney what was confirmed by computed tomography and magnetic resonance. A laparoscopic left nephrectomy was performed. Histological examination showed a low grade collecting duct carcinoma of the kidney. An infrequent variant of kidney tumor.

Carcinoma renal de los conductos colectores de bajo grado en un paciente en tratamiento con hemodiálisis / Low-grade collecting duct carcinoma of the kidney in a patient treated by dialysis

Los pacientes en tratamiento con diálisis por enfermedad renal en estadio terminal tienen un riesgo aumentado de padecer varios tipos de cáncer, especialmente de riñón y del tracto urinario. Presentamos el caso de un varón de 56 años en tratamiento con hemodiálisis. En una ecografía de control se apreció una imagen compatible con un quiste complicado de unos dos centímetros a nivel del polo inferior de riñón izquierdo, que es confirmada mediante TC y RM abdominal. Se practicó una nefrectomía izquierda por vía laparoscópica. El diagnóstico histológico fue de carcinoma renal de los conductos colectores de bajo grado, una variante infrecuente de tumor renal (AU)

Patient treated by dialysis for end-stage renal disease are at increased risk of many cancers, especially those of kidney and urinary tract. A 56 years old man who undergoing chronic dialysis, presented in ultrasonographya 2 cm complex cystic mass in the left kidney what was confirmed by computed tomography and magnetic resonance. A laparoscopic left nephrectomy was performed. Histological examination showed a low grade collecting duct carcinoma of the kidney. An infrequent variant of kidney tumor (AU)

Uréter ectópico como causa de pionefrosis e incontinencia urinaria / Ectopic ureter as cause of pyonephrosis and incontinence urinary

El ureter ectópico se presenta aproximadamente en 1 de cada 2000 recién nacidos. En un 85% de los casos va asociado a una duplicidad pieloureteral. Las manifestaciones clínicas de esta entidad incluyen la incontinencia y las infecciones del tracto urinario. Frecuentemente el uréter ectópico se asocia a un polo superior displásico y poco funcionante. En estos casos, el tratamiento de elección es la nefrectomía polar superior. Se presenta un caso de una mujer de 23 años con dolor tipo cólico en fosa renal izquierda, fiebre y escapes urinarios. La ecografía, la urografía y la pielografía anterograda mostraron bifidez ureteral derecha, duplicidad ureteral izquierda e hidronefrosis del pielón superior izquierdo con desembocadura ectópica del mismo en la uretra. Una vez hecho el diagnóstico, se realizó una nefrectomía polar superior izquierda y ureterectomía parcial (AU)

Ectopic ureter accounts with an incidence of 1 in 2000 newborns. When present, ectopic ureter can be associated with duplex kidneys in an 85 % of the cases. Clinical manifestations of this malformation include incontinence and urinary tract infections. Ectopic ureter frequently occurs in association with a dysplastic upper pole renal moiety. When a poorly functioning upper pole segment is present, a standard surgical treatment is upper pole heminephrectomy. A 23-years old woman presented with left renal colic pain, fever and urinary leak. Ultrasound, intravenous pyelogram and antegrade pyelogram revealed a partial duplex right kidney and a complete duplex left kidney with hydronephrosis and ectopic insertion into the urethra of the left upper pole moiety. Following diagnosisupper pole heminephrectomy and partial ureterectomy was performed (AU)

[Spontaneous hemorrhage and arterial hypertension as complication of Adrenal Pseudocyst. Report of a case]. / Hemorragia espontánea e hipertensión arterial como complicaciones de un pseudoquiste suprarrenal. Presentación de un caso.

Adrenal Pseudocyst are uncommon and asymptomatic tumors. We report an unusual case who had previous high blood pressure and acute hemorrhage presented with abdominal pain and shock. Diagnosis was made with ultrasonography and computed tomography revealed the presence of large retroperitoneal hematoma around the superior pole of the left kidney. Urgent surgery was made with a complete excision of a 10 cm. tumor with preservation of adrenal tissue and the left kidney. Histopathological diagnosis was: Adrenal Pseudocyst. Blood pressure normalized after surgery.

Hemorragia espontánea e hipertensión arterial como complicaciones de un pseudoquiste suprarrenal. Presentación de un caso / Spontaneous hemorrhage and arterial hypertension as complication of adrenal pseudocyst. Report of a case

Los pseudoquistes suprarrenales son lesiones muy poco frecuentes y asintomáticas. Se describe un caso de presentación inusual caracterizado por hipertensión arterial previa y sangrado agudo espontáneo manifestado por dolor abdominal y shock. El diagnóstico se realizó por medio de Ecografía y Tomografía computarizada, las cuales demostraron la presencia de un hematoma retroperitoneal importante alrededor de una lesión situada en el polo superior del riñón izquierdo. Se realizó intervención quirúrgica de urgencia con resección completa de la lesión de aproximadamente 10 cm. De diámetro preservando parte del tejido suprarrenal y el riñón izquierdo. El diagnóstico anatomopatológico fue: pseudoquiste suprarrenal. Las cifras tensionales se normalizaron después de la cirugía (AU)

Adrenal Pseudocyst are uncommon and asymptomatic tumors. We report an unusual case who had previous high blood pressure and acute hemorrhage presented with abdominal pain and shock. Diagnosis was made with ultrasonography and computed tomography revealed the presence of large retroperitoneal hematoma around the superior pole of the left kidney. Urgent surgery was made with a complete excision of a 10 cm. tumor with preservation of adrenal tissue and the left kidney. Hystopathological diagnosis was: Adrenal Pseudocyst. Blood pressure normalized after surgery (AU)

[Primary renal lymphoma]. / Linfoma renal primario.

OBJECTIVE: To describe a case of primary renal lymphoma. MATERIAL AND METHODS: We presents a patient with a right renal mass which histological analysis revealed a non-Hodgkin Lymphoma. RESULTS: A 78-year-old male patient with right flank pain mass was referred to our Service. He was diagnosed of renal mass by imaging studies. Inmunohistochemical investigations revealed a B-cell-type lymphoma. He received combination chemotherapy with CHOP. CONCLUSIONS: Primary renal lymphoma is a rare disease whose existence has been questioned, because the kidney does not normally contain lymphoid tissue. Its clinical presentation is like any other renal tumor and its definitive diagnosis is by histology. Elective treatment is chemotherapy (CHOP).

[Hypercalcemia, leukemoid reaction, and thrombocytosis as paraneoplastic presentation of transitional cell carcinoma of the kidney]. / Hipercalcemia, reacción leucemoide y trombocitosis como presentación paraneoplásica del carcinoma renal de células transicionales.

The most common etiologies of hypercalcemia are hyperparathyroidism or malignancy, most often of the lung, breast or hematological system, but rarely occur in transitional cell carcinoma. The appearance of this metabolic disorder and other paraneoplastic signs like leukemoid reaction or thrombocytosis is a potential marker for malignant behaviour and poor prognosis in advanced tumours. Simultaneous presentation of that three paraneoplastic signs have only been described in two patients with wellknown bladder carcinoma. Most paraneoplastic syndromes appear only during the late stages of malignancy when the diagnosis has long been established, but sometimes may be an early sign of the malignancy. We describe a case of a previously unknown infiltrating transitional cell carcinoma of the kidney without bony metastasis, that presented itself with hypercalcemia, hyperleukocytosis resembling a leukemoid reaction and thrombocytosis. We think recognizing the paraneoplastic syndrome is very important because it is an alarm sign of malignancy.

Hipercalcemia, reacción leucemoide y trombocitosis como presentación paraneoplásica del carcinoma renal de células transicionales / Hypercalcemia, leukaemoid reaction and thrombocytosis as a paraneoplastic presentation of transitional cell carcinoma of kidney

Las causas más comunes de hipercalcemia son el hiperparatiroidismo y las neoplasias malignas con más frecuencia de pulmón, mama o del sistema hematológico, pero raramente ocurren en el carcinoma de células transicionales. La aparición de este desorden metabólico y de otros signos paraneoplásicos como la reacción leucemoide o la trombocitosis, es un marcador potencial de comportamiento maligno y mal pronóstico en tumores avanzados. La presentación simultánea de estos tres signos paraneoplásicos sólo ha sido descrita en dos pacientes con carcinoma vesical, en ambos previamente conocido. La mayoría de los síndromes paraneoplásicos aparecen sólo durante las etapas tardías del tumor maligno cuando el diagnóstico ha sido bien establecido, pero en algunos casos pueden ser un signo precoz de malignidad. Describimos un caso no conocido previamente de carcinoma infiltrante de células transicionales de riñón con estudio negativo para metástasis óseas, que se presentó con hipercalcemia, hiperleucocitosis simulando una reacción leucemoide y trombocitosis. Pensamos que es importante el reconocimiento del síndrome paraneoplásico como señal de alarma de malignidad (AU)

[Granulomatous orchitis]. / Orquitis granulomatosa.

Granulomatous orchitis is an inflammatory change of the testis. This is a rare lesion of unknown etiology. Usually are unilateral. The clinical appearance varies, and it is difficult to differentiate from testicular cancer. The diagnosis usually being made on histological examination after orchiectomy. Our paper report one case of granulomatous orchitis in a 27 year old patient. A review of the literature is made on the diagnosis and pathogenesis.