[Risk factors for contrast extravasation in renal colic]. / Factores de riesgo para extravasación de contraste en cólico renal.

INTRODUCTION: Non-traumatic ruptureof the pyeloureterocaliceal system (PUC) is anuncommon clinical entity. The most frequent cause isureteral obstruction due to lithiasic pathology, whichis present in up to 75%. To our knowledge, there isno description in the literature of the possible factorsassociated with this event. Our objective is to analyzethe variables associated with intravenous contrastextravasation in patients with renal colic due to singleureteral lithiasis. MATERIALS AND METHODS: We performed aretrospective, descriptive analysis of a series ofpatients who, in the context of renal colic, presentedendovenous contrast extravasation throughthe urinary system in computed tomography (CT).Patients with single ureteral lithiasis without otherassociated pathology were included. A comparisonof the samples from the group with contrast leakage(group 1) with an equal number of consecutiveCT scans without contrast leakage (group 2) in patientswith renal colic lithiasis was performed in alogistic regression model to identify risk factors forcontrast leakage. RESULTS: There were 117 cases of contrast leakagefrom January 2013 to July 2018. Eighty-sixpercent of the lithiases were 5 mm and 79% werelocated in the lower ureter. 72% of patients presentedwith intrarenal pelvis. In the univariate analysisboth location in lower ureter, lithiasis 5 mm, andintrarenal pyelic anatomy increased the probabilityof extravasation. In multivariate model, 5 mmlithiasis increased five times the risk of extravasationcompared to larger ones, the location in distalureter increased three times and the anatomy withintrarenal pelvis increased two times compared toother location and extrarenal pelvis, respectively, ina statistically significant way the risk of presentingcontrast leakage. CONCLUSION: In this series, we found an increasedrisk of contrast leakage in a lithiasic renalcolic in patients with intrarenal pelvic anatomy,with lithiasis less than or equal to 5 mm and locatedin the lower ureter.

INTRODUCCIÓN: La ruptura no traumaticadel sistema pieloureterocalicial (PUC) es una entidadclínica poco común. La causa más frecuente esla obstrucción ureteral por patología litiásica, que sepresenta hasta en un 75%. A nuestro conocimiento, noexiste en la literatura una descripción de los posiblesfactores asociados con este evento. Nuestro objetivo esanalizar las variables asociadas con la extravasaciónde contraste endovenoso en pacientes con cólico renalpor litiasis ureteral única.MATERIALES Y MÉTODOS: Se realizó un análisis retrospectivo,descriptivo, de una serie de pacientes que,en contexto de cólico renal, presentaron extravasaciónde contraste endovenoso por el sistema urinario entomografía computada (TC). Se incluyeron pacientescon litiasis ureteral única sin otra patologia asociada.Se realizó una comparación de las muestras del grupocon fuga de contraste (grupo 1) con igual número detomografías consecutivas sin fuga de contraste (grupo2) en paciente con cólico renal litiásico, en un modelode regresión logística para identificar factores de riesgode fuga de contraste. RESULTADOS: Se registraron 117 casos de fuga decontraste desde enero de 2013 hasta julio de 2018. El86% de los litos fueron ≤ 5 mm y el 79 % se ubicaronen uréter inferior. El 72% de los pacientes presentópelvis intrarrenal. En el análisis univariado tanto ubicaciónen uréter inferior, litiasis ≤ 5 mm, como anatomíapielica intrarrenal aumentaron la probabilidad deextravasación. En el modelo multivariado, litiasis ≤ 5mm aumentaron cinco veces el riesgo de extravasacióncomparado con las mayores, la ubicación en uréterdistal aumentó en tres veces y la anatomía con pelvisintrarrenal aumentó en dos veces comparado conotra ubicación y pelvis extrarrenal, respectivamente,de manera estadísticamente significativa el riesgo depresentar fuga de contraste.CONCLUSIÓN: En esta serie, encontramos aumentode riesgo de fuga de contraste en un cólico renal litiásicoen pacientes con anatomía piélica intrarrenal,con litos menores o iguales a 5 mm y ubicados enuréter inferior.

[Moderate/severe hydronephrosis before ureteral double-j stent insertion is associated with less back pain during micturition.] / La hidronefrosis moderada/severa antes de la inserción del catéter ureteral doble J se asocia con menos dolor de espalda durante la micción.

OBJECTIVE: Symptoms related toureteral double-J stent are the most common complaintamong patients. Back pain during micturition isone of the most frequent but intensity and durationmay vary between them. This study aimed to assessthe relationship between hydronephrosis grade beforeureteral double-j stent insertion and back pain duringmicturition. PATIENTS AND METHODS: All consecutive patientsundergoing a ureteral double-j insertion secondaryto urolithiasis between 2017 and 2019 were prospectivelyenrolled. Hydronephrosis was assessed using aCT scan and was categorized according to renal pelvismeasure as 0-10 mm (low group), and ≥10 mm(moderate group). At one week postoperative, patientsymptoms were evaluated using the Spanish validatedversion of the Ureteral Stent Symptom Questionnaire(USSQ) and 10 cm visual analog scale (VAS). Meanscores for USSQ domains and mean VAS scores werecompared. RESULTS: 149 patients were included and evaluated.The mean age was 48.2±15.1 years. We found no significantdifferences in mean scores for each main domainin the USSQ or VAS. The presence of flank painduring micturition was present in 73.5% and 52.5 %for the low vs moderate hydronephrosis group respectively(p=0.01). Sub-analysis by gender was 78.7 % vs44.0 % (p=0.00) and 58.6% vs 66.6% (p=0.6) of low andmoderate group in men and women respectively.Analysis of the USSQ item score revealed thatthe moderate hydronephrosis group presented less''pain or discomfort when urinating,'' less ''presenceof back pain when urinating,'' less ''admission orprocedure because of discomfort,'' and less ''feelingabout reinsertion''. CONCLUSION: Patients in the moderate hydronephrosisgroup did not have significant advantagesin terms of voiding symptoms, pain, general health,sexual matters, or additional problems determined bythe USSQ or in VAS. However, sub-analysis reportedadvantages concerning pain and additional questions.Men with moderate hydronephrosis presented statisticallysignificantly less pain during micturition.

INTRODUCCIÓN Y OBJETIVO: Lossíntomas relacionados con el catéter ureteral doble-Json la queja más común en los pacientes. El dolor deespalda durante la micción es uno de los más frecuentes,pero la intensidad y la duración varían entre ellos.El objetivo de este estudio fue evaluar la relación entreel grado de hidronefrosis antes de la inserción del catéterureteral doble-J y el dolor de espalda durante lamicción. PACIENTES Y MÉTODOS: Se incluyeron prospectivamentetodos los pacientes consecutivos que sesometieron a la inserción de un catéter ureteral doblej debido a la urolitiasis entre 2017 y 2019. La hidronefrosisse evaluó mediante una tomografía computarizaday se clasificó según la medida de la pelvis renalcomo 0-10 mm (grupo bajo), y ≥10 mm (grupo moderado/severo). Una semana después de la operación,los síntomas del paciente se evaluaron utilizando laversión validada en español del Cuestionario de Síntomasdel Catéter Ureteral (USSQ) y la la escala visualanáloga (EVA) de 10 cm. Se compararon las puntuaciones medias de los dominios del USSQ y las puntuacionesmedias de la EVA. RESULTADOS: Se incluyeron y evaluaron 149 pacientes.La edad media fue de 48,2±15,1 años. No seencontraron diferencias significativas en las puntuacionesmedias de cada dominio principal en la USSQo la EVA. La presencia de dolor en el flanco durante lamicción estuvo presente en el 73,5% y el 52,5% parael grupo de hidronefrosis baja vs. moderada respectivamente(p=0,01). El subanálisis por género fue 78,7% vs 44,0 % (p=0,00) y 58,6 % vs 66,6 % (p=0,6) delgrupo de baja y moderada en hombres y mujeres respectivamente.El análisis de la puntuación de los ítems de laUSSQ reveló que el grupo de hidronefrosis moderadapresentó menos "dolor o molestia al orinar", menos"presencia de dolor de espalda al orinar", menos "admisióno procedimiento por molestia" y menos "sensaciónde reinserción". CONCLUSIÓN: Los pacientes del grupo de hidronefrosismoderada no ofrecen ventajas significativas encuanto a los síntomas de evacuación, el dolor, la saludgeneral, las cuestiones sexuales o los problemasdeterminados por el USSQ o en EVA. Sin embargo, elsubanálisis informó de ventajas relativas al dolor ypreguntas adicionales. Los hombres con hidronefrosismoderada presentaban un dolor estadísticamente significativodurante la micción.

Renal tumor growth rate in patients with previously normal CT scan: Analysis of the initial stage of growth.

OBJECTIVE: Most of the studies regarding natural history of renal masses are based on active surveillance series and suggest that the renal masses have a slow growth rate. Nevertheless, only a few studies report the time between a normal computed tomography (CT) scan to the first detection of a tumor. We aimed to analyze the growth rate in newly diagnosed kidney tumors. MATERIAL AND METHODS: We analyzed patients with enhancing renal masses that developed after a normal CT scan, which was performed at most 12 months earlier. Variables examined included patient age, gender, tumor size, volume, tumor linear growth rate (LGR). All cases were surgically treated. Mann-Whitney U test was used to compare variables. A p<0.05 was considered as statistically significant. RESULTS: We found 31 patients with 33 lesions. Male to female ratio was 1.58 (19/12). The average age was 59.2 years (standard deviation [SD]±12.1), and the mean tumor size was 4.27 cm (SD±4.3). Tumor LGR was 0.87 cm/month (range: 0.28-1.66) and presumed to be 10.4 cm at 1 year (range: 3.36-19.9). Tumor LGR for time detection at <6 month or ≥6 months were 1.1 cm/month and 0.68 cm/month (range: 0.27-1.08 and 0.88-1.76, respectively; p=0.0004), respectively. Tumor LGRs for low- and high-grade tumors were 0.89 cm/month and 0.83 cm/month (p=0.65), respectively. Median volume was 36.1 cm3 (range: 2.61-143.7), and for low and high grade the median volumes were 27.9 cm3 and 47.6 cm3, respectively (p=0.54). Malignant pathology was present in 93.9 % (31 of 33) of masses (lesions). CONCLUSION: We found differences in tumor LGR in tumors detected before and after 6 months. We did not find any correlation between tumor growth rate and Fuhrman grade system, gender, histology, or age. We found the highest LGR published up to date.

Antegrade Ejaculation Preservation Technique with GreenLight XPS 180-W: Functional Ejaculatory Results.

Introduction: Ejaculatory dysfunction is a common complication of surgeries for benign prostatic obstruction. It causes a clear deterioration in quality of life. Techniques have been developed to attempt to preserve antegrade ejaculation (AE). Our objective was to analyze results of ejaculatory function using an AE preservation technique during anatomical vaporization with XPS 180-W. Methods: Between 2017 and 2019, sexually active patients were treated using this technique by the same surgical team. A questionnaire (MSHQ-EjD Short Form) was mailed, patients who did not answer were contacted by phone or personally during follow-up. Responses were analyzed. Voiding function was evaluated using International Prostatic Symptoms Score (IPSS), Qmax, and postvoid residual volume. t-Test for paired samples was used to compare conformity of patients with and without AE and voiding results. A p < 0.05 was considered statistically significant. Results: In total, 77 of 112 patients (68.8%) completed questionnaires and were included. Mean age was 64.1 years (standard deviation [SD] 6.9) and median prostate size was 57.2 g (interquartilic range 30-85). A total of 68 of 77 (88.3%) patients reported AE. Of these, 58 (85.3%) reported AE always or most of the time and 10 (14.7%) reported AE half of the time. In total, 42 (61.7%) patients had preserved strength or slightly less than before the procedure, and 33 (48.5%) reported the same or slightly less volume than before. In terms of satisfaction, the average response values of patients with preserved AE and ejaculatory disfunction were 0.97 (SD 1.12) and 2.7 (SD 1.78), respectively (p = 0.000). Pre- and postoperative variables were as follows: mean Qmax was 11.6 mL/sec vs 19.6 (p = 0.00), mean IPSS was 13.8 vs 8.9 (p = 0.000), and mean postvoiding residual urine was 125.3 vs 33.1 mL (p = 0.00), respectively. Conclusion: It is feasible to perform the AE preservation technique with anatomical vaporization XPS 180-W. In our medium size prostate series, we had a satisfactory patient perception of the ejaculatory function and satisfactory voiding function results.

Large Hepatic Subcapsular Hematoma Secondary to Double-J Stent Placement.

Introduction and Background: Urinary diversion with the endoscopic Double-J stent is a frequent procedure; complications can include irritation, suprapubic or flank pain, vesicoureteral reflux, hematuria, or urinary infection. We report a case of hepatic subcapsular hematoma secondary to Double-J stent placement. Case Presentation: A 28-year-old woman presented with a history of Sjögren's disease, nephrocalcinosis, and chronic kidney disease (CKD). The patient underwent multiple percutaneous and endoscopic procedures during the previous 2 years: right kidney: extracorporeal shock wave lithotripsy (SWL) × 4, ureteroscopic lithotripsy × 2, percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery; left kidney: SWL × 2, ureteroscopic lithotripsy × 5, and PCNL. Ultrasound imaging showed severe dilation in the right kidney and moderate dilation in the left kidney. CT scanning without contrast revealed a right pyelourethral dilation caused by a 13 mm ureteral lithiasis; also, cortical atrophy was observed. Urosepsis with exacerbated CKD was diagnosed and bilateral 7F Double-J stents were placed on both sides under general anesthesia. On postoperative day (POD) 8, the patient presented with pain in the right hemithorax and dullness to percussion. CT scans showed a heterogeneous hepatic subcapsular collection, of 15 × 7 × 23 cm, of hematic aspect, displacing vascular structures, and no active bleeding. Treatment was expectant and symptomatic. On POD 16, a new CT scan ruled out progression of the hematoma. The patient was finally discharged on POD 19. Four months later, bilateral semirigid ureteroscopy showed a right ureteral lithiasis of 8 × 7 mm, which was fragmented with a holmium laser. Nineteen months after the first episode, the patient is asymptomatic, with no residual lithiasis or hepatic hematoma. Conclusion: This case shows a very rare complication of Double-J stent placement that could be managed by conservative treatment.

[Partial nephrectomy in mesorrenal tumors greater than 4 cm: 15 years of experience.] / Nefrectomia parcial en tumores mesorrenales mayores de 4 cm: experiencia de 15 años.

OBJECTIVES: Mesorenal tumors (those located in the renal middle line or between both poles) are complex cases for partial nephrectomy (PN). Our objective is to evaluate oncological and perioperative results of PN in these patients with mesorenal tumors greater than 4 cm, mesophytic or endophytic. METHODS: A review of the medical records of patients with tumors with these characteristics operated between January 2016 and June 2016 was performed. RESULTS: 36 cases were included. The mean age was 54.2 years (24-79) with 12 cases of male gender. Mean surgical time: 139 minutes (120-280); 30 cases with complete clamping with mean ischemia of 19 minutes (10-90) and 6 compression of the parenchyma. Mean estimated bleeding: 280 ml (100-900). Mean tumor diameter: 4.3 cm (4.0 to 7.6). Preoperative and postoperative mean glomerular filtration rate 89 ml/min and 76 ml/min (p=0.32) respectively. Median length of stay: 3.8 days (2-21). There were 2 (6.5%) complications (II and IIIb). One case (3.3%) presented positive margin. One patient died due to progression at 14 months. With a median follow-up of 52.1 months (10-168) no recurrences were observed. CONCLUSIONS: We consider that mesorenal tumors, with significant penetration within the renal parenchyma and greater than 4 cm, PN presents both oncological and satisfactory results.

OBJETIVO: Los tumores mesorrenales (aquellos ubicados en la línea media renal o entre ambos polos) son casos complejos para una nefrectomía parcial. Nuestro objetivo es evaluar resultados oncológicos y perioperatorios de NP (nefrectomía parcial) en estos pacientes con tumores mesorrenales mayores a los 4 cm, mesofiticos o endofiticos. METODOS: Se realizó una revisión de las historias clínicas de pacientes con tumores con estas características operados entre enero de 2011 y junio de 2016 y se analizaron distintas variables. RESULTADOS: Se obtuvieron 36 casos. La edad media fue 54,2 años (24-79) con 12 casos de sexo masculino. Tiempo quirúrgico medio: 139 minutos (120- 280); 30 casos con clampeo completo con isquemia media de 19 minutos (10-90) y 6 compresión del parénquima. Sangrado promedio estimado: 280 ml (100-900). Diámetro tumoral medio: 4,3 cm (4,0 a 7,6). Tasa media de filtrado glomerular preoperatoria y posoperatoria 89 ml/min y 76 ml/min (p=0,32) respectivamente. Mediana de internación: 3,8 días (2-21). Hubo 2 (6,5%) complicaciones (II y IIIb). Un caso (3,3%) presentó margen positivo. Un paciente falleció por progresión a los 14 meses. Con una mediana seguimiento de 52,1 meses (10-168) no se observaron recidivas. CONCLUSION: Consideramos que en los tumores mesorrenales, con penetración significativa dentro del parénquima renal y mayores a los 4 cm, la NP presenta resultados tanto oncológicos como funcionales satisfactorios.

Laparoscopic partial nephrectomy using the Simon clamp: our experience in 18 cases. / Clamp de Simon para nefrectoméa parcial laparoscópica, nuestra experiencia en 18 casos.

OBJECTIVE: Kidney tumors represent 2- 3% of adult tumors. Partial nephrectomy is the standard of care for the treatment of localized tumors. Minimizing ischemia time is critical for postoperative renal function. The aim of this paper is to present our experience in laparoscopic partial nephrectomy with selective renal parenchymal compression using the Simon clamp. METHODS: We analyzed the record of patients that underwent surgery for renal tumors between January 2011 and June 2016 at our institution. Cases treated conwith this technique were selected. Demographic variables, operative, and postoperative outcomes were analyzed. RESULTS: 323 nephrectomies were performed and 18 cases treated with this technique were analyzed. Average age was 56.27 years (34- 75) with 10 female cases. BMI was 25.01 kg/m2 (21.2- 34.3). 17 cases were lower pole and one upper pole with 11 right and 7 left. Average surgical time was 83.25 minutes (43- 120); renal ischemia time was 21.36 minutes (12- 40) with an estimated blood loss of 91 ml (0- 400). Average tumor diameter was 2.6 cm (1.8 to 5.3). Glomerular filtration rate preoperative and immediate postoperative was 83 ml/min and 87 ml/min (p=0.42) respectively. Average length of stay was 2.75 days (1- 7). All cases had negative margins. With a mean follow up of 23.1 months (1- 58) no recurrences were observed. CONCLUSIONS: Laparoscopic partial nephrectomy using the Simon clamp for vascular control is a feasible technique for selected cases with polar exophytic tumors. Immediate postoperative glomerular filtration rate showed no significant changes and oncological control in our experience was satisfactory.

La hidronefrosis moderada/severa antes de la inserción del catéter ureteral doble j se asocia con menos dolor de espalda durante la micción / Moderate/severe hydronephrosis before ureteral double-j stent insertion is associated with less back pain during micturition

INTRODUCCIÓN Y OBJETIVO: Lossíntomas relacionados con el catéter ureteral doble-Json la queja más común en los pacientes. El dolor deespalda durante la micción es uno de los más frecuentes, pero la intensidad y la duración varían entre ellos.El objetivo de este estudio fue evaluar la relación entreel grado de hidronefrosis antes de la inserción del catéter ureteral doble-J y el dolor de espalda durante lamicción.PACIENTES Y MÉTODOS: Se incluyeron prospectivamente todos los pacientes consecutivos que sesometieron a la inserción de un catéter ureteral doblej debido a la urolitiasis entre 2017 y 2019. La hidronefrosis se evaluó mediante una tomografía computarizada y se clasificó según la medida de la pelvis renalcomo 0-10 mm (grupo bajo), y ≥10 mm (grupo moderado/severo). Una semana después de la operación,los síntomas del paciente se evaluaron utilizando laversión validada en español del Cuestionario de Síntomas del Catéter Ureteral (USSQ) y la la escala visualanáloga (EVA) de 10 cm. Se compararon las puntuaciones medias de los dominios del USSQ y las puntuaciones medias de la EVA.RESULTADOS: Se incluyeron y evaluaron 149 pacientes. La edad media fue de 48,2±15,1 años. No seencontraron diferencias significativas en las puntuaciones medias de cada dominio principal en la USSQo la EVA. La presencia de dolor en el flanco durante lamicción estuvo presente en el 73,5% y el 52,5% parael grupo de hidronefrosis baja vs. moderada respectivamente (p=0,01). El subanálisis por género fue 78,7% vs 44,0 % (p=0,00) y 58,6 % vs 66,6 % (p=0,6) delgrupo de baja y moderada en hombres y mujeres respectivamente.El análisis de la puntuación de los ítems de laUSSQ reveló que el grupo de hidronefrosis moderadapresentó menos “dolor o molestia al orinar”, menos“presencia de dolor de espalda al orinar”, menos “admisión o procedimiento por molestia” y menos “sensación de reinserción”.

OBJECTIVE: Symptoms related toureteral double-J stent are the most common complaint among patients. Back pain during micturition isone of the most frequent but intensity and durationmay vary between them. This study aimed to assessthe relationship between hydronephrosis grade beforeureteral double-j stent insertion and back pain duringmicturition.PATIENTS AND METHODS: All consecutive patientsundergoing a ureteral double-j insertion secondaryto urolithiasis between 2017 and 2019 were prospectively enrolled. Hydronephrosis was assessed using aCT scan and was categorized according to renal pelvis measure as 0-10 mm (low group), and ≥10 mm(moderate group). At one week postoperative, patientsymptoms were evaluated using the Spanish validatedversion of the Ureteral Stent Symptom Questionnaire (USSQ) and 10 cm visual analog scale (VAS). Meanscores for USSQ domains and mean VAS scores werecompared.RESULTS: 149 patients were included and evaluated.The mean age was 48.2±15.1 years. We found no significant differences in mean scores for each main domain in the USSQ or VAS. The presence of flank painduring micturition was present in 73.5% and 52.5 %for the low vs moderate hydronephrosis group respectively (p=0.01). Sub-analysis by gender was 78.7 % vs44.0 % (p=0.00) and 58.6% vs 66.6% (p=0.6) of low andmoderate group in men and women respectively.Analysis of the USSQ item score revealed thatthe moderate hydronephrosis group presented less‘‘pain or discomfort when urinating,’’ less ‘‘presence of back pain when urinating,’’ less ‘‘admission orprocedure because of discomfort,’’ and less ‘‘feelingabout reinsertion’’.CONCLUSION: Patients in the moderate hydronephrosis group did not have significant advantagesin terms of voiding symptoms, pain, general health,sexual matters, or additional problem

Factores de riesgo para extravasación de contraste en colico renal / Risk factors for contrast extravasation in renal colic

INTRODUCCIÓN: La ruptura no traumatica del sistema pieloureterocalicial (PUC) es una entidad clínica poco común. La causa más frecuente esla obstrucción ureteral por patología litiásica, que sepresenta hasta en un 75%. A nuestro conocimiento, noexiste en la literatura una descripción de los posiblesfactores asociados con este evento. Nuestro objetivo esanalizar las variables asociadas con la extravasaciónde contraste endovenoso en pacientes con cólico renalpor litiasis ureteral única.MATERIALES Y MÉTODOS: Se realizó un análisis retrospectivo, descriptivo, de una serie de pacientes que,en contexto de cólico renal, presentaron extravasaciónde contraste endovenoso por el sistema urinario entomografía computada (TC). Se incluyeron pacientescon litiasis ureteral única sin otra patologia asociada.Se realizó una comparación de las muestras del grupocon fuga de contraste (grupo 1) con igual número detomografías consecutivas sin fuga de contraste (grupo2) en paciente con cólico renal litiásico, en un modelode regresión logística para identificar factores de riesgo de fuga de contraste. RESULTADOS: Se registraron 117 casos de fuga decontraste desde enero de 2013 hasta julio de 2018. El86% de los litos fueron ≤ 5 mm y el 79 % se ubicaronen uréter inferior. El 72% de los pacientes presentópelvis intrarrenal. En el análisis univariado tanto ubicación en uréter inferior, litiasis ≤ 5 mm, como anatomía pielica intrarrenal aumentaron la probabilidad deextravasación. En el modelo multivariado, litiasis ≤ 5mm aumentaron cinco veces el riesgo de extravasación comparado con las mayores, la ubicación en uréter distal aumentó en tres veces y la anatomía con pelvis intrarrenal aumentó en dos veces comparado conotra ubicación y pelvis extrarrenal, respectivamente,de manera estadísticamente significativa el riesgo depresentar fuga de contraste.

INTRODUCTION: Non-traumatic rupture of the pyeloureterocaliceal system (PUC) is anuncommon clinical entity. The most frequent cause isureteral obstruction due to lithiasic pathology, whichis present in up to 75%. To our knowledge, there isno description in the literature of the possible factorsassociated with this event. Our objective is to analyzethe variables associated with intravenous contrastextravasation in patients with renal colic due to singleureteral lithiasis. MATERIALS AND METHODS: We performed aretrospective, descriptive analysis of a series ofpatients who, in the context of renal colic, presented endovenous contrast extravasation throughthe urinary system in computed tomography (CT).Patients with single ureteral lithiasis without otherassociated pathology were included. A comparisonof the samples from the group with contrast leakage (group 1) with an equal number of consecutiveCT scans without contrast leakage (group 2) in patients with renal colic lithiasis was performed in alogistic regression model to identify risk factors forcontrast leakage.RESULTS: There were 117 cases of contrast leakage from January 2013 to July 2018. Eighty-sixpercent of the lithiases were 5 mm and 79% werelocated in the lower ureter. 72% of patients presented with intrarenal pelvis. In the univariate analysisboth location in lower ureter, lithiasis 5 mm, andintrarenal pyelic anatomy increased the probability of extravasation. In multivariate model, 5 mmlithiasis increased five times the risk of extravasation compared to larger ones, the location in distalureter increased three times and the anatomy withintrarenal pelvis increased two times compared toother location and extrarenal pelvis, respectively, ina statistically significant way the risk of presentingcontrast leakage.CONCLUSION: In this series, we found an increased risk of contrast leakage in a lithiasic renalcolic in patients with intrarenal pelvic anatomy with lithiasis less

Nefrectomia parcial en tumores mesorrenales mayores de 4 cm: experiencia de 15 años / Partial nephrectomy in mesorrenal tumors greater than 4 cm: 15 years of experience

Objetivo: Los tumores mesorrenales (aquellos ubicados en la línea media renal o entre ambos polos) son casos complejos para una nefrectomía parcial. Nuestro objetivo es evaluar resultados oncológicos y perioperatorios de NP (nefrectomía parcial) en estos pacientes con tumores mesorrenales mayores a los 4 cm, mesofiticos o endofiticos. Metodos: Se realizó una revisión de las historias clínicas de pacientes con tumores con estas características operados entre enero de 2011 y junio de 2016 y se analizaron distintas variables. Resultados: Se obtuvieron 36 casos. La edad media fue 54,2 años (24-79) con 12 casos de sexo masculino. Tiempo quirúrgico medio: 139 minutos (120- 280); 30 casos con clampeo completo con isquemia media de 19 minutos (10-90) y 6 compresión del parénquima. Sangrado promedio estimado: 280 ml (100-900). Diámetro tumoral medio: 4,3 cm (4,0 a 7,6). Tasa media de filtrado glomerular preoperatoria y posoperatoria 89 ml/min y 76 ml/min (p = 0,32) respectivamente. Mediana de internación: 3,8 días (2-21). Hubo 2 (6,5%) complicaciones (II y IIIb). Un caso (3,3%) presentó margen positivo. Un paciente falleció por progresión a los 14 meses. Con una mediana seguimiento de 52,1 meses (10-168) no se observaron recidivas. Conclusión: Consideramos que en los tumores mesorrenales, con penetración significativa dentro del parénquima renal y mayores a los 4 cm, la NP presenta resultados tanto oncológicos como funcionales satisfactorios

Objectives: Mesorenal tumors (those located in the renal middle line or between both poles) are complex cases for partial nephrectomy (PN). Our objective is to evaluate oncological and perioperative results of PN in these patients with mesorenal tumors greater than 4 cm, mesophytic or endophytic. Methods: A review of the medical records of patients with tumors with these characteristics operated between January 2016 and June 2016 was performed. Results: 36 cases were included. The mean age was 54.2 years (24-79) with 12 cases of male gender. Mean surgical time: 139 minutes (120-280); 30 cases with complete clamping with mean ischemia of 19 minutes (10-90) and 6 compression of the parenchyma. Mean estimated bleeding: 280 ml (100-900). Mean tumor diameter: 4.3 cm (4.0 to 7.6). Preoperative and postoperative mean glomerular filtration rate 89 ml/min and 76 ml/min (p = 0.32) respectively. Median length of stay: 3.8 days (2-21). There were 2 (6.5%) complications (II and IIIb). One case (3.3%) presented positive margin. One patient died due to progression at 14 months. With a median follow-up of 52.1 months (10-168) no recurrences were observed. Conclusions: We consider that mesorenal tumors, with significant penetration within the renal parenchyma and greater than 4 cm, PN presents both oncological and satisfactory results

Clamp de Simon para nefrectomía parcial laparoscópica, nuestra experiencia en 18 casos / Laparoscopic partial nephrectomy using the Simon clamp: our experience in 18 cases

Objetivo: Los tumores renales representan el 2-3% de los tumores del adulto. La nefrectomía parcial es el gold standard para el tratamiento de los tumores localizados. Minimizar el tiempo de isquemia es determinante para la función renal posoperatoria. El objetivo de este trabajo es presentar nuestra experiencia en nefrectomía parcial laparoscópica con compresión selectiva del parénquima renal utilizando el clamp de Simon. Métodos: Se realizó una revisión de los pacientes con tumor renal operados entre enero de 2011 y junio 2016 en esta institución. Se seleccionaron los casos tratados con esta técnica. Se analizaron variables demográficas, operatorias, posoperatorias y resultados. Resultados: Se realizaron 323 nefrectomías y se analizaron los 18 casos tratados con esta técnica. La edad promedio fue 56,27 años (34-75) con 10 casos de sexo femenino. El Índice de masa corporal fue 25,01 kg/m2 (21,2-34,3). 17 casos fueron de polo inferior y uno de polo superior con 11 derechos y 7 izquierdos. El tiempo quirúrgico promedio fue 83,25 minutos (43-120); tiempo de isquemia renal de 21,36 minutos (12-40) y sangrado estimado promedio de 91 ml (0-400). El diámetro tumoral promedio fue 2,6 cm (1,8 a 5,3). La tasa de filtrado glomerular preoperatoria y posoperatoria inmediata fue 83 ml/min y 87 ml/min (p=0,42). El tiempo medio de internación fue 2,75 días (1-7). Todos los casos presentaron márgenes negativos. Con un seguimiento medio de 23,1 meses (1-58) no se observaron recidivas. Conclusiones: La nefrectomía parcial laparoscópica utilizando el clamp de Simon para control vascular es una técnica factible para casos seleccionados con tumores exofíticos polares. La tasa de filtrado glomerular posoperatoria inmediata no presentó modificaciones significativas y el control oncológico fue satisfactorio (AU)

Objetive: Kidney tumors represent 2-3% of adult tumors. Partial nephrectomy is the standard of care for the treatment of localized tumors. Minimizing ischemia time is critical for postoperative renal function. The aim of this paper is to present our experience in laparoscopic partial nephrectomy with selective renal parenchymal compression using the Simon clamp. Methods: We analyzed the record of patients that underwent surgery for renal tumors between January 2011 and June 2016 at our institution. Cases treated conwith this technique were selected. Demographic variables, operative, and postoperative outcomes were analyzed. Results: 323 nephrectomies were performed and 18 cases treated with this technique were analyzed. Average age was 56.27 years (34-75) with 10 female cases. BMI was 25.01 kg/m2 (21.2-34.3). 17 cases were lower pole and one upper pole with 11 right and 7 left. Average surgical time was 83.25 minutes (43- 120); renal ischemia time was 21.36 minutes (12-40) with an estimated blood loss of 91 ml (0-400). Average tumor diameter was 2.6 cm (1.8 to 5.3). Glomerular filtration rate preoperative and immediate postoperative was 83 ml/min and 87 ml/min (p=0.42) respectively. Average length of stay was 2.75 days (1-7). All cases had negative margins. With a mean follow up of 23.1 months (1-58) no recurrences were observed. Conclusions: Laparoscopic partial nephrectomy using the Simon clamp for vascular control is a feasible technique for selected cases with polar exophytic tumors. Immediate postoperative glomerular filtration rate showed no significant changes and oncological control in our experience was satisfactory (AU)