Accuracy of magnetic resonance imaging in differentiating between benign and malignant vertebral lesions: role of diffusion-weighted imaging, in-phase/opposed-phase imaging and apparent diffusion coefficient.

OBJECTIVE: To determine the ability of MRI to distinguish between benign and malignant vertebral lesions. MATERIAL AND METHODS: We included 85 patients and studied a total of 213 vertebrae (both pathologic and normal). For each vertebra, we determined whether the lesion was hypointense in T1-weighted sequences and whether it was hyperintense in STIR and in diffusion-weighted sequences. We calculated the in-phase/out-of-phase quotient and the apparent diffusion coefficient for each vertebra. We combined parameters from T1-weighted, diffusion-weighted, and STIR sequences to devise a formula to distinguish benign from malignant lesions. RESULTS: The group comprised 60 (70.6%) women and 25 (29.4%) men with a mean age of 67±13.5 years (range, 33-90 y). Of the 85 patients, 26 (30.6%) had a known primary tumor. When the lesion was hypointense on T1-weighted sequences, hyperintense on STIR and diffusion-weighted sequences, and had a signal intensity quotient greater than 0.8, the sensitivity was 97.2%, the specificity was 90%, and the diagnostic accuracy was 91.2%. If the patient had a known primary tumor, these values increased to 97.2%, 99.4%, and 99%, respectively. CONCLUSION: Benign lesions can be distinguished from malignant lesions if we combine the information from T1-weighted, STIR, and diffusion-weighted sequences together with the in-phase/out-of-phase quotient of the lesion detected in the vertebral body on MRI.

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.

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.

[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.

[Malignant fibrous histiocytoma of the spermatic cord. Presentation of one case and literature revision]. / Histiocitoma fibroso maligno de cordón espermático. Presentación de un caso y revisión de la literatura.

We present a case of malignant fibrous histiocytoma (MFH) of the spermatic cord. An 80-years-old man was admitted to the hospital with a left scrotal mass, related to a genital traumatism several months ago. Under the suspicion of a testicular tumor, left radical orchiectomy was performed. Histological examination of the tumoral mass revealed a malignant fibrous histiocytoma. The tumor was firmly adhered to the spermatic cord. MFH is an extremely rare, highly malignant connective tissue tumor, which may, occasionally, affect the male genital tract. There are no agreed treatment principles. The overall prognosis is poor.

[The use of double J stent for prevention of urological complications in kidney transplants]. / Empleo del catéter doble J para la prevención de las complicaciones urológicas en el trasplante renal.

OBJECTIVE: To analyze the impact of the use of the double J stent in the incidence of urological complications, like fistula urinary and ureteral obstruction in kidney transplants. MATERIALS AND METHODS: Between August 2003 and December 2005, 59 adult recipients underwent renal transplant. A retrospective study was conducted on two groups of patients: Group A with double J stent and group B without it. We reviewed the urological complications: fistula, ureteral obstruction and urinary tract infection. RESULTS: Group A: One ureteral obstruction and two urinary fistulas (7%) were developed in this group. 13 patients (46%) had a positive urinary culture. In only one case was necessary to retire the double J stent because of ureteral obstruction. Group B: Four patients (13%) developed ureteral obstruction and another five (16%) developed urinary fistula. 9 patients (29%) had a positive urinary culture. CONCLUSION: The routine insertion of a double J stent in kidney transplants reduces the number of early complications urinary fistula and ureteral obstructions.

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

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 diagnosis upper pole heminephrectomy and partial ureterectomy was performed.

[Vesical hemangioma]. / Hemangioma vesical.

Bladder hemangiomas are mesenquimal tumors, generally benign and of difficult diagnosis, representing only 0.6% primary bladder tumors. Fundamental diagnosis is histological, since imaging test can't differenciate this from other bladder tumors. We present a case of a 60-year-old male who came to our service with macroscopic hematuria. RTU of one blue mass in the bladder was performed and the histological examination showed to be cavernous hemangioma. A review of literature was realized, commenting on the most typical clinical aspects, the diagnostic methods and the last therapeutic techniques in this type of lesions.

TNF-alpha blockade induce clinical remission in patients affected by polymyalgia rheumatica associated to diabetes mellitus and/or osteoporosis: a seven cases report.

Polymyalgia rheumatica (PMR) is a chronic inflammatory condition of the elderly, characterized by aching and morning stiffness in the cervical region, shoulders and pelvic girdles. A steroid treatment course of 6-24 months is often required, but, due to important side effects, it is troublesome if the PMR patient is also affected by diabetes mellitus (DM) and/or osteoporosis. Aim of our study is to test anti-TNF alpha treatment as a steroid sparing tool in PMR patients affected by DM or osteoporosis. In particular, we hypothesise that TNF alpha blockade can be useful not only in remission maintaining, but also in the induction of clinical remission without corticosteroids in this kind of patients. In a six months follow up, patients had clinical improvement, confirmed by physical medical examination, and a statistically significant reduction in ESR and CRP mean values. Anti-TNF alpha treatment was well tolerated by all patients. These preliminary data suggest than Infliximab can be useful in the treatment of PMR patients, not only for steroid sparing purposes, but also as first line therapy in PMR patients with severe comorbidity, such as diabetes mellitus or osteoporosis.

Principales lugares de producción de las patologías que requieren recompresión en cámara hiperbárica / Main places of production of the pathologies that require recompression in hyperbaric chamber

INTRODUCCIÓN: Las principales patologías que requieren tratamiento en cámara hiperbárica son la enfermedad descompresiva y el embolismo arterial gaseoso. Ambas comparten la necesidad de cambios de la presión ambiental y del contenido gaseoso en el organismo. Además del buceo, existen otras situaciones que suponen cambios de presión y por tanto propician el riesgo de presentar lesiones que requieran recompresión. OBJETIVOS: Describir los principales lugares de producción de estas patologías y los mecanismos fisiopatológicos que las generan. Material y MÉTODO: Expedientes de accidentes de buceo recogidos en el Centro de Buceo de la Armada desde 1970 hasta 2017. RESULTADOS: Total 392 casos, 345 (88%) se producen en la mar, 36 (9,18%) en cámara hiperbárica, 6 (1,53%) en relación con submarinos y 4 (1,02%) en actividades hipobáricas. CONCLUSIONES: Cualquier situación que suponga un cambio de presión expone al sujeto a presentar una patología descompresiva y a necesitar un tratamiento hiperbárico. El lugar más frecuente es en la mar pero pruebas, en principio no lesivas, como un tratamiento hiperbárico, pueden predisponer a estas lesiones

INTRODUCTION: The main pathologies that require a recompression therapy are decompression sickness (DCS) and arterial gas embolism (AGE), boths can be caused by pressure-related activites and certain amount of gas (dissolved or not) in the victim's blood. Besides diving other pressure-related activities put the person in risk of this pathologies. AIM: To investigate the main place of production of these pathologies and their physiological base. METHODS: we reviewed all charts of patients with DCS and AGE from 1970-2017 at Centro de Buceo de la Armada (Cartagena). RESULTS: There were 392 cases, 345 (88%) diving related, 36 (9,18%) hyperbaric chamber-related, 6 (1,53%) submarine activities related and 4 (1,02%) hypobaric activities-related. CONCLUSIONS: Diving injuries rates are the most important but any pressure-related activity can be risky even hyperbaric chamber activity, considered the safest pressure-related activity

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)

Precisión de la resonancia magnética en la diferenciación entre lesión vertebral maligna y benigna: papel de las secuencias de difusión, del cociente fuera de fase/en fase y de los valores del coeficiente de difusión aparente / Accuracy of magnetic resonance imaging in differentiating between benign and malignant vertebral lesions: Role of Diffusion-weighted imaging, in-phase/opposed-phase imaging and apparent diffusion coefficient

Objetivo: Establecer la capacidad diagnóstica de la RM para distinguir las lesiones vertebrales benignas de las malignas. Material y métodos: Incluimos en el estudio a 85 pacientes con un total de 213 vértebras estudiadas (tanto patológicas como normales). Para cada vértebra determinamos si la lesión era hipointensa en T1 y si era hiperintensa o no en las secuencias STIR y potenciada en difusión. Calculamos el valor del cociente fuera de fase/en fase y el valor del coeficiente de difusión aparente de cada vértebra. A partir de los parámetros T1, difusión y STIR establecimos una combinación diagnóstica de lesión maligna. Resultados: El grupo comprendía 60 (70,6%) mujeres y 25 (29,4%) hombres con una edad media de 67 ± 13,5 años (33-90 años). De los 85 pacientes, un total de 26 (30,6%) tenían antecedentes de tumor primario. Cuando la lesión era hipointensa en las imágenes potenciadas en T1, hiperintensa en STIR y en las imágenes potenciadas en difusión, y con un cociente de intensidad de señal mayor de 0,8, la sensibilidad fue del 97,2%; la especificidad del 90% y la exactitud diagnóstica del 91,2%. Si el paciente tenía un tumor primario conocido, los valores se incrementaron hasta el 97,2; 99,4 y 99%, respectivamente. Conclusión: Es posible distinguir las lesiones benignas de las malignas si valoramos de forma conjunta la señal en T1, STIR y difusión y el cociente fuera de fase/en fase de la lesión detectada con RM en el cuerpo vertebral (AU)

Objective: To determine the ability of MRI to distinguish between benign and malignant vertebral lesions. Material and methods: We included 85 patients and studied a total of 213 vertebrae (both pathologic and normal). For each vertebra, we determined whether the lesion was hypointense in T1-weighted sequences and whether it was hyperintense in STIR and in diffusion-weighted sequences. We calculated the in-phase/out-of-phase quotient and the apparent diffusion coefficient for each vertebra. We combined parameters from T1-weighted, diffusion-weighted, and STIR sequences to devise a formula to distinguish benign from malignant lesions. Results: The group comprised 60 (70.6%) women and 25 (29.4%) men with a mean age of 67 ± 13.5 years (range, 33-90 y). Of the 85 patients, 26 (30.6%) had a known primary tumor. When the lesion was hypointense on T1-weighted sequences, hyperintense on STIR and diffusion-weighted sequences, and had a signal intensity quotient greater than 0.8, the sensitivity was 97.2%, the specificity was 90%, and the diagnostic accuracy was 91.2%. If the patient had a known primary tumor, these values increased to 97.2%, 99.4%, and 99%, respectively. Conclusion: Benign lesions can be distinguished from malignant lesions if we combine the information from T1-weighted, STIR, and diffusion-weighted sequences together with the in-phase/out-of-phase quotient of the lesion detected in the vertebral body on MRI (AU)

[Minor surgery in the family physician's office. Description of one year's experience]. / Cirugía menor en la consulta del médico de familia. Descripción de un año de experiencia.

OBJECTIVE: To describe the first results from minor surgery (MS) performed by the family doctor (FD) and to analyse the concordance between presurgical diagnosis and anatomical pathology. DESIGN: Prospective study. SETTING: Health centre and hospital anatomical pathology service. PARTICIPANTS: Interventions over a year by 4 FD and 8 third-year family medicine interns. MEASUREMENTS AND MAIN RESULTS: Descriptive variables for all the interventions were analysed. There were: age and gender; place, size and diagnosis of the lesion; reason for the MS; type of intervention; waiting time; and histological findings. The prior diagnosis was compared with the anatomical pathology for simple agreement. There were 243 interventions. Complete data were obtained for 229 (124 female and 105 male, aged between 4 and 79). The most common reason for MS was aesthetic, followed by fear of malignity and pain. The techniques used most often were: surgical exeresis (56.3%) and cryotherapy (36.2%). Most problems treated were naevi (72 cases), verrucas (83) and epidemic-sebaceous cysts (23). All the substances extracted (140) were sent to Pathology and there was 84.1% agreement between the Laboratory report and doctor's diagnosis. Average waiting time for the intervention was 15 days. CONCLUSIONS: Performing MS in primary care is feasible, as long as the FD is correctly trained. In our unit there is little waiting time and high histopathologic concordance.

Tumores del tracto urinario superior. Nuestra experiencia / Tumors of the upper urinary tract. Our experience

Objetivo: Estudiar la clínica, el diagnóstico, el tratamiento, y la evolución de los tumores del tracto urinario superior. Métodos: Se realizó un estudio retrospectivo de los tumores del aparato urinario superior tratados en nuestro centro, HCU Valladolid, entre 1994 y 2007. Resultados: Se diagnosticaron 65 tumores, de los cuales sólo 59 entraron en el estudio. La edad media de los pacientes fue de 68 años (intervalo entre 46 y 88 años). Nos encontramos 47 varones frente a 12 mujeres. La hematuria fue el signo clínico inicial más frecuente, apareciendo en el 79,9% de los casos. La Urografía fue la técnica diagnóstica más utilizada (96,6%). La técnica quirúrgica más empleada fue la nefroureterectomía con desinserción endoscópica del uréter, realizada en 28 ocasiones. En 9 pacientes se aplicó tratamiento conservador vía percutánea con una única recidiva y en 2 tratamiento ureteroscópico. El 50,9% de los tumores fueron superficiales. Hubo un 37% de afectación vesical concomitante. La supervivencia a los cinco y diez años fue del 55 y 47% respectivamente. Conclusiones: Los tumores de aparato urinario superior son una entidad rara, que aparece en la edad media-avanzada de la vida. La nefroureterectomía radical es hoy por hoy el tratamiento estandar, ya sea vía abierta o laparóscopica. El tratamiento endóscopico cada vez tiene más importancia y presenta excelentes resultados en casos seleccionados (AU)

Objectives: To study the clinical presentation, diagnosis, treatment, and evolution of upper urinary tract tumours. Methods: We carried out a retrospective study on the upper urinary tract tumours treated in our centre, HCU Valladolid, between 1994 and 2007. Results: 65 tumours were diagnosed, although only 59 were valid for the study. Mean patient age was 68 years (interval between 46 and 88 years). 47 were men and 12 women. The most common symptom on presentation was hematuria (79,9%). Urography was the most frequently used diagnostic technique (96,6%) and nephroureterectomy with transurethral resection of the intramural ureter was the most common surgical treatment performed, carried out in 28 cases. 9 patients underwent percutaneous treatment with only one recurrence, and 2 patients received ureteroscopic treatment. 50,9 % of the lesions were classified as superficial tumours. The 5 and 10-year survival rates were 55 and 47%. Conclusions: Upper urinary tract tumours are an unusual disease characteristic of medium-advanced ages. Nowadays nephroureterectomy by open surgery or laparoscopy is the standard treatment. Conservative endoscopic procedures have more and more importance and present excellent results in highly selected cases (AU)

Empleo del catéter doble J para la prevención de las complicaciones urológicas en el trasplante renal / The use of double J stent for prevention of urological complications in kidney transplants

Objetivo: Analizar si la cateterización sistemática de la anastomosis ureterovesical en el trasplante renal mediante un catéter doble J disminuye la incidencia de las complicaciones urológicas tipo fístula y estenosis ureterales. Material y métodos: En el periodo comprendido entre agosto de 2003 y diciembre de 2004 realizamos 59 trasplantes renales de donante cadáver. Establecemos dos grupos, grupo A pacientes que durante el trasplante se les coloca un catéter doble J y grupo B pacientes trasplantados sin colocación de catéter. Mediante un estudio retrospectivo analizamos la incidencia de fístulas urinarias, estenosis ureterales y procesos infecciosos en ambos grupos. Resultados: En el grupo A (con catéter doble J) se detectaron 1 caso de estenosis ureteral y 2 casos (7%)de fístula urinaria. En un paciente fue necesaria la retirada del catéter al producir obstrucción por coágulos. Trece pacientes (46%) presentaron un cultivo de orina positivo. En el grupo B (sin catéter doble J) se evidenciaron 4 casos (13%) de estenosis ureteral y 5 casos (16%) de fístula urinaria. Nueve pacientes (29%) presentaron un cultivo de orina positivo. Conclusión: El empleo del catéter doble J de forma profiláctica en el trasplante renal, disminuye las fístulas urinarias y en mayor medida las estenosis ureterales (AU)

Objetive: To analyze the impact of the use of the double J stent in the incidence of urological complications, like fistula urinary and ureteral obstruction in kidney transplants. Materials and methods: Between August 2003 and December 2005, 59 adult recipients underwent renal transplant. A retrospective study was conducted on two groups of patients: Group A with double J stent and group B without it. We reviewed the urological complications: fistula, ureteral obstruction and urinary tract infection. Results: Group A: One ureteral obstruction and two urinary fistulas (7%) were developed in this group. 13 patients (46%) had a positive urinary culture. In only one case was necessary to retire the double J stent because of ureteral obstruction. Group B: Four patients (13%) developed ureteral obstruction and another five (16%) developed urinary fistula. 9 patients (29%) had a positive urinary culture. Conclusion: The routine insertion of a double J stent in kidney transplants reduces the number of early complications urinary fistula and ureteral obstructions (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)

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)