Initial results of the implementation of an ambulatory mini percutaneous nephrolithotomy program.

OBJECTIVE: To present our program for ambulatory mini percutaneous nephrolithotomy (mini-PCNL) and evaluate its initial results. MATERIAL AND METHODS: We analyzed the implementation of the protocol into the clinical practice with the first 30 outpatient mini-PCNL cases performed in our center between April 2021 and September 2022. Demographic characteristics, perioperative variables, complications and need for unplanned health care, stone-free rate (SFR), stone type and patient satisfaction with the major ambulatory surgery (MAS) process were collected. RESULTS: A total of 30 patients with a mean age of 60.2 ±â€¯11.6 years who met the inclusion criteria underwent surgery. The mean stone size was 15 mm [range: 5-20]. No intraoperative complications were recorded. All patients except one were discharged the same day of surgery as planned. In the month following discharge, the rate of complications, emergency department (ED) revisits or hospital readmissions rates were 0%. Stone-free-rate (SFR) at 3 months was 83%. Overall satisfaction with the whole perioperative process was assessed with the EVAN-G questionnaire, obtaining 124.3 points out of a maximum of 150, which is equivalent to a 78.6% level of satisfaction. CONCLUSION: Ambulatory mini-PCNL can be implemented as a treatment option in centers with experience in endourology, an established MAS Unit, and strictly selected patients. Our initial results show an adequate safety profile and high overall satisfaction perceived by patients undergoing the ambulatory approach.

[Treatment of lithiasis in horseshoe kidney with extracorporeal shock-wave lithotripsy]. / Tratamiento de la litiasis en el riñón en herradura mediante litotricia extracorpórea por ondas de choque.

UNLABELLED: The horseshoe kidney is the most frequent renal anomaly. As a consequence of impaired urinary drainage, urolithiasis is present in 20% of the cases. Indications for extracorporeal shock wave lithotripsy (ESWL) in the treatment of patients with anomalous kidneys is still the subject of controversy. OBJECTIVE: To evaluate ESWL efficacy in the treatment for lithiasis in horseshoe kidney. MATERIAL AND METHODS: Between april 1988 and december 1999 a total of 32 symptomatic lithiasis in 30 patients with horseshoe kidneys were managed by 65 sessions with ESWL. Until march 1999 a Dornier HM-4 electrohydraulic lithotripter was used. Posteriorly, two treatments was performed with an electromagnetic Dornier Lithotripter S. These procedures have been performed without anaesthesia or sedation for the Dornier HM-4 equipment. Analgesia with Meperidine was used for the Dornier Lithotripter S. Diuresis was not forced during or after treatment with diuretics or serotherapy. Treatments was conducted in an outpatient clinic in all cases. RESULTS: Treatment/lithiasis rate was 2.03. Following treatment 16 patients (54%) were stone-free by X-ray, 9 patients (30%) had residual fragments and in 5 patients (16%) no sign of stone disintegration was observed. Open surgery was performed in three of this patients. Better results was achieved in stones located in the renal pelvis and stone size is 10 mm or less. Clinical evolution: free of symptoms in 20 patients; chronic vague flank pain in 5 patients and acute renal colic with or without hematuria in 5 patients. No major complication was observed in our compilation. CONCLUSIONS: These results suggest that ESWL is the method of primary choice in the treatment for small lithiasis (10 mm or less) in horseshoe kidney.

[Incidence and treatment of urinary lithiasis in renal transplantation]. / Incidencia y tratamiento de la litiasis urinaria en el injerto renal.

INTRODUCTION: Urinary calculi is an uncommon complication in kidney transplantation; several stone risk factors are found in transplanted patients, but in most cases there is not a relationship between these risk factors and stone formation. The treatment of these patients is complex due to their both immunosuppressive status and border-line renal function. MATERIAL AND METHOD: From 1980 to February 2000, 1198 kidney transplant have been performed in our institution. We describe our series consisting in 22 urinary calculi (15 in the graft, 3 in the urether and 4 in the bladder) in 18 patients, including 7 stones detected in cadaveric donor patients. RESULTS: We performed external shock wave lithotripsy in 7 patients, bench surgery in 4, endoscopic mechanic lithotripsy in 5, open surgery in 1 and observation in 6. Calcium oxalate (mono and dihidrate) was found in 9 of 13 calculi. Metabolic changes were found in 15 of the 18 patients, the most common was hiperuricemia. There were not complications of every treatment applied and 9% of them needed a savage treatment. We found recurrence in 4 cases (22.2%). Now 12 of the patients are stone-free (66.7%) and three have non-significative stones (83.3% without symptoms). CONCLUSIONS: Detection of renal calculi in cadaveric renal donors is not a reason to refuse the graft for further transplantation. In both renal calculi up to 2 cm and uretheric calculi surgical treatment is assessed as first option. In caliceal stones smaller than 5 mm observations is the best treatment.

[Preservation by pulsatile perfusion machine: the initial experience]. / Preservación mediante maquina de perfusión pulsátil: experiencia inicial.

The increasing numbers of patients in a waiting list for a renal transplantation together with the epidemiological changes in donor's characteristics have given rise to a growing interest in preservation with pulsatile perfusion machines. The availability of objective predictive parameters of renal functioning after transplantation as well as of improving preservation to reduce the incidence of acute tubular necrosis (ATN) are the major features of this preservation technique. This paper presents our experience in preservation with pulsatile perfusion machines which have allowed us to have objective parameters to assess an organ's future functioning and to improve, as far as possible, the quality of treated kidneys preservation.

[Diverticulum of the female urethra: presentation of 3 cases]. / Divertículo de uretra femenino: presentación de tres casos.

Contribution of three cases of female urethral diverticulum diagnosed and treated in our Service. Presence in women presenting to the practice with chronic signs and symptoms of the lower urinary tract unresponsive to conventional medical management should be ruled out. A review is made of the most significant aspects in terms of clinical presentation, diagnosis and therapeutic options.

[Current treatment of lithiasis in congenital renoureteral malformations]. / Tratamiento actual de la litiasis en malformaciones congénitas renoureterales.

OBJECTIVE: To evaluate the treatment of urinary calculi in renoureteral malformations. METHODS: From April 1988 to December 2000, we have treated 158 patients with renoureteral malformations (36 horseshoe kidneys, 32 caliceal diverticula, 2 megacaliosis, 2 crossed renal ectopy, 3 polycystosis, 7 hydrocalyx, 24 complete duplex ureter, 18 incomplete duplex ureter, 22 ureterocele, 2 segmental megaureter). RESULTS: Renoureteral malformations were diagnosed in 158 of 19,000 patients that were treated in our stone unit from April 1988 and December 2000. Horseshoe kidney: 54% of the patients treated by ESWL are stone-free; PNL was performed in 2 patients and conventional surgery in another 2 patients. Caliceal diverticulum: 42% of the patients treated by ESWL are stone-free; 3 patients underwent conventional surgery. Other renal malformations: 62% of the patients treated by ESWL are stone-free. Ureteral malformations: duplex ureter and megaureter: 82% of the patients treated by ESWL are stone-free. Ureterocele: due to the poor results achieved by ESWL, we performed endoscopic transurethral meatotomy. CONCLUSIONS: These results indicate that ESWL alone can be considered to be the treatment of choice for small calculi in patients with renal malformations, although we consider it to be mandatory to perform individual assessment of the urinary tract and stone size in these patients in order to choose the best therapeutic option. The same criteria for the normal urinary tract can be applied in ureteral malformations except ureteroceles, for which we advocate performing endoscopic surgery for stone removal.