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Objetivo Identificar factores de riesgo asociados a complicaciones mayores en pacientes con pielonefritis xantogranulomatosa sometidos a nefrectomia. Metodo Analisis retrospectivo de expedientes clinicos de pacientes con pielonefritis xantogranulomatosa sometidos a nefrectomia. Se analizaron el sexo, el indice de masa corporal, el indice de comorbilidad de Charlson, la clasificacion del estado fisico de la American Society of Anesthesiologists, la etapa de Malek, el conteo leucocitario y los valores de creatinina. Las complicaciones se estratificaron en menores y mayores segun la clasificacion de Clavien-Dindo. Se realizo analisis univariado y bivariado usando las pruebas exacta de Fisher y ji al cuadrado de Pearson, y se establecieron medidas de riesgo utilizando la odds ratio (OR). Resultados Se analizaron 72 pacientes con una edad media de 50 anos, el 83% mujeres, el 58.3% con urocultivo positivo y el 66% con litiasis renal. El 32% tuvieron alguna complicacion mayor y el 15% requirieron admision a la unidad de cuidados intensivos. Los valores elevados de creatinina (OR: 3.8; intervalo de confianza del 95% [IC95%]: 1.1-13; p = 0.02) y la etapa Malek II-III (OR: 4.5; IC95%: 1.2-17.5; p = 0.02) se asociaron con complicaciones mayores. Conclusion El estadio de Malek y los valores elevados de creatinina incrementan el riesgo de desarrollar complicaciones mayores en los pacientes con pielonefritis xantogranulomatosa sometidos a nefrectomia. Objective To identify preoperative risk factors associated with major complications in patients with xanthogranulomatous pyelonephritis undergoing total nephrectomy. Method Retrospective analysis of patient’s charts with xanthogranulomatous pyelonephritis who underwent nephrectomy. Risk factors included for analysis were gender, body mass index, Charlson comorbidity index, American Society of Anesthesiologists physical status classification, Malek’s stage, leukocyte count and creatinine levels. Postoperative complications were stratified in minor and major according to Clavien-Dindo’s classification. Univariate and bivariate analysis using Fisher’s exact test, Pearson’s chi-squared and odds ratio (OR) was performed. Results 72 patients were analyzed, 83% women, mean age of 50 years, 58.3% positive urine cultures and 66% kidney stones. Major complications were present in 32% of cases, and 15% were admitted to the intensive care unit. Elevated creatinine (OR: 3.8; 95% confidence interval [95%CI]: 1.1-13; p = 0.02) and Malek’s stage II to III (OR: 4.5; 95%CI: 1.2-17.5; p = 0.02) were associated with major complications. Conclusion The Malek Stage and elevated creatinine increases the risk of major complications in patients undergoing nephrectomy due to xanthogranulomatous pyelonephritis.

espanolIntroduccion: El exito en nefrolitotomia percutanea (NLP) se define como estatus libre de litos, sin embargo, las complicaciones mayores se presentan con alta frecuencia y han sido reportadas como resultado secundario. Objetivo: Presentar una nueva definicion de exito en NLP que comprenda la tasa libre de litos sin complicaciones mayores y una escala de riesgo para predecir este desenlace. Metodo: Cohorte historica de pacientes sometidos a NLP. Las variables incluidas fueron edad, sexo, urocultivo, indice de comorbilidad de Charlson (ICC) y lito complejo. Se definio exito: sin litos, sin o con complicacion Clavien ≤ 2; exito intermedio: con litos sin o con complicacion Clavien ≤ 2; fracaso: con o sin litos con complicacion Clavien > 2. Se realizo analisis bivariado para identificar los factores asociados con el desenlace. Por regresion logistica multiple se calculo el peso independiente de cada factor. Resultados: Se incluyeron 568 procedimientos, 59 % en el sexo femenino. La mediana de edad fue de 49 anos; 65, 22 y 13 % de los casos tuvieron exito, exito intermedio y fracaso. El sexo femenino, urocultivo positivo, lito complejo e ICC severo se asociaron con fracaso. Conclusion: La probabilidad de exito fue directamente proporcional al numero de factores de riesgo. EnglishIntroduction: Success in percutaneous nephrolithotomy (PCNL) is defined as a stone-free status; however, major complications are highly common and have been reported as a secondary outcome. Objective: To propose a new definition of PCNL success that comprises a stone free rate without major complications and a risk scale to predict this outcome. Methods: Historical cohort of patients undergoing PCNL. The included variables were age, gender, urine culture, Charlson’s comorbidity index (CCI) and complex stones. Success was defined as a stone free status with or without Clavien grade ≤ 2 complication; intermediate success: with stones, with or without Clavien grade ≤ 2 complication; and failure: with or without stones with Clavien grade ≤ 2 complication. Bivariate analysis was performed to identify which factors are associated with the outcome. The independent weight of each factor was calculated by multiple logistic regression analysis. Results: 568 procedures were included, 59% of which were in females. Median age was 49 years; 65%, 22% and 13% of cases were classified as success, intermediate success and failure, respectively. Female sex, positive urine culture, complex stones and severe CCI were associated with failure. Conclusions: The likelihood of success was directly proportional to the number of risk factors.

espanolIntroduccion: La ureteroscopia flexible con litotricia laser (URSLL) es una modalidad minimamente invasiva de tratamiento quirurgico de calculos renales. La seleccion inadecuada de pacientes para este procedimiento genera un desbalance de costo-efectividad. Objetivo: Conocer los factores predictores de estado libre de litos en un solo tiempo quirurgico en pacientes sometidos a URSLL. Metodo: Cohorte retrospectiva de pacientes sometidos a URSLL. Se realizo un analisis univariado y multivariado (regresion logistica) de los predictores de estado libre de calculos en la primera URSLL, global y categorizado por sexo. Resultados: El estado libre de calculos en la primera URSLL fue de 73.62 %. Los predictores de estado libre de calculos en hombres fueron edad y tamano, densidad y multiplicidad del calculo; en las mujeres, el indice de masa corporal y la multiplicidad del calculo. Conclusiones: Los factores pronosticos de estado libre de calculos en la primera URSLL son distintos en hombres y mujeres. Las mujeres con obesidad y sobrepeso probablemente tengan calculos de facil fragmentacion y extraccion asociados con acido urico. EnglishIntroduction: Flexible ureteroscopy and laser fragmentation (FURSL) is a minimally invasive modality for surgical treatment of renal stones. Inadequate selection of patients for this treatment generates a cost-effectiveness unbalance. Objective: To know the stone-free rate predictors in a single surgical time in patients undergoing FURSL. Method: Retrospective cohort of patients undergoing FURSL. Global and gender-categorized univariate and multivariate (logistic regression) analyses were performed to identify stone-free predictors at first FURSL. Results: Stone-free rate at first FURSL was 73.62%. Predictors in males were patient age and stone size, density and multiplicity; in females, body mass index and multiplicity of stones. Conclusions: Stone-free rate predictors at first FURSL are different in males and females. Women with overweight and obesity probably have easy-to-fragment and easy-to-extract stones associated with uric acid.

The aim of this paper is to compare the efficacy of tamsulosin, oxybutynin or their combination for the treatment of symptoms related to double J stent (DJS).Randomized clinical non-blinded trial with three arms (tamsulosin, oxybutynin or combination) to assess the improvement of ureteral related symptoms with DJS with the questionnaire of Ureteral Stent Symptom Questionnaire (USSQ) and the adverse effects of treatment. Evaluations were made at 7 and 21 days after the placement of DJS. The maneuvers were compared using Chi squared test, Kruskall-Wallis, ANOVA and Wilcoxon considering a statistically significant p ≤ 0.05.170 patients with CJJ were evaluated. A perprotocol analysis was performed in 142 patients, 53 received tamsulosin (37.4%), 42 oxybutynin (29.6%) and 47 the combination of both (33%). At 7 and 21 days the improvement was similar in all three arms. Men with tamsulosin and women with oxybutynin had less general symptoms.Tamsulosin, oxybutynin or its combination similarly improve ureteral stent related symptoms and this improvement becomes more noticeable over time. Men are less symptomatic with tamsulosin and women with oxybutynin.comparar la eficacia de tamsulosina, oxibutinina o su combinación para el tratamiento de los síntomas relacionados con el uso de catéter doble J (CJJ).ensayo clínico aleatorizado, no cegado, de tres brazos (tamsulosina, oxibutinina o la combinación), para evaluar la mejoría de los síntomas asociados a CJJ con el cuestionario de síntomas asociados a catéteres ureterales (USSQ) y los efectos adversos del tratamiento. Las evaluaciones se hicieron a los 7 y 21 días de colocado el CJJ. Las maniobras se compararon mediante Chi cuadrada, Kruskall-Wallis, ANOVA y Wilcoxon, considerando estadísticamente significativa una p ≤ 0.05.se evaluaron 170 pacientes con CJJ. El análisis se realizó por protocolo con 142 pacientes, 53 recibieron tamsulosina (37.4%), 42 oxibutinina (29.6%) y 47 la combinación de ambos (33%). A los 7 y 21 días la mejoría fue similar en los tres brazos. Los hombres con tamsulosina y las mujeres con oxibutinina tuvieron menos síntomas generales.la tamsulosina, oxibutinina o su combinación mejoran de manera similar los síntomas por CJJ y esta mejoría se hace más notoria a través del tiempo. Los hombres están menos sintomáticos con tamsulosina y las mujeres con oxibutinina.

Emphysematous pyelonephritis (EPN) is a severe infection of the urinary tract, caused by gas accumulation within the collecting system, the renal parenchyma, and/or the perirenal tissue. The cause of this infection is not known at all; however, it has been suggested that it is produced by the glucose fermentation provoked by enterobacteriaceae or anaerobic organisms. Our objective was to evaluate the predictors of morbidity and mortality in patients diagnosed with EPN.It was carried out a historical cohort study of patients diagnosed with EPN in our hospital from March 2005 to December 2014. Patients with adverse outcome were identified. We defined adverse outcome as patients requiring stay in intensive care unit, who presented nephrectomy and/or who died. A multiple regression analysis was conducted to establish the relation of each clinical factor with the adverse outcome.73 records were included for analysis, 48 were women (65.8 %) and 25 men. Diabetes, urolithiasis, E. coli infection and septic shock occurred in 68.5, 68.5, 63, and 15.1 %, respectively. We found that leukocytosis ≥12 000 µl (OR 43.65, 95 % CI 2.36-805, p0.001), thrombocytopenia ≤120 000 µl (OR 363, 95 % 9.2-14208, p0.0001), and Huang's radiological class 3 (OR 62, 95 % CI 4-964, p0.001) were factors significantly associated with adverse outcome.Thrombocytopenia, leukocytosis and Huang's radiological class 3 are associated with adverse outcome in patients with EPN.Introducción: La pielonefritis enfisematosa es una infección grave del tracto urinario caracterizada por la presencia de gas en los sistemas colectores, en el parénquima renal o en el tejido perirrenal; su causa no es del todo conocida, pero se ha sugerido que se debe a la fermentación de glucosa por enterobacterias y anaerobios. El objetivo fue evaluar los factores pronósticos de morbimortalidad en pacientes con diagnóstico de pielonefritis enfisematosa. Métodos: estudio de cohorte histórica en pacientes con diagnóstico de pielonefritis enfisematosa que ingresaron a nuestro hospital de marzo de 2005 a diciembre de 2014. Se identificaron los pacientes con desenlace adverso definido como aquel que requirió estancia en unidad de cuidados intensivos, nefrectomía o muerte. Se realizó una regresión logística múltiple para obtener la relación de cada factor pronóstico con el desenlace adverso. Resultados: Fueron evaluados 73 pacientes (48 mujeres [65.8 %]). Diabetes, litiasis urinaria, infección por Escherichia coli y el estado de choque se presentaron en 68.5 %, 68.5 %, 63 % y 15.1 %, respectivamente. Fueron factores significativos para desenlace adverso la leucocitosis ≥ 12 000 μL (RM 43.65, IC 95 % 2.36-805, p0.001), la trombocitopenia ≤ 120 000 μL (RM 363, IC 95 % 9.2-14208, p0.0001), y la clase radiológica 3 de Huang (RM 62, IC 95 % 4-964, p0.001). Conclusión: la trombocitopenia, la leucocitosis y la clase radiológica 3 se asociaron con un desenlace adverso en los pacientes con pielonefritis enfisematosa.

Percutaneous nephrolithotomy remains the standard of care for kidney stones larger than 2cm. Therefore, setting a prognosis for complete stone resolution through this method is essential. The prognostic tools available have limited prediction.To evaluate the stone-free rate in patients undergoing percutaneous nephrolithotomy with the Clinical Research Office of the Endourological Society nomogram and suggest modifications to improve the classification.We analyzed a retrospective cohort of patients undergoing percutaneous nephrolithotomy applying the nephrolithometric nomogram specified. We modified the scale dividing the patients into 3groups: i from 80 to 110 points, II from 111 to 170 points, and III more than 170 points, respectively assessing the stone-free rate (Kruskall-Wallis test was performed, p0.05).A total of 126 patients were included. According to the nehrolithometric nomogram the stone-free rate was 12.5% for patients with fewer than 111 points and 70.9% for those with 111 points or more. In the modification proposed for groups I, IIand III the stone-free rate was 12.5%, 50% and 80% respectively (p=0.000).Evaluation using the nephrolithometric nomogram demonstrated accurate stone-free rate prediction for complex and simple stones, with a lack of discrimination for patients with intermediate scores. Our modification enabled better differentiation of the intermediate groups from the high and low stone-free rate groups.

To determine the preoperative and perioperative predictive factors of morbidity/mortality in patients undergoing percutaneous nephrolithotomy (PCNL), using the Clavien's classification.We performed a retrospective chart review of patients who underwent PCNL between January 2005 and January 2012. Preoperative and postoperative factors, such as age, obesity, surgical risk, Charlson comorbidity index, stone complexity, access calix, type of dilator used, and surgery time, were evaluated as predictors of complications.A total of 354 patients were included in the study. Of these, 56% were women, with the average age of 47±12.5 years. Stone-free rate for noncomplex calculi was 85% and for complex calculi it was 68%. A total of 103 complications were recorded (29.3%). According to the modified Clavien classification system, 32 (9%) were grade 1, 39 (11%) were grade 2, 16 (4.5%) were grade 3A, 8 (2.3%) were grade 3B, 3 (0.8%) were grade 4A, 1 (0.3%) was grade 4B, and 4 (1.1%) were grade 5. In multivariate analysis female gender (odds ratio [OR] 3.1, confidence interval [CI] 1.1-8.0), Charlson score of ≥3 (OR 23.2, CI 3.5-151.1), complex stone (OR 4, CI 1.6-9.6), and duration of surgery of ≥120 minutes (OR 2.9, CI 1.2-6.9) were associated with major complications.PCNL is a safe procedure with acceptable efficacy for the resolution of renal calculi. The safety of the procedure should improve, especially to reduce the presence of severe complications (Clavien ≥3). We identified factors that are associated with severe complications: female gender, high Charlson, complex calculi, and surgical length ≥120 minutes.

To present a case report of crossed fused renal ectopia treated with percutaneous nephrolithotomy at our hospital and to perform a literature review.We present the case of a male with renal calculi in a crossed ectopic and fused kidney, treated satisfactorily with percutaneous nephrolithotomy in a one-stage surgery through an upper pole accessPercutaneous nephrolithotomy is a minimally invasive procedure with good results and low morbidity in this kind of patients. It is technically demanding and requires surgeon's ability and experience.

The aim of this study was to describe the technique of subtrigonal sling with abdominal fascia and demonstrate its usefulness in resolving complex stress urinary incontinence (SUI).We performed a cohort, longitudinal, observational study in adult females who attended the Urodynamics Department of the Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, with recurrent SUI or with risk factors for recurrence, whether or not associated with urge urinary incontinence (UUI).Between 1995 and 2006, 40 patients were included. Mean follow-up was 41.95 months (9-106), and the average patient age was 55 years. In 35 patients (87.5%) SUI was resolved, in two patients (5%) it improved, and in three patients (7.5%) it persisted. Of the 40 study patients, 18 had UUI and in only 7/18 patients (39%) was it resolved postoperatively. UUI de novo was noted in 12/40 patients (30%). One patient presented crural hernia, two patients presented postincisional hernia and two patients required blood transfusion. No patient presented acute urinary retention or urinary voiding problems postoperatively.Results obtained by this surgical technique are effective and long-lasting in patients with complex SUI. We did not observe bladder emptying dysfunction but there were formations of abdominal wall hernias. The minimally invasive approach consisting of the subtrigonal placement of synthetic tapes may maintain efficacy with minimal morbidity.

Prostatic cysts are rare lesions with a reported incidence from 1 to 7.9%. They have been associated with primary infertility. The main characteristic is the benign course and positive prognosis after correct surgical management.We present three clinical cases, two with primary infertility and another with a history of primary infertility who presented with recurrent hemospermia and refractory medical treatment. All patients had hypospermia and alteration of the seminal parameters represented by moderate oligospermia (MOS), asteno- and teratozoospermia, in addition to hemospermia in two patients. Diagnosis was confirmed by transrectal ultrasound. Transurethral resection (TUR) of the cyst was performed in two cases and resection of the veru montanum in one, obtaining improvement in the seminal parameters after 1 month of follow-up and acceptable parameters for spontaneous conception at 6 months.Infertility associated with partially obstructed ejaculatory ducts may be suspected clinically by hypospermia. Transrectal ultrasound is essential to confirm the diagnosis. TUR of this lesion reestablishes the free passage of semen in almost all patients, with potential recovery of fertility 6 months after treatment.

To determine predisposing factors in perinephric abscesses and to find events associated with unfavourable outcome.We carried out a clinical, descriptive, retrospective and cross-sectional study, including 23 patients diagnosed of perinephric abscess admitted to our hospital.In patients with perinephric abscess, clinical charts included diabetes mellitus in 65.2%, history of nephrolithiasis in 43.47% and history of urological surgery in 17.38%. On hospital admission, haemoglobin greater than 10.5 g/dL and white blood cell count lower than 15 x 10(3) / microL were associated with nephrectomy, and platelet count lower than 140 x 10(3) / microL with septic shock. General mortality was 8.69%, and 78.3% if patient required nephrectomy. Patients who died had fever, anaemia, white blood cell count greater than 16 x 10(3) / microL, platelet count lower than 130 x 10(3) / microL, and hyponatremia of 125 mEq/L or lower at hospital admittance, and all of them had septic shock and required nephrectomy.In our series, a higher percentage of patients had diabetes mellitus and/or nephrolithiasis. Haemoglobin level and white blood cells count were associated with loss of the renal unit, thrombocytopenia was associated with septic shock and hyponatremia with mortality.

To evaluate and review the Fournier's gangrene clinical presentation, initial APACHE II score and integral treatment of patients affected in HECMNSXXI.Retrospective, descriptive and cross-sectional study in 40 patients with Fournier's gangrene diagnosis, accepted for treatment in HECMNSXXI who gather inclusion criteria, from February 1996 to February 2006.Patients were between 21 and 93 yr old. In total 39 men and 1 woman were recruited. The most common etiologic factor was urethral stricture in 40% of patients. Escherichia coli was detected in 42.5% of the cultures, and represented the most common pathogen. Initial Apache II score was more commonly between 10 and 14 points (35%). 6 patients died (15%) all of them with and Apache II score above 25 points. 55% of patients were affected by diabetes mellitus. All patients with Fournier's Gangrene received a triple antibiotic schema from admittance day, associated with emergency surgical dèbridement in the whole group.Aggressive and multidisciplinary treatment is mandatory in all the patients affected by Fournier's gangrene. We recommend utilisation of the APACHE II score as very useful tool to determine the prognosis.

Horseshoe kidney has a frequency of 1 in 1000 renal paiss. Diseases in this type of kidneys have anatomical particularities that should be taken into account during surgery. We present the case of a renal cell carcinoma in this type of renal fusion.