Search

Objective: Compare the different definitions for bladder outlet obstruction (BOO) in women with dysfunctional voiding (DV) and find which one is most specific and sensitive to achieve a more accurate diagnosis. Materials and methods: a cross-sectional study of urodynamic investigation studies from women diagnosed with DV in a period from 2017-2020 were classified with obstruction or not, based on 6 urodynamic definitions. The control group were women who had been categorized with obstruction in at least 3 definitions of BOO. Likelihood positive ratio, sensitivity and specificity were calculated. Statistical analysis was carried out by IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, N.Y., USA). A p 100. The comparison between our the control group and every definition of BOO has shown statistically significant difference. Conclusions: The diagnosis of BOO requires expertise and individualization, it is made through physical examination and complete urodynamic study, Solomon-Greenwell has shown to be specific and sensitive for diagnosis in the group of study.

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.

Objective We propose a modification of the original Guy's Stone Score (GSS) to hold on 20 % of prognostic discrimination among groups which makes this score a more reliable resource for risk assessment in patients undergoing percutaneous nephrolithotomy (PCNL). Material and methods Historical cohort of 126 patients undergoing PCNL from December 2010 to November 2014 was included in the survey. Every patient was classified according to the original GSS. For the new classification of Guy Stone Score (GSS-M) all of the subgroups included in the scale were analyzed individually and then ranked from better to worst according to the postoperative stone- free rates (SFRs). This ranking led us to reclassify all the original subgroups, clustering them in three new categories according to their SFRs as subgroups of good, intermediate and poor prognosis, trying to achieve at least 20% of prognostic discrimination among the groups. Results Hundred and twenty-six PCNL procedures were evaluated, but only 124 were included for statistical analysis and classified based on SFR according to the GSS as follows: 76% for grade 1, 71% for grade 2, 55% for grade 3 and 20% for grade 4. The SFRs were also assessed for the GSS-M obtaining the following predictive values as 93%, 67% and 44% for the good, intermediate and poor prognostic groups, respectively. The prognostic difference among the GSS-M groups was always >20% (p

Background Percutaneous nephrolithotomy remains the standard of care for kidney stones larger than 2 cm. Therefore, setting a prognosis for complete stone resolution through this method is essential. The prognostic tools available have limited prediction. Objectives 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. Material and methods We analyzed a retrospective cohort of patients undergoing percutaneous nephrolithotomy applying the nephrolithometric nomogram specified. We modified the scale dividing the patients into 3 groups: I from 80 to 110 points, II from 111 to 170 points, and III more than 170 points, respectively assessing the stone-free rate (Kruskal–Wallis test was performed, p Results 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, II and III the stone-free rate was 12.5%, 50% and 80% respectively (p = 0.000). Conclusions 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.

Resumen Antecedentes La nefrolitotomia percutanea es la cirugia de eleccion para litos mayores de 2 cm. El establecer un pronostico para la resolucion de la litiasis por este metodo es crucial. Las herramientas pronosticas propuestas hasta el momento presentan limitaciones predictivas. Objetivo Evaluar la tasa libre de litos por nomograma nefrolitometrico de la Clinical Research Office de la Endourological Society en pacientes tratados con nefrolitotomia percutanea y proponer modificaciones para mejorar la clasificacion. Material y metodos Evaluamos una cohorte retrospectiva de pacientes intervenidos mediante cirugia percutanea aplicando el nomograma nefrolitometrico especificado. Realizamos una modificacion para mejorar su prediccion dividiendo a los pacientes en 3 grupos: i de 80 a 110 puntos, ii de 111 a 170 puntos y iii de mas de 170 puntos, con el calculo respectivo de tasa libre de litos (se realizo la prueba de Kruskall-Wallis p Resultados Se incluyeron 126 pacientes. Por nomograma nefrolitometrico, la tasa libre de litos fue de 12.5% para pacientes con menos de 111 puntos y de 70.9% con 111 puntos o mas. En la modificacion propuesta para los grupos i, ii y iii la tasa libre de litos fue 12.5, 50 y 80%, respectivamente (p = 0.000). Conclusiones La evaluacion con nomograma nefrolitometrico demostro prediccion de la tasa libre de litos para litos complejos y simples, sin poder discriminar los pacientes con puntuaciones intermedias. Nuestra propuesta permite diferenciar mejor al grupo intermedio de los grupos de alta y baja tasa libre de litos.

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.

Background Training devices for percutaneous renal access are expensive, have hazardous biological materials, or radiation. Two devices were designed that eliminate some or all of these characteristics (ManiPERC and iPERC). Objective To compare the improvement in access time to the posterior lower calix with 2 inanimate models in a group of urology residents. Material and methods Quasi-experimental clinical trial with 16 urology residents to compare the improvement over time of percutaneous renal access by training in 2 inanimate models (iPERC: simulated fluoroscopy and ManiPERC: real fluoroscopy). Results Subjects were assigned to one of 2 groups (iPERC and ManiPERC) and a video analysis of all of them was performed before and after 20 training sessions. Both groups improved their access time; with iPERC from 133.88 ± 41.40 to 76 ± 12.62 s ( p = 0.006) and from 176.5 ± 85.81 to 68.75–18.40 s ( p = 0.007) with ManiPERC. Comparing iPERC versus ManiPERC there was no difference between them in improving access time (ANCOVA: Model F (1.13) = 1.598, p = 0.228). Conclusions Both models are equivalent in improving skills; however, even though none of them generated bio-waste, the absence of radioactive emissions makes iPERC the more advantageous model.

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.

Training devices for percutaneous renal access are expensive, have hazardous biological materials, or radiation. Two devices were designed that eliminate some or all of these characteristics (ManiPERC and iPERC).To compare the improvement in access time to the posterior lower calix with 2 inanimate models in a group of Urology residents.Quasi-experimental clinical trial with 16 Urology residents to compare the improvement over time of percutaneous renal access by training in 2 inanimate models (iPERC: simulated fluoroscopy and ManiPERC: real fluoroscopy).Subjects were assigned to one of 2 groups (iPERC and ManiPERC) and a video analysis of all of them was performed before and after 20 training sessions. Both groups improved their access time; with iPERC from 133.88±41.40 to 76±12.62s (p=0.006) and from 176.5±85.81 to 68.75 to 18.40s (p=0.007) with ManiPERC. Comparing iPERC versus ManiPERC there was no difference between them in improving access time (ANCOVA: Model F (1.13)=1.598, p=0.228).Both models are equivalent in improving skills; however, even though none of them generated bio-waste, the absence of radioactive emissions makes iPERC the more advantageous model.

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.

Resumen Presentamos un caso clinico de prostatitis incrustante, termino que no se encuentra en la busqueda hecha en MedLine. La cistitis alcalina incrustante se describio hace 70 anos y son pocos los casos descritos desde entonces, la mayoria de ellos asociados a infeccion por Corynebacterium1. De hecho, consideramos que estas dos entidades son muy similares, excepto en lo que se refiere al organo afectado. Ambas presentan sintomas urinarios causantes de irritacion, orina alcalina y necrosis tisular por debajo de una capa de calcificacion. Otra entidad descrita en 1993 es la pielitis incrustante, relacionada con pacientes con inmunodeficiencia, especialmente los receptores de trasplante renal y tambien asociada a bacterias ureoliticas. El tratamiento de la cistitis y la pielitis incrustantes puede incluir antibioticos especificos, acidificacion urinaria y escision endoscopica de las lesiones calcificadas. Abstract We report a case of encrusted prostatitis, term which is not found in MedLine search. Alkaline encrusted cystitis was described 70 years ago and few cases have been described since that time, most of them associated with Corynebacterium infection1 In fact, we find these two entities very similar, except for the organ affected. Both present irritative urinary symptoms, alkaline urine and tisular necrosis below a calcification layer. Another entity described in 1993 is encrusted pyelitis, related to patients with immunodeficiency, particularly those with renal transplantation and also associated with ureolytic bacteria. The treatment of encrusted cystitis an pyelitis may include specific antibiotics, urinary acidification and endoscopic excision of the calcified lesions

This report describes a partial nephrectomy with a minimally invasive approach, carried out laparoscopically as a treatment for a hydrocalicosis caused by a congenital infundibular stenosis.The patient presented a clinical background of one year of evolution, manifested as recurrent urinary tract infections caused by urine accumulation in the adjacent collecting tubules which were compressed by the superior hydrocalicosis. This procedure was made using a transperitoneal access, making a superior pole resection of the right kidney and respecting the adrenal gland.In our opinion, to widen the usage of the laparoscopic surgery in urology can benefit patients to reduce post-surgery complications and hospitalization time, with a more comfortable recovery.

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.

Introducción: se describe el caso de un paciente con nefrectomía parcial tratado por vía laparoscópica por hidrocalicosis originada por estenosis infundibular congénita. Caso clínico: paciente con cuadro clínico de un año de evolución, con infecciones recurrentes de las vías urinarias originadas por acumulación de orina en los colectores adyacentes, comprimidos por la hidrocalicosis superior. El procedimiento se efectuó por acceso transperitoneal mediante la resección del polo superior del riñón derecho y sin afectar la glándula suprarrenal. Conclusiones: la cirugía laparoscópica como medio terapéutico de afecciones urológicas beneficia a los pacientes porque se reducen las complicaciones postoperatorias y el tiempo de hospitalización, con una recuperación más cómoda.

Retrocaval ureter is a rare congenital anomaly with an incidence of approx. 1/1000 live births. Recently, the laparoscopic approach has become the gold standard for treatment, relegating open surgery as a second option.We present the case of a 27-year-old male with a 2-year history of colicky pain in the right flank radiating to the ipsilateral thigh and genital region. The patient was initially treated with a right double-pigtail catheter stent due to obstructive uropathy as evidenced by ultrasound. He underwent laparoscopic ureteral anteposition with a successful outcome and has remained asymptomatic during a 12-month follow-up.Retrocaval ureter is a rare entity that requires a high grade of suspicion for initial diagnosis to provide adequate and opportune treatment that will have repercussions on kidney function and quality of life for the patient. Open surgery has traditionally been the treatment of choice; however, in recent decades laparoscopic surgery has been practiced more during this era of minimally invasive therapy, without yet displacing open surgery in our country.

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.

Objetivo: Describir la técnica de cabestrillo subtrigonal con fascia abdominal y demostrar su utilidad en la resolución de la incontinencia urinaria de esfuerzo compleja. Material y métodos: Estudio de cohorte longitudinal y observacional en mujeres adultas que acudieron al Servicio de Urodinamia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, para tratamiento de incontinencia urinaria de esfuerzo recidivante o con factores de riesgo para recidiva, asociada o no a incontinencia urinaria de urgencia. Resultados: Entre 1995 y 2006 incluimos 40 pacientes; el seguimiento fue de 41.95 meses (rango 9 a 106) y el promedio de edad de 55 años. En 35 pacientes (87.5 %) fue resuelta la incontinencia urinaria de esfuerzo, dos pacientes mejoraron (5 %) y tres persistieron (7.5 %) con la incontinencia. De las 40 pacientes, 18 presentaban incontinencia urinaria de urgencia y solo en siete de éstas (39 %) se resolvió después de la cirugía. La incontinencia urinaria de urgencia de novo se presentó en 12 (30 %). Una tuvo hernia crural, dos hernia posincisional y dos requirieron transfusión sanguínea. Ninguna evidenció problemas de vaciamiento urinario posterior a la cirugía. Conclusiones: Los resultados con la técnica descrita son eficaces y duraderos en pacientes con incontinencia urinaria de esfuerzo recidivante o factores de riesgo para recidiva. No se observó disfunción de vaciamiento vesical, sin embargo, hubo hernias abdominales. El abordaje de mínima invasión para colocar las cintas sintéticas en posición subtrigonal podría mantener la eficacia con mínima morbilidad.

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.

Introducción: Los quistes de próstata constituyen una patología rara, con una incidencia publicada de 1 a 7.9 %; se han asociado a infertilidad primaria, teniendo como principal característica un curso benigno y un buen pronóstico con el tratamiento quirúrgico adecuado. Casos clínicos: Dos pacientes con infertilidad primaria y uno con antecedente de infertilidad primaria que se presentó con hematospermia recurrente y refractaria a tratamiento médico; los tres tuvieron hipospermia decreciente y alteración de los parámetros seminales representados por oligospermia moderada, asteno y teratozoospermia. El diagnóstico fue confirmado con ultrasonido transrectal y se realizó resección transuretral del quiste de los conductos eyaculadores en dos casos, y en otro más resección transuretral de veru montanum, obteniendo mejoría en los parámetros seminales al mes de seguimiento y parámetros adecuados para la concepción espontánea a los seis meses en los tres pacientes. Conclusiones: La infertilidad asociada a los quistes de conductos eyaculadores parcialmente obstructivos puede ser sospechada clínicamente por hipospermia decreciente; es esencial la realización de ultrasonido transrectal para confirmar el diagnóstico. La resección transuretral de esta lesión reestablece el libre paso del semen en casi todos los pacientes, pudiendo recuperar el potencial de fertilidad seis meses después del tratamiento.

OBJETIVO: Determinar los factores predisponentes para la formacion de abscesos perirrenales y encontrar eventos asociados a una evolucion desfavorable. METODOS: Realizamos un estudio clinico, descriptivo, retrospectivo y transversal que incluyo 23 pacientes con diagnostico de absceso perirrenal ingresados en nuestro hospital. RESULTADOS: Las entidades clinicas asociadas con el absceso perirrenal fueron: Diabetes mellitus en 65.2%, antecedente de litiasis renal en 43.47% y el antecedente de cirugia urologica en 17.38%. Al ingreso, la hemoglobina mayor a 10.5 g/dL y leucocitos menores a 15 x 103 / �EL se asociaron con mayor frecuencia a nefrectomia y las plaquetas menores a 140 x 103 / �EL se asociaron a choque septico. La mortalidad general fue de 8.69% y 78.3% requirieron nefrectomia. Los pacientes que murieron presentaron al ingreso fiebre, anemia, leucocitosis mayor a 16 x 103 / �EL, plaquetas menores a 130 x 103 / �EL, sodio serico menor a 125 mEq/L, requirieron nefrectomia y presentaron choque septico. CONCLUSIONES: En nuestra serie un buen porcentaje de pacientes con absceso perirrenal son portadores de diabetes mellitus y/o litiasis renal. El nivel de hemoglobina y de leucocitos se asocio con la perdida de la unidad renal, la trombocitopenia se asocio a choque septico y la hiponatremia con la mortalidad

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.

OBJETIVOS Evaluar la presentacion clinica de la gangrena de Fournier, la escala de APACHE II al ingreso de los pacientes y el manejo integral en el HE CMN SXXI. METODOS Estudios retrospectivo, transversal, descriptivo en 40 pacientes con diagnostico de gangrena de Fournier ingresados en el Hospital de Especialidades del CMN SXXI que reunieron los criterios de inclusion, entre febrero de 1996 a febrero del 2006. RESULTADOS El rango de edad oscilo entre 21 y 93 anos, siendo 39 pacientes del sexo masculino y una del sexo femenino. La etiologia mas comun encontrada de los pacientes estudiados fue estenosis de uretra 40%. El germen patogeno que se desarrollo en los cultivos fue principalmente Escherichia coli (42.5%). La calificacion de acuerdo a la escala de Apache II al ingreso fue predominantemente de 10-14 puntos (35%). La mortalidad fue de 15% que corresponde a 6 pacientes, todos con escala de Apache II mayor a 25 puntos. El factor mas importante asociado a la morbilidad fue diabetes mellitus (55%). Todos los pacientes recibieron terapia con antibioticos triple esquema desde su ingreso al servicio, asociado al manejo quirurgico de urgencia en el 100%. CONCLUSIONES El tratamiento agresivo y multidisciplinario es obligatorio en los pacientes con diagnostico de gangrena de Fournier. Se recomienda la utilizacion de la clasificacion de Apache II ya que es una herramienta util para determinar el pronostico.

To report one case of VURD syndrome (posterior urethral valves, vesicoureteral reflux, and renal dysplasia) in an adult.32-year-old male patient with recurrent urinary tract infections and the diagnosis of VURD syndrome after imaging tests ond cystoscopy.One year after valve resection the patient keeps renal function and adequate voiding without needing dialysis.The VURD syndrome is a congenital disease, frequently with poor prognosis in the first years of life. Etiology is not clear. A cause-effect relationship between dysplasia and obstruction-reflux has been proposed; alternotively, the "theory of the bud" suggests vesicoureteral reflux and renal dysplasia are the result of an anomaly of the ureteral bud and not necessarily of obstruction and/or VURD per se.

Objetivo: Presentar un caso de síndrome VURD (Valvas de uretra posterior, reflujo vesicoureteral y displasia renal), en el adulto. Métodos: Varón de 32 años con infección de vías urinarias de repetición, con estudios de gabinete y cistoscopia al cual se le diagnostica síndrome VURD. Resultados: Se resecan las valvas, al año de cirugía el paciente mantiene su función renal y adecuada micción sin necesidad de tratamiento dialítico. Conclusiones: El síndrome de VURD es un padecimiento congénito, que frecuentemente tiene un desenlace fatal en los primeros años de vida. La etiología no esta bien clara. Se ha planteado la relación causa efecto de displasia en relación a la obstrucción y reflujo; por otra parte, existe la "teoría de la yema", la cual sugiere que el reflujo vesicoureteral (RVU) y la displasia renal son el resultado de una anormalidad en la yema ureteral y no necesariamente a la obstrucción y/o RVU per se.

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.

Adrenal cysts are rare entities, and hemorrhagic pseudocysts are even less frequent. Generally, they are unsuspected during first patient evaluation and can suggest acute abdomen. We present the case of a hemorrhagic pseudocyst with sudden onset of abdominal pain and features compatible with acute appendicitis.

ResumenAntecedentesLos dispositivos de entrenamiento en punción percutánea renal son costosos, usan residuos biológicos infecciosos o emiten radiación. Diseñamos 2 dispositivos que eliminan algunas o todas estas características (ManiPERC e iPERC).ObjetivoComparar la mejoría en el tiempo de acceso al colector posterior e inferior al practicar en los dispositivos.Material y métodosEnsayo clínico cuasiexperimental con 16 residentes de urología. Se asignaron los sujetos a uno de dos modelos de dispositivo de entrenamiento para realizar 20 sesiones de punción y se analizaron los videos del entrenamiento antes y después de 20 sesiones.ResultadosAmbos grupos mejoraron su tiempo de acceso; con iPERC pasó de 133.88±41.40 a 76±12.62s (p=0.006), y con ManiPERC, de 176.5±85.81 a 68.75±18.40s (p=0.007). Al comparar iPERC versus ManiPERC, no hay diferencia entre ellos en la mejoría del tiempo de acceso (ANCOVA: F Modelo (1.13)=1.598, p = 0.228).ConclusionesAmbos modelos son equivalentes en la mejoría de las destrezas; sin embargo, aun cuando ninguno de ellos genera residuos biológicos, la ausencia de emisiones radiactivas hace del iPERC el modelo con mayor ventaja.AbstractBackgroundTraining devices for percutaneous renal access are expensive, have hazardous biological materials, or radiation. Two devices were designed that eliminate some or all of these characteristics (ManiPERC and iPERC).ObjectiveTo compare the improvement in access time to the posterior lower calix with 2 inanimate models in a group of Urology residents.Material and methodsQuasi-experimental clinical trial with 16 Urology residents to compare the improvement over time of percutaneous renal access by training in 2 inanimate models (iPERC: simulated fluoroscopy and ManiPERC: real fluoroscopy).ResultsSubjects were assigned to one of 2 groups (iPERC and ManiPERC) and a video analysis of all of them was performed before and after 20 training sessions. Both groups improved their access time; with iPERC from 133.88±41.40 to 76±12.62s (p=0.006) and from 176.5±85.81 to 68.75 to 18.40s (p=0.007) with ManiPERC. Comparing iPERC versus ManiPERC there was no difference between them in improving access time (ANCOVA: Model F (1.13)=1.598, p=0.228).ConclusionsBoth models are equivalent in improving skills; however, even though none of them generated bio-waste, the absence of radioactive emissions makes iPERC the more advantageous model.