Revista mexicana de urologia最新文献

Background

Percutaneous nephrolithotomy (PNL) is a procedure with precise indications. An evaluation method for predicting the stone-free rate after PNL is needed. The Guy's stone score and the S.T.O.N.E. score are based on stone number and size, kidney anatomy, tract length, obstruction, the calyces involved, and Hounsfield units.

Aim

To evaluate the Guy's stone score and the S.T.O.N.E. score as stone-free rate predictors in percutaneous nephrolithotomy.

Material and Methods

A retrospective study of patients managed with PNL within the time frame of January 2013 to June 2015 was conducted. The Guy's stone score and the S.T.O.N.E. score were evaluated as stone-free rate predictors. Statistical analysis was done using the chi-square test (SPSS).

Results

Twenty-two patients were included, 10 women (45%) and 12 men (55%), and their mean age was 44 years. The stone-free rate was 63%. The Guy's stone score was correlated with a stone-free rate (P=.04), whereas the S.T.O.N.E. score had no relation (P=.7). The absence of ectasia was correlated with a higher stone-free rate (42%). Eighty-five percent of the patients without nephrostomy at the time of surgery resulted stone-free. Mechanical energy was the most widely utilized form of energy for lithotomy, being used in 45% of the patients. One renal pelvis perforation and bleeding were the complications that prevented the procedure from being finished, but transfusion was not required.

Conclusions

Correlation was found with the Guy's stone score, but there was no statistically significant difference in the S.T.O.N.E. score. The Guy's stone score had statistical value, but a greater number of patients are needed to increase the correlation of the 2 scores in our hospital.

We present herein the ultrasonographic follow-up of renal ectasia in a male twin fetus.

Clinical case

A 29-year-old woman with a history of 3 pregnancies, one normal delivery, and one cesarean section, had first trimester ultrasound screening at the Center for Opportune Screening of the Instituto de Salud Pública del Estado de Guanajuato (ISAPEG) that revealed a dichorionic diamniotic twin pregnancy with negative screening test results.

At 20.1 weeks of gestation, a structural ultrasound detected left renal ectasia in one of the twins. The 2010 Antenatal Hydronephrosis Grading Classification of the Society of Fetal Urology was used to measure and classify the ectasia of the left renal pelvis.

The ultrasonographic follow-up of the left renal pelvis in the twin detected with hydronephrosis according to the abovementioned classification was: at 20.1 weeks of gestation the anteroposterior diameter of the left renal pelvis was 4.5 mm; at 24 weeks of gestation it was 5.3 mm; at 28 weeks of gestation it was 8.1 mm; and at 30.5 weeks of gestation it was 11.2 mm. When re-evaluated by the Fetal and Pediatric Pathology Department, the diagnosis was grade 3 hydronephrosis.

Prenatal screening in Mexico is advancing with innovative technology and the urologist must become familiar with prenatal diagnoses to be prepared to meet this new challenge.

The possible participation of interneurons in the mechanisms of action of neuromodulation through posterior tibial nerve stimulation for the treatment of overactive bladder syndrome is reviewed. A brief review of the neurophysiology of the lower urinary tract, overactive bladder syndrome, the different neuromodulation techniques for the lower urinary tract, and the participation of the interneurons in the storage-voiding cycle of the bladder are included. We conclude that the antidromic action potential generated by the electrical stimulation for neuromodulation, specifically posterior tibial nerve stimulation, has an inhibitory effect on the detrusor muscle through the spinal interneurons and that the medullary changes (in gene expression and neuropeptides, among others) can prolong its effect. A synergistic inhibition is the result of supraspinal plastic changes, also occurring via the interneurons. Central nervous system plasticity could explain the chronic effect of posterior tibial nerve stimulation and other electrical neurostimulation techniques for the treatment of overactive bladder.

High blood pressure is one of the most frequent pathologies in the general population and is estimated to affect approximately 26% of the world population. Hypertensive patients have greater morbidity and mortality due to stroke, acute coronary syndromes, and heart failure. The excessive production of aldosterone caused by primary aldosteronism is one form of high blood pressure that can be cured. Laparoscopic adrenalectomy is the criterion standard for the approach to the adrenal gland, reducing the morbidity and mortality of that procedure. High blood pressure is reported to reach normal figures at an average of 6 months in 30-90% of the patients. Presented herein is the case of a female patient with primary aldosteronism. Diagnosis was made by determining renin and aldosterone levels and through tomography studies with and without contrast. A hyper-secreting adenoma was found and laparoscopic adrenalectomy was performed. Interdisciplinary management is recommended for ruling out multiple pathologies that condition high blood pressure of adrenal gland origin. Such management leads to efficacious medical treatment and laparoscopic adrenalectomy can then be performed.

UroLume^®, or urethral endoprosthesis, was conceived as an easy placement device for patients with recurrent bulbar urethral stricture. With the passage of time, it was shown to cause more complications than benefits and its use was discontinued. However, it created a group of patients with complex urethral stricture that required multiple surgical treatments with unsatisfactory results. The widespread use at the end of the 1990s of buccal mucosa grafts for the treatment of urethral stricture began a new stage in the search for a definitive treatment for this type of patient.

The aim of our article was to present a surgical technique for the treatment of UroLume^®-associated bulbar urethral stricture that has not been described in the literature.

A 71-year-old man presented with bulbar urethral stricture secondary to transurethral resection of the prostate who, 8 years ago, had UroLume® placement. He presented with another urethral stricture and was treated with numerous urethral dilations. Through the perineal approach, the endoprosthesis was completely removed, and based on the local tissue characteristics, a dorsal inlay and ventral onlay double buccal mucosa graft was placed with successful results at the 6th month of follow-up.

Pelvic organ prolapse is a frequent entity and is the cause of high morbidity in the female population. The criterion standard for resolving apical prolapse is sacrocolpopexy, which is usually performed through laparotomy. However, the laparoscopic approach is now being carried out with greater frequency because it is a treatment alternative with the benefits of minimally invasive surgery and no higher incidence of complications has been reported.

Aims

To review a case series of laparoscopic sacrocolpopexy with the following variables: surgery duration, blood loss, conversion, hospital stay, and 6-month follow-up.

Materials and methods

The study was retrospective, observational, and analytic. Fourteen cases of sacrocolpopexy were reviewed and divided into 2 groups. One case was excluded due to endometrial malignancy. The continuous variables were expressed as mean and standard deviation (SD) or median and interquartile range.

Results

The sacrocolpopexy group was made up of 6 patients with a mean age of 62.2 years (SD = 4.7), mean surgery duration of 171 min (SD = 43.4), and mean blood loss of 90 cc (SD = 50.9). Two patients presented with complications.

The hysterectomy plus sacrocolpopexy group had 7 patients with a mean age of 54.4 years (SD = 4.4), mean surgery duration of 198 min (SD = 26.9), and median blood loss of 125 cc (interquartile range 62.5-337). No complications or conversions to laparotomy were registered.

Conclusions

Laparoscopic sacrocolpopexy is a safe and accessible procedure in our environment that offers the benefits of minimally invasive surgery.

Introduction

Urothelial tumors are the fourth most common malignant neoplasia. Ninety to ninety-five percent are located in the bladder, and the less common upper tract urothelial carcinomas have an incidence of 2:100,000 inhabitants. Peak presentation is in patients between 70-80 years of age. Sixty percent of the tumors are invasive at the time of diagnosis and bladder recurrence in upper tract patients is 22-47%, depending on the technique employed in bladder cuff management.

Materials and methods

A 30-year-old man with no remarkable past history or risk factors sought medical attention for gross hematuria and left flank pain. A tomography scan revealed a left renal tumor suggestive of upper urinary tract urothelial tumor, which was confirmed through ureterorenoscopy with biopsy and urinary cytology. Cystoscopy showed no intravesical lesions.

Results

Transperitoneal laparoscopic nephroureterectomy with transurethral endoscopic bladder cuff excision was performed. The patient was released on the second postoperative day with no complications. The histopathology study reported transitional cell carcinoma with muscle invasion, lymph nodes negative for metastasis, and bladder cuff with no signs of tumor activity.

Discussion

Upper urinary tract urothelial tumor management has traditionally been performed as open surgery with different forms of bladder cuff excision, each with its particular advantages as well as technical difficulties. Several authors have shown the laparoscopic approach to be efficacious and safe, but the dilemma of distal ureter management has been a subject of debate.

Conclusions

When performed by the experienced surgeon, transperitoneal laparoscopic nephroureterectomy with endoscopic bladder cuff excision is a reproducible technique that has a low local recurrence rate in the management of upper tract urothelial carcinomas.

Background

The role of hormonal influence on prostate cancer is reflected mainly on the effect of androgen deprivation therapy in metastatic disease. Nevertheless, in localized prostate cancer there is increasing evidence of a more aggressive clinical course directly correlated with low serum total testosterone levels.

Aim

To analyze the correlation between preoperative serum total testosterone levels and the histologic grade obtained through transrectal biopsy and the definitive anatomopathologic report in patients that underwent open radical retropubic prostatectomy at a tertiary care hospital in Mexico City.

Methodology

A retrospective, observational, analytic study was conducted that included 52 patients operated on with open radical retropubic prostatectomy at a tertiary care hospital in Mexico City. A correlation was established between low serum total testosterone levels and the Gleason score obtained through transrectal biopsy and the definitive histopathologic report, as well as surgical margin status.

Results

A statistically significant association was found between low serum total testosterone levels and a Gleason score of 8 or higher in the definitive histopathologic report after radical prostatectomy (P = .00165), positive surgical margins (P = .0148), and the presence of locally advanced disease after the analysis with the Fisher's exact test (P = .0110).

Conclusions

The present study showed positive results in relation to the influence of total testosterone on the histopathologic variables that determine cancer-specific survival in localized prostate cancer, consistent with numerous case series reported in the literature.

Introduction

Urinary tract infections caused by organisms that are extensively drug-resistant has become an important and difficult-to-manage health problem that requires our attention, given its notable increase in recent years. Urinary tract infections are the most frequent group of bacterial infections, with Escherichia coli continuing to be the most common causative agent, and they have very significant economic implications. Urinary tract infections are the third cause of notifiable disease in Mexico and there is very little information on extensively drug-resistant bacteria.

Aim

The aim of this study was to provide evidence on the current situation of extensively drug-resistant bacteria in urine cultures in our region.

Materials and methods

A retrospective study was conducted on urine cultures from 2007 to the first quarter of 2015. A statistical analysis of the information was carried out utilizing circle and dispersion graphs.

Results

From the database, we filtered 8,164 urine cultures by complete resistance results in the antibiogram and found 44 extensively drug-resistant bacteria (0.53%). The most frequent was Pseudomonas aeruginosa in 38 cases (86.36% of the drug-resistant bacteria), followed by Acinetobacter baumannii in 3 cases (6.81%). The information was filtered by year and we found that the presence of these types of super bacteria has increased in the urinary tract over the last few years.

Conclusion

Extensively drug-resistant bacteria are a serious health problem and it is necessary to know their epidemiology in our region. Their alarming increase in recent years, most likely due to inadequate antibiotic use, makes it essential for us to be aware of the therapeutic options with which we can control these bacteria, as well as highlighting the need for new antibiotics.

Background

To describe our experience with emergency percutaneous nephrostomy in patients with advanced cervical cancer accompanied by obstructive uropathy.

Material and methods

A descriptive study was conducted that evaluated 12 patients diagnosed with advanced cervical cancer, obstructive uropathy, and kidney function damage.

Results

Two study groups were formed: group A (with previous cancer-specific treatment) and group B (without previous cancer-specific treatment). Eight patients (66.7%) presented with bilateral ureteral obstruction and only 4 (33.3%) with unilateral obstruction. A total of 41.7% had obstructive anuria, with elevated levels of serum creatinine, and 33.3%, in addition to presenting with anuria, had associated symptoms of sepsis and fluid and electrolyte imbalance. A significant decrease was more remarkable when bilateral percutaneous nephrostomy was carried out over a 7-day period. The procedure caused minor complications in 75% of the patients, the most frequent of which was catheter obstruction.

Conclusions

Percutaneous nephrostomy was more effective as a temporary measure for saving kidney function than retrograde catheterization or surgical diversion.