Armando Zuluaga Gómez

Applications of Bladder Ultrasonography. I. Bladder Content and Residue

In reviewing our experience in the field of bladder ultrasonography, we conclude that this method is seldom used because its value has not been disseminated widely. Such a method is especially valuable in the investigation of infiltrative bladder tumors and the calculation of bladder volume. We herein report the results obtained in 100 patients whose bladder content has been calculated with the formula 12.56 times radius times height. We also outline the advantages of ultrasound over catheterization.

Estudio de factores físico-químicos en pacientes con litiasis renal

Resumen es: Objetivo: La litiasis urinaria tiene un origen multifactorial en el que participan factores fisico-quimicos y anatomicos.factores fisico-quimicos de orig...

TRATAMIENTO DE LA LITIASIS RENAL CON BIFOSFONATOS.

Resumen es: Objetivo: El tratamiento actual de la hipercalciuria aun es controvertido, no recomendandose la restriccion de calcio ya que puede producir un balance ne...

Caracterización por la imagen de las masas renales: Atlas por la imagen

The diagnostic study, analysis and characterization of renal masses and their behavior is one of the key elements for elaborating a surgical or therapeutic strategy, determining the prognosis, and for the follow-up of treatment efficacy in patients with benign or malignant disease. At present, computed tomography (CT) and magnetic resonance imaging (MRI) are the two most reliable, effective and efficient instruments in this context--offering sensitivity and specificity values in excess of 87%, with a diagnostic relaibility of over 90% in application to renal masses of a cystic or complex nature, with nonspecific or specific inflammatory characteristics, or of a primary or secondary neoplastic nature. The aim of this study is to present the principal CT and MRI parameters in relation to renal pathology of this kind, correlating them to the clinical, physiopathological and histopathological data with a view to affording architectural, density, signal intensity and biological behavior parametric information of help in understanding the changes occurring in the renal and retroperitoneal regions secondary to such pathologies.Resumen El estudio diagnostico, analisis y caracterizacion de las masas renales y su comportamiento representa uno de los pilares maestros para la elaboracion de una estrategia quirurgica o terapeutica de otros ordenes, en la elaboracion de un pronostico y en el seguimiento de la eficacia terapeutica tanto en casos de patologia benigna como maligna. La TC y la RMI representan, en la actualidad, los dos modos mas fiables, eficaces y eficientes en tal tipo de analisis y caracterizacion con indices de sensibilidad y especificidad superiores el 87% y con una fiabilidad diagnostica superior al 90% dentro de las masas renales, sean quisticas simples o complejas, de orden inflamatorio inespecifico o especifico o de origen tumoral primario o secundario de la esfera renal. El proposito de este estudio es el demostrar los principales parametros de estudio mediante TC y RMI de tales tipos patologicos y correlacionarlos con los datos clinicos, patofisiologicos e histopatologicos para obtener datos parametricos en arquitectura, densidad, intensidad de senal y comportamiento biologico que nos ayuden a comprender los cambios que se producen en el area renal y retroperitoneal derivados de tales patologias.

Hiperparatiroidismo secundario en el cancer de prostata avanzado

BACKGROUND AND OBJECTIVE High parathyroid hormone (PTH) concentrations are associated with increased bone resorption and bone matrix degradation. Some studies show elevated PTH concentrations and hypocalcemia in patients with advanced prostate carcinoma, although the pathophysiological significance of these findings is not well defined. MATERIALS AND METHODS We performed a retrospective study of 60 patients diagnosed with advanced prostate cancer (44 nonmetastatic and 16 metastatic) treated with androgen deprivation. In all patients, PTH, calcium, phosphorus, 25 (OH) vitamin D and prostate-specific antigen (PSA) were determined. Bone scintigraphy had previously been performed. RESULTS In patients with bone metastases, mean concentrations were as follows: calcium 9.19 mg/dl, phosphorus 3.47 mg/dl, 25 (OH) vitamin D 13.85 ng/ml, PTH 66.8 pg/ml and total PSA 101.27 ng/ml. For those without bone metastases, the results were calcium 9.39 mg/dl, phosphorus 3.38 mg/dl, 25 (OH) vitamin D 20.50 ng/ml, PTH 52.23 pg/ml and total PSA 2.52 ng/ml. PTH levels were significantly higher in patients with prostate cancer and bone metastases than in those without metastases (p=0.03). Vitamin D levels were also significantly lower in this group (p=0.03). There were no differences in other values. CONCLUSIONS The present study found increased PTH concentrations in patients with advanced prostate cancer. This finding could be useful to predict disease progression.

Metodología y límites de la ureteroscopia ambulatoria

OBJECTIVES: To demonstrate the efficacy of ambulatory ureteroscopy under sedation-analgesia as diagnostic and/or therapeutic procedure for the upper urinary tract diseases, neoplasias, stenosis, stones. METHODS: We analyze the results of a series of diagnostic and/or therapeutic procedures in 1243 patients divided into five groups: 1. Work up for filling defects with positive cytology and hematuria, 36 cases. 2. Treatment of urinary stones, 1135 cases. 3. Treatment and follow-up of upper urinary tract tumors, 19 cases. 4. Foreign body extraction, 27 cases. 5. Dilation/ section of ureteral stenosis, 26 cases. We perform the procedure under local anesthesia (urethral xylocaine gel), sedation with midazolam and analgesia with remifentanil perfusion (0.08-0.20 mcg kg/minute); the operation is subdivided into three steps: access to the ureter, progression/ureteral examination, and diagnostic and/or therapeutic actions. RESULTS: Fifteen percent of the patients presented pain or intolerance at the start or during the procedure, and they progress to general anesthesia. 10% of the cases have a hospital admission longer than six hours. Ureteroscopy was effective as a diagnostic procedure in 30/36 cases. Ureteroscopy was indicated as elective treatment in 833 cases of ureteral stones (54 lumbar; 248 iliac; 531 pelvic), achieving good results in 93% of the patients; it was indicated for failures or complications of extracorporeal shockwave lithotripsy in 302 cases (73 lumbar; 83 iliac; 146 pelvic), with good results in 98% of the patients. Ureteroscopy was used to treat conservatively low-grade ureteral tumors of the pelvic ureter in 12 cases, or as palliative therapy (7 cases). From the 26 cases of ureteral stenosis, 8 underwent ureterotomy and 18 balloon dilation, leaving a ureteral catheter for 4-6 weeks, obtaining good results in 21 cases. CONCLUSIONS: Ureteroscopy is an effective technique in 94% of the cases, and it can be performed as an outpatient procedure for diagnosis or treatment of urinary stones and ureteral stenosis.Resumen es: Objetivo: Demostrar la eficiencia de la ureteroscopia ambulatoria bajo sedacion-analgesia como procedimiento diagnostico y/o terapeutico en la patologia ...OBJECTIVES: To demonstrate the efficacy of ambulatory ureteroscopy under sedation-analgesia as diagnostic and/or therapeutic procedure for the upper urinary tract diseases, neoplasias, stenosis, stones. METHODS: We analyze the results of a series of diagnostic and/or therapeutic procedures in 1243 patients divided into five groups: 1. Work up for filling defects with positive cytology and hematuria, 36 cases. 2. Treatment of urinary stones, 1135 cases. 3. Treatment and follow-up of upper urinary tract tumors, 19 cases. 4. Foreign body extraction, 27 cases. 5. Dilation/ section of ureteral stenosis, 26 cases. We perform the procedure under local anesthesia (urethral xylocaine gel), sedation with midazolam and analgesia with remifentanil perfusion (0.08-0.20 mcg kg/minute); the operation is subdivided into three steps: access to the ureter, progression/ureteral examination, and diagnostic and/or therapeutic actions. RESULTS: Fifteen percent of the patients presented pain or intolerance at the start or during the procedure, and they progress to general anesthesia. 10% of the cases have a hospital admission longer than six hours. Ureteroscopy was effective as a diagnostic procedure in 30/36 cases. Ureteroscopy was indicated as elective treatment in 833 cases of ureteral stones (54 lumbar; 248 iliac; 531 pelvic), achieving good results in 93% of the patients; it was indicated for failures or complications of extracorporeal shockwave lithotripsy in 302 cases (73 lumbar; 83 iliac; 146 pelvic), with good results in 98% of the patients. Ureteroscopy was used to treat conservatively low-grade ureteral tumors of the pelvic ureter in 12 cases, or as palliative therapy (7 cases). From the 26 cases of ureteral stenosis, 8 underwent ureterotomy and 18 balloon dilation, leaving a ureteral catheter for 4-6 weeks, obtaining good results in 21 cases. CONCLUSIONS: Ureteroscopy is an effective technique in 94% of the cases, and it can be performed as an outpatient procedure for diagnosis or treatment of urinary stones and ureteral stenosis.

Litiasis renal en pacientes con hiperparatiroidismo primario: Evolución y tratamiento

Resumen es: Objetivo: La relacion hiperparatiroidismo-litiasis renal es bien conocida y el estudio de paratiroides es obligado en paciente con litiasis, sobre todo s...

Tumor adenomatoide dependiente de la porción inferior del epidídimo

Resumen El tumor adenomatoide es el tumor paratesticular mas frecuente. Es un tumor benigno, que en la mujer se localiza fundamentalmente en el utero y trompas de Falopio, mientras que en el varon su localizacion mas frecuente es el epididimo, aunque estas lesiones tambien pueden afectar a la albuginea, cordon espermatico y, excepcionalmente, al parenquima testicular, donde solo hay publicados 5 casos, conductos eyaculadores, prostata, etc. Sus manifestaciones clinicas y datos radiologicos son, en muchas ocasiones, dificiles de diferenciar de lesiones solidas, malignas, intraparenquimatosas, lo que conlleva a realizar orquiectomias innecesarias. Presentamos un nuevo caso de tumor adenomatoide dependiente de la porcion inferior del epididimo.

Tratamiento de la litiasis vesical con láser

OBJETIVOS El uso del laser para litotricia endoscopica, comienza en 1968 al utilizar Mulvaney un laser de rubi sin exito, posteriormente se probaron laser de CO2 y Neodymio-YAG. Con el laser pulsado de colorante y el laser de alexandrita se obtienen unos rendimientos energeticos que oscilan de 30 a 200 mJ, su capacidad de fragmentacion no es universal y esta limitada a pequenos calculos, generalmente ureterales, por lo que no han sido alternativa terapeutica en la litiasis vesical. El laser de Holmio genera pulsos de energia de 400-2500 mJ, capaz de fragmentar todo tipo de calculos. El Objetivo de este trabajo es analizar los resultados de la litotricia vesical endoscopica con laser de holmio YAG. METODOS En el periodo de 2006-2008 hemos tratado 21 casos de litiasis vesical, con tamanos de 1 a 4 cm. en pacientes de 8-76 anos, 6 mujeres y 15 hombres, que corresponden a: Cuatro casos de litiasis infantil, 3 de acido urico, 1 caso de cistina, litiasis de oxalato y/o fosfato calcico en 7 casos, 5 casos de litiasis vesical sobre extremo inferior de doble jota, 1 caso de litiasis en ureterocele intravesical. El tratamiento se ha realizado con un equipo Dornier Medilas de 20 watios de Holmio-YAG como fuente de energia, que se ha aplicado a traves de cistoscopios infantil-adulto o ureteroscopios de 7-8.5 Ch. semirrigido y flexible. El control postoperatorio se ha realizado con radiografia simple de aparato urinario y ecografia. Realizamos estudio de factores de riesgo litogeno y analisis de los fragmentos del calculo. RESULTADOS Los 21 casos descritos corresponden a litiasis vesical secundaria o tipo II. En todos los casos se ha comprobado la ausencia de litiasis residual con estudios de imagen y se han corregido los factores de riesgo litogeno con procedimientos medicos o quirurgicos. CONCLUSIONES Consideramos que hoy, la litotricia vesical endoscopica con laser de holmio si es alternativa terapeutica. A pesar de que existen multiples opciones de tratamiento endoscopico, la litotricia transuretral con laser de holmio ofrece buenos resultados con un bajo porcentaje de complicaciones.OBJECTIVES: The use of laser for endoscopic lithotripsy started in 1968 when Mulvaney tried a ruby laser without success; Later on, the CO2 laser and the Nd:YAG were tried. With the pulsed dye and alexandrite lasers energetic performances between 30 and 200 mJ are obtained, their capacity of fragmentation is not universal and is limited to small stones, generally ureteral stones, so that it has not been a therapeutic alternative for bladder lithiasis. The holmium laser generates energy pulses of 400-2500 mJ, it is able to fragment every type of stone. The objective of this work is to analyze the results of endoscopic bladder lithotripsy with holmium-YAG laser. METHODS: In the period between 2006-2008 we treated 21 cases of bladder lithiasis, with a stone size between 1 and 4 cm in patients from 8-76 years, six women and 15 men, which correspond to: four cases of infantile lithiasis, 3 of uric acid, one case of cystine, seven cases of calcium oxalate and/or phosphate, five cases of bladder lithiasis growing around a double J catheter, and one case of lithiasis within on intravesical ureterocele. Treatment was performed with a 20W Dornier Medilas holmium-YAG equipment, applied using children/adult cystoscopes or 7-8.5 Ch ureteroscopes, both semirigid and flexible. Post operative control included KUB x-ray and ultrasound. We performed a study of lithogenic risk factors and stone fragments analysis. RESULTS: The 21 cases described are all secondary or type II bladder lithiasis. In all cases the absence of residual lithiasis was checked with imaging studies and the lithogenic risk factors were corrected with medical or surgical procedures. CONCLUSIONS: We consider that today bladder endoscopic lithotripsy with holmium laser is a therapeutic alternative. Despite there are multiple options for endoscopic treatment, transurethral lithotripsy with holmium laser offers good results with a low complication rate.

Calcificación gigante en extremo distal de stent ureteral.

OBJETIVOS Las indicaciones mas habituales para la colocacion de un stent ureteral son nefrolitiasis obstructivas, cirugia nefroureteral, oncologia urologica, endourologia, compresion ureteral extrinseca y como apoyo previo al tratamiento con LEOC. METODOS Presentamos un caso de un varon de 77 anos de edad con cateter ureteral DJ colocado durante 8 meses y con antecedentes personales de nefrolitiasis que presenta calcificacion de 60 mm x 30 mm de extremo distal del mismo. RESULTADOS Se realizo cistolitotomia abierta y extraccion del stent que solvento el cuadro. La composicion del calculo fue fosfato amonico magnesico con trazas de urato amonico y fosfato calcico. CONCLUSIONES En muchas ocasiones la persistencia prolongada de dicho stent, junto con antecedentes de nefrolitiasis e infeccion urinaria predispone a la calcificacion y encrustamiento de dicho cateter ureteral, siendo necesarias tecnicas de endourologia, litotricia extracorporea o cirugia abierta para la resolucion de dichos cuadros.