Eduardo Serrano-Brambila

Prognostic Factors of Morbidity in Patients Undergoing Percutaneous Nephrolithotomy

OBJECTIVE To determine the preoperative and perioperative predictive factors of morbidity/mortality in patients undergoing percutaneous nephrolithotomy (PCNL), using the Claviens classification. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.

Absceso perirrenal: factores asociados a su desarrollo y mortalidad

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

Gangrena de fournier: experiencia en el hospital de especialidades del CMN SXXI

OBJECTIVES: To evaluate and review the Fourniers gangrene clinical presentation, initial APACHE II score and integral treatment of patients affected in HECMNSXXI. METHODS: Retrospective, descriptive and cross-sectional study in 40 patients with Fourniers gangrene diagnosis, accepted for treatment in HECMNSXXI who gather inclusion criteria, from February 1996 to February 2006. RESULTS: 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 Fourniers Gangrene received a triple antibiotic schema from admittance day, associated with emergency surgical debridement in the whole group. CONCLUSIONS: Aggressive and multidisciplinary treatment is mandatory in all the patients affected by Fourniers gangrene. We recommend utilisation of the APACHE II score as very useful tool to determine the prognosis.

Prostatitis incrustante: Caso clínico y revisión de la bibliografía

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

Evaluación de la tasa libre de litos posterior a la nefrolitotomía percutánea mediante el nomograma nefrolitométrico

BACKGROUND 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. 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 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, p<0.05). 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, IIand 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.

Uraco-cistopexia: nueva técnica de cisto-suspensión asociada al Burch para el tratamiento del cistocele e incontinencia urinaria de esfuerzo, seguimiento a largo plazo

Resumen es: Objetivo: Comparar la eficacia y morbilidad a largo plazo de pacientes con incontinencia urinaria de esfuerzo a las que se realizo uretro-cervico-suspens...