Mariano S. González

Percutaneous lithotripsy in Valdivia-Galdakao decubitus position: our experience.

Percutaneous nephrolithotripsy (PNL) is actually the first therapeutic option to resolve complex renal stones. Our department initiated its experience in 1985 and treated the first 585 patients in ventral decubitus, as the original technique was described. Then, in 1998, the dorsal decubitus was adopted (Valdivia Uria), in which 695 patients were treated. Since 2006 the Valdivia Galdakao variant has been used. The Valdivia Galdakao position is an intermediate dorsal decubitus with extension of its homolateral lower limb and flexion of the contralateral. It is a practical way to place the patient for percutaneous renal surgery, avoiding hyperextensions and hyperflexions that can result in articular damage. It preserves cardiovascular and ventilatory dynamics and allows a better access to the respiratory tract. In this position, the bowel slips away from the puncture area lowering the risk of its damage. A single lumbar and genital sterile surgical field is created allowing antegrade and retrograde simultaneous endoscopic and even laparoscopic access, increasing efficiency and safety of the minimal invasive procedures. Between April 2006 and March 2008, 175 PNLs were performed in our department with the patient in Valdivia Galdakao position. The aim of this article is to describe our experience in this decubitus confirming that the Valdivia Galdakao is a safe, practical and versatile position that should be considered as first choice when a percutaneous renal surgery is indicated.

Tomografía computada como predictor de composición y fragilidad de la litiasis urinaria al tratamiento con litotricia extracorporea por ondas de choque in vitro

OBJECTIVES To evaluate the ability of non contrast computed tomography (NCCT) to predict stone composition and fragility for treatment with extracorporeal shock wave lithotripsy (ESWL). METHODS 27 stones of about 10 mm from patients who had undergone different endourological procedures were collected. All patients had been evaluated with NCCT. To perform in vitro ESWL an experimental device was designed. Three thousand pulses were applied with 17.2 Kv intensity using an electromagnetic generator (Lithostar) to all stones. Composition of each fragment was studied with crystallographic study. Results were statistically analyzed with Student Test, Chi2 Test and multivariate study. RESULTS In vitro ESWL had a success rate of 59.26%. Average stone HU, grouped by composition: cistine 1015 HU, Calcium monohydrate oxalate 1193 HU, uric acid 419 HU, dihydrate calcium oxalate 2122 HU, struvite 1543 HU and basic phosphate magnesium 1517 HU. A statistically significant relationship was found between values which were lower than 500 HU and uric acid composition (p=0.0006), as well as values higher than 2000 HU and composition of dihydrated calcium acid (p=0.0244). In the group of stones with less than 1000 HU (n=11) efficacy was 81.1%, whereas it was 43.75% in the others (p=0.0479). We found a statistically significant relationship between uric acid and effectiveness (p=0.021). There was not statistically significant relationship between size and treatment effectiveness. CONCLUSIONS The use of NCCT will allow predicting stone composition and fragility.

Estudio randomizado sobre continencia urinaria postprostatectomía radical con rehabilitación perineal kiesica previa

La incontinencia urinaria es una de las principales complicaciones luego de la realizacion de prostatectomia radical (PR). La rehabilitacion kinesica preoperatoria, podria ser de utilidad como tratamiento preventivo de esta complicacion. Demostrar la utilidad de la kinesiologia perineal preoperatoria en la recuperacion precoz de la continencia urinaria post prostatectomia radical. METODOS Ensayo Clinico Controlado Randomizado Aleatorizado. 38 pacientes fueron divididos en dos grupos de 19 previo a la realizacion de la PR. El primer grupo (K) recibio tratamiento kinesico preoperatorio, mientras que el segundo grupo (NK) no (grupo control). Se evaluo la continencia de orina a los 14, 30 y 60 dias post extraccion de sonda. RESULTADOS No hubo diferencias epidemiologicas y de biologia tumoral entre grupos. El porcentaje de pacientes continentes en el grupo K al los 14, 30 y 60 dias, respectivamente fue de 47,36%, 47,36% y 78,9%, respectivamente, mientras que en el grupo NK fueron de 47,36%, 47,36% y 89,4%, respectivamente (p>0,05). CONCLUSIONES Los ejercicios kinesicos perineales previos a la prostatectomia radical, no disminuyeron los tiempos de recuperacion de la continencia urinaria ni la ocurrencia de la misma.

VARIABLES PREOPERATORIAS PRONÓSTICAS EN EL CÁNCER DE RIÑÓN.

Resumen es: Objetivo: Analizar la correlacion existente entre factores preoperatorios en pacientes con cancer de rinon, y el hallazgo posterior de factores de mal pr...

Intraoperative Complications: How to Avoid Them?

At present, PNL is the minimally invasive technique of choice to treat complex renal stones. Despite being a safe surgical intervention, PNL is not exempt from potential complications, which can arise at any stage of the procedure: patient positioning, renal puncture, tract dilation, intraoperative manipulation, stone fragmentation and postoperative management. Besides being the majority of them minor, they can be kept to a minimum in experienced hands with the development of new techniques and improved technologies. However, patient positioning-related complications are not considered in any classification, as well as those related to anaesthesiological problems, which are the ones minimised adopting ECIRS in the Galdakao-modified supine Valdivia position. In particular, with regard to the potential complications due to decubitus, haemodynamic conditions, management of the respiratory tract and the relative location of the colon with respect to the puncture site, PNL performed in supine decubitus or in any of its variations proves to be safer than in prone decubitus.