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Introduction and objectives Hemorrhage due to arteriovenous fistula (AVF) or pseudoaneurysm (PA) is a rare complication after percutaneous nephrolithotomy (PCNL). The objective of this study is to evaluate hemorrhagic complications (HC) after PCNL and the results of their endovascular treatment. Materials and methods Between May 2009 and December 2019, 1335 PCNL were performed in our center for kidney stone disease. We analyzed the incidence of early and late HC, their management, the need for subsequent embolization, as well as clinical and analytical data of these patients. Results A total of 59 (4.4%) patients presented HC. Bleeding was managed with arteriography and selective embolization (ASE). Perirenal hematoma was seen in 38 patients (64%). Regarding angiographic findings, there were 32 (54%) PA, 8 (14%) AVF, 4 (7%) extravasations due to vascular laceration and 15 (25%) PA combined with AVF. In one case, 3 procedures were required to control the bleeding. In 30 patients (51%) blood transfusions were not necessary, while in 29 (49%), a mean of 1.3 units were transfused. Median follow-up was 24 ± 21 months. Mean time interval between PCNL and ASE was 7.3 ± 4.9 days. A total of 24 (41%) patients were readmitted after discharge due to late HC requiring ASE. Delay between readmission and ASE was 4.8 ± 4.6 h in average. Conclusion Early and late HC after PCNL can be severe. Rapid identification and treatment with ASE is an effective and minimally invasive and avoids multiple blood transfusions which in many cases constitute an insufficient treatment.

The capability of the electroencephalography (EEG) of recording the bioelectrical activity of the brain has made of it a fundamental tool for the evaluation of the patient's neurological condition. In recent years, moreover, it has also begun to be used in obtaining information for other kind of variables, as the ones related with the cerebral hemodynamics.To study the potential relationship between the EEG activity and the intracranial pressure (ICP) in patients suffering from traumatic brain injury and subarachnoid hemorrhage, during their stay at the intensive care unit.Twenty-one adult patients (10 women) were included in the present observational prospective cohort study. They suffered from either traumatic brain injury or subarachnoid hemorrhage, requiring continuous EEG and ICP monitoring. In every patient, Granger causality between spectral functions of the EEG and the ICP was evaluated. Temporal windows of 10 minute were used to evaluate whether a causal relationship between those variables exist or not. In all of the cases, several days of continuous recording and assessment were performed.In most patients and during most of the time, Granger causality turns out to be significant in the direction from the EEG to the ICP, meaning that the EEG dynamics actually leads the ICP dynamics.The present work provides useful information and shed light in discovering a hidden relationship between the ICP and EEG dynamics. The potential use of this relationship could lead to develop a medical device to measure ICP in a non-invasive fashion.Es posible obtener informacion de la presion intracraneal a partir de la actividad electroencefalografica?Introduccion. El electroencefalograma (EEG) permite obtener informacion directa de la actividad bioelectrica del cerebro y es una herramienta fundamental para la evaluacion de la condicion neurologica del paciente. En los ultimos años ha comenzado a emplearse tambien para obtener indirectamente informacion sobre la hemodinamica cerebral y las variables que intervienen en la autorregulacion del flujo sanguineo cerebral. Objetivo. Estudiar la posible relacion entre la actividad electroencefalografica y la presion intracraneal (PIC) en pacientes con traumatismo craneoencefalico y hemorragia subaracnoidea ingresados en cuidados intensivos. Pacientes y metodos. Se incluyo a 21 pacientes (10 mujeres) mayores de 18 años con traumatismo craneoencefalico o hemorragia subaracnoidea que requerian monitorizacion de la PIC y a los que se les registro el EEG de forma continua. Se determino la causalidad de Granger entre la PIC con respecto a las variables espectrales del EEG para ventanas temporales de 10 minutos durante la estancia en cuidados intensivos. Resultados. La causalidad de Granger mostro una alta correlacion entre la PIC con las bandas del EEG. En la mayoria de los pacientes existe una causalidad de Granger significativa en la direccion del EEG hacia la PIC en gran parte del tiempo de monitorizacion, de forma que las variables del EEG precedian a la PIC. Conclusiones. El presente trabajo expone la relacion temporal subyacente entre la dinamica de la PIC y la actividad bioelectrica cerebral registrada mediante EEG en pacientes con traumatismo craneoencefalico y hemorragia subaracnoidea. El potencial uso de esta relacion podria permitir estimar la PIC de manera no invasiva.

To evaluate the effectiveness and safety of simultaneous bilateral percutaneous nephrolithotomy performed in patients affected with bilateral renal calculi.This is a prospective study from September 2012 to November 2016. Patients diagnosed of bilateral kidney stones with abdominal CT scan were included. Surgical technique prone position, renal puncture guided by fluoroscopy and tract dilation up to 24Ch. We reviewed demographic and stone characteristics, stone free rate, clinical success, complications and follow-up.During the study period, 732 percutaneous nephrolithotomies were performed. Eighteen patients were included (36 renal units, 2.5%), 13 men and 5 women, with a median age of 58 years and an interquartile range (IQR) of 40-66. Median stone burden was 228mmSimultaneous bilateral percutaneous nephrolithotomy is an effective and safe procedure in patients affected with bilateral renal calculi. It is a surgical challenge that should be performed in selected patients and in centers with experience.

Clavien-Dindo classification system has been proposed to grade perioperative complications in percutaneous nephrolithotomy. The complications of this technique that have taken place in the last 2 years are reported in this paper according Clavien-Dindo classification.Between 2011 and 2012 a total of 255 percutaneous nephrolithotomy were performed at our center for stones more than 2 cm in size. In order to determine the incidence of complications classified in the modified Clavien-Dindo system, statistical analysis of the data obtained was carried out.During the period analyzed, 255 percutaneous nephrolithotomy were performed in 249 patients, 41% of the right side, 57% of the left side and 2% bilateral and simultaneous. 137 and 112 patients were males and females, respectively. The most prevalent comorbidities were: hypertension (AHT) in 101 patients (40.6%), BMI30 in 81 patients (32%), diabetes mellitus in 46 patients (18.5%) and coagulation abnormalities in 24 patients (9.6%). A total of 70 cases (27.4%) were distributed according to Clavien-Dindo classification: grade i, 8.4%, grade ii 8.4%, grade iiia 4.4%, grade iiib 6% grade iva .8%, grade ivb: 0% and grade v 0%.A graded classification scheme for reporting the complications of percutaneous nephrolithotomy is useful for monitoring and reporting outcomes. We propose a standardized use of this classification in order to make the results comparable among different centers performing the technique.

Urinary calculi is an uncommon complication in kidney transplantation; several stone risk factors are found in transplanted patients, but in most cases there is not a relationship between these risk factors and stone formation. The treatment of these patients is complex due to their both immunosuppressive status and border-line renal function.From 1980 to February 2000, 1198 kidney transplant have been performed in our institution. We describe our series consisting in 22 urinary calculi (15 in the graft, 3 in the urether and 4 in the bladder) in 18 patients, including 7 stones detected in cadaveric donor patients.We performed external shock wave lithotripsy in 7 patients, bench surgery in 4, endoscopic mechanic lithotripsy in 5, open surgery in 1 and observation in 6. Calcium oxalate (mono and dihidrate) was found in 9 of 13 calculi. Metabolic changes were found in 15 of the 18 patients, the most common was hiperuricemia. There were not complications of every treatment applied and 9% of them needed a savage treatment. We found recurrence in 4 cases (22.2%). Now 12 of the patients are stone-free (66.7%) and three have non-significative stones (83.3% without symptoms).Detection of renal calculi in cadaveric renal donors is not a reason to refuse the graft for further transplantation. In both renal calculi up to 2 cm and uretheric calculi surgical treatment is assessed as first option. In caliceal stones smaller than 5 mm observations is the best treatment.

The horseshoe kidney is the most frequent renal anomaly. As a consequence of impaired urinary drainage, urolithiasis is present in 20% of the cases. Indications for extracorporeal shock wave lithotripsy (ESWL) in the treatment of patients with anomalous kidneys is still the subject of controversy.To evaluate ESWL efficacy in the treatment for lithiasis in horseshoe kidney.Between april 1988 and december 1999 a total of 32 symptomatic lithiasis in 30 patients with horseshoe kidneys were managed by 65 sessions with ESWL. Until march 1999 a Dornier HM-4 electrohydraulic lithotripter was used. Posteriorly, two treatments was performed with an electromagnetic Dornier Lithotripter S. These procedures have been performed without anaesthesia or sedation for the Dornier HM-4 equipment. Analgesia with Meperidine was used for the Dornier Lithotripter S. Diuresis was not forced during or after treatment with diuretics or serotherapy. Treatments was conducted in an outpatient clinic in all cases.Treatment/lithiasis rate was 2.03. Following treatment 16 patients (54%) were stone-free by X-ray, 9 patients (30%) had residual fragments and in 5 patients (16%) no sign of stone disintegration was observed. Open surgery was performed in three of this patients. Better results was achieved in stones located in the renal pelvis and stone size is 10 mm or less. Clinical evolution: free of symptoms in 20 patients; chronic vague flank pain in 5 patients and acute renal colic with or without hematuria in 5 patients. No major complication was observed in our compilation.These results suggest that ESWL is the method of primary choice in the treatment for small lithiasis (10 mm or less) in horseshoe kidney.

First described by the end of the fifties, pelvic lipomatosis is an uncommon disease that develops as a result of an excessive proliferation of benign fat tissue within the perivesical and perirectal spaces. The compressive effect on the urinary, and to a lesser degree, the digestive and vascular structures result in the well-known symptoms. Diagnosis is reached through X-ray studies, primarily computerised tomography. Contribution of four new cases in young males diagnosed through imaging studies as well as biopsies in three of them. Evolution has been varying, with medical control of symptoms in two cases and renal function impairment due to upper obstructive uropathy in the other two.

Three factors in extracorporeal shock-wave lithotripsy (ESWL) result in pain: shock wave pressure, size of focal area and pressure distribution at entry in the skin. Our Lithotripsy Unit has performed 21,000 outpatient treatments (Dornier HM-4 Lithotripter) with no sedation or anaesthetics. Pain requiring treatment discontinuation resulted in 10% instances. Anxiety-associated pain increases the perceived intensity of pain and influences the emotional response to pain.To determine whether the variability in the response to the pain stimulus caused by ESWL is related to the patient's status/trait of anxiety.Sample 20 patients; inclusion criteria: pyelic lithiasis2 cm, no previous SWEL and no obesity. One SWEL session (2500 pulses, 22 Kv). Anxiety was first evaluated using the status/trait of anxiety index (STAI) questionnaire; after treatment, pain was evaluated on a Numerical Analogic Scale.Pain scores ranged from 2 to 8, mean score 4.1 (S.D. = 1.67); mean score for trait of anxiety 21.8 (S.D. = 8.52), and status of anxiety 29 (S.D. = 5.89). A significant correlation was found between pain-anxiety trait (R = .51; p = .02), which was higher when compared to pain-anxiety status (R = .67; p = .001).SWEL is a painful therapy (95% of sample had mild-to-moderate pain); pain perception is increased by status of anxiety (45% of pain variance) more than by the trait of anxiety (26.3%); therefore, usage of sedation-analgesia in patients with high anxiety status would improve the lithotripter efficacy ratio.

Caliceal diverticula may be congenital or acquired malformations of the collecting system, normally asymptomatic and discovered during an IVP. Indications for treatment included chronic vague flank pain, acute renal colic, urinary tract infection and hematuria. We present the results of 29 patients with symptomatic calculi in caliceal diverticula who were managed by ESWL monotherapy. All treatments were performed with electrohydraulic machine (Dornier HM 4) in ambulatory form.The average followup was 42 months. 12 patients (40%) had passed successfully all of the stone fragments, while 2 patients (7%) had passed more than half and 4 (13.5%) had passed less than half of the fragments. 66 per cent of patients had been rendered free of symptoms. The possibility of producing a satisfactory result (66% free of symptoms and 40% stone free by X ray) and the low morbidity of ESWL suggest that this treatment may be appropriate for majority of calculi in calicea diverticula.

Presentation of the results obtained with extracorporeal shock wave lithotripsy (ESWL) applied to 3173 ureteral lithiasis with a Dornier HM-4 equipment. Location of lithiasis was pyeloureteral junction (329), lumbar ureter (1068), sacral ureter (238), iliopelvic ureter (1474) and "lithiasic path" (64). All lithiasis were treated in situ. Treatments were carried out ambulatory with no anaesthesia. Treatment/lithiasis rate was 1.3. Percentage of stone-free patients with ESWL alone was 79.2% after the first session, and reached 86.14% with retreatment. Percentage of success for lithiasis in pyeloureteral junction was 81.8%, 79.7% for lumbar ureter lithiasis, 80.09% sacral lithiasis, 90.10% iliopelvic ureter lithiasis and 79.9% for those in the "lithiasic path". 12.6% lithiasis required post-ESWL auxiliary manoeuvres. Post-ESWL minor complications (pain, vegetations) occurred in 5.6% cases and major complications (obstruction, fever, sepsis) in 2.9%. The factors influencing lithiasis fragmentation were the number of shock waves and the lithiasis duration. Size of lithiasis and presence or absence of ureteral catheter had no influence. These results suggest that ESWL is an effective method for managing ureteral lithiasis.

Verruciform xanthoma is a rare benign lesion. The most common presentation is at the oral mucosa level, although it has also been described at other locations. Our case is the twelfth verruciform xanthoma of the penis ever published. We highlight the relevance of the differential diagnosis and its excellent prognosis, the choice treatment being the simple exeresis of the lesion.

Renal haematomas after shock wave extracorporeal lithotripsy (SWEL) represent a potentially serious complication. This paper examines those cases of post-SWEL renal haematoma seen in our Centre, analyzing the likely risk factors.Between May 1988 and June 1996, 12,800 patients were treated with 15100 lithiasis at some level of the urinary tract requiring 16,000 SWEL sessions. All treatments were done with a Dornier HM-4 lithotripter. Voltage applied ranged from 18 to 26 Kv, averaging 2500 waves/session. Complementary testing (ultrasound/computerised tomography) was requested immediately after treatment if clinical complications were suspected.A total of 10 renal haematomas (0.078%) were diagnosed. Six cases were mild, but 4 presented extensive haematoma with significant haemodynamic consequence. Although in one case nephrectomy was undertaken to control haemorrhage, death finally occurred by disseminated intravascular coagulation. Four patients who developed haematoma were hypertensive and 3 had a previously corrected haemostasis alteration.The possibility of renal haematoma should be taken into account in the face of persistent and unjustified pain after SWEL treatment. Normalization of blood pressure values, correction of urinary infection as well as adequate correction of haemostatic disorders is advisable.

Primary melanoma of the female urethra is very rare. Early diagnosis is very difficult and thus involves a long-term non-resolutive therapeutic approach. This paper presents the case of a 61-year old female patient with this type of tumour and nodular dissemination at the time of diagnosis. The patient developed lung and cranial metastasis with 5-year survival.

Presentation of one case of intrasinusale located renal angiomyolipoma. Given the location, the ECO as well as the IVU, arteriography and CAT presented diagnostic doubts. We believe this unusual presentation should be added to those circumstances where uncertainty of tumor diagnosis due to size, behaviour or clinical signs and symptoms, elicits a more aggressive attitude.

Leukoplakia is a morphological term that attempts to define keratinizing desquamative squamous metaplasia of the transitional epithelium. It is uncommon in the upper urinary tract (less than 100 cases have been reported) and has been attributed to infection or mechanical injury to the epithelium and/or genetic factors. We present a case of leukoplakia in a male patient with renal tuberculosis that had been in remission for the past 15 years. Eight years earlier he had intermittently passed keratin laminas (pathognomonic of leukoplakia) during the course of various episodes of nephritic colic. After discarding a reactivation of tuberculosis and malignancy of the metaplastic lesion, we continued conservative treatment with radiologic and cytologic control evaluations.

Review of 18 cases of ureterocele in the adult. The first clinical symptoms are unspecific, with a long-term evolution, and were found while carrying out routine urological examinations. The association to secondary lithiasis in over 60% cases and the presence of complete duplicity in 44% cases is highlighted. The choice treatment is by endoscopy in the simple cases without hydronephrosis or associated reflux. The technique of transversal incision in 'smiling mouth' at the base of the ureterocele produces good results.

Renal metastasis of localized tumours in the economy are rare. In our series of 162 renal tumours only 3 were metastatic. Even more unusual is that the metastasis should be the presenting form. Such is the case we are reporting: a 59 year-old male complaining from back pain and toxic syndrome. Supplementary examinations were performed sequentially until arriving at an open biopsy which confirmed the oat cell histology. The paper explains the results from the various examinations. The ominous prognosis of this histology is illustrated.

Patients with bone marrow transplant may present with acute, life-threatening complications which frequently (40% of our cases) require intensive care unit treatment and result in an increased mortality (76% in this series). In an attempt to reach a more objective prognostic assessment, we have analyzed those factors related to the worst outcome in the 25 patients with bone marrow transplant admitted into our intensive care unit. Respiratory failure was the most frequent complication (72%), with an 83% mortality. Graft-versus-host disease and neutropenia led to a greater number of infectious complications with a poor outcome. Failure of more than three organ systems, septic shock and mechanical ventilation were statistically associated with mortality (p less than 0.05), and all patients who required mechanical ventilation for more than seven days or needed intensive therapy for more than 10 days died. The presence of septic shock, multisystem failure and severe neutropenia on admission should be considered as initial indicators of a poor prognosis. More than 7 days of mechanical ventilation and an intensive care unit stay of more than 10 days could be critical points in the reassessment of the intensity and prolongation of treatment.

Summary— Testosterone concentrations in saliva were measured in 13 patients with prostatic carcinoma after surgical or medical (diethylstilboestrol or Estracyt) orchiectomy. The salivary testosterone values in these patients were significantly lower than in normal males but not significantly different from those in normal females. The salivary testosterone concentrations were measured for 6 consecutive months and did not vary significantly from month to month. The results suggest that the measurement of salivary testosterone concentrations could be useful in evaluating the androgenic function of patients with prostatic carcinoma after medical or surgical orchiectomy.

We set forth the results obtained after application of a hormonal protocol in prostate carcinoma (P.C.) on 257 patients controlled between June 1976 and June 1987, of whom we have selected 160 who fulfilled the following requirements: under 80 years old, confirmed anatomopathological diagnosis, state equal to or above the T1 of the Union International contre le Cancer (U.I.C.C.) classification, tolerance of treatment applied, clinical, analytical and complete, systematic iconographic follow up and minimum survival of more than one year. We treated those patients with localised P.C. (they have no demonstrable metastases), who in our series numbered 78 (78/160), with Diethylethylbestrol (D.E.S.) at an orally administered dose of 1 mgr. a day. In these the plasma testosterone dropped below 100 nanograms/l. in 57 cases (57/79). In this case metastases appeared in 22 cases (22/78). We treated those patients with metastatized P.C., who in our series numbered 59 (59/160), with orally administered Estramustine Phosphate (Estracyt) at a dose of 560 mgr. every 24 h. in two goes. In these the plasma testosterone dropped below 100 nanograms/l. in 50 cases (50/59). In this group the metastases disappeared in 7 patients, became stabilized in 30 and worsened in the other 22 patients. We carried out surgical orchiectomy on 49 patients (49/160): in 17 cases due to associate vascular pathology, in 13 cases for sociocultural reasons, in 5 cases because of advanced age and in 14 cases it was conducted on patients with a poor response to D.E.S.

The high rate of septicaemias (20%, 19% and 14%) observed in our Intensive Care Unit (ICU) during the first 3 years was due to an epidemic incidence of Serratia sp. (S) (26% during the first year) and Klebsiella sp. (K) (25% during the third) and decreased significantly in the following 6 years (mean incidence of 11%) (p less than 0.01). During this epidemic phase these organisms were isolated quite frequently (between a 14% and a 6%) from all patients admitted. The K was more regularly present, for the mean time intervals free of its bacteriological presence were shorter (11 days) than those of S (27 days) (p less than 0.01). The K was isolated in more patients (160) than S (79) (p less than 0.01) and in more samples (360) than S (235) (p less than 0.01), but caused less secondary septicaemias per colonized patient (7% versus 29%) (p less than 0.01). In 59% of all S septicaemias the organism was previously isolated in other culture, while this was observed in only 34% of K septicaemias (x2 = 3.78, p = 0.052). The large variations in the incidence of septicaemias within our ICU, the appearance of sequential epidemic outbreaks, with a different behaviour of S and K and the individual risk of septicaemia of patients colonized by these organisms are noted.

A 53 year old diabetic patient underwent CABG and aortic valve replacement in another institution and developed postoperative oliguric and hyperkalemic acute renal failure. Shortly after transferring to our unit a cardiac arrest occurred. Immediate resuscitative measures were ineffective. The serum potassium level was 10.2 mmol/l. Conventional arteriovenous hemodialysis was initiated while the patient was still undergoing cardiac massage. When the serum potassium level was lowered to 6.5 mmol/l, 90 min later, the heart began to beat. After hemodialysis was discontinued the patient was reactive and fully conscious. The use of simultaneous hemodialysis with prolonged mechanical heart massage as a reliable method for recovery in hyperkalemic cardiac standstill is stressed.