[Urinary lithiasis treatment by laparoscopy. Combined techniques.].

Over the last 30 years, the treatment of urinary lithiasis has changed dramatically. With the advent of extracorporeal lithotripsy and the advances on ureterorenoscopy and percutaneous nephrolithotomy, the need to turn to open and laparoscopic/robotic surgery has diminished. The objective of this article is to review the different indications for open and/or laparoscopic treatment of urinary lithiasis, to achieve its complete elimination with the less invasive possible means and trying to minimize the number of secondary procedures as well as complications.

Endoscopic treatment of a giant fibroepithelial polyp of the ureter.

Summary Objectives: Fibroepithelial polyps are benign mesenchymal tumors with a morphology and clinical presentation very similar to transitional cell carcinomas, so that differential diagnosis is of paramount importance.

Methods/results: We present the case of a 42-year-old female patient, with history of mediastinal Hodgkin/s lymphoma, which came to the office reporting right low back colic pain and haematuria. CT scan showed pediculated neoformation of about 10 cm protruding into the bladder, with negative urine cytology.

[Prognostic significance of the microscopic invasion of the renal vein wall in renal cell cancer].

Objectives: International TNM Staging System for renal cell carcinoma (RCC) classifies as T3b when "tumor grossly extends into the renal vein or its segmental branches, or vena cava below the diaphragm". The finding of microscopic invasion of the vein wall is not taken into account for TNM staging. We analyse its prognostic significance in localized and locally advanced RCC.

[Atypical lymphatic dissemination of a testicular tumor from a cryptorquid testicle].

Objectives: Atypical lymphatic spread of germ cell tumors to inguinal lymph nodes has been reported mostly related to prior surgical involvement of the inguinoscrotal region, as in orchiopexy.

Methods: A patient with cryptorchidism and failed orchiopexy in his childhood was diagnosed with a testicular neoplasm. Inguinal orchiectomy was performed.

[Percutaneous treatment of calyceal diverticulum associated with lithiasis].

Objectives: To report the case of a 47-years-old woman with several small stones located inside a calyceal diverticulum of the right kidney and to highlight the importance of minimally invasive endourological treatment in these cases.

Methods: Owing to the presence of diverticular calculi and clinical symptoms of recurrent infection, we decided to perform percutaneous nephrolithotomy (PNL). After Holmium-YAG laser calculi fragmentation and removal of all stone material, we fulgurated the diverticular lining and infundibulum with a resectoscope and a rollerball electrode.

[Antimigration devices during endoscopic lithotripsy with holmium: yag laser].

Lithiasic pathology continues being very prevalent in our environment. There are multiple approaches and treatments to solve it in current urology. Lately, endourological techniques have suffered a spectacular advance which has permitted to increase their success rates, diminishing also their comorbidity very much.

[Lower calyx lithiasis: usefulness of the laser].

There is controversy yet about which is the best treatment modality for lithiasis of the lower calyx. The range of lithiasis clearance of the stones localized in the lower calyx will depend on various factors such as size, composition of the stone, type of lithotripter employed, type of urinary transport, and anatomy of the lower calyx. The role of flexible ureteroscopy in the treatment of intrarenal pathology has experimented a dramatic evolution, impulsed by the improvements in design of flexible ureterscopes, their degree of deflection, and better quality of image, in the great diversification of small calibre accessory instruments, and the use of the holmium laser for lithotripsy.

[Retrograde laser endopyelotomy].

Ureteropyelic junction obstruction (UPJO) is the most frequent congenital anomaly of the upper urinary tract. Until some years ago, the treatment of first choice was open pyeloplasty, but the development of endoscopic surgery and the clinical improvement on instruments, enables the treatment in a minimally invasive fashion, offering the advantages of shorter operative time, less morbidity, reduction of post operative analgesic requirements, shorter hospital stay, and shorter convalescence period. Retrograde endopyelotomy represents the natural evolution of the minimally invasive surgical treatment of the UPJO by eliminating the need of a percutaneous renal tract and its possible complications.

[Usefulness of the holmium:yag laser in the endoscopic section of ureteral stenosis].

The incidence of ureteral stenosis is frequent in our environment. Lately, due to the massive use of endourological techniques its incidence has increased. Etiology represents a decisive factor for the final result of treatment, but there are also common characteristics to all stenosis that influence very importantly the final success: time of evolution, length of the stenosis, side and function of the affected renal unit.

[Usefullness of the StoneBreaker lithotripter for percutaneous nephrolithotomy].

Objective: Throughout the history, many devices have been used for breaking urinary tract stones. StoneBreaker (LMA Urology, Gland, Switzerland) is a second generation of intracorporeal lithotripter, pneumatic and portable, which adds several new advantages, like effectiveness in stone fragmentation and easy handling, very useful during percutaneous lithotripsy.

Methods/results: We report the case of a 40 year-old male patient, with a left kidney pyelic lithiasis, who was treated by percutaneous lithotripsy, under general anaesthesia, with StoneBreaker (LMA Urology, Gland, Switzerland) as lithotripter.

[Proximal migration of a Double J catheter: case report and review of the literature].

Objective: To report one case of proximal migration of ureteral stent. To perform a bibliographic review about other cases and management to avoid this complication.

Methods/results: 48-year-old woman who presents right obstructive uropathy after gynecologic surgery.

[The use of the Stone Sweeper catheter for stone disease of the upper urinary tract].

Objectives: The treatment of patients with a great burden of stones is very difficult and often requires complex treatments including different kinds of surgery, associated in some cases with ureteral stents.

Methods: We present the case of a patient with complex renoureteral stone disease in whom we used the stone sweeper stent before SWL. The catheter is a 6.

[Testicular microlithiasis].

Objectives: Testicular microlithiasis, characterized by the existence of microscopic calcifications within the seminiferous tubules, is rare, generally an incidental finding during a scrotal ultrasound.

Methods: We report the case of a 45-year-old male without risk factors for the development of a germ cell testicular tumor with the diagnosis of bilateral testicular microlithiasis.

Results: The patient was followed yearly with testicular ultrasound, without evidence of germ cell tumor over a four-year follow-up period.

[Cystic ectasia of the rete testis].

Objectives: The cystic ectasia of the rete testis is a benign entity with a typical ultrasound appearance as a collection of small hypoechoic structures in the confluence of the mediastinum testis. The clinical importance of these entity remains on doing an adequate differential diagnosis with testicular neoplasias with a cystic component.

Methods: We retrospectively reviewed the database of the Ultrasound Unit in the Department of Urology looking for patients with a diagnosis of cystic ectasia of the rete testis over a six-year period.

[Hemospermia and Mullerian duct cyst].

Objectives: To report one case of utriculum cyst treated endoscopically.

Methods: We describe the case of a mid-age male patient consulting for long-term monosymptomatic hemospermia. Rectal digital examination revealed a non suspicious adenomatous prostate.

[Ultrasound diagnosis of intratesticular varicocele].

Objectives: Varicocele is a relatively frequent entity; in most cases venous dilation only involves the extratesticular portion, but 2% of the cases present intratesticular dilation. We report one case of left intratesticular varicocele.

Methods/results: We report the case of a 25-year-old male patient referred for study of left testicular pain, whose work up only found left intratesticular varicocele.

[Stone Cone: a device that prevents ureteral stone migration during intracorporeal lithotripsy].

Objectives: Proximal migration of stone fragments during ureteroscopic lithotripsy is a common problem influenced by pressure of irrigation solution, type of energy for lithotripsy, site and degree of fixation of the stone to the ureteral wall, and degree of proximal ureteral dilation. The Stone Cone (Boston Scientific & Spencer) is a device that helps to prevent proximal migration of fragments and favours a safe extraction during ureteroscopic lithotripsy.

Technique: The Stone Cone is an helical device made of stainless steel and nitinol alloy, which consists of an internal guide wire and a sheath-like radiopaque catheter with a 3 Fr.

[Diagnostic antegrade ureteroscopy of the upper urinary tract in the orthotopic neobladder].

Objectives: To demonstrate the usefulness of antegrade endoscopical examination in the evaluation of the upper urinary tract pathology in patients with orthotopic neobladder.

Methods/results: We present the technique of percutaneous antegrade ureteroscopy and the indications for treatment of the upper urinary tract urothelial tumor (radical or conservative) depending on multiple pyelo-calyceal biopsies and tumor lesions.

Conclusions: Endoscopical evaluation of the upper urinary tract in patients with orthotopic neobladder offers safer information than urine analysis, urine cytology, and the various radiological tests.

["Mini-percutaneous" percutaneous nephrolithotomy: technique and indications].

Objectives: Since Helal and Jackman developed the mini-percutaneous ("mini-perc") percutaneous nephrolithotomy (PCNL) for the treatment of pediatric renal lithiasis various authors have used is technique in adults with the aim to preserve renal parenchyma and diminish morbidity associated with the standard PCNL.

Methods: We describe the surgical technique of "mini-perc" PCNL in the treatment of renal lithiasis.

Results: We review various case series from the literature of "mini perc" PCNL for the treatment of adult renal lithiasis, its current indications, percentages of stone free patients, and associated problems, mainly the required instruments.

[Descriptive analysis of adverse events associated with transrectal prostatic biopsy after 603 procedures].

Objectives: To establish the incidence of complications secondary to performance of transrectal prostatic biopsy, and to establish the hypothetical relationship between the rate of fever and the type of antibiotic prophylaxis employed.

Methods: All patients undergoing transrectal prostatic biopsy between January 1992 and December 2003 were included in this prospective nonrandomized study. Patients were given a self-administered questionnaire to obtain data about complications related to biopsy that included the following variables: fever, hematuria, rectal bleeding, hemospermia, voiding difficulties, acute urinary retention, need to visit primary care physician or an emergency department, hospital admissions and need of medication.

[Is there a risk of carcinoma dissemination in the percutaneous access for endoscopical treatment of upper urinary tract urothelial tumors?].

Objectives: The incidence of transitional cell carcinoma of the renal pelvis and ureter is low, and the standard treatment is nephroureterectomy with a bladder cuff. However, there are special circumstances, from both patient and tumor characteristics, which are subsidiary of a minimally invasive endoscopic treatment, such as percutaneous resection. Very satisfactory results have been obtained with this technique, which has been performed since 1985.

[Protocol for percutaneous treatment of upper urinary tract urothelial tumors].

We develop the diagnostic methodology to select patients with upper urinary tract urothelial tumors who are candidates for percutaneous endoscopic treatment. This treatment is indicated for low grade and stage lesions in the pyelocalyceal system (> 3 cm), lumbar ureter (> 1-2 cm) and for failures of the retrograde approach. In this protocol, we emphasize the performance of intraoperative biopsy and pyelocalyceal mapping, as well as the need of a second look to rule out residual tumor.

[Antegrade and retrograde endourological techniques. Equipment and methodology].

Low grade and stage upper urinary tract tumors may be treated endoscopically by antegrade or retrograde approach. The approach mainly depends on tumor size and site. Generally, retrograde ureteroscopy is used for small size tumors of the ureter and kidney, whereas the antegrade approach is indicated for bigger tumors in the upper ureter or kidney, or those tumors which cannot be adequately managed in a retrograde manner because of their site (lower calyx) or previous urinary diversion.