Biomedical subjects

Inmaculada Fernández González

Publications and source records attributed to Inmaculada Fernández González.

12 recordsLinked to original sources

PubMed2006

[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 6.5 Fr radial expanding stent with small baskets, a special structure designed to extract small stones < 5mm. RESULTS: The placement and retrieval of bilateral stents were performed without complications, extracting several small stones inside the baskets. CONCLUSIONS: The Stone Sweeper stent may play an important role in the treatment of patients with great stone burden; by dilating the ureter and helping the passage of stones and capturing small residual fragments it may decrease the need of new treatments. Currently, more clinic and research tests with this stent are necessary to determine proper indications and associated complications.

Equipment Design↗

PubMed2005

[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. The difficulty for retrograde examination is on the identification of the ureteral neomeatus, so that in case of failure, antegrade percutaneous approach allows complete ureteral and pyelocalyceal examination and biopsies thanks to the development of flexible endoscopes. The information supplied by these endoscopical examinations of upper urinary tract urothelial tumors (grade, stage, multifocality) allows the choice of radical or conservative (open surgery or endoscopical) treatment.

Female↗

PubMed2005

[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. CONCLUSIONS: Intratesticular varicocele is an infrequent entity which can be associated with testicular pain, scrotal mass and infertility or may be asymptomatic. The diagnosis is established by Doppler ultrasound; if symptomatic, it may be treated by spermatic vein ligation.

Adult↗

PubMed2005

[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. Transrectal ultrasound showed a complicated utriculum cyst. RESULTS: Endoscopical marsupialization of the cyst was performed with complete remission of hemospermia. CONCLUSIONS: Transrectal ultrasound should be performed in all patients presenting with long-term hemospermia. Endoscopical marsupialization of the mullerion duct cyst is indicated in symptomatic patients or those with complex cysts on ultrasound, offering a high cure/improvement rate in this group of patients without secondary effects.

Cysts↗

PubMed2005

[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. calibre. Once the cone is placed above the stone it is maintained in that position during lithotripsy to avoid fragment migration. The external catheter is used to coil and unroll the cone, and allows access to place the cone above the stone. METHODS: We describe two cases of urinary calculi in the left lumbar ureter treated by ureteroscopy and intracorporeal lithotripsy with holmium YAG laser using the Stone Cone to avoid migration of fragments. RESULTS: One month after surgery no lithiasic fragments were observed in the imaging tests. CONCLUSIONS: The Stone Cone decreases the need to perform repeated ureteral instrumentations, and is also a safer and simpler method for the extraction of stone fragments. The use of Stone Cone seems to have more advantages than Dormia's basket during ureteroscopic lithotripsy in terms of lower incidence of residual fragments and reoperation rate.

Adult↗

PubMed2004

[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. This article presents the techniques of retrograde ureteroscopy and percutaneous antegrade resection, as well as the equipment needed for adequate endoscopic treatment of the upper urinary tract urothelial tumors.

Humans↗

PubMed2004

[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.

Humans↗

PubMed2004

[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. Nevertheless, theoretically there exists a potential risk of disseminating tumor cells when performing this technique. The objective of this article is to review our experience, and that of other groups, performing percutaneous resection of upper urinary tract tumors, and to determine the incidence tumor dissemination. METHODS: We performed a bibliographic search in Medline (PubMed) and reviewed the articles about upper urinary tract tumors treated by percutaneous resection. We also evaluated the incidence of tumor dissemination related to surgery RESULTS: Published data show a very low incidence of tumor dissemination after endoscopic resection by a percutaneous approach. Theoretically tumor dissemination can be the result of dissemination to the blood or lymphatic circulation, or the implant of tumor cells in the contiguous or distant urothelial mucosa, or propagation of these tumor cells to the retroperitoneal space or the nephrostomy track. CONCLUSIONS: Percutaneous endoscopic resection of upper urinary tract urothelial tumors is a safe and effective technique that enables a minimally invasive and nephron sparing treatment. If some precautions are taken, this surgical technique does not involve a significant risk for tumor cell dissemination.

Humans↗

PubMedDate not supplied

["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. CONCLUSIONS: Morbidity associated with "miniperc" PCNL seems to be lower than with the standard PCNL, but the use a smaller calibre tract with the only aim to preserve renal parenchyma does not offer advantages. It is a complementary technique to the standard PCNL; however, the diameter of the percutaneous access is not well defined yet and depends on the calibre of the instruments used.

Humans↗

PubMedDate not supplied

[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. RESULTS: Three cases of cystic ectasia of the rete testis were diagnosed over the six-year period, in all the indication for ultrasound was testicular pain. Mean patient age was 62 years. No patient developed testicular tumor on follow-up. CONCLUSIONS: The knowledge of the ultrasound characteristics found in the cystic ectasia of the rete testis helps to make a proper diagnosis of this benign entity without the need of indication of testicular biopsy.

Dilatation, Pathologic↗

PubMedDate not supplied

[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. CONCLUSIONS: Although the clinical significance of testicular microlithiasis is under debate due to the various controversies found in the literature about its association or not with testicular tumors, as well as the various protocols for initial management and adequate intervals for follow-up, it seems reasonable to perform an ultrasound yearly independently of the existence or not of associated risk factors.

Calculi↗

PubMedDate not supplied

[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. The incidence of observed complications was calculated and the relationship between post-biopsy fever and type of antibiotic prophylaxis employed (oral ciprofloxacin vs. intramuscular tobramycin) was studied by means of the chi-square test, using the SPSS 11.5 for Windows; a p < 0.05 was considered significant. RESULTS: Overall, 705 questionnaires were received; 603 (85.5%) were considered valid for processing. Almost three quarters (73.9%) of the patients undergoing biopsy presented some complications, being hematuria the most frequent (53% of the cases). 40 patients presented fever (6.64%). Among 360 patients treated with oral ciprofloxacin for three days 16 developed fever (4.4%), in comparison to 24 patients out of 243 treated with intramuscular tobramycin (9.87%) (p = 0.009). CONCLUSIONS: Ultrasound guided transrectal prostatic biopsy is associated with frequent complications, although most of them are mild. The most frequent complication is hematuria; fever is the most severe. To prevent post-biopsy fever, antibiotic prophylaxis with ciprofloxacin for three days is more effective than single dose intramuscular tobramycin. However, prospective randomize studies are required to confirm it.

Antibiotic Prophylaxis↗