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ABSTRACT: Four cases of isolated dissection of the renal artery were diagnosed and treated in our institution. In 2 cases, angiography showed dissection of the left renal artery with involvement of peripheral branches; in 1 case, the dissection involved the right renal artery with complete occlusion of an upper-pole branch and upper-pole infarction, and 1 patient presented a bilateral dissection, limited to the main trunk on the right side and involving prepelvic and retropelvic branches on the left side. Surgical treatment consisted in renal autotransplantation in the iliac fossa after extracorporeal reconstruction of the arterial pedicle. The results were encouraging with normalization of blood pressure and improvement of renal function in all cases.
European Urology 02/1993; 24(3):424-7. · 8.49 Impact Factor
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ABSTRACT: Six patients with a stone disease and/or ureteropelvic junction obstruction in a horseshoe kidney underwent percutaneous surgery. No major complications were observed and only 1 patient presented residual fragments in the lower calyx 3 months after treatment. The special features of the use of percutaneous nephrolithotomy and endopyelotomy for this anomaly are described.
European Urology 02/1992; 21(2):134-7. · 8.49 Impact Factor
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ABSTRACT: The hardness and frequent recurrence of cystine stones present a special challenge to the urologist. In this study, 15 cystinuric patients (11 males, 4 females; mean age 36 years, range 17-54) were treated and followed up over a period of 30 months (range 2-40). Most patients had previous history of open surgery. The diagnosis of cystinuria was confirmed by metabolic studies and infrared spectrometry of stones. Over the follow-up period recurrence was observed in 23 instances in 11 patients, leading to 38 "stone treatments" on 74 cystine stones. The percutaneous approach was used alone in 9 cases and in association with extracorporeal shock wave lithotripsy (ESWL) in 9 cases. ESWL was used alone in 18 cases. Medical treatment included high fluid intake, alkalinisation and Thiola (tiopronin, N-(2-mercaptopropionyl)glycine) in 6 patients. The overall stone-free rate assessed 3 months after treatment was 44.7%, which compares poorly with the rate for non-cystine stones. The recurrence rate is very high and instrumental treatment should not therefore be used excessively; it is indicated only for stones that are symptomatic or refractory to intensive medical therapy.
British Journal of Urology 10/1991; 68(3):234-9.
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ABSTRACT: A total of 140 pancreatic transplants have been performed in 132 insulin-dependent diabetic patients at Lyon (France). Most cases received a double pancreatic and renal transplant. The duct obstruction technique was utilized in 113 segmental transplants. A total pancreatic transplant was performed in 27 patients, with duct obstruction in 27, GI tract derivation in 14, urinary tract derivation in 11 and intraductal obstruction in 2 patients. Utilizing quadruple immunosuppression, the one year survival rate was 90% and the transplant survival was 60%.
Revista medica de Chile 03/1991; 119(2):152-7. · 0.33 Impact Factor
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ABSTRACT: The hardness and frequent recurrence of cystine stones represent a special challenge for the urologist. Fifteen cystinuric patients were treated in our department and followed over a mean period of 30 months. Most patients had a previous history of open surgery (1.5 pyelolithotomy/patient). Diagnosis of cystinuria was confirmed by metabolic studies and stone analysis. Over the follow-up period recurrence was observed in 23 instances in 11 patients thus leading to 38 stone treatments on 74 cystine stones. Stone size was less than 10 mm: 35 (47%); 10-20 mm: 21 (28%); 20-30 mm: 14 (19%); 30 mm: 4 (staghorn stones). A percutaneous approach was used in 9 cases as monotherapy (55% success) and in association with ESWL in 10 cases (50% success). ESWL was employed 18 times as monotherapy (39% success). Medical treatment included high fluid intake, alkalinisation and thiola in 6 patients. In conclusion, results obtained are poor in terms of stone clearance when compared to non-cystine stones. Recurrence rate is very high. Instrumental treatment should not be used excessively and is only indicated in symptomatic stones or refractory to intensive medical therapy.
Annales d Urologie 02/1991; 25(1):19-24. · 0.36 Impact Factor
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ABSTRACT: Two cases of fibroepithelial polyps of the upper urinary tract are reported, the conservative management of this benign tumor is described.
European Urology 02/1991; 19(2):178-80. · 8.49 Impact Factor
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British Journal of Urology 12/1990; 66(5):549-50.
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ABSTRACT: Two patients in end-stage renal failure and with neurogenic bladders due to spina bifida complicated by myelomeningocele were considered for renal transplantation. One patient had had a right nephrectomy and urinary diversion via an ileal conduit; the other, after various external drainage procedures (cystostomy, bilateral nephrostomy), had had a tubular ileocystoplasty. Both underwent 2 surgical procedures prior to renal transplantation: in case 1 we performed a left nephrectomy and then ileal conduit removal + Kock pouch; in case 2 a bilateral nephrectomy was performed via 2 posterior incisions and then we removed the ileocystoplasty and formed the pouch. The continent ileostomy was formed according to the original technique with slight modifications. The patients have been followed up for 12 and 15 months after transplantation.
British Journal of Urology 05/1990; 65(4):317-21.
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ABSTRACT: Isolated dissection of renal artery is uncommon; 150 cases were reported in the literature, whose 2/3 diagnosed during patient's life and 1/3 post mortem, during autopsy. From 1976 to 1988 4 cases of isolated dissection of the renal artery were diagnosed and treated in our Institution. Three men and one woman with age ranging from 39 to 46 yrs (mean age 41.75) were seen at our Institution for intense abdominal pain and blood hypertension (mean blood pressure 196.25/113.75 mmHg) of recent occurrence. In 2 cases angiography showed dissection of the left renal artery, with involvement of peripheral branches; in 1 case the dissection involved the right renal artery with complete occlusion of an upper pole branch and upper pole infarction; our youngest patients presented a bilateral dissection, limited to the main trunk on the right side and involving prepelvic and retropelvic branches on the left side. Surgical treatment consisted of renal autotransplantation in the iliac fossa after extracorporeal reconstruction of the arterial pedicule; a branched hypogastric graft was used in 3 patients; in the patient with bilateral dissection an hypogastric graft was used on the right side and a sapehenous graft on the left side (3 months later). Partial nephrectomy was also performed in the patient having right upper pole infarction. Histologic examination showed that dissection always started from lesions of the lamina media. All patient were alive from 6 to 48 months after renal revascularization, with normalization of blood pressure (mean BP 125/80 mmHg); postoperative angiographic control showed thrombosis of 2 small branches in 1 case and partial stenosis of 3 anastomoses in another patient.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal d'urologie 02/1990; 96(2):81-5.
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ABSTRACT: Vesico-ureteric reflux in adult patient may now be treated endoscopically by injecting teflon under the ureteral orifices. Twenty-six ureteral units were treated by this technique in 18 patients. Correction of the reflux was obtained in 22 units (85 p. 100); the technique was ineffective in 4 units (15 p. 100). No complication was observed in this series; in particular, there was no stenosis of the intramural ureter. These encouraging preliminary results have to be confirmed on a long-term basis in large series of patients.
La Presse Médicale 04/1988; 17(8):373-5. · 0.67 Impact Factor
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ABSTRACT: From September 1984 to March 1986, 70 patients with upper ureteral stones were treated in our institution. 43 patients underwent endoscopic procedures including retrograde ureterorenoscopy, antegrade ureterorenoscopy and percutaneous surgery. A second group of 27 patients was treated by extracorporeal shock wave lithotripsy (ESWL). The overall success rate was 74.5 and 85% for the endoscopic and the ESWL groups, respectively. Obstruction and dilatation of the renal collecting system seemed to play a major role in the failure of either endoscopic or ESWL treatment.
European Urology 02/1988; 14(2):111-4. · 8.49 Impact Factor
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ABSTRACT: Submucosal injection of Teflon for treatment of vesicoureteral reflux (the sting of O'Donnell) was used in 43 patients (66 ureters-21 bilateral cases). 14 patients were on dialysis and reflux was diagnosed at medical evaluation during pretransplantation work-up; correction of reflux was indicated as a preparation for renal transplantation. In another group of 24 patients with normal renal function reflux appeared as a simple congenital abnormality. 5 patients had reflux secondary to TUR or ureteral reimplantation. The procedure was performed under general or epidural anesthesia. Ultrasound examination of kidneys was performed 24 hours after the procedure, cystography and UIV was performed after 30, 100 days and one year. No ureteral obstruction were observed. In the first group of patients (on dialysis) correction of reflux was effective in 40% of cases. In the second group (congenital vesicoureteral reflux) correction was observed in 85% of cases (30/35 controlled cases). In the third group correction of reflux was observed in 83% of cases (5/6). Results in the first group of patients may be due to technical difficulties while injecting of Teflon in small, thickened sclerotic bladders. Though longterm results are still to be evaluated. The sting may be beneficial in patients on dialysis waiting for a renal transplant as it obviates the need for bilateral nephrectomy. In simple congenital reflux short and middle term results are excellent.
Journal d'urologie 02/1987; 93(5):263-8.
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ABSTRACT: Surgery plays an important role in the treatment of renovascular Hypertension (RVHT). 123 RVHT carrier patients were treated by means of 101 single autotransplants (11 double autotransplants) and 34 autotransplants preceded by extracorporeal replacement of the branches of the renal artery (1 bilateral case). Taken all round, the patients improved either totally or partly (93.5%). In lesions involving multiple branches of the renal artery, replacement of these by a hypogastric autologous arterial transplant is regularly the only technique possible to save the kidney.
Actas urologicas españolas 13(2):109-13. · 0.46 Impact Factor
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ABSTRACT: Thirteen patients with a benign tumor or pseudotumor of the upper urinary tract underwent endourological treatment on 17 occasions. These patients were divided into two groups according to the anatomopathological findings. Five patients comprised group I. Mean patient age, 57.3 years. These patients had a tumor in the excretory cavity. Endoscopic work up revealed 3 papillary necroses, 1 inflammatory polyp, 1 Von Brun islet. One ureterorenoscopy (biopsy + laser) and four percutaneous (tumor resection) procedures were performed. Eight patients comprised group II. Mean patient age, 59 years. Six patients had pyelocaliceal tumors and two patients had ureteric tumors. Histologic analyses revealed a noninvasive low grade tumor on six occasions and two fibroepithelial polyps. Two ureteric tumors and 1 pelvic tumor were treated by retrograde ureterorenoscopy (2 resections and 1 Nd/Yag laser photocoagulation). Five patients were treated percutaneously (resection alone or combined with Nd/Yag laser). Four patients received local chemotherapy. Patient follow-up ranged from 1 to 3 years. Tumor recurrence was observed in 3 patients treated by percutaneous resection.
Archivos españoles de urología 43(1):51-8.
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ABSTRACT: Endourologic treatment of the ureteropelvic junction syndrome was performed 48 times in 45 patients (1 was bilateral, and 2 required repeat treatment) via a percutaneous incision of the stenosis, and placement of a modelling double-J catheter, which was left indwelling for 4 to 6 weeks. Evaluation of the results between 6 months and 3 years revealed a success rate of 81.5% for secondary stenosis and 73.7% for congenital stenosis. If the foregoing technique fails, pyeloplasty can be performed without difficulty.
Archivos españoles de urología 42(6):552-6.
