Indicaciones y resultados del tratamiento de litiasis renal única asintomática menor de 10mm en adultos

ResumenIntroducciónNo existe evidencia de primer orden que permita emitir recomendaciones inapelables cuando se identifican litos únicos de pequeño tamaño, ya sea en pacientes asintomáticos o como litos residuales después de algún procedimiento invasivo.ObjetivoDescribir la evidencia disponible sobre el pronóstico y tratamiento de litos únicos renales<10mm.MétodosRevisión retrospectiva que incluyó las bases de datos PubMed, MEDLINE, IMBIOMED.ResultadosSe describe el tratamiento para 2 grupos: 1) litiasis renal única<10mm asintomática como hallazgo incidental o por escrutinio, y 2) litiasis renal residual única<10mm después de intervención terapéutica.ConclusionesLos autores concluyen y recomiendan el tratamiento de litos renales asintomáticos siempre que tengan un diámetro≥5mm. Aquellos de menor tamaño deben ser vigilados al menos anualmente previa discusión con el paciente sobre el riesgo de eventos futuros.AbstractIntroductionAt present there is not enough evidence to support final recommendations when small, single kidney stones are identified, either in asymptomatic patients or as residual stone fragments after an invasive procedure.AimTo describe the available evidence in relation to the prognosis and treatment of single kidney stones <10mm.MethodsA retrospective review was carried out utilizing the PubMed, MEDLINE, and IMBIOMED databases.ResultsThe collected information was organized into 2 groups: 1) single asymptomatic kidney stones <10mm as an incidental finding or identified through screening, and 2) single residual kidney stones <10mm after a therapeutic intervention.ConclusionsThe authors recommend treating asymptomatic kidney stones that have a diameter ≥5mm. Smaller stones should be under yearly surveillance once the patient has been informed about the risk for future events

Trans-splenic puncture during percutaneous nephrolithotomy: Outcome spectrum of the same complication

AbstractPercutaneous nephrolithotomy is an endourologic technique commonly used in the management of nephrolithiasis. However, this procedure is not complication-free. Splenic injury is exceptionally rare with a reported rate of 1% from the total case load. We present herein two cases of splenic puncture during percutaneous nephrolithotomy that illustrate two different outcomes. In the first case, the patient remained asymptomatic and was discharged on her third post-operative day after removing the nephrostomy, without any sign of hemodynamic compromise. In the second case, the patient presented with hemodynamic instability and an abdominal computed tomography scan was done that showed free fluid in the peritoneal cavity. Emergency laparotomy was performed and revealed a deep peripheral laceration (20mm×5mm in length) that required splenectomy. After a thorough review of the existing literature, we could find only 11 other instances of injury to the spleen in which treatment outcomes were reported. Patient hemodynamic status was the main factor in deciding on the type of treatment