Javier Medrano-Sánchez

Objective: Fluoroscopy has been the most widely used guidance method for percutaneous nephrolithotomy (PCNL); however, radiation exposure is a significant concern. Recently, ultrasound has gained popularity, offering several advantages. The objective was to evaluate the safety and outcomes of the pure-ultrasound PCNL with a two-step tract dilation. Material and Methods: The authors retrospectively analyzed the data of patients from March 2019 to October 2023. In all patients, percutaneous renal access was ultrasound guided, and they were divided into 2 groups: Group 1, all steps of PCNL were performed under ultrasound guidance, and Group 2, tract dilation, confirmation of stone clearance, and exit strategy were done with fluoroscopy. Results: The authors included 100 patients, 60 in Group 1 and 40 in Group 2, with a mean body mass index of 30.8 kg/m2. Mean stone burden was 4,162 mm3, 53% were complex stones and 59% of the cases were without hydronephrosis in the targeted calyx. Fluoroscopy was absent in Group 1 and 20 (11.3-31.5) seconds in Group 2 (P < .001). Complications were present in 13% of the cases. Group 1 patients had a lower complication rate than those in Group 2 (10% and 17%, respectively, P = .27). The authors had a global stone-free rate of 79%, Group 1: 78.3% and Group 2: 80% (P = 1.0). Multivariate analysis revealed that the stone-free rate is associated with the total operative time (P = .002) and the number of tracts (P = .031). Conclusion: Pure ultrasound PCNL is a safe and effective technique, offering a similar stone-free rate compared to fluoroscopy and providing an alternative method to avoid radiation exposure during PCNL. Cite this article as: Pulido-Contreras E, Garcia-Padilla MA, Rios-Melgarejo C, Medrano-Sanchez J, Leon-Verdin MG, Sur RL. Pure ultrasound with two-step dilation vs. combined ultrasoundfluoroscopy in percutaneous nephrolithotomy: Is fluoroscopy still needed? Urol Res Pract. 2025;51(6):217-224.

Percutaneous nephrolithotomy (PCNL) is the treatment for large and complex renal stones. Fluoroscopic guidance is the most used imaging method; however, radiation exposure is a significant concern. Recent studies have shown that ultrasound-guided PCNL is also feasible. To evaluate the safety of the two-step tract dilation technique using ultrasound guidance to avoid radiation exposure. Retrospective evaluation of data of patients treated between February 2019 and January 2023. Two groups were included based on tract dilation: Group 1 (G1): two-step totally ultrasound-guided dilation, and group 2 (G2): fluoroscopy-guided dilation. 100 patients were included, 50 in each group. Body mass index (31.7 vs. 28.7kg/m²; p = 0.002) and stone burden (10,935.69 vs. 5,460.86mm³; p = 0.006) were higher in G1; fluoroscopy was absent in the same group (0 vs. 29.4 sec; p < 0.005). Complications occurred in 13 patients in G1 and in 7 in G2 (p = 0.32); no complications grade 3b, 4 or 5 were observed in either group. The overall stone-free rate was 76% (74% vs. 78%; p = 0.81). Ultrasound-guided PCNL is a safe technique that avoids radiation exposure without compromising clinical outcomes.

Priapism is a partial or total erection which lasts more than 4 hours that occurs in the absence of sexual stimulation. It has an incidence rate of 1.5 per 100,000 people. It is classified as ischemic (low-flow) or non-ischemic (high-flow). Non-ischemic priapism is an atypical presentation characterized by a non-rigid erection without pain, and it is frequently associated with trauma. Our objective is to present this clinical case to highlight the importance of correctly classifying priapism types to provide appropriate treatment and avoid complications. A 37-year-old male with no history of chronic degenerative diseases. Patient's condition began with a morning erection followed by sexual activity. Patient came to the Emergency Room 5 days later since the erection persisted, which he reported was pain-free. He denied recent trauma or the use of erectile stimulants. High-flow priapism was diagnosed via Doppler ultrasound. Selective angioembolization was performed, achieving an immediate detumescence of 40%. Corporal blood gas testing is essential in the initial evaluation of any patient presenting with priapism. For high-flow priapism, conservative management should first be attempted; if priapism persists, embolization of the affected pudendal artery can be offered.

Objective: The aim of this study was to develop and validate a low-cost and reproduc ible training model using gelatin that can be useful for acquiring the necessary skills for successful ultrasound-guided access in percutaneous nephrolithotomy without exposing patients to clinical risks. Methods: A prospective and analytical study involving 12 urology residents was con ducted to validate the model using content and construct validation systems. The study consisted of 2 parts: content validation through expert opinion surveys and construct validation through resident skill assessments before and after training on the model. This model imitates the calyx to puncture and was developed using pitted olives in dense gelatin. The model was constructed for a total cost of $29.7 per unit with an easy and reproducible construction. Each model can be used to perform approxi mately 40 punctures before the image quality deteriorates. Results: Globally, this training model increased skills. Puncture time decreased from 106 to 40.5 seconds after training (P = .002). The study found that the model was accepted by 71.4% of urologists as a safe training alternative and provided a risk-free environment for practicing the 2 skills required for a successful puncture: adjusting the ultrasound machine for an adequate image of the target and surrounding tissues and needle-probe alignment. Conclusion: This model is easy to build, reproducible, and cost-effective. It enhances the residents’ skills to increase success and safety when performing ultrasound-guided percutaneous access. Cite this article as: Pulido-Contreras E, Gonzalez-Villegas HO, Lopez-Hernandez JA, Medrano-Sanchez J, Garcia-Padilla MA. A low-cost gelatin-based model for ultrasound-guided percutaneous renal access. Urol Res Pract. 2025;51(2):54-60.

Patients with chronic kidney disease (CKD) have risk of multiple nutritional and metabolic alterations, including loss of protein and energy, obesity, nutritional deficiency, and complications derived from uremia that manifest with changes in taste and lack of appetite. However, the nutritional status of patients on hemodialysis (HD) is unknown. To determine the nutritional status of patients with CKD with renal replacement therapy receiving HD in a tertiary care center. Observational, ambispective, longitudinal study. The population included patients receiving HD in a third-level hospital. The Malnutrition and Inflammation Score (MIS) was administered to patients who agreed to participate. Together with the identification card, data on name, age, sex, body mass index (BMI), leukocytes, albumin, transferrin level, and HD time were collected. 52 patients were included. Mean age was of 46.51 years (15.54); 34 patients (65.4%) were male and 18 female (34.6%); 1 (1.9%) presented normal MIS, 32 (61.5%) mild MIS, 18 (34.6%) moderate MIS, and 1 (1.9%) severe MIS. Nutritional status is poor in patients with CKD receiving HD, which is why it must include a monitoring protocol that translates into a benefit in the face of patient morbidity and mortality.

Clinical case description: A 48-year-old man had a history of giant platelet disorder and diagnosis of horseshoe kidney with kidney stones. Standard 24 Fr percutaneous nephrolithotomy was performed. Ten days after surgery, the patient presented with clot-forming gross hematuria, resulting in anemia. Arteriovenous fistula was suspected and evaluation at the interventional cardiology service was ordered. Arteriovenous fistula diagnosis was confirmed and superselective embolization was performed in the anterior and posterior segmental artery, with complete resolution of the hematuria. Relevance: To present the uncommon, post-percutaneous nephrolithotomy complication of hematuria secondary to arteriovenous fistula that was resolved through a minimally invasive technique in a patient with a kidney fusion anomaly. Clinical implications: To take measures in that patient group to reduce what can be a life-threatening complication, managing it through superselective embolization to prevent kidney function deterioration. Conclusions: Color Doppler ultrasound-guided percutaneous access aids in the prevention of injury to the renal vasculature during puncture and the use of miniaturized tracts can reduce the development of segmental artery lesion that could later condition fistula formation. Embolization is safe and effective in that group of patients.

Descripción del caso clínico: Masculino de 48 años con antecedente de enfermedad de las plaquetas gigantes y diagnóstico de riñón en herradura con litiasis renal, se realizó nefrolitotomía percutánea estándar 24Fr, se presentó 10 días posteriores al evento quirúrgico con hematuria macroscópica anemizante, formadora de coágulos, por lo que se sospecha de fístula arteriovenosa, se solicita valoración al servicio de cardiología intervencionista confirmando el diagnóstico y realizando embolización superselectiva en arteria segmentaria anterior y posterior, con resolución completa de la hematuria. Relevancia: Presentar una complicación poco frecuente de la nefrolitotomía percutánea como es la hematuria secundaria a fístula arteriovenosa en paciente con anomalía de la fusión renal resuelta mediante mínima invasión. Implicaciones clínicas: Tomar medidas en este grupo de pacientes para reducir esta complicación que puede poner en peligro la vida y el manejo mediante embolización superselectiva para evitar un deterioro de la función renal. Conclusiones: El acceso percutáneo guiado con ultrasonido y Doppler color puede permitir evitar la vasculatura renal durante la punción y el uso de tractos miniaturizados podría reducir el desarrollo de lesión a arterias segmentarias con posterior desarrollo de fistulas. La embolización es segura y efectiva en este grupo de pacientes.

Antecedentes: Los catéteres doble j, son herramientas ampliamente utilizadas en urología, sin embargo, al tratarse de un cuerpo extraño en el tracto urinario estos presentan efectos adversos tras su aplicación hasta en el 30 % de los casos. Estos síntomas son atribuidos a la irritación local del espiral del catéter en la vejiga o si se encuentra en el cáliz renal. Numerosos estudios demuestran que la tamsulosina y algunos anticolinérgicos disminuyen los síntomas relacionados a catéteres ureterales. Materiales y métodos: Se realizó un estudio prospectivo observacional, aleatorizado y comparativo. La distribución se hizo de forma aleatoria de casos consecutivos 1 a 1. Los pacientes fueron sometidos a tratamiento endourológico, con ureteroscopia semirrígida y/o flexible, así como litotricia neumática y/o láser. Se obtuvieron dos grupos, incluyendo un total de 77 pacientes, 39 pacientes asignados al grupo 1 que recibieron tamsulosina 0.4 mg por vía oral cada 24 horas durante un mes posterior a la cirugía y 38 pacientes asignados al grupo 2, que recibieron 20 mg de butilhioscina por vía oral cada 8 horas por un mes posterior a la cirugía. La evaluación se realizó en el consultorio de urología, se aplicó el cuestionario validado Ureteric Stent Symptom Questionnaire (ussq), a la semana 1, 2, y 4 posterior a la inserción del catéter doble J. Resultados: Ambos tratamientos disminuyeron los síntomas irritativos y el dolor desde la segunda semana, presentando significancia estadística en la semana 4 respecto a la basal obtenida en la semana 1 (p<0.05). Además, se observa una mejoría en la calidad de vida con decremento de más de 4.3 puntos del cuestionario validado en la semana 4 (p<0.05). Al comparar ambos grupos de tratamiento no hubo diferencia significativa en la mejoría de los síntomas irritativos, en la mejoría del dolor o en la mejoría de la calidad de vida tras 4 semanas de tratamiento.

Antecedentes: Los catéteres doble j, son herramientas ampliamente utilizadas en urología, sin embargo, al tratarse de un cuerpo extraño en el tracto urinario estos presentan efectos adversos tras su aplicación hasta en el 30 % de los casos. Estos síntomas son atribuidos a la irritación local del espiral del catéter en la vejiga o si se encuentra en el cáliz renal. Numerosos estudios demuestran que la tamsulosina y algunos anticolinérgicos disminuyen los síntomas relacionados a catéteres ureterales. Materiales y métodos: Se realizó un estudio prospectivo observacional, aleatorizado y comparativo. La distribución se hizo de forma aleatoria de casos consecutivos 1 a 1. Los pacientes fueron sometidos a tratamiento endourológico, con ureteroscopia semirrígida y/o flexible, así como litotricia neumática y/o láser. Se obtuvieron dos grupos, incluyendo un total de 77 pacientes, 39 pacientes asignados al grupo 1 que recibieron tamsulosina 0.4 mg por vía oral cada 24 horas durante un mes posterior a la cirugía y 38 pacientes asignados al grupo 2, que recibieron 20 mg de butilhioscina por vía oral cada 8 horas por un mes posterior a la cirugía. La evaluación se realizó en el consultorio de urología, se aplicó el cuestionario validado Ureteric Stent Symptom Questionnaire (ussq), a la semana 1, 2, y 4 posterior a la inserción del catéter doble J. Resultados: Ambos tratamientos disminuyeron los síntomas irritativos y el dolor desde la segunda semana, presentando significancia estadística en la semana 4 respecto a la basal obtenida en la semana 1 (p