Manejo de la litiasis asociada a estenosis intrarrenales mediante el uso del videoureterorrenoscopio flexible

Abstract

OBJETIVO: Reportar dos casos de estenosis intrarrenales asociado a litiasis manejados con el videoureterrenoscopio flexible (STORZ) y el láser de Holmium (CALCULASE II) como herramienta tecnológica y moderna. MATERIAL Y MÉTODOS: El caso 1 presentaba un divertículo calicial el cual fue tratado mediante la incisión del ostium diverticular con láser y posterior tratamiento de la litiasis. El segundo caso presentaba una estenosis del ostium caliceal secundario a una cirugía percutánea previa pudiendo acceder al cáliz mediante la dilatación del mismo. RESULTADOS: El tiempo quirúrgico fue de 60 y 82 minutos para el caso 1 y 2, con una estancia hospitalaria de 8 horas y sin complicaciones perioperatorias. La tasa libre de enfermedad fue del 100%. CONCLUSIONES: El videoureterorrenoscopio flexible y laser de Holmium para el manejo de las estenosis intrarrenales es altamente efectivo y seguro con las ventajas de presentar menos complicaciones perioperatorias, menos invasividad y ser ambulatorio comparado con la cirugía percutánea.

OBJECTIVE: Intrarenal stenosis, even caliceal diverticula or neck diverticular stenosis, associated with lithiasis are infrequent therefore their management is a challenge. The aim of this article is to report two cases who underwent retrograde intrarenal surgery and Holmium laser as a modern technological tool, proposing a new gold standard. METHODS: We report 2 cases of intrarenal stenosis associated with lithiasis managed with flexible videoureteroscope (STORZ) and Holmium laser (CALCULASE II). One case presented a caliceal diverticulum and the other a caliceal ostium stenosis secondary to previous percutaneous surgery. The ostium was incised with laser to access the diverticulum in the first case and in the second case a dilatation was required. Lithiasis treatment was performed with laser. Disease free rate was defined when the cavity completely disappeared and lithiasis fragments were less than 2 mm on CT Scan one month after procedure. RESULTS: Surgical time were 60 and 82 minutes for cases 1 and 2, respectively. Both patients evolved satisfactorily with 8 hours hospital stay and without perioperative complications. The disease-free rate was 100%. CONCLUSION: Flexible videoureterorrenoscopy and Holmium laser for the management of intrarenal stenosis are highly effective and safe with the advantages of less perioperative complications, less invasiveness and being an outpatient procedure compared to percutaneous surgery.