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INTRODUCTION: Percutaneous Nephrolithotomy (PCNL) is currently the treatment of choice in large kidney stones. Guy's stone score was developed to predict treatment outcomes. The aim of this study was to evaluate the relationship between Guy's score and outcomes in our institution. MATERIALS AND METHODS: The medical records of patients diagnosed with urolithiasis and treated by PCNL were retrospectively evaluated between January 2017 and December 2018. Analyzed data included: age, sex, Guy's score based on preoperative findings, transfusion, stone-free rate and requirement of auxiliary procedures. Chi-square test was used for the comparison of proportions. Odds ratios (OR) with confidence intervals (CIs) of 95% were calculated by logistic regression. RESULTS: A total of 386 patients, 53.89% female, mean age of 45.59 ±â€¯15 years were analyzed. Guy's score was as follows: 112 patients (29.04%) were classified as Guy I, 92 patients (23.82%) as Guy II, 94 patients (24.34%) as Guy III, and 88 patients (22.80%) as Guy IV. There were no differences between groups in terms of blood transfusions. Stone-free rate was 96.43% (n = 108) for patients Guy I; 84.78% (n = 72) for Guy II; 76.59% (n = 72) for Guy III and 50% (n = 44) for Guy IV categories (p < 0.0001). Taking as a reference Guy I group, the OR to require new treatment for residual stones were: Guy II 4.85 (CI = 0.95 to 24.60, P = 0.05) to Guy III 8.25 (CI = 1.73 to 39.44, P = 0.008) and Guy IV 27 (CI = 5.84 to 124.70; p < 0.0001). CONCLUSION: There was a statistically significant association between Guy's Score and stone-free rates following PCNL. Guy's score was useful to predict results of PCNL in our group.

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Desde la primera introducción de la nefrolitotomía percutánea (NLP) por Fernstrom y su popularización en EE. UU. por Smith, la NLP se ha convertido en el estándar de oro para pacientes con cálculos renales de gran tamaño.1 Las opciones actuales para el tratamiento de cálculos renales son: la litotripcia extracorpórea, la ureterorrenoscopia flexible y la NLP, escogiendo cada una según el tamaño del cálculo, la anatomía del sistema colector, las características del paciente y las preferencias del especialista.2 Para cálculos piélicos o de cáliz superior mayores de 2 cm o para cáliz inferior mayores de 1,5 cm, se prefiere la NLP.2

Since the first introduction of percutaneous nephrolithotomy (PNL) by Fernstrom and its popularization in the US by Smith, PNL has become the gold standard for patients with large kidney stones.1 Current options for the treatment of kidney stones include extracorporeal lithotripsy, flexible ureterorenoscopy, and PNL, each chosen according to the size of the stone, the anatomy of the collecting system, the patient's characteristics, and the specialist's preferences.2 For upper calyx or skin stones larger than 2 cm or for lower calyx larger than 1.5 cm, PNL is preferred.2

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A antibioticoprofilaxia (ATBp) em Urologia tem sido um assunto controverso por décadas, apesar de já haver estudos suficientes que justifiquem seu emprego. O aumento da resistência da Escherichia coli torna necessária a adequação da ATBp para cada hospital. O objetivo primário é avaliar a adequabilidade da ATBp proposta para os procedimentos endoscópicos no Hospital do Servidor Público Municipal (HSPM).Trata-se de estudo transversal, retrospectivo e observacional compreendendo os pacientes submetidos a cirurgias endoscópicas no Serviço de Urologia do HSPM no período de julho de 2013 a julho de 2014. Os critérios de inclusão do estudo foram procedimento cirúrgico endoscópico realizado no HSPM e resultado de urocultura até um mês após a cirurgia. O perfil de resistência bacteriana das amostras coletadas foi analisado e comparado ao esquema de ATBp recomendado pela Comissão de Controle de Infecção Hospitalar (CCIH) do HSPM.Foram analisados 255 pacientes dentre os quais 83 pacientes possuíam urocultura no período peri-operatório, sendo 15 uroculturas positivas no pós-operatório. Todos os pacientes foram submetidos à ATBp com cefazolina. Os procedimentos que tiveram urocultura positiva foram: 4 RTU de próstata, 4 RTU de bexiga, 4 ureterolitotripsias endoscópicas e 3 implantes de catéter Duplo J. As bactérias identificadas foram: 10 (67,5%)Escherichia coli, 1 (6,5%) Enterococcus faecalis, 1 (6,5%) Klebsiella pneumoniae, 1 (6,5%)Proteus mirabilis, 1 (6,5%) Providencia stuartii e 1 (6,5%) Bacilo Gram Negativo. Em um paciente foi identificado E. coli produtora de Betalactamase de Espectro Ampliado (ESBL). Dentre as 13 bactérias analisadas, 7 (54%) foram sensíveis à cefalotina. Se analisarmos somente as E. coli, 5 (50%) são sensíveis à cefalotina e ciprofloxacino.

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Objetivos: La endourología con procedimientos menos invasivos ha sustituido la cirugía convencional en el manejo de algunas patologías, con una baja morbilidad y altos índices de resolución. El progreso de la ureteroscopia con disminución del calibre del instrumental y mejoría de los sistemas ópticos y accesorios han permitido mejor acceso y visión del tracto urinario, disminuyendo los índices de complicaciones. Material y Método: análisis retrospectivo de nuestra experiencia en el abordaje ureteroscópico de lalitiasis ureteral durante el período febrero 2004 - diciembre 2005. Se definió el éxito de la cirugía según la fragmentación completa de la litiasis y la desobstrucción respectiva. Resultados: Se realizaron 50 cirugías, distribuidas en rango etareo 18-83 años, 28 pacientes de sexo masculino y 22 de sexo femenino. El tamaño litiásico abordado varió de 0,5 -2 cm. Se logró la fragmentación completa del cálculo en 92 por ciento de los casos, en 2 pacientes se logró fragmentación parcial y en otros 2 no se logró el acceso por migración de la litiasis. Se describen como complicaciones las inherentes al procedimiento, hematuria, perforación ureteral localizada y 1 caso de falsa vía. Conclusiones: La ureterolitotomia endoscópica resulta un procedimiento seguro y eficaz en la resolución de la litiasis ureteral distal con baja morbilidad asociada, la disponibilidad de la litotripsia intracorporea permite mayor flexibilidad en la indicación de esta técnica. Constituye nuestra modalidad de elección, considerando la poca disponibilidad de litotripsia extracorpórea.

Introduction: Endourology has replaced conventional surgery in management of several urological diseases, with a low morbidity and excellent results. The progress of ureteroscopy with reduced and improved instruments and more advanced optical systems have allowed better access and vision of the urinary tract, reducing the rates of complications. Material and Methods: Retrospective analysis of our experience in the ureteroscopic management of ureteral stones during the period from February 2004 - December 2005. Succesful surgery was define We define as successful according to both the fragmentation of the stones and resolution of obstruction. Results: Fifty surgeries were performed in patients with an age range 18-83 years. Male to female ratio was 3/2. Stone tone size ranged from 0.5 to 2 cm. Complete fragmentation was achieved in 92 percent of the cases, 2 patients achieved partial fragmentation and in one case we experienced migration of stone and the procedure was not completed. The complications rate observed I the series was low. Conclusions: Endourological management of ureteral stones is safe and effective for the resolution of distal ureteral calculi with low morbidity. Availability of intracorporeal lithotripsy allows greater flexibility in the indication of this technique. In our hands this woud be the technique of choice.

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