PURPOSE: Duplex system is one of the most common anomalies of upper urinary tract. Anatomical and clinical presentation determine its treatment. Usually, the upper moiety has a poor function and requires resection, but when it is not significantly impaired, preservation is recommended. Laparoscopic reconstruction with upper pole preservation is presented as an alternative treatment. MATERIALS AND METHODS: Four female patients with duplex system, one presenting with recurrent urinary tract infection and the others with urinary incontinence associated to infrasphincteric ectopic ureter, were treated. Surgical procedure envolved a laparoscopic ureteropyeloanastomosis of the upper pole ureter to the pelvis of the lower moiety, with prior insertion of a double J stent. RESULTS: Surgical time varied from 120 to 150 minutes, with minimal blood loss in all cases. Follow-up varied from 15 to 30 months, with resolution of the clinical symptoms and preservation of the upper moiety function. CONCLUSION: Laparoscopic ureteropyeloanatomosis is a feasible and safe minimally invasive option in the treatment of duplex system.

PURPOSE: Two different regimens of SWL delivery for treating urinary stones were compared. METHODS: Patients with urinary stones were randomly divided into two groups, one of which received 3000 shocks at a rate of 60 impulses per minute and the other of which received 4000 shocks at 90 impulses per minute. Success was defined as stone-free status or the detection of residual fragments of less than or equal to 3 mm three months after treatment. Partial fragmentation was considered to have occurred if a significant reduction in the stone burden was observed but residual fragments of 3mm or greater remained. RESULTS: A total of 143 procedures were performed with 3000 impulses at a rate of 60 impulses per minute, and 156 procedures were performed with 4000 impulses at 90 impulses per minute. The stone-free rate was 53.1% for patients treated with the first regimen and 54.8% for those treated with the second one (p = 0.603). The stone-free rate for stones smaller than 10 mm was 60% for patients treated with 60 impulses per minute and 58.6% for those treated with 90 impulses per minute. For stones bigger than 10 mm, stone-free rates were 34.2% and 45.7%, respectively (p = 0.483). Complications occurred in 2.3% of patients treated with 60 impulses per minute and 3.3% of patients treated with 90 impulses per minute. CONCLUSION: No significant differences in the stone-free and complication rates were observed by reducing the total number of impulses from 4000 to 3000 and the frequency from 90 to 60 impulses per minute.

Objectives: Vesico-ureteric reflux (VUR) is a common cause of urinary tract infections in children, being less commonly diagnosed in adults. Several anti-reflux plasties have been used successfully for the treatment of such condition, such as Politano-Leadbetter, Cohen and Gregoir-Lich techniques, the latter being our preferred approach in open procedures. Here we describe our experience with laparoscopic Gregoir-Lich anti-reflux plasty (LGLP) in children and adults. Methods: The LGLP was used for the treatment of VUR in 15 patients (7 adults and 8 children). Four adults and 5 children had bilateral disease and both sides were treated at the same procedure. Data was collected prospectively and we analysed age at treatment, laterality, degree of VUR, previous anti-reflux procedures, operative time, number of detrusor stitches used in each side, intra-operative and post-operative complications, success rate and follow-up. Results: A total of 23 ureteral units were treated. VUR was graded as I in one unit, II in 4 units, III in 10 units, IV in 7 units and 1 unit was not classified, as it was diagnosed by radioisotopic cystography. Two children had failed previous endoscopic procedures. There were no open conversions. Two muccosal perforations occurred during the procedure and were successfully treated laparoscopically. Nineteen out of 21 ureteral units (90%) presented no VUR at the cystographic control, and no bladder dysfunction was identified on follow-up. Conclusions: The LGLP is a feasible, minimally invasive alternative for VUR that reproduces the open procedure. It has an excelent success rate and is not associated to bladder disfunction, even in bilateral procedures.

Objetivo: El reflujo vesicoureteral (RVU) es una causa común de infecciones del tracto urinario en niños, siendo diagnosticado con menos frecuencia en adultos. Se han utilizado varias técnicas antirreflujo para el tratamiento de dicha condición, como las técnicas de Politano-Leadbet-ter, Cohen y Gregoir-Lich, siendo ésta última nuestro abordaje preferido en cirugía abierta. Describimos nuestra experiencia con la plastia antirreflujo laparoscópica de Gregoir-Lich en niños y adultos. Métodos: La plastia de Gregoir-Lich laparoscópica fue utilizada en el tratamiento del RVU en 15 pacientes (7 adultos y 8 niños). Cuatro adultos y cinco niños respectivamente tenían reflujo bilateral, tratándose ambos lados en el mismo acto quirúrgico. Los datos fueron recogidos prospectivamente y se analizó edad en el momento el tratamiento, lado, grado de RVU, operaciones antirreflujo previas, tiempo operatorio, número de puntos del detrusor utilizados en cada lado, complicaciones intra y postoperatorias, tasa de éxitos y seguimiento. Resultados: Se trataron un total de 23 unidades ureterales. El RVU fue grado I en 1 uréter, II en 4, III en 10 y IV en 7, en un uréter no se asignó grado porque se diagnosticó mediante cistografía radioisotópica. Dos niños habían tenido operaciones endoscópicas previas que fracasaron. No hubo ninguna conversión a cirugía abierta. Hubo dos casos de perforación mucosa durante el procedimiento que fueron tratadas con éxito por vía laparoscópica. Diecinueve de las 21 unidades ureterales (90%) no presentaban RVU en el control mediante cistografía, y no se identificó disfunción vesical en el seguimiento. Conclusiones: La plastia laparoscópica de Gregoir-Lich es una alternativa factible, mínimamente invasiva para el RVU que reproduce el procedimiento abierto. Tiene un excelente porcentaje de éxitos y no se asocia con disfunción vesical, cruzó en procedimientos bilaterales.

INTRODUCTION: This work evaluates the results of ureteroscopic treatment of impacted ureteral stones with a pneumatic lithotripter. MATERIALS AND METHODS: From March 1997 to May 2002, 42 patients with impacted ureteral stones were treated by retrograde ureteroscopic pneumatic lithotripsy. Twenty-eight patients were female and 14 were male. The stone size ranged from 5 to 20 mm. The ureteral sites of the stones were distal in 21, middle in 12 and proximal in 9. RESULTS: Considering stones with distal location in the ureter, 1 patient had ureteral perforation and developed a stricture in the follow-up (4.7%). As for stones in the middle ureter, 2 perforations and 1 stricture were observed (8.3%) and regarding stones located in the proximal ureter, 5 perforations and 4 strictures occurred (44%). In the mid ureter, 1 ureteral avulsion was verified. In 34 patients without ureteral perforation, only 1 developed a stricture (2.9%). Of 8 patients who had perforation, 6 developed strictures. The overall incidence of stricture following treatment of impacted ureteral calculi was 14.2%. CONCLUSIONS: Ureteroscopy for impacted ureteral calculi is associated with a higher incidence of ureteral perforation and stricture. Ureteroscopy of proximal ureteral calculi is associated with a high risk of perforation, when compared to mid or distal ureteral calculi. Ureteral perforation at the site of the stone seems to be the primary risk factor for stricture formation in these cases.