Xanthogranulomatous pyelonephritis (XGP) is an uncommon chronic granulomatous infection of renal parenchyma. XGP is often associated with long-term urinary tract obstruction due to stones and infection. We aimed to analyze the clinical, laboratory, and microbial culture profiles from bladder and kidney urine of patients who were diagnosed with XGP. Databases of patients with histopathological diagnosis of XGP from 10 centers across 5 countries were retrospectively reviewed between 2018 and 2022. Patients with incomplete medical records were excluded. A total of 365 patients were included. There were 228 (62.5%) women. The mean age was 45 ± 14.4 years. The most common comorbidity was chronic kidney disease (71%). Multiple stones were present in 34.5% of cases. Bladder urine culture results were positive in 53.2% of cases. Kidney urine culture was positive in 81.9% of patients. Sepsis and septic shock were present in 13.4% and 6.6% of patients, respectively. Three deaths were reported. Escherichia coli was the most common isolated pathogen in both urine (28.4%) and kidney cultures (42.4%), followed by Proteus mirabilis in bladder urine cultures (6.3%) and Klebsiella pneumoniae (7.6%) in kidney cultures. Extended-spectrum beta-lactamases producing bacteria were reported in 6% of the bladder urine cultures. On multivariable analysis, urosepsis, recurrent urinary tract infections, increased creatinine, and disease extension to perirenal and pararenal space were independent factors associated with positive bladder urine cultures. On multivariable analysis, only the presence of anemia was significantly more frequent in patients with positive kidney cultures. Our results can help urologists counsel XGP patients undergoing nephrectomy.

RESÚMEN La nefrolitotomía percutánea (NLPC) es el tratamiento de elección para litos coraliformes y cálculos renales grandes (mayores de 2 cm). El acceso renal percutáneo se puede lograr ya sea guiado por ultrasonido o fluoroscopia. El método de elección depende de la formación y las preferencias personales. El ultrasonido tiene varias fortalezas como herramienta de intervención y ofrece varias ventajas sobre la fluoroscopía: es fácilmente disponible, portátil, relativamente barato así como la reducción de la exposición a la radiación. Si bien existe una curva de aprendizaje para dominar estas técnicas, su adopción puede conducir a una menor exposición a la radiación para los pacientes, urólogos y proveedores de servicios de salud auxiliares al realizar la nefrolitotomia percutánea. Objetivos Describir la técnica quirúrgica, así como las características clínicas de los pacientes sometidos Nefrolitotomía Percutánea con acceso renal guiado por USG en el Hospital Regional De Alta Especialidad de la Península de Yucatán en el periodo enero 2019 a enero del 2021. Material y método Se realizó un estudio observacional, retrospectivo, descriptivo, de los expedientes clínicos de un total de 22 pacientes con diagnóstico litiasis renal corroborado por estudio de tomografía, sometidos a NLPC con punción guiada por ultrasonido. Resultados Se realizaron un total de 22 NLPC con acceso renal guiado por ultrasonido en un periodo de un año (enero 2019 a enero 2020). El 72.7% de los pacientes fueron del sexo femenino y 27.3% del sexo masculino. El 50% (11) tenían obesidad. El 68.2% (15) pertenecían a la clasificación de riesgo anestésico ASA 2, el 22.7% (5) ASA 3 y 9.1% (2) ASA 1. Dentro de las características del lito de acuerdo a la clasificación de GUY Stone Score, el 40.9% (9) contaban con un GUY III y el 27.3% (6) contaban con un GUY IV. Dentro de las características quirúrgicas: el tracto fue realizado en el 45.5% por un fellow de endourología en el (10) 22.7%, (5) por R5, 9.1% (2) por R4 y 22.7% por médico adscrito de endourología. En cuanto al número de punciones, el 45.5% (10) solamente requirieron una punción. 5 pacientes 2 punciones, 5 pacientes 3 punciones, 1 paciente 4 punciones y 1 paciente más 5 punciones; En el 95.5% (21) el tracto fue exitoso, únicamente en un paciente el tracto fue fallido. La punción se realizó en posición de Valdivia/Galdakao en el 90.0% (20) y en posición prono en el 9.1% (2). El número de tractos realizados fue unitracto en el 95.5% (21). Conclusiones El acceso guiado por ultrasonido para la nefrolitotomía percutánea (NLPC) es una técnica segura, efectiva, libre de radiación y de bajo costo que puede ser utilizada en cualquier hospital. Esta técnica requiere de entrenamiento estructurado el cual debe comenzar desde la residencia.

Introduction: Urolithiasis in a solitary kidney is a significant endourological challenge, any procedures to kidney or its drainage can lead to significant morbidity. There is no international consensus for its management. Procedure selection should be based on stone burden, comorbidities, and complications. Objectives: To describe the clinical characteristics, complications, and stone-free rates of patients with solitary kidneys and complex renal stones from July 2017 to September 2023. Materials and methods: A descriptive, retrospective study was conducted on patients with solitary kidneys and renal stones classified as GUY III and IV treated with PCNL. Continuous variables were expressed as means ± standard deviation. T-Student or U-Mann-Whitney tests, χ², Spearman or Pearson correlations, and ANOVA were utilized as appropriate. A P-value <0.05 was considered statistically significant. Results: a total of 318 records were analyzed, of which 26 patients were included, with 84.6 % being female and a mean age of 45.15 years. All patients had a history of previous episodes of renal lithiasis. The mean stone burden was 984.92 mm3, with a STONE SCORE of 9.3. The stone-free rate was 30.8 % after a single procedure, with Clavien-Dindo I complications in 15.38 % of cases and renal function improvement in 57.7 %. Stone burden, Stone Score, and stone density were significantly associated with the stone-free rate. Conclusion: PCNL emerges as one of the most effective and safest techniques with few complications for complex stones in solitary kidney patients, with minimal impact on renal function

Percutaneous nephrolithotomy (PCNL) is the treatment of choice for staghorn stones and large kidney stones (greater than 2 cm). Percutaneous renal access can be achieved either guided by ultrasound or fluoroscopy. The method of choice depends on training and personal preferences. Ultrasound has several strengths as an interventional tool and offers several advantages over fluoroscopy: it is readily available, portable, relatively inexpensive as well as reduced radiation exposure. While there is a learning curve to mastering these techniques, their adoption can lead to less radiation exposure for patients, urologists, and ancillary healthcare providers when performing percutaneous nephrolithotomy. Goals Describe the surgical technique, as well as the clinical characteristics of the patients undergoing Percutaneous Nephrolithotomy with renal access guided by USG at the Hospital Regional De Alta Especialidad de la Peninsula de Yucatán in the period January 2019 to January 2021. Material and methods An observational, retrospective, descriptive study was carried out of the clinical records of a total of 22 patients with a diagnosis of renal lithiasis corroborated by a tomography study, who underwent PCNL with ultrasound-guided puncture. Results A total of 22 PCNL with ultrasound-guided renal access were performed in a period of one year (January 2019 to January 2020). 72.7% of the patients were female and 27.3% male. 50% (11) had obesity. 68.2% (15) belonged to the ASA 2 anesthetic risk classification, 22.7% (5) ASA 3 and 9.1% (2) ASA 1. Within the characteristics of the stone according to the GUY Stone Score classification, the 40.9% (9) had a GUY III and 27.3% (6) had a GUY IV. Among the surgical characteristics: the tract was performed in 45.5% by an endourology fellow in (10) 22.7%, (5) by R5, 9.1% (2) by R4 and 22.7% by an endourology physician. Regarding the number of punctures, 45.5% (10) only required one puncture. 5 patients 2 punctures, 5 patients 3 punctures, 1 patient 4 punctures and 1 patient plus 5 punctures; In 95.5% (21) the tract was successful, only in one patient the tract was failed. The puncture was performed in the Valdivia / Galdakao position in 90.0% (20) and in the prone position in 9.1% (2). The number of tracts performed was unitract in 95.5% (21). Conclusions Ultrasound-guided access for percutaneous nephrolithotomy (PCNL) is a safe, effective, radiation-free and low-cost technique that can be used in any hospital. This technique requires structured training which must start from the residence.

Introduction: in Mexico, bladder tumors rank fourth in urological tumor presentation, accounting for 14.4 % of cases, following prostate, testicular, and kidney cancer. The male-to-female ratio is 3.8:1. Bladder cancer is one of the main causes of consultation in patients with macroscopic hematuria and clot formation. Therefore, it should always be considered as an exclusion diagnosis in these patients due to its potential progression and impact on morbidity and mortality if detected in advanced stages. Objectives: to determine the prevalence and clinical characteristics of registered cases of bladder cancer in the urology department. Materials and methods: this is a descriptive, observational, cross-sectional study that will evaluate the medical records of patients with registered cases of bladder cancer in the Urology Department of the Hospital Regional de Alta Especialidad de la Península de Yucatán in Mexico, from from January 2017 to July 2021. Results: of total 453 genitourinary tumors, 15.62 %, 29 patients with bladder tumor and a 4-year medical follow-up were included, bladder tumor is predominantly found in men with a male-to-female ratio of 3.83 men per woman. The mean age at diagnosis is 65 years. Among modifiable risk factors, smoking is the main factor affecting 44.8 % of the cases. According to the histological classification, the predominant subtype was urothelial carcinoma. The average time from symptom onset to medical attention by the patients was 11.9 months. T4 stage was detected in 27.59 % of the cases, with a mortality rate of 6.9 %. Conclusion: bladder cancer is one of the three most common urological cancers, affecting the quality of life and with a high morbidity and mortality when detected at advanced stages, requiring aggressive surgical procedures with a high risk of complications.