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Manejo actual de la Litiasis
Urinaria
Dr. Javier Arancibia
Urólogo Trasplante renal
© European Association of Urology 2015
Conocer El Terreno
Síndrome Metabolico
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
Litotripsia Extracorpórea
Recomendaciones
 Cálculos menores de 2 cm. ó 30 milímetros
cuadrados.
 Densidad menor a 1000 UH.
 Distancia Piel Cálculo menor a 10 cm.
Litotripsia Extracorpórea
Anatomía del cáliz inferior
15 mm
Litotripsia Extracorpórea
Longitud Infundibular
3 cm.
Litotripsia Extracorpórea
Ancho de infundibulo
4 mm.
Litotripsia Extracorpórea
Angulo del infundibulo
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
© European Association of Urology 2015
El Tamaño Importa ?
– Menor de un cm.
• Observación ( Terapia Medica expulsiva)
• LEC
• URS
– Mayor de un cm menor de 2 cm
• LEC
• Valorar dureza Endoscopico vs Laparoscopico
– Mayor de 2 cm
• LEC
• Cirugía Percutánea PNC
Litotripsia Extracorpórea
Litotripsia Extracorpórea
Litotripsia Extracorpórea
Litotripsia Extracorpórea
LEC
Litotripsia Extracorpórea
Litotripsia Extracorpórea
Litotripsia Extracorpórea
Litotripsia Extracorpórea
Complicaciones
 Dolor.
 Hidronefrosis por calle litiasica.
 Fiebre.
 Hematomas.
Litiasis Calicial Inferior
 35% de los pac. Tx. con LEC no eliminan
los cálculos.
 En ausencia de explicación geométrica el
tamaño y dureza de los cálculos es el factor
mas importante.
 Fisiología calicial.
© European Association of Urology 2015
Litiasis Calicial Inferior
Litiasis uréter Superior
• Femenina 36 años.
• Cálculo de 1.5 x 1.0
mm. UUPI.
• No contamos laser.
Post ureterolitotomia Laparoscópica
Resultados Cosméticos
Gracias