Objectives: In a swine model of renal ischemia, we compared the effectiveness of the transureteral retrograde cold saline perfusion technique to the traditional method of renal cooling with ice slush, in achieving adequate parenchymal temperatures for functional preservation of the organ. Physiological and histological effects were also assessed. Methods: Twenty-four domestic male pigs were sampled into four groups to be submitted to a 60-minute ischemia of the left kidney without cooling, with either one of the two cooling techniques (cold saline retrograde perfusion or ice slush), or sham surgery. All of them had also a concomitant right nephrectomy. Renal cortical and medullary temperatures were recorded throughout the experiment. Urinary output was measured, and serum renal function tests were carried on, pre-and postoperatively. After 5 days, the animals were euthanized and their kidneys were submitted to histological analysis. Results: Mean renal temperature fell in both groups submitted to kidney cooling. With ice slush, a faster drop was observed and a lower minimum temperature was achieved (5.08C in the cortex and 6.38C in the medulla, vs. 25.48C and 24.98C with retrograde cooling). In the other groups, temperature was unchanged. Urinary output and serum creatinine worsened after the experiment, but without significant differences among groups. The histological analysis showed no differences among the four groups, for the studied ischemia time. Conclusions: Ice slush and retrograde perfusion of cold saline are both effective for cooling the kidney during ischemia. Ice slush is faster in doing so, and it allows much lower temperatures to be achieved in the renal parenchyma. With ischemia time of 60 minutes, no significant differences on the occurrence of functional and histological alterations were detected, even for the group without a cooling procedure.

Substantive scientific and intellectual contributions to the study, conception and design, critical revision, final approval.

Objetivo: Relatar o caso de uma paciente portadora de ureterolitíase que foi submetida à ureteroscopia, procedimento no qual ocorreram dificuldades devido ao histórico de radioterapia pélvica prévia da paciente. Detalhamento do caso: Paciente de 50 anos com história de dor lombar à direita a cerca de um ano com histórico de tratamento oncológico de braquiterapia para câncer de colo uterino. A anamnese revelou que a paciente já possuía história prévia de nefrolitíase, com cálculo de 1,6cm em pelve renal direita, mas após ser submetida à Litotripsia Extracorpórea por Onda de Choque (LECO), evoluiu com uropatia obstrutiva por impactação dos fragmentos de cálculo. Esse quadro levou a paciente a realização de tratamento endourológico. A realização de ureterolitotripsia endoscópica revelou ureter com estenoses em porção distal e paredes fibrosadas, relacionadas o tratamento radioterápico prévio. Considerações finais: Nesses casos, é necessário que o urologista esteja alerta aos antecedentes clínicos de cada paciente, pois – ao se deparar com histórico positivo, terá um sinal de alerta e estará mais preparado mediante possíveis dificuldades considerando que os efeitos adversos do tratamento radioterápico podem alterar os resultados esperados tanto da LECO quando da ureterolitotripsia endoscópica, impondo dificuldades significativas ao tratamento.