Validez actual de la litotricia extracorpórea como tratamiento de primera línea de la litiasis / Is extracorporeal lithotripsy a first-line treatment for urinary stones today?

Objetivo Evaluar la eficacia y complicaciones de la litotricia extracorpórea por ondas de choque (LEOCh) como tratamiento de primera línea de la litiasis renal y ureteral. Métodos Estudio observacional retrospectivo de todos los pacientes tratados con litotricia en un centro de tercer nivel entre enero de 2014 y enero de 2021. Se recogieron las características de los pacientes, de la litiasis, y las complicaciones y resultados de la LEOCh. Se realizó una regresión logística multivariante de los factores asociados a la reducción del tamaño litiásico. También se llevó a cabo un análisis estadístico de los factores asociados a la necesidad de tratamiento adicional tras la LEOCh y de los factores asociados a las complicaciones. Resultados Se incluyeron 1.727 pacientes. El tamaño litiásico medio fue de 9,5 mm. En 1.540 (89,4%) pacientes se observó la reducción del tamaño litiásico. En el análisis multivariante, el tamaño (OR=1,13; p=0,00), la localización de la litiasis en el uréter (OR=1,15; p=0,052) y el número de ondas (p=0,002; OR=1,00) utilizadas en la LEOCh son los factores asociados a la reducción del tamaño litiásico. Un total de 665 pacientes (38,5%) precisaron tratamiento adicional tras la litotricia. Los factores asociados a la necesidad de retratamiento fueron el tamaño litiásico (OR=1.131; p=0,000), el número de ondas (OR=1.000; p=0,000) y la energía administrada (OR=1.005; p=0,000). En 153 pacientes (8,8%) se produjeron complicaciones tras la LEOCh. Se encontró una asociación estadísticamente significativa entre el tamaño de la litiasis (p=0,024; OR=1.054) y la derivación urinaria previa (p=0,004; OR=0,571). Conclusión La litotricia sigue siendo eficaz como tratamiento de primera línea para la litiasis reno-ureteral, con un bajo porcentaje de complicaciones. (AU)

Objective To evaluate the efficacy and complications of extracorporeal lithotripsy (SWL) as a first-line treatment for renal and ureteral stones. Methods Retrospective and observational study of all the patients treated with lithotripsy in a third level center between January 2014 and January 2021; characteristics of the patients, the stones, complications and results of SWL is recollected. Multivariate logistic regression of the factors associated with stone size reduction was performed. A statistical analysis of the factors associated with additional treatment after SWL and factors associated with complications is also executed. Results 1727 patients are included. Stone mean size was 9,5 mm. 1540 (89.4%) patients presented reduction in stone size. In multivariate analysis, stone size (OR=1.13; P=0.00), ureteral location of the lithiasis (OR=1.15; P=0.052) and number of waves (P=0.002; OR=1.00) used in SWL are the factors associated with reduction of stone size. Additional treatment after lithotripsy was needed in 665 patients (38.5%). The factors associated with the need for retreatment were stone size (OR=1.131; P=0.000), number of waves (OR=1.000; P=0.000), energy (OR=1.005; P=0.000). 153 patients (8.8%) suffered complications after SWL. A statistically significant association was found between the size of the lithiasis (P=0.024, OR=1.054) and the previous urinary diversion (P=0.004, OR=0.571). Conclusion Lithotripsy remains an effective treatment as the first line of therapy for reno-ureteral lithiasis with a low percentage of complications. (AU)

¿Cómo calcular el volumen litiásico y cuál es su aplicación quirúrgica? / How to estimate stone volume and its use in stone surgery: A comprehensive review?

Objetivo Las guías actuales para el tratamiento intervencionista sugieren el diámetro acumulativo de la litiasis (DAL) como factor decisivo en la elección del tratamiento quirúrgico óptimo (ureteroscopia [URS], litotricia extracorpórea por ondas de choque [LEOCh] y nefrolitotomía percutánea [NLPC]). El volumen litiásico (VL) se ha introducido recientemente para obtener una estimación más precisa de la carga litiásica. El objetivo de esta revisión es resumir los métodos disponibles para calcular el VL y su aplicación quirúrgica. Material y métodos En diciembre de 2022 se realizó una revisión sistemática de la literatura mediante búsquedas en las bases de datos Embase, Cochrane y Pubmed. Los artículos se consideraron elegibles si describían la medición del VL o la tasa libre de litiasis (TLL) tras diferentes modalidades de tratamiento (LEOCh, URS, NLPC) o la expulsión espontánea, basándose en la medición del VL. Dos revisores evaluaron de forma independiente la elegibilidad y la calidad de los artículos y realizaron la extracción de datos. Resultados En total se incluyeron 28 estudios. Todos los estudios utilizaron diferentes técnicas para calcular el VL. La medición automática del volumen pareció ser más precisa que la estimación del volumen. Los estudios in vitro mostraron que la medición automática del volumen se ajustaba más al volumen real de la litiasis, con una menor variabilidad interobservador. A diferencia de la NLPC y la LEOCh, en la URS se observó que el VL era un mejor predictor de mejor la TLL que el diámetro litiásico mayor o el diámetro acumulativo en litiasis >20mm. Conclusiones Calcular el VL —de forma manual o automática— es factible, y probablemente se ajuste más a la carga litiásica real. Aunque en el caso de las litiasis grandes tratadas mediante cirugía intrarrenal retrógrada el VL parece predecir mejor la TLL, la superioridad del VL en todas las cargas litiásicas y para todos los tipos de tratamiento está aún por demostrar. ... (AU)

Objective Current interventional guidelines refer to the cumulative stone diameter to choose the appropriate surgical modality (ureteroscopy (URS), extracorporeal shockwave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL)). The stone volume (SV) has been introduced recently, to better estimate the stone burden. This review aimed to summarize the available methods to evaluate the SV and its use in urolithiasis treatment. Material and methods A comprehensive review of the literature was performed in December 2022 by searching Embase, Cochrane and Pubmed databases. Articles were considered eligible if they described SV measurement or the stone free rate after different treatment modalities (SWL, URS, PCNL) or spontaneous passage, based on SV measurement. Two reviewers independently assessed the eligibility and the quality of the articles and performed the data extraction. Results In total, 28 studies were included. All studies used different measurement techniques for stone volume. The automated volume measurement appeared to be more precise than the calculated volume. In vitro studies showed that the automated volume measurement was closer to actual stone volume, with a lower inter-observer variability. Regarding URS, stone volume was found to be more predictive of stone free rates as compared to maximum stone diameter or cumulative diameter for stones >20mm. This was not the case for PCNL and SWL. Conclusions Stone volume estimation is feasible, manually or automatically and is likely a better representation of the actual stone burden. While for larger stones treated by retrograde intrarenal surgery, stone volume appears to be a better predictor of SFR, the superiority of stone volume throughout all stone burdens and for all stone treatments, remains to be proven. Automated volume acquisition is more precise and reproducible than calculated volume. (AU)

Innovaciones tecnológicas en la litotricia de ondas de choque / Technological innovations in shock wave lithotripsy

Introducción Desde 1980, la litotricia extracorpórea por ondas de choque (SWL) ha sido empleada en el tratamiento de las litiasis urinarias, ofreciendo alternativas no invasivas a las técnicas quirúrgicas. Aunque limitada por tamaño y ubicación de las piedras, su efectividad se ve afectada por varios factores. A pesar de la evolución de técnicas quirúrgicas, la SWL podría mantener su relevancia con nuevos avances. Nuestro objetivo es revisar la bibliografía existente para recopilar los mayores avances hasta la fecha en el tratamiento extracorpóreo de la litiasis. Material y métodos Se ha realizado una revisión bibliográfica no sistemática, entre los años 2017 a 2023 para obtener 26 artículos sobre 3 tipos de innovación tecnológica en litotricia extracorpórea: Burst Wave Lithotripsy (BWL), Histotripsy y Microbubble Lithotripsy (ML). Resultados La BWL emplea ondas sinusoidales ultrasónicas de menor y mayor frecuencia que la SWL tradicional. Su mecanismo de acción genera una fragmentación de mayor calidad (finos fragmentos) en lugar de generar fuerzas tensionales como en la SWL tradicional que generan líneas de fractura que dan lugar a fragmentos de mayor tamaño. Resultados en cerdos y humanos han mostrado fragmentación efectiva con buen perfil de seguridad. Basada en la tecnología de ultrasonido focalizado de alta intensidad (HIFU), la histotricia fragmenta tejido empleando fenómenos de cavitación. Han mostrado buenos resultados in vitro, aunque la formación de microburbujas que se interponen entre la litiasis y las ondas de ultrasonido son un impedimento para el progreso de esta técnica. La ML combina microburbujas y ultrasonido para fragmentar litiasis con seguridad y eficacia. Resultados in vitro y en cerdos son prometedores. Puede optimizar tratamientos y reducir niveles energéticos. Conclusiones La innovación tecnológica no solo se está aplicando a técnicas endourológicas, sino también a la ESWL. ... (AU)

Introduction Since 1980, extracorporeal Shock Wave Lithotripsy (SWL) has been employed in the treatment of urolithiasis, offering noninvasive alternatives to surgical techniques. In addition to being limited by the size and location of the stones, its efficacy is influenced by several factors. Despite the advancement of other surgical techniques, SWL could maintain its position with new improvements. Our objective is to review the existing literature on the latest advances in the extracorporeal treatment of lithiasis. Material and methods A non-systematic literature review was carried out from 2017 to 2023 to obtain 26 articles on three different emerging technologies in extracorporeal lithotripsy: Burst Wave Lithotripsy (BWL), Histotripsy, and Microbubble Lithotripsy (ML). Results The BWL uses sinusoidal bursts of US waves delivered at lower and higher frequencies than conventional SWL. Its mechanism of action generates a higher quality fragmentation (fine fragments) instead of generating tensile stresses for stone fracture resulting in larger fragments, as in traditional SWL. Studies in pigs and humans have shown effective fragmentation with a good safety profile. Based on High Intensity Focused Ultrasound (HIFU) technology, histotripsy fragments tissue through cavitation. Good in vitro results have been shown, but the formation of microbubbles between the stone and ultrasound waves hinders the progress of this technique. Microbubble Lithotripsy (ML) combines microbubbles and ultrasound for safe and effective stone fragmentation. In vitro and pig results are promising. This technique can help optimize treatments and reduce energy levels. Conclusions Technological innovation is not only being applied to endourological techniques, but also to ESWL. New techniques such as BWL, histotripsy and ML are promising, with good results in the research phase. (AU)

Litotricia extracorpórea por ondas de choque (LEOCh) Para litiasis de grupo calicial inferior: ¿cómo predecir el éxito del tratamiento? / Extracorporeal shock wave lithotripsy for lower calyx stones: Predicting treatment success

Introducción El uso de la litotricia extracorpórea por ondas de choque (LEOCh) en litiasis de grupo calicial inferior (GCI) se asocia con una alta tasa de fragmentos residuales. Nuestro objetivo es analizar la efectividad y complicaciones del tratamiento con LEOCh en litiasis de GCI. Métodos Revisión retrospectiva de pacientes con litiasis en GCI tratadas con LEOCh entre enero 2014 y diciembre del 2020. Se determina anatomía favorable del GCI mediante longitud infundibular, ancho infundibular y ángulo infundibulopélvico. Se considera fracaso de LEOCh la presencia de fragmentos >3mm en radiografía simple, TC o ecografía a los 3 meses del procedimiento. Análisis de complicaciones, procedimientos auxiliares y factores de riesgo asociados con hematoma perirrenal. Análisis estadístico mediante software SPSS. Resultados En total, 512 pacientes con litiasis en GCI fueron tratados con LEOCh. El 80,3% de los pacientes tenía anatomía GCI favorable. La tasa libre de litiasis (TLL) fue 70,5%. Las principales complicaciones fueron: calle litiásica (5 pacientes) e infección del tracto urinario (3 casos). Se describen 10 hematomas perirrenales (2%). La toma de antiagregantes mostró asociación estadística con el riesgo de hematoma perirrenal (p=0,004). Mediante regresión logística binaria se demuestra asociación entre anatomía desfavorable del GCI (p=0,000), tamaño de litiasis (p=0,001), número de ondas de choque (p=0,003), energía aplicada (p=0,038) y necesidad de tratamiento adicional tras LEOCh. Conclusiones El tratamiento con LEOCh puede ser considerado de primera elección en litiasis de GCI. El tamaño de la litiasis, anatomía calicial desfavorable, número de ondas de choque y energía utilizadas pueden predecir la necesidad de retratamiento. (AU)

Introduction The use of extracorporeal shock wave lithotripsy (ESWL) for lower calyx stones is associated with a high rate of residual fragments. Our aim is to analyse the effectiveness and complications of ESWL for lower calyx stones. Methods Retrospective review of patients with lower renal calyx stones treated with ESWL between January-2014 and December-2020. Measurement of infundibular length, infundibular width and infundibulopelvic angle in lower renal pole to determine favourable anatomy. ESWL failure: fragments >3mm detected in plain abdominal film, CT scan and/or renal ultrasound 3 months after treatment. Complications after ESWL, auxiliary procedures along with risk factors associated with perirenal haematoma were analysed. SPSS statistical software was used. Results 512 patients with lower calyx stones were treated with ESWL. 80.3% of patients had a favourable anatomy. Overall stone-free rate was 70.5%. Regarding main complications after ESWL, stainstrasse was described in 5 patients and urinary tract infection in 3 patients. 10 perirenal haematomas (2%) were reported. Statistical association was found between antiplatelet treatment and the risk of perirenal haematoma (p=0.004). Logistic binary regression proved the association between unfavourable anatomy of the lower renal pole (p=0.000), size of the stone (p=0.001), number of shock waves (p=0.003), energy applied (p=0.038) and the need for additional treatment after ESWL. Conclusions ESWL can still be considered as the initial treatment option for lower renal pole stones. The size of the stone, an unfavourable anatomy of the lower renal calyx, number of shock waves and energy applied can help predict the need for additional treatment. (AU)

Is Extracorporeal Shock Wave Lithotripsy a Treatment Option for Renal Colic?

Background: Renal colic is characterized by sharp, intense flank pain. Nonsteroidal anti-inflammatory drugs are the treatment of choice, although extracorporeal shock wave lithotripsy (SWL) is a noninvasive alternative for pain management. The objective of our study is to present results obtained using rapid SWL to treat renal colic in our center. Methods: We analyzed 214 patients undergoing rapid shockwave extracorporeal lithotripsy between October 2014 and June 2018: 69.63% were male, and 30.37% female, with a mean age of 47.35 years (range, 16–84). The average stone size was 6.71 mm (3–16). Stone locations were as follows: The pelviureteric junction (PUJ) (10.75%), proximal ureter (45.79%), midureter (24.77%), and distal ureter (18.69%). Results: Pain relief was achieved in 81.31% of the patients. The rates of successful pain control according to stone location were 65.22% when the stone was located in the PUJ, 79.59% in the proximal ureter, 88.68% in the midureter, and 85.00% in the distal ureter. Complete or partial stone resolution was achieved 4 weeks postoperatively in 78.50% of cases (64.95% and 13.55%, respectively). According to the stone location, the overall rate of resolution (complete + partial) was 90.00% for distal ureteral stones, 86.80% in the midureter, 73.47% in the proximal ureter, and 60.86% in the PUJ. 44 patients (20.56%) demonstrated complications. The most common complications were persistent pain, acute renal failure and fever. Conclusions: Immediate SWL was found to be a safe and effective treatment option for pain related to renal colic in 81% of the patients studied (AU)

Effect of Flexible Ureteroscopic Lithotripsy on Surgical Outcomes, Renal Function and Quality of Life of Patients with 2–3 cm Renal Calculi

Aim: This retrospective study aims to analyse the effect of flexible ureteroscopic lithotripsy (FURSL) on the surgical outcome, renal function (RF) and quality of life (QoL) of patients with 2–3 cm renal calculi. Methods: A total of 111 patients with renal calculi (2–3 cm) admitted from January 2019 to May 2022 were selected. Among them, 55 patients who underwent minimally invasive percutaneous nephrolithotomy (PCNL) were set as the control group and 56 patients treated with FURSL served as the research group. The control group consisted of 29 males and 26 females aged (43.31 ± 6.49) years on average. The research group consisted of 31 males and 25 females, with a mean age of (42.46 ± 7.44) years. Parameters such as surgical outcomes (stone clearance rate, bleeding volume, operation time and postoperative recovery time), incidence of adverse reactions (ARs: Gross hematuria, fever, urinary tract infection (UTI) and urinary tract injury), RF (blood urea nitrogen (BUN) and serum creatinine (Scr)), pain degree and QoL were compared. Results: No significant difference in the stone clearance rate was found between the groups. Compared with the control group, the research group had statistically longer operation time, less bleeding, postoperative recovery time, and incidence of ARs and pain and obviously higher QoL. BUN and Scr differed insignificantly between the groups before and after surgery. Conclusions: FURSL can accelerate postoperative recovery in patients with 2–3 cm renal calculi, lower the risk of postoperative ARs, mitigate pain and improve QoL without significantly affecting RF (AU)

¿Son suficientes los nomogramas actuales para predecir los resultados de la litotricia por ondas de choque? / Are the current nomograms sufficient to predict shockwave lithotripsy outcomes?

Introducción y objetivos: Investigar los factores que afectan los resultados del tratamiento con LEOCH, validar tres nomogramas actuales (Kim JK, Triple D y S3HoCKwave) y comparar la capacidad predictiva de los nomogramas para los resultados de la LEOCH en los cálculos del tracto urinario superior.Pacientes y métodosSe revisaron retrospectivamente las historias clínicas de los pacientes con cálculos renales y ureterales proximales tratados con LEOCH entre marzo de 2013 y octubre de 2020. Se analizaron los factores que afectan al éxito de LEOCH con un análisis de regresión logística multivariante y se compararon los tres sistemas de puntuación con el área bajo la curva (AUC).ResultadosNuestro estudio incluyó un total de 580 pacientes. La tasa global de eliminación de cálculos fue del 61% y 144/580 pacientes (24,8%) estaban libres de cálculos tras una sesión. En el análisis de regresión logística multivariante, la ubicación del cálculo en el cáliz superior (OR: 2,988; IC 95%: 1,350-6,612; p=0,007), en el cáliz medio (OR: 3,036; IC 95%: 1,472-6,258; p=0,003) y en el cáliz inferior (OR: 2,131; IC 95%: 1,182-3,839; p=0,012), así como el número de cálculos (OR: 1,663; IC 95%: 1,140-2,425; p=0,008), el diámetro máximo del cálculo (OR: 1,156; IC 95%: 1,098-1,217; p<0,001) y el valor máximo de unidades Hounsfield (OR: 1,001; IC 95%: 1,001-1,002; p<0,001) fueron factores de riesgo independientes del fracaso de LEOCH. Las AUC de las puntuaciones Kim JK, Triple D y S2HoCKwave para predecir el éxito de la LEOCH fueron de 0,678, 0,548 y 0,626, respectivamente (AU)

Introduction and objectives: To investigate factors affecting SWL outcomes, validate three current nomograms (Kim JK, Triple D and S3HoCKwave) and compare the predictive ability of the nomograms for SWL outcomes in upper urinary tract stones.Patients and methodsMedical records of patients with renal and proximal ureteral stones treated with SWL between March 2013 and October 2020 were retrospectively reviewed. Factors affecting SWL success were analyzed with multivariate logistic regression analysis and the three predictive scoring systems compared with the area under the curve (AUC).ResultsA total of 580 patients were included in our study. The overall stone free rate was 61% and 144/580 patients (24.8%) were stone free after one session. In multivariate logistic regression analysis, stone location at upper calyx (OR:2.988; 95%Cl: 1.350–6.612; p=0.007), middle calyx (OR:3.036; 95%Cl: 1.472–6.258; p=0.003), and lower calyx (OR:2.131; 95%Cl: 1.182–3.839; p=0.012), as well as number of stones (OR:1.663; 95%Cl: 1.140–2.425; p=0.008), maximum diameter of stone (OR:1.156; 95%Cl: 1.098–1.217; p<0.001) and maximum Hounsfield Unit (OR:1.001; 95%Cl: 1.001–1.002; p<0.001) were independent risk factors of SWL failure. The AUCs of the Kim JK, Triple D and S2HoCKwave scores for predicting SWL success were 0.678, 0.548, and 0.626 respectively.ConclusionsStone location, number, maximal diameter, and maximum HU were independent predictive factors for SWL outcome in the treatment of upper urinary tract stones. Current nomograms, Kim JK nomogram, Triple D score and S3HoCKwave score can predict treatment success after SWL, but all of them have poor discrimination according to AUC analysis. (AU)

Clinical Characteristics and Risk Factors of Systemic Inflammatory Response Syndrome after Flexible Ureteroscopic Lithotripsy

Objectives: Flexible ureteroscopic lithotripsy (FURL), as a common method for treating upper urinary tract calculi, has the risks of complications such as infection and bleeding. Especially, systemic inflammatory response syndrome (SIRS) after FURL may induce multiple organ dysfunction threatening the lives of patients. We aimed to investigate the clinical characteristics and risk factors of SIRS after FURL. Methods: A total of 157 upper urinary tract calculus patients treated with FURL from January 2018 to December 2019 were enrolled, and clinical outcomes and complications were analyzed. Patients were divided into SIRS group (n = 31) and non-SIRS group (n = 126) according to the presence or absence of SIRS after FURL. Their clinical data were compared by univariate analysis, and the factors with statistically significant difference were incorporated into LASSO logistic regression analysis. The model was visualized using a nomogram, and model discrimination and accuracy were verified. Results: The results of univariate analysis indicated that there were significant differences in gender, average stone size, preoperative urinary white blood cell count, surgery time and postoperative stone bacterial culture between the two groups. The results of LASSO logistic regression analysis showed that the above factors were independent risk factors for patients with SIRS. The C-index of the SIRS risk prediction model was 0.992. The area under the ROC curve of this model was 0.944 (95% CI: 0.913-0.997), the sensitivity was 97.9%, and the specificity was 95.8%. The average absolute error between actual and predicted risk probabilities was 0.028. The model for predicting the risk of SIRS had good discrimination and high consistency with the actual observed value (AU)

Value of Music and Nitrous Oxide for Pain Control during Extracorporeal Shock Wave Lithotripsy (ESWL)

Objectives: To compare the efficacy of 4 different analgesic regimens that include music and nitrous oxide during the treatment of renal lithiasis with ambulatory extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: A single-centre, longitudinal, prospective, randomized, open and parallel group study was conducted. Patients with renal lithiasis were included and were randomized to Group A (basal analgesia: midazolam (1 mg), fentanyl (0.05 mg) and dexketoprofen (50 mg)), Group B (basal analgesia and nitrous oxide), Group C (basal analgesia and music) and Group D (basal analgesia, nitrous oxide and music). For the measurement of pain, a visual analogue scale ranging from 0 (no pain) to 100 (maximum pain imaginable) was used. Patient satisfaction was assessed using a Likert questionnaire. The epidemiological data of the patients in terms of lithiasis, previous clinical and ESWL sessions, and pain measured with the VAS before, during (maximum) at the end of the session and at discharge were recorded. Data on complications were also collected, as was the patients’ subjective evaluation of the treatment and their satisfaction. The ESWL procedure was performed with a Storz Modulith SLX-F2® lithotripter. A maximum of 4000 waves were applied at a frequency of 1.5 Hz. Results: Eighty patients were included (20 per group). None of the analgesia guidelines proved to be superior to the others for pain control during the ESWL session. Patients younger than 50 years had significantly higher values for the maximum VAS. Only 13.75% of patients required rescue analgesia. A total of 77.5% described their experience as good, very good or excellent, regardless of the assigned group. Conclusions: The addition of nitrous oxide and/or music did not result in a statistically significant improvement over the basal analgesia regimen of midazolam, fentanyl and dexketoprofen; however, the degree of patient satisfaction was very high (AU)

The Clinical Efficacy of Percutaneous Nephrolithotomy and Flexible Ureteroscopic Lithotripsy in the Treatment of Calyceal Diverticulum Stones: A Meta-Analysis

Background: The clinical efficacy of percutaneous nephrolithotomy (PCNL) and flexible ureteroscopic lithotripsy (FURL) in the treatment of calyceal diverticulum stones (CDs) remains controversial. We performed a meta-analysis to assess the clinical efficacy of PCNL and FURL in the treatment of CDs. Methods: We searched a number of relevant electronic databases including China National Knowledge Infrastructure (CNKI), MEDLINE, PubMed, Web of Science, EMBASE, and Cochrane Library until January 31, 2022. STATA 15.1 software was used to analyze all data for this article. The quality of these studies was assessed by the Newcastle-Ottawa Scale (ranged from 0 to 9 stars). Results: Finally, we selected 11 high-quality studies in our meta-analysis,which containing 486 patients. Meta-analysis showed that PCNL had higher stone-free rate [OR=3.55, 95% CI: 2.07 -6.10, P = 0.000], symptom-free rate [OR=3.56, 95% CI: 1.51 -8.38, p= 0.004], while it was slightly inferior to the FURL in bleeding volume [SMD = 1.27, 95% CI: (0.67,1.87), P = 0.000], hospital stay [SMD =2.86, 95% CI: 1.75-3.97, P = 0.000] and complication rate [OR =1.92, 95% CI: 1.10-3.33, P = 0.021], and there was no significant difference in operative time [SMD = -0.011, 95% CI: (-0.41,0.39), P = 0.957]. Conclusion: PCNL is safe and effective in the treatment of CDs, which can be considered as the first choice for the clinical treatment of CDs (AU)

Standardization of retrograde intrarenal surgery with "gravity irrigation" technique leads to low postoperative infection rate regardless of surgeon experience

Objectives: We aimed to evaluate the prevalence and predictive factors of postoperative infections after a standardized low-pressure RIRS technique. The secondary outcome was comparing surgeons’ experience in terms of infective complication and stone-free rate. Methods: A single-center retrospective analysis was conducted on all patients who underwent RIRS for kidney stones between January 2018 and February 2019. Inclusion criteria: adults, stone ≤ 20 mm (unless percutaneous nephrolithotomy contraindica-tions). Concomitant ureteral lithotripsy was allowed. Exclusion criteria: bilateral surgery, active urinary tract infections (UTI), pregnancy, fever at surgery. Low-pressure RIRS and ureteroscopy was achieved with gravity irrigation, a 5 Ch open-ended urethral catheter (ureteral lithotripsy), intravenous furosemide (20 mg), and ureteral access sheath above the ureteral-pelvic junction (RIRS). Results: 236 patients were included in the analysis. Mean age was 55.89±13.96 years. Mean stone diameter was 14.28±5.81mm. 43 (18.2%) patients underwent concomitant ureteral lithotripsy. Mean operative time was 61.10 ± 31.36 minutes. Infective complications occurred in 13 (5.5%) patients. Sepsis occurred in 10 (4.2%) patients and septic shock occurred in 1 (0.4%). One patient (0.4%) required stent substitution. Multivariate logistic regression analysis showed that history of UTI predicted for higher risk of postoperative infections (OR 8.434, CI 95% 2.36–29.46). Outcomes comparison of surgical expertise did not statistically differ in terms of stone-free rate and infective complications. Conclusion: Our standardized RIRS technique achieved a low postoperative infective complication rate. History of UTI was the strongest predictor of postoperative infections (AU)

Is spinal anesthesia a safe alternative for retrograde intrarenal surgery for stone disease in daily practice?

Objectives: Retrograde intrarenal surgery (RIRS) is commonly performed under general anesthesia (GA) because renal mobilityduring breathing may affect lithotripsy. However, spinal anesthesia (SA) is adopted in clinical practice due to clinical conditionsthat contraindicate GA. We aimed to compare results of RIRS for stones performed under GA compared to SA regarding stonefree rate (SFR) status and postoperative complications in a consecutive single-center series.Methods: We retrospectively reviewed all patients who underwent RIRS for stones between 2017 and 2020. Inclusion criteria:age ≥ 18 years, renal stone burden deemed suitable for RIRS with a stone diameter ≤ 20 mm. Exclusion criteria: stones >20mm, urinary tract infection, bilateral surgery, second-look procedures, unmodifiable bleeding diathesis, <5mm asymptomaticlower calyx stones. SFR was defined as no residual fragment >3 mm at 6-12 weeks follow-up. The choice of anesthesia was ashared decision between anesthesiologists and patient preference.Results: 230 patients were included in the analysis. Mean age was 57.50±13.73 years. 33% of stones were located in the pelvis.28.7% of patients had multiple stones. Mean cumulative stone diameter was 16.60±6.54 mm. 63% of patients underwent RIRSunder SA. There were no significant differences between the two groups in terms of preoperative characteristics, except for comorbidity, significantly higher in the GA group. Mean time of operating room occupation was longer in the GA group (81.58±35.37minutes) than in the SA group (72.85±25.91 minutes,p=0.033). Length of stay was shorter in the SA group (mean 2.2±1.66 days vs3.46±5.88 in GA,p=0.019). Logistic regression showed that multiple stones in the collecting system were associated with residualfragments (HR 0.386, 95%CI 0.151-0.991,p=0.04). There were no statistically significant differences in overall and high-gradecomplications, and in SFR between SA (75.9%) and GA groups (70.6%,p=0.317)...(AU)

Modelo novedoso basado en los parámetros de la tomografía para predecir el éxito de la litotricia por ondas de choque en los cálculos ureterales de diferentes localizaciones / A novel model using computed tomography parameters to predict shock wave lithotripsy success in ureteral stones at different locations

ObjetivoIncorporar los parámetros basados en la tomografía computarizada sin contraste (TCSC) a las características de los cálculos y de los pacientes comúnmente asociadas con el éxito de la litotricia por ondas de choque (LEOCH) para evaluar la efectividad de este nuevo modelo en la predicción del éxito de LEOCH en cálculos ureterales únicos situados en diferentes localizaciones.Materiales y métodosSe revisaron retrospectivamente los datos de los pacientes tratados con LEOCH por un único cálculo ureteral entre enero de 2017 y enero de 2019. Los parámetros basados en la TCSC se evaluaron junto con los parámetros demográficos de los pacientes y las características de los cálculos. Los parámetros basados en TCSC incluyeron la presencia o ausencia de hidronefrosis, trabeculación de la grasa perirrenal, edema periureteral, diámetro del uréter proximal, grosor de la pared ureteral (GPU) en el sitio del cálculo ureteral. Se utilizó el método de regresión logística para desarrollar un modelo predictivo útil. Posteriormente, se utilizó la curva ROC para determinar los puntos de corte, y se desarrolló un sistema de puntuación para la predicción del éxito de LEOCH.ResultadosLa tasa libre de cálculos fue del 77,1% (267/346) en toda la cohorte. El análisis univariante reveló que la edad, el volumen de los cálculos, la densidad, la trabeculación perirrenal, el diámetro del uréter proximal y el GPU se asociaron con el éxito de la LEOCH. En el análisis multivariante, la localización del cálculo ureteral proximal, el volumen del cálculo, la densidad y el GPU fueron predictores independientes del éxito de la LEOCH. La fórmula utilizada en el análisis de regresión logística fue: 1/[1+exp {-8,856+0,008(volumen del cálculo)+0,002 (densidad del cálculo)+0,673 (GPU)+1026 (cálculo ureteral proximal)}]. Las puntuaciones de 0, 1, 2, 3 y 4 se asociaron con un 97,8%, 83,4%, 60,8%, 33,2% y 11,1% de éxito, respectivamente, en el modelo de predicción basado en estos parámetros.

ObjectiveTo combine non-contrast computerized tomography (NCCT)-based parameters with stone and patient characteristics that are already known to affect shock wave lithotripsy (SWL) success and assess this novel model's effectiveness in predicting SWL success for single ureteral stones in different locations.Materials and methodsData of patients treated by SWL for a single ureteral stone between January 2017 and January 2019 were retrospectively reviewed. Demographic parameters of patients and stone characteristics were combined with NCCT-based parameters. NCCT-based parameters included the presence or absence of hydronephrosis, perinephric stranding, periureteral edema, diameter of the proximal ureter, ureteral wall thickness (UWT) at ureteral stone site. The logistic regression method was used for the development of a useful predictive model. Subsequently, the receiver operating curve was used to determine cut-off levels, and a scoring system was developed for prediction of SWL success.ResultsStone-free rate was 77,1% (267/346) in the entire cohort. Univariate analysis revealed that age, stone volume, density, perinephric stranding, diameter of proximal ureter, and UWT, were associated with SWL success. In multivariate analysis, proximal ureteral stone location, stone volume, density, and UWT were independent predictors of SWL success. The formula used during logistic regression analysis was: 1/[1+exp {-8.856+0.008(stone volume)+0.002 (stone density)+0.673 (UWT)+1026 (proximal ureteral stone)}]. The scores of 0, 1, 2, 3 and 4 were associated with 97,8%, 83,4%, 60,8%, 33,2% and 11,1% success rates, respectively, in the prediction model based on these parameters.ConclusionWe conclude that our model can facilitate decision-making for SWL treatment of ureteral stones in different locations (AU)

Litotricia neumática vs. Litotricia láser ho: yag en el tratamiento de la litiasis ureteral / Pneumatic lithotripsy vs. Ho: yag laser lithotripsy in the treatment of ureteral lithiasis

Obetivo: La litotricia neumática (LN) yláser Ho: YAG (LH) son los métodos más aceptados enel tratamiento endoscópico de la litiasis ureteral. El objetivo es comparar eficacia y seguridad de la litotricianeumática vs. litotricia láser Ho: YAG en el tratamientode la litiasis ureteral. Material y métodos: Estudio prospectivo, simpleciego, multicéntrico. Se incluyeron pacientes adultosque se sometieron a tratamiento de litiasis ureteral, desde agosto de 2017 a marzo de 2019, en 23 instituciones nacionales. Las variables analizadas incluyeron:datos demográficos, tamaño y ubicación del lito, presencia de catéter doble J previo al procedimiento, tasalibre de litiasis (LL) y de complicaciones. Resultados: Se incluyeron un total de 366 pacientescon litiasis ureteral, 204 en el grupo LN y 162 en elgrupo LH. La tasa libre de litiasis fue significativamentesuperior en el grupo LH (77% vs. 92%), OR 3,43 (1,76a 6,70) y la tasa de complicaciones fue significativamente menor en el grupo LH (9,8% vs. 2,5%), OR 0,23(0,07 a 0,71). En el análisis multivariado, la utilizaciónde la energía Ho: YAG, la ubicación de la litiasis enuréter distal y la colocación preoperatoria de catéterdoble J, resultaron ser factores predictores del estado LL. Conclusión: La litotricia láser Ho: YAG presenta unamayor tasa libre de litiasis y una menor tasa de complicaciones, en comparación con la litotricia neumática.(AU)

Objetive: Pneumatic lithotripsy (PL) andHo: YAG laser lithotripsy (LL) are the most widely accepted methods in the endoscopic treatment of ureterallithiasis. The objective is to compare efficacy and safetyof pneumatic lithotripsy vs. Ho: YAG laser lithotripsy inthe treatment of ureteral lithiasis. Material and methods: Prospective, single-blind,multicenter study. Adult patients were recruited from August 2017 to March 2019, in 23 institutions throughoutArgentina. Patient demographics, stone characteristics,presence of double J stent prior to the intervention, stonefree rate (SF) and postoperative complications wereevaluated and analyzed. Results: A total of 366 patients with ureteral lithiasiswere included, 204 in the PL group and 162 in theLL group. The SF rate was significantly higher in the LLgroup (77% vs. 92%), OR 3 .43 (1.76 to 6.70). Thecomplication rate was significantly lower in the LL group(9.8% vs. 2.5%), OR 0.23 (0.07 to 0.71). In the multivariate analysis, the use of Ho: YAG energy, the locationof the lithiasis in the distal ureter, and the preoperativeplacement of double J stent, were found to be predictorsof SF status. Conclusions: Ho: YAG laser lithotripsy has a higherstone-free rate and a lower complication rate comparedto pneumatic lithotripsy.(AU)

Pielolitotomía laparoscópica en riñón ectópico pélvico: informe de un caso y revisión de la literatura / Laparoscopic pyelolithotomy in pelvic ectopic kidney: Case report and literature review

Introducción: Los riñones pélvicos son una malformación congénita poco frecuente, pero con una tasa de complicaciones no despreciable, entre ellas el desarrollo de litiasis renales. Su manejo quirúrgico puede resultar complejo. El objetivo de este trabajo fue realizar una revisión de la literatura disponible sobre el tratamiento de la litiasis en riñones ectópicos.Material y métodosDescripción de un caso de pielolitotomía laparoscópica transperitoneal para el tratamiento de litiasis calicial inferior en riñón pélvico derecho. Se realizó una revisión de la literatura mediante PubMed. Se buscaron los siguientes términos: «pelvic ectopic kidney», « ureterorenoscopy», «extracorporeal lithotripsy», «NLPC», «pyelolithotomy». Se incluyeron artículos originales, metaanálisis, revisiones e informes de casos.ResultadosSe excluyeron 130 artículos por título o duplicación. Se evaluaron 62 resúmenes y 50 artículos de texto completo. La tasa libre de cálculos fue del 75% (LEOCH), 85% (URS-f), 85-90% (NLPC) y 100% (pielolitotomía laparoscópica).ConclusiónFactores como el tamaño de la litiasis, densidad y localización de la misma, así como las alteraciones anatómicas del tracto urinario superior, influyen en la elección de la vía de abordaje terapéutica (retrógrada, percutánea y/ o laparoscópica/robótica). (AU)

Introduction: Pelvic kidney is a rare congenital anomaly. The ectopic kidney is more susceptible to developing lithiasis. The management of this type of lithiasis is a challenge. The objective of this paper was to conduct a review of available literature on the treatment of stone in ectopic kidney.Material and methodsDescription of a case of transperitoneal laparoscopic pyelolithotomy for the treatment of inferior calyceal lithiasis in a right pelvic kidney. A literature review was performed by using Pubmed. The following terms and combination terms were searched: «pelvic ectopic kidney», «ureterorenoscopy», «extracorporeal lithotripsy», «PCNL», «pyelolithotomy». We included original articles, meta-analysis, review and case reports.Results130 articles were excluded by title or duplication. 62 abstracts articles and them 50 full text articles were evaluated. Stone free rate were 75% (SLW), 85% (URSf), 85-90% (PCNL) and 100% (laparoscopic pyelolithotomy). The literature on treatment on pelvic kidney is poor.ConclusionFactors such stone size, density and location, and upper urinary tract abnormalities, influence the choice of therapeutic approach (retrograde, percutaneous and/or laparoscopic/robotic). Laparoscopic pyelolithotomy is a safe and minimally invasive treatment option for large kidney stones with unfavorable anatomy for the endoscopic approach. (AU)

Efficacy of low energy shock-wave therapy generated using an electrohydraulic device in the treatment of ed: a systematic review and meta-analysis of randomized controlled trials / Eficacia de la terapia de ondas de choque de baja energía generada usando undispositivo electrohidráulico en el tratamiento de la disfunción eréctil: una revisión sistemáticay metanálisis de ensayos controlados aleatorios

Objectives: Over 50% of elderly menand 70% of male cardiac patients suffer from erectiledysfunction (ED). Although pharmacotherapy is effectiveand safe, it only brings a short-term improvement andmay cause side effects. Low energy shock-wave therapy(LESWT) is a promising causative modality for the treatment of ED. The evidence is still limited with differentresults obtained using different devices. The aim of thiswork was to evaluate evidence from randomized controlled trials regarding the efficacy of LESWT generatedby an electrohydraulic unit for the treatment of ED. Methods: A systematic review of the literature wasconducted in PubMed on May 20th, 2018 and supplemented by a Google search of grey literature, aswell as a hand search of the bibliographies of retrievedarticles. Out of 34 studies, 5 studies on 354 patientswere included in the quantitative synthesis.Results: The studies evaluated an abridged International Index of Erectile Function (IIEF-5), the Erectile Hardness Scale (EHS) and Flow-Mediated Dilatation (FMD).The meta-analysis revealed that LESWT improved theIIEF-5 score (mean difference: 5.16; 95% CI, 1.398.93; p=0.0073) and EHS score (risk difference:0.72; 95% CI, 0.73-0.80; p<0.001). Reporting ofFMD was inconsistent and not analyzed. The meta-anal-ysis of studies conducted with electrohydraulic devicesshowed greater benefits to patients in comparison to themeta-analyses of heterogeneous studies conducted usingvarious devices for generating shock waves.Conclusions: Evidence exists that LESWT generated with an electrohydraulic unit is effective. Further research is needed in order to evaluate this method indifferent patient populations and for the long-term

Objetivo: Más del 50% de los hombresancianos y más del 70% de hombres con enfermedades cardiacas sufren de disfunción eréctil (DE). Aunquela farmacoterapia es efectiva y segura, solo conllevauna mejoría temporal y puede causar efectos secundarios. La terapia con ondas de choque de baja energía(OCBE) es una técnica prometedora para el tratamientode la DE. La evidencia es aún limitada con resultadosdiferentes obtenidos con aparatos diferentes. El objetivo de este trabajo es evaluar la evidencia de ensayosrandomizados en relación a OCBE generado con unidades electrohidráulicas para el tratamiento de la DE. Materiales y métodos: Una revisión sistemática de la literatura fueconducida en PubMed el 20 mayo 2018 y suplementada por la búsqueda de Google en literatura gris. También se hicieron búsquedas individuales de artículos.De 34 estudios, 5 estudios en 354 pacientes fueronincluidos para la síntesis cuantitativa. Resultados: Los estudios evaluaron abridged International Index of Erectile Function (IIEF-5), Erectile Hardness Scale (EHS) y Flow-Mediated Dilatation (FMD).El metanálisis reveló que OCBE mejoró el score deIIEF-5 (diferencia media: 5,16; 95% CI, 1,39-8,93;p=0,0073) y EHS score (diferencia de riesgo: 0,72;95% CI, 0,73-0,80; p<0,001). Los reportes de FMDfueron inadecuados y no se analizaron. El metanálisisde estudios conducidos con aparatos electrohidráulicosdemostró mayores beneficios a pacientes en comparación con el metanálisis de estudios heterogéneos conducido utilizando varios aparatos generadores de ondas. Conclusiones: La evidencia demuestra que OCBEgenerado por una unidad electrohidráulica es efectiva.Es necesaria más investigación para poder evaluar estemétodo en diferentes poblaciones de pacientes y parael largo plazo.(AU)

Evaluación del tratamiento de litiasis renal radiopaca mediante la combinación de litotricia extracorpórea por ondas de choque y fagolitos plus. Estudio preliminar de casos y controles / Evaluation of the treatment of radiopaque renal lithiasis through the combination of extracorporeal lithotripsy by shock waves and phagoliths plus. Preliminary case-control study

Objetivo: El objetivo de este estudio es evaluar la efectividad del tratamiento combinado de Fagolitos plus® yLitotricia extracorpórea en la fragmentación de la litiasis.Material y métodos: Estudio retrospectivo de casosy controles, incluye 88 pacientes con litiasis. Grupo 1:Tratados con 1 sesión de litotricia extracorpórea y Fagolitos plus ®. Grupo 2: Tratados con 1 sesión de litotriciaextracorpórea. Las variables analizadas fueron: Edad, sexo, índice de masa corporal, diámetro máximo dela litiasis, área de la litiasis, unidades hounsfield de lalitiasis medida por Tomografía axial, localización de lalitiasis, resultado tras 1 sesión de Litotricia extracorpóreapor ondas de choque [fragmentación completa, fragmentación parcial (presencia de un fragmento mayor a5 mm) y ausencia de fragmentación (mismo tamaño dela litiasis)], efectos adversos acontecidos tras la toma deFagolitos plus ®, días de tratamiento con Fagolitos plus ®y energía de ondas de choque aplicada a la litiasis. Seanalizaron resultados con SPSS 20.0, p≤0,05. Resultados: La edad media de los pacientes incluidos en el estudio es de 53,81 ± 12,62 años en elgrupo 1 frente a 56,53 ± 12,37 años en el grupo 2,p=0,31. Según la distribución por sexos, tampoco existen diferencias estadísticamente significativas (p=0,5),incluyendo 24 hombres y 24 mujeres en el grupo 1 y23 hombres y 17 mujeres en el grupo 2. El índice demasa corporal medio de los pacientes del grupo 1 fuede 28,39 ± 2,27 kg/m 2 en el grupo 1 frente a 28,39± 3,03 kg/m2 en el grupo 2, p=0,9. El diámetro máximo de la litiasis fue de 11,5 ± 3,91 mm en el grupo1 frente a 13,15 ± 5,49 mm en el grupo 2, p=0,1.El área de la litiasis medida por tomografía computarizada fue de 104,74 ± 70,56 mm 2 en el grupo 1frente a 141,91 ± 80,95 mm2 en el grupo 2, p=0,3.Las unidades Hounsfield medidas por tomografía de lalitiasis en el grupo 1 fue de 1061,98 ± 213,68 frentea 1143,15 ± 172,24 en el grupo 2, p=0,06...(AU)

Objetive: The objective of this study is to evaluatethe effectiveness of the combined treatment of Fagolitosplus® and extracorporeal lithotripsy in the fragmentationof the lithiasis.Material and methods: Retrospective case-control study includes 88 patients with lithiasis. Group 1:Treated with 1 session of extracorporeal lithotripsy andFagoliths plus ® . Group 2: Treated with 1 session of extracorporeal lithotripsy. The variables analyzed were:Age, sex, body mass index, maximum diameter of thestone, area of the stone, hounsfield units of the stonemeasured by axial tomography, location of the stone,result after 1 session of extracorporeal wave lithotripsy.shock [complete fragmentation, partial fragmentation(presence of a fragment greater than 5 mm) and absence of fragmentation (same size of the lithiasis)], adverse effects that occurred after taking Fagolitos plus ® ,days of treatment with Fagolitos plus ® and energyshock wave applied to lithiasis. Results were analyzedwith SPSS 20.0, p≤0.05.Results: The mean age of the patients included in thestudy is 53.81 ± 12.62 years in group 1 compared to56.53 ± 12.37 years in group 2, p=0.31. Accordingto the distribution by sex, there were no statisticallysignificant differences (p=0.5), including 24 men and24 women in group 1 and 23 men and 17 women ingroup 2. The mean of body mass index of the patientsin group 1 was 28.39 ± 2.27 kg/m 2 in group 1 versus 28.39 ± 3.03 kg/m 2 in group 2, p=0.9. The maximum diameter of the stone was 11.5 ± 3.91 mm ingroup 1 compared to 13.15 ± 5.49 mm in group 2,p=0.1. The area of the lithiasis measured by tomography was 104.74 ± 70.56 mm 2 in group 1 comparedto 141.91 ± 80.95 mm 2 in group 2, p=0.3. TheHounsfield units measured by tomography of the lithiasis in group 1 was 1061.98 ± 213.68 compared to1143.15 ± 172.24 in group 2, p=0.06.Relation to fragmentation, complete fragmentation wasobserved in 66.7% of group 1 patients, compared to...(AU)

Factores de riesgo predictivos de infección del tracto urinario después de la litotricia ureteroscópica flexible / Predictive risk factors for urinary tract infection after flexible ureteroscopic lithotripsy

Objetivos: El objetivo del presente estudio fue evaluar la prevalencia de las infecciones deltracto urinario (UTI) postoperatorias después de la ureteroscopia flexible (f-URS) y determinar los factores predictivos de esas infecciones. Métodos: Se inscribieron en el estudio un total de 420 pacientes con urolitiasis que se sometieron a f-URS entre agosto de 2018 y agosto de 2019. Las características perioperatorias de los pacientes con y sin ITUUTI postoperatorias se compararon mediante análisis univariados. Los factores predictivos de las infecciones urinarias después de f-URS se determinaron mediante un análisis de regresión logística multivariante. Resultados: Cuarenta y uno (9,8%) de 420 pacientes tuvieron infección urinaria postoperatoria despuésde f-URS y esos pacientes se clasificaron como grupo 1. El grupo 2 consistió en 379 pacientes que no desarrollaron UTI postoperatorias. El porcentaje de sexofemenino fue del 58,5% frente al 42% en los grupos 1 y 2, respectivamente (p=0,042). La tasa de antecedentes de UTI preoperatoria fue del 51,2% frente al 20,8% (p<0,001) y la tasa de inserción preoperatoria de un stent doble J (DJS) del 39% frente al 17,7% en los grupos 1 y 2, respectivamente (p=0,001). Los análisis deregresión univariante mostraron que el sexo femenino (OR=1,98), los antecedentes de UTI (OR=3,99) y la inserción preoperatoria de DJS (OR=2,98) aumentaron significativamente la posibilidad de UTI postoperatoria (p<0,05). Los análisis de regresión multivariante revelaron que los antecedentes de UTI (OR=3,41, IC del95%: 1,73–6,72, p<0,001) y la inserción preoperatoria de DJS (OR=2,30, IC del 95%: 1,13–4,68,p=0,021) eran factores de riesgo independientes para las complicaciones infecciosas después de f-URS. Si ambos factores están presentes, la probabilidad de infección es del 55,2%.(AU)

Objectives: The goal of current study was to evaluate prevalence of postoperative urinary tract infections (UTI) following flexible ureteroscopy (f-URS) and to determine predictive factors for those UTIs. Methods: A total of 420 patients with urolithiasis that underwent f-URS between August 2018 and August 2019 were enrolled in the study. Peri-operative characteristics of patients with and without postoperative UTIs were compared using univariate analyses. Predictive factors for UTIs following f-URS were determined using multivariate logistic regression analysis. Results: Forty-one (9.8%) out of 420 patients had postoperative urinary infection after f-URS and those patients were classified as group 1. Group 2 consisted of 379 patients that did not develop postoperative UTIs. The percentage of female gender was 58.5% vs 42% in groups 1 and 2, respectively (p=0.042). The preoperative UTI history rate was 51.2% vs 20.8% (p<0.001)and preoperative double J stent (DJS) insertion rate 39% vs 17.7% in groups 1 and 2, respectively (p=0.001). Univariate regression analyses showed that the female gender (OR=1.98), history of UTI (OR=3.99), and preoperative DJS insertion (OR=2.98) significantly increased the possibility of postoperative UTI (p<0.05).Multivariate regression analyses revealed that history of UTI (OR=3.41, 95%CI:1.73–6.72, p<0.001) and preoperative DJS insertion (OR=2.30, 95%CI:1.13–4.68,p=0.021) were independent risk factors for infectious complications following f-URS. If both factors are present, the probability of infection is 55.2%.Conclusions: Even if f-URS is considered a safe procedure, the risk of postoperative infectious complications is far from negligible. We found that the presence of UTI history and preoperative DJS were independent risk factors for UTI after f-URS.(AU)

Colocación preoperatoria de catéter doble j en el tratamiento endoscópico de la litiasis ureteral y renal: estudio multicéntrico, nacional / Preoperative placement of a double J stent in the endoscopic treatment of ureteral and renal lithiasis: a multicenter, national study

Objetivo: El objetivo fue evaluar la efectividad y seguridad de la colocación preoperatoria delcatéter doble J comparado con no hacerlo, en pacientes sometidos a ureteroscopía por litiasis ureteral y renal.Materiales y métodos: Estudio prospectivo, observacional, multicéntrico. Se reclutaron pacientes adultos,que se sometieron al tratamiento ureteroscópico paralitiasis ureteral y renal, desde agosto de 2017 a marzode 2019, en 23 instituciones Argentinas. Las variables analizadas incluyeron: datos demográficos, tamaño yubicación de la litiasis, tasa libre de litiasis (LL) al finalizar el procedimiento y de complicaciones en el posoperatorio inmediato.Resultados: Se incluyeron 580 pacientes. 473 conlitiasis ureteral (309 con y 164 sin doble J previo) y107 con litiasis renal (77 con y 30 sin doble J previo).La tasa LL fue mayor en el grupo con doble J previo,tanto en el tratamiento de la litiasis ureteral (82,2% vs.90,9%, OR 2,15 (1,17 a 3,96)), como en el tratamiento de la litiasis renal (73,3% vs. 89,6%, OR 3,14 (1,02a 9,61)). No se establecieron diferencias en la tasade complicaciones tanto en el tratamiento de la litiasisureteral (6,1 vs 6,1%, OR 0,98 (0,45 a 2,19)) comoen el tratamiento de la litiasis renal (6,7 vs 5,2%, OR0,76 (0,13 a 4,46)).Conclusiones: La colocación preoperatoria delcatéter doble J mejoró la tasa LL en el tratamiento dela litiasis ureteral y renal, pero no disminuyó la tasa decomplicaciones.(AU)

Objetive: Aim of our study was to evaluate the effectiveness and safety of the preoperativeplacement of JJ stent compared to not doing in patientsundergoing ureteroscopy for ureteral and kidney stone.Materials and methods: Prospective, observational, multicenter study. Adult patients, who underwent ureteroscopy treatment for ureteral and kidney stone, wererecruited from August 2017 to March 2019, in 23Argentine institutions. The variables analyzed included:demographic data, stone size and location, stone-freerate (SFR) and complications.Results: 580 patients were included. 473 with ureteral stone (309 with and 164 without prior JJ stent)and 107 with kidney stone (77 with and 30 withoutprior JJ stent). The SFR was higher in the group withprevious JJ stent, both in the treatment of ureteral stone(82.2% vs. 90.9%, OR 2.15 (1.17 to 3.96)), and inthe treatment of kidney stone (73.3% vs. 89.6%, OR3.14 (1.02 to 9.61)). No differences were establishedin the complication rate both in the treatment of ureteralstone (6.1 vs. 6.1%, OR 0.98 (0.45 to 2.19)) and inthe treatment of kidney stone (6.7 vs. 5.2%, OR 0.76(0.13 a 4.46)).Conclusions: The preoperative placement of JJstent, increases SFR in the treatment of ureteral and kidney stone, but not decrease the complication rate.(AU)