[Quality of life for ureteral stone patients (diversion).] / Calidad de vida en pacientes con litiasis ureteral (derivación).

The high prevalence and incidence of urinary stone disease, the severity of its symptoms, its high recurrence rate and resulting healthcare costs, make urolithiasis a chronic disease with significant impact on healthcare services and patient quality of life. There are several general tools available to assess health related quality of life in patients with chronic illnesses, as wellas some specific ones directed to urinary stone disease, such as the ureteral stent symptom questionnaire. Patient swith an obstructive ureteral stone or those indwelling aureteral stent, often present symptoms that may affecttheir quality of life considerably. Patient education and counselling regarding stent-related symptoms, as well as medical treatment, may help improve their perception of quality of life.

La elevada prevalencia de la enfermedadl itiásica, su pico de incidencia en una población socialmente activa, la severidad de sus síntomas, su elevada tasa de recurrencia y los costes sanitarios que de esto se derivan, hacen de la enfermedad litiásica una enfermedad crónica que impacta seriamente en la calidad de vida. Para el estudio de la Calidad de Vida Relacionada con la Salud tenemos diferentes instrumentos que evalúan enfermedades crónicas en general y también instrumentos específicos para pacientes litiásicos, así como cuestionarios exclusivos para pacientes portadores de catéter ureteral doble j. El paciente afecto de una litiasis ureteral o portador de un catéter ureteral doble j por patología obstructiva litiásica presenta una sintomatología asociada que puede condicionar de una forma muy importante su calidad de vida. Una información exhaustiva al paciente sobre el comportamiento del catéter y aplicar medidas preventivas y terapeúticas de los síntomas derivados del mismo mejoran significativamente la percepción de calidad d evida.

[Update in the management of ureteral lithiasis: Semirigid and flexible ureterorenoscopy.] / Actualización en el tratamiento de la litiasis ureteral: URS semirrígida y flexible.

OBJECTIVE: The contribution of therapeutic ureteroscopy done by Perez Castro in 1980 varied the management algorithm for ureteral lithiasis worldwide. The techniques of Retrograde Ureteroscopy and transrenal antegrade ureteroscopy led to the abandonment of open surgery for the treatment of ureteral lithiasis. Only Shock wave lithotripsy has maintained similar success rates in selected cases. METHODS: Descriptive analysis of the semirigid and flexible ureteroscopy techniques performed in our department over the last 10 years giving detail on the technique and safety tips to increase the efficacy and efficiency of ureteroscopy. 4,533 semirigid ureterorenoscopies and 980 flexible ureterorenoscopies were performed between January 2005 and July 2016. RESULTS: We registered 82% lithiasis elimination on a single operation with a 1,8% overall complication rate for complications higher than Clavien III. We registered 108 urinary sepsis episodes with 2 deaths secondary to massive shock. One patient required supra-selective renal embolization due to renal rupture and hemorrhage after URS. Four patients have required open or laparoscopic surgical repair Five patients required nephrectomy due to absent function of the renal unit after URS and 2 for complete ureteral avulsion on ureteroscope extraction. CONCLUSIONS: Semirigid ureterorenoscopy enables the elimination of ureteral lithiasis on a major ambulatory surgery regimen with an acceptable complication rate and a low rate of ancillary measures. Flexible ureteroscopy has resolved intrarenal lithiasis of up to 2 cm, being a substitute for percutaneous nephrolithotomy for these cases.

Obesity in percutaneous nephrolithotomy. Is body mass index really important?

OBJECTIVE: To evaluate the influence of obesity in the results of percutaneous nephrolithotomy (PCNL) in terms of efficacy and safety and to evaluate other aspects such as fluoroscopy time, radiation exposure, total operative time, hemoglobin loss, hospital stay, and the need of auxiliary procedures. MATERIALS AND METHODS: We evaluated prospectively all the PCNLs performed at our institution between 2011 and 2012. A series of perioperative and postoperative details were recorded in our database. The patients were distributed in 4 groups using World Health Organization's classification of body mass index (BMI): normal weight, ≤ 25 kg/m(2); overweight, 25-29.9 kg/m(2); obese, 30-39.9 kg/m(2); and morbidly obese, ≥ 40 kg/m(2). Modified Clavien classification was used for reporting the complications. Results were compared between the groups using the chi square and multivariate logistic regression tests. RESULTS: A total of 255 procedures were performed between January 2011 and December 2012. Overall stone clearance was 76.3% and complication rate using the modified Clavien grading system was 31.4%. No statistical differences in terms of complication rate and stone free rate were noted between the 4 groups. Total operative time and radiation doses increase along with BMI. No difference was found in fluoroscopy time, failure to gain access, hospital stay, or need for auxiliary procedures. CONCLUSION: Obesity does not increase complications in PCNL, and the efficacy of the technique is similar to normal weight patients with appropriate expertise. Total operative time and radiation exposure increase along with BMI, putting patients at risk.