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.

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.

Effectiveness of two ultrasound-guided transrectal biopsy schemes in the diagnosis of prostate cancer. A randomized study.

OBJECTIVE: To determine whether a 10-core prostate biopsy scheme is superior to the sextant scheme in diagnosing prostate cancer in patients programmed for a first biopsy, with negative rectal digital examination and PSA between 3.5-20 ng/ml. METHODS: A randomized prospective study was performed comparing two prostate biopsy schemes, with randomization stratification according to prostate volume (< or = 50 ml and > 50 ml). Sample size predetermination yielded a minimum of 304 patients in order to achieve the primary objective. Statistical analysis was carried out on an intent-to-treat basis, using the chi-squared test and uni- and multivariate analysis via logistic regression. RESULTS: Cancer was detected in 27.3% of the cases. A significant association was observed between cancer diagnosis and age (p=0.03), prostate volume (p=0.0001) and ultrasound nodule identification (p=0.0001). No correlation was observed with the total number of cores in the series (p=0.37) or with prostate volume < or = 50 ml (p=0.87) or > 50 ml (p=0.09). In the multivariate analysis, age > 70 years (p=0.005), prostate volume < or = 50 ml (p=0.001), and ultrasound nodule identification (p=0.003) were identified as independent variables associated to cancer diagnosis. CONCLUSION: No statistically significant differences were found between the two prostate biopsy schemes. In glands over 50 ml in size, the sextant scheme may prove to be insufficient.

[Mondor's syndrome. Case review and bibliographic review]. / Síndrome de Mondor. Revisión de la literatura. A propósito de un caso.

OBJECTIVE: We review the presentation, diagnosis and treatment of Mondor's disease of the penis, with the contribution of a new clinical case. METHODS: A 43-year-old male reported to the emergency room with preputial inflammation and edema associated to swelling of the dorsal region of the penis for the previous three weeks. RESULTS: Doppler ultrasound revealed thrombosis of the superficial dorsal vein of the penis, associated to candidiasic balanitis. Treatment was provided in the form of nonsteroidal antiinflammatory drugs and antibiotic and antifungal agents. The symptoms disappeared after 7 days of treatment, followed by the development of punctate phimosis that required circumcision. CONCLUSIONS: Mondor's syndrome is an infrequent condition usually caused by trauma, though it is important to consider the possibility of associated coagulation problems, infections and neoplastic processes. Doppler ultrasound is the technique of choice for confirming the diagnosis and resolution of the condition. Treatment is based on nonsteroidal antiinflammatory medication, antibiotherapy and sexual abstinence. The use of anticoagulation is controversial, but may prove useful in patients with coagulation disorders.

[Prostate and KTP laser]. / Próostata y láser KTP.

OBJECTIVES: To analyze safety and efficacy of KTP green laser photovaporization for the treatment of lower urinary tract obstruction caused by benign prostatic hyperplasia based on data from the medical literature. RESULTS: Most articles consulted emphasize its low complication rate, efficacy, and short learning curve. They have the limitation that most papers are not comparative, the number of patients included is low, and follow-up in many of them short. CONCLUSIONS: Prostatic vaporization with KTP laser is today an alternative to TUR, more in patients with comorbidities, due to its low complication rate. Nevertheless, we accept it is an expensive technology and more follow-up is required to confirm the results remain.