RESUMEN
PURPOSE: Ultrasonic propulsion is an investigational procedure for awake patients. Our purpose was to evaluate whether ultrasonic propulsion to facilitate residual kidney stone fragment clearance reduced relapse. MATERIALS AND METHODS: This multicenter, prospective, open-label, randomized, controlled trial used single block randomization (1:1) without masking. Adults with residual fragments (individually ≤5 mm) were enrolled. Primary outcome was relapse as measured by stone growth, a stone-related urgent medical visit, or surgery by 5 years or study end. Secondary outcomes were fragment passage within 3 weeks and adverse events within 90 days. Cumulative incidence of relapse was estimated using the Kaplan-Meier method. Log-rank test was used to compare the treatment (ultrasonic propulsion) and control (observation) groups. RESULTS: The trial was conducted from May 9, 2015, through April 6, 2024. Median follow-up (interquartile range) was 3.0 (1.8-3.2) years. The treatment group (n = 40) had longer time to relapse than the control group (n = 42; P < .003). The restricted mean time-to-relapse was 52% longer in the treatment group than in the control group (1530 ± 92 days vs 1009 ± 118 days), and the risk of relapse was lower (hazard ratio 0.30, 95% CI 0.13-0.68) with 8 of 40 and 21 of 42 participants, respectively, experiencing relapse. Omitting 3 participants not asked about passage, 24 treatment (63%) and 2 control (5%) participants passed fragments within 3 weeks of treatment. adverse events were mild, transient, and self-resolving, and were reported in 25 treated participants (63%) and 17 controls (40%). CONCLUSIONS: Ultrasonic propulsion reduced relapse and added minimal risk. CLINICAL TRIAL REGISTRATION NO.: NCT02028559.
RESUMEN
Cincuenta y un niños en quienes presentando los criterios clásicos clínicos y biológicos fueron diagnosticados un primer episodio de Infección Urinaria Complicada (Pielonefritis aguda). Se realizaron una ecografia renal y una scintigrafia renal 99m TC-DMSA dentro de las 24 horas seguidas a su admisión. Una uretrocistografía miccional y un control de la 99m TC-DMSA fueron realizadas después del episodio agudo. Defectos corticales renales en 47 exámenes (92,2 por ciento) fueron detectados con 99m TC-DMSA y en 28 (55 por ciento) a la ecografía. La scintigrafía renal 99m TC-DMSA es entre todas las técnicas de imagenería para evaluar el tracto urinario superior; la que más ayuda en la localización de la infección urinaria y en la identificación de niños susceptibles de desarrollar cicatrices renales.