Reduction of ureteral stent encrustation by modulating the urine pH and inhibiting the crystal film with a new oral composition: a multicenter, placebo controlled, double blind, randomized clinical trial.

BACKGROUND: Encrustation of ureteral double J stents is a common complication that may affect its removal. The aim of the proposed study is to evaluate the efficacy and safety of a new oral composition to prevent double J stent encrustation in indwelling times up to 8 weeks. METHODS: A double-blinded, multicenter, placebo-controlled trial was conducted with 105 patients with indwelling double J stents enrolled across 9 public hospitals in Spain. The patients were randomly assigned (1:1) into intervention (53 patients) or placebo (52 patients) groups for 3 to 8 weeks and both groups self-monitored daily their morning urine pH levels. The primary outcome of analysis was the degree of stent ends encrustation, defined by a 4-point score (0 - none; 3 - global encrustation) using macroscopic and electron microscopy analysis of crystals, after 3 to 8-w indwelling period. Score was exponentially transformed according to calcium levels. Secondary endpoints included urine pH decrease, stent removal, and incidence of adverse events. RESULTS: The intervention group benefits from a lower global encrustation rate of stent ends than placebo group (1% vs 8.2%; p < 0.018). Mean encrustation score was 85.12 (274.5) in the placebo group and 18.91 (102.27) in the intervention group (p < 0.025). Considering the secondary end points, treated patients reported greater urine pH decreases (p = 0.002). No differences in the incidence of adverse events were identified between the groups. CONCLUSIONS: Our data suggest that the use of this new oral composition is beneficial in the context of ureteral double J indwelling by decreasing mean, as well as global encrustation. TRIAL REGISTRATION: This trial was registered at www.clinicaltrials.gov under the name "Combined Use of a Medical Device and a Dietary Complement in Patient Urinary pH Control in Patients With an Implanted Double J Stent" with date 2nd November 2017, code NCT03343275, and URL.

[MicroPerc: Fashion or reality.] / Microperc: moda o realidad.

Miniaturization in percutaneous surgery has seen its zenith in microperc. Technological advances have enabled us to treat renal lithiasis through a 4.8 Ch. caliper percutaneous access. According to published literature, the technique is reproducible and when applied to small and medium size renal lithiasis has a high success rate keepin a low complication rate. Its main advantage is the absence of tract dilatation, diminishing the bleeding risk inherent to percutaneous access, postoperative pain and hospital stay. Nevertheless, it presents a series of technical limitations: low maneuverability and versatility, impossible extraction of significant fragments, limited vision and high intrarenal pressure. Does microperc have a place among proven techniques such as SWL, flexible ureteroscopy or minipercutaneous surgery? In our article we try to answer this question by reviewing the available literature, and review all technical features, advantages and limitations of the procedure at the same time.