NTrap in prevention of stone migration during ureteroscopic lithotripsy for proximal ureteral stones: a meta-analysis.

PURPOSE: To evaluate the effectiveness of NTrap in the prevention of stone migration during ureteroscopic lithotripsy for proximal ureteral stones. METHODS: Eligible studies were identified from electronic databases (PubMed, Embase, the Cochrane Library, ISI - Science Citation Index, and Chinese biomedicine literature database). The database search, quality assessment, and data extraction were independently performed by two reviewers. Our primary outcomes were the stone-free (SF) and incidence of stone migration. Secondary outcomes were operative time and the rate of auxiliary procedures. The outcomes were explored by using Review Manager 5.0. Sensitivity analysis was performed to explore the influence of low-quality studies. RESULTS: Two randomized controlled trials and one case-control study including 456 patients met the inclusion criteria. Meta-analysis of extractable data showed that patients who underwent ureteroscopic lithotripsy with the use of the NTrap demonstrated a significant advantage over without the use of the NTrap in terms of the stone-free rate (odds ratio [OR]=3.08, 95% confidence interval [CI] [1.45-6.53], P=0.003); the incidence of stone migration was significantly lower in NTrap treatment than without NTrap (OR=0.23, 95% CI: 0.10-0.53, P=0.0006, while there was no significant difference in operative time between NTrap and control (mean difference=-3.25, 95% CI: -16.11-9.62, P=0.62). Our pooled meta-analysis showed that the incidence of auxiliary shockwave lithotripsy was significantly lower in NTrap treatment than control (OR=0.29, 95% CI: 0.12-0.70, P=0.006). CONCLUSION: The results of this meta-analysis suggested that the NTrap stone occlusion device is efficient at preventing stone retropulsion during ureteroscopic lithotripsy of proximal ureteral calculi. The findings of this review highlight the need for more efficient performance of higher quality, more rigorous, large sample, long-term randomized controlled trials where outcomes are detailed in description.

[Economic aspects of evidence-based metaphylaxis]. / Okonomische Aspekte der evidenzbasierten Harnsteinmetaphylaxe.

The calculation model which we developed for the cost of stone therapy and metaphylaxis in Germany some years ago with a social health insurance company is based on estimates of stone incidence, types and recurrence rates, actual costs for stone removal, and metaphylaxis (based on data from a district of the social health care system). There are 200,000 stone recurrences per year in Germany. Costs for treatment of these stones amount to $687,000,000. Stone metaphylaxis reduces the recurrence rate by some 40%. The annual cost for stone removal could be lowered by $275,300,000. Metabolic evaluation/metaphylaxis amount to $70,100,000 per year, resulting in a net saving of $205,200,000. In 1997, there were 96 days off work per stone patient resulting in 5,800,000 days off work in Germany per year. Metaphylaxis is not only medically effective in stone formers but also can lower health care cost significantly. Although health care conditions may vary from country to country, in principle this calculation model is applicable also to other countries.

Steinstrasse after extracorporeal shockwave lithotripsy: aetiology, prevention and management.

OBJECTIVE: To determine the causes of steinstrasse, methods of prevention and treatment strategies. PATIENTS AND METHODS: Fifty-two patients with steinstrasse were identified and treated: all patients were initially treated conservatively but when there was obstruction, infection or no progression of the stone fragments, further treatment was used, ranging from repeated extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrostomy (PCN), endoscopic manipulations and finally open surgery, depending on the degree of obstruction, infection, renal function and response to each kind of therapy. RESULTS: Conservative management was successful in 25 patients (48%), repeated ESWL in 12 (23%), PCN in 10 (19%), ureteroscopy in three (6%) and open surgery in two (4%). CONCLUSION: As many patients, and particularly those with larger stones, are treated by ESWL, the risk of developing steinstrasse will increase, with associated patient discomfort, infection or impaired renal function. The optimum selection of cases (aiming to pulverize the stones rather than fragment them) and accurate stone targeting are essential to minimise the development of steinstrasse. The meticulous follow-up of patients with steinstrasse should prevent any loss of renal function. When there is obstruction and/or infection or renal damage, active treatment is indicated, of which ESWL and PCN are the most effective, with ureteroscopy and open surgery reserved for difficult cases.

[Urinary calculi and indinavir sulfate in patients with HIV infection. Apropos of 4 cases]. / Lithiase urinaire et sulfate d'indinavir chez les patients infectés par le VIH. A propos de 4 cas.

We report on 4 cases of urinary stone observed in patients treated with the drug Crixivan (Indinavir Sulfate) and review the literature. Comments include stone composition, clinical aspects, treatment and prevention.

Cateterismo vesical intermitente / Intermittent bladder catheterization

Os autores apresentam a técnica de cateterismo vesical intermitente näo-estéril indicada nas situaçöes agudas ou crônicas que se acompanham de dificuldade no esvaziamento da bexiga. Este procedimento, a superdistensäo da bexiga, preserva o suprimento sanguíneo e o estado funcional da mesma. Os índices de infecçäo urinária, incontinência, litíase e deterioraçäo do aparelho urinário superior e inferior foram comparados com os outros métodos de esvaziamento vesical utilizados. A eficácia terapêutica a curto e longo prazo e a simplicidade da técnica proporcionou-lhe a grande aceitaçäo entre os profissionais de saúde e os pacientes