Innovaciones tecnológicas en la litotricia de ondas de choque / Technological innovations in shock wave lithotripsy

Introducción Desde 1980, la litotricia extracorpórea por ondas de choque (SWL) ha sido empleada en el tratamiento de las litiasis urinarias, ofreciendo alternativas no invasivas a las técnicas quirúrgicas. Aunque limitada por tamaño y ubicación de las piedras, su efectividad se ve afectada por varios factores. A pesar de la evolución de técnicas quirúrgicas, la SWL podría mantener su relevancia con nuevos avances. Nuestro objetivo es revisar la bibliografía existente para recopilar los mayores avances hasta la fecha en el tratamiento extracorpóreo de la litiasis. Material y métodos Se ha realizado una revisión bibliográfica no sistemática, entre los años 2017 a 2023 para obtener 26 artículos sobre 3 tipos de innovación tecnológica en litotricia extracorpórea: Burst Wave Lithotripsy (BWL), Histotripsy y Microbubble Lithotripsy (ML). Resultados La BWL emplea ondas sinusoidales ultrasónicas de menor y mayor frecuencia que la SWL tradicional. Su mecanismo de acción genera una fragmentación de mayor calidad (finos fragmentos) en lugar de generar fuerzas tensionales como en la SWL tradicional que generan líneas de fractura que dan lugar a fragmentos de mayor tamaño. Resultados en cerdos y humanos han mostrado fragmentación efectiva con buen perfil de seguridad. Basada en la tecnología de ultrasonido focalizado de alta intensidad (HIFU), la histotricia fragmenta tejido empleando fenómenos de cavitación. Han mostrado buenos resultados in vitro, aunque la formación de microburbujas que se interponen entre la litiasis y las ondas de ultrasonido son un impedimento para el progreso de esta técnica. La ML combina microburbujas y ultrasonido para fragmentar litiasis con seguridad y eficacia. Resultados in vitro y en cerdos son prometedores. Puede optimizar tratamientos y reducir niveles energéticos. Conclusiones La innovación tecnológica no solo se está aplicando a técnicas endourológicas, sino también a la ESWL. ... (AU)

Introduction Since 1980, extracorporeal Shock Wave Lithotripsy (SWL) has been employed in the treatment of urolithiasis, offering noninvasive alternatives to surgical techniques. In addition to being limited by the size and location of the stones, its efficacy is influenced by several factors. Despite the advancement of other surgical techniques, SWL could maintain its position with new improvements. Our objective is to review the existing literature on the latest advances in the extracorporeal treatment of lithiasis. Material and methods A non-systematic literature review was carried out from 2017 to 2023 to obtain 26 articles on three different emerging technologies in extracorporeal lithotripsy: Burst Wave Lithotripsy (BWL), Histotripsy, and Microbubble Lithotripsy (ML). Results The BWL uses sinusoidal bursts of US waves delivered at lower and higher frequencies than conventional SWL. Its mechanism of action generates a higher quality fragmentation (fine fragments) instead of generating tensile stresses for stone fracture resulting in larger fragments, as in traditional SWL. Studies in pigs and humans have shown effective fragmentation with a good safety profile. Based on High Intensity Focused Ultrasound (HIFU) technology, histotripsy fragments tissue through cavitation. Good in vitro results have been shown, but the formation of microbubbles between the stone and ultrasound waves hinders the progress of this technique. Microbubble Lithotripsy (ML) combines microbubbles and ultrasound for safe and effective stone fragmentation. In vitro and pig results are promising. This technique can help optimize treatments and reduce energy levels. Conclusions Technological innovation is not only being applied to endourological techniques, but also to ESWL. New techniques such as BWL, histotripsy and ML are promising, with good results in the research phase. (AU)

Technological innovations in shock wave lithotripsy.

INTRODUCTION: Since 1980, extracorporeal shock wave lithotripsy (SWL) has been employed in the treatment of urolithiasis, offering noninvasive alternatives to surgical techniques. In addition to being limited by the size and location of the stones, its efficacy is influenced by several factors. Despite the advancement of other surgical techniques, SWL could maintain its position with new improvements. Our objective is to review the existing literature on the latest advances in the extracorporeal treatment of lithiasis. MATERIAL AND METHODS: A non-systematic literature review was carried out from 2017 to 2023 to obtain 26 articles on three different emerging technologies in extracorporeal lithotripsy: Burst Wave Lithotripsy (BWL), Histotripsy, and Microbubble Lithotripsy (ML). RESULTS: The BWL uses sinusoidal bursts of US waves delivered at lower and higher frequencies than conventional SWL. Its mechanism of action generates a higher quality fragmentation (fine fragments) instead of generating tensile stresses for stone fracture resulting in larger fragments, as in traditional SWL. Studies in pigs and humans have shown effective fragmentation with a good safety profile. Based on High Intensity Focused Ultrasound (HIFU) technology, histotripsy fragments tissue through cavitation. Good in vitro results have been shown, but the formation of microbubbles between the stone and ultrasound waves hinders the progress of this technique. Microbubble Lithotripsy (ML) combines microbubbles and ultrasound for safe and effective stone fragmentation. In vitro and pig results are promising. This technique can help optimize treatments and reduce energy levels. CONCLUSIONS: Technological innovation is not only being applied to endourological techniques, but also to ESWL. New techniques such as BWL, histotripsy and ML are promising, with good results in the research phase.

Análisis comparativo de costes directos e indirectos de dos técnicas mínimamente invasivas, para el tratamiento de la litiasis renoureteral menor de 2 cm / Comparative analysis of direct and indirect costs of two minimally invasive techniques for the treatment of renal/ureteral calculi smaller than 2 cm

OBJETIVO: Analizar de forma comparativa los costes indirectos y directos de dos técnicas mínimamente invasivas (litotricia extracorpórea (LEOC) vs. ureterorrenoscopia-láser holmium (URS/RIRS)) para el tratamiento de la litiasis reno-ureteral menor de 2 cm. MATERIAL Y MÉTODOS: Estudio prospectivo y comparativo, no aleatorizado de 84 pacientes tratados por litiasis reno-ureteral menor de 2 cm entre enero y diciembre de 2016. De estos, 38 (45,67%) se trataron con LEOC (18 litiasis renales y 20 litiasis ureterales) y 46 (54,32%) con URS/RIRS (22 litiasis renal y 24 litiasis ureteral). Un total de 19 (41,3%) pacientes estaban activos laboralmente en el grupo de URS/RIRS y 15 (39,5%) pacientes en el grupo de LEOC. Las variables analizadas fueron sexo, edad, número y tamaño de las litiasis, días de baja laboral debido al tratamiento, estimación del coste indirecto por la pérdida de productividad laboral y el coste directo del tratamiento aplicado incluyendo el seguimiento (número total de procedimientos, procedimientos auxiliares, visitas y pruebas diagnósticas). Para la estimación del coste indirecto se empleó la Encuesta de Estructura Salarial 2015 (INE). Además, también se utilizó el cuestionario «Work Productivity and Activity Impairment» (WPAI) para determinar el grado de percepción de pérdida de productividad. RESULTADOS: El número medio de sesiones hasta la resolución de la litiasis fue de 2,57 para el grupo de LEOC y de 1,04 para la URS. El promedio de días de baja laboral en el grupo de la URS fue de 7,16 días, mientras que en el caso de la LEOC fue de 3,18 (p = 0,034). Los costes indirectos totales derivados de la pérdida de productividad fueron de 621,55 € y de 276,05 € para la URS y LEOC, respectivamente. Los costes directos en el grupo de la LEOC fueron de 1.382,9 € y 2.317,71 € en el grupo de la URS. El grado de afectación en el trabajo percibido por los pacientes sometidos a URS fue del 18,88% y del 21,33% en el grupo de LEOC. El grado de afectación para realizar actividades cotidianas fue del 24,44% en URS y del 15% en LEOC. CONCLUSIONES: La LEOC es una técnica que precisa de un mayor número medio de sesiones para la resolución de la litiasis reno-ureteral menor de 2 cm, pero con una menor repercusión en los costes totales y en la percepción del grado de afectación

OBJECTIVE: To perform a comparative analysis of indirect and direct costs of two minimally invasive techniques (extracorporeal shock wave lithotripsy (ESWL) vs. ureteroscopy with holmium laser (URS/RIRS)) for the treatment of renal/ureteral calculi smaller than 2 cm. MATERIAL AND METHODS: Prospective, comparative, non-randomized study of 84 patients treated for kidney stones smaller than 2 cm between January and December 2016. Of these, 38 (45.67%) were treated with ESWL (18 renal lithiasis and 20 ureteral lithiasis) and 46 (54.32%) with URS/RIRS (22 renal lithiasis and 24 ureteral lithiasis). A total of 19 (41.3%) patients in the URS/RIRS group and 15 (39.5%) patients in the ESWL group were actively working before treatment. The variables analyzed were sex, age, number and size of lithiasis, time (days) off from work due to treatment, estimate of indirect cost due to labor productivity loss and direct treatment costs including follow-up (total number of procedures, ancillary care, visits and diagnostic tests). The 2015 Wage Structure Survey (INE) was used to estimate the indirect cost. In addition, the «Work Productivity and Activity Impairment» (WPAI) questionnaire was also used to determine the level of perceived productivity loss. RESULTS: The mean number of sessions until lithiasis resolution was achieved was 2.57 for the ESWL group and 1.04 for the URS. The mean number of days off from work in the URS group was 7.16 days and 3.18 (p = 0.034) in the ESWL group. The total indirect costs resulting from productivity loss were EUR 621.55 and EUR 276.05 for the URS and ESWL, respectively. Direct costs in the ESWL group were EUR 1,382.9 and EUR 2,317.71 in the URS group. The level of work impairment perceived by patients undergoing URS was 18.88% and 21.33% in the ESWL group. The degree of impairment for performing activities of daily living was 24.44% in the URS and 15% in ESWL. CONCLUSIONS: The ESWL technique requires a higher number of sessions for the resolution of kidney stones under 2 cm, but it has a lower impact on total costs and on the perceived degree of affectation

Comparative analysis of direct and indirect costs of two minimally invasive techniques for the treatment of renal/ureteral calculi smaller than 2 cm. / Análisis comparativo de costes directos e indirectos de dos técnicas mínimamente invasivas, para el tratamiento de la litiasis renoureteral menor de 2 cm.

OBJECTIVE: To perform a comparative analysis of indirect and direct costs of two minimally invasive techniques (extracorporeal shock wave lithotripsy (ESWL) vs. ureteroscopy with holmium laser (URS/RIRS)) for the treatment of renal/ureteral calculi smaller than 2 cm. MATERIAL AND METHODS: Prospective, comparative, non-randomized study of 84 patients treated for kidney stones smaller than 2 cm between January and December 2016. Of these, 38 (45.67%) were treated with ESWL (18 renal lithiasis and 20 ureteral lithiasis) and 46 (54.32%) with URS/RIRS (22 renal lithiasis and 24 ureteral lithiasis). A total of 19 (41.3%) patients in the URS/RIRS group and 15 (39.5%) patients in the ESWL group were actively working before treatment. The variables analyzed were sex, age, number and size of lithiasis, time (days) off from work due to treatment, estimate of indirect cost due to labor productivity loss and direct treatment costs including follow-up (total number of procedures, ancillary care, visits and diagnostic tests). The 2015 Wage Structure Survey (INE) was used to estimate the indirect cost. In addition, the «Work Productivity and Activity Impairment¼ (WPAI) questionnaire was also used to determine the level of perceived productivity loss. RESULTS: The mean number of sessions until lithiasis resolution was achieved was 2.57 for the ESWL group and 1.04 for the URS. The mean number of days off from work in the URS group was 7.16 days and 3.18 (p = 0.034) in the ESWL group. The total indirect costs resulting from productivity loss were EUR 621.55 and EUR 276.05 for the URS and ESWL, respectively. Direct costs in the ESWL group were EUR 1,382.9 and EUR 2,317.71 in the URS group. The level of work impairment perceived by patients undergoing URS was 18.88% and 21.33% in the ESWL group. The degree of impairment for performing activities of daily living was 24.44% in the URS and 15% in ESWL. CONCLUSIONS: The ESWL technique requires a higher number of sessions for the resolution of kidney stones under 2 cm, but it has a lower impact on total costs and on the perceived degree of affectation.

Factores predictores de complicaciones infecciosas en el postoperatorio de la nefrolitotomía percutánea / Predictive factors of infectious complications in the postoperative period of percutaneous nephrolithotomy

Objetivo: Las complicaciones infecciosas (CI) tras la nefrolitotomía percutánea (NLPC) pueden llegar a ser de gravedad. Nuestro objetivo fue analizar factores predictores preoperatorios de CI tras la NLPC. Materiales y métodos: Se incluyó en un estudio prospectivo a un total de 203 pacientes que se trataron con NLPC entre enero de 2013 y febrero de 2016. Se definió CI postoperatoria como infección urinaria/pielonefritis, síndrome de respuesta inflamatoria sistémica o sepsis. Las variables analizadas fueron: edad, sexo, número, lado y tamaño (cm) de la litiasis; unidades Hounsfield, diabetes (insulinodependiente o no), cultivo de orina preoperatorio, bacteria aislada, multitrayecto, índice de masa corporal y tiempo quirúrgico (min). Se llevó a cabo un análisis multivariante (regresión logística). Resultados: Se produjeron CI en 30 pacientes (14,8%): en 9 de ellos (4,4%) se presentó infección urinaria, en 14 (6,9%) síndrome de respuesta inflamatoria sistémica y en 7 (3,5%) sepsis. Además, 13 (43,3%) tenían un cultivo de orina preoperatorio negativo, 15 (50%) positivo y en 2 (6,7%) no estaba disponible. En la regresión logística, el tamaño de la litiasis, la diabetes insulinodependiente y el sexo femenino resultaron factores predictores independientes de CI (OR: 1,03; 14,6 y 7,8, respectivamente; p = 0,0001). Conclusiones: Pacientes con litiasis de mayor tamaño, diabéticos insulinodependientes y mujeres deberían ser aconsejados de forma preoperatoria sobre el riesgo de CI tras la NLPC, y ser estrechamente seguidos tras la cirugía. Además, un cultivo de orina preoperatorio negativo no ofrece fiabilidad suficiente para excluir el riesgo de CI

Objective: Infectious complications (IC) following percutaneous nephrolithotomy surgery (PCNL) can be life-threatening. Our objective was to analyze preoperative predictors of IC in PCNL. Materials and methods: A total of 203 patients who underwent PCNL were included in a prospective study between January 2013 and February 2016. A postoperative IC was defined as urinary infection/pyelonephritis, systemic inflammatory response syndrome or sepsis. The variables analyzed were age, gender, number, size (cm) and side of stone; Hounsfield units, diabetes (insulin dependent or not), preoperative culture, isolated bacteria, multitract, body mass index and surgical time (min). A multivariate forward stepwise (logistic regression) was performed. Results: IC occurred in 30 patients (14.8%): 9 (4.4%) had urinary infection, 14 (6.9%) systemic inflammatory response syndrome and 7 (3.5%) sepsis. In addition, 13 (43.3%) had negative preoperative urine culture, 15 (50%) positive and in 2 (6.7%) was not available. On the logistic regression analysis, stone size (cm), insulin dependent diabetes and female sex were independently associated with increased risk of IC (odds ratio [OR] 1.03, 14.6 and 7.8, respectively; p = 0.0001). Conclusions: Patients with large stone burdens, insulin-dependentdiabetes condition and female gender, should be counselled properly regarding postoperative infection risks and closely followed up to diagnose IC (specially sepsis) soon enough. Negative preoperative urine culture seems not reliable enough to exclude an infectious complication according to our results

Predictive factors of infectious complications in the postoperative of percutaneous nephrolithotomy. / Factores predictores de complicaciones infecciosas en el postoperatorio de la nefrolitotomía percutánea.

OBJECTIVE: Infectious complications (IC) following percutaneous nephrolithotomy surgery (PCNL) can be life-threatening. Our objective was to analyse preoperative predictors of IC in PCNL. MATERIALS AND METHODS: A total of 203 patients who underwent PCNL were included in a prospective study between January 2013 and February 2016. A postoperative IC was defined as urinary infection/pyelonephritis, systemic inflammatory response syndrome or sepsis. The variables analysed were age, gender, number, size(cm) and side of stone; Hounsfield units,diabetes (insulin dependent or not), preoperative culture, isolated bacteria, multitract, bodymass index and surgical time (min). A multivariate forward stepwise (logistic regression) was performed. RESULTS: IC occurred in 30 patients (14.8%): 9 (4.4%) had urinary infection, 14 (6.9%) systemic inflammatory response syndrome and 7 (3.5%) sepsis. In addition, 13 (43.3%) had negative preoperative urine culture, 15 (50%) positive and in 2 (6.7%) was not available. On the logistic regression analysis, stone size (cm), insulin dependent diabetes and female sex were independently associated with increased risk of IC (odds ratio [OR] 1.03, 14.6 and 7.8, respectively; P=.0001). CONCLUSIONS: Patients with large stone burdens, insulin diabetes condition and female gender, should be counselled properly regarding postoperative infection risks and closely followed up to diagnose IC (specially sepsis) soon enough. Negative preoperative urine culture seems not reliable enough to exclude an infectious complication according to our results.

Litotricia por ondas de choque con música: un tratamiento menos doloroso y más satisfactorio / Shockwave lithotripsy with music: Less painful and more satisfactory treatment

Introducción: El objetivo del estudio fue determinar si escuchar música durante una sesión de litotricia extracorpórea por ondas de choque (LEOC) mejora el dolor de los pacientes. Material y método: Se realizó una aleatorización simple y oculta de pacientes con litiasis renales o ureterales que acudieron por vez primera a una sesión de LEOC de 7.000 ondas, entre septiembre y diciembre de 2014. Un grupo recibió música mientras que el otro no. Se registraron la edad, sexo, localización de la litiasis (renal/ureteral) y 2 cuestionarios pre-LEOC (cuestionario A) y post-LEOC (cuestionario B). Cada cuestionario contiene una pregunta sobre ansiedad y otra sobre dolor en escala Likert (0 al 10). El B, además, contiene otra sobre satisfacción y otra sobre comodidad (Likert 0 al 10). Otras variables fueron la frecuencia cardiaca, respiratoria, tensión arterial sistólica y diastólica en la onda 2.000, 5.000 y 7.000, causa de interrupción del procedimiento, petidina total (mg), analgesia secundaria, energía (J) y frecuencia (Hz). Se realizó un análisis bivariante con t de Student, X2/Fisher y un modelo de regresión lineal múltiple. Resultados: La muestra incluyó a 95 pacientes, con una media de edad de 52 años (±13), 35 mujeres (36,84%), 60 hombres (63,2%); 25 para litiasis ureterales (26,3%) y 70 (26,3%) para renales (73,7%). Un total de 42 pacientes (44,2%) pacientes recibieron música. No hubo diferencias entre las variables demográficas ni en las puntuaciones del cuestionario A. La satisfacción y el dolor fueron mejores en el cuestionario B con música. Conclusión: La música es capaz de disminuir el dolor y mejorar la satisfacción del paciente en los tratamientos con LEOC. Más estudios son necesarios para comprobar este efecto

Introduction: The objective of this study was to determine whether listening to music during a session of extracorporeal shockwave lithotripsy (ESWL) improves patients' pain. Material and method: A simple, blind randomisation was undertaken of patients with kidney and ureter stones attending an ESWL session of 7,000 waves for the first time, between September and December 2014. One group was given music and the other was not. The age, gender, location of stones (kidney/ureter) were recorded and 2 questionnaires: pre ESWL (questionnaire A) and postESWL (questionnaire B). Each questionnaire contained a question about anxiety and another question on pain on the Likert scale (0-10). Questionnaire B also had a question on satisfaction and comfort (Likert 0-10). Other variables included heart rate, respiratory rate, systolic and diastolic blood pressure on wave 2,000, 5,000 and 7,000, reason for halting the procedure, total pethidine (mg), secondary analgesia, energy (J) and frequency (Hz). Bivariate analysis using the Student's t-test, X2/Fisher test and a multiple linear regression model. Results: The sample comprised 95 patients, with a mean age of 52 (±13) years, 35 (36.84%) females, 60 (63.2%) males. A total of 25 (26.3%) ureter stones and 70 (73.7%) kidney stones. A number of 42 (44.2%) patients were given music. There were no differences between the demographic variables or questionnaire A scores. Satisfaction and pain were better on questionnaire B with music. Conclusion: Music can reduce pain and improve patient satisfaction in ESWL treatment. More studies are required to confirm this effect

¿Es la litotricia extracorpórea por ondas de choque en la actualidad un tratamiento vigente para el tratamiento de la litiasis urinaria? Revisión sistemática / Is extracorporeal shock wave lithotripsy a current treatment for urolithiasis? A systematic review

Introducción: Los avances tecnológicos han motivado un cambio en el manejo de la urolitiasis. Las técnicas endourológicas están cobrando mayor importancia, ya que son tratamientos altamente eficaces. El objetivo de este trabajo es responder a la cuestión de si la LEOCH sigue siendo una alternativa competitiva frente a otras modalidades terapéuticas. Adquisición de la evidencia: Se realizó una búsqueda bibliográfica de artículos publicados en los últimos 5 años. Fueron identificados 12 estudios aleatorizados y comparativos. Se evaluó la metodología y el resultado de las variables estudiadas. Se ha realizado una síntesis narrativa de los estudios incluidos. Para resumir las variables se ha utilizado la media y la desviación estándar en variables continuas, y para variables cualitativas el número absoluto y el porcentaje. Análisis de la evidencia: De los estudios revisados, 7 trabajos evaluaban los distintos tratamientos para litiasis renales y 5 para litiasis ureterales. A nivel renal, con LEOCH se alcanza una TLL a los 3 meses entre 91,5-33,33%, mientras que con otras técnicas endourológicas entre 100-90,4%, sin encontrar diferencias estadísticamente significativas en todos los estudios. A nivel ureteral con LEOCH se alcanza una TLL a los 3 meses entre 82,2-73,5%, mientras que con otras técnicas endourológicas entre 94,1-79%, sin encontrar diferencias estadísticamente significativas todos los estudios. Conclusión: Existe una falta de homogeneidad entre los estudios publicados. La LEOCH es un tratamiento mínimamente invasivo, que con una adecuada técnica y selección del paciente alcanza una elevada efectividad, manteniendo un papel importante en la actualidad

Introduction: Technological advances have prompted a change in the management of urolithiasis. Endourological techniques are gaining importance because they are highly effective treatments. The aim of this study was to answer the question of whether extracorporeal shock wave lithotripsy (ESWL) is still a competitive alternative compared with other therapeutic modalities. Acquisition of evidence: We conducted a literature search of articles published in the past 5 years. We identified 12 randomized and comparative studies and assessed the methodology and results of the study variables. We performed a narrative synthesis of the included studies. To summarise the variables, we used the mean and standard deviation for continuous variables and absolute numbers and percentages for the qualitative variables. Analysis of the evidence: Of the studies reviewed, 7 evaluated the various treatments for nephrolithiasis and 5 evaluated the treatments for ureteral lithiasis. At the renal level, a stone-free rate of 33.33-91.5% at 3 months was reached with ESWL, while a rate of 90.4-100% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. At the ureteral level, a stone-free rate of 73.5-82.2% at 3 months was reached with ESWL, while a rate of 79-94.1% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. Conclusion: There is a lack of homogeneity among the published studies. ESWL is a minimally invasive treatment that with an appropriate technique and patient selection achieves high effectiveness, thus maintaining an important role at this time

Shockwave lithotripsy with music: Less painful and more satisfactory treatment. / Litotricia por ondas de choque con música: un tratamiento menos doloroso y más satisfactorio.

INTRODUCTION: The objective of this study was to determine whether listening to music during a session of extracorporeal shockwave lithotripsy (ESWL) improves patients' pain. MATERIAL AND METHOD: A simple, blind randomisation was undertaken of patients with kidney and ureter stones attending an ESWL session of 7,000 waves for the first time, between September and December 2014. One group was given music and the other was not. The age, gender, location of stones (kidney/ureter) were recorded and 2questionnaires: pre ESWL (questionnaire A) and postESWL (questionnaire B). Each questionnaire contained a question about anxiety and another question on pain on the Likert scale (0-10). Questionnaire B also had a question on satisfaction and comfort (Likert 0-10). Other variables included heart rate, respiratory rate, systolic and diastolic blood pressure on wave 2,000, 5,000 and 7,000, reason for halting the procedure, total pethidine (mg), secondary analgesia, energy (J) and frequency (Hz). Bivariate analysis using the Student's t-test, X2/Fisher test and a multiple linear regression model. RESULTS: The sample comprised 95 patients, with a mean age of 52 (±13) years, 35 (36.84%) females, 60 (63.2%) males. A total of 25 (26.3%) ureter stones and 70 (73.7%) kidney stones. A number of 42 (44.2%) patients were given music. There were no differences between the demographic variables or questionnaire A scores. Satisfaction and pain were better on questionnaire B with music. CONCLUSION: Music can reduce pain and improve patient satisfaction in ESWL treatment. More studies are required to confirm this effect.

Is extracorporeal shock wave lithotripsy a current treatment for urolithiasis? A systematic review. / ¿Es la litotricia extracorpórea por ondas de choque en la actualidad un tratamiento vigente para el tratamiento de la litiasis urinaria? Revisión sistemática.

INTRODUCTION: Technological advances have prompted a change in the management of urolithiasis. Endourological techniques are gaining importance because they are highly effective treatments. The aim of this study was to answer the question of whether extracorporeal shock wave lithotripsy (ESWL) is still a competitive alternative compared with other therapeutic modalities. ACQUISITION OF EVIDENCE: We conducted a literature search of articles published in the past 5 years. We identified 12 randomized and comparative studies and assessed the methodology and results of the study variables. We performed a narrative synthesis of the included studies. To summarise the variables, we used the mean and standard deviation for continuous variables and absolute numbers and percentages for the qualitative variables. ANALYSIS OF THE EVIDENCE: Of the studies reviewed, 7 evaluated the various treatments for nephrolithiasis and 5 evaluated the treatments for ureteral lithiasis. At the renal level, a stone-free rate of 33.33-91.5% at 3 months was reached with ESWL, while a rate of 90.4-100% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. At the ureteral level, a stone-free rate of 73.5-82.2% at 3 months was reached with ESWL, while a rate of 79-94.1% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. CONCLUSION: There is a lack of homogeneity among the published studies. ESWL is a minimally invasive treatment that with an appropriate technique and patient selection achieves high effectiveness, thus maintaining an important role at this time.

[Impact in the quality of life of the patients with double J catheter.] / Impacto en la calidad de vida de los pacientes con catéter doble J.

OBJECTIVE: Double J ureteral stents are frequently used to allow free diuresis from the kidney to the bladder, but their presence has a major impact on patient's quality of life (QoL). Our aim is to describe such impact, and to describe possible solutions that can alleviate the symptoms associated with their use. METHODS: Systematic search in bibliographic sources including Cochrane library, UpToDate, Pubmed, Tripdatabase, selecting publications between 2000- 2015, and also the EAU European guidelines (2016). Studies that assessed QoL with double J stents and possible solutions were selected. RESULTS: We included 6 qualitative studies on QoL, 6 clinical trials of double J catheters new designs, and 3 systematic reviews. Most studies used the USSQ (QoL) questionnaire and main problems are described, being storage symptoms and pain the most frequent and important. Possible solutions include modifications in design and composition of the catheter and specially, the use of alpha-blockers and anticholinergics to improve QoL. CONCLUSION: Double J stents have an important symptomatic impact that impairs QoL. They should be used under appropriate indication; their duration should be limited and we must employ all the technological and pharmacological approaches to mitigate their effects.

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Análisis del perfil de seguridad del tratamiento con un número ampliado de ondas de choque por sesión en litotricia extracorpórea / Analysis of the safety profile of treatment with a large number of shock waves per session in extracorporeal lithotripsy

Objetivo: Evaluar la seguridad del incremento del número de ondas por sesión en el tratamiento de la litiasis urinaria mediante litotricia extracorpórea. Material y métodos: Estudio prospectivo, comparativo, no aleatorizado, de grupos paralelos de pacientes con litiasis reno-ureteral e indicación de litotricia extracorpórea incluidos consecutivamente entre 2009 y 2010. Se comparó un grupo i (160 pacientes) tratado programadamente con un número medio de ondas/sesión estándar (2858,3 ± 302,8) y un litotriptor Dornier Lithotripter U/15/50, frente a un grupo ii (172 pacientes) tratado con un número medio de ondas/sesión ampliado (6728,9 ±889,6) y un litotriptor Siemens Modularis. Las variables analizadas fueron edad, sexo, localización, tamaño de la litiasis, número de ondas/sesión y totales hasta la resolución, tasa libre de litiasis (TLL) y tasa de complicaciones (clasificación Clavien-Dindo). Para el análisis estadístico fueron empleados la «t» de Student y la Chi cuadrado. Resultados: La tasa de complicaciones totales fue 11,9% para el grupo i y 10,46% para el grupo ii (p = 0,39). Todas ellas fueron complicaciones menores grado i (Clavien-Dindo). La más frecuente en el grupo i fue el dolor cólico y en el grupo ii la hematuria, con tasa de intolerancia al tratamiento similar (p > 0,05). El número de ondas totales necesarias fue inferior en el grupo ii respecto al grupo i (p = 0,001), con TLL del 96,5% y 71,5% respectivamente (p = 0,001). Conclusión: El tratamiento con un número ampliado de ondas por sesión en litotricia extracorpórea no implica mayor tasa de complicaciones ni mayor severidad de las mismas. Sin embargo, podría aumentar la efectividad global del tratamiento

Objective: To assess the safety of increasing the number of waves per session in the treatment of urolithiasis using extracorporeal lithotripsy. Material and methods: Prospective, comparative, nonrandomized parallel study of patients with renoureteral lithiasis and an indication for extracorporeal lithotripsy who were consecutively enrolled between 2009 and 2010. We compared group I (160 patients) treated on schedule with a standard number of waves/session (mean 2858,3 ± 302,8) using a Dornier lithotripter U/15/50 against group II (172 patients) treated with an expanded number of waves/session (mean, 6728,9 ± 889,6) using a Siemens Modularis lithotripter. The study variables were age, sex, location, stone size, number of waves/session and total number of waves to resolution, stone-free rate (SFR) and rate of complications (Clavien-Dindo classification). Student's t-test and the chi-squared test were employed for the statistical analysis. Results: The total rate of complications was 11.9% and 10.46% for groups I and II, respectively (P = .39). All complications were minor (Clavien-Dindo grade I). The most common complications were colic pain and hematuria in groups I and II, respectively, with a similar treatment intolerance rate (P > .05). The total number of waves necessary was lower in group II than in group I (P = .001), with SFRs of 96.5% and 71.5%, respectively (P = .001). Conclusion: Treatment with an expanded number of waves per session in extracorporeal lithotripsy does not increase the rate of complications or their severity. However, it could increase the overall effectiveness of the treatment

Analysis of the safety profile of treatment with a large number of shock waves per session in extracorporeal lithotripsy.

OBJECTIVE: To assess the safety of increasing the number of waves per session in the treatment of urolithiasis using extracorporeal lithotripsy. MATERIAL AND METHODS: Prospective, comparative, nonrandomized parallel study of patients with renoureteral lithiasis and an indication for extracorporeal lithotripsy who were consecutively enrolled between 2009 and 2010. We compared group I (160 patients) treated on schedule with a standard number of waves/session (mean 2858,3±302,8) using a Dornier lithotripter U/15/50 against group II (172 patients) treated with an expanded number of waves/session (mean, 6728,9±889,6) using a Siemens Modularis lithotripter. The study variables were age, sex, location, stone size, number of waves/session and total number of waves to resolution, stone-free rate (SFR) and rate of complications (Clavien-Dindo classification). Student's t-test and the chi-squared test were employed for the statistical analysis. RESULTS: The total rate of complications was 11.9% and 10.46% for groups I and II, respectively (P=.39). All complications were minor (Clavien-Dindo grade I). The most common complications were colic pain and hematuria in groups I and II, respectively, with a similar treatment intolerance rate (P>.05). The total number of waves necessary was lower in group II than in group I (P=.001), with SFRs of 96.5% and 71.5%, respectively (P=.001). CONCLUSION: Treatment with an expanded number of waves per session in extracorporeal lithotripsy does not increase the rate of complications or their severity. However, it could increase the overall effectiveness of the treatment.

Análisis del valor pronóstico de la trombosis tumoral venosa en el adenocarcinoma renal / Prognostic value of venous tumor thrombus in renal cell carcinoma

Objetivo: Analizar el valor pronóstico de la trombosis tumoral venosa en el carcinoma de células renales (CCR).Material y métodos: Estudio retrospectivo de 167 pacientes con carcinoma de células renales (estadio pT3) intervenidos mediante nefrectomía radical y linfadenectomía (julio de 1969 a mayo de 2008). Para el análisis se seleccionaron los pacientes con afectación venosa (73 pacientes; 43,7%). Para el análisis de supervivencia, se utilizaron las curvas de Kaplan-Meyer y el test de log-rank. El análisis multivariante se realizó mediante regresión de Cox. Resultados: En 30 pacientes (41,1%) existía afectación ganglionar, y en 9 pacientes (12,3%) enfermedad metastásica. El subtipo histológico más frecuente fue el carcinoma convencional en 50 pacientes (68,5%), seguido del indiferenciado en 11 pacientes (15,5%) y el cromófobo en 9 pacientes (12,3%). El 57% de los tumores fueron de alto grado (Furhman 3-4). El nivel de trombotumoral se extendía hasta la vena renal en 61 pacientes (83,6%), hasta la cava infradiafragmática en 9 pacientes (12,3%), y en 3 casos (4,1%) al atrio. El análisis de supervivencia mostró peor supervivencia en aquellos pacientes con trombosis tumoral venosa (p=0,001) y con invasión de la pared venosa (p=0,0042) pero no en función del nivel del trombo (p= 0,12). El análisis multivariante identificó el grado de Furhman y la trombosis tumoral venosa como factores pronósticos independientes de supervivencia. Conclusiones: En nuestra serie la trombosis tumoral venosa es un factor pronóstico independiente de supervivencia, junto al grado nuclear de Furhman. Ni el nivel de extensión cefálica del trombo ni la invasión de la pared venosa mostraron valor pronóstico independiente (AU)

Objective: To evaluate the prognostic value of venous tumor thrombus in renal cell carcinoma. Material and methods: A retrospective study of 167 patients with renal cell carcinoma and stage pT3 who underwent radical nephrectomy and extended lymphadenectomy from July 1969 to May 2008 was conducted. Patients with any kind of venous involvement were selected for the analysis (73 patients; 43.7%). The Kaplan Meier survival curves and log-rank test for comparisons were used for the survival analysis. Multivariate analysis was done by Coxregression. Results: Lymph node involvement was present in 30 patients (41.1%) and metastatic disease in9 patients (12.3%). The most frequent histologic renal cell carcinoma subtype was 50 (68.5%) conventional carcinoma, followed by non differentiated in 11 (15.5%), and chromophobe in9 (12.3%). High grade tumors (Furhman 3-4) were present in 57% of the cases. Venous thrombus level extended to renal vein in 61 patients (83.6%), to inferior vena cava in 9 patients (12.3%) and to the cardiac right atrium in 3 cases (4.1%). The survival analysis showed worse survival in those patients with venous tumor thrombosis (p=.001) and with vein wall invasion (p=0.0042), but not in function on the level of the thrombus (p=0.12). The multivariate analysis identified the Furhman grade and venous tumor thrombosis as independent survival prognostic factors. Conclusions: In our series, venous tumor thrombosis, together with the Furhman nuclear grade, is an independent survival prognostic factor. However, neither cephalic extension of the thrombusn or the invasion of the vein wall showed independent prognostic value (AU)

[Prognostic value of venous tumor thrombus in renal cell carcinoma]. / Análisis del valor pronóstico de la trombosis tumoral venosa en el adenocarcinoma renal.

OBJECTIVE: To evaluate the prognostic value of venous tumor thrombus in renal cell carcinoma. MATERIAL AND METHODS: A retrospective study of 167 patients with renal cell carcinoma and stage pT3 who underwent radical nephrectomy and extended lymphadenectomy from July 1969 to May 2008 was conducted. Patients with any kind of venous involvement were selected for the analysis (73 patients; 43.7%). The Kaplan Meier survival curves and log-rank test for comparisons were used for the survival analysis. Multivariate analysis was done by Cox regression. RESULTS: Lymph node involvement was present in 30 patients (41.1%) and metastatic disease in 9 patients (12.3%). The most frequent histologic renal cell carcinoma subtype was 50 (68.5%) conventional carcinoma, followed by nondifferentiated in 11 (15.5%), and chromophobe in 9 (12.3%). High grade tumors (Furhman 3-4) were present in 57% of the cases. Venous thrombus level extended to renal vein in 61 patients (83.6%), to inferior vena cava in 9 patients (12.3%) and to the cardiac right atrium in 3 cases (4.1%). The survival analysis showed worse survival in those patients with venous tumor thrombosis (p=.001) and with vein wall invasion (p=.0042), but not in function on the level of the thrombus (p=.12). The multivariate analysis identified the Furhman grade and venous tumor thrombosis as independent survival prognostic factors. CONCLUSIONS: In our series, venous tumor thrombosis, together with the Furhman nuclear grade, is an independent survival prognostic factor. However, neither cephalic extension of the thrombus nor the invasion of the vein wall showed independent prognostic value.

In vivo aneuploidization during the expansion of renal adenocarcinoma.

BACKGROUND/AIMS: A correlation has been observed between DNA ploidy and other prognostic parameters such as tumor stage and grade. The present study evaluates tumor aneuploidization during renal adenocarcinoma expansion and growth. METHODS: A total of 252 renal tumors were analyzed between 1969 and 2001. Evaluated variables were age, TNM, Fuhrman classification, histology, size and DNA. A tumor was homogeneous when all the samples were diploid or aneuploid, and a heterogeneous tumor was the coexistence of aneuploid and diploid samples, or all-aneuploid with different aneuploid clones. RESULTS: A total of 224 tumors were included (coefficient of variation <8). The DNA study classified 129 (57.6%) as diploid and 95 (42.4%) as aneuploid. The percentage of aneuploid tumors increased significantly with the pathological stage. Both aneuploid patterns were also significantly more frequent in advanced pathological stages. Tumors with multiple aneuploid clones (n = 17) were significantly more frequent in tumors measuring `4 cm. Both aneuploid patterns showed no differences in survival (p = 0.83), indicating that the heterogeneous pattern probably represents an intermediate step between diploid and homogeneous aneuploid tumor status. CONCLUSIONS: The aneuploid pattern is more common in more advanced stages of the disease, with no clear correlation to primary tumor size. This suggests gradual aneuploidization with tumor expansion and growth.