Conhecimento da população portadora de doença renal calculosa sobre os fatores de risco associados à urolitíase / Awareness of the population with calculus kidney disease about the risk factors associated with urolitiasis / Conocimiento de la población con enfermedad renal por cálculo sobre los factores de riesgo asociados a la urolitiasis

Introdução: A litíase urinária é uma doença que ocorre devido à formação de cálculos no aparelho urinário, especialmente os compostos por oxalato de cálcio. Sua prevalência vem aumentando, variando de 5 a 15% na população adulta ocidental, tendo aspectos genéticos e ambientais como fatores de risco para seu surgimento. Objetivo: Verificar o conhecimento da população portadora de doença renal calculosa sobre os fatores de risco associados à urolitíase buscando correlacionar variáveis sociodemográficas ao número de acertos. Material e Método: Foi realizado um estudo do tipo transversal de caráter descritivo com abordagem qualitativa, incluindo 84 indivíduos que tenham sido submetidos a tratamento de ureterolitíase. O trabalho foi desenvolvido por meio do envio de questionários em plataformas digitais. Resultados: A idade média dos participantes foi de 39,8 anos, sendo que 40 indivíduos (50,6%) não possuíam comorbidades e 56 deles (66,7%) afirmaram que receberam informação a respeito de como prevenir a formação de novos cálculos no trato urinário. Em relação aos fatores predisponentes, 67 indivíduos (79,8%) acreditaram que certos alimentos e bebidas poderiam afetar o risco de formação de cálculos no trato urinário. Além disso, 67 pacientes (79,8%) da amostra estariam dispostos a promover mudanças dietéticas e de estilo de vida, caso elas reduzissem o risco de incidência de doença calculosa no trato urinário. Conclusão: Dessa forma, ressalta-se a importância de estabelecimento de uma comunicação médico-paciente efetiva de modo a promover melhoras no desempenho dos indivíduos acerca dos fatores de risco para doença calculosa.(AU)

Introduction: Urinary lithiasis is a disease that occurs due to the formation of stones in the urinary tract, especially those composed of calcium oxalate. Its prevalence has been increasing, ranging from 5 to 15% in the Western adult population, with genetic and environmental aspects as risk factors for its emergence. Objective: Verify the knowledge of the population with calculus kidney disease about the risk factors associated with urolithiasis seeking to correlate sociodemographic variables to the number of hits. Material and Method: A cross-sectional study of descriptive character with a qualitative approach was carried out, including 84 individuals who have undergone treatment of ureterolithiasis. The work was developed by sending questionnaires on digital platforms. Results: The average age of the participants was 39.8 years, 40 individuals (50.6%) did not have comorbidities and 56 of them (66.7%) stated that they received information about how to prevent the formation of new stones in the urinary tract. Regarding predisposing factors, 67 individuals (79.8%) believed that certain foods and beverages could affect the risk of formation of stones in the urinary tract. In addition, 67 patients (79.8%) of the sample would be willing to promote dietary and lifestyle changes if they reduced the risk of incidence of calculus disease in the urinary tract. Conclusion: Thus, we emphasize the importance of establishing effective medical-patient communication in order to promote improvements in the performance of individuals about risk factors for computed disease.(AU)

Introducción: La litiasis urinaria es uma enfermedad que se produce por la formación de cálculos en las vías urinarias, especialmente los compuestos por oxalato de cálcio. Su prevalência ha ido em aumento, oscilando entre el 5 y el 15% en la población adulta occidental, siendo los factores genéticos y ambientales para su aparición. Objetivo: Verificar el conocimiento de la población con enfermedad renal calculosa sobre los factores de riesgo asociados a la urolitiasis, buscando correlacionar variables sociodemográficas com el número de aciertos. Materiales y métodos: Se realizó un estudio descriptivo transversal con abordaje cualitativo, en el que se incluyeron 84 individuos en tratamiento por ...(AU)

Comparison of the Diagnostic Values of Leukocytes, Neutrophils, Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Distinguishing between Acute Appendicitis and Right Ureterolithiasis.

BACKGROUND: To compare the diagnostic values of leukocytes, neutrophils, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in distinguishing between acute appendicitis (AA) and right ureterolithiasis (RU). METHODS: In this retrospective study, 106 patients diagnosed with AA (Appendicitis group) and 33 cases with RU (Ureterolithiasis group) were enrolled due to acute right lower abdominal pain. The levels of peripheral blood leukocyte counts (leukocytes), neutrophil counts (neutrophils), lymphocyte counts (lymphocytes), platelet counts (platelets), NLR and PLR were recorded and compared between the two groups. Student's t-test for independent samples was adopted for comparing the mean between the two groups. Model discrimination was evaluated using the area under the receiver operating characteristic curve (AUC). Comparison of AUC was performed using the Z-test. RESULTS: The levels of leukocytes, neutrophils, NLR, and PLR were significantly increased in AA compared with RU (all p < 0.01), while there were no significant statistical differences of lymphocytes and platelets (all p > 0.05); moreover, AUC in distinguishing AA from RU was 0.797 (95% confidence interval (CI), 0.721 to 0.861) for leukocytes, 0.814 (95% CI, 0.740 to 0.875) for neutrophils, 0.770 (95% CI, 0.691 to 0.837) for NLR, and 0.608 (95% CI, 0.522 to 0.690) for PLR, and significant differences were observed between PLR and any of the three other parameters (all p < 0.01), while there were no significant statistical differences after pairwise comparison between leukocytes, neutrophils and NLR (all p > 0.05). Finally, the cutoff values were 13.1 × 109/L in distinguishing between AA and RU (specificity 87.88%, sensitivity 63.21%, and Youden index 0.511) for leukocytes, 7.4 x 109/L (specificity 69.70%, sensitivity 83.02%, and Youden index 0.527) for neutrophils, 5.57 (specificity 81.82%, sensitivity 68.87%, and Youden index 0.507) for NLR, and 182.5 (specificity 84.85%, sensitivity 37.74%, and Youden index 0.226) for PLR. CONCLUSIONS: Leukocytes, neutrophils, and NLR can demonstrate more accurate and reliable diagnostic values than PLR, suggesting that they are useful and potential biomarkers in distinguishing between AA and RU.

The "old" 15 mm renal stone size limit for RIRS remains a clinically significant threshold size.

PURPOSE: To investigate the performance of retrograde intrarenal surgery (RIRS) for the 1-2 cm renal stone size range in comparison to smaller stones. MATERIALS AND METHODS: From a data base of 3000 ureteroscopies between 2004 and 2014, 635 consecutive patients underwent RIRS for renal stones. Patients were divided to three groups according to their renal stone size (<10, 10-15, 15-20 mm). Preoperative, operative, stone free rate (SFR) and follow-up data were analyzed and compared. RESULTS: The SFR for the three groups was 94.1, 90.1 and 85%, respectively. Patients with renal stone size above 15 mm had a statistically significantly lower SFR. The efficiency quotient calculated for stones larger and smaller than 15 mm was 83.9 vs. 91.8%, respectively (p < 0.01). The mean operative time and hospital stay were longer for patients with renal stones larger than 15 mm (73.6 ± 29.9 vs. 53 ± 19.4 min, p < 0.01 and 2.2 ± 2 vs. 1.8 ± 1.8 days, p = 0.031, respectively). Moreover, the complication rate was almost two times higher (10 vs 5.4%, p = 0.08). Concomitant ureteral stones and older age were independent predictors of failure in the large stone group. CONCLUSIONS: While the overall SFR following RIRS for renal stones up to 2 cm is generally high, the SFR for 15-20 mm stones is significantly lower, with a longer operating time and hospital stay, and a higher complication rate.

Clinical relevance of seasonal changes in the prevalence of ureterolithiasis in the diagnosis of renal colic.

Ureterolithiasis is one of the most frequently diagnosed urologic diseases worldwide. Its annual incidence in Japan increased three-fold from 1965 to 2005. Ureterolithiasis incidence is affected by numerous factors, including race, sex, body weight, fluid intake, and climate. Here, we aimed to address the latter by considering the effect of seasonal variation on stone incidence and incorporating this information into a predictive model for differential diagnosis of ureteral stone from other conditions with similar presentations. We retrospectively identified 491 patients in our emergency department computer database who complained of back, flank, or lower abdominal pain during 2007-2015. Among them, 358 had stones, as confirmed by computerized tomography or plain abdominal X-ray of kidney-ureter-bladder. We also charted the mean ambient temperatures in our city for a year. The cases of ureteral stones paralleled the ambient temperatures, peaking during the hottest weather. Univariate analysis identified 13 factors associated with ureteral stones. Multivariate analysis narrowed the number to eight: age <60 years, male sex, short duration of pain (<6 h), nausea/vomiting, hydronephrosis, hematuria, history of urinary stone(s), and summer (July-September in Japan). Pain appearing during summer was nine times more likely to be due to a ureteral stone than was pain appearing during other seasons. We incorporated the eight variables identified into a predictive logistic regression model, which yielded good prediction of ureteral stones. Awareness that hot weather is associated with increased incidence of ureterolithiasis could facilitate differential diagnosis, and our prediction model could be useful for screening for ureterolithiasis.

The efficacy and safety of silodosin for the treatment of ureteral stones: a systematic review and meta-analysis.

BACKGROUND: To evaluate the efficacy and safety of silodosin as a medical expulsive therapy for ureteral stones by means of a systematic review and meta-analysis. METHODS: We searched MEDLINE, EMBASE and the Cochrane Controlled Trials Register to identify randomized controlled trials (RCTs) of silodosin in the treatment of ureteral stones. The reference lists of retrieved studies were also investigated. RESULTS: Six RCTs, including 916 participants and comparing silodosin with controls, were used in the meta-analysis. Silodosin was superior to controls in terms of stone expulsion rate, the primary efficacy end point in all six RCTs (odds ratio [OR] for expulsion 2.16, 95 % confidence interval [CI] 1.62 to 2.86, p <0.00001). Silodosin was also more effective for secondary efficacy end points; the stone expulsion time (standardized mean difference [SMD] -3.66, 95 % CI -6.61 to -0.71; p =0.01) and analgesic requirements (SMD -0.89, 95 % CI -1.19 to -0.60; p < 0.00001) were significantly reduced compared with those of controls. Other than the incidence of abnormal ejaculation, which was higher in the silodosin groups (OR 2.84, 95 % CI 1.56 to 5.16, p =0.0006), few adverse effects were observed. CONCLUSION: This meta-analysis indicates silodosin is an effective and safe treatment option for ureteral stones with a low occurrence of side effects.

Tratamiento médico expulsivo de la litiasis ureteral con bloqueadores adrenérgicos alfa / Expulsive medical treatment of ureteral stone with adrenergic alfa-blockers

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Risk factors for formation of steinstrasse after extracorporeal shock wave lithotripsy for pediatric renal calculi: a multivariate analysis model.

OBJECTIVES: To define various stone, renal and therapy factors that could affect steinstrasse (SS) formation after extracorporeal shock wave lithotripsy (SWL) for pediatric kidney stones. Thus, SS could be anticipated and prophylactically avoided METHODS: From January 1999 through December 2012, 317 children underwent SWL with Dornier Lithotripter S for the treatment of renal stones. Univariate and multivariate statistical analyses of patients, stones and therapy characteristics in relation to the incidence of SS were performed to detect the factors that had a significant impact on SS formation. RESULTS: The overall incidence of SS was 8.5%. The steinstrasse was in the pelvic ureter in 74.1% of the cases, lumbar ureter in 18.5% and iliac ureter in 7.4%. Steinstrasse incidence significantly correlated with stone size, site and age of child. Steinstrasse was more common with increasing stone length and stones located in renal pelvis or upper calyx with the age below 4 years. A statistical model was constructed to estimate the risk of steinstrasse formation accurately. The equation for logistic regression is Z = -4.758 + B for age + B for size stone X length in mm + B for stone site. CONCLUSIONS: The stone size, site and age are the most important risk factors responsible for SS formation in children. Our regression analysis model can help with prospective identification of children who will be at risk of SS formation. Those children at high risk of SS formation should be closely monitored or treated by endoscopic maneuvers from the start.

Percutaneous nephrolithotomy and ureteroscopy in children: evolutions.

The increasing incidence of pediatric stone disease has coincided with significant advances in technology and equipment, resulting in drastic improvements in management. Miniaturization of both ureteroscopes and percutaneous nephrolithotomy (PCNL) equipment has facilitated access to the entirety of the urinary tract and has made ureteroscopy a first-line therapy option along with shock-wave lithotripsy for kidney and ureteral stones. Advances in PCNL have decreased patient morbidity while preserving stone clearance rates. In this review, the advances in operative approach for ureteroscopy and PCNL in children and its applicability to current surgical management of pediatric stone disease are discussed.

Emergency department visits in the United States for upper urinary tract stones: trends in hospitalization and charges.

PURPOSE: Using the Nationwide Emergency Department Sample (NEDS) we examined trends in visits, hospitalization and charges for patients with upper urinary tract stones who presented to the emergency department in the United States. MATERIALS AND METHODS: All visits with a primary diagnosis of kidney calculus (ICD-9-CM code 592.0), ureter calculus (592.1) or urinary calculus unspecified (592.9) were extracted from NEDS between 2006 and 2009. A weighted sample was used to calculate incidence rates. Temporal trends were quantified by the estimated annual percent change. Patient and hospital characteristics associated with hospitalization were evaluated using logistic regression models adjusted for clustering. RESULTS: Between 2006 and 2009 there were 3,635,054 emergency department visits for upper urinary tract stones. The incidence increased from 289 to 306/100,000 individuals. More men visited than women but women showed significant increases in visits (estimated annual percent change 2.85%, p = 0.018). Total monthly emergency department visits ranged from 5.8% in February to 8.4% in August. Overall 12.0% of patients were hospitalized and the hospitalization rate remained stable (estimated annual percent change -1.02%, p = 0.634). Patients were more likely to be hospitalized if they were female, more ill, seen at an urban teaching or low volume hospital, or had Medicaid or Medicare (each p <0.001). Sepsis was associated with the highest likelihood of hospital admission (OR 69.64, p <0.001). In 2009 charges for emergency department visits increased to $5 billion (estimated annual percent change 10.06%, p = 0.003). CONCLUSIONS: Women showed significant annual increases in emergency department visits for upper urinary tract stones. While emergency department charges increased substantially, hospitalization rates remained stable. Greater use of computerized tomography and medical expulsive therapy could be the reasons for this observation, which warrants further study.

Retención urinaria aguda en varones jóvenes y de mediana edad debida a cálculos en la uretra: experiencia de un solo centro del norte de India / Acute Urinary Retention in Young Adult and Middle-Aged Males Due to Calculi in the Urethra: A Single Centre Experience From North India

Objetivo: Presentar nuestra experiencia en el tratamiento de la retención urinaria aguda (RUA) en hombres jóvenes y de mediana edad, debido a piedra/s en la uretra en un centro de atención terciaria. Material y métodos: Entre julio de 2004 y abril de 2011, se trató a 102 pacientes varones jóvenes y de mediana edad (18-40 años) que presentaban RUA debido a un cálculo en la uretra en nuestro centro. El tratamiento inicial consistió en la cateterización uretral o cistostomía suprapúbica con trocar. El tratamiento definitivo se realizó inmediatamente o después de un par de días en función de la disponibilidad de la anestesia y/o quirófano. La piedra se fragmentó con litotrito mecánico, litotrito neumático u holmio: láser YAG. Resultados: Todos los pacientes quedaron totalmente libres de sus piedra/s siguiendo el procedimiento definitivo. En todos los casos se consiguió micción espontánea. La infección post-operatoria del tracto urinario se observó en 8 pacientes que habían recibido tratamiento endoscópico inmediato. Se observó hematuria leve durante aproximadamente 48 h en 6 pacientes que recibieron cistolitotricia suprapúbica. Conclusión: El tratamiento endoscópico es actualmente la elección para piedra/s en la uretra que puede/n causar RUA en varones jóvenes y de mediana edad (AU)

Objective: To present our experience of managing acute urinary retention (AUR) in young and middle-aged male due to stone/s in the urethra at a tertiary care centre. Material and methods: Between July 2004 to April 2011, 102 male patients, young and middle-aged (18-40 years), who suffered from AUR due to calculus in the urethra were managed at our center. Initial management consisted of urethral catheterization or suprapubic trocar cystostomy. Definitive management was performed immediately or after a couple of days depending upon the availability of anesthesia and/or operation theatre. Stone was fragmented by mechanical lithotrite, pneumatic lithotrite or holmium: YAG laser. Results: All the patients were completely free of their stone/s following the definitive procedure. Voiding trial was successful in all the cases. Postoperative urinary tract infection was observed in eight patients who had undergone immediate endoscopic management. Mild hematuria for approximately 48hours was noted in six patients who underwent suprapubic cystolithotripsy. Conclusion: Endoscopic management is currently the treatment of choice for stone/s in the urethra which may cause AUR in young and middle-aged male (AU)

Resultados de la litotricia extracorpórea utilizando el litotritor MODULITH SLX-MX (STORZ) para el tratamiento de la litiasis ureteral / Results of the shock waves extracorporeal lithotripsy using the MODULITH SLX-MX (STORZ) lithotriptor for treatment or ureteral lithiasis

INTRODUCCIÓN. La litiasis del uréter constituye una gran preocupación para los médicos debido a que frecuentemente ocasiona una uropatía obstructiva y el deterioro progresivo de la función renal ipsolateral, estado patológico de alta prevalencia, por lo que los hospitales con frecuencia no pueden dar solución quirúrgica con la celeridad necesaria. El objetivo de esta investigación fue conocer los resultados de la litotricia extracorpórea por ondas de choque (LEC) con el litotritor MODULITH SLX-MX (STORZ) para el tratamiento de la litiasis ureteral. MÉTODOS. Se incluyeron 598 pacientes con litiasis radiopaca del uréter, atendidos en el Hospital Hermanos Ameijeiras entre enero de 2007 y diciembre de 2008. Se conformaron 4 grupos según la localización del cálculo: en la unión pieloureteral (UPU) (96), uréter lumbar (UL) (263), iliaco (UI) (40), pelviano (UP) (199) y se analizó su relación con la superficie litiásica, sesiones de tratamiento, maniobras complementarias previas a la litotricia, aplicación de procedimientos auxiliares posteriores, resolución definitiva por otra técnica quirúrgica y eficacia terapéutica. La colimación se realizó por fluoroscopia. RESULTADOS. El mayor número de cálculos se localizó en el uréter lumbar, y en segundo lugar, en el uréter pelviano. El tamaño medio de la litiasis fue de 0,8 ± 0,5233 cm2, en rango de 0,09-4 cm2. La media de sesiones utilizadas fue de 1,24 ± 0,531, rango de 1-4. Se realizaron maniobras complementarias previas en 72 pacientes (12,04 por ciento) y la más utilizada fue la nefrostomía percutánea (40; 6,6 por ciento). Después de la LEC fue necesaria la conversión a otro procedimiento para la solución del 4,68 por ciento de los casos. La LEC fue eficaz en el 95,32 por ciento, con mejores resultados en el UP (96,99 por ciento) y peores en el UI (92,50 por ciento). CONCLUSIONES. Los resultados fueron buenos utilizando el litotritor MODULITH SLX-MX (STORZ). Los mejores resultados se obtuvieron en el uréter pelviano y en general es posible considerar la LEC como la primera opción terapéutica de la litiasis ureteral(AU)

INTRODUCTION. Ureter lithiasis is a concern for physicians because frequently provokes an obstructive uropathy and a progressive deterioration of ipsilateral renal function and a high prevalence of pathological state that is why the hospitals can not give a surgical solution as quickly as possible. The objective of present research was to know the results of the shock waves extracorporeal lithotripsy (SWEL) using the MODULITH SLX-MX (STORZ) lithotriptor for treatment or ureteral lithiasis. METHODS. In present research 598 patients presenting with ureter radiopaque lithiasis, seen in the Hermanos Ameijeiras Clinical Surgical Hospital from January, 2007 to December, 2008, divided into four groups according to the calculus localization: in pyeloureteral joint (PUJ) (96), lumbar ureter (LU) (263), iliac joint (IJ) (40), pelvic joint (PJ) (199) analyzing its relationship with lithiasis surface, treatment sessions, complementary manoeuvres previous to lithotripsy, application of subsequent auxiliary procedures, definite resolution using other surgical technique and therapeutical effectiveness. Collimation was carried out by fluoroscopy. RESULTS. Most of calculi were located in the lumbar ureter and in the second place in pelvic ureter. The mean size of lithiasis was of 0,8 ± 0,5233 cm2 in the rank of 0,09-4 cm2. The mean of sessions used was of 1,24 ± 0,531, in the rank of 0,09-4 cm2. The mean of sessions used was of 1,24 ± 0,531, rank of 1-4. In 72 patients 12,04 percent) previous complementary manoeuvres were carried out and the more used one was the percutaneous nephrostomy (40; 6,6 percent). After SWEL it was necessary the conversion to other procedure for solution of 4,68 percent of the cases. The SWEL was effective in the 95,32 percent with better results in the UP (96,99 percent) and with worse results in the IJ (92,50 percent). CONCLUSIONS. The results were good using the MODULITH SLX-MX (STORZ) lithotriptor. The better results were obtained in the pelvic ureter and in general, it is possible to consider the SWEL as the first therapeutical choice of ureteral lithiasis(AU)

[A retrospective review of children hospitalised with urinary tract calculi]. / En retrospektiv analyse af børn indlagt med sten i urinvejene.

INTRODUCTION: The incidence of urinary stones in Danish children is unknown. An estimate from The National Diagnosis Registry in Denmark is approximately 1:13,500. The purpose was to estimate the incidence of urinary stones and their composition in children in relation to sex, age and family history. MATERIALS AND METHODS: A retrospective review of all children presented at Aarhus University Hospital, Skejby, or Roskilde Hospital from October 1999 through October 2005 with urinary tract calculi. RESULTS: 42 patients with an average age of 7.9 years. The sex ratio was 1.7 boys to 1 girl. 7 were of an ethnic origin other than Danish. 12, all boys, had inborn urogenital tract malformation. Two had secondary malformation and one had inborn error of metabolism. The incidence of urogenital infection was higher in children with malformation. In 26 patients, stone analysis and composition were available. 54% of the stones had a calcium component. One third of the children had a family history of urolithiasis. CONCLUSION: Urinary tract stone is a rather difficult pediatric diagnosis. The most frequent symptom is abdominal pain. Ultrasound established the diagnosis in 50% of cases. All concrements were diagnosed with excretory urogram or computerized tomography. 30% of the children had a family history of urolithiasis. This confirms the importance of metabolic screening and stone analysis in children.

The utility of unenhanced helical CT in assessing the frequency of ureterolithiasis in Saudi patients.

OBJECTIVE: To identify 650 patients who underwent CT for renal colic, and review them for age and gender, in Saudi Arabia. METHODS: Scans were performed on a 16 multislice scanner. A total of 650 patients, with the clinical suspicion of ureteric colic were reviewed; 220 females (33.8%) and 430 males (66.2%), with a female to male ratio of 1:2. Exams were carried out from January 2005 to November 2006, at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. RESULTS: Three hundred and ninety five patients out of 650 had stones; 2 of 395 (0.5%) had stones in the 5-15 years age group, 28 (7.1%) in the 16-25 years age group, 99 (25.1%) in the 26-35 years, 106 (26.8%) in the 36-45 age group, 84 (21.9%) in the 46-55 age group, 51 (12.9%) in the 56-65 age group, and 25 (6.3%) in the above 66 years age group. The most significant finding in our study is that as the patients age increases so does the percentage of stones up to the age of 56, with a peak at age group of 26-35 where stone percentage reaches 26.8%. CONCLUSION: Unenhanced helical CT is useful for the diagnosis of ureterolithiasis.