RESUMO
PURPOSE: To evaluate the efficacy of extracorporeal shock wave lithotripsy (SWL) on lower calyceal calculi in relation to the renal anatomical factors and determine which of these factors can be used to select patients who will benefit from SWL. MATERIALS AND METHODS: We analyzed retrospectively 78 patients with single radiopaque lower calyceal stones treated with SWL. The patients were evaluated 3 months after lithotripsy with a simple abdominal X-ray and a kidney ultrasound scan. The success of the treatment, removal of all fragments, was correlated with renal anatomical factors measured in the pre-treatment intravenous urography: infundibulopelvic angle, lower infundibulum width, lower infundibulum length, ratio length/width, infundibulum height, and number of minor calyces in the lower calyceal group. RESULTS: Three months after SWL treatment, 39 patients were stone-free (NR group) and 39 had residual fragments (R group). Both groups presented no differences in relation to infundibulopelvic angle, width and length of the lower calyceal infundibulum, length/width ratio of the lower infundibulum or number of lower calyces. Height of the infundibulum, described as the distance between the line passing through the lowest part of the calyx containing the calculus and the highest point of the lower lip of renal pelvis, was the only parameter in which significant differences (p = 0.002) were found between the NR and R groups. CONCLUSIONS: Lower Infundibular height could be a good measurement tool for deciding which patients with lower calyceal lithiasis would benefit from SWL treatment. Height of less than 22 mm suggests a good outcome from lithotripsy.
Assuntos
Cálculos Renais/terapia , Cálices Renais/anatomia & histologia , Litotripsia , Feminino , Humanos , Litotripsia/normas , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the efficacy of extracorporeal shock wave lithotripsy (SWL) on lower calyceal calculi in relation to the renal anatomical factors and determine which of these factors can be used to select patients who will benefit from SWL. MATERIAL AND METHODS: We analyzed retrospectively 78 patients with single radiopaque lower calyceal stones treated with SWL. The patients were evaluated 3 months after lithotripsy with a simple abdominal X-ray and a kidney ultrasound scan. The success of the treatment, removal of all fragments, was correlated with renal anatomical factors measured in the pre-treatment intravenous urography: infundibulopelvic angle, lower infundibulum width, lower infundibulum length, ratio length/width, infundibulum height, and number of minor calyces in the lower calyceal group. RESULTS: Three months after SWL treatment, 39 patients were stone-free (NR group) and 39 had residual fragments (R group). Both groups presented no differences in relation to infundibulopelvic angle, width and length of the lower calyceal infundibulum, length/width ratio of the lower infundibulum or number of lower calyces. Height of the infundibulum, described as the distance between the line passing through the lowest part of the calyx containing the calculus and the highest point of the lower lip of renal pelvis, was the only parameter in which significant differences (p = 0.002) were found between the NR and R groups. CONCLUSIONS: Lower Infundibular height could be a good measurement tool for deciding which patients with lower calyceal lithiasis would benefit from SWL treatment. Height of less than 22 mm suggests a good outcome from lithotripsy.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cálculos Renais/terapia , Cálices Renais/anatomia & histologia , Litotripsia , Modelos Logísticos , Litotripsia/normas , Estudos Retrospectivos , Curva ROC , Resultado do TratamentoRESUMO
OBJECTIVE: Ureteral stenosis secondary to vasculitis is a rare disease. The etiology and treatment of this unusual cause of ureteral obstruction are discussed. METHODS/RESULTS: We report a case of ureteral obstruction secondary to Churg-Strauss vasculitis in a 45-year-old man. The patient was treated with prednisone and cyclophosphamide. Subsequently ureteral resection and reanastomosis were performed. CONCLUSIONS: Vasculitis of the ureter should be considered in patients with connective tissue disorders who present with ureteral dilatation. In some cases ureteral stenosis may require surgery in combination with steroid and/or immunosuppressive therapy.
Assuntos
Síndrome de Churg-Strauss/complicações , Obstrução Ureteral/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução Ureteral/diagnósticoRESUMO
OBJECTIVES: The urological complications in orthopedic surgery, the mechanisms of injury and its treatment are discussed. METHODS/RESULTS: Herein we describe a case of ureterohydronephrosis arising from extrinsic ureteral compression by cement utilized in total hip arthroplasty in a patient with a solitary kidney. CONCLUSIONS: The risk of acetabular perforation and subsequent migration of the cement into the pelvic cavity must be taken into account in patients undergoing hip replacement surgery. Conservative endourological management should first be attempted in the event of ureteral involvement, although resolution is by surgical repair in most cases.
Assuntos
Cimentos Ósseos/efeitos adversos , Migração de Corpo Estranho/complicações , Prótese de Quadril , Hidronefrose/etiologia , Metilmetacrilatos/efeitos adversos , Obstrução Ureteral/etiologia , Idoso , Feminino , Humanos , MetilmetacrilatoRESUMO
OBJECTIVES: This study briefly reviews the histological types, clinical features, diagnostic and therapeutic aspects of urethral hemangioma, an uncommon benign vascular tumor. METHODS/RESULTS: A case of urethral hemangioma in a male patient with a long history of hematuria is described. CONCLUSIONS: Urethroscystoscopy is the most useful diagnostic technique in urethral hemangioma. Treatment is by transurethral resection, radical surgery, radiotherapy or selective arterial embolization depending on tumor location, number, size and patient condition. This tumor type frequently recurs.
Assuntos
Hemangioma , Neoplasias Uretrais , Hemangioma/diagnóstico , Hemangioma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Uretrais/diagnóstico , Neoplasias Uretrais/cirurgiaRESUMO
Presentation of our experience in the use of extracorporeal shock wave lithotripsy (ESWL) for the treatment of lithiasis that occurred in 34 renal units from 28 patients with horseshoe kidneys. All patients but one were placed in supine decubitus with the calculus positioned in F2. A total of 47 sessions were performed for 34 treatments apart from 3 ureteroscopies for ureteral voiding. The results of the follow-up is absence of lithiasis in 13 renal units, debris of less than 3 mm in six, non-removable debris in 13 cases and relapse in two.
Assuntos
Cálculos Renais/terapia , Rim/anormalidades , Litotripsia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Cálculos Renais/complicações , Cálculos Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
Herein we describe what may be the first case of ESWL used in the treatment of mechanical ileus caused by a fragment of clam shell lodged in the terminal ileum. The 66-year-old patient was referred by the emergency department with symptoms and signs of upper GI tract obstruction. ESWL with the modified Dornier HM3 was performed under neuroleptoanalgesia with the patient in the prone decubitus position. 1700 shock waves at 20 Kv were used to achieve fragmentation and restore intestinal transit, thus avoiding surgery.
Assuntos
Bivalves , Migração de Corpo Estranho/terapia , Valva Ileocecal , Litotripsia , Idoso , Animais , Feminino , HumanosRESUMO
During treatment of renal lithiasis with extracorporeal shock wave lithotripsy (ESWL) hemorrhagic events, especially renal hematoma, may present. A coagulation study is warranted in order to institute hemotherapy for blood factor deficiencies. We reviewed the records of 4,000 patients that had undergone ESWL. Of these, 17 (12 males, 5 females) presented coagulation disorders. The bleeding diatheses were due to platelet deficiency in 6 cases, plasma defects in 5, platelet and plasma disorders in 2, and capillary wall defects in 5 cases. The underlying cause was hepatosplenic disease in 12 cases, iatrogenic in 1, connectivopathy and corticoids in 2, and capillary purpura of unknown cause in 2 cases. Due to this protocol, no patient presented hemorrhage or hematoma from shock wave-induced lesions. These results show that a complete coagulation study must be performed in order to institute the necessary measures in patients with disorders of hemostasis due to the high risk of hematoma repeatedly reported in the literature.
Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico , Litotripsia , Adulto , Idoso , Transtornos da Coagulação Sanguínea/complicações , Testes de Coagulação Sanguínea , Feminino , Hematoma/etiologia , Hematoma/prevenção & controle , Hemorragia/etiologia , Hemorragia/prevenção & controle , Humanos , Cálculos Renais/sangue , Cálculos Renais/complicações , Cálculos Renais/terapia , Nefropatias/etiologia , Nefropatias/prevenção & controle , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-IdadeRESUMO
A review of the history of lasertripsy from continuous to intermittent Nd:YAG, Alexandrite, or liquid-dye laser is undertaken. Certain calculi require intraureteral fragmentation owing to stone hardness or location. Within a period spanning 20 months, we have treated 350 patients (199 males, 151 females) utilizing dye laser through a very fine caliber 7.5 F ureteroscope. Twenty-six had bilateral calculi. The calculi were located in the upper third in 10% (37), middle third in 25% (93), and lower third in 65% (241). Complete fragmentation was achieved in 341 (93%), push up + ESWL was performed in 24 (6.4%), and two calculi (0.6%) required ultrasonic fragmentation. No patient required surgery and there were no severe complications.
Assuntos
Terapia a Laser , Litotripsia a Laser , Litotripsia/métodos , Cálculos Ureterais/radioterapia , Adolescente , Adulto , Idoso , Criança , Endoscopia , Estudos de Avaliação como Assunto , Feminino , Humanos , Lasers/classificação , Litotripsia/instrumentação , Masculino , Pessoa de Meia-IdadeRESUMO
The pulsating colour laser generates a shock wave with a high energy power capable of shattering urinary calculi. Owing to their location and impaction, certain ureteral require intraureteral fragmentation, and ureteroscopy with a semi-rigid miniureteroscope permits the use of laser beams. We have treated 70 patients with ureteral lithiasis with this method and obtained complete fragmentation of the calculi in 61 patients, ascent of the calculus to caliceal cavities in 7, whilst no fragmentation was achieved in 2. No case required a surgical operation and no complications were observed. Laser therapy in the treatment of ureteral lithiasis.
Assuntos
Terapia a Laser , Cálculos Ureterais/terapia , Feminino , Humanos , MasculinoRESUMO
We analyzed our experience in 3,000 patients submitted to ESWL. Patient age ranged from 6-92 years. Stone size was 1 cm. in 33.2%, 1-3 cm. in 43.8%, and 23% had incomplete or complete staghorns. Following treatment 83.2% were stone-free, 13.1% had stone fragments that could be passed spontaneously, 3.4% had fragments larger than 4 mm., and 0.3% were submitted to surgery because attempts at stone fragmentation had failed. Our results show that indication of ESWL may be questionable in renal anomalies (horseshoe kidney, caliceal diverticulum, pyeloureteric stricture, urinary diversion), in some cases of lithiasis (cystine stone, infundibular lithiasis, staghorn or ureteral calculi) and in some patients (para and tetraplegics and those with solitary kidneys).
Assuntos
Cálculos Renais/terapia , Rim/anormalidades , Litotripsia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos de Avaliação como Assunto , Feminino , Seguimentos , Humanos , Cálculos Renais/complicações , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/patologia , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
We present here a 42-year-old female who developed a renopleural fistula after a percutaneous nephrolithotomy through the 11th intercostal space of a calculus of the upper calyces of the right kidney. The fistula was resolved with a chest tube and a double-J ureteral catheter.
Assuntos
Fístula/etiologia , Nefropatias/etiologia , Nefrostomia Percutânea/efeitos adversos , Doenças Pleurais/etiologia , Fístula Urinária/etiologia , Adulto , Feminino , Humanos , Cálculos Renais/cirurgiaRESUMO
Extracorporeal shock wave lithotripsy (ESWL) has been the fundamental treatment applied to 88 patients with renal calculi in a solitary kidney. Epidemiological information is given, including lithiasis antecedents and associated pathologies as well as the etiology of the solitary kidney, location and size of stones. The initial treatment was ESWL in 83 patients, ureteroscopy in 2, surgery in 2, and percutaneous nephrolithotomy in 1. Three months after treatment in the ESWL group, 68 patients were completely free of stones and 15 had insignificant caliceal residual fragments. The rest of the patients were treated successfully using the above methods. The secondary complications of ESWL were colic pain (20 cases), fever (13 cases) and obstruction (9 cases).