Can infundibular height predict the clearance of lower pole calyceal stone after extracorporeal shockwave lithotripsy?

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.

Can infundibular height predict the clearance of lower pole calyceal stone after extracorporeal shockwave lithotripsy?

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.

[Infective lithiasis. Treatment and complications]. / Litiasis infecciosa. Tratamiento y complicaciones.

OBJECTIVE: To establish the criteria for treatment of staghorn stones according to stone surface and distribution in cadaver kidneys. METHODS: Retrospective study of 344 cases treated from 1985 to 1992 and classified into two groups according to treatment by extracorporeal lithotripsy or by percutaneous nephrolithotomy (PNL). RESULTS: Mean age 48.69 years, prevalence of females and positive urinary culture in almost 70%, mainly Proteus. Stone composition was varied, but mainly magnesium ammonium phosphate. Treatment was by extracorporeal lithotripsy in 80.81% and by PNL in 19.9%. CONCLUSIONS: Treatment of this type of lithiasis should be by combined surgical removal and medical treatment. Lithotripsy is advocated for large caliceal calculi and PNL for large pyelic calculi.

[Characteristics of bladder leiomyoma in our setting]. / Características del leiomioma vesical en nuestro medio.

OBJECTIVES: To determine the incidence, form of presentation, symptoms, diagnostic methods and treatment most commonly used, and prognosis of leiomyoma of the bladder in our setting. METHODS: We conducted a retrospective, multicenter analysis of the last 700 cases submitted to surgery for a bladder tumor that was found to be leiomyoma of the bladder. We reviewed the Spanish literature of the last twenty years for the following variables: patient age, sex, presenting symptoms, incidental finding or not, value of the tests performed, treatment, follow-up and prognosis. RESULTS: Leiomyoma of the bladder accounted for 0.43% of the bladder tumors diagnosed at three urological centers. Apart from the three cases described, ten additional cases are reviewed. Forty-six percent were incidentally discovered. US proved to be the best diagnostic method. Treatment was frequently by open surgery. The prognosis was excellent; there has been no recurrence at 22 months' mean follow-up. CONCLUSIONS: Leiomyoma of the bladder is a benign tumor with little or no clinical symptoms or signs, often discovered incidentally during US and accounts for 0.5% of the cases that had undergone surgery for a bladder tumor.

[Extracorporeal shock-wave lithotripsy in horseshoe kidney]. / Litotricia extracorpórea por ondas de choque en el riñón en herradura.

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.

[Biochemical effects of potassium citrate in the treatment of calcium oxalate lithiasis]. / Efectos bioquímicos del citrato potásico en el tratamiento de la litiasis oxalocálcica.

The serum and urinary biochemical changes observed one month and six months after oral potassium citrate therapy (600 mEq/day) in 119 patients with calcium oxalate calculi were compared with those of 16 untreated cases with lithiasis. The patients that received treatment were previously divided into two groups: group A comprised 61 hypocitraturic patients and group B comprised 58 patients with other urinary disorders who were normo or hypocitraturic. The urinary pH increased by approximately half a point in both treated groups. In group A calciuria increased slightly from 180 +/- 8 to 216 +/- 10 mg/24 h but remained within the normal ranges. Creatinuria, oxaluria, uricosuria and diuresis showed no changes. Citraturia increased very significantly in both groups and more markedly in the hypocitraturic group of patients (from 198 +/- 13 to 476 +/- 35 mg/24 h). The LRC (lithogenic risk coefficient = Ca/Cit x Diu) dropped by 50%. The patients tolerated the treatment regimen well; of the 119 treated patients, only 11 abandoned treatment due to GI intolerance.

[Extracorporeal shockwave lithotripsy on a clam shell fragment lodged in the ileocecal valve]. / Litotricia extracorpórea por ondas de choque de almeja en válvula ileocecal.

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.

[Extracorporeal shockwave lithotripsy in patients with coagulation disorders]. / Litotricia extracorpórea por ondas de choque en pacientes con trastornos de coagulación.

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.

[Treatment of ureteral lithiasis using the laser]. / Tratamiento de la litiasis ureteral con láser.

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.

[Lasertripsy in the treatment of ureteral lithiasis]. / Lasertricia en el tratamiento de la litiasis ureteral.

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.

[New ultrasonic images in patients with lithiasis after undergoing extracorporeal shock wave lithotripsy]. / Neuvas imágenes ecográficas en los litiásicos sometidos a litotricia extracorpórea por ondas de choque.

Evaluation and follow-up of patients submitted to extracorporeal shock wave lithotripsy (ESWL) by ultrasonography is a good adjunct to radiology. Plain x-ray and ultrasound imaging permit following the course of stone patients submitted to treatment by ESWL without recurring to IVP in most of the cases. One-thousand kidney units corresponding to 931 stone patients were submitted to ESWL. Patient evaluation by ultrasound was performed prior to and 24 hours after treatment. Ultrasonographic evaluation is important because it permits: 1. Detection of changes in size, number, and site of the hyperechogenic image. 2. Evaluation and follow-up of urinary tract dilatation. 3. Control of radiolucent calculi thereby avoiding repeated explorations using contrast medium. 4. Detection of possible perirenal hematoma post-ESWL. 5. Diagnosis of other renal or extrarenal disorders.

[Controversies on extracorporeal shockwave lithotripsy]. / Controversias en la litotricia extracorpórea por ondas de choque.

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).

Treatment of lithiasis in the patient with a solitary kidney.

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).