Impact of the adherence to medical treatment on the main urinary metabolic disorders in patients with kidney stones.

OBJECTIVE: To assess the effect of the adherence to medical treatment on urinary parameters in the 24-h metabolic study of patients with kidney stones. METHODS: A retrospective, longitudinal, descriptive, and observational study was carried out by reviewing the hospital electronic medical record from 2014 to 2018. The adherence to drug treatment was measured 6 months after its initiation, and the numerical values of the metabolic studies were compared. Wilcoxon tests were performed to compare the difference before and after treatment. RESULTS: Ninety patients were evaluated, with 73.3% of adherence. The 180-day overall adherence rate was 61.2% in patients treated with a single drug and 85.4% in patients treated with multiple drugs. There is a statistically significant increase in citrate levels in patients with good adherence in comparison with non-adherent patients (p=0.031 vs. p=0.528). CONCLUSIONS: Medical treatment and dietary measures in patients with kidney stones have an initial impact at 6 months on the values of the main urinary metabolic alterations that predispose to calculi formation; the most significant is seen in those patients with adherence to medical treatment for hypocitraturia.

A Novel Visual Grading for Ureteral Encrusted Stent Classification to Help Decide the Endourologic Treatment.

Objective: The aim of the study is to propose a visual classification for encrusted stents (ESs) to help choose the appropriate endourologic treatment. Materials and Methods: A multicenter, retrospective, and descriptive study was performed. A total of 140 patients with encrusted Double-J stents were enrolled from 5 different institutions. The novel visual grading for ureteral encrusted stent (V-GUES) classification system ranges from A to D, increasing with severity of encrustation. Results: ESs could be removed with a single intervention in 112 patients (86.8%). Type A and B ESs could be removed in all patients (100% success). Type D stents had minor retrieval and stone-free rates (p = 0.006 and p < 0.0001, respectively). Flexible ureteroscopy had a low success rate (77.7%) for type C stents (odds ratio [OR]: 0.21). Combined access had a 100% success rate for retrieval of type C ESs and a 92.9% success rate for type D ESs (OR: 9.18). Type D stents were associated with patients requiring more than one session to retrieve the stent (OR: 0.11) and stones (OR: 0.21). Conclusions: The V-GUES system is associated with treatment success rates of ES retrieval and stone-free status. It is also associated with the complication rate and the number of sessions needed for patients to be stent and stone free. The V-GUES classification could help counsel patients about the best treatment options and their outcomes. Further prospective studies will be needed to provide external validation.

Efficacy of the Endoscopic Combined Intrarenal Surgery for the Treatment of a Staghorn Calculus in Crossed Fused Renal Ectopia.

Background: Crossed fused renal ectopia (CFRE) is an unusual anomaly in which both kidneys lie fused on one side, with double pelvis and ureters draining into both sides of the bladder. Complex renal stones are a considerable challenge to endourologists, and when a staghorn stone is associated with abnormal anatomy, its treatment is even more difficult. Today there is no consensus about the right treatment for complex renal stones in CFRE. So, the objective of this case is to present the efficacy of the endoscopic combined intrarenal surgery (ECIRS) for the treatment of a staghorn renal stone in one patient with CFRE. Case Presentation: We described a case of a 23-year-old man with prolonged lasting and pain on the left flank associated with intermittent gross hematuria. Enhanced CT revealed a crossed fused kidney on the left side, drained by an intercommunicating pelvis and a single ureter, with a staghorn stone wholly occupying both renal units. The patient was effectively treated by one single session of ECIRS. Conclusion: The ECIRS is a good alternative to consider in patients with CFRE that have a staghorn calculus with a reasonable success rate.