Prevalence of distal renal tubular acidosis in patients with calcium phosphate stones.

INTRODUCTION AND PURPOSE: Distal renal tubular acidosis (DRTA) is a metabolic disorder that associates urolithiasis and urinary pH > 6. The prevalence of DRTA in patients with calcium phosphate stones is not well known. The objective is to determine the prevalence of DRTA in patients with calcium phosphate stones and urinary pH above 6 based on the furosemide test. METHODS: A total of 54 patients with calcium phosphate stones and urinary pH above 6.0 were submitted to the furosemide test. The association of DRTA with age, sex, type of stone, stone recurrence, stone bilaterality, 24-h urine biochemistry, and adverse effects of the furosemide test were examined. RESULTS: The furosemide test indicated that 19 of 54 patients (35.2%) had DRTA. The sex ratio was similar in the two groups (p < 0.776). The DRTA group was significantly younger (p < 0.001), and had a higher prevalence of bilateral stones (p < 0.001), a higher prevalence of recurrent stones (p < 0.04), a lower plasma potassium level (p < 0.001), a higher urinary Ca level (p ≤ 0.05), and a lower urinary citrate level (p < 0.001). None of the patients reported adverse effects from the furosemide test. CONCLUSIONS: There was a high prevalence of DTRA in patients with urinary pH above 6 and calcium phosphate stones. Young age, bilateral stones, stone recurrence, hypercalciuria, hypocitraturia, and plasma hypokalemia were associated with DRTA. None of the patients reported adverse effects of the furosemide test.

[Efficacy and safety of bilateral RIRS for renal lithiasis.] / Eficacia y seguridad de la RIRS bilateral para el tratamiento de litiasis renal.

OBJECTIVES: We present our experience in single-stage bilateral retrograde intrarenal surgery (RIRS), analyzing the stone free rate (SFR), surgical time, hospital stay, pre- and post procedure creatinine, stone composition and complications. METHODS: Between April 2012 and February 2016, 24 RIRS were carried out in 12 patients with bilateral renal stones. Patients were 9 men and 3 women with a median age of 47.5 (range:55),IMC: 23.59 (range: 12.5). RESULTS: Mean number of stones per renal unit was 2.7 (range: 12), mostly located in the renal pelvis (40%), with an average size of 16.08±8.06 mm and an average stone burden of 258.54±242.59 mm². The SFR at 3 months was 83.33%. Average operation time was 75 minutes and median hospital stay was 2 days. Three complications were recorded (25%), all of them minor (Clavien I-II). No major complications were recorded (Clavien III-V). CONCLUSIONS: Single-stage bilateral RIRS is a safe and effective tool for the treatment of patients with bilateral renal stones.

Eficacia y seguridad de la RIRS bilateral para el tratamiento de litiasis renal / Efficacy and safety of bilateral RIRS for renal lithiasis

OBJETIVOS: Presentar nuestra experiencia en cirugía intrarrenal retrógrada (RIRS) bilateral en un mismo acto quirúrgico, analizando la tasa de pacientes libres de litiasis (SFR), el tiempo quirúrgico, la estancia hospitalaria, las complicaciones, las diferencias entre la creatinina pre- y postoperatoria y la composición de los cálculos. MÉTODOS: Entre abril de 2012 y febrero de 2016 se han realizado 24 RIRS en 12 pacientes con litiasis renal bilateral, entre los que se encuentran 9 hombres y 3 mujeres, con mediana de edad de 47,5 (rango: 55), IMC: 23.59 (rango: 12,5). RESULTADOS: El número de cálculos por unidad renal es de 2,7 (rango: 12), localizados preferentemente en la pelvis renal (40%), con un tamaño medio de 16,08±8,06 mm y una carga litiásica media de 258,54±242,59 mm2. El SFR a los 3 meses es de 83,33%. El tiempo operatorio medio ha sido 75 minutos y la estancia hospitalaria mediana de 2 días. Se han registrado 3 complicaciones (25%), todas ellas complicaciones menores (Clavien I-II). No se han registrado complicaciones mayores (Clavien III-V). CONCLUSIONES: La RIRS bilateral en un mismo acto quirúrgico es una herramienta eficaz y segura para el tratamiento de pacientes con litiasis renales bilaterales

OBJECTIVES: We present our experience in single-stage bilateral retrograde intrarenal surgery (RIRS), analyzing the stone free rate (SFR), surgical time, hospital stay, pre- and post procedure creatinine, stone composition and complications. METHODS: Between April 2012 and February 2016, 24 RIRS were carried out in 12 patients with bilateral renal stones. Patients were 9 men and 3 women with a median age of 47.5 (range: 55), IMC: 23.59 (range: 12.5). RESULTS: Mean number of stones per renal unit was 2.7 (range: 12), mostly located in the renal pelvis (40%), with an average size of 16.08±8.06 mm and an average stone burden of 258.54±242.59 mm2. The SFR at 3 months was 83.33%. Average operation time was 75 minutes and median hospital stay was 2 days. Three complications were recorded (25%), all of them minor (Clavien I-II). No major complications were recorded (Clavien III-V). CONCLUSIONS: Single-stage bilateral RIRS is a safe and effective tool for the treatment of patients with bilateral renal stones