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Int J Urol ; 20(12): 1205-10, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23441845


OBJECTIVES: To define factors affecting the stone-free rate of extracorporeal shockwave lithotripsy in the treatment of pediatric renal calculi, and to establish a regression model for pretreatment prediction of stone-free probability. METHODS: From January 1999 through February 2012, 207 children with mean age 6.4 ± 3.8 years underwent shockwave lithotripsy with Dornier Lithotripter S for treatment of renal stones. The stone-free rate was evaluated 3 months after the last shockwave lithotripsy session with non-contrast computed tomography. Treatment success was defined as complete clearance of the stones with no residual fragments. Multivariate logistic regression analysis was used to identify independent risk factors and to predict the probability of being stone free. RESULTS: The mean length of the stone was 11.6 ± 4 mm. The stone-free rate was 71%. Independent factors that adversely affect stone-free rate were increasing stone length and calyceal site of the stone. Relative risks for not being free of stones were 1.123 for stone length, 2.673 for stones in the upper or middle calyx and 4.208 for lower calyx stones. CONCLUSION: Stone length and location are prognostic factors determining stone-free rate after shockwave lithotripsy for renal calculi in pediatric patients. Based on our analysis, shockwave lithotripsy should be recommended for renal pelvis stones up to 24 mm, upper or middle calyceal stones up to 15 mm and lower calyceal stones up to 11 mm.

Cálculos Renais/epidemiologia , Cálculos Renais/terapia , Litotripsia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Humanos , Litotripsia/efeitos adversos , Modelos Logísticos , Masculino , Análise Multivariada , Prognóstico , Medição de Risco/métodos , Fatores de Risco , Resultado do Tratamento
BJU Int ; 101(11): 1420-6, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18070192


OBJECTIVE: To asses the efficacy and safety of bidirectional synchronous twin-pulse extracorporeal shock wave lithotripsy (ESWL) compared with standard ESWL. PATIENTS AND METHODS: Between March 2003 and December 2006, 240 patients with a radio-opaque single renal stone of 10 mm the rate for the failure of disintegration was 13.3% for the DLS vs 1.4% for the TH (P = 0.009). For stones of 10 mm it was 78.1% and 66.7%, respectively (P = 0.14). The median (range) number of sessions in both groups was 2 (1-5). After ESWL urinary NAG levels were increased significantly in both groups; in the TH group it declined below the level before ESWL after 2 days, while in the DLS group it remained high after 7 days. In the DLS group four patients developed subcapsular or parenchymal haematoma after ESWL, vs none in the TH group. There was loss of corticomedullary differentiation after ESWL in three patients in the DLS group and only one in the TH group. In the DLS group there was a statistically significantly decrease in bilateral renal perfusion after ESWL, but no changes in the TH group. CONCLUSIONS: Synchronous twin-pulse ESWL has clinical advantages over standard ESWL in terms of safety and efficacy.

Cálculos Renais/terapia , Litotripsia a Laser/normas , Acetilglucosaminidase/urina , Adolescente , Adulto , Idoso , Feminino , Humanos , Litotripsia a Laser/efeitos adversos , Litotripsia a Laser/métodos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
BJU Int ; 96(6): 828-30, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16153211


OBJECTIVE: To evaluate the success of rotoresection of the prostate for benign prostatic hyperplasia (BPH), after a follow-up of 24 months. PATIENTS AND METHODS: The 24 patients who were the subject of a previous report were followed for up to 24 months; only one patient was lost to follow-up. RESULTS: The mean (sd) American Urologic Association-7 score decreased from 20.5 (3.8) before surgery to 1.12 (1.56) at 24 months; the mean maximum urinary flow rate increased from 8.7 (2.1) to 21.8 (8.5) mL/s, and the mean total prostate volume decreased from 36.5 (12.9) to 21 (7.9) mL. Early complications were urinary tract infection in 10 patients and mild stress urinary incontinence in 11. One patient had a urethral stricture and another had a posterior urethral stone at 6 months; both were treated successfully with good urinary flow rates thereafter. At 24 months, 23 patients had sterile urine and were continent. CONCLUSION: Thus far, rotoresection of the prostate is a safe and effective method for treating BPH. The hospital stay was short and the functional results excellent at up to 24 months.

Eletrocirurgia/métodos , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos