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1.
World J Urol ; 38(1): 207-212, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30944968

RESUMO

PURPOSE: To evaluate the efficacy of oral dissolution therapy (ODT), shock wave lithotripsy (SWL), and combined SWL and ODT for medium-sized radiolucent renal stone (RLS). METHODS: A randomized controlled trial for patients with medium-sized RLS, 1-2.5 cm, ≤ 500 Hounsfield unit (HU). The ODT patients were counseled for oral potassiumsodium-hydrogen citrate (Uralyt-U®). The 2nd group underwent SWL and the last group had combined SWL and ODT. The primary outcome, stone-free rate (SFR) at 3 months, was assessed by non-contrast computed tomography (NCCT). We defined complete response (success) if no residual fragment were detected by NCCT; partial response (failure) if there was a decrease in stone size, but presence of residual stones; no response if there was no change or increase in stone size (failure). RESULTS: 150 patients completed follow-up. The SFR at 1st month and 3rd month were, respectively; 16% and 50% in the ODT group, 10% and 46% in the SWL group, and 35% and 72% patients in combined group with (p = 0.03 and 0.003, respectively. The overall SFR for all groups was 66%. Combined treatment and initial response in first month follow-up were independent factors predicting SFR. In addition, combined treatment significantly decreased the overall stone volume (p = 0.03) and the need for additional stone management procedures after 3 months (p = 0.01). CONCLUSION: Combined ODT and SWL treatment constitutes the most rapid and effective therapeutic approach for medium-sized RLS, decreasing overall stone volume as well as the number of SWL sessions needed in comparison to SWL therapy, alone.

2.
Arab J Urol ; 17(3): 216-220, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489238

RESUMO

Objective: To evaluate the efficacy and safety of botulinum toxin A (BoNT-A) instillation in the bladder under the effect of low-energy shockwaves (LESWs) for the treatment of refractory idiopathic overactive bladder (OAB). Patients and methods: A preliminary clinical study was conducted, including 15 patients with refractory OAB, between September 2016 and July 2017. Intravesical instillation of 100 IU of BoNT-A was done followed by LESWs (3000 shocks over 10 min) exposure to the supra-pubic area. Patients were followed-up by urine analysis, urine culture, post-void residual urine volume (PVR), and Overactive Bladder Symptom Score (OABSS) at 1, 2 and 3 months. Results: There were statistically significant improvements in all OABSS domains and the total score after 1 and 2 months of treatment (P < 0.05). Whereas, only the nocturia domain remained significantly improved after 3 months (P = 0.02). There was no significant increase in PVR throughout the study period (P > 0.05) and none of the patients required clean intermittent catheterisation. Two, two and three patients developed urinary tract infections after 1, 2 and 3 months, respectively. Conclusion: Intravesical instillation of BoNT-A and LESWs is safe and effective method for the treatment of refractory OAB with a durable response for 2 months. Abbreviations: BoNT-A: botulinum toxin A; CIC: clean intermittent catheterisation; DO: detrusor overactivity; LESWs: low-energy shockwaves; OAB: overactive bladder; OABSS: Overactive Bladder Symptom Score; Qmax: maximum urinary flow rate; QoL: quality of life; UUI: urgency urinary incontinence.

3.
Investig Clin Urol ; 60(4): 251-257, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31294134

RESUMO

Purpose: To compare the safety and efficacy of xylocaine gel and ketorolac as opioid-sparing analgesia compared with pethidine for shock wave lithotripsy (SWL) pain. Materials and Methods: A single-blinded randomized controlled trial (RCT) was performed in 132 patients with renal and upper ureteral stones amenable to treatment with SWL. The first patient group received intravenous (IV) pethidine and placebo gel; the second group received IV ketorolac plus placebo gel; the third group received lidocaine gel locally plus normal saline IV. Stone disintegration was classified as none (no change from basal by kidney, ureter, bladder X-ray or ultrasound [US] imaging), partial (fragmented and >4-mm residual fragments), and complete (≤4-mm residual fragments). Stone disintegration was assessed by kidney-ureter-bladder X-ray and US imaging. Pain was evaluated by use of the Numeric Pain Rating Scale (NPRS). Results: The NPRS scores were highest in the xylocaine group at 10, 20, and 30 minutes (p=0.0001) with no significant difference between the ketorolac and pethidine groups, except at 10 minutes (p=0.03) and a near significant difference at 30 minutes (p=0.054) in favor of ketorolac. Results for stone disintegration (none, partial, and complete, respectively) were as follows: 25 (50.0%), 23 (46.0%), and 2 (4.0%) for pethidine; 19 (35.8%), 23 (43.4%), and 11 (20.8%) for ketorolac; and 26 (89.7%), 3 (10.3%), and 0 (0.0%) for lidocaine (p=0.008). Conclusions: Ketorolac is a safe and more effective alternative to morphine derivatives for SWL analgesia. Lidocaine gel should not be used as mono-analgesia for SWL.

4.
World J Urol ; 37(5): 879-884, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30105456

RESUMO

PURPOSE: Shock wave lithotripsy (SWL) in treatment of bladder and urethral stones was not precisely determined. The objective of this study is to compare the efficacy and safety of SWL versus visual cystolitholapaxy in the management of calcular acute urine retention. METHODS: From March 2015 to February 2017, a randomised controlled study was conducted on 100 patients for whom urethral catheter fixed for acute retention of urine due to urethral or vesical radio-opaque stone(s) ≤ 2 cm. Patients were randomised to either SWL group (n = 50) or visual cystolitholapaxy (endoscopy group) (n = 50). RESULTS: No statistically significant differences between the pre-operative parameters of both groups were found. The mean stone diameter was 12.2 ± 3 mm and 12.2 ± 3.2 mm in SWL and endoscopy groups, respectively (p value = 0.4). The overall success rates of SWL group were 94% (47 of 50 patients) and endoscopy group were 98% (49 of 50 patients). SWL failed in 3 patients (6%); these 3 patients underwent cystolitholapaxy and were rendered free of stones. Intra-operative and post-operative complications were comparable between both groups (p value = 0.5 and 1, respectively). One patient had bladder perforation in the endoscopy group and was managed conservatively. CONCLUSIONS: SWL mono-therapy is safe, non-invasive and as effective as visual cystolitholapaxy in management of patients presenting with acute urine retention by vesical or urethral stones 2 cm or less and could be useful for patients unwilling/unfit for general anaesthesia.


Assuntos
Cistoscopia/métodos , Litotripsia/métodos , Cálculos da Bexiga Urinária/terapia , Cálculos Urinários/terapia , Retenção Urinária/terapia , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Cálculos da Bexiga Urinária/complicações , Cálculos Urinários/complicações , Retenção Urinária/etiologia
5.
Int Urol Nephrol ; 50(11): 2007-2014, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30232721

RESUMO

AIM: To evaluate the role of low-intensity extra corporeal shock wave therapy (LI-ESWT) in penile rehabilitation (PR) post nerve-sparing radical cystoprostatectomy (NS-RCP). MATERIALS AND METHODS: This study included 152 sexually active men with muscle invasive bladder cancer. After bilateral NS-RCP with orthotopic diversion by a single expert surgeon between June 2014 and July 2016, 128 patients were available categorized into three groups: LI-ESWT group (42 patients), phosphodiesterase type-5 inhibitors (PDE5i) group (43 patients), and control group (43 patients). RESULTS: Mean age was 53.2 ± 6.5 years. Mean ± SD follow-up period was 21 ± 8 months. During first follow-up FU1, all patients of the three groups had insufficient erection for vaginal penetration; with decrease of preoperative IIEF-EF mean score from 27.9 to 6.9. Potency recovery rates at 9 months were 76.2%, 79.1%, and 60.5% in LI-ESWT, PDE5i, and control groups, respectively. There was statistically significant increase in IIEF-EF and EHS scores during all follow-up periods in all the study groups (p < 0.001). However, there was no significant difference between the three groups during all follow-up periods. Statistical evaluation showed no significant difference in continence and oncological outcomes during all follow-up points among the three groups (p = 0.55 and 0.07, respectively). CONCLUSIONS: During last follow-up, 16% more patients in LI-ESWT group had recovery of potency as compared to the control group. Although the difference is not statistically significant, but of clinical importance. LI-ESWT is safe as oral PDE5i in penile rehabilitation post nerve-sparing radical cystoprostatectomy.


Assuntos
Carcinoma/cirurgia , Cistectomia/reabilitação , Disfunção Erétil/reabilitação , Tratamento por Ondas de Choque Extracorpóreas/métodos , Prostatectomia/reabilitação , Neoplasias da Bexiga Urinária/cirurgia , Adulto , Carcinoma/patologia , Cistectomia/efeitos adversos , Disfunção Erétil/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Fosfodiesterase 5/uso terapêutico , Prostatectomia/efeitos adversos , Recuperação de Função Fisiológica , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologia
6.
Urolithiasis ; 46(3): 291-296, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28555349

RESUMO

The objective of this study was to determine risk factors of hospital admission for treatment of complications after extracorporeal shock wave lithotripsy (SWL). The electronic files and images of all patients who underwent SWL for treatment of renal stones between January 2011 and December 2015 were retrospectively reviewed. All patients underwent SWL with the same electromagnetic lithotripter (Dornier Lithotripot S). The data of those who needed hospital admission for treatment of complications within 30 days after SWL were compared with patients who did not require hospital admission. Compared data included patients' demographics (age, gender, BMI, ASA score, and pre-SWL stenting), renal characters (side, hydronephrosis, and solitary kidney), and stone characters (site, length, density, and previous treatment). Univariate and multivariate statistical analyses were used to identify risk factors. The study included 1179 patients. Complications that required hospital admission were observed in 108 patients (9.2%). They included obstructing steinstrasse in 91 (7.7%), peri-renal hematoma in 3 (0.25%), and fever (>38.0 °C) in 14 (1.2%). Independent risk factors on multivariate analysis were solitary kidney (OR 2.855, P = 0.017), pre-SWL stenting (RR 2.03, P = 0.044), ASA II (OR 1.965, P = 0.007), hydronephrosis (RR 1.639, P = 0.024), and stone length (RR 1.083, P < 0.001). Patients with medical co-morbidities, pre-SWL ureteral stents, large stones and those with obstructed and/or solitary renal unit are more liable to post-SWL complications that need hospital admission. The probability of hospital admission has to be explained to patients with these risk factors.


Assuntos
Hospitalização/estatística & dados numéricos , Cálculos Renais/cirurgia , Litotripsia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Feminino , Hematoma/epidemiologia , Hematoma/etiologia , Humanos , Hidronefrose/epidemiologia , Hidronefrose/etiologia , Cálculos Renais/complicações , Litotripsia/instrumentação , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Fatores de Risco , Rim Único/epidemiologia , Rim Único/cirurgia , Resultado do Tratamento
7.
Arab J Urol ; 15(2): 110-114, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29071139

RESUMO

OBJECTIVES: To validate the Arabic version of the Functional Assessment of Cancer Therapy-Bladder (FACT-Bl) questionnaire in Egyptian patients who underwent radical cystectomy (RC) and orthotopic neobladder (ONB) construction. PATIENTS SUBJECTS AND METHODS: The English version of the FACT-Bl was translated into the Arabic language using multi-step process by two urologist and two independent translators. The Arabic version was validated by inviting 90 patients who underwent RC and ONB and 72 normal individuals to complete the questionnaire. The reliability of the questionnaire was tested for internal consistency using the Cronbach's α test. Inter-domain association was tested by Spearman's correlation coefficient. The discrimination validity was measured by comparing the scores in RC patients and in normal individuals using the Mann-Whitney U-test and independent sample t-test. RESULTS: Internal consistency was high for all domains. There was high correlation between all domains. This high internal consistency and good correlation was maintained when assessment included patients with <7.5 and those with ≥7.5 years follow-up. Discrimination validation was confirmed by the statistically significant lower scores of all domains in the studied patients in comparison to the controls. CONCLUSION: The Arabic version of the FACT-Bl is a reliable and validated instrument that can be used to evaluate health-related quality of life in patients after RC and ONB.

8.
Urol Oncol ; 35(12): 671.e11-671.e16, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28843339

RESUMO

PURPOSE: To investigate the long-term cumulative incidence of chronic urinary retention (CUR) after radical cystectomy (RC) and orthotopic neobladder (ONB) in women and the possible risk factors. MATERIAL AND METHODS: We retrospectively analyzed a prospectively evaluated cohort of women for whom RC and ONB were performed. Patients in CUR were evaluated for the cumulative incidence of CUR using Kaplan-Meier curve and for the possible risk factors using log rank and Cox regression analysis. RESULTS: A total of 234 women with mean age ± SD of 52.3 ± 9 years and a median (range) of follow-up of 92 (12-247) months were included. The incidence of CUR increased with time, where 12 (5.2%), 21 (8.97%), 35 (14.9%), 53 (22.6%), and 56 (24%) patients started clean intermittent catheterization in 1, 2, 2 to 5 years, 5 to 10 years, and after 10 years of follow-up, respectively. In univariate and multivariate analysis, diabetes mellitus and urethral Kock pouch were independent predictors of CUR development (HR [95% CI] = 2.45 [1.2-5.1], and 2.1 [1.05-4.2], P = 0.01 and 0.03, respectively). Genital- sparing RC and surgical modification to provide pouch back support were independent factors that reduce CUR development (HR [95% CI] = 9.3 [1.25-69.9], and 2.1 [1.19-3.9], P = 0.02 and 0.01, respectively). CONCLUSION: The incidence of CUR after RC and ONB in women increases with time even after 10 years of follow-up. Presence of diabetes mellitus increases the risk of CUR development. Genital-sparing RC and modification to prevent CUR reduced the likelihood of CUR development.


Assuntos
Cistectomia/métodos , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Coletores de Urina , Retenção Urinária/diagnóstico , Adulto , Doença Crônica , Cistectomia/efeitos adversos , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , /estatística & dados numéricos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Derivação Urinária/efeitos adversos , Retenção Urinária/etiologia
9.
BJU Int ; 119(1): 142-147, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27686059

RESUMO

OBJECTIVE: To evaluate the protective effects of selenium with vitamins A, C and E (selenium ACE, i.e. antioxidants), verapamil (calcium channel blocker), and losartan (angiotensin receptor blocker) against extracorporeal shockwave lithotripsy (ESWL)-induced renal injury. PATIENTS AND METHODS: A randomised controlled trial was conducted between August 2012 and February 2015. Inclusion criteria were adult patients with a single renal stone (<2 cm) suitable for ESWL. Patients with diabetes, hypertension, congenital renal anomalies, moderate or marked hydronephrosis, or preoperative albuminuria (>300 mg/L) were excluded. ESWL was performed using the electromagnetic DoLiS lithotripter. Eligible patients were randomised into one of four groups using sealed closed envelopes: Group1, control; Group 2, selenium ACE; Group 3, losartan; and Group 4, verapamil. Albuminuria and urinary neutrophil gelatinase-associated lipocalin (uNGAL) were estimated after 2-4 h and 1 week after ESWL. The primary outcome was differences between albuminuria and uNGAL. Dynamic contrast-enhanced magnetic resonance imaging was performed before ESWL, and at 2-4 h and 1 week after ESWL to compare changes in renal perfusion. RESULTS: Of 329 patients assessed for eligibility, the final analysis comprised 160 patients (40 in each group). Losartan was the only medication that showed significantly lower levels of albuminuria after 1 week (P < 0.001). For perfusion changes, there was a statistically significant decrease in the renal perfusion in patients with obstructed kidneys in comparison to before ESWL (P = 0.003). These significant changes were present in the control or antioxidant group, whilst in the losartan and verapamil groups renal perfusion was not significantly decreased. CONCLUSIONS: Losartan was found to protect the kidney against ESWL-induced renal injury by significantly decreasing post-ESWL albuminuria. Verapamil and losartan maintained renal perfusion in patients with post-ESWL renal obstruction.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Antioxidantes/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Rim/lesões , Litotripsia/efeitos adversos , Losartan/uso terapêutico , Selênio/uso terapêutico , Verapamil/uso terapêutico , Vitaminas/uso terapêutico , Adulto , Ácido Ascórbico/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Masculino , Vitamina A/uso terapêutico , Vitamina E/uso terapêutico , Ferimentos e Lesões/prevenção & controle
10.
Arab J Urol ; 14(2): 108-14, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27489737

RESUMO

OBJECTIVES: To investigate the effect of stone fragmentation on late stone recurrence by comparing the outcome of extracorporeal shockwave lithotripsy (ESWL) and non-fragmenting percutaneous nephrolithotomy (PCNL), and to investigate factors contributing to recurrent calculi. PATIENTS AND METHODS: We evaluated stone recurrence in 647 patients who initially achieved a stone-free status after ESWL and compared the outcomes to 137 stone-free patients treated with PCNL without stone fragmentation. Patients were evaluated every 3 months during the first year and every 6 months thereafter to censorship or time of first new stone formation. Stone recurrence rates were calculated using the Kaplan-Meier method. The effects of demographics, stone characteristics, and intervention on the recurrence rate were studied using the log-rank test and the Cox-regression analysis. RESULTS: For ESWL the recurrence rates were 0.8%, 35.8% and 60.1% after 1, 5 and 10 years, which were comparable to the 1.5%, 35.5% and 74.9%, respectively found in the PCNL group (P = 0.57). Stone burden (>8 mm) and a previous history of stone disease were significantly associated with higher recurrence rates regardless of the method of stone intervention (P = 0.02 and P = 0.01, respectively). In the ESWL group, a stone length of >8 mm showed a higher recurrence rate (P = 0.007). In both the ESWL and PCNL groups, there was a significant shift from baseline stone location, with an increased tendency for most new stones to recur in the calyces as opposed to the pelvis. CONCLUSIONS: In comparison with PCNL, ESWL does not increase long-term stone recurrence in patients who become stone-free. The stone burden appears to be the primary factor in predicting stone recurrence after ESWL.

11.
J Endourol ; 30(5): 565-6, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-26984026
13.
Arab J Urol ; 13(3): 212-6, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26413350

RESUMO

OBJECTIVE: To compare the efficacy, safety and cost of extracorporeal shockwave lithotripsy (ESWL) and percutaneous nephrolithotomy (PNL) for treating a 20-30 mm single renal pelvic stone. PATIENTS AND METHODS: The computerised records of patients who underwent PNL or ESWL for a 20-30 mm single renal pelvic stone between January 2006 and December 2012 were reviewed retrospectively. Patients aged <18 years who had a branched stone, advanced hydronephrosis, a solitary kidney, anatomical renal abnormality, or had a surgical intervention within the past 6 months were excluded. The study included 337 patients with a mean (SD, range) age of 49.3 (12.2, 20-81) years. The patients' criteria (age, sex, body mass index) and the stone characteristics (side, stone length, surface area, attenuation value and skin-to-stone distance) were compared between the groups. The re-treatment rate, the need for secondary procedures, success rate, complications and the total costs were calculated and compared. RESULTS: In all, 167 patients were treated by ESWL and 170 by PNL. The re-treatment rate (75% vs. 5%), the need for secondary procedures (25% vs. 4.7%) and total number of procedures (three vs. one) were significantly higher in the ESWL group (P < 0.001). The success rate was significantly higher in the PNL group (95% vs. 75%, P < 0.001), as was the complication rate (13% vs. 6.6%, P = 0.050). The total costs of primary and secondary procedures were significantly higher for PNL (US$ 1120 vs. 490; P < 0.001). CONCLUSIONS: PNL was more effective than ESWL for treating a single renal pelvic stone of 20-30 mm. However, ESWL was associated with fewer complications and a lower cost.

14.
Urology ; 86(3): 593-8, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26126693

RESUMO

OBJECTIVE: To assess the outcome of clinically insignificant residual fragments (CIRFs) after shock wave lithotripsy (SWL) and percutaneous nephrolithotomy (PNL) in children. METHODS: Sixty-one children with CIRFs diagnosed by noncontrast computed tomography (NCCT) 3 months after SWL and 1 month after PNL with documented follow-up ≥6 months were included in the study. Children were evaluated by urinalysis, urine culture, plain abdominal radiography, and urinary ultrasonography or noncontrast computed tomography. Outcomes measured were fragment regrowth, spontaneous fragment passage, and secondary interventions. A clinically significant outcome was defined as the need for secondary intervention for development of complications or regrowth of the residual fragment (RF). RESULTS: The study included 42 boys and 19 girls with mean age of 6.2 years (range 1-14). After a median follow-up of 18 months, 16 children (26.2%) passed RF spontaneously. Regrowth of the RF was observed in 15 children (24.6%), and in 4 children (6.6%) the RF (of the same original size) slipped to the ureter and was treated by ureteroscopy. Therefore, a clinically significant outcome occurred in 31.2% of children with RF. Children with history of stone disease were more likely to develop clinical significance with time (HR, 4.38; 95% CI, 1.37-14; P = .013) CONCLUSION: The term CIRF is not appropriate for all children with post-SWL and -PNL fragments, as one-third of patients have had fragments that became clinically significant. History of stone disease was the only predictor of clinical significance.


Assuntos
Cálculos Renais/terapia , Litotripsia/métodos , Nefrostomia Percutânea/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Cálculos Renais/diagnóstico , Masculino , Recidiva , Retratamento , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ureteroscopia , Urinálise
15.
Int Urol Nephrol ; 47(4): 573-7, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25737073

RESUMO

OBJECTIVES: To define various stone, renal and therapy factors that could affect steinstrasse (SS) formation after extracorporeal shock wave lithotripsy (SWL) for pediatric kidney stones. Thus, SS could be anticipated and prophylactically avoided METHODS: From January 1999 through December 2012, 317 children underwent SWL with Dornier Lithotripter S for the treatment of renal stones. Univariate and multivariate statistical analyses of patients, stones and therapy characteristics in relation to the incidence of SS were performed to detect the factors that had a significant impact on SS formation. RESULTS: The overall incidence of SS was 8.5%. The steinstrasse was in the pelvic ureter in 74.1% of the cases, lumbar ureter in 18.5% and iliac ureter in 7.4%. Steinstrasse incidence significantly correlated with stone size, site and age of child. Steinstrasse was more common with increasing stone length and stones located in renal pelvis or upper calyx with the age below 4 years. A statistical model was constructed to estimate the risk of steinstrasse formation accurately. The equation for logistic regression is Z = -4.758 + B for age + B for size stone X length in mm + B for stone site. CONCLUSIONS: The stone size, site and age are the most important risk factors responsible for SS formation in children. Our regression analysis model can help with prospective identification of children who will be at risk of SS formation. Those children at high risk of SS formation should be closely monitored or treated by endoscopic maneuvers from the start.


Assuntos
Cálculos Renais/terapia , Litotripsia/efeitos adversos , Ureterolitíase/etiologia , Adolescente , Criança , Pré-Escolar , Egito/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Lactente , Masculino , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Ureterolitíase/epidemiologia
16.
J Urol ; 192(6): 1705-9, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24977320

RESUMO

PURPOSE: We studied acute renal morphological and hemodynamic changes after shock wave lithotripsy of renal stones. MATERIALS AND METHODS: A total of 60 adult patients with a single renal stone 25 mm or less in a radiologically normal urinary tract were eligible for shock wave lithotripsy and included in analysis. Study exclusion criteria were hypertension, diabetes mellitus, previous recent stone management and other contraindications to shock wave lithotripsy. Renal perfusion and morphological changes were evaluated by dynamic magnetic resonance imaging before, and 2 to 4 hours and 1 week after lithotripsy. RESULTS: In all cases there was a statistically significant decrease in renal perfusion 1 week after shock wave lithotripsy compared to before and 2 to 4 hours after lithotripsy (66% vs 71% and 72% of the aortic blood flow, respectively, p <0.05). At 1-week followup 39 unobstructed renal units (65%) showed no significant difference in renal perfusion at any time while 21 (35%) obstructed renal units showed a significant decrease in renal perfusion compared to before and 2 to 4 hours after lithotripsy (63% vs 76% and 75%, p = 0.003 and 0.005, respectively). Hematomas were observed in 7 cases (12%) 2 to 4 hours after lithotripsy, of which 5 were subcapsular and 2 were intrarenal. Three subcapsular hematomas resolved after 1 week. Localized loss of corticomedullary differentiation was observed in 2 patients (3.3%) with intrarenal hematoma 2 to 4 hours after treatment. Generalized loss of corticomedullary differentiation was observed 1 week after lithotripsy in 5 cases (8.3%). CONCLUSIONS: Shock wave lithotripsy alone induces minimal, reversible acute renal morphological changes and does not induce significant changes in renal perfusion. Posttreatment obstruction has a major effect on renal perfusion on the treated side and must be managed urgently.


Assuntos
Cálculos Renais/terapia , Rim/irrigação sanguínea , Rim/patologia , Litotripsia/efeitos adversos , Imagem por Ressonância Magnética , Adulto , Feminino , Hemodinâmica , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
17.
Arab J Urol ; 12(4): 290-3, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26019964

RESUMO

OBJECTIVE: To validate the Arabic version of the Ureteral Stent Symptoms Questionnaire (USSQ). PATIENTS AND METHODS: The English version of the USSQ was translated into Arabic using a multi-step process by three urologists and two independent translators. The Arabic version was validated by asking 37 patients with temporary unilateral ureteric stents to complete the questionnaire at 2 weeks after stent insertion. The second group included 53 healthy individuals who agreed to complete the Arabic version of the questionnaire. The reliability of the Arabic version was evaluated for internal consistency using Cronbach's α test. Domain structures were examined by interdomain (section) associations using Spearman's correlation coefficient (r). The discrimination validity was evaluated by comparing the scores of patients with those of healthy individuals, using the Mann-Whitney test. RESULTS: Internal consistency was high for the sexual index and intermediate for urinary, pain and general health indices. There were good correlations of urinary symptoms with body pain (r = 0.596) and general health (r = 0.690). There was also a good correlation between body pain and general health (r = 0.681). For discrimination validity, there were significant changes in all domain scores when comparing patients with ureteric stents and healthy individuals (P < 0.001). CONCLUSION: The Arabic version of the USSQ is a reliable and valid instrument that can be used to evaluate symptoms and health-related quality of life in Arabic patients with ureteric stents.

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