Evaluation of renovated double J stents using ureter models with and without stenosis.

PURPOSE: Commercial double J stents (DJS) have a uniform shape regardless of the specific nature of various ureteral diseases. We tested renovated DJS and compared them with conventional DJS using ureter models. METHODS: One straight ureter model included stenosis at the distal ureter near the ureterovesical junction and the other did not. We used conventional DJS and renovated 5- and 6-Fr soft DJS for ureter stones and 6-, 7-, and 8.5-Fr hard DJS for tumors. The DJS comprised holes in the upper, middle, or lower one-third of the shaft (length, 24 cm; 2-cm-diameter coils at both ends). More holes were created along the shaft based on the ureteral disease location. Conventional DJS had holes spaced 1 cm apart along the shaft. Renovated DJS had holes spaced 1 cm apart along the shaft with 0.5-cm intervals on the upper, middle, or lower one-third of the shaft. Urine flow was evaluated. RESULTS: As the DJS diameter increased, the flow rate decreased. The flow rates of DJS with holes in the lower shaft were relatively lower than those of conventional DJS and DJS with holes in the upper and middle shafts. In the ureter model without stenosis, 6-, 7-, and 8.5-Fr renovated stents exhibited significantly higher flow rates than conventional stents. In the ureter model with stenosis, 5-, 6-, 7-, and 8.5-Fr renovated stents did not exhibit significantly higher flow rates than conventional stents. CONCLUSION: Renovated stents and conventional stents did not exhibit significant differences in urine flow with stenosis.

Validez actual de la litotricia extracorpórea como tratamiento de primera línea de la litiasis / Is extracorporeal lithotripsy a first-line treatment for urinary stones today?

Objetivo Evaluar la eficacia y complicaciones de la litotricia extracorpórea por ondas de choque (LEOCh) como tratamiento de primera línea de la litiasis renal y ureteral. Métodos Estudio observacional retrospectivo de todos los pacientes tratados con litotricia en un centro de tercer nivel entre enero de 2014 y enero de 2021. Se recogieron las características de los pacientes, de la litiasis, y las complicaciones y resultados de la LEOCh. Se realizó una regresión logística multivariante de los factores asociados a la reducción del tamaño litiásico. También se llevó a cabo un análisis estadístico de los factores asociados a la necesidad de tratamiento adicional tras la LEOCh y de los factores asociados a las complicaciones. Resultados Se incluyeron 1.727 pacientes. El tamaño litiásico medio fue de 9,5 mm. En 1.540 (89,4%) pacientes se observó la reducción del tamaño litiásico. En el análisis multivariante, el tamaño (OR=1,13; p=0,00), la localización de la litiasis en el uréter (OR=1,15; p=0,052) y el número de ondas (p=0,002; OR=1,00) utilizadas en la LEOCh son los factores asociados a la reducción del tamaño litiásico. Un total de 665 pacientes (38,5%) precisaron tratamiento adicional tras la litotricia. Los factores asociados a la necesidad de retratamiento fueron el tamaño litiásico (OR=1.131; p=0,000), el número de ondas (OR=1.000; p=0,000) y la energía administrada (OR=1.005; p=0,000). En 153 pacientes (8,8%) se produjeron complicaciones tras la LEOCh. Se encontró una asociación estadísticamente significativa entre el tamaño de la litiasis (p=0,024; OR=1.054) y la derivación urinaria previa (p=0,004; OR=0,571). Conclusión La litotricia sigue siendo eficaz como tratamiento de primera línea para la litiasis reno-ureteral, con un bajo porcentaje de complicaciones. (AU)

Objective To evaluate the efficacy and complications of extracorporeal lithotripsy (SWL) as a first-line treatment for renal and ureteral stones. Methods Retrospective and observational study of all the patients treated with lithotripsy in a third level center between January 2014 and January 2021; characteristics of the patients, the stones, complications and results of SWL is recollected. Multivariate logistic regression of the factors associated with stone size reduction was performed. A statistical analysis of the factors associated with additional treatment after SWL and factors associated with complications is also executed. Results 1727 patients are included. Stone mean size was 9,5 mm. 1540 (89.4%) patients presented reduction in stone size. In multivariate analysis, stone size (OR=1.13; P=0.00), ureteral location of the lithiasis (OR=1.15; P=0.052) and number of waves (P=0.002; OR=1.00) used in SWL are the factors associated with reduction of stone size. Additional treatment after lithotripsy was needed in 665 patients (38.5%). The factors associated with the need for retreatment were stone size (OR=1.131; P=0.000), number of waves (OR=1.000; P=0.000), energy (OR=1.005; P=0.000). 153 patients (8.8%) suffered complications after SWL. A statistically significant association was found between the size of the lithiasis (P=0.024, OR=1.054) and the previous urinary diversion (P=0.004, OR=0.571). Conclusion Lithotripsy remains an effective treatment as the first line of therapy for reno-ureteral lithiasis with a low percentage of complications. (AU)

Prevalence and implications of perinephric fluid on renal point-of-care ultrasound in the emergency department.

BACKGROUND: Point-of-care ultrasound (PoCUS) is commonly utilized in the setting of renal colic. The presence of perinephric fluid may be an overlooked finding associated with ureteral obstruction. Our aims were to determine the prevalence of perinephric fluid on emergency physician-performed PoCUS and to determine whether perinephric fluid was associated with stone size or urologic intervention. METHODS: This was a 12-month cross-sectional study at an academic emergency department (ED) that took place from January 1, 2022, to December 31, 2022. All adult ED patients ≥18 years of age who had a renal PoCUS examination performed were included. Patients with missing or inadequate PoCUS images were excluded. Investigators blinded to PoCUS images and interpretations performed chart review for demographic data and outcome variables, while separate investigators blinded to clinical data reviewed PoCUS images to assess for perinephric fluid and hydronephrosis. A chi-square analysis was used to determine significance of association between perinephric fluid and outcome variables (stone size, urologic intervention). RESULTS: There were 442 patients screened; 18 were excluded due to inadequate images and 4 were repeat visits of which only the initial visit was analyzed. Of the remaining 420 patients included, the prevalence of perinephric fluid was 6.2% (n = 26). Most patients (23/26) with perinephric fluid had final diagnoses consistent with ureterolithiasis. Hydronephrosis was present in 115 of the 420 patients (27.4%) and of these, 22 (19.1%) had perinephric fluid which was significantly associated with a need for urologic intervention; odds ratio (OR) 10.38 (95% CI 2.70-39.85), p < 0.01. Among the 67 patients with confirmed ureterolithiasis on computed tomography, perinephric fluid was associated with stone size ≥5 mm; OR 4.00 (95% CI 1.01-15.85), p = 0.04. CONCLUSION: The prevalence of perinephric fluid on emergency physician-performed renal PoCUS was 6.2% of all studies and 19.1% of patients with hydronephrosis. In the setting of ureterolithiasis, perinephric fluid was associated with larger stone size and need for urologic intervention.

A modified triangular Double-J stent for retrograde intrarenal surgery improvement of free-stone rate, and quality of life: a randomized controlled, multiple centers, perspective trial.

PURPOSE: The goal of this study is to evaluate the efficacy and safety of modified triangular double-J (DJ) stent in 1-2 cm renal or ureter calculi after retrograde intrarenal surgery (RIRS) via a randomized, controlled clinical study. METHODS: A total of 196 patients with 1-2 cm renal or ureter calculi who were performed RIRS and received 7Fr modified triangular DJ stents (100 cases) or 6Fr normal DJ stents (96 cases). All operations were performed by experienced surgeons. The clinical characteristics and outcomes were analyzed. RESULTS: There were no significant differences between two groups in terms of age, gender, BMI, location, hydronephrosis, urea WBC, urea RBC, BUN, Cr, laser emission time, operation time, Hb loss, postoperative BUN, postoperative Cr. Patients who received modified triangular DJ stents were shown to have higher stone-free rate (p = 0.038), but lower general health (p = 0.004). CONCLUSION: The modified triangular 7Fr DJ stents were more efficient for patients underwent RIRS than 6Fr normal DJ stents.

The use of intelligent analysis (IA) in determining the tactics of treating patients with nephrolithiasis.

INTRODUCTION: The use of modern information technologies allows to increase confidence in the choice of a surgical treatment method of kidney stones, as well as to improve the quality of treatment due to an adequate combination of therapeutic techniques. MATERIALS AND METHODS: In our study we analyzed the treatment results of 625 patients with kidney stones. We created a register with the information on more than 50 parameters for each patient. Each example had an output parameter representing a predefined treatment strategy (extracorporeal shock-wave lithotripsy [ESWL]-1, percutaneous nephrolithotomy [PCNL]-2, pyelolithotomy or nephrolithotomy-3). The initial database served as the basis for training the neural network estimation technique. The aim of our study was to assess the possibility of using neural network algorithms in choosing a method for surgical treatment of urolithiasis. RESULTS: A prospective study was conducted to assess the clinical effectiveness of implementing the recommendations of the system. The average number of sessions in the group using the neural network assessment technique was 1.4. Residual fragments remained at the time of discharge in seven (15.6%) patients: four in the kidney, three in the lower third of the ureter "stone path." Inversion of therapeutic tactics-PCNL-was performed in four cases. The efficiency of the ESWL was 91.1%. The indicators of the ESWL in the comparison groups differed statistically significantly: in the second group, the efficiency was higher due to more stone fragmentation, with lower energy costs (the average number of sessions was 0.4 less). CONCLUSION: The presented technique can be of help for a practicing urologist to choose the optimal treatment method for each patient, thereby minimizing the risk of early postoperative complications.

Determinants of ureteral obstruction after percutaneous nephrolithotomy.

BACKGROUND: Ureteral obstruction after percutaneous nephrolithotomy (PCNL) may require prolonged drainage with a nephrostomy tube (NT) or ureteral stent, but it is not well understood how and why this occurs. The goal of this study was to identify risk factors associated with postoperative ureteral obstruction to help guide drainage tube selection. METHODS: Prospective data from adult patients enrolled in the Registry for Stones of the Kidney and Ureter (ReSKU) who underwent PCNL from 2016 to 2020 were used. Patients who had postoperative NTs with antegrade imaging-based flow assessment on postoperative day one (POD1) were included. Patients with transplanted kidneys or those without appropriate preoperative imaging were excluded. We assessed the association between patient demographics, stone characteristics, and intraoperative factors using POD1 antegrade flow, a proxy for ureteral patency, as the primary outcome. Stepwise selection was used to develop a multivariate logistic regression model controlling for BMI, stone location, stone burden, ipsilateral ureteroscopy (URS), access location, estimated blood loss, and operative time. RESULTS: We analyzed 241 cases for this study; 204 (84.6%) had a visual clearance of stone. Antegrade flow on POD1 was absent in 76 cases (31.5%). A multivariate logistic regression model found that stones located anywhere other than in the renal pelvis (OR 2.63, 95% CI 1.29-5.53; p = 0.01), non-lower pole access (OR 2.81, 95% CI 1.42-5.74; p < 0.01), and concurrent ipsilateral URS (OR 2.17, 95% CI 1.02-4.65; p = 0.05) increased the likelihood of obstruction. BMI, pre-operative stone burden, EBL, and operative time did not affect antegrade flow outcomes. CONCLUSION: Concurrent ipsilateral URS, absence of stones in the renal pelvis, and non-lower pole access are associated with increased likelihood of ureteral obstruction after PCNL. Access location appears to be the strongest predictor. Recognizing these risk factors can be helpful in guiding postoperative tube management.

Paediatric stone management: innovations and standards.

PURPOSE OF REVIEW: The aim of this study was to discuss current trends and recent developments in the surgical management of paediatric urolithiasis. RECENT FINDINGS: Medical expulsive therapy (MET) is considered as an option for the treatment of children with ureter stones. Extracorporeal shockwave lithotripsy (SWL) remains as a first option for majority of kidney stones and upper ureter stones. Advances in endourology have led to increased adoption of retrograde intrarenal surgeries (RIRS) and percutaneous nephrolithotomy (PCNL/mini-PCNL/ultra-mini-PCNL/micro-PCNL). SUMMARY: Management of paediatric stone disease has developed significantly in the past decade. However, the evidence in the literature remains disproportional to these advances. Well designed multicentric studies are still needed to compare effectiveness and safety of these procedures.

Obstructive struvite ureterolithiasis in 4-month-old intact male Bernese mountain dog.

A 4-month-old, 7 kg, intact male, Bernese mountain dog was presented for obstructive struvite ureterolithiasis. Multiple urethroliths, ureteroliths, and urocystoliths were present. Based on an abdominal ultrasound, there was severe left hydronephrosis and hydroureter from distal ureterolith obstruction, just proximal to the vesicoureteral junction. The dog was not azotemic. Successful treatment was accomplished via ventral cystotomy. Bladder wall culture revealed a methicillin-resistant Staphylococcus spp. No predisposing cause was identified. There are no known genetic predispositions in Bernese mountain dogs for struvite urolithiasis. The urinary tract infection resolved with surgical retrieval of the uroliths and antibiotic treatment. The dog remained clinically normal after the cystotomy but developed a subclinical urinary tract infection 4 mo post-operatively. Key clinical message: Urolithiasis is rare in pediatric veterinary patients. To the authors' knowledge, this is the first report of obstructive ureterolithiasis in a puppy. There is no known genetic predisposition for urolithiasis in Bernese mountain dogs.

Urétérolithiase obstructive à struvite chez un bouvier bernois mâle intact de 4 mois. Un bouvier bernois mâle intact de 4 mois, pesant 7 kg, a été présenté pour une urétérolithiase obstructive à struvite. De multiples urétrolithes, urétérolithes et urocystolithes étaient présents. Sur la base d'une échographie abdominale, il y avait une hydronéphrose gauche sévêre et un hydro-uretêre dû à une obstruction distale de l'urétérolithe, juste en amont de la jonction vésico-urétérale. Le chien n'était pas azotémique. Le succês du traitement a été obtenu par cystotomie ventrale. La culture de la paroi vésicale a révélé un Staphylococcus spp. résistant à la méticilline. Aucune cause prédisposante n'a été identifiée. Il n'y a pas de prédisposition génétique connue chez les bouviers bernois pour la lithiase urinaire à struvite. L'infection des voies urinaires s'est résolue avec l'extraction chirurgicale des urolithes et un traitement antibiotique. Le chien est resté cliniquement normal aprês la cystotomie mais a développé une infection subclinique des voies urinaires 4 mois aprês l'opération.Message clinique clé:La lithiase urinaire est rare chez les patients vétérinaires pédiatriques. À la connaissance des auteurs, il s'agit du premier rapport d'urétérolithiase obstructive chez un chiot. Il n'y a pas de prédisposition génétique connue pour la lithiase urinaire chez les bouviers bernois.(Traduit par Dr Serge Messier).

Risk factors for concomitant positive midstream urine culture in patients presenting with symptomatic ureterolithiasis.

In patients with symptomatic ureterolithiasis, immediate treatment of concomitant urinary tract infection (UTI) may prevent sepsis. However, urine cultures require at least 24 h to confirm or exclude UTI, and therefore, clinical variables may help to identify patients who require immediate empirical broad-spectrum antibiotics and surgical intervention. Therefore, we divided a consecutive cohort of 705 patients diagnosed with symptomatic ureterolithiasis at a single institution between 2011 and 2017 into a training (80%) and a testing cohort (20%). A machine-learning-based variable selection approach was used for the fitting of a multivariable prognostic logistic regression model. The discriminatory ability of the model was quantified by the area under the curve (AUC) of receiver-operating curves (ROC). After validation and calibration of the model, a nomogram was created, and decision curve analysis (DCA) was used to evaluate the clinical net-benefit. UTI was observed in 40 patients (6%). LASSO regression selected the variables elevated serum CRP, positive nitrite, and positive leukocyte esterase for fitting of the model with the highest discriminatory ability. In the testing cohort, model performance evaluation for prediction of UTI showed an AUC of 82 (95% CI 71.5-95.7%). Model calibration plots showed excellent calibration. DCA showed a clinically meaningful net-benefit between a threshold probability of 0 and 80% for the novel model, which was superior to the net-benefit provided by either one of its singular components. In conclusion, we developed and internally validated a logistic regression model and a corresponding highly accurate nomogram for prediction of concomitant positive midstream urine culture in patients presenting with symptomatic ureterolithiasis.

Factores de riesgo para extravasación de contraste en colico renal / Risk factors for contrast extravasation in renal colic

INTRODUCCIÓN: La ruptura no traumatica del sistema pieloureterocalicial (PUC) es una entidad clínica poco común. La causa más frecuente esla obstrucción ureteral por patología litiásica, que sepresenta hasta en un 75%. A nuestro conocimiento, noexiste en la literatura una descripción de los posiblesfactores asociados con este evento. Nuestro objetivo esanalizar las variables asociadas con la extravasaciónde contraste endovenoso en pacientes con cólico renalpor litiasis ureteral única.MATERIALES Y MÉTODOS: Se realizó un análisis retrospectivo, descriptivo, de una serie de pacientes que,en contexto de cólico renal, presentaron extravasaciónde contraste endovenoso por el sistema urinario entomografía computada (TC). Se incluyeron pacientescon litiasis ureteral única sin otra patologia asociada.Se realizó una comparación de las muestras del grupocon fuga de contraste (grupo 1) con igual número detomografías consecutivas sin fuga de contraste (grupo2) en paciente con cólico renal litiásico, en un modelode regresión logística para identificar factores de riesgo de fuga de contraste. RESULTADOS: Se registraron 117 casos de fuga decontraste desde enero de 2013 hasta julio de 2018. El86% de los litos fueron ≤ 5 mm y el 79 % se ubicaronen uréter inferior. El 72% de los pacientes presentópelvis intrarrenal. En el análisis univariado tanto ubicación en uréter inferior, litiasis ≤ 5 mm, como anatomía pielica intrarrenal aumentaron la probabilidad deextravasación. En el modelo multivariado, litiasis ≤ 5mm aumentaron cinco veces el riesgo de extravasación comparado con las mayores, la ubicación en uréter distal aumentó en tres veces y la anatomía con pelvis intrarrenal aumentó en dos veces comparado conotra ubicación y pelvis extrarrenal, respectivamente,de manera estadísticamente significativa el riesgo depresentar fuga de contraste.

INTRODUCTION: Non-traumatic rupture of the pyeloureterocaliceal system (PUC) is anuncommon clinical entity. The most frequent cause isureteral obstruction due to lithiasic pathology, whichis present in up to 75%. To our knowledge, there isno description in the literature of the possible factorsassociated with this event. Our objective is to analyzethe variables associated with intravenous contrastextravasation in patients with renal colic due to singleureteral lithiasis. MATERIALS AND METHODS: We performed aretrospective, descriptive analysis of a series ofpatients who, in the context of renal colic, presented endovenous contrast extravasation throughthe urinary system in computed tomography (CT).Patients with single ureteral lithiasis without otherassociated pathology were included. A comparisonof the samples from the group with contrast leakage (group 1) with an equal number of consecutiveCT scans without contrast leakage (group 2) in patients with renal colic lithiasis was performed in alogistic regression model to identify risk factors forcontrast leakage.RESULTS: There were 117 cases of contrast leakage from January 2013 to July 2018. Eighty-sixpercent of the lithiases were 5 mm and 79% werelocated in the lower ureter. 72% of patients presented with intrarenal pelvis. In the univariate analysisboth location in lower ureter, lithiasis 5 mm, andintrarenal pyelic anatomy increased the probability of extravasation. In multivariate model, 5 mmlithiasis increased five times the risk of extravasation compared to larger ones, the location in distalureter increased three times and the anatomy withintrarenal pelvis increased two times compared toother location and extrarenal pelvis, respectively, ina statistically significant way the risk of presentingcontrast leakage.CONCLUSION: In this series, we found an increased risk of contrast leakage in a lithiasic renalcolic in patients with intrarenal pelvic anatomy with lithiasis less

[The tale of two stones in an obstructed partial duplex kidney: case presentation].

Duplex renal systems is a common anomalies. Incidence rate of 0.8% in healthy adult population and 2-4% in patients investigated for urinary tract symptoms. Urolithiasis management for patients with anomalies is complex and require proper imaging and planning. We have a patient with a partial duplex collecting system presented with a right renal calculus in a non-functioning lower moiety and multiple distal ureteric calculi. Preoperative planning done and surgery performed with good outcome without any early and late complications.

Conhecimento da população portadora de doença renal calculosa sobre os fatores de risco associados à urolitíase / Awareness of the population with calculus kidney disease about the risk factors associated with urolitiasis / Conocimiento de la población con enfermedad renal por cálculo sobre los factores de riesgo asociados a la urolitiasis

Introdução: A litíase urinária é uma doença que ocorre devido à formação de cálculos no aparelho urinário, especialmente os compostos por oxalato de cálcio. Sua prevalência vem aumentando, variando de 5 a 15% na população adulta ocidental, tendo aspectos genéticos e ambientais como fatores de risco para seu surgimento. Objetivo: Verificar o conhecimento da população portadora de doença renal calculosa sobre os fatores de risco associados à urolitíase buscando correlacionar variáveis sociodemográficas ao número de acertos. Material e Método: Foi realizado um estudo do tipo transversal de caráter descritivo com abordagem qualitativa, incluindo 84 indivíduos que tenham sido submetidos a tratamento de ureterolitíase. O trabalho foi desenvolvido por meio do envio de questionários em plataformas digitais. Resultados: A idade média dos participantes foi de 39,8 anos, sendo que 40 indivíduos (50,6%) não possuíam comorbidades e 56 deles (66,7%) afirmaram que receberam informação a respeito de como prevenir a formação de novos cálculos no trato urinário. Em relação aos fatores predisponentes, 67 indivíduos (79,8%) acreditaram que certos alimentos e bebidas poderiam afetar o risco de formação de cálculos no trato urinário. Além disso, 67 pacientes (79,8%) da amostra estariam dispostos a promover mudanças dietéticas e de estilo de vida, caso elas reduzissem o risco de incidência de doença calculosa no trato urinário. Conclusão: Dessa forma, ressalta-se a importância de estabelecimento de uma comunicação médico-paciente efetiva de modo a promover melhoras no desempenho dos indivíduos acerca dos fatores de risco para doença calculosa.(AU)

Introduction: Urinary lithiasis is a disease that occurs due to the formation of stones in the urinary tract, especially those composed of calcium oxalate. Its prevalence has been increasing, ranging from 5 to 15% in the Western adult population, with genetic and environmental aspects as risk factors for its emergence. Objective: Verify the knowledge of the population with calculus kidney disease about the risk factors associated with urolithiasis seeking to correlate sociodemographic variables to the number of hits. Material and Method: A cross-sectional study of descriptive character with a qualitative approach was carried out, including 84 individuals who have undergone treatment of ureterolithiasis. The work was developed by sending questionnaires on digital platforms. Results: The average age of the participants was 39.8 years, 40 individuals (50.6%) did not have comorbidities and 56 of them (66.7%) stated that they received information about how to prevent the formation of new stones in the urinary tract. Regarding predisposing factors, 67 individuals (79.8%) believed that certain foods and beverages could affect the risk of formation of stones in the urinary tract. In addition, 67 patients (79.8%) of the sample would be willing to promote dietary and lifestyle changes if they reduced the risk of incidence of calculus disease in the urinary tract. Conclusion: Thus, we emphasize the importance of establishing effective medical-patient communication in order to promote improvements in the performance of individuals about risk factors for computed disease.(AU)

Introducción: La litiasis urinaria es uma enfermedad que se produce por la formación de cálculos en las vías urinarias, especialmente los compuestos por oxalato de cálcio. Su prevalência ha ido em aumento, oscilando entre el 5 y el 15% en la población adulta occidental, siendo los factores genéticos y ambientales para su aparición. Objetivo: Verificar el conocimiento de la población con enfermedad renal calculosa sobre los factores de riesgo asociados a la urolitiasis, buscando correlacionar variables sociodemográficas com el número de aciertos. Materiales y métodos: Se realizó un estudio descriptivo transversal con abordaje cualitativo, en el que se incluyeron 84 individuos en tratamiento por ...(AU)

[UROLOGICAL CONSULT FOR PATIENT WITH RENAL COLIC BEFORE DISCHARGE FROM THE EMERGENCY DEPARTMENT (ED): THE OUTCOME EFFECT ON SPONTANEOUS STONE EXPULSION AND RE-VISIT TO ED].

INTRODUCTION: Renal colic due to ureterolithiasis is a frequent reason for visiting the emergency departments (ED). The majority of those patients are managed non-surgically and will experience a spontaneous stone expulsion. The ED at our hospital works as a unified department, which is a well-established practice in Europe and North America. AIMS: Assess the outcome of urological consultation in the ED for patients with urolithiasis. METHODS: A retrospective cohort examined 402 ureterolithiasis patients proven by abdominal CT-scan at the ED. Patients were divided into 3 groups: Group1: patients were discharged after evaluation by ED physician alone. In Group 2: patients were discharged after being evaluated by an ED physician and urologist. In Group 3: patients who were admitted to the Urology Department. Clinical, laboratory and imaging parameters were examined as well as patients' outcomes: spontaneous stone expulsion, re-visit to ED and surgical intervention. RESULTS: There were not significant differences between group 1 and 2 regarding age, stone size, stone location, WBC levels, stone expulsion rate or surgical intervention. Group 1 had a significant higher rate of ED re-visits compared with group 2 (79 (43.3%) vs. 12 (17.9%). p=0.0002). Group 3 had significantly higher stone size, creatinine levels, inflammatory markers, proximal stone location and surgical interventions. CONCLUSIONS: ED working as a unified department provides excellent management to patients with renal colic due to ureterolithiasis, with a high rate of spontaneous stone expulsion and urologist referral to admissions and surgical interventions. Nevertheless, urological consultation significantly decreases re-visits to ED.

Litotricia neumática vs. Litotricia láser ho: yag en el tratamiento de la litiasis ureteral / Pneumatic lithotripsy vs. Ho: yag laser lithotripsy in the treatment of ureteral lithiasis

Obetivo: La litotricia neumática (LN) yláser Ho: YAG (LH) son los métodos más aceptados enel tratamiento endoscópico de la litiasis ureteral. El objetivo es comparar eficacia y seguridad de la litotricianeumática vs. litotricia láser Ho: YAG en el tratamientode la litiasis ureteral. Material y métodos: Estudio prospectivo, simpleciego, multicéntrico. Se incluyeron pacientes adultosque se sometieron a tratamiento de litiasis ureteral, desde agosto de 2017 a marzo de 2019, en 23 instituciones nacionales. Las variables analizadas incluyeron:datos demográficos, tamaño y ubicación del lito, presencia de catéter doble J previo al procedimiento, tasalibre de litiasis (LL) y de complicaciones. Resultados: Se incluyeron un total de 366 pacientescon litiasis ureteral, 204 en el grupo LN y 162 en elgrupo LH. La tasa libre de litiasis fue significativamentesuperior en el grupo LH (77% vs. 92%), OR 3,43 (1,76a 6,70) y la tasa de complicaciones fue significativamente menor en el grupo LH (9,8% vs. 2,5%), OR 0,23(0,07 a 0,71). En el análisis multivariado, la utilizaciónde la energía Ho: YAG, la ubicación de la litiasis enuréter distal y la colocación preoperatoria de catéterdoble J, resultaron ser factores predictores del estado LL. Conclusión: La litotricia láser Ho: YAG presenta unamayor tasa libre de litiasis y una menor tasa de complicaciones, en comparación con la litotricia neumática.(AU)

Objetive: Pneumatic lithotripsy (PL) andHo: YAG laser lithotripsy (LL) are the most widely accepted methods in the endoscopic treatment of ureterallithiasis. The objective is to compare efficacy and safetyof pneumatic lithotripsy vs. Ho: YAG laser lithotripsy inthe treatment of ureteral lithiasis. Material and methods: Prospective, single-blind,multicenter study. Adult patients were recruited from August 2017 to March 2019, in 23 institutions throughoutArgentina. Patient demographics, stone characteristics,presence of double J stent prior to the intervention, stonefree rate (SF) and postoperative complications wereevaluated and analyzed. Results: A total of 366 patients with ureteral lithiasiswere included, 204 in the PL group and 162 in theLL group. The SF rate was significantly higher in the LLgroup (77% vs. 92%), OR 3 .43 (1.76 to 6.70). Thecomplication rate was significantly lower in the LL group(9.8% vs. 2.5%), OR 0.23 (0.07 to 0.71). In the multivariate analysis, the use of Ho: YAG energy, the locationof the lithiasis in the distal ureter, and the preoperativeplacement of double J stent, were found to be predictorsof SF status. Conclusions: Ho: YAG laser lithotripsy has a higherstone-free rate and a lower complication rate comparedto pneumatic lithotripsy.(AU)

Comparison of the effects of retroperitoneoscopic ureterolithotomy and ureteroscopic lithotripsy in the treatment of upper ureteral calculi.

ABSTRACT: This study compares the efficacy of retroperitoneoscopic ureterolithotomy (RPUL) and ureteroscopic lithotripsy (URL) in the treatment of upper ureteral calculi.The clinical data of 150 patients with upper ureteral calculi who underwent RPUL and 136 patients who underwent URL between January 2014 and October 2019 were retrospectively analyzed. The operation time, postoperative hospital stay, operation success rate, stone clearance rate, and surgical complications were evaluated between the two groups.For the RPUL and URL groups, respectively, the average operation time was 74.5 ±â€Š24.6 minutes and 54.5 ±â€Š13.2 minutes; the postoperative hospital stay was 5.8 ±â€Š1.4 days and 3.2 ±â€Š1.2 days; the operation success rate was 96.0% (144/150) and 85.3% (116/136); the incidence rate of complications was 3.5% (5/144) and 17.5% (18/103); and the stone clearance rate was 100% (144/144) and 88.8% (103/116), which were all statistically significant (P < .05).Both RPUL and URL had the advantages of low trauma and fast recovery rate for patients with upper ureteral calculi. However, patients who underwent RPUL showed higher success and fewer complication rate. RPUL might be a safe and effective laparoscopic method for the treatment of patients with upper ureteral calculi.

Catéter doble j: colocación guiada por ultrasonido, experiencia inicial / Double J catheter: ultrasound-guided placement, initial experience

Introducción y objetivos: El catéter ureteral es utilizado para proporcionar un drenaje adecuado del tracto urinario superior. Se han usado para prevenir o aliviar la obstrucción ureteral pormúltiples causas. La literatura menciona la colocaciónestándar de catéter doble J guiado por fluoroscopia,reportándose el uso de ultrasonido exclusivamente encasos de pacientes embarazadas con el fin de evitarlas radiaciones ionizantes. Sobre la base de los antesexpuesto, se consideró como objetivo primario evaluarla colocación de catéter doble J guiado por ultrasonido, como técnica alternativa al uso del fluoroscopio enobstrucciones ureterales, como objetivos secundarios seevaluaron, el tiempo de colocación del catéter, la intensidad del dolor y las complicaciones del procedimiento Materiales y métodos: Se realizó un estudio observacional, descriptivo y prospectivo, con 41 pacientesque acudieron a la consulta de litiasis.Resultados: Se evaluaron en total 41 pacientes aquienes se les colocó catéter doble J guiado por ultrasonido, lográndose la misma de forma exitosa en 35 delos casos, resultando en mal posición en 2 pacientes ysiendo imposible la inserción del mismo en 4. La edadpromedio fue 41 años, tamaño del lito 10,41mm. Lascomplicaciones presentadas fueron del 17% con el usode la escala de Clavien modificado, dichas complicaciones fueron representadas de la siguiente manera:4,9% grado I dolor lumbar, 7,2% grado II síntomas deltracto urinario bajo e infecciones del tracto inferior, y4,9% grado IIIa malposición.Coclusiones: La colocación de catéteres ureterales guiados por ultrasonido, representan una herramienta útil, segura, con complicaciones manejables, efectuándose en tiempos ajustados al procedimiento.(AU)

Introduction and objetives: The ureteral catheter is used to provide adequate drainage of the upper urinary tract. They have been usedto prevent or relieve ureteral obstruction due to multiplecauses. The literature mentions the standard placementof double J catheter guided by fluoroscopy, reporting theuse of ultrasound exclusively in cases of pregnant patients in order to avoid ionizing radiation. Based on theaforementioned, the primary objective was to evaluatethe placement of double J catheter guided by ultrasound, as an alternative technique to the use of the fluoroscopein ureteral obstructions, as secondary objectives the intensity of the pain and the complications of the procedure.Materials and methods: An observational, descriptive and prospective study was carried out with 41patients who attended the lithiasis consultation. Results:A total of 41 patients who underwent double J catheter guided by ultrasound were evaluated, achieving itsuccessfully in 35 of the cases, resulting in bad positionin 2 patients and being impossible to insert it in 4. average age was 41 years, size of the lithium 10.41mm.The complications presented were 17% with the use ofthe scale of Clavien modified these complications wererepresented as follows: 4.9% grade I back pain, 7.2%grade II lower urinary tract symptoms, lower tract infections , and 4.9% grade IIIa malposition.Conclusions: The placement of ureteral cathetersguided by ultrasound, represent a useful tool, safe, withmanageable complications, taking place in times adjusted to the procedure.(AU)