Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.522
Filtrar
1.
Expert Rev Med Devices ; 17(12): 1257-1264, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33307869

RESUMO

Introduction: Flexible ureteroscopy is a commonly performed urologic procedure for visualization and treatment of the upper urinary tracts. Traditionally, ureteroscopy has been performed with reusable scopes, which have large initial purchasing costs. LithoVue was the first widely adopted single-use flexible ureteroscope clinically available in 2016 and has caused reevaluation of this paradigm. Areas covered: This review is an objective assessment of the LithoVue single-use ureteroscope based on available studies at the time of publication. The authors searched major databases for papers that included the term 'LithoVue' and included relevant papers. The state of the market, technical specifications, results from clinical studies and cost analyses, and competitors are discussed. Expert opinion: The LithoVue single-use flexible ureteroscope has comparable clinical performance to existing reusable ureteroscopes based on available data. Direct clinical comparisons to competing single-use ureteroscopes, many of which are relatively new, are limited. In numerous pre-clinical studies LithoVue performed favorably compared to available competitors. Cost analyses suggest that benefit of single-use ureteroscopes is institution-specific, and will likely be favorable at a low volume of cases and with high local costs for repairs of reusable scopes.


Assuntos
Cálculos Renais/cirurgia , Ureteroscópios/efeitos adversos , Aprovação de Equipamentos , Desenho de Equipamento , Humanos , Vigilância de Produtos Comercializados/economia , Resultado do Tratamento , Ureteroscópios/economia
2.
Zhonghua Yi Xue Za Zhi ; 100(47): 3801-3805, 2020 Dec 22.
Artigo em Chinês | MEDLINE | ID: mdl-33379846

RESUMO

Objective: To investigate the feasibility and advantages of establishing percutaneous nephrolithotomy pathway guided by C-arm CT. Methods: The data of 258 patients who were established a percutaneous nephrolithotomy pathway under the guidance of C-arm CT in the Department of Interventional Medicine of the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2019 were retrospectively analyzed, including168 males and 90 females, and aged 19-88 (60±11) years. There were 84 cases of single stone, 174 cases of multiple stone, and 18 cases of cast stone. The stone size was 9-42 (22±6) mm. Among them, dual access was established in 18 cases, and nephrolithotomy access was established in 276 cases. The three-dimensional guiding function of C-arm CT was used to puncture the target calyces and establish the percutaneous nephrolithotomy pathway. Results: The pathway was successfully established in 258 cases at the first time, with a success rate of 93.5%; successfully established in 15 cases at the second time, with a success rate of 98.9%; and unable to establish in 3 cases, with a failure rate of 1.1%. The operation time was (7.9-32.5) min, with an average of (16±5) min. The lithotripsy time was (25-115) min, with an average of (43±8) min. The intraoperative blood lose was (45-420) ml, with an average of (75±11) ml. There were 23 cases with postoperative calculus residual (8.3%). Postoperative complications included fever in 86 cases (33.3%), which improved after symptomatic treatment. Postoperative hematuria was observed in 128 patients (49.6%) with varying degrees of gross hematuria, among which 2 patients (0.72%) were treated with arterial embolization due to excessive bleeding and ineffective conservative treatment, while the hematuria disappeared after symptomatic treatment in the rest of the patients. Conclusion: The method of establishing percutaneous nephrolithotomy pathway under the guidance of C-arm CT was simple to operate. Especially for patients without hydronephrosis, this method had a high success rate and low complications, which was worthy of clinical promotion and reference.


Assuntos
Cálculos Renais , Litotripsia , Nefrolitotomia Percutânea , Nefrostomia Percutânea , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
3.
Arch Esp Urol ; 73(9): 803-812, 2020 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-33144534

RESUMO

INTRODUCTION: The Holmium laser is the most used energy source in flexible ureterrenoscopy (URSf). The Lumenis Pulse 120H® laser has a higher system energy, a higher energy per pulse and a higher repetition frequency in relation to other types of lasers, which offers advantages in the treatment of lithiasis. OBJECTIVE: To analyze the results that we have obtained with the use of the Lumenis Pulse120H® laser in patients treated by intrarenal retrograde surgery (RIRS). As secondary objectives there are: the study of the demographic variables of the patients, the characteristics of the stones and the complications associated with the procedure. MATERIAL AND METHODS: An observational, retrospective study of the first 26 patients treated by RIRS and Lumenis Pulse 120H® laser has been performed in our Service between August 2018 and February 2019. The size of the lithiasis was measured on the simple radiography and the CT, in addition, the volume of the lithiasis was calculated. For the realization of RIRS, 8.5Fr digital flexible ureterorenoscope (Olympus®) and the Holmium Lumenis 120H® laser with 200 micron laser fibers from Lumenis® were used. Statistical analysis was performed with the SPSSv21 system. RESULTS: A total of 26 patients with renal lithiasis have been analyzed. The median age was 55.15 years (40.67-67.05). 57.7% of the patients had prior surgical treatment of lithiasis. Thirteen patients presented the litiasis in the renal pelvis, ten in the Upper Calicial Group (GCS), fifteen in the Middle Calicial Group (GCM) and eighteen in the Lower Calicial Group (GCI). The median of the lithiasic volume was 1826.41 mm3. Our overall success rate was 80.8% (100% success in lithiasis less than 2 cm and 85.7% in lithiasis between 2-3 cm). Five patients presented complications, of which 4 were ClavienII and 1 Clavien IIIb. No significant results were found between the lithiasic size and the presence of complications (p = 0.128). CONCLUSIONS: The use of the Lumenis Pulse 120H®laser is an useful tool for the treatment of kidney stones by RIRS, due to his efficiency in the fragmentation and dusting, taking into account that very large lithiasic masses require, in a high percentage of cases, more than one treatment session.


Assuntos
Cálculos Renais , Lasers de Estado Sólido , Litíase , Hólmio , Humanos , Cálculos Renais/cirurgia , Lasers de Estado Sólido/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
Arch Esp Urol ; 73(9): 837-842, 2020 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33144538

RESUMO

OBJECTIVES: Renal access in percutaneous nephrolithotomy (PCNL) may be obtained via a pre-existing nephrostomy tube (NT) tract; however, emergent NTs are not always ideal for subsequent surgery. We sought to determine the rate of NT tract usability and assess factors related to the usability of emergently placed NTs. METHODS: A retrospective review was performed of UC San Diego subjects undergoing percutaneous renal surgery between January 2016 and October 2018. Demographics and peri-operative variables were collected. The primary outcome was the usability of NT tract for dilation and instrumentation. "Usable" indicated a tract in which PCNL could be completed; "unusable" indicated lack of dilation and the requirement of additional tract(s) for PCNL. RESULTS: 35 PCNL cases had previous emergently placed NT which were indwelling at time of percutaneous surgery. 51% of these NT tracts (18/35) were deemed usable and dilated for PCNL. No significant difference was seen between usable and unusable NT groups for number of dilated tracts during PCNL (p=0.13), or either the location of indwelling NT (p=0.96) or renal stones (p=0.95). In the usable NT tract cohort PCNL access was via the lower pole 56% of the time, where as when previous NT tracts were deemed unusable, a separate upper-pole access was obtained intra-operatively 53% of the time (p<0.01). CONCLUSIONS: Pre-existing, emergent NTs served a ssufficient PCNL access tracts in over half of recorded cases. Contrary to recently published reports, the utility of pre-existing NTs appears to vary among health systems. Other variables, including the desired location of PCNL appear to directly influence the like lihood of NT tract usability.


Assuntos
Cálculos Renais , Nefrolitotomia Percutânea , Nefrostomia Percutânea , Humanos , Rim , Cálculos Renais/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
5.
Arch Esp Urol ; 73(9): 843-851, 2020 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33144539

RESUMO

OBJECTIVE: To investigate the factors affecting surgical success rates and duration of operation in retrograde intrarenal surgery (RIRS) without fluoroscopy in children. The aim of the study was to demonstrate the efficacy of RIRS without fluoroscopy on the treatment of renal stones in children. MATERIALS AND METHODS: All RIRS procedures were performed on pediatric patients at our clinic from August 2013 to January 2017. We studied 52 pediatric patients who had one stone in one kidney and under went one session. We mapped the kidney collecting system anatomically, and stone localization was defined according to this mapping. Size and localization of the stone, placement of preoperative J stent, use of ureteral access sheath (UAS), and surgical success rates were recorded. The effects of these factors on surgical success rates and the duration of the operations were analyzed. RESULTS: Each patient underwent RIRS once. Of these 52 pediatric patients, 23 (44%) were between 0-5 years of age children (Group 1), 13 (25%) were between 6-11 years of age children (Group 2), and 16 (31%) were between 11-17 years of age children (Group 3). The surgical success rates for each group were 65%, 77%, and 81%, respectively (73% overall). The surgical success rates were found to be affected only by stone size (p<0.01). The durations of the operations were found to be affected by stone size, stone localization, passive dilatation of ureter, and the application of an UAS (p<0.05). CONCLUSION: RIRS is a safe and effective method for the treatment of intrarenal stones in pediatric patients. High success rates can be achieved using kidney mapping without the use of fluoroscopy.


Assuntos
Cálculos Renais , Ureter , Adolescente , Criança , Pré-Escolar , Fluoroscopia , Humanos , Lactente , Recém-Nascido , Rim , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Estudos Retrospectivos , Stents , Resultado do Tratamento
6.
Arch Esp Urol ; 73(9): 856-859, 2020 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-33144541

RESUMO

OBJECTIVE: Horseshoe kidney is the most common renal fusion anomaly. Its peculiar anatomical characteristics increase the risk of lithiasis formation and always entails a surgical challenge for its treatment. MATERIAL AND METHODS: We present the cases of men with horseshoe kidneys diagnosed by CT one case of alarge pyelic lithiasis with others of a smaller size in the calyces, and the other of a big solitary lithiasis in renal pelvis. RESULTS: We performed a laparoscopic pyelolitectomy to remove the pyelic lithiasis and we used a flexible cystoscope through a trocar to extract the calyceal stones. The postoperative period was uneventful without evidence of urinary leakage or residual lithiasis. CONCLUSIONS: The laparoscopic approach to lithiasisis a suitable alternative in especially complex cases such as horseshoe kidney. The use of a flexible cystoscope allows to navigate through the renal cavities and extract the lithiasis which cannot be accessed through laparoscopic instruments, improving the efficiency of this approach.


Assuntos
Rim Fundido , Cálculos Renais , Laparoscopia , Rim Fundido/complicações , Rim Fundido/cirurgia , Humanos , Rim/cirurgia , Cálculos Renais/cirurgia , Cálices Renais , Pelve Renal/cirurgia , Masculino
7.
Urologiia ; (5): 139-148, 2020 11.
Artigo em Russo | MEDLINE | ID: mdl-33185362

RESUMO

Percutaneous nephrolithotomy (PCNL) is the gold standard treatment of large and staghorn kidney stones. Despite technological progress and improvement of PCNL technique, this procedure is associated with complications and in some cases remain a challenge for endourologists. According to the time, complications can be divided into intra- and postoperative. Intraoperative complications include bleeding, injury of the renal collecting system, visceral organs, pulmonary complications, thromboembolic disorders, extrarenal migration of the stone fragments and incorrect nephrostomy tube placement. Postoperative complications include infection and sepsis, bleeding, persistent urinary fistula, infundibular stenosis and death of the patient. The different recommendations that might be useful for the timely diagnosis of various complications in patients undergoing PCNL are provided in the review. Additionally, information on treatment algorithms is included.


Assuntos
Cálculos Renais , Nefrolitotomia Percutânea , Nefrostomia Percutânea , Cálculos Coraliformes , Humanos , Cálculos Renais/diagnóstico , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/efeitos adversos , Nefrostomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Resultado do Tratamento
8.
Medicine (Baltimore) ; 99(40): e22477, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019439

RESUMO

INTRODUCTION: Percutaneous nephrolithotomy is a procedure used for management of refractory renal calculi. Oral and parenteral opioids, along with local anesthetic infiltration, neuraxial anesthesia, and paravertebral blocks are the most common methods of managing intra-operative and post-operative pain for these patients. The erector spinae plane block with catheter (ESPC) is a newer interfascial regional anesthetic technique that can be used to manage peri-operative pain in these patients. CLINICAL FINDINGS: Three patients complained of significant flank pain were scheduled for percutaneous nephrolithotomy under general anesthesia in the prone position. DIAGNOSES: Patients were diagnosed with large renal calculi. THERAPEUTIC INTERVENTIONS: Patients received ESPC in the pre-operative holding area at the level of the T7 transverse process. The ESPCS were bolused with a solution of 30 mL 0.25% bupivacaine with 4 mg dexamethasone prior to surgery. Patients also received oral tramadol 50 mg and acetaminophen 1 g as part of the multimodal pain protocol prior to surgery. After the procedure, the patients were bolused with 0.25% bupivacaine or started on an infusion of 0.25% bupivacaine to manage their pain. OUTCOMES: No opioid or other pain medications, other than the local anesthetic solution given in the ESPCs, were used during the intra-operative or post-operative period for management of pain in these patients. Visual analogue scale (VAS) scores were below 4 for all patients in the post-operative period, and patients did not report any issues with post-operative nausea or vomiting. CONCLUSION: These patients were compared to 3 prior patients who had undergone percutaneous nephrolithotomy without ESPC. The 3 patients without ESPC placement reported increased VAS scores, had increased opioid/pain medication consumption intraoperatively and postoperatively, and had increased incidence of perioperative nausea when compared to our ESPC patients. Our report shows that ESPC, in combination with a multimodal pain protocol, can be a good option for management of patients undergoing percutaneous nephrolithotomy.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Idoso , Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Dexametasona/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Músculos Paraespinais
9.
Arch Esp Urol ; 73(7): 643-650, 2020 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32886079

RESUMO

OBJECTIVE: To compare miniaturized percutaneous nephrolithotomy (mini-PNL) and retrograde intrarenal surgery (RIRS) in children with 10-20 mm renal stones. MATERIALS AND METHODS: Between 2015 and 2019, 63 pediatric patients aged under 16 years who under went mini-PNL and RIRS for the treatment of kidney stones sized 10-20 mm were analyzed retrospectively. The mini-PNL group (n=30) was defined as group 1 and the RIRS group (n=33) was defined as group 2. Peri-operative data including stone-free rate, operative time, fluoroscopy time, hospitalization time, number of anesthesia sessions, complication rates, and cost-effectiveness were analyzed. RESULTS: The mean age was 8.09±5.49 years in group 1 and 5.75±4.56 years in group 2. The stone free rate was not different at the first (80.0% vs. 57.6%) and third month (93.3% vs. 90.9%) follow-up in group 1 and group 2. The mean hospitalization, operative, and fluoroscopy times were statistically significantly longer in group 1. The mean number of anesthesia sessions for patients was 1.20±0.40 in group 1 and 2.15±0.44 in group 2 (p=0.00). Minor complication rates were not different and no major complications were observed in either group. The cost per patient was calculated as 365.97 Euros in group 1 and 698.64 Euros in group 2 (p=0.001). CONCLUSIONS: This study suggested that RIRS was an effective alternative treatment method for 10-20 mm kidney stones in children, with comparable stone-free and complication rates. RIRS has a shorter operative time, fluoroscopy time, hospital stay than mini-PNL, with a similar stone-free rate for 10-20 mm kidney stones in children. However, mini-PNL is cheaper and allowed a lower need for anesthesia sessions.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea , Nefrostomia Percutânea , Adolescente , Criança , Pré-Escolar , Humanos , Estudos Retrospectivos , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(34): e21847, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846834

RESUMO

RATIONALE: Lesch-Nyhan syndrome (LNS) is an X-linked recessive disorder presenting with uric acid overproduction, neurocognitive disability, and behavioral disturbances. Inhalational anesthesia has been frequently used in LNS patients undergoing surgery. Characteristic compulsive self-injurious behavior and high risk of emesis may hinder inhalational induction. Propofol may be beneficial for these patients because of its easy and rapid titration for anesthetic depth during induction, early recovery from anesthesia, and antiemetic effect as well as uricosuric effect. PATIENT CONCERNS: A 16-year-old male adolescent was scheduled for percutaneous nephrolithotomy. He exhibited poorly controlled muscle, self-injurious behaviors and intellectual disability. DIAGNOSIS: The patient presented with neurodevelopmental delay in the first year of life, and was diagnosed with LNS, with a substitution of phenylalanine to leucine in hypoxanthine-guanine phosphoribosyltransferase (HPRT) 1 gene on the X-chromosome at 3 years of age. INTERVENTIONS: Total intravenous anesthesia was used for induction and maintenance of anesthesia with propofol and remifentanil using target-controlled infusion. OUTCOMES: Time to recovery of consciousness was prolonged after uneventful surgery. Serum uric acid levels gradually increased during postoperative period. LESSONS: Propofol anesthesia using target-controlled infusion does not provide significant clinical advantages in rapid emergence from anesthesia and management of hyperuricemia in LNS patients undergoing urological surgery.


Assuntos
Anestesia Geral/efeitos adversos , Hipoxantina Fosforribosiltransferase/genética , Síndrome de Lesch-Nyhan/psicologia , Propofol/administração & dosagem , Administração Intravenosa , Adolescente , Período de Recuperação da Anestesia , Anestesia Geral/métodos , Humanos , Hiperuricemia/tratamento farmacológico , Hiperuricemia/etiologia , Deficiência Intelectual/etiologia , Cálculos Renais/cirurgia , Síndrome de Lesch-Nyhan/sangue , Síndrome de Lesch-Nyhan/diagnóstico , Síndrome de Lesch-Nyhan/genética , Masculino , Nefrolitotomia Percutânea/métodos , Transtornos do Neurodesenvolvimento/etiologia , Comportamento Autodestrutivo/etiologia , Resultado do Tratamento , Ácido Úrico/sangue , Vômito/induzido quimicamente
11.
Int J Surg ; 81: 55-60, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32738550

RESUMO

OBJECTIVE: To compare the predictive performance of five previously described scoring systems (i.e., S.T.O.N.E., Guy's, Clinical Research Office of the Endourological Society (CROES), the Seoul National University Renal Stone Complexity (S-RESC) and the new Stone Kidney Size (SKS) score) for postoperative outcomes regarding stone-free rate (SFR) and complications in adult patients. METHODS: Data from 349 patients who underwent percutaneous nephrolithotomy (PCNL) in three urology departments were analyzed. SKS, S.T.O.N.E., S-ReSC, CROES and Guy's nephrolithometry scoring systems were used to retrospectively calculate predictions for each patient. Univariate and multivariate analyses were performed to evaluate factors associated with SFR and complication rates. Receiver operating characteristic (ROC) curves were generated and areas under curves (AUC) were compared to identify the method with the highest predictive value. RESULTS: Median SKS, S.T.O.N.E., S-ReSC, CROES and Guy's scores were 4, 7, 3, 170.8 and 2, respectively. Overall, SFR was 67.0% (234/349) with a complications rate of 36.7% (128/349). AUCs of each method for predicting stone-free status, highlighted reasonable predictive capabilities with 0.709, 0.806, 0 0.869, 0.207, and 0.735, respectively; however, the S-ReSC scoring system had the best discriminative performance. According to multivariate logistic regression and AUC results, none were effectively capable of predicting complications. CONCLUSIONS: All scoring systems correlated significantly with stone-free status; although, S-ReSC appears to have the greatest predictive ability. This method is also relatively easy to implement and highly reproducible. However, none of the methods analyzed are able to accurately predict postoperative complications.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Adulto , Área Sob a Curva , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
12.
Curr Opin Urol ; 30(5): 679-683, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32701722

RESUMO

PURPOSE OF REVIEW: To provide an updated overview of different exit strategies for percutaneous nephrolithotomy (PCNL) in times of miniaturization and minimal invasive surgery. RECENT FINDINGS: The majority of the reported studies concluded that a tubeless procedure is associated with less patient discomfort and a shorter hospital stay compared to the standard PCNL. Additionally, no significant difference in the complication rate was observed, including postoperative fever, hematocrit decrease, stone-free rate, and urine extravasation. SUMMARY: Underlined by recent literature tubeless PCNL is a well tolerated and effective treatment. Nevertheless the decision whether or not to place a nephrostomy tube after PCNL is still depending on the clinical judgment and experience of the surgeon.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Nefrostomia Percutânea/métodos , Humanos , Tempo de Internação , Nefrolitotomia Percutânea/efeitos adversos , Nefrostomia Percutânea/efeitos adversos , Resultado do Tratamento
13.
BJU Int ; 126(2): 273-279, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32619050

RESUMO

OBJECTIVE: To compare the effectiveness and safety of standard percutaneous nephrolithotomy (sPCNL) and super-mini PCNL (SMP). PATIENTS AND METHODS: A total of 150 patients presenting with renal calculi of <2 cm were randomised to either sPCNL (Group 1) or SMP (Group 2). Randomisation was based on centralised computer-generated numbers. Variables studied included: stone-free rates (SFRs), operative time, intra- and postoperative complications, postoperative pain score, analgesic requirement, and hospital stay. Statistical analysis was performed using a t-test or Mann-Whitney U-test for continuous variables and chi-squared test or Fisher's exact test for categorical variables. RESULTS: Between September 2018 and April 2019, 75 patients were included in each group. The SFRs of the groups were similar (97.33 vs 98.66%, P = 0.56). The mean (sd) operative time was significantly longer in Group 2, at 36.40 (14.07) vs 23.12 (11.96) min (P < 0.001). The mean (sd) decrease in haemoglobin was significantly less in Group 2, at 3.0 (4.9) vs 7.5 (6.5) g/L (P < 0.001). The mean (sd) pain score at 24 h was significantly lower in Group 2, at 0.3 (0.46) vs 0.75 (0.53) (P < 0.001). The mean (sd) analgesic requirement was significantly less in Group 2, at 67 (22.49) vs 91.5 (30.56) mg tramadol (P < 0.001). The mean (sd) hospital stay was significantly less in Group 2, at 28.38 (3.6) vs 39.84 (3.7) h (P < 0.001). CONCLUSIONS: SMP is equally as effective as sPCNL for managing renal calculi of <2 cm, with improved safety. Although SMP is associated with a longer operative time, it has a significantly lower incidence of bleeding and postoperative pain, and a shorter hospital stay.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Cálculos Renais/patologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
14.
Surg Technol Int ; 37: 168-170, 2020 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-32520387

RESUMO

The aim of this novel in vivo study was to characterize the effect of short pulse-width versus long pulse-width Holmium-YAG laser lithotripter settings on retropulsion and fragmentation in a real-life setting. A prospective, crossover study was conducted at a tertiary teaching hospital in NSW, Australia. Patients who underwent flexible ureteroscopy with laser lithotripsy for renal calculi in 2018 were included. All patients underwent flexible ureteroscopy using a Flexor® 10.7/12 French ureteric access sheath (Cook Medical LLC, Bloomington, IN, USA) and lithotripsy with a 30W Holmium-YAG laser (Rocamed, Monaco). Thirty-two renal calculi were subjected to 1 min of laser treatment using both short and long pulse-width settings. Using 5-point, operator-assessed Likert scales, the level of retropulsion and fragmentation efficacy were assessed. There was significantly less retropulsion and improved stone fragmentation (p<0.001) using the long pulse-width compared to the short pulse-width setting. Regardless of stone size, in vivo renal calculi lithotripsy with a long pulse-width significantly improves the efficacy of lithotripter treatment.


Assuntos
Cálculos Renais , Lasers de Estado Sólido , Litotripsia , Estudos Cross-Over , Hólmio , Humanos , Cálculos Renais/cirurgia , Lasers de Estado Sólido/uso terapêutico , Estudos Prospectivos
15.
Pan Afr Med J ; 35: 60, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32537064

RESUMO

Percutaneous nephrolithotomy is a potentially invasive technique associated with a risk of complications, in particular bleeding. We report the case of a 70-year old female patient who had only left kidney and with a history of renal calculi treated with percutaneous nephrolithotomy. Persistent, average abundant haematuria had occurred two and a half months before, requiring computerized tomography (CT) scan. This had showed false iatrogenic intrarenal inferior polar aneurysm. It required effective selective embolization of biological glue.


Assuntos
Falso Aneurisma/terapia , Embolização Terapêutica/métodos , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/efeitos adversos , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Feminino , Hematúria/etiologia , Humanos , Nefrolitotomia Percutânea/métodos , Rim Único , Tomografia Computadorizada por Raios X
16.
Int J Infect Dis ; 97: 162-166, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32502660

RESUMO

OBJECTIVE: To assess the relevance of urine test (UT), urine culture (UC) and stone culture (SC) for postoperative infections and to investigate the optimal perioperative antibiotic treatment strategy in association with percutaneous nephrolithotomy (PCNL) in patients with renal calculi. MATERIALS AND METHODS: Between September 2016 and September 2018 1,060 patients treated with PCNL were included in the study. The results of UT, UC and SC were reviewed. The details of perioperatively administered antibiotics and postoperative infections were recorded. RESULTS: A positive UT was associated with an increased incidence of infection; this was also the case in patients with negative UC (p < 0.05). There was no significant difference in incidence of infection between patients who were given a single dose of antibiotics compared with those given multiple doses when UC was negative, whether UT was positive or negative (all p > 0.05). The incidence of infection was decreased when pre-operative antibiotics were administered according to the sensitivity pattern based on UC (p < 0.05). This outcome was particularly evident when the treatment duration exceeded 7 days (p < 0.05). A positive SC was associated with increased incidence of infection, even if the patient had a negative UC and UT (p < 0.05). The incidence of infection was significantly decreased when antibiotic treatment was administered based on the results of SC (p < 0.05). CONCLUSION: Pre-operative prophylaxis with a single-dose antibiotic was sufficient in patients with negative UC, whether UT was positive or negative. Pre-operative treatment with antibiotics according to the bacterial sensitivity pattern should be administered for ≥7 days in patients with positive UC. The postoperative antibiotic treatment strategy should be tailored according to the SC results.


Assuntos
Antibacterianos/uso terapêutico , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea , Adulto , Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Feminino , Humanos , Cálculos Renais/complicações , Cálculos Renais/microbiologia , Cálculos Renais/urina , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos
17.
Urologe A ; 59(9): 1017-1025, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32533201

RESUMO

BACKGROUND: Percutaneous access to the renal pelvis still remains the most difficult step before nephrolitholapaxy (PCNL). New imaging techniques, such as 3D imaging and various navigation instruments such as electromagnetic, sonographic, CT-controlled and marker-based/iPAD try to simplify this step and reduce complications. OBJECTIVES: In this review, various new techniques for puncturing the renal collecting system are presented and their advantages and disadvantages are evaluated. MATERIALS AND METHODS: A systematic literature search was carried out in MEDLINE, whereby only puncture techniques that have already been evaluated in clinical studies were included. RESULTS: Five different navigation methods for puncturing the renal pelvis before PCNL were found. CONCLUSION: Intraoperative navigation can be useful when puncturing the collecting system. The combination of ultrasound and fluoroscopy currently remains the gold standard. However, there is still a need for further, primarily clinical, prospective studies to determine which new imaging technology and navigation systems will prevail and thus facilitate the access route to the kidney, especially in the case of special anatomical conditions.


Assuntos
Cálculos Renais/cirurgia , Rim/diagnóstico por imagem , Rim/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Nefrostomia Percutânea/métodos , Punções/métodos , Humanos , Cálculos Renais/diagnóstico por imagem
18.
J Urol ; 204(4): 769-777, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32364838

RESUMO

PURPOSE: We compared the hydrocoated silicone stent (Coloplast Imajin® hydro) to Percuflex™ Plus stent (Boston Scientific) in terms of patient comfort and quality of life after flexible ureteroscopy for stone disease over a 5-week prospective followup. MATERIALS AND METHODS: This is a multicenter, single-blind, prospective, randomized trial of 141 patients treated with flexible ureteroscopy for renal stones. Primary outcome was Ureteral Stent Symptom Questionnaire (USSQ) Body Pain Index recorded before Double-J® stent removal at day (D) 20. Secondary endpoints were USSQ scores at intermediate dates (D2, D7, D20) and 2 weeks after stent withdrawal (D35), occurrence of adverse events and stent encrustation. RESULTS: The trial was completed by 113 (80.1%) patients. Mean (SD) USSQ body pain scores were 25% lower at D20 for the silicone stent at 18.7 (11.4) vs 25.1 (14.2) (p=0.015). No difference in terms of adverse events and safety profile was observed. USSQ urinary symptoms scores at D2, D7 and D20 were lower in the silicone stent group at 26.4 (7.7) vs 31.8 (8.1) at D20 (p <0.001). The use of USSQ self-questionnaires was associated with a limited number of missing or incomplete answers. CONCLUSIONS: The primary results of this large sample prospective randomized controlled study comparing the silicone Imajin hydro stents to the Percuflex Plus stent show that silicone stents are associated with significantly less patient discomfort. We would recommend their use in patients who require stenting for stone disease.


Assuntos
Cálculos Renais/cirurgia , Qualidade de Vida , Stents , Ureteroscopia , Adulto , Feminino , Humanos , Cálculos Renais/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Silicones , Método Simples-Cego , Avaliação de Sintomas , Ureter , Ureteroscopia/métodos
20.
Arch Esp Urol ; 73(4): 307-315, 2020 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32379066

RESUMO

OBJECTIVE: To compare efficiency, safety and full cost of lower retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) types for the treatment of lower calyceal stones between 1 and 2 cm in size. METHODS: This was a prospective, randomized study. In all, 175 patients were randomly divided into five groups of 35 patients each: Group A was managed by RIRS, Group B by micro PNL, Group C by ultra-mini PNL, Group D by mini PNL, and Group E by standard PNL. Operating and fluoroscopy time, length of hospital stay, stone-free rates (SFR), complications, secondar y ureterolithotripsy and cost were compared between groups. RESULTS: A total of 168 patients were included in the final analysis. The SFR was 76%, 77%, 90.1%, 94.1% and 94%; median length of hospital stay 1, 1.5, 2, 2, and 3 days was for RIRS, micro, ultra-mini, mini, and standard PNL, respectively (p<0.001). The mean costs of the procedures per case were $1,250, $962,$695, $632, and $619, and the mean return to daily activities time was 3.9, 4.5, 6.5, 9.3, and 13.5 days for RIRS, micro, ultra-mini, mini,and standard PNL, respectively (p<0.001). CONCLUSIONS: SFR of treatment of lower calyceal stone was higher in ultra-mini, mini and standard PNL than micro PNL and RIRS. Moreover, patients should be informed about the results of all different procedures ; with increasing of the invasiveness of treatment, cost of the procedure decrease; but the hospital stay and return to daily activity interval increase.


Assuntos
Cálculos Renais/cirurgia , Nefrostomia Percutânea , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA