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1.
Urologiia ; (5): 139-148, 2020 Nov.
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
3.
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
4.
Am J Physiol Renal Physiol ; 318(2): F363-F374, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31790303

RESUMO

In stone formers (SFs) with idiopathic hypercalciuria, urine pH governs the mineral phase of stones. Calcium phosphate (CaP) SFs have higher urine pH than calcium oxalate (CaOx) SFs. Normal women have higher urine pH than men on fixed diets, accompanied by greater absorption of food alkali. Female CaP and male CaOx SFs have similar urine pH as same sex normal individuals, but male CaP and female CaOx SFs may have abnormal acid-base handling. We studied 25 normal individuals (13 men and 12 women), 17 CaOx SFs (11 men and 6 women), and 15 CaP SFs (8 men and 7 women) on fixed diets. Urine and blood samples were collected under fasting and fed conditions. Female CaOx SFs had lower urine pH and lower alkali absorption, fed, compared with normal women; their urine NH4 was higher and urine citrate excretion lower than in normal women, consistent with their higher net acid excretion. Male CaOx SFs had higher urine citrate excretion and higher serum ultrafilterable citrate levels than normal men. Both male and female CaP SFs had higher urine pH fasting than same sex normal individuals, but only men were higher in the fed period, and there were no differences from normal in gut alkali absorption. CaP SFs of both sexes had higher urine NH4 and lower urine citrate than same sex normal individuals. The lower urine pH of female CaOx SFs seems related to decreased gut alkali absorption, while the higher pH of CaP SFs, accompanied by higher urine NH4 and lower urine citrate, suggests a proximal tubule disorder.


Assuntos
Equilíbrio Ácido-Base , Desequilíbrio Ácido-Base/urina , Oxalato de Cálcio/urina , Fosfatos de Cálcio/urina , Hipercalciúria/urina , Cálculos Renais/urina , Túbulos Renais Proximais/metabolismo , Desequilíbrio Ácido-Base/sangue , Desequilíbrio Ácido-Base/diagnóstico , Desequilíbrio Ácido-Base/fisiopatologia , Adulto , Compostos de Amônio/urina , Biomarcadores/sangue , Biomarcadores/urina , Estudos de Casos e Controles , Ácido Cítrico/urina , Cristalização , Dieta/efeitos adversos , Feminino , Absorção Gastrointestinal , Humanos , Concentração de Íons de Hidrogênio , Hipercalciúria/sangue , Hipercalciúria/diagnóstico , Hipercalciúria/fisiopatologia , Cálculos Renais/sangue , Cálculos Renais/diagnóstico , Cálculos Renais/fisiopatologia , Túbulos Renais Proximais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Adulto Jovem
5.
BJU Int ; 125(5): 732-738, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31869527

RESUMO

OBJECTIVES: To evaluate the utility of kidney injury test (KIT) assay urinary biomarkers to detect kidney stones and quantify stone burden. PATIENTS AND METHODS: A total of 136 spot urine samples from 98 individuals, with and without kidney stone disease, were processed in a predefined assay to measure six DNA and protein markers in order to generate a risk score for the non-invasive detection of nephrolithiasis. From this cohort, 56 individuals had spot, non-timed urine samples collected at the time of radiographically confirmed kidney stones, and 54 demographically matched, healthy controls without kidney stone disease also provided spot, non-timed urine samples. Sixteen individuals with persistent stone disease had more than one urine sample. Using a proprietary microwell-based KIT assay, we measured cell-free DNA (cfDNA), methylated cfDNA, clusterin, creatinine, protein and CXCL10. A KIT stone score was computed across all markers using the prior locked KIT algorithm. The KIT stone score, with a scale of 0 to 100, was then correlated with demographic variables, kidney stone burden, obstructive kidney stone disease, and urine solutes in 24-h urine collections. RESULTS: The scaled KIT stone score, a composite of all six biomarkers, readily discriminated individuals with current or prior radiographically confirmed kidney stones from healthy controls without kidney stone disease (P < 0.001). In individuals with nephrolithiasis, KIT stone score also correlated with radiologically measured stone size (P = 0.017) and differentiated patients with a clinical radiological diagnosis of obstructive nephrolithiasis associated with upper renal tract dilatation (P = 0.001). Stone burden as assessed by KIT stone score, however, did not correlate with the any of the traditional measures of 24-h urine solutes or the 24-h urine supersaturation levels. In patients with persistent stone disease, where multiple urine samples were collected over time and after different interventions, the use of KIT stone score could non-invasively track stone burden over time through a spot urine, non-timed urine sample. CONCLUSIONS: A random, spot urine-based assay, KIT stone score, can non-invasively detect, quantify and monitor current stone burden, and may thus minimize radiographic exposure for kidney stone detection. The KIT stone score assay may also help monitor stone recurrence risk for patients with nephrolithiasis, without the requirement for 24-h urine collections.


Assuntos
Bioensaio/métodos , Creatinina/urina , Cálculos Renais/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/urina , Feminino , Humanos , Cálculos Renais/urina , Masculino , Pessoa de Meia-Idade , Adulto Jovem
6.
Urology ; 137: 152-156, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31883881

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of supracostal percutaneous nephrolithotomy (PCNL) through the 11th intercostal space and compare it with subcostal PCNL in children with renal calculi. MATERIALS AND METHODS: Children with renal calculi who underwent PCNL between January 2010 and December 2017 were divided into 2 groups: supracostal PCNL (group 1) and subcostal PCNL (group 2). Stone location, stone burden, location of the access points, operative time, postoperative visual pain score, success rate, hospital stay, and complications according to the modified Clavien classification were compared. Comparison of medians was done using Mann Whitney U test and the means were compared using t test. RESULTS: Group 1 had 50 patients while group 2 had 60 patients. The stone-free rate was 84.0% and 85.0% in groups 1 and 2, respectively after 1 session of PCNL (P = .885). After auxiliary procedures, it increased to 96.0% and 96.6%, respectively (P = .852). The mean fall in hematocrit was 0.9% in group 1 and 1.5% in group 2 (P = .11) whereas the median pain score was 4 in group 1 and 3 in group 2 (P = .37). In all, 54 complications were recorded the commonest among which were grade I (81.5%). Twenty-nine complications were observed in group 1 while 25 complications were observed in group 2 (P = .088). One patient developed nephropleural fistula while another patient developed hydropneumothorax. Both belonged to group 1. CONCLUSION: Supracostal access for PCNL is an effective and safe alternative to subcostal access for children with renal calculi in terms of stone-free rate and complications.


Assuntos
Hidropneumotórax , Cálculos Renais , Nefrolitotomia Percutânea , Complicações Pós-Operatórias/diagnóstico , Fístula Urinária , Criança , Feminino , Humanos , Hidropneumotórax/diagnóstico , Hidropneumotórax/etiologia , Índia/epidemiologia , Cálculos Renais/diagnóstico , Cálculos Renais/epidemiologia , Cálculos Renais/cirurgia , Tempo de Internação/estatística & dados numéricos , Masculino , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Duração da Cirurgia , Resultado do Tratamento , Fístula Urinária/diagnóstico , Fístula Urinária/etiologia
8.
Medicine (Baltimore) ; 98(48): e18165, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770263

RESUMO

RATIONALE: Crossed renal ectopia (CRE) is a rare congenital anomaly that is frequently associated with gastrointestinal, cardiovascular, genital and bone malformations. To the best of our knowledge, only 35 cases of crossed renal ectopia involving calculi and 30 cases of CRE associated with renal carcinoma have been reported to date. PATIENT CONCERNS: Here, we present 2 cases of crossed renal ectopia. A 59-year-old woman with diabetes presented to our hospital with abdominal pain. The second patient was a 24-year-old woman who complained with abdominal pain with a duration of 1 day. DIAGNOSES: On the basis of abdominal ultrasonography, we suspected a solitary kidney both in the two patients. Combined with retrograde pyelography and 3D computed tomography, case 1 was diagnosed as an S-shaped right-to-left crossed-fused ectopic kidney with many stones in the left (normal) renal pelvis and case 2 was confirmed to have lump right-to-left crossed-fused renal ectopia with two 3-mm stones in the renal pelvis of the 2 kidneys. INTERVENTIONS: Case 1 underwent percutaneous nephrolithotomy while case 2 refused to undergo surgery and underwent conservative treatment for pain relief. OUTCOMES: Two patients have been followed up and have no stones recurrence. LESSONS: Crossed fused renal ectopia is easily misdiagnosed as a solitary kidney. CRE is so rare that the recognition of the disease needs to be improved and effective treatment should be taken timely. According to the two cases and literature review, minimally invasive surgery has become increasingly common to treat CRE with stones and carcinoma.


Assuntos
Dor Abdominal , Rim Fundido , Cálculos Renais , Rim , Nefrolitotomia Percutânea/métodos , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Diagnóstico Diferencial , Erros de Diagnóstico/prevenção & controle , Feminino , Rim Fundido/complicações , Rim Fundido/diagnóstico , Rim Fundido/fisiopatologia , Humanos , Rim/anormalidades , Rim/diagnóstico por imagem , Rim/cirurgia , Cálculos Renais/complicações , Cálculos Renais/diagnóstico , Cálculos Renais/fisiopatologia , Cálculos Renais/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia/métodos , Urografia/métodos
10.
Prog Urol ; 29(16): 962-973, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31537493

RESUMO

INTRODUCTION: Genetic factors must be considered in etiological diagnosis of urinary lithiasis. The aim of this study was to determine clinical, metabolic characteristics and the progression of hereditary urinary lithiasis in our patients. METHODS: A retrospective study was conducted between 2008 and 2018 and 60 patients were included. Patients were referred to our department from pediatrics departments to be followed-up in adulthood in 9 cases, for etiological investigation in 42 cases and for chronic renal failure in 9 cases. RESULTS: Thirty-five men and twenty-five women were enrolled in this study with a M/F sex ratio equal to 1.4. The mean age at the time of diagnosis of the hereditary character of the urinary lithiasis was 28.6years (3months-63years). The average delay between the onset of the lithiasis disease and the etiological diagnosis was 8years (0-42years). We noted 31 cases of cystinuria, 18 cases of primary hyperoxaluria type 1 with two mutations (I244T in 14 cases, 33-34 Insc in 23 cases) and 11 cases of renal tubulopathy. Fourteen patients were affected with chronic renal failure, of which five were in the end-stage renal disease. Crystalluria was positive in 62% of cases. The morpho-constitutional analysis of stones was performed in 37 cases and it contributed to the diagnosis in 29 cases. After an average follow-up of 16years, we noted normal renal function in 42 cases, chronic renal failure in 7 cases, hemodialysis in 10 cases all with primary hyperoxaluria and transplantation in 1 case. CONCLUSION: The etiological diagnosis of hereditary urinary lithiasis in our study was made with considerable delay. Cystinuria was the most frequent etiology and primary hyperoxaluria was the most serious affection. LEVEL OF EVIDENCE: 4.


Assuntos
Cálculos Renais/genética , Adolescente , Adulto , Criança , Pré-Escolar , Progressão da Doença , Feminino , Hospitais Especializados , Humanos , Lactente , Cálculos Renais/complicações , Cálculos Renais/diagnóstico , Cálculos Renais/metabolismo , Masculino , Pessoa de Meia-Idade , Nefrologia , Estudos Retrospectivos , Adulto Jovem
11.
Urologe A ; 58(11): 1289-1297, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31501985

RESUMO

Ureterorenoscopy and percutaneous nephrolitholapaxy are minimally invasive procedures and are the standard procedures for the treatment of kidney stones and ureteral calculi. To achieve an adequate view, in both methods an optimal and sufficient irrigation flow is necessary. The intrarenal pressure is influenced by the irrigation pressure and irrigation volume and has to be controlled. Pathologically elevated intrarenal pressure can lead to irreversible damage of the kidneys. Lasers are frequently used for stone fragmentation. It has been shown in studies that the laser energy can lead to an increase in the temperature and that thermal effects can also damage the kidneys. This article provides the surgeon with an overview about the effects of temperature and pressure changes during ureterorenoscopy and percutaneous nephrolitholapaxy and how damages can be avoided.


Assuntos
Temperatura Alta/efeitos adversos , Cálculos Renais/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Nefrostomia Percutânea/métodos , Pressão/efeitos adversos , Cálculos Ureterais/cirurgia , Ureteroscopia/métodos , Humanos , Cálculos Renais/diagnóstico , Resultado do Tratamento , Cálculos Ureterais/diagnóstico
12.
Emerg Med Clin North Am ; 37(4): 637-648, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563199

RESUMO

Renal colic is a common complaint that presents to the emergency department. It is estimated that 13% of men and 7% of women will develop a renal stone. There is a high probability of recurrence, with 50% within 5 years. Computed tomographic scan of the abdomen and pelvis without contrast and the ultrasound of the kidneys, ureters, and bladder are the common diagnostic imaging modalities used for diagnosis. Initial treatment includes analgesics and medical expulsive therapy. Most of the patients will pass their stone spontaneously within 3 days. The remaining 20% will require urologic intervention.


Assuntos
Cálculos Renais/diagnóstico , Cálculos Ureterais/diagnóstico , Humanos , Cálculos Renais/terapia , Nefrolitíase/diagnóstico , Nefrolitíase/terapia , Cálculos Ureterais/terapia , Urolitíase/diagnóstico , Urolitíase/terapia
13.
Urologiia ; (3): 54-59, 2019 Jul.
Artigo em Russo | MEDLINE | ID: mdl-31356013

RESUMO

AIM: to study the calcium level in the urine, serum and hairs and to assess the diagnostic value of the calcium level in various biosubstrates in patients with calcium and non-calcium stones. MATERIALS AND METHODS: a total of 99 patients with urinary stone disease were included in the study. A diagnostic value of calcium level in biosubstrates according to the chemical analysis of stone composition performed using qualitative chemical reactions and microcrystalloscopy was evaluated. RESULTS: Urinary level of calcium and oxalate is proved to have high diagnostic value in patients with calcium nephrolithiasis (specificity 93.9% and 96.9%, and positive predictive value 88.2% and 97.2%, respectively). The specificity and positive predictive value of the calcium level in the hairs was 81.2% and 87.2%, respectively. CONCLUSION: A comprehensive study of the elemental spectrum in urine, hair, and serum increases the diagnostic value of the evaluation of calcium, determined by the type of studied biosubstrate and stone type in patients with nephrolithiasis.


Assuntos
Cálcio , Cálculos Renais , Cálculos Urinários , Cálcio/sangue , Cálcio/urina , Cabelo/química , Humanos , Cálculos Renais/diagnóstico , Oxalatos , Cálculos Urinários/diagnóstico
14.
Urologiia ; (3): 60-65, 2019 Jul.
Artigo em Russo | MEDLINE | ID: mdl-31356014

RESUMO

INTRODUCTION: Oral dissolution therapy has been successfully used in urologic practice since 1950s. However, many doctors attempt to improve efficiency of this approach. Use of different medical personalized digital devices which are increasingly used in clinical practice, represent one of the solutions of this problem. AIM: Our aim was to assess efficiency of oral dissolution therapy with drug Blemaren in patients with uric acid stones using of portable urinary analyzer with system of remote monitoring. MATERIALS AND METHODS: A total of 12 patients with uric acid stones were followed. All of them had kidney stone with a density less than 500 HU according to CT-urography. Oral dissolution therapy was performed with the drug Blemaren for 8-9 weeks. All patients were advised to maintain urine pH of 6.5-7.0. With aim of dynamic monitoring of urine parameters, a portable urine analyzer "ETTA AMP-01" was given to all patients for 2 months. RESULTS: Complete dissolution was achieved in 10 (83.3%) patients. In one case (8.3%) oral dissolution therapy was complicated by acute pyelonephritis. A stenting was performed and dissolution therapy was continued with a positive effect. In another case (8.3%) partial dissolution was seen, however, extracorporeal shockwave lithotripsy was decided to perform. Doctor who remotely monitored different parameters of urinalysis (n=11) followed urine pH, density, leukocytes, erythrocytes, level of nitrite, which provided a more comprehensive assessment of patients current state. If necessary, the specialist contacted the patient and adjusted the therapy. CONCLUSION: The possibility of remote monitoring of urinalysis and simple communication with urologist allows to titrate drug dose more convenient compared to conventional approach when outpatient urologist controls pH diaries based on dip-stick test. Moreover, such approach gives an opportunity to quickly identify complications and correct the therapy in a timely manner.


Assuntos
Cálculos Renais , Litotripsia , Urinálise , Citratos , Ácido Cítrico , Humanos , Cálculos Renais/diagnóstico , Cálculos Renais/terapia , Ácido Úrico , Urinálise/métodos
15.
BMC Urol ; 19(1): 57, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262284

RESUMO

BACKGROUND: Clinical studies assessing the feasibility and accuracy of three stone scoring systems's (SSSs: Guy's stone score, CROES nomogram and S.T.O.N.E nephrolithometry scoring system) have reported contradictory outcomes. This systematic evaluation was performed to obtain comprehensive evidence with regard to the feasibility and accuracy of three SSSs. METHODS: A systematic search of Embase, Pubmed, Medline, and the Cochrane Library was conducted to identify studies that compared three SSSs up to Mar 2018. Patients were categorized according to stone free (SF) and no-stone free (NSF), Outcomes of interest included perioperative variables, stone-free rate (SFR), and complications. RESULTS: Ten studies estimating three SSSs were included for meta-analysis. The results showed that SF patients had a significantly lower proportion of male (OR = 1.48, P = 0.0007), lower stone burden (WMD = -504.28, P < 0.0001), fewer No of involved calyces (OR = -1.23, P = 0.0007) and lower proportion of staghorn stone (OR = 0.33, P < 0.0001). Moreover, SF patients had significantly lower score of Guy score (WMD = -0.64, P < 0.0001), but, S.T.O.N.E. score (WMD = -1.23, P < 0.0001) and a higher score of CROES nomogram (WMD = 29.48, P = 0.003). However, the comparison of area under curves (AUC) of predicting SFR indicated that there was no remarkable difference between three SSSs. Nonetheless, Guy score was the only stone scoring system that predicted complications after PCNL (WMD = -0.29, 95% CI: - 0.57 to - 0.02, P = 0.03). CONCLUSIONS: Our meta-analysis indicated that the three SSSs were equally, feasible and accurate for predicting SFR after PCNL. However, Guy score was the only stone scoring system that predicted complications after PCNL.


Assuntos
Cálculos Renais/diagnóstico , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Índice de Gravidade de Doença , Humanos , Nefrolitotomia Percutânea/tendências , Valor Preditivo dos Testes , Estudos Retrospectivos
16.
BMC Urol ; 19(1): 58, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272430

RESUMO

BACKGROUND: The use of ureteral access sheath (UAS) during ureteroscopy is controversial. We aimed to explore practice patterns of UAS during ureteroscopy for nephrolithiasis among endourologists worldwide. METHODS: A 15-question survey was designed using the SurveyMonkey® platform. The questions covered the background and professional experience of the potential respondents, indications for UAS insertion, UAS caliber and possible complications associated with its use. The questions were anonymously tabulated in order to determine practice patterns of UAS during ureteroscopy for nephrolithiasis among endourologists. The survey was then distributed via e-mail to all the Endourological Society members. RESULTS: 216 members responded. 99.53% of the respondents practice as endourologists, 63.4% are fellowship trained and 74.4% are at least 6 years post-fellow. 73.2% practice in an academic facility. 77.3% perform at least 100 ureteroscopies annually. 46 and 76% routinely use UAS for the treatment of ureteral and kidney stones, respectively. In both cases, the 12/14 access sheath is the most common. 42% use UAS in primary ureteroscopy. 90.3% believe that a double J stent insertion is not mandatory prior to UAS insertion. 79.1% think the use of UAS does not increase postoperative complications rate, and if the latter does encounter, then most likely it is either a ureteral stricture (93.2%) or pain (48%). CONCLUSIONS: UAS is commonly used by highly skilled endourologists during ureteroscopy. 12/14 UAS is mostly used. Ureteral stricture and post-operative pain are proposed as possible complications following UAS introduction, however pre-stenting is not mandatory as overall low complication rate is expected.


Assuntos
Nefrolitíase/cirurgia , Inquéritos e Questionários , Ureter/cirurgia , Ureteroscopia/métodos , Urologistas , Humanos , Cálculos Renais/diagnóstico , Cálculos Renais/cirurgia , Nefrolitíase/diagnóstico , Ureter/patologia , Cálculos Ureterais/diagnóstico , Cálculos Ureterais/cirurgia , Ureteroscopia/normas , Urologistas/normas
17.
BMC Urol ; 19(1): 61, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277626

RESUMO

BACKGROUND: One of the greatest challenges presented with RIRS is the potential for movement of the stone within the operative field associated with diaphragm and chest respiratory excursions due to mechanical ventilation. To overcome this challenge, we propose in this pilot study a new general anesthesia technique combining high frequency jet ventilation (HFJV) with small volume mechanical ventilation (SVMV). Data regarding safety, feasibility and surgeons' impression was assessed. METHODS: Patients undergoing RIRS for kidney stones from November 2017 to May 2018 were prospectively recruited to participate in the study. In each case after the beginning of general anesthesia (GA) with mechanical ventilation (MV) surgeons were asked to assess the mobility of the operative field and conditions for laser lithotripsy according to the developed questionnaire scale. The questionnaire consisted of 5 degrees of assessment of kidney mobility and each question was scored from 1 to 5, 1 being very mobile (extremely poor conditions for dusting) and 5 completely immobile (Ideal conditions for dusting). After the assessment GA was modified with combined respiratory support (CRS), reducing tidal volume and respiratory rate (small volume mechanical ventilation, SVMV) and applying in the same time transcatheter high frequency jet ventilation (HFJV) inside the closed circuit. After beginning of CRS, surgeons were once again asked to assess the mobility of the operative field and the conditions for laser lithotripsy. Main ventilation parameters were recorded and compared in both regimens. RESULTS: A total of 38 patients were included in the study. The mean age was 49 (range 45-53) with a mean stone size of 10 mm (range 10-14) and Hounsfield unit of 1060 (range 930-1190). All patients underwent successful RIRS and no intraoperative complications occurred throughout the duration of the study. A statistically significant difference between ventilation parameters prior to and after CRS institution was detected in all cases, however their clinical impact was negligible. Despite this, assessment via the questionnaire scale point values varied significantly before and after the application of CRS and were 2.3 (2.1; 2.6) and 3.8 (3.7; 4.0) respectively (p < 0.001). CONCLUSIONS: The novel combined respiratory approach consisting of HFJV and SVMV appears to provide better conditions for stone dusting through reduced respiratory kidney motion and is not associated with adverse health effects or complications. TRIAL REGISTRATION: NCT03999255 , date of registration: 25th June 2019 (retrospectively registered).


Assuntos
Anestesia Geral/métodos , Cálculos Renais/cirurgia , Litotripsia/métodos , Respiração Artificial/métodos , Anestesia Geral/normas , Feminino , Humanos , Cálculos Renais/diagnóstico , Litotripsia/normas , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Respiração Artificial/normas
18.
Saudi J Kidney Dis Transpl ; 30(3): 723-725, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31249241

RESUMO

Adenine phosphoribosyltransferase deficiency is an inherited condition presenting from infancy to late adulthood. The common features are recurrent kidney and urinary tract stones and obstructive symptoms. The stones are characteristically radiolucent. 2, 8-Dihydroxyadenine (2, 8-DHA) formation is blocked by xanthine oxidase blocker allopurinol. Here, we report the case of an eight-month-old baby girl who presented with obstructive acute kidney injury secondary to calculi which was treated with surgical removal of stone. The analysis of the calculi revealed 2, 8-DHA crystals.


Assuntos
Lesão Renal Aguda/etiologia , Adenina Fosforribosiltransferase/deficiência , Adenina/análogos & derivados , Cálculos Renais/etiologia , Erros Inatos do Metabolismo/complicações , Urolitíase/complicações , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/metabolismo , Lesão Renal Aguda/cirurgia , Adenina/metabolismo , Alopurinol/uso terapêutico , Cristalização , Inibidores Enzimáticos/uso terapêutico , Feminino , Humanos , Lactente , Cálculos Renais/diagnóstico , Cálculos Renais/metabolismo , Cálculos Renais/cirurgia , Erros Inatos do Metabolismo/diagnóstico , Erros Inatos do Metabolismo/tratamento farmacológico , Resultado do Tratamento , Urolitíase/diagnóstico , Urolitíase/tratamento farmacológico , Xantina Oxidase/antagonistas & inibidores , Xantina Oxidase/metabolismo
19.
Am J Kidney Dis ; 74(5): 700-702, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31155325

RESUMO

Kidney failure is common in patients with a monoclonal gammopathy, most frequently due to hypercalcemia or myeloma cast nephropathy. Immunoglobulin crystallization is an uncommon phenomenon that also results in kidney injury. We report the case of a 74-year-old man with recurrent renal colic and acute kidney injury. He presented with κ light chain Bence-Jones proteinuria, hypogammaglobulinemia, anemia, and high plasma κ light chain level, leading to the diagnosis of κ light chain multiple myeloma. One calculus was collected and its analysis revealed a unique protein structure consisting of κ immunoglobulin free light chain. Genetic sequencing of the κ light chain identified a subgroup of variable domain previously identified as prone to crystallization. Eight cycles of cyclophosphamide-bortezomib-dexamethasone chemotherapy resulted in a partial hematologic response and kidney recovery without recurrence of renal colic. This rare case of urinary light chain nephrolithiasis highlights the importance of genetic and molecular analysis of the immunoglobulin variable domain to better understand the wide spectrum of monoclonal gammopathies.


Assuntos
Cadeias Leves de Imunoglobulina/metabolismo , Cálculos Renais/complicações , Túbulos Renais/patologia , Mieloma Múltiplo/complicações , Cólica Renal/etiologia , Doença Aguda , Idoso , Diagnóstico Diferencial , Humanos , Cálculos Renais/diagnóstico , Cálculos Renais/metabolismo , Túbulos Renais/metabolismo , Masculino , Mieloma Múltiplo/diagnóstico , Cólica Renal/diagnóstico , Tomografia Computadorizada por Raios X
20.
Am J Emerg Med ; 37(11): 2107-2110, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31196585

RESUMO

OBJECTIVE: In this study, we investigated the relationship between the severity of pain level and hydronephrosis, hematuria and pyuria presence in the acute renal colic attack and whether there was a correlation between the stone size and inflammatory markers. METHODS: The patients' pain scores determined by Visual Analog Scale (VAS), CRP, WBC and NLR levels from the laboratory results, hematuria and pyuria presence in the urine analysis and hydronephrosis presence in the imaging methods were recorded. Moreover, stone size was measured for the patients for whom computed tomography (CT) method was applied. RESULTS: Mean age of the 275 patients was 41.0 ±â€¯14.9 and 61.1% of them were male. The patients' mean VAS score was 73.3 ±â€¯16.5.The mean VAS score of the groups of which hematuria and pyuria were positive and which have hydronephrosis finding was statistically higher than those whose were negative. The mean stone size was 5.2 ±â€¯2.1 mm, and those with signs of hydronephrosis on their CT (n = 66) were 5.4 ±â€¯2.3 mm, while those with no signs of hydronephrosis (n = 57) were 4.9 ±â€¯1.7. No statistical difference was found in stone size between patients with hydronephrosis and those without. Not any correlations were determined between the stone size and VAS pain score of the cases. CONCLUSIONS: We detected that the pain level was not correlated with the stone size and big stones were not statistically riskier in the hydronephrosis development. However, we think that the risk of complications such as hydronephrosis is higher in the patients whose pain level are higher and the infection may be accompanied by this group.


Assuntos
Hematúria/etiologia , Hidronefrose/etiologia , Cálculos Renais/diagnóstico , Medição da Dor , Piúria/etiologia , Cólica Renal/etiologia , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/metabolismo , Feminino , Hematúria/diagnóstico , Humanos , Hidronefrose/diagnóstico , Cálculos Renais/metabolismo , Cálculos Renais/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Piúria/diagnóstico , Cólica Renal/diagnóstico , Adulto Jovem
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