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1.
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
2.
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
3.
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
4.
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
5.
J Urol ; 202(2): 309-313, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31026215

RESUMO

PURPOSE: Kidney stone formers have lower health related quality of life than nonstone formers. The North American Stone Quality of Life Consortium is a multicenter, longitudinal, prospective study of health related quality of life in patients with kidney stones using the WISQOL (Wisconsin Stone Quality of Life Questionnaire) with data on 2,052 patients from a total of 11 centers. This study is a subanalysis of cross-sectional data looking at the association of age, gender and race on health related quality of life of stone formers. MATERIALS AND METHODS: We performed multivariable analyses of ordinal logistic regression analyses to determine the impact of age, gender and race on health related quality of life, adjusting for other baseline covariates. The proportional odds assumption of ordinal logistic regression was checked. Total score and scores on 4 subdomains (social functioning, emotional functioning, stone related impact and vitality) were included. RESULTS: Median total score for all patients was 80.4. On multivariable analysis older patients had a significantly higher total health related quality of life score than younger patients (per 10-year increase OR 1.25, p <0.0001). Male patients had higher scores than females (OR 1.56, p = 0.0003) and nonCaucasian patients had lower health related quality of life than nonLatino Caucasian patients (OR 0.63, p = 0.0045). CONCLUSIONS: Younger and female patients with kidney stones have lower health related quality of life than older and male patients, respectively. NonCaucasian patients with stones also have lower health related quality of life. The clinical impact of these findings might include future implications for patient counseling, including dietary and medical management of stone disease, and potential changes to the paradigm of the surgical management of stones.


Assuntos
Cálculos Renais , Qualidade de Vida , Adulto , Fatores Etários , Estudos Transversais , Autoavaliação Diagnóstica , Feminino , Humanos , Cálculos Renais/diagnóstico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Sexuais
6.
Iran J Kidney Dis ; 13(1): 21-26, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30851715

RESUMO

INTRODUCTION: The frequency of kidney disorders varies in pulmonary sarcoidosis patients. Since the prevalence of kidney disorders among Iranian sarcoidosis patients is uncertain, this study aimed to evaluate kidney disorders and associated manifestations in Iranian pulmonary sarcoidosis patients. MATERIALS AND METHODS: One hundred patients with confirmed granuloma as pulmonary sarcoidosis were studied for renal disorders. Size of urinary tract and the presence of renal stones were checked via clinical examination and urinary organ ultrasonography. Patients' 24-hour urine sample was examined for pH, calcium, protein (over 250 mg) and creatinine (over 1.4 mg). RESULTS: Thirty-three percent of the patients expressed renal disorders simultaneously.Uric acid in pulmonary sarcoidosis patients could be correlated with the probability of developing renal stone. In addition, 1,25-dihydroxyvitamin D levels above 30 ng/mL and uric acid levels above 7 mg/dL in urine were directly correlated with renal disorders in sarcoidosis patients. CONCLUSIONS: Urinalysis is an easy and reliable method for assessing renal disorders in sarcoidosis patients. The current study proposes inclusion of urinalysis in routine checkups of sarcoidosis individuals.


Assuntos
Cálculos Renais/diagnóstico , Sarcoidose Pulmonar/complicações , Urinálise , Adolescente , Adulto , Idoso , Colecalciferol/análise , Creatinina/análise , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Cálculos Renais/epidemiologia , Masculino , Pessoa de Meia-Idade , Ácido Úrico/análise , Adulto Jovem
7.
Urolithiasis ; 47(3): 219-224, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30848320

RESUMO

Currently an evidence-based approach to nephrolithiasis is hampered by a lack of randomized controlled trials. Thus, there is a need for common platforms for data sharing and recruitment of patients to interventional studies. A first step in achieving this objective would be to share practice methods and protocols for subsequent standardization in what is still a heterogeneous clinical field. Here, we present the results of a pilot survey performed across 24 European clinical kidney stone centers. The survey was distributed by a voluntary online questionnaire circulated between June 2017 and January 2018. About 46% of centers reported seeing on average 20 or more patients per month. Only 21% adopted any formal referral criteria. Centers were relatively heterogeneous in respect of the definition of an incident stone event. The majority (71%) adopted a formal follow-up scheme; of these, 65% included a follow-up visit at 3 and 12 months, and 41% more than 12 months. In 79% of centers some kind of imaging was performed systematically. 75% of all centers performed laboratory analyses on blood samples at baseline and during follow-up. All centers performed laboratory analyses on 24-h urine samples, the majority (96%) at baseline and during follow-up. There was good correspondence across centers for analyses performed on 24-h urine samples, although the methods of 24-h urine collection and analysis were relatively heterogeneous. Our survey among 24 European stone centers highlights areas of homogeneity and heterogeneity that will be investigated further. Our aim is the creation of a European network of stone centers sharing practice patterns and hosting a common database for research and guidance in clinical care.


Assuntos
Medicina Baseada em Evidências/estatística & dados numéricos , Disseminação de Informação , Cálculos Renais/terapia , Padrões de Prática Médica/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Assistência ao Convalescente/normas , Assistência ao Convalescente/estatística & dados numéricos , Europa (Continente) , Medicina Baseada em Evidências/normas , Humanos , Cálculos Renais/diagnóstico , Projetos Piloto , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Inquéritos e Questionários/estatística & dados numéricos , Centros de Atenção Terciária/normas
8.
Arch Ital Urol Androl ; 90(4): 265-269, 2019 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-30655638

RESUMO

OBJECTIVES: We conducted this study to evaluate patients with retained encrusted ureteral stents, identify the predisposing factors and present our experience in the management of such challenging problem. MATERIALS AND METHODS: This prospective study was carried out in the period from May 2007 to February 2011 at the Urology and Nephrology Center, Al-Thawra General Hospital, Sana'a, Yemen. 40 patients with retained encrusted ureteric stents were treated at our center. All patients were initially evaluated with a radiographic imaging for assessment of stent encrustation and stone burden. Treatment decisions were based on the site and severity of encrustations in the renal pelvis, ureter and bladder and on our technical situation and availability of instrumentations. Multi-modal approaches ranging from extracorporeal shock wave lithotripsy (ESWL) to endourological and open urologic procedures were used to achieve stent removal. RESULTS: A total of 90 urological procedures were performed to render all 40 patients stent and stone free. The average duration of stent remained indwelling was 24.2 months (range 4 months -16 years). All patients were managed either by minimally or more invasive multi-modal endourological approaches. For upper coil encrustation percutaneous nephrolithotripsy was performed in eight patients, pyelolithotomy in two patients and ESWL in three patients. Encrustation of the body was treated initially by ESWL, followed by retrograde ureteroscopic manipulation in 12 patients. Lower coil encrustation was successfully managed by cystolitholapaxy in seven patients and one patient required cystolithotomy. Cystolithotomy, pyelolithotomy and ureterolithotomy were carried out in two patients. Two patients who had large burden bladder and kidney stones with loss of kidney function underwent nephrectomy and cystolithotomy. CONCLUSIONS: The retrieval of severely encrusted retained ureteral stent and its associated stone burden poses a real management challenge for urologists due to the need for multimodal procedures and the lack of standardized treatment plan.


Assuntos
Remoção de Dispositivo/métodos , Cálculos Renais/terapia , Stents/efeitos adversos , Ureter/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Cálculos Renais/diagnóstico , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Estudos Prospectivos , Procedimentos Cirúrgicos Urológicos/métodos , Adulto Jovem
9.
Int Urol Nephrol ; 51(2): 239-245, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30604235

RESUMO

PURPOSE: We investigated the clinical efficacy of the Triple D score (TrD-S) on stone-free rate (SFR) prediction following shockwave lithotripsy (SWL) for renal stones 10-20 mm in diameter and modified the scoring system to improve outcome prediction. METHODS: We retrospectively examined clinical data from the medical records of 226 consecutive patients who underwent SWL for 10-20 mm kidney stones. The TrD-S was calculated according to the cutoffs of < 150 mm3 for stone volume, < 600 Hounsfield unit for stone density, and < 12 cm for skin-to-stone distance on computed tomography. The Quadruple D score was defined as the sum of the TrD-S and stone location (0/1 point for intrarenal stone distribution at lower/non-lower poles, respectively). Complete clearance 3 months after the final SWL was considered the stone-free status. RESULTS: The residual group (n = 102) had significantly older age, larger stones, higher stone density, higher lower-pole stone incidence, and lower TrD-S than the stone-free group (n = 124). In the multivariate analysis, age, TrD-S, and non-lower-pole stones independently predicted the SFR. The TrD-Ss of 0, 1, 2, and 3 points showed SFRs of 40.0%, 51.9%, 73.0%, and 100.0%, respectively. The Quadruple D scores of 0, 1, 2, 3, and 4 points showed SFRs of 0.0%, 37.9%, 54.5%, 84.4%, and 100.0%, respectively, with better prediction accuracy than the TrD-S (p = 0.01). CONCLUSIONS: The TrD-S is successfully validated for use in Japanese patients with 10-20-mm renal stones. Simple addition of the stone location to the TrD-S could reinforce SFR prediction after SWL.


Assuntos
Cálculos Renais , Rim/diagnóstico por imagem , Litotripsia , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Japão/epidemiologia , Cálculos Renais/diagnóstico , Cálculos Renais/epidemiologia , Cálculos Renais/terapia , Litotripsia/efeitos adversos , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Projetos de Pesquisa , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
10.
Manchester; The National Institute for Health and Care Excellence (NICE); Jan. 2019. 33 p.
Monografia em Inglês | BIGG | ID: biblio-1010393

RESUMO

This guideline covers assessing and managing renal and ureteric stones. It aims to improve the detection, clearance and prevention of stones, so reducing pain and anxiety, and improving quality of life.


Assuntos
Humanos , Cálculos Renais/diagnóstico , Cálculos Renais/terapia , Cálculos Ureterais/diagnóstico , Cálculos Ureterais/terapia , Cálculos Renais/prevenção & controle , Cálculos Ureterais/prevenção & controle , Ureterolitíase , Manejo da Dor
11.
Urol Int ; 102(2): 160-166, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30415255

RESUMO

OBJECTIVE: To compare outcomes and postoperative quality of life (QoL) among patients with kidney stone who received mini-percutaneous nephrolithotomy (mPCNL), partial tubeless mPCNL or mPCNL with ureter catheter in a prospective randomized clinical trial. METHODS: From May 2017 to December 2017, 60 patients with kidney stone who underwent mPCNL were randomized into 3 groups: Group I (mPCNL), Group II (partial tubeless mPCNL), Group III (mPCNL with ureter catheter). We evaluated perioperative characteristics, stone clearance, analgesic requirements and QoL by using the Wisconsin Stone QOL questionnaire. RESULTS: The age, gender, stone diameter, body mass index, length of operation, drop in hemoglobin and stone-free rates for the 3 groups were similar among these groups. However, the postoperative visual analog scale and the analgesic requirement in Group II were significantly the lowest (p < 0.05). According to Wisconsin Stone QOL questionnaire, compared to Group I, statistical significant difference in the QoL was seen in Group II and III, indicating a meaningful and immediate improvement in the postoperative QoL following mPCNL. CONCLUSION: Compared with standard and partial tubeless mPCNL, mPCNL with ureter catheter is a safe and useful form of mPCNL, which can offer better QoL and is more cost effective.


Assuntos
Cálculos Renais/terapia , Nefrolitotomia Percutânea/instrumentação , Qualidade de Vida , Cateterismo Urinário/instrumentação , Cateteres Urinários , Adulto , Idoso , Analgésicos/uso terapêutico , China , Desenho de Equipamento , Feminino , Humanos , Cálculos Renais/diagnóstico , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Cateterismo Urinário/efeitos adversos
14.
Int Urol Nephrol ; 51(2): 201-206, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30542945

RESUMO

OBJECTIVES: To compare two different treatment strategies, one-stage and two-stage multi-tract mini-percutaneous nephrolithotomy (mt-mPCNL), for pediatric complex renal calculus disease. METHODS: Between the period of July 2016 and July 2018, a total of 36 children aged 15 years and younger, with complex renal calculi disease, who underwent total ultrasound-guided mt-mPCNL by a single experienced urologist were enrolled in our study. All patients were assigned either to Group 1 (n = 18) who received one-stage mt-mPCNL or Group 2 (n = 18) who received planned two-stage mt-mPCNL. RESULTS: The demographic data were comparable between the two groups. There were no serious complications (Modified Clavien Grade ≥ III) observed in either group. The stone -free rate (SFR), operation time, postoperative creatinine increase, and perioperative complication rates were similar in both groups (P = 0.603, 0.818, 0.161, and 0.402, respectively). The postoperative hospital stay (5.8 days vs. 7.4 days) and cost (17373.3 CNY vs. 23717.1 CNY) were statistically less in Group 1. Group 2 had significantly less total estimated blood loss (70.6 ml vs. 130.0 ml, P < 0.001). The operation time of two cases in Group 1 with perioperative sepsis or systemic inflammatory response syndrome (SIRS) was more than two hours. CONCLUSIONS: Our preliminary results indicated that both one-stage and two-stage mt-mPCNL were safe and effective for pediatric complex renal calculi. Two-stage mt-mPCNL could significantly reduce blood loss; while one-stage mt-mPCNL could significantly decrease the length and costs of hospitalization. We also suggest that the planned two-stage mt-mPCNL should be applied in children with estimated operation time more than two hours.


Assuntos
Perda Sanguínea Cirúrgica , Cálculos Renais , Nefrolitotomia Percutânea , Complicações Pós-Operatórias , Síndrome de Resposta Inflamatória Sistêmica , Adolescente , Perda Sanguínea Cirúrgica/prevenção & controle , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Criança , China/epidemiologia , Pesquisa Comparativa da Efetividade , Feminino , Humanos , Cálculos Renais/diagnóstico , Cálculos Renais/fisiopatologia , Cálculos Renais/cirurgia , Tempo de Internação/estatística & dados numéricos , Masculino , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Ultrassonografia de Intervenção/métodos
15.
Mayo Clin Proc ; 94(2): 202-210, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30527866

RESUMO

OBJECTIVE: To predict symptomatic recurrence among community stone formers with one or more previous stone episodes. PATIENTS AND METHODS: A random sample of incident symptomatic kidney stone formers in Olmsted County, Minnesota, was followed for all symptomatic stone episodes resulting in clinical care from January 1, 1984, through January 31, 2017. Clinical and radiographic characteristics at each stone episode predictive of subsequent episodes were identified. RESULTS: There were 3364 incident kidney stone formers with 4951 episodes. The stone recurrence rates per 100 person-years were 3.4 (95% CI, 3.2-3.7) after the first episode, 7.1 (95% CI, 6.4-7.9) after the second episode, 12.1 (95% CI, 10.3-13.9) after the third episode, and 17.6 (95% CI, 15.1-20.0) after the fourth or higher episode (P<.001 for trend). A parsimonious model identified the following independent risk factors for recurrence: younger age; male sex; higher body mass index; family history of stones; pregnancy; incident asymptomatic stone on imaging before the first episode; suspected stone episode before the first episode; history of a brushite, struvite, or uric acid stone; no history of calcium oxalate monohydrate stone; kidney pelvic or lower pole stone on imaging; no ureterovesical junction stone on imaging; number of kidney stones on imaging; and diameter of the largest kidney stone on imaging. The model had a C-index corrected for optimism of 0.681 and was used to develop a prediction tool. The risk of recurrence in 5 years ranged from 0.9% to 94%, depending on risk factors, number of past episodes, and years since the last episode. CONCLUSION: The revised Recurrence Of Kidney Stone tool predicts the risk of symptomatic recurrence by using readily available clinical characteristics of stone formers.


Assuntos
Cálculos Renais/diagnóstico , Cálculos Renais/epidemiologia , Fatores Etários , Índice de Massa Corporal , Feminino , Seguimentos , Previsões , Humanos , Incidência , Masculino , Minnesota , Radiografia Abdominal , Recidiva , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Ultrassonografia , Urinálise , Urografia
16.
Urol Int ; 102(2): 181-186, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30463076

RESUMO

AIMS: We aimed to evaluate the durability and cost effectiveness of the latest digital flexible ureterescope by comparing it with the conventional fiberoptic one. MATERIALS AND METHODS: Data of patients who underwent retrograde intrarenal surgery between January 2013 and December 2014 were collected. Fiberoptic Flex-X2 or digital Cobra vision flexible ureteroscopes were used for the procedures. The comparison of both ureteroscopes was performed in terms of patient and stone characteristics, operative outcomes, durability, and cost effectiveness. RESULTS: A total of 105 patients were evaluated for the study. The patient and stone characteristics and operative outcomes were similar between the groups. Overall, 54 and 51 procedures were performed using Flex-X2 and Cobra vision, respectively, before they were sent for renovation. The purchase prices were USD 29,500 for Flex-X2 and USD 58,000 for Cobra vision. Costs of per case were determined as USD 549.29 for Flex-X2 and as USD 1,137.25 for Cobra vision. Per minute working time costs were USD 772.04 and 1,471.33 for Flex-X2 and Cobra vision respectively. CONCLUSIONS: The digital Cobra vision has high costs without any difference in durability as compared to Flex-X2. Moreover, it has no benefit over Flex-X2 in terms of surgical outcomes.


Assuntos
Tecnologia de Fibra Óptica/economia , Tecnologia de Fibra Óptica/instrumentação , Custos de Cuidados de Saúde , Cálculos Renais/cirurgia , Ureteroscópios/economia , Ureteroscopia/economia , Ureteroscopia/instrumentação , Adulto , Análise Custo-Benefício , Desenho de Equipamento , Falha de Equipamento/economia , Feminino , Humanos , Cálculos Renais/diagnóstico , Masculino , Pessoa de Meia-Idade , Maleabilidade , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscopia/efeitos adversos
17.
Urolithiasis ; 47(1): 99-105, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30460526

RESUMO

Here we define precision medicine approaches and discuss how these may be applied to renal stone-formers to optimise diagnosis and a management. Using the gene discovery of monogenic stone disorders as examples, we discuss the benefits of personalising therapies for renal stone-formers to provide improved prevention and treatment of these disorders.


Assuntos
Testes Genéticos/métodos , Cálculos Renais/diagnóstico , Cálculos Renais/genética , Medicina de Precisão/métodos , Urinálise/métodos , Humanos , Cálculos Renais/terapia , Cálculos Renais/urina
18.
Urol Int ; 102(2): 187-193, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30481771

RESUMO

BACKGROUND: The Post-Ureteroscopic Lesion Scale (PULS) is a validated, standardised scale that classifies iatrogenic ureteral lesions during ureteroscopy (URS). OBJECTIVE: To determine risk factors for the various PULS-grades caused by URS. METHOD: We prospectively investigated the independent influence of various risk factors in correlation with PULS-Grade 1+ and 2+ on 307 patients with ureterorenoscopic stone treatment from 14 German urologic departments. RESULTS: The following are the outcomes of the study: 117 (38.4%) and 188 (61.6%) of the calculi (median stone size 6 mm) were found in the kidney or ureter; 70% and 82.4% underwent preoperative or postoperative ureteral stenting; 44.3 and 7.2% received laser or ballistic lithotripsy; 60% of the patients presented with PULS grade 1+ and 8% with PULS grade of 2+. Only intracorporal lithotripsy revealed a significant independent risk factor for PULS grade 1+ or 2+. Both laser and ballistic therapies raised the probability of PULS grade 1+ by the factors 3.6 (p < 0.001) and 3.9 (p = 0.021), respectively. The ORs in conjunction with PULS grade 2+ were 3.1 (p = 0.038) and 5.8 (p = 0.014) respectively. Neither endpoint exhibited a significant difference regarding the lithotripsic procedure (laser vs. ballistic). CONCLUSION: Intracorporal lithotripsy is associated with a significant increase in damage to the ureter; further research is needed to determine its long-term effects.


Assuntos
Doença Iatrogênica , Cálculos Renais/cirurgia , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Ureter/lesões , Cálculos Ureterais/cirurgia , Ureteroscópios/efeitos adversos , Ureteroscopia/efeitos adversos , Adulto , Idoso , Benchmarking , Feminino , Alemanha , Humanos , Cálculos Renais/diagnóstico , Litotripsia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Intervalo Livre de Progressão , Estudos Prospectivos , Fatores de Risco , Stents , Fatores de Tempo , Cálculos Ureterais/diagnóstico , Ureteroscopia/instrumentação , Ureteroscopia/normas
19.
Urolithiasis ; 47(2): 155-163, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29356875

RESUMO

High fluid intake has been universally recommended for kidney stone prophylaxis. We evaluated 24-h urine osmolality regarded as the best biomarker of optimal hydration and upper metastable limit osmolality after water evaporation from urine sample to the onset of spontaneous crystallization and its usefulness as a new risk index that would describe an individual lithogenic potential. We collected 24-h urine from 257 pediatric patients with kidney stones and 270 controls. After volume and osmolality assessment, the urine samples were subjected to volume reduction in vacuum rotavapor continued to the onset of an induced urinary crystallization. The upper metastable limit osmolality of urine sample was calculated based on its initial osmolality value and the amount of water reduction. Pediatric stone formers presented with higher urine volume and lower urine osmolality than healthy controls. Despite that, their urine samples required much lower volume reduction to induce the spontaneous crystallization than those of controls. The ROC analysis revealed an AUC for the upper metastable limit osmolality of 0.9300 (95% CI 0.9104-0.9496) for distinguishing between stone formers and healthy subjects. At the cutoff of 2696 mOsm/kg, the test provided sensitivity and specificity of 0.8638 and 0.8189, respectively. 24-h urine osmolality provided the information about current hydration status, whereas evaporation test estimated the urinary potential to crystalize dependent on urine composition. Upper metastable limit osmolality may estimate the individual lithogenic capability and identify people at risk to stone formation when exposed to dehydration.


Assuntos
Hidratação/métodos , Cálculos Renais/diagnóstico , Urina/química , Adolescente , Biomarcadores/química , Oxalato de Cálcio , Criança , Pré-Escolar , Cristalização , Estudos de Viabilidade , Feminino , Humanos , Cálculos Renais/etiologia , Cálculos Renais/prevenção & controle , Cálculos Renais/urina , Masculino , Concentração Osmolar , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Medição de Risco/métodos , Fatores de Risco , Sensibilidade e Especificidade
20.
Londres; National Institute for Health and Clinical Excellence; 2019.
Monografia em Inglês | BIGG | ID: biblio-1015576

RESUMO

This guideline covers assessing and managing renal and ureteric stones. It aims to improve the detection, clearance and prevention of stones, so reducing pain and anxiety, and improving quality of life. This guideline includes recommendations on: diagnostic imaging; managing pain; medical expulsive therapy; surgical treatments, including shockwave lithotripsy; stenting before and after treatment; metabolic testing; and preventing recurrence, including dietary and lifestyle advice, potassium citrate and thiazides.


Assuntos
Humanos , Cálculos Renais/diagnóstico , Cálculos Ureterais/complicações , Cálculos Ureterais/diagnóstico
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