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1.
Arch Esp Urol ; 73(1): 26-31, 2020 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-31950920

RESUMO

OBJECTIVE: To evaluate the impact of a new renal lithiasis classification on the stone free rate. The new system would allow standarization of comparison between different series of percutaneous nephrolithotomy. MATERIAL AND METHODS: Patients undergoing NPCL between November 2011 and November 2016 were retrospectively analyzed. The stones were classified as simple (pelvic and/or calyceal stones that required a single access and/or use of a rigid nephroscope), complex (required the use of more than one percutaneous access and/or flexible instruments and/or combined access) and extremely complex (complete staghorn stones or anatomical alterations), according to the Ibarluzea-Llanes classification. Other variables analyzed were age, sex, diabetes, hypertension or taking anticoagulants, stones composition, placement of postoperative nephrostomy and surgical time. We performed a univariate and multivariate analysis using the chi-square or Fisher test and logistic regression. RESULTS: Sixty-nine procedures were included in 57 patients with a mean age of 51 years (13-84) and a mean follow-up time of 30 months. The stone free rate was 86%, 75% and 55% for a simple, complex or extremely complex stone, both at three months and a year. Only the stone type was associated with a worse stone free rate (p 0.03) with RR of 2.5 for a 95% CI. CONCLUSIONS: The Ibarluzea-Llanes clasification could be used as a new system for standarization of PCNL outcomes reporting.


Assuntos
Cálculos Renais , Nefrolitotomia Percutânea , Nefrostomia Percutânea , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Cálculos Renais/terapia , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
2.
Arch Esp Urol ; 73(1): 47-53, 2020 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31950923

RESUMO

OBJECTIVES: To evaluate the effect of silodosin on stages of the flexible ureterorenoscopy (F-URS) procedures. METHODS: Between November 2015 and August 2017, a total of 76 patients suffering from 10-30 mm kidney stone were enrolled in this randomized prospective study. Patients were randomly divided into 2 groups for treatment: Group 1 had F-URS with preoperative daily uptake of 8 mg silodosin for 10 days, and group 2 had F-URS without silodosin uptake. None of the patients had preoperative JJ stenting. Stages of the F-URS was defined as entrance to bladder time (ETBT) with a semirigid ureterorenoscope (R-URS), entrance to ureteric orifice time (ETUOT) with R-URS using a guide wire and proceeding 2 cm inside the ureter, application of access sheath time (AAST) using the guide wire advanced through R-URS, F-URS time (FURST) + lithotripsy with laser time (LT), and total operation time (OT). We compared the time of each stage between two groups. RESULTS: There were 38 patients group1 and 2, respectively. There was one ureteral access sheath (UAS) application failure in group 1, and 3 failures in group 2 (p=0.307). The ETBT, ETUOT, and AAST were significantly short in group 1 than group 2 (p=0.001,0.007,0.002). CONCLUSIONS: Although preoperative use of silodosin facilitated only an insignificant positive effect on UAS placement failure, it eased the F-URS procedure by reducing the ETBT, ETUOT, and AAST in seconds. More studies are needed to make an exact conclusion.


Assuntos
Cálculos Renais , Litotripsia , Cálculos Ureterais , Ureteroscopia , Humanos , Indóis , Cálculos Renais/terapia , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Cálculos Ureterais/terapia
3.
Urologiia ; (5): 114-118, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808644

RESUMO

The problem of urinary stone disease and acute destructive pyelonephritis remains to be relevant in the current urologic practice. The acute pyelonephritis is the most common infectious and inflammatory complication after retrograde ureteroscopy. According to data of leading urologists in Russian Federation and worldwide, the incidence of acute purulent pyelonephritis ranges from 0.1 to 0.2%. Infectious and inflammatory complications of retrograde ureteroscopy often require urgent interventions. Acute pyelonephritis can result in destructive changes in the renal parenchyma. In case of ineffective conservative measures, pyelonephritis can progress into sepsis with the development of multiple organ failure. Therefore, infectious and inflammatory complications require to start combined antibacterial, anti-inflammatory and detoxification therapy, as well as to resolve any upper urinary tract obstruction. If acute pyelonephritis leads to destructive phase with a formation of a carbuncle or an abscess in the kidney, an open surgery is indicated. Despite being minimally-invasive, retrograde ureteroscopy can lead to serious complications requiring an open surgical intervention. In some cases, the severity of the patients condition may require nephrectomy.


Assuntos
Abscesso/tratamento farmacológico , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Cálculos Renais/terapia , Litotripsia/efeitos adversos , Pielonefrite/tratamento farmacológico , Ureteroscopia/efeitos adversos , Humanos , Nefrectomia , Pielonefrite/complicações , Pielonefrite/microbiologia , Federação Russa , Índice de Gravidade de Doença , Cálculos Urinários
4.
Urologiia ; (4 ()): 7-11, 2019 Sep.
Artigo em Russo | MEDLINE | ID: mdl-31535791

RESUMO

Laser technology has taken a place among the methods of treatment of various urological diseases. The new laser devices are being developed in addition to commonly used. Physicists of the russian NTO "IRE Polus" in collaboration with doctors from Sechenov University have developed a new generation laser device - thulium fiber laser. It has been actively used since 2017 for laser enucleation of prostate. Later the laser was used for treatment of bladder tumor, lithotripsy. The device has already managed to prove its efficacy in in-vitro experiments and clinical practice surpassing foreign analogues.


Assuntos
Cálculos Renais/terapia , Fotocoagulação a Laser/instrumentação , Terapia a Laser , Litotripsia a Laser/instrumentação , Túlio , Urologia , Humanos , Litotripsia a Laser/métodos , Masculino , Próstata/patologia , Próstata/cirurgia , Cálculos Ureterais/terapia , Cálculos da Bexiga Urinária/terapia , Neoplasias da Bexiga Urinária/terapia
5.
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
6.
J Ayub Med Coll Abbottabad ; 31(3): 351-354, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31535504

RESUMO

BACKGROUND: Renal stone disease is a very common medical problem in general population. As with invent of newer therapeutic modalities, ESWL is already losing its popularity. But we believe it as an effective way of treating renal stones. This study was conducted to evaluate any improvement in success rate of ESWL therapy for treating renal stones with latest shockwave lithotripsy machines. METHODS: Study conducted from June 2016 until November 2017 in Alkhor hospital, Hamad Medical Corporation, Qatar. All patients undergoing ESWL for renal stones in mentioned period were included. Total 197 patients underwent ESWL using newer machines. Factors already studied to affect the success rate like stone size, location, consistency (measured by Hounsfield units on CT), presence of stent were taken in consideration. After a period of 3 months either complete stone clearance or stone fragments smaller than 4 mm were considered as a treatment success. These results were compared to the results from literature. RESULTS: Patients were followed until 3 months after treatment. 170 patients (86.29%) had complete stone clearance. Eleven patients (5.58%) had residual stone less than 4 mm, thus achieving an overall success of 181 patients (91.88%). 42 patients (21.32%) needed repeat session of ESWL with a maximum number of 3 sessions. 16 patient's (8.12%) required auxiliary procedures like flexible ureteroscopy. Post-ESWL complications were recorded in 12 patients (6.09%). Success rate was affected mainly by stone size with negligible effect of stone location. Presence of stent affected the number of sessions but has no impact on stone clearance.. CONCLUSIONS: Although the stone size and to a negligible extent, the stone location and presence of stent may affect the stone clearance, nevertheless a significant improvement in success rate has been observed by use of new shockwave lithotripsy machines.


Assuntos
Cálculos Renais/terapia , Litotripsia , Humanos , Litotripsia/instrumentação , Litotripsia/métodos , Litotripsia/estatística & dados numéricos , Catar , Stents , Resultado do Tratamento
7.
Hinyokika Kiyo ; 65(6): 209-213, 2019 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-31501387

RESUMO

For the management of patients with cystinuria, forced hydration and medication have been used to prevent stone recurrence and growth, but not a few cystine stones require surgical intervention. However, the long-term follow-up data about surgical intervention for cystine stones is lacking. Here, we report a case of cystine calculi of cystinuria with many sessions of extracorporeal shock wave lithotripsy (ESWL) during the long-term follow-up period. A 13-year-old woman went to a local clinic with right flank pain in January 1993, and abdominal ultrasonography revealed right kidney stones. She was admitted to our hospital for treatment using ESWL. Analysis of the stone components revealed the stone to be composed of cystine. During the next 25 years, she received 157 sessions of ESWL and 2 sessions of transurethral ureterolithotripsy (TUL). Current examination revealed that although the lower pole of her right kidney is slightly atrophic, her renal function is stable and kidney stones remain small. Our case suggests that early intervention by ESWL could prevent stone growth and the deterioration in renal function.


Assuntos
Cistinúria , Cálculos Renais , Litotripsia , Adolescente , Cistina , Cistinúria/terapia , Feminino , Seguimentos , Humanos , Cálculos Renais/terapia
8.
Urology ; 133: 103-108, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31377258

RESUMO

OBJECTIVE: To characterize shock wave lithotripsy (SWL) utilization and assess for regional variation in the use of this procedure across the United States. MATERIALS AND METHODS: We examined SWL and URS utilization among Medicare Beneficiaries with a diagnosis of nephrolithiasis for the years 2006, 2009, and 2014. Adjusted utilization rates were calculated per 1000 beneficiaries accounting for age, sex, and race. Utilization rates were examined nationally and by hospital referral region (HRR). RESULTS: A total of 511,495, 604,493, and 806,652 Medicare beneficiaries had a diagnosis of nephrolithiasis in 2006, 2009, and 2014, respectively. The adjusted rate of SWL per 1000 beneficiaries with nephrolithiasis decreased from 59.4/1000 in 2006 to 52.2/1000 and 45.5/1000 in 2009 and 2014 (13.9% decrease, P < .001). Variation was observed in SWL utilization; up to a 12-fold difference between HRRs (9.2/1000 in Winchester, VA to 105.8/1000 in Lincoln, NE). The adjusted rate of URS per 1000 beneficiaries increased by 10.2% (P < .001) between 2006 and 2014. However, the percent decrease in SWL utilization did not correlate with the percent increase in URS utilization when examined by HRR (P = .66). CONCLUSION: Variation exists in the utilization of SWL among Medicare beneficiaries (12-fold difference). This variation is likely secondary to a series of supply, urologist, and patient-specific factors. SWL utilization decreased between 2006 and 2014, while URS increased. Stone procedure type is likely highly dependent on where patients receive their urologic care.


Assuntos
Cálculos Renais/terapia , Litotripsia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino , Medicare , Estados Unidos
9.
Med Sci Monit ; 25: 5878-5885, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31389405

RESUMO

BACKGROUND Advances in percutaneous nephrolithotomy (PCNL) have resulted in smaller devices that cause less trauma and bleeding, while flexible ureterorenoscopy (f-URS) allows access to any calyces. These methods are often used in isolation, but used in combination they may improve treatment of complex renal calculi. This study assessed the effectiveness and complications of f-URS combined with super-mini-PCNL (SMP) to treat complex renal calculi. MATERIAL AND METHODS A retrospective cohort analysis was made of patients with unilateral complex renal stones treated between March 2013 and December 2016. Patients were grouped according to surgical procedure: SMP (SMP Group), f-URS holmium laser lithotripsy (f-URS Group), and combined SMP and f-URS (Combined Group). The postoperative complications and complete stone-free rate were analyzed and compared among the 3 groups. RESULTS A total of 140 patients with complex renal stones were included: 40 patients in the SMP Group, 55 in the f-URS Group, and 45 in the Combined Group. The complete stone-free rate 3 days after the procedure was 77.5% in the SMP Group, 78.2% in the f-URS Group, and 97.8% in the Combined Group (p=0.010). The operation time, intraoperative blood loss, and hospitalization time of the Combined Group were all significantly lower than those in the SMP Group but higher than those in the f-URS Group. The follow-up was 9 months (range, 6-12 months). There were no medium-term complications reported. CONCLUSIONS SMP combined with f-URS holmium laser lithotripsy in the prone position is an effective treatment for complex renal calculi.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Ureteroscopia/métodos , Adulto , Idoso , Perda Sanguínea Cirúrgica , Estudos de Coortes , Feminino , Humanos , Rim/patologia , Cálculos Renais/terapia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Decúbito Ventral , Estudos Retrospectivos , Resultado do Tratamento
10.
Australas Phys Eng Sci Med ; 42(3): 771-779, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31332724

RESUMO

A decision support system (DSS) was developed to predict postoperative outcome of a kidney stone treatment procedure, particularly percutaneous nephrolithotomy (PCNL). The system can serve as a promising tool to provide counseling before an operation. The overall procedure includes data collection and prediction model development. Pre/postoperative variables of 254 patients were collected. For feature vector, we used 26 variables from three categories including patient history variables, kidney stone parameters, and laboratory data. The prediction model was developed using machine learning techniques, which includes dimensionality reduction and supervised classification. A novel method based on the combination of sequential forward selection and Fisher's discriminant analysis was developed to reduce the dimensionality of the feature space and to improve the performance of the system. Multiple classifier scheme was used for prediction. The derived DSS was evaluated by running leave-one-patient-out cross-validation approach on the dataset. The system provided favorable accuracy (94.8%) in predicting the outcome of a treatment procedure. The system also correctly estimated 85.2% of the cases that required stent placement after the removal of a stone. In predicting whether the patient might require a blood transfusion during the surgery or not, the system predicted 95.0% of the cases correctly. The results are promising and show that the developed DSS could be used in assisting urologists to provide counseling, predict a surgical outcome, and ultimately choose an appropriate surgical treatment for removing kidney stones.


Assuntos
Inteligência Artificial , Sistemas de Apoio a Decisões Clínicas , Cálculos Renais/patologia , Cálculos Renais/terapia , Algoritmos , Transfusão de Sangue , Feminino , Humanos , Cálculos Renais/cirurgia , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea , Stents , Resultado do Tratamento
11.
Urologiia ; (3): 43-49, 2019 Jul.
Artigo em Russo | MEDLINE | ID: mdl-31356012

RESUMO

BACKGROUND: Rowatinex is a combined drug based on plant terpenes which provides diuretic, anti-inflammatory and antispasmodic effect. A use of herbal preparation Rowatinex in patients with urinary stone disease after extracorporeal shock-wave therapy (ESWL) is analyzed in the article. AIM: To clarify the efficiency of the drug Rowatinex in patients with urinary stone disease after ESWL. MATERIALS AND METHODS: All patients were divided into two groups depending on therapy administered after ESWL. In main group (n=150) patients received Rowatinex, while in control group (n=70), antispasmodics were administered. Spontaneous passage of fragments was observed in 104 patients in main group (69.3%) and 30 patients in control group (42.9%). RESULTS: When studying the effect of therapy on the changes of complete blood count, biochemical panel and daily excretion of some substances (magnesium, uric acid, calcium, etc) there were no significant differences between main group and control group. All values were normal. It was estimated that increase in diuresis during use of Rowatinex contributes to effective and rapid passage of stone fragments. In addition, there was a decrease in leukocyturia in both groups. CONCLUSION: Drug Rowatinex allows to reduce the time to spontaneous passage of fragments after ESWL, intensity of pain syndrome and leukocyturia as well as to increase in daily diuresis. This is not accompanied by the development of complications and side effects which allows to administer Rowatinex for a long time as part of complex medical expulsive therapy and use it for recurrence prevention of urinary stone disease. Effect of Rowatinex didnt depend on the stone composition.


Assuntos
Tratamento por Ondas de Choque Extracorpóreas , Cálculos Renais , Litotripsia , Terpenos , Cálculos Urinários , Terapia Combinada , Humanos , Cálculos Renais/terapia , Terpenos/uso terapêutico , Cálculos Urinários/terapia
12.
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
13.
Urologiia ; (3): 72-79, 2019 Jul.
Artigo em Russo | MEDLINE | ID: mdl-31356016

RESUMO

INTRODUCTION: The least invasive technique of PCNL is micropercutaneous nephrolithotripsy (micro-PCNL). A possibility of kidney puncture under direct endoscopic control with the creation of a working channel sized of 8-4.85 F is a characteristic feature of this system. AIM: To study the possibilities of micro-PCNL and to determine its role in the treatment of kidney stones. MATERIALS AND METHODS: A total of 74 patients aged 49.8+/-16.3 years were included in the study. In majority cases an isolated kidney stone was diagnosed (86.4%). The most common stone localization was pelvis (51.5%), followed by lower pole (35.9%). Considering the technical aspects of microPCNL, all patients were divided into 2 groups depending on the stone burden. In 46 patients (62.1%), the stone size was < 1.5 cm, while in 28 patients (37.9%) stones were bigger than 1.5 cm. Prestenting was performed in 54.0% due to renal colic or obstructive pyelonephritis. For the purpose of passive flushing of stone fragments during the lithotripsy, in most patients with a stone size > 1.5 cm, as well as in some prestented patients a ureteral access sheath with a diameter of 10/12 F (56.7%) was placed under x-ray control. In most patients with stones less than 1.5 cm, a 4.85 Ch sheath was utilized. In patients with larger stones, working sheath of 8 Ch was put. For stone disintegration, 50 W and 100 W holmium lasers, as well as the Russian innovative thulium fiber laser were used. RESULTS: The average duration of surgery from the puncture was 30.6+/-11.6 minutes. The effectiveness was determined by use of a non-contrast computed tomography, performed one month after the surgery. An overall stone-free rate after one-session was 89.1%, and it was 93.4% and 82.4%, respectively, in patients with stones sized less and more than 1.5 cm. In 32.4% cases the stenting was placed due to the large number of small residual fragments and risk of obstruction. In one case, a conversion into a mini-PCNL was done. Two patients (2.7%) required stenting because of renal colic caused by the migration of stone fragments into the ureter. There was no bleeding. In 8.1% of cases, acute pyelonephritis was developed that was treated conservatively. In 9.4% of patients, ESWL was required due to residual stones diagnosed one month after the surgery. CONCLUSION: Micro-PCNL is highly effective and safe method for treatment of kidney stones. Placing of ureteral access sheath of size 10/12 F contributes to the passive flushing of fragments during lithotripsy, which, together with the use of the 8 F working sheath, makes it possible to effectively perform micro-PCNL in patients with kidney stones larger than 1.5 cm.


Assuntos
Cálculos Renais , Terapia a Laser , Litotripsia , Ureter , Adulto , Idoso , Humanos , Rim , Cálculos Renais/terapia , Pessoa de Meia-Idade , Federação Russa
14.
Urologiia ; (3): 84-88, 2019 Jul.
Artigo em Russo | MEDLINE | ID: mdl-31356018

RESUMO

AIM: to study an adaptability of the Clavien-Dindo classification of complications for contact ureterolithotripsy. MATERIALS AND METHODS: A total of 506 patients with ureteric stones who were undergone 545 endoscopic interventions in the Urologic Department of "MONIKI" named after M.F. Vladimirsky were included in retrospective analysis. RESULTS: Complications of grade 1, II, IIIa and IIIb were noted in 39 (7.1%), 24 (4.3%), 15 (2.8%) and 14 cases (2,6%), respectively. Among the complications of grade IVa, an acute pyelonephritis was complicated by the septic shock. The complication of grade IVb developed in 1 case (0.2%). There were no complications of Grade V. The Clavien-Dindo classification allows to grade only postoperative complications and attempts to adapt it for the assessment of intraoperative complications can lead to the distortion of study results. CONCLUSION: The uncontrolled use of the Clavien-Dindo classification in all areas of surgery can lead to a decrease in its accuracy, thereby reducing its value as fairly universal tool. In our opinion, a further work aimed to the development of strict criteria for the different grades of complications of the Clavien-Dindo classifications is needed. We believe it is possible and necessary to develop a single tool for the assessment of complications of typical interventions within a single surgical area.


Assuntos
Complicações Intraoperatórias , Cálculos Renais , Litotripsia , Complicações Pós-Operatórias , Humanos , Cálculos Renais/terapia , Litotripsia/efeitos adversos , Estudos Retrospectivos
15.
Urologiia ; (1): 23-27, 2019 Apr.
Artigo em Russo | MEDLINE | ID: mdl-31184013

RESUMO

AIM: To obtain the information about functional state of kidneys in patients with urolithiasis before and after treatment, as well as to study the damaging effect of different types of energy used for fragmentation of high-density stones. MATERIALS AND METHODS: A total of 105 patients aged from 25 to 62 years with high-density stones were undergone to lithotripsy. In Group 1 (n=38), Group 2 (n=32) and Group 3 (n=35) contact laser lithotripsy, contact ultrasound lithotripsy and extracorporeal shock-wave lithotripsy was used, respectively. In all cases the clinical and biochemical blood and urine tests were performed as well as leukocyte migration inhibition test, selective proteinuria, a urine level of inteleukin-18 (IL-18) and urine NGAL (lipocalin-2) were assessed. The first examination was done the day before lithotripsy and the next ones were performed after 3 hours, on the 1st and 5th day after the intervention. RESULTS: In all cases dense unilateral kidney stones of size 0.8-2 cm were detected. The stone-free rate after contact lithotripsy was 92.8%. After ESWL, the stone-free rate after two weeks was 94.9%. The average duration of lithotripsy in the Group 1, 2 and 3 was 40+/-3.8 min, 35+/-2.3 min and 32+/-3.6 min, respectively. Based on the level of biomarkers of AKI, laser lithotripsy allows to achieve stone fragmentation with the least damage. CONCLUSION: Our study proves that IL-18, NGAL, leukocyte migration inhibition test and selective proteinuria allows to diagnose AKI at early stages, as well as to objectively assess the functional state of the kidneys after lithotripsy. The obtained data proves that laser lithotripsy is the safest method as assessed by damaging effects on the kidney parenchyma.


Assuntos
Cálculos Renais , Rim , Litotripsia a Laser , Litotripsia , Nefrolitíase , Adulto , Biomarcadores , Humanos , Rim/lesões , Cálculos Renais/terapia , Litotripsia/efeitos adversos , Litotripsia a Laser/efeitos adversos , Pessoa de Meia-Idade , Nefrolitíase/terapia
16.
Pan Afr Med J ; 32: 109, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31223399

RESUMO

Extracorporeal shock wave lithotripsy-related pain is the largest limiting factor in this technique. Our study aimed to compare the effectiveness of different types of analgesics for pain management used during ESWL sessions. We conducted a prospective study of 300 patients with urinary lithiasis justifying ESWL treatment. The patients were randomized to three groups: group I, included 100 patients who received intramuscular injection of 2cc of physiological saline solution (placebo), group II included 100 patients who received intramuscular injection of ketoprofen 100mg while group III included 100 patients who received lidocaine and prilocaine topical cream. Visual Analog Scale (VAS) was used to assess pain 10 minutes after and at the end of the session. Mean VAS score 10 minutes after and at the end of ESWL session was 3.7 and 4.91 respectively. There was no significant difference among the three groups with respect to: epidemiological data (age, sex, BMI, patient's history) and the characteristics of the renal stone (side, size, location, presence or not of double-J ureteral catheter). Eleven patients in the Group I terminated treatment early, with a significant difference compared to the other groups (p=0.003). VAS score 10 minutes after and at the end of ESWL session was statistically higher in Group I compared to Groups II and III (p < 0.001). Moreover, ESWL session was significantly more effective in Groups (II and III) compared to Group I (p<0.001). Pain treatment is necessary during ESWL sessions. Two painkillers molecules were assessed, which showed good pain control as well as an increase in the effectiveness of lithotripsy.


Assuntos
Analgésicos/administração & dosagem , Cálculos Renais/terapia , Litotripsia/métodos , Dor/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Feminino , Humanos , Cetoprofeno/administração & dosagem , Combinação Lidocaína e Prilocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Medição da Dor , Estudos Prospectivos , Adulto Jovem
17.
Arch Esp Urol ; 72(4): 353-359, 2019 05.
Artigo em Espanhol | MEDLINE | ID: mdl-31070130

RESUMO

OBJECTIVES: Extracorporeal shock wave lithotripsy is a minimally invasive therapeutic option for the treatment of renal-ureteral lithiasis. The aim of this study was to analyze the results and complications of shock wave extracorporeal lithotripsy treatment with the Dornier Gemini® Generator EMSE 220f-XXP device in patients with renal and ureteral lithiasis. MATERIAL AND METHODS: Retrospective study including 377 patients with renal or ureteral lithiasis with indication for treatment with extracorporeal shock wave lithotripsy. The following variables were analyzed, age, sex, body mass index, lithiasis size, lithiasis location, presence of urinary diversion, number of lithotripsy sessions, number of shock waves, fluoroscopy time, wave energy, applied focal energy coefficient, efficiency coefficient, lithiasic fragmentation, lithiasic clearance, residual lithiasis, presence of lithiasis and complications. The results were analyzed with SPSS 17.0 considering statistical significance p≤0.05. RESULTS: Of the 377 patients, 213 were men and 164 women, with a mean age of 51.28 ± 12.77 years. The mean size of the stones in maximum diameter was 11.77 ± 6.13 mm. Lithiasis fragmentation occurred in 81.9% of cases, with a percentage of residual lithiasis after the first session of 58.7% and a total or partial expulsion rate of lithiasis fragments of 68.3%, with global success at the end of sessions of lithotripsy of 69.8%. The overall Efficiency Ratio was 0.42, higher in upper calyx 0.51 and lower in medium calyx 0.35, with significant differences (p<0.05). The only differences were found in relation to the success of lithotripsy treatment (75% versus 64.6%, p=0.02), according to lithiasis size (≤10 mm maximum diameter in comparison to >10 mm). In patients with a DJ catheter there is a higher percentage of residual lithiasis (p=0.006). CONCLUSIONS: Treatment with extracorporeal lithotripsy in small lithiasis and in well-selected patients obtains good results with a low rate of complications regardless of sex and body mass index.


Assuntos
Cálculos Renais , Litotripsia , Ureter , Cálculos Ureterais , Adulto , Idoso , Feminino , Humanos , Rim , Cálculos Renais/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
Arch Esp Urol ; 72(4): 406-414, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31070137

RESUMO

OBJECTIVES: Micropercutaneous nephrolithotomy (microperc) is a new minimal-invasive technique.We aimed to investigate whether preoperative hydronephrosis has an impact on the stone-free rate of microperc. METHODS: In this study, 66 consecutive patients were included and divided into 2 groups:patients without preoperative hydronephrosis (group-1) and patients with preoperative hydronephrosis (group-2).Both groups were compared for age, gender, body mass index (BMI), stone burden, stone location, fluoroscopy and operative time, blood loss, stone-free rate and perioperative and postoperative complication rates. Parameters were analyzed using univariate and multivariate analyses for the stone-free rate. RESULTS: The mean age, gender, BMI, stone location, and blood loss were similar in both groups (p > 0.05). Stone burden in group-2 was greater than group-1 (p=0.011). In addition, mean fluoroscopy time in group-1 was found to be significantly lower (p < 0.05). However, operative time was comparable among the groups (p=0.169). Lastly, group-2 had a higher rate of perioperative and postoperative complication rates and lower success rate (p=0.023, p=0.027 and p=0.001, respectively). The success was significantly affected by hydronephrosis, stone burden and location (p < 0.05). Logistic regression analysis revealed that unsuccessful outcome was significantly associated only with the presence of hydronephrosis (OR 0.225,p=0.033). CONCLUSION: This study seems to suggest that presence of hydronephrosis is a major factor on the stone free rate of microperc procedures.


Assuntos
Hidronefrose , Cálculos Renais , Nefrolitotomia Percutânea , Nefrostomia Percutânea , Humanos , Hidronefrose/complicações , Cálculos Renais/terapia , Estudos Retrospectivos , Resultado do Tratamento
19.
Minerva Urol Nefrol ; 71(4): 365-372, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31086132

RESUMO

Over the last four decades, extracorporeal shockwave lithotripsy (ESWL) has been used as an effective technique to treat kidney and ureteral stones. Nowadays, ESWL still plays a role in stone treatment and is a primary treatment option in different guidelines. New technologies are now available to endourologists, but this procedure remains valid. This narrative review will shortly illustrate the history of ESWL and its clinical applications, limits, and specific uses.


Assuntos
Cálculos Renais/terapia , Litotripsia/métodos , Litotripsia/tendências , Cálculos Ureterais/terapia , Humanos
20.
J Urol ; 202(5): 986-993, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31112104

RESUMO

PURPOSE: In this study we assessed the effects of a ramping protocol in patients undergoing extracorporeal shock wave lithotripsy of renal stones. MATERIALS AND METHODS: In this prospective study patients with renal stones were randomized to receive shock wave lithotripsy delivered using a ramping protocol in group 1 (first 1,000 shocks at energy level 5 followed by 1,000 shocks at energy level 6 and 1,000 final shocks at energy level 7) and a fixed voltage protocol in group 2 (all 3,000 shocks at energy level 7). Treatment was administered using a Modulith® SLX-F2. The primary outcome was treatment success 12 weeks after a single shock wave lithotripsy session, defined as lack of a stone or a less than 4 mm stone fragment on computerized tomography. Other outcomes included the stone-free rate and the perinephric hematoma incidence. RESULTS: A total of 300 patients (150 per group) were recruited between February 2016 and June 2018. The 2 groups did not differ in baseline parameters. Group 1 received 14.8% lower energy than group 2, which was significant (p <0.001). The treatment success rate in groups 1 and 2 was 67.8% and 73.6%, respectively, which did not statistically differ (group 1 crude OR 0.753, 95% CI 0.456-1.244, p=0.268). The stone-free rate in groups 1 and 2 was 36.6% and 41.9%, respectively, which did not differ statistically between the groups. However, in groups 1 and 2 perinephric hematoma developed in 23.8% and 43.8% of patients, respectively, which was a statistically significant difference (p <0.001). CONCLUSIONS: The fixed voltage shock wave lithotripsy and ramping protocols provided similar treatment success rates for renal stones. However, the ramping protocol reduced the incidence of perinephric hematoma after shock wave lithotripsy.


Assuntos
Cálculos Renais/terapia , Litotripsia/métodos , Feminino , Seguimentos , Hematoma/epidemiologia , Hematoma/etiologia , Hong Kong/epidemiologia , Humanos , Incidência , Rim/irrigação sanguínea , Cálculos Renais/diagnóstico , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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