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1.
Medicine (Baltimore) ; 99(10): e19324, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150068

RESUMO

The surgical outcomes of patients with single ureteral stones who had undergone ureteroscopic Holmium laser lithotripsy as outpatients and compare them with those of patients who had received the same procedure as inpatients. Records were obtained from January 2012 to December 2016 for selected patients who had undergone the above mentioned procedure at our institution. Patients were excluded if their ECOG performance status was ≥2, presented with multiple stones or concomitant renal stones, had histories of cancer or congenital urinary system abnormalities, or had undergone urinary system reconstruction surgery. Patients could decide whether to receive the procedure as an outpatient or inpatient. All surgeries were performed by a single surgeon. Patients preoperative, operative, and postoperative data were recorded. The clinical results, such as urinary tract infection, analgesic requirement, rate of returning to the emergency room, stone clearance, surgical complications, and medical expenditure for the treatment courses were analyzed and compared between the 2 cohorts. In total, 303 patients met the inclusion criteria. Among them, 119 patients decided to receive ureteroscopic laser lithotripsy as outpatients, whereas 184 decided to be inpatients. The outpatient cohort was younger (P < .001), had smaller stone diameters (P < .001), and fewer comorbidity factors (P = .038). Patients with a history of stone manipulation favored receiving the procedure under admission (P < .001). After 1:1 propensity score matching, no significant differences were discovered between the cohorts with regard to operative time, rate of lithotripsy failure, and operative complications. Furthermore, rates of stone clearance, post-op urinary tract infection, analgesic requirement, and returning to the emergency room were comparable between the 2 groups. However, the medical expenditure was significantly lower in the outpatient cohort (P < .001). Our data revealed that outpatient ureteroscopic lithotripsy with a Holmium laser was more economical compared with the inpatient group and achieved favorable outcomes for patients with a single ureteral stone.


Assuntos
Litotripsia a Laser/tendências , Pacientes Ambulatoriais/estatística & dados numéricos , Cálculos Ureterais/complicações , Cálculos Ureterais/terapia , Adulto , Idoso , Feminino , Humanos , Litotripsia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Cálculos Ureterais/epidemiologia , Ureteroscopia/métodos , Ureteroscopia/tendências
2.
Urologe A ; 59(3): 289-293, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32006059

RESUMO

Compared with adults, urolithiasis is quite rare in children (1-2% of all urinary stones occur during childhood). In principle, all therapy modalities for adults can also be used in children. However, due to some anatomic and functional peculiarities in children, the differential indication for the various treatment modalities differ. As a rule, asymptomatic renal stones are not treated but observed. More urinary stones pass spontaneously in children compared with adults. If spontaneous passage is not possible or does not occur, noninvasive and minimally invasive techniques are indicated. Extracorporeal shock wave lithotripsy is the therapy of choice in most instances. Today, endoscopic techniques, however, can be safely used even in very small infants. For larger renal stones and those consisting of cysteine or whewellite, percutaneous nephrolithotomy (PCNL) is the therapy of choice, and for distal ureteral stones ureteroscopy is the method of choice. Laparoscopic and open surgery are reserved for very rare cases, especially with concomitant pathologies. Bladder calculi are treated by transurethral or suprapubic lithotripsy.


Assuntos
Litotripsia , Nefrolitotomia Percutânea , Ureteroscopia , Urolitíase/cirurgia , Criança , Humanos , Cálculos Renais , Cálculos Ureterais , Urolitíase/diagnóstico por imagem
3.
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
5.
Urology ; 136: 70-74, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31704458

RESUMO

OBJECTIVE: To study patients who initially presented to the Emergency Department with acute renal colic to determine if patient-reported stone passage detects stone expulsion as accurately as follow-up computed tomography (CT) scan. METHODS: This is a secondary analysis of a multi-center prospective trial of patients diagnosed by a CT scan with a symptomatic ureteral stone <9 mm in diameter. Patient-reported stone passage, defined as capture or visualization of the stone, was compared to CT scan-confirmed passage performed 29-36 days after initial presentation. RESULTS: Four-hundred-three patients were randomized in the original study and 21 were excluded from this analysis because they were lost to follow-up or received ureteroscopic surgery. Of the 382 remaining evaluable patients, 237 (62.0%) underwent a follow-up CT scan. The mean (standard deviation) diameter of the symptomatic kidney stone was 3.8 mm (1.4). In those who reported stone passage, 93.8% (91/97) demonstrated passage of the symptomatic ureteral stone on follow-up CT. Of patients who did not report stone passage, 72.1% (101/140) demonstrated passage of their stone on follow-up CT. CONCLUSIONS: For patients who report capture or visualization of a ureteral stone, a follow-up CT scan may not be needed to verify stone passage. For patients who do not capture their stone or visualize stone passage, imaging should be considered to confirm passage.


Assuntos
Autoavaliação Diagnóstica , Cálculos Renais/complicações , Cálculos Renais/diagnóstico por imagem , Cólica Renal/etiologia , Tomografia Computadorizada por Raios X , Cálculos Ureterais/complicações , Cálculos Ureterais/diagnóstico por imagem , Adulto , Serviço Hospitalar de Emergência , Feminino , Humanos , Cálculos Renais/terapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Cálculos Ureterais/terapia
7.
Urologiia ; (5): 31-36, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808629

RESUMO

THE AIM: To assess the diagnostic performance of dual-energy computed tomography (DECT) in the evaluation of the composition of urinary stones "in vivo". MATERIALS AND METHODS: A total of 91 patients aged from 20 to 70 years old (mean 42.7) with urinary stone disease were examined at Sechenov University, including 68 men (75%) and 23 women (25%). Prior to surgery, all patients underwent DECT (Canon, Japan) in order to predict the chemical composition of urinary stones in vivo. Extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) was performed in 53 (58.2%), 18 (19.7%) and 20 (22.1%) patients, respectively. Postoperatively, all stones or stone fragments (n=91; 100%) were examined using a comprehensive physical and chemical analysis (X-ray phase analysis, electron microscopy, infrared spectroscopy). RESULTS: In 6 patients (6.6%) staghorn stones were diagnosed, while in 15 (16.5%), 17 (18.7%), 22 (24.2%) and 31 (34.1%) stones were located in ureteropelvic junction, pelvis and ureter, respectively, including 24 patients with lower ureteric stones (26.4%). Prediction of the stone composition in vivo was carried out on the basis of the one indicator, the dual energy ratio (DER). The threshold values of DER for different types of stones were taken from the literature. All stones were divided into 4 groups according to the DECT results: vevellite stones (n=40, 43.9%), Ca-containing stones without vevellite (n=34, 37.3%), uric acid stones (n=10, 10.9%) and struvite stones (n=7, 7.9%). Thus, when comparing the results of DECT and physical and chemical analysis, in the first group four stones were incorrectly assigned by DECT to the group of Ca-containing stones without vevellite and three stones were incorrectly assigned to the group of struvite stones; in the second group four stones were incorrectly assigned to the group of vevellite stones; in the third group one stone was incorrectly assigned to the group of struvite stones; in the fourth group one stone was incorrectly assigned to the group of vevellite stones and one stone in the group of uric acid stones. In order to increase the diagnostic efficiency of DECT, we performed a comprehensive analysis of five specific DECT indicators (stone density at 135 kV, Z eff of the stone, DER, DEI, DED) using discriminant analysis. Thus, the sensitivity, specificity and overall accuracy of DECT with the use of just one indicator (DER) were 83.3%, 89.8%, 86.8% for vevellite, 88.2%, 92.9%, 91.2% for Ca-containing stones without vevellite, 90%, 98.8%, 97.8% for uric acid stones and 60%, 95.3%, 93.4% for struvite stones, respectively. When using discriminant analysis with five specific DECT indicators, higher values of sensitivity, specificity and overall accuracy were seen: 95.2%, 89.8%, 92.3% for a vevellite, 85,3%, 96,4%, 92,3% for Ca-containing stones without a vevellite and 100%, 100% and 100% for both uric acid and struvite stones, respectively. CONCLUSIONS: Dual-energy computed tomography is a highly informative method which allows to perform preoperatively the reliable assessment of the chemical composition. DECT in patients with urinary stone disease allows to optimize the treatment strategy and carry out preventive measures on individual basis, taking into account the stone type.


Assuntos
Cálcio/análise , Tomografia Computadorizada por Raios X/métodos , Ácido Úrico/análise , Cálculos Urinários/química , Cálculos Urinários/diagnóstico por imagem , Urolitíase/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Litotripsia , Masculino , Pessoa de Meia-Idade , Cálculos Ureterais , Adulto Jovem
8.
Urologiia ; (5): 38-43, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808630

RESUMO

INTRODUCTION: Urinary stone disease is one of the most significant urologic diseases, since its prevalence increases annually, which makes it necessary to study and improve effective preventive measures, diagnostic methods and to implement new treatment interventions. AIM: to study changes in blood flow in the renal cortex and medulla in patients with ureteral stones using CT perfusion. MATERIALS AND METHODS: From 2017 to 2019, a total of 53 patients with upper ureteric stones were evaluated at the Russian-Japanese Center for Imaging and the Institute of Urology and Reproductive Health of the FGAOU VO I.M. Sechenov First Moscow State Medical University. Preoperatively, all patients underwent CT perfusion. The study was performed on a Toshiba Aquilion One 640 in volume mode with a slice thickness of 0.5 mm. In this study, blood flow changes were evaluated depending on the degree of dilatation of collecting system. RESULTS: In patients without dilatation of the collecting system, the average values of cortical and medullary blood flow and blood volume were within normal values. In patients with a dilatation of collecting system, there were significant differences cortical and medullary blood flow between the affected renal unit and contralateral side (27% and 34%, respectively). A decrease in cortical and medullar perfusion by 55% and 58%, respectively, in patients with the dilatation of calyxes was more pronounced in comparison with a decrease in perfusion in patients with the dilatation of only the ureter and pelvis. CONCLUSION: CT perfusion performed on the 640-slice CT scan allows an objective assessment of changes in renal blood flow in patients with ureteric stones.


Assuntos
Litotripsia , Circulação Renal , Tomografia Computadorizada por Raios X/métodos , Cálculos Ureterais/diagnóstico por imagem , Cálculos Ureterais/terapia , Humanos , Federação Russa , Resultado do Tratamento , Cálculos Urinários
9.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 404-406, dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185138

RESUMO

Objetivo. Evaluar la efectividad del tratamiento médico expulsivo con tamsulosina. Método. Ensayo clínico prospectivo aleatorizado doble ciego realizado en un servicio de urgencias. Se incluyen adultos con ureterolitiasis distal única no complicada, que fueron asignados aleatoriamente a tamsulosina 0,4 mg/día más antiinflamatorio no esteroideo (AINE) (grupo A), o con placebo más AINE (grupo B), durante 21 días. Resultados. No se observaron diferencias estadísticamente significativas en la tasa de expulsión de litiasis entre ambos grupos (p = 0,29) ni en el tiempo de expulsión de esta (p = 0,91). Conclusiones. La terapia expulsiva con tamsulosina no se asocia a una mayor tasa de expulsión de litiasis ureteral


Objective. To assess the effectiveness of medical expulsive therapy with tamsulosin. Methods. Randomized double-blind controlled trial in an emergency department. We enrolled adults with uncomplicated distal ureterolithiasis and no other complaint. Patients were randomized to take either tamsulosin (0.4 mg/d) plus a nonsteroidal anti-inflammatory drug (NSAID) or placebo plus the NSAID for 21 days. Results. The stone expulsion rate did not differ statistically between the 2 groups (P=.29). Time until expulsion was also similar (P=.91). Conclusion. Medical expulsive therapy with tamsulosin does not improve the rate of distal ureteral stone expulsion


Assuntos
Humanos , Masculino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Resultado do Tratamento , Tansulosina/administração & dosagem , Cálculos Ureterais/tratamento farmacológico , Serviços Médicos de Emergência , Chile , Estudos Prospectivos , Método Duplo-Cego , Ureterolitíase/tratamento farmacológico , Ureterolitíase/diagnóstico por imagem , Acetaminofen/administração & dosagem , Cetorolaco/administração & dosagem , Análise Estatística
11.
Actas urol. esp ; 43(9): 474-479, nov. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185248

RESUMO

Objetivo: Evaluar la relación del espesor de la pared ureteral (EPU) con el éxito y los parámetros relacionados con la ureteroscopia para el tratamiento de cálculos ureterales proximales. Pacientes y métodos: Se incluyó a 82 pacientes con cálculos ureterales proximales y se dividieron en 2 subgrupos de acuerdo con el grosor de la pared ureteral: un grupo con 38 pacientes, EPU > 5 mm, y el segundo con 44, EPU < 5mm. Se evaluaron los siguientes parámetros: tamaño de la piedra, grado de hidronefrosis, diámetro de la luz ureteral proximal, el EPU y los datos demográficos de los pacientes. Se realizó ureteroscopia semirrígida con láser Ho-YAG y se evaluó el posible impacto del EPU sobre las tasas de éxito y los parámetros relacionados con el procedimiento. Resultados: La media de edad de los pacientes y el tamaño de los cálculos fueron 47,55 ± 1,78 años y 8,17 ± 0,29 mm, respectivamente. Con respecto al impacto del valor del EPU sobre los parámetros mencionados anteriormente, la tasa libre de cálculos una semana después del procedimiento fue mayor en el grupo 2 y la tasa de fragmentos residuales, así como la necesidad de colocación de catéter doble J, fueron más altas en el grupo 1. Adicionalmente, la duración media del procedimiento fue significativamente más larga en el grupo 1 y se observaron alteraciones patológicas en la pared ureteral significativamente mayores en estos casos (p = 0,0243). Conclusiones: El EPU es un factor útil al predecir el éxito del tratamiento ureteroscópico y otros parámetros relacionados con el procedimiento para los cálculos ureterales proximales. Con este enfoque, se podría realizar un plan operativo más adecuado, con mayores tasas de éxito, menos complicaciones y procedimientos adicionales


Aim: To evaluate the possible impact of stone impaction in terms of ureteral wall thickness (UWT) on the success and procedure related parameters of ureteroscopic management in proximal ureteral calculi. Patients and methods: 82 patients with proximal ureteric stones were included and were divided into 2 subgroups where UWT was > 5 mm in 38 cases; and < 5 mm in 44 cases. Stone size, degree of hydronehrosis, diameter of proximal ureteral luz, UWT and patient's demographics were evaluated. Semi-rigid ureteroscopy with Ho-YAG laser was performed and the possible impact of UWT as an objective parameter for stone impaction on the success rates and procedure related parameters was evaluated. Results: Mean patient age and stone size values were 47.55 ± 1.78 years and 8.17 ± 0.29 mm respectively. Regarding the impact of UWT value at the stone site for the parameters mentioned above stone free rates particularly at 1-week after the procedure was higher in group 2 and the rate of residual fragments as well as the need for double J stent placement was higher in group 1. Additionally, mean duration of the procedures was significantly longer in Group 1 during which pathologic alterations were significantly higher in ureteral wall at stone site were observed in these cases (P = .0243). Conclusions: UWT may be used to predict the success of ureteroscopic management and other procedure related parameters for proximal ureteral stones in an effective manner. With this approach a more rational operative plan with higher success rates, limited complications and auxiliary procedures could be made


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Cálculos Ureterais/diagnóstico , Cálculos Ureterais/cirurgia , Ureteroscopia/métodos , Litotripsia/métodos , Ureter/patologia , Ureter/cirurgia , Cateteres
12.
Turk J Ophthalmol ; 49(5): 294-296, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31650813

RESUMO

Endogenous endophthalmitis is a serious sight-threatening ocular emergency that usually occurs in patients with serious underlying risk factors. In this report, we describe a case of endogenous Candida endophthalmitis following trans-urethral lithotripsy in an immunocompetent woman. In our case, the retinal lesion regressed completely and vision was restored. We discuss diagnostic procedures and management strategies in this article.


Assuntos
Antifúngicos/uso terapêutico , Candida albicans/isolamento & purificação , Candidíase/terapia , Endoftalmite/terapia , Infecções Oculares Fúngicas/terapia , Litotripsia/efeitos adversos , Vitrectomia/métodos , Adulto , Candida albicans/genética , Candidíase/etiologia , Candidíase/microbiologia , DNA Fúngico/análise , Endoftalmite/etiologia , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/microbiologia , Feminino , Humanos , Tomografia por Emissão de Pósitrons , Cálculos Ureterais/terapia , Acuidade Visual
13.
J Biol Regul Homeost Agents ; 33(5 Suppl. 1): 39-44, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31630712

RESUMO

Urolithiasis is a well-known condition that can affect any part of the urinary tract. With a rate of 3-5% the incidence of upper urinary tract for long has been higher in adults (1-3), but recently it has increased among children reaching 3,3% . Indeed, more than 1% of all urinary stones are seen in patients aged less than 18 years (4). Pediatric urolithiasis is endemic in Turkey and Far East and it is probably due to malnutrition and racial factors (5). The spontaneous stone passage is more likely in children than in adults, indeed ureteral calculi spontaneously pass into 41-63% of children (1). Rate of stone passage depends on size and stone location in the urinary system. Stones sized less than 5 mm have a passage rate ranging from 40% to 98%, whilst stones > 5 mm have between 55% and 50% (6). In the last decade, the use of alpha blockers has proven well efficacious in helping spontaneous passage of distal ureteric stones in adults (7-9). The latest EAU guidelines support their use in adults while remain vague about their use in children because of unclear safety and efficacy (4). In search of evidence supporting or not the use of medical expulsive therapy in children we reviewed the literature dealing with the management of urolithiasis in pediatric patients. The primary aim of the present study was to evaluate the efficacy of medical expulsive therapy (MET), defined as stone expulsion rate, with a-blockers compared to a control group. The secondary aim was to assess the safety, defined as side effects rate, of MET compared to a control group.


Assuntos
Cálculos Ureterais/terapia , Urolitíase/terapia , Antagonistas Adrenérgicos alfa/uso terapêutico , Criança , Pré-Escolar , Humanos
14.
Medicine (Baltimore) ; 98(37): e17057, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517825

RESUMO

BACKGROUND: Ureteral calculi generally refer to the temporary obstruction of the human body after the ureteral stenosis. When the ureteral stones are not discharged in time, they can grow in the original site, causing the patient to have corresponding clinical manifestations, such as: renal colic, hematuria, etc, when severe, can cause renal obstruction and hydronephrosis, seriously endangering the patient's health. Ureteral calculi usually occur in young and middle-aged people. The peak age of the disease is between 20 and 50 years old. It also occurs in the young and middle-aged labor force. The men incidence rate is 2 to 3 times that of women. Ureteral calculi is one of the current refractory diseases, and the effect after treatment with integrated Chinese and Western medicine is remarkable. METHODS AND ANALYSIS: We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to November 2018. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of ureteral. ETHICS AND DISSEMINATION: This systematic review will evaluate the efficacy and safety of Traditional Chinese medicine for ureteral. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial.Registration number: PROSPERO CRD42019137095.


Assuntos
Medicina Tradicional Chinesa , Metanálise como Assunto , Revisão Sistemática como Assunto , Cálculos Ureterais/terapia , Humanos
15.
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
16.
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
17.
Urologe A ; 58(11): 1304-1312, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31506761

RESUMO

The increase of medical knowledge and technical innovations together with the demographic change represent a challenge for the new conception of guidelines and clinical studies. The present S2k guidelines, which are exclusively concerned with kidney and ureteral stones, should support the treatment of urolithiasis in hospitals and private practices and provide information on urolithiasis for patients. Increasing interdisciplinary collaboration in stone treatment is also demonstrated in the number of professional and working groups participating in the update of the new guidelines. The present S2k guidelines emerged from a consensus process and demonstrate the current recommendations in step with actual practice. They provide decision-making guidance for diagnostics, treatment and metaphylactic measures based on expert opinions and available published fundamental evidence from the literature.


Assuntos
Litotripsia/normas , Guias de Prática Clínica como Assunto , Ureteroscopia/normas , Urolitíase/cirurgia , Procedimentos Cirúrgicos Urológicos/normas , Urologia/normas , Tratamento por Ondas de Choque Extracorpóreas , Humanos , Cálculos Renais , Nefrolitotomia Percutânea , Resultado do Tratamento , Cálculos Ureterais , Urolitíase/diagnóstico , Urolitíase/prevenção & controle , Procedimentos Cirúrgicos Urológicos/instrumentação
18.
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
19.
Urologiia ; (4): 9-15, 2019 Sep.
Artigo em Russo | MEDLINE | ID: mdl-31535798

RESUMO

AIM: to evaluate the possibilities and efficiency of using 3D technologies for the laparoscopic interventions in patients with renal and ureteric stones. MATERIALS AND METHODS: A retrospective analysis of the results of surgical treatment of patients with renal and ureteric stones performed in the urology clinic of the I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia for the period from January 2012 to December 2017 was carried out. During this period a total of 4958 interventions were done. Among them, 98 laparoscopic (1.97%) surgeries were performed, including nephron-sparing interventions (n=47; 48%), pyelolithotomy (n=15; 15.3%), ureterolithotomy (n=32; 32.65%) and partial nephrectomy (n=4; 4.05 %). The average patients age was 55.76+/-10.5 (29-80) years. There were 51 men (52%) and 47 women (48%). The mean stone density was 1237.6+/-354.6 HU (from 500 to 1913 HU). In 14 (22.9%) cases, nephrostomy tube or ureteric stent had been put before surgery. In addition, 40 (40.8%) patients previously underwent one surgical intervention on the kidneys and 17 patients with urinary stone disease (17.3%) underwent surgery more or equal 2 times. 88 (89.8%) patients had severe concomitant diseases and the most common pathology in 51 (52.0%) patients with urinary stone disease was arterial hypertension. In 11 (11.2%) cases, the interventions were performed in patients with abnormal kidneys, including horseshoe kidney (n=6; 6.1%), duplicated collecting system (n=3; 3.1%) and pelvic kidney (n=2; 2%). In addition to standard preoperative diagnostic methods in 22 cases (22.4%) the 3D-planning and multivariate virtual performing of intervention based on the multidetector computer tomography scan was done using Amira 3D-modeling program. Among these patients, virtual interventions were performed prior to all pyelolithotomy and partial nephrectomy. Intraoperative data of virtual constructions were used by surgeons as navigation. The interventions were performed by seven urologists at the clinic with various experience in laparoscopic surgery. RESULTS: The mean duration of laparoscopic pyelolithotomy, laparoscopic partial nephrectomy, laparoscopic ureterolithotomy and laparoscopic nephrectomy was 183.2+/-69.6, 201.3+/-35.2 min, 97.6+/-43.7 and 165.4+/-92.3 min, respectively. The minimal blood loss was observed during laparoscopic ureterolithotomy (53.33+/-31.2 ml). During these interventions, in 8 cases (8.16%) a flexible endoscope was used for inspection and complete removal of stones. Intraoperative complications were noted in 6 patients (6.1%). There were 4 conversions to open surgery (4.1%). Postoperative surgical complications were observed in 1 (1%) patient, while non-surgical complications developed in 4 patients (4.1%). There was no mortality. CONCLUSION: Laparoscopic access for the treatment of patients with urinary stone disease should be used for the treatment of patients with large, long-standing ureteral calculi and patients with kidney stones who have concomitant pathology of kidney or upper urinary tract (UPJ obstruction, kidney tumors) requiring surgical intervention. Laparoscopic access should be considered primarily for the planning of laparoscopic partial nephrectomy and laparoscopic nephrectomy in patients with urinary stone disease. The use of 3D computer-assisted technologies is advisable for patients with urinary stone disease and abnormal kidneys if laparoscopic pyelolithotomy, partial nephrectomy or ureterolithotomy is planned.


Assuntos
Laparoscopia , Cálculos Urinários/diagnóstico por imagem , Feminino , Humanos , Masculino , Moscou , Estudos Retrospectivos , Federação Russa , Cálculos Ureterais
20.
JNMA J Nepal Med Assoc ; 57(216): 123-126, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31477947

RESUMO

Persistent Mullerian duct syndrome is a rare entity and usually presents with common symptoms of undescended testis and hernia. The syndrome is caused by an insufficient amount of Mullerian inhibiting substance or due to the insensitivity of the target organ to Mullerian inhibiting substance. Polysplenia is a rare congenital disease manifested by multiple small accessory spleens. The association of these two entities, Persistent Mullerian duct syndrome and polysplenia, is rare and has not been reported in the literature. We reported a case of a 27 years old male presented with complains of right flank pain and nausea. Ultrasound showed right ureteric calculus with hydronephrosis and elongated soft tissue mass posterior to bladder. Contrast enhanced Computed Tomography showed soft tissue suggestive of infantile uterine structure with multiple splenculi and short pancreas. He was diagnosed as Persistent Mullerian duct syndrome with unilateral cryptorchidism, polysplenia and short pancreas, coincidentally detected while evaluating for ureteric colic. He underwent Ureteroscopic Lithotripsy with stenting for ureteric calculus, however, he refused laparotomy with excision of mullerian structures. Keywords: cryptorchidism; persistent mullerian duct syndrome; short pancreas.


Assuntos
Transtorno 46,XY do Desenvolvimento Sexual/diagnóstico , Pâncreas/anormalidades , Baço/anormalidades , Adulto , Criptorquidismo/diagnóstico , Humanos , Masculino , Cálculos Ureterais/diagnóstico , Cálculos Ureterais/terapia
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