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1.
Zhonghua Yi Xue Za Zhi ; 100(40): 3161-3163, 2020 Nov 03.
Artigo em Chinês | MEDLINE | ID: mdl-33142399

RESUMO

Objective: To investigate the clinical efficacy and safety of one-time percutaneous transhepatic establishment of intrahepatic bile duct sinus, choledochoscope combined with holmium laser lithotripsy in elderly patients with hepatolithiasis combined with benign stricture. Methods: The clinical data of 56 elderly patients diagnosed with intrahepatic bile duct stones combined with stricture in our hospital from January 2018 to January 2019 were collected. All patients underwent PTCD puncture and drainage, and simultaneously expanded the punctured sinus channels step by step, intrahepatic bile duct stones lithotripsy and lithotomy were performed under choledochoscope combined with holmium laser. The intraoperative operation and postoperative complications were analyzed. Results: The sinus tract was established in 53 patients, the stones were removed, and the stenosis was relieved. Two cases of puncture bleeding and 1 case of bleeding when the stenosis was relieved by holmium laser and the surgery was timely transferred. The patients received 4(2-8) times of laser lithotripsy, and it took 30(28-32) min for each treatment. The T tubules were removed when colour Doppler ultrasound and choledochography were rechecked well. The patients were followed-up for an average of 6 months with the liver function and cholerythrin recovered. Conclusion: The one-time establishment of sinus tract combined with choledochoscope holmium laser provides a new therapeutic approach for the elderly patients with hepatolithiasis and benign stricture who cannot tolerate surgery.


Assuntos
Coledocolitíase , Lasers de Estado Sólido , Litotripsia a Laser , Litotripsia , Idoso , Constrição Patológica , Hólmio , Humanos , Resultado do Tratamento
2.
Arch Esp Urol ; 73(9): 826-836, 2020 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33144537

RESUMO

OBJECTIVES: This study aims to investigatel ongitudinal changes in sexual functions (SF), anxiety status, and health-related quality of life (HRQoL) after shock wave lithotripsy (SWL) in male urolithiasis patients. METHODS: Between February 2015 and April 2017, 85 consecutive male patients with kidney or ureter stones and treated with SWL were included. Patients were evaluated for SF, anxiety status, and HRQoL with questionnaire forms before and at the third month after SWL. Correlation between baseline and third-month scores of International Index of Erectile Function-15 (IIEF-15) subdomains and anxiety was evaluated. Uni- and multivariable linear regression analyses were used to identify changes in IIEF-15 subdomain scores at three months. RESULTS: Mean age was 42.80 ± 9.42 years. Significantly decreased IIEF-15 subdomain scores, increased anxiety and Short Form-36 (SF-36) subdomain scores were achieved at three months (p<0.05, for each). The baseline median values of erectile function (IIEFEF), orgasmic function (IIEF-OF), sexual desire (IIEF-SD), intercourse satisfaction (IIEF-IS), and overall satisfaction (IIEF-OS) were 26, 9, 8, 12, and 8, respectively. The same scores were 26, 9, 6, 9, and 8 at month 3, respectively. According to multivariable analysis, the difference in Beck Anxiety Inventory (BAI) scores was an independent risk factor for both changing in IIEF-SD and IIEF-IS (b= -0.094, 95%CI: -0.179 - -0.009, p=0.030 and b= -0.197, 95%CI: -0.350 - -0.044, p=0.012, respectively). The difference in the State Anxiety (STAISA) scores was an independent risk factor for changing in IIEF-IS (b= -0.075, 95%CI: -0.146 - -0.004,p=0.039). CONCLUSIONS: SWL may lead to impaired SF related to treatment-driven anxiety and significantly improve HRQoL of male patients in short term.


Assuntos
Disfunção Erétil , Litotripsia , Adulto , Ansiedade/epidemiologia , Ansiedade/etiologia , Humanos , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários
3.
Urologiia ; (5): 28-32, 2020 Nov.
Artigo em Russo | MEDLINE | ID: mdl-33185342

RESUMO

PURPOSE: to determine the characteristics of the surgeon training curve in the development of percutaneous nephrolithotripsy (PN). MATERIALS AND METHODS: The first 125 PNs performed by one team of surgeons were investigated. In chronological order, five groups of 25 operations were formed. The assessment was carried out according to the following parameters: the duration of the operation; the number of perioperative complications; stone free rate (SFR). RESULTS: With the advanced training of the surgical team, the duration of the operation tended to decrease; after 50 PN the time decreased from 164+/-12 to 113+/-11 minutes. The duration of the next 50 PN conducted in the third and fourth groups remained unchanged - 105+/-10 and 103+/-12 minutes. In the fifth group, a decrease in time to 99+/-9 minutes had no significant differences with the third and fourth groups. The frequency of complications tended to decrease up to the 75th operation, followed by a plateau. The structure was dominated by complications related, according to the modified Clavien-Dindo classification, to Grade I and Grade II. With the accumulation of surgeons experience, there was a tendency towards an increase in SFR: in the 1st group - 72%, in 2 - 84%, in 3 and 4 - 88%, in 5 - 92% (p<0,05). CONCLUSIONS: in order to achieve the average indicators of the duration and effectiveness of PN, the surgical team must have experience of at least 50 such operations. Due to the long training process, it is advisable to use PN in organization with an estimated number of such operations of at least 30 per year.


Assuntos
Curva de Aprendizado , Litotripsia , Litotripsia/métodos
4.
Nihon Shokakibyo Gakkai Zasshi ; 117(11): 1001-1007, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33177252

RESUMO

An 88-year-old patient had undergone endoscopic stenting for the treatment of acute cholangitis caused by choledocholithiasis. After a year and two months, he presented with cholangitis caused by common bile duct stones that formed a stent-stone complex. Another stent was observed adjacent to the old stent;however, the cholangitis relapsed in a short term. Thus, we planned to remove as many stones as possible. These stones were not free-floating and had affected the bile duct. Endoscopic mechanical lithotripsy was attempted;however, it failed. He was successfully treated using peroral cholangioscopy and electrohydraulic lithotripsy. After three months, he developed cholangitis because of the recurrence of choledocholithiasis. After removing as many stones as possible and performing endoscopic stenting, he was followed up as an outpatient. He had no symptoms for seven months after the procedure.


Assuntos
Coledocolitíase , Cálculos Biliares , Litotripsia , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Masculino , Stents , Resultado do Tratamento
5.
PLoS One ; 15(10): e0237783, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33017397

RESUMO

A systematic review and meta-analysis was conducted to explore the effect of a eutectic mixture of local anaesthetics (EMLA) on pain reduction during extracorporeal shockwave lithotripsy (ESWL). PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases (updated March 2020) were searched for randomised controlled trials (RCTs) assessing the effect of EMLA for patients that underwent ESWL. The search strategy and study selection process were managed according to the PRISMA statement. Six RCTs were included in the meta-analysis. Overall, the results indicated that EMLA significantly reduced pain compared to the control group (RR = -2.98, 95% CI = -5.82 to -0.13, P = 0.04) with a heterogeneity of I2 = 57% (P = 0.04). Subgroup analysis showed that EMLA did not significantly reduce pain when the patients took an analgesic premedication (RR = -1.46, 95% CI = -5.89 to 2.98, P = 0.52) with a heterogeneity of I2 = 38% (P = 0.52). Conversely, studies without premedication showed a significant pain relief effect (RR = -4.08, 95% CI = -7.36 to -0.65, P = -0.80) with a heterogeneity of I2 = 48% (P = 0.14). Most studies showed there was no difference in the patient's need for analgesics. EMLA was effective for reducing pain during EWSL. However, this analgesic effect was limited and did not reduce the need for analgesics.


Assuntos
Anestésicos Combinados/administração & dosagem , Anestésicos Locais/administração & dosagem , Combinação Lidocaína e Prilocaína/administração & dosagem , Litotripsia/métodos , Manejo da Dor/métodos , Administração Cutânea , Analgesia/métodos , Anestesia Local/métodos , Humanos , Litotripsia/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico
6.
Arch Esp Urol ; 73(8): 735-744, 2020 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33025918

RESUMO

OBJECTIVE: To review recent and relevant information regarding the use of high-power (HPL) and low-power (LPL) Holmium:YAG lasers (Ho:YAG) in retrograde intrarenal surgery (RIRS) for lithotripsy. METHODS: A PubMed/Embase search was conducted and recent and relevant papers on Ho:YAG for RIRS were reviewed. RESULTS: Settings for Ho:YAG are pulse energy (PE), pulse frequency (PF), and pulse width. Currently, the majority of LPL can also adjust pulse-width but cannot reach PF as high as HPL, however, the higher energy outputs reached by HPL are rarely useful in lithotripsy. Higher PE might enhance ablation but generates larger fragments and higher retropulsion. Pulse width does not affect energy output but delivers energy for a longer time-length. Dusting and basketing are complementary techniques. Dusting seeks to pulverize stones into particles ≤250 µm avoiding the use of instruments for stone retrieval, whereas in fragmenting, the stones are break into smaller pieces which are then retrieved. Dusting can prevent the use of supplies such as access sheaths and baskets and also prevent the complications related to their use. However, is not always feasible in clinical practice to fully ablate a stone into dust, then the use of this supplies and popcorn technique are helpful for rendering a patient stonefree. The energy gap between HPL and LPL is wide and leaves room for a mid-power laser classification, which can overcome the main drawback of LPL, the expenses of HPL, and still holding its versatility for other procedures beyond stones. CONCLUSIONS: HPL and LPL have similar effectiveness, but long-term cost-effectiveness comparisons are underexplored. Newer HPL would need to be compared to emerging technologies as the thulium fiber, and prove superiority to mid-power laser to determine how powerful is enough for Ho:YAG in the years to come.


Assuntos
Cálculos , Lasers de Estado Sólido , Litotripsia a Laser , Litotripsia , Humanos , Lasers de Estado Sólido/uso terapêutico , Túlio
7.
Arch Esp Urol ; 73(8): 753-766, 2020 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33025920

RESUMO

Holmium laser has been established asthe gold-standard for the ureteroscopic management of urinary stone disease. However the role of laser inpercutaneous nephrolithotomy (PCNL) varies, as multiple energy sources and lithotripters are available. Currently, lasers are becoming more relevant with the development of several miniaturized PCNL techniques. The purpose of this article is to review the role of laser in percutaneous renal surgery, and whether or not it is the best option for this approach. Discussion points include: the history and background of lasers in urologic surgery, PCNL and its outcomes in the literature, the positives and negatives of lasers versus other lithotripters in several different PCNL techniques, emerging laser technology such as thulium fiber laser, the use of lasers in establishing percutaneous renal access, and laser's role in non-stone percutaneous renal surgery.


Assuntos
Lasers de Estado Sólido , Litotripsia , Cálculos Urinários , Humanos , Rim , Lasers de Estado Sólido/uso terapêutico , Túlio
8.
Medicine (Baltimore) ; 99(39): e22293, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991432

RESUMO

RATIONALE: The indwelling ureteral stents is a common procedure in routine urological practice. The double-J (D-J) stent is the most common type of stents used and is indicated mainly for short-term urinary drainage and prevention of obstruction and infection. However, prolonged indwelling stents may result in disastrous complications, such as hematuria, infection, encrustation, and stone formation. In this context, the persistence of stent in situ might play a key role as a nidus in deposition of urinary sediment, then forming calculus. Although the encrustation may become more serious as time goes on, large bladder stones are relatively rare. However, the serious encrustation and giant stone may complicate or exacerbate the conditions in turn. PATIENT CONCERNS: A 45-year-old female patient who underwent right ureteral stent placement after open ureterolithotomy 6 years ago complained of dysuria, urinary frequency, and urgency over 2 months. DIAGNOSIS: The kidney ureter bladder (KUB) x-ray showed the presence of a giant stone in the bladder and an entire D-J stent. The computed tomography (CT) urography scans revealed normal left kidney, right hydronephrosis, and an encrusted D-J stent with the significant stone, diameter 4.2 cm with a CT value of 1211.0 ±â€Š221.6 HU, on the vesical coil. On the basis of these auxiliary examinations, the case was diagnosed as cystolith and prolonged-indwelling stents. INTERVENTIONS: Pneumatic ballistic lithotripsy was used for crushing the bladder calculi followed by the successful extraction of intact D-J ureteral stent. OUTCOMES: No residual stone was detected on postoperative KUB x-ray and CT urography scans. Patient recovered well and was discharged 10 days after surgery. Semi-annual ultrasound examination was suggested to monitor the effect of therapy. LESSONS: This case reminds us that it is crucial to take various measures to avoid the forgotten ureteral stent and its unfortunate late complication.


Assuntos
Stents/efeitos adversos , Ureter/patologia , Cálculos da Bexiga Urinária/etiologia , Feminino , Humanos , Litotripsia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Cálculos da Bexiga Urinária/terapia
9.
Medicine (Baltimore) ; 99(38): e21910, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957310

RESUMO

BACKGROUND: Extracorporeal shockwave lithotripsy (ESWL) has gained worldwide popularity as one of the most commonly used minimally invasive management of urinary tract stones. The objective of this study was to evaluate the efficacy and safety of ESWL for patients with kidney stones (KS). MATERIALS AND METHODS: This protocol established in this study has been reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Web of Science, PubMed, Embase, Cochrane Library, China Biomedical Literature Database (CBM), China Knowledge Network Database (CNKI), Chinese Scientific Journal Database (VIP), and Wan Fang Database were searched for case-control studies in ESWL treating patients with KS until July 1, 2020. We will use a combination of Medical Subject Heading and free-text terms with various synonyms to search based on the Eligibility criteria. Two investigators independently reviewed the included studies and extracted relevant data. The relative risk (RR) and 95% confidence intervals (CIs) were used as effect estimate. I test, substantial heterogeneity, sensitivity analysis, and publication bias assessment will be performed accordingly. Stata 14.0 and Review Manger 5.3 are used for a meta-analysis. RESULTS: The results will be published in a peer-reviewed journal. CONCLUSION: The results of this review will be widely disseminated through peer-reviewed publications and conference presentations. This evidence may also provide helpful evidence of the efficacy and safety of ESWL treating patients with KS. PROSPERO REGISTRATION NUMBER: CRD42019157243.


Assuntos
Tratamento por Ondas de Choque Extracorpóreas/métodos , Cálculos Renais/terapia , Litotripsia/métodos , Humanos , Projetos de Pesquisa
10.
Medicine (Baltimore) ; 99(36): e21692, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899002

RESUMO

To explore the safety and effectiveness of ureteroscopic holmium laser lithotripsy (UHLL) and ureteroscopic pneumatic lithotripsy (UPL) in the treatment of impacted ureteral calculi (IUC).Clinical data of 280 patients in our hospital from April 2016 to May 2019 were retrospectively collected and analyzed, including 136 cases of UHLL group and 144 cases of UPL group. The general clinical data, operation time, intraoperative bleeding volume, hospital stay, stone-free rate (SFR), and surgical complications were collected and analyzed in 2 group.Compared with UPL group, the operation time of UHLL group was significantly reduced (27.25 ±â€Š8.39 vs 34.32 ±â€Š10.57, P < .05), but the hospitalization cost was significantly increased (9.25 ±â€Š0.75 vs 8.24 ±â€Š0.51, P < .05). In terms of total SFR, the UHLL group was significantly higher than the UPL group (93.38% vs 83.33%, P = .011). For proximal IUC, compared with the UPL group, the SFR of the UHLL group was significantly increased (88.33% vs 70.31%, P = 0.005). For distal IUC, there was no significant difference in SFR (97.37% vs 93.75%, P = .638) between the UHLL group and UPL group. There were no significant differences in the complications of local mucosal injury, hematuria, febrile urinary tract infection, ureteral perforation, and urinary sepsis in the 2 groups (P > .05). However, the UHLL group was significantly lower in stone residual rate than the UPL group (6.61% vs 16.67%, P = .001).This study found that UHLL and UPL are safe and effective in the treatment of IUC, but UHLL has the advantages of shorter operation time and high SFR in the treatment of IUC.


Assuntos
Lasers de Estado Sólido/uso terapêutico , Litotripsia/métodos , Cálculos Ureterais/cirurgia , Adulto , Idoso , Feminino , Humanos , Litotripsia/efeitos adversos , Litotripsia/economia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos
11.
Urologiia ; (4): 5-9, 2020 Sep.
Artigo em Russo | MEDLINE | ID: mdl-32897006

RESUMO

INTRODUCTION: In the structure of hospital urological pathology, urolithiasis is about 40%, while 2/3 of patients are hospitalized for emergency reasons. Surgical treatment, even in a modern minimally invasive format, can cause postoperative complications in 10-30% of cases, of which up to 5% are hemorrhagic complications requiring blood transfusion in 0.7-1.4% of cases. MATERIALS AND METHODS: To determine the diagnostically significant risk factors for postoperative bleeding, the results of treatment of urolithiasis in 574 patients using remote lithotripsy were used. Based on the results of the statistical analysis, a computer program module "Method for predicting the development of hemorrhagic complications of the postoperative period in patients with urolithiasis" was developed. RESULTS: Of the 45 alleged risk factors for postoperative bleeding, 9 diagnostically significant ones were selected, including recurrent urolithiasis, a history of bleeding, hematuria, size and density of the calculus, and some indicators of the coagulogram. The threshold value of the amount of bleeding risk assessment in points is set to 8, that is, a result of more than 8 points corresponds to a high risk of bleeding. It was established that the risk of hemorrhagic complications in the postoperative period in urolitiasis increases with large stones (size from 5 mm) with high density (from 400 HU), with a decrease in the number of platelets (from 1701012/l) and lengthening of AChTV (from 40 c), PV (from 15 s) and TV (from 16 s), as well as in the presence of a history of recurrent urolithiasis, bleeding and preoperative microhematuria. CONCLUSION: The developed computer program module allows you to quickly and objectively assess the risk of hemorrhagic complications at the stage of choosing the method of surgery, conduct preoperative prophylaxis and increase the effectiveness of surgical treatment of urolithiasis.


Assuntos
Litotripsia , Urolitíase , Hematúria , Humanos , Complicações Pós-Operatórias , Hemorragia Pós-Operatória
12.
Urologiia ; (4): 18-20, 2020 Sep.
Artigo em Russo | MEDLINE | ID: mdl-32897009

RESUMO

Over the past several decades, there has been a significant increase in the prevalence of nephrolithiasis in the general population. Ureteroscopy has become the treatment of choice for a growing number of urologic conditions; ureteroscopy is still relatively new procedure and continue to undergo significant advancement. The recent technical development of small caliber semi rigid and flexible deflectable ureteroscopes and the development of diminutive intra-corporeal lithotripsy probes have made the retrograde access to urinary calculi throughout the entire ureter a more feasible and low-risk technique. The study aims to identify the need for use of laser lithotripsy and/or other ureteroscopic ancillary equipment (ureteric stent, ureteric catheter, forceps and dormia basket) in patient undergoing ureteroscopy for ureteric stone management. A prospective observational study from 2013 to 2015. The study conducted in urosurgical theater in Al-Jumhoori Teaching Hospital. 200 patient with ureteric stone in the study treated by ureteroscopy. The mean age of the patient is 36 years. Ureteroscopy had done in the right side in 98 patients, left side in 83 patients, and bilateral ureteroscopy in 19 patients. Ureteric stones found in upper ureter in 86 patients, middle ureteric stone seen in 40 patients, and lower ureteric stone founded in 108 patients, whereas 16 patients had stones at more than one location. Ureteric catheter used in 33 patients, and had been removed after 48-72 hours, while Double J stent had been used in 175 patients and had been removed after 2 to 8 weeks.


Assuntos
Cálculos Renais , Litotripsia a Laser , Litotripsia , Cálculos Ureterais/terapia , Adulto , Humanos , Resultado do Tratamento , Ureteroscopia
13.
Urologiia ; (4): 45-49, 2020 Sep.
Artigo em Russo | MEDLINE | ID: mdl-32897013

RESUMO

INTRODUCTION: There are more than 20 drugs, that are widely used as medical expulsive therapy after extracorporeal shock wave lithotripsy (ESWL). Herbal plants are actively used along with the drug therapy in order to improve the efficiency of the treatment. PURPOSE OF THE STUDY: to evaluate the efficiency of the drug "Renotinex" in patients with kidney stones, as medical expulsive therapy. MATERIALS AND METHODS: A total of 41 patients with kidney stones who undergone ESWL were included in the study. Patients were divided into two groups of 21 patients. In the main group, patients received the dietary supplement "Renotinex" 2 capsules 2 times a day for 1 month, along with standard medical expulsive therapy (NSAIDs [Diclofenac suppositories 50 mg in case of pain] + alpha blockers [Tamsulosin 0.4 mg in the morning for 1 month). The efficiency of treatment was evaluated after 2 and 4 weeks by means of ultrasound and x-ray. A presence and mean size of the stone and dilatation of the collecting system were assessed. In addition, complete blood count (hemoglobin, level of red blood cells and white blood cells), as well as urinalysis (microhematuria and leukocyturia) were performed. For statistical analysis, Student's criterion and the Fishers method were used. RESULTS: After 2 weeks of treatment, a decrease in the hemoglobin level, number of leukocytes and erythrocytes in urine, as well as a significant decrease in pelvis size and the average size of the urinary stone were seen in the main group. In the control group, there was also a slight decrease in the hemoglobin and a significant increase in the grade of leukocyturia and microhematuria. After 4 weeks, significant intergroup differences were documented in the level of microhematuria, pelvis size and the presence of stone in the collecting system, as confirmed by ultrasound and X-ray study. Stone-free rate in the main group was 47.6%, compared to 20% in the control group. CONCLUSION: Medical expulsive therapy in combination with dietary supplements "Renotinex" after ESWL is more efficient than standard medical expulsive therapy (NSAIDs and -blockers) as monotherapy.


Assuntos
Cálculos Renais/terapia , Litotripsia , Óleos Voláteis , Humanos , Terpenos , Vitaminas
14.
Urologiia ; (4): 90-94, 2020 Sep.
Artigo em Russo | MEDLINE | ID: mdl-32897020

RESUMO

INTRODUCTION: The aim of the study was to retrospectively evaluate the efficiency of extracorporeal shock wave lithotripsy (ESWL) with ultrasound guidance and the results of treatment of children with urolithiasis, of different age groups depending on the stone location and size. MATERIALS AND METHODS: A total of 135 children and adolescents, aged from 1 to 18 years treated by ESWL at IZMIRLIAN Medical Center from 2005 to 2016 were enrolled in this study. Number, size and location of stones were evaluated. A total of 153 ESWL sessions were performed, including two sessions in 9 cases, three sessions in 1 case, and four sessions in 2 cases. Intra- and posttreatment stone fragmentation rate, number of ESWL sessions, shock-wave pulses per session, stone-free rate, and number of ancillary procedures depending on the stone location and size as well as radiation exposure were evaluated. Follow-up observation was performed after 14, 30 and 90 days. RESULTS: In most cases, there was a good stone fragmentation after ESWL. From 200 to 3000 low-energy pulses with a frequency 1-2 Hz and power of 30-50 units on Modulith SLK scale were delivered. Number of shock-wave pulses up to 1000, 2000 and 3000 was sufficient in 18.3%, 51.9% and 26.8% cases, respectively. SFR in children aged 1-5 years was 95.2%, compared to 100%, 100% and 83.7% in patients in the 6-10, 11-15 and 16-18 year age groups, respectively. Complete stone clearance was achieved in patients of 1-5 and 6-10 years after two weeks. In only one patient in the 11- to 15-year age group, all fragments passed after two weeks, while in 4 adolescents in the 16- 18-year age group SFR was achieved after more than 3 months. In addition, in other 3 patients in this age group ESWL was unsuccessful. CONCLUSION: Our results suggest high efficiency of ESWL under ultrasound guidance in children and adolescents. Absence of X-ray exposure, minimal complication rate, non-invasiveness and high efficiency allow to consider ESWL as a method of choice for the treatment of urolithiasis in children and adolescents.


Assuntos
Litotripsia , Urolitíase , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia
15.
Arch Esp Urol ; 73(7): 634-642, 2020 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32886078

RESUMO

OBJECTIVE: Ureteroscopic lithotripsy (URS) is the current standard choice of treatment for both ureteral and adequate renal stones. Although it is known to be a safe procedure, postoperative febrile urinary tract infection (UTI) is not rare. Especially in diabetic patients, rate of urinary tract infection is higher. Therefore, we aimed to describe the risk factors for UTI following URS in diabetics. MATERIALS AND METHODS: Between January 2017and April 2019, 546 patients who under went ureteroscopic lithotripsy for ureteral and/or renal stones were included. A matched-pair analysis was performed to compare postoperative UTI rates between diabetics and nondiabetics. We retrospectively reviewed the medical records including age, gender, BMI, comorbidities, UTI history, hemoglobin A1c (HbA1c), operating time, stone size and hounsfield unit (HU), preoperative hydronephrosis, ureteroscopic methods and ureteral stenting. Logistic regression analysis was done to determine the risk factors for postoperative UTI in diabetics. RESULTS: In diabetic patients rate of postoperative UTI was 29% (13/45). After matched-pair analysis within the group of non-diabetics, incidence was 11% (5/44) (p=0.04). In univariate analysis, preoperative ureteral stent, UTI history and HbA1c level were the risk factors for UTI after URS in diabetics. UTI history and HbA1clevel were the independent risk factors for developing postoperative UTI in diabetic patients. HbA1c threshold 6.9% afforded 75% sensitivity and 67% specificity for predicting postoperative UTI in diabetics. CONCLUSIONS: Diabetic patients are under greater risk to develop postoperative UTI following URS. Those patients with UTI history and HbA1c level higher than 6.9% must be followed carefully.


Assuntos
Diabetes Mellitus/epidemiologia , Litotripsia/efeitos adversos , Cálculos Ureterais/cirurgia , Infecções Urinárias/etiologia , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscopia
16.
Zhonghua Yi Xue Za Zhi ; 100(32): 2494-2497, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32829594

RESUMO

Objective: To observe the clinical efficacy of external physical vibration lithecbole (EPVL) in the treatment of calculous renal colic under different positions. Method: A total of 120 calculous renal colic patients who underwent EPVL from September 2018 to September 2019, were randomly divided into three groups utilizing random number table: supine position group, the lateral position group and the hybrid position group, with 40 cases in each group. Prior to the EPVL, each patient was given an intravenous injection of 20 mg furosemide. When the patients accumulated enough urine, they began to undergo EPVL. Numeric Rating Scale (NRS) was applied to assess the pain intensity before and after the treatment. Furthermore, all the patients were examined by B-ultrasound or urinary CT a day and a week after the treatment. The NRS score, side effects, stone discharge rate, time of pain relief, and pain recurrence rate were compared among different groups. Results: Prior to the treatment, there was no significant difference of the pain intensity among three groups (P>0.05). After the treatment, the pain intensity considerably alleviated in all the groups. The NRS score decreased by 4.05±0.24, 3.23±0.23 and 2.90±0.21 in supine, lateral and hybrid position groups, respectively. The time of pain relief was (8.88±0.46) min, (10.33±0.44) min and (10.38±0.50) min in supine, lateral and hybrid position groups, respectively. Overall, the efficacy of lateral position group was better than the other two groups in terms of speed and degree of pain relief (P< 0.05). The total pain relief rate was 91.7%. However, the pain recurrence rate was 15.0% (6/40), 15.0% (6/40) and 12.5% (5/40) in supine, lateral and hybrid position groups, respectively, however, there was no significant difference among three groups (P>0.05). But the hybrid position group had a relatively low rate of pain recurrence. The aggregate stone discharge rate of three groups was 25.8% and 62.5% a day and a week after the treatment respectively. The calculus clearance rate of surgical day was 22.5% (9/40), 35% (14/40) and 20% (8/40) in supine, lateral and hybrid position groups, respectively. Moreover, the stone removal rate was 60% (24/40), 75% (30/40) and 52.5% (21/40) in supine, lateral and hybrid position groups, respectively. The result indicated that the supine position group had the highest stone discharge rate (P<0.05). Overall, there was no case with severe complications, and there was no significant difference of side effects among three groups (P>0.05). Conclusion: EPVL can safely and effectively improve calculous renal colic and assist the removal of stone. When calculous renal colic was treated under EPVL, the patients can benefit from all three positions, and thus it is crucial to decide which position is more appropriate in different scenarios.


Assuntos
Litotripsia , Cólica Renal , Cálculos Ureterais/terapia , Humanos , Modalidades de Fisioterapia , Vibração
18.
Arq Bras Cir Dig ; 33(1): e1491, 2020 Jun 26.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32609255

RESUMO

INTRODUCTION: Endoscopic removal of common bile duct stones has a high success rate ranging from 85% to 95%. Bile duct stones >15 mm are difficult and frequently require lithotripsy. Peroral cholangioscopy (POC) allows lithotripsy with similar success rates. AIM: To determine the efficacy and safety of cholangioscopy-guided lithotripsy used in the treatment of difficult to remove bile duct stones vs. conventional therapy. METHODS: Search was based in Medline, Embase, Cochrane Central, Lilacs/Bireme. Studies enrolling patients referred for the removal of difficult bile duct stones via POC were considered eligible. Two analyses were carried out separately, one included randomized controlled trials (RCTs) and another observational studies. RESULTS: Forty-six studies were selected (3 RTC and 43 observational). In the analysis there was no statistical significant difference between successful endoscopic clearance (RD=-0.02 CI: -0.17, 0.12/I²=0%), mean fluoroscopy time (MD=-0.14 CI -1.60, 1.32/I²=21%) and adverse events rates (RD=-0.06 CI: -0.14, 0.02/I²=0%), by contrast, the mean procedure time favored conventional therapy with statistical significance (MD=27.89 CI: 16.68, 39.10/I²=0%). In observational studies, the successful endoscopic clearance rate was 88.29% (CI95: 86.9%-90.7%), the first session successful endoscopic clearance rate was 72.7 % (CI95: 69.9%-75.3%), the mean procedure time was 47.50±6 min for session and the number of sessions to clear bile duct was 1.5±0.18. The adverse event rate was 8.7% (CI95: 7%-10.9%). CONCLUSIONS: For complex common bile duct stones, cholangioscopy-guided lithotripsy has a success rate that is similar to traditional ERCP techniques in terms of therapeutic success, adverse event rate and means fluoroscopy time. Conventional ERCP methods have a shorter mean procedure time.


Assuntos
Cálculos Biliares , Litotripsia a Laser , Litotripsia , Colangiopancreatografia Retrógrada Endoscópica , Humanos , Resultado do Tratamento
19.
Arch Esp Urol ; 73(6): 487-490, 2020 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-32633243

RESUMO

Few specialties have gone through as many transitions in the last decades as Urology. Progressive physiology advances in several disease have become part of the urological knowledge. Laparoscopic surgery and ESWL (Extracorporeal Shock Wave Lithotripsy) wave have completely turn upside down the whole management of disease. The current text provides a back to the future sigh into Urology.


Assuntos
Laparoscopia , Litotripsia , Urologia
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