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3.
Medicina (Kaunas) ; 57(12)2021 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-34946314

RESUMO

Background and Objectives: This systematic review and meta-analysis was conducted to analyze the treatment outcomes of shock wave lithotripsy (SWL) and ureteroscopic lithotripsy (URSL) according to the ureteral stone size. Materials and Methods: In this systematic review, relevant articles that compared SWL and URSL for treatment of ureteral stones were identified. Articles were selected from four English databases including Ovid-Medline, Ovid-EMBASE, the Cochrane Central Register of controlled Trials (Central), and Google Scholar. A quality assessment was carried out by our researchers independently using the Scottish Intercollegiate Guidelines Network (SIGN). A total of 1325 studies were identified, but after removing duplicates, there remained 733 studies. Of these studies, 439 were excluded, 294 were screened, and 18 met the study eligibility criteria. Results: In randomized control trial (RCT) studies, URSL showed significantly higher SFR than SWL (p < 0.01, OR= 0.40, 95% CI 0.30-0.55, I² = 29%). The same results were shown in sub-group analysis according to the size of the stone (<1 cm: p < 0.01, OR = 0.40, 95% CI 0.25-0.63; >1 cm: p < 0.01, OR = 0.38, 95% CI 0.19-0.74, I² = 55%; not specified: p < 0.01, OR = 0.43, 95% CI 0.25-0.72, I² = 70%). In the non-RCT studies, the effectiveness of the URSL was significantly superior to that of SWL (p < 0.01, OR = 0.33, 95% CI 0.21-0.52, I² = 83%). Retreatment rate was significantly lower in URSL than in SWL regardless of stone size (p < 0.01, OR = 10.22, 95% CI 6.76-15.43, I² = 54%). Conclusions: Meta-analysis results show that SFR was higher than SWL in URSL and that URSL was superior to SWL in retreatment rate. However, more randomized trials are required to identify definitive conclusions.


Assuntos
Litotripsia , Ureter , Cálculos Ureterais , Humanos , Resultado do Tratamento , Cálculos Ureterais/terapia , Ureteroscopia
4.
Stomatologiia (Mosk) ; 100(6): 35-37, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34953186

RESUMO

BACKGROUND: The pathologies of the salivary glands are very diverse. Salivary stone disease occupies a special place among diseases of the salivary glands of a non-neoplastic nature. The incidence of salivary stone disease is extremely extensive and accounts for up to 85% of all pathologies of the salivary glands. OBJECTIVE: Improvement of minimally invasive methods of treatment of salivary stone disease, which does not lead to excision of the gland. MATERIAL AND METHODS: On the basis of the Clinics of the Samara State Medical University of the Ministry of Health of Russia, in the period from 2010 to 2020, a clinical group was formed, consisting of 193 patients with salivary stone disease of various localization. The age of the patients ranged from 16 to 84 years. All patients were therapeutically examined at the preoperative stage, voluntary informed consent was signed. Shockwave sialotripsy was performed in 95 patients of the main group (in 64 patients the calculus was located in the submandibular salivary gland, in 31 patients - in the parotid salivary gland). For lithotripsy, we used a lithotripter apparatus «Edap¼ (France) and «Wolf¼ (Germany). RESULTS: The analysis of the results obtained as a result of the study made it possible to draw a conclusion about reasonably better results of removal of calculi in the ducts of the salivary glands using the lithotripter «Swiss LithoClast® Master¼ (Switzerland). At the first visit and the therapeutic effect of the lithotripter, all patients suffering from bouts of salivary colic showed complete cessation. CONCLUSION: Thus, our study, which was devoted to the study of the results of various methods of treating patients with salivary stone disease, showed that sialolithotripsy using special narrowly targeted devices for crushing and subsequent excretion of salivary calculi allows to achieve the best results at present.


Assuntos
Litotripsia , Cálculos das Glândulas Salivares , Doenças das Glândulas Salivares , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Federação Russa , Cálculos das Glândulas Salivares/cirurgia , Glândula Submandibular , Adulto Jovem
5.
World J Gastroenterol ; 27(44): 7597-7611, 2021 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-34908801

RESUMO

Endoscopic management for difficult common bile duct (CBD) stones still presents a challenge for several reasons, including anatomic anomalies, patients' individual conditions and stone features. In recent years, variable methods have emerged that have attributed to higher stone removal success rates, reduced cost and lower adverse events. In this review, we outline a stepwise approach in CBD stone management. As first line therapy, endoscopic sphincterotomy and large balloon dilation are recommended, due to a 30%-50% reduction of the use of mechanical lithotripsy. On the other hand, cholangioscopy-assisted lithotripsy has been increasingly reported as an effective and safe alternative technique to mechanical lithotripsy but remains to be reserved in special settings due to limited large-scale evidence. As discussed, findings suggest that management needs to be tailored to the patient's characteristics and anatomical conditions. Furthermore, we evaluate the management of CBD stones in various surgical altered anatomy (Billroth II, Roux-en-Y and Roux-en-Y gastric bypass). Moreover, we could conclude that cholangioscopy-assisted lithotripsy needs to be evaluated for primary use, rather than following a failed management option. In addition, we discuss the importance of dissecting other techniques, such as the primary use of interventional endoscopic ultrasound for the management of CBD stones when other techniques have failed. In conclusion, we recognize that endoscopic sphincterotomy and large balloon dilation, mechanical lithotripsy and intraductal lithotripsy substantiate an indication to the management of difficult CBD stones, but emerging techniques are in rapid evolution with encouraging results.


Assuntos
Cálculos Biliares , Litotripsia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Ducto Colédoco , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Litotripsia/efeitos adversos , Esfinterotomia Endoscópica/efeitos adversos , Resultado do Tratamento
6.
Semin Vasc Surg ; 34(4): 172-187, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34911623

RESUMO

Endovascular treatment of peripheral arterial disease has evolved and expanded rapidly over the last 20 years. New technologies have increased the diversity of devices available and have made it possible to approach even the most challenging and high-risk lesions using endovascular techniques. In this review, we examine the clinical evidence available for several categories of endovascular devices available to treat peripheral arterial disease, including intravascular lithotripsy, atherectomy, and drug-coated devices. The best application for some technologies, such as intravascular lithotripsy and atherectomies, have yet to be identified. In contrast, drug-coated devices have an established role in patients at high risk for long-term failure, but have been the subject of much controversy, given recent concerns about possible adverse effects of paclitaxel. Future investigation should further assess these technologies in patients with complex disease using updated staging systems and outcomes with direct clinical relevance, such as functional improvement, wound healing, and freedom from recurrent symptoms.


Assuntos
Angioplastia com Balão , Litotripsia , Doença Arterial Periférica , Angioplastia com Balão/efeitos adversos , Aterectomia/efeitos adversos , Artéria Femoral , Humanos , Paclitaxel/efeitos adversos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Resultado do Tratamento , Grau de Desobstrução Vascular
7.
Curr Urol Rep ; 22(12): 64, 2021 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-34913152

RESUMO

PURPOSE OF REVIEW: Data are lacking on distribution of size of fragments created with the laser lithotripsy, stone density, and composition. Dust (< 1 mm) and small fragments (1-3 mm) may be too small to be efficiently removed with forceps compared to larger fragments (> 3 mm). We aim to report the size distribution of fragments formed during holmium laser lithotripsy. RECENT FINDINGS: One hundred ten patients with renal calculi < 3 cm underwent miniPCNL using ClearPetra sheath (Well Lead Medical Co., China) with controllable irrigation and suction system that minimizes fragment dispersion and maximizes fragment aspiration. Moses holmium laser (Lumenis INC, Israel) was used with predefined laser energy settings for lithotripsy. Proportion of fragment size < 1 mm was 46.36 ± 16.68%, 1-3 mm was 28.18 ± 10.01%, and > 3 mm was 25.19 ± 16.18% for the entire cohort. Complete stone clearance at 48 h was achieved in 77.3% cases. The remaining 22.7% patients had complete clearance at 1-month follow-up CT. In all the stone density, volume, and composition groups, majority of fragments created were either < 1 mm or 1-3 mm. Only 25% fragments were > 3 mm that would get aspirated out through the sheath with suction or could be retrieved with forceps. The combination of a high-power holmium laser and suction would help in complete stone clearance with effective aspiration of smaller stone fragments and dust simultaneously during lasing.


Assuntos
Cálculos Renais , Lasers de Estado Sólido , Litotripsia a Laser , Litotripsia , Hólmio , Humanos , Cálculos Renais/terapia , Lasers de Estado Sólido/uso terapêutico , Sucção
8.
Arch Ital Urol Androl ; 93(4): 431-435, 2021 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-34933539

RESUMO

BACKGROUND: One of the greatest challenges in semi-rigid ureteroscopies, for both stones and tumors, is the control of endoscopic vision and the maintenance of low intracavitary liquid pressure. We present a comparison between two operative techniques: in the first method an ordinary guide wire (diameter 0.032'') is used for the procedure; in the second one a 5 Fr ureteral catheter replaces the guidewire (we called it "Active guidewire") Methods We compared 50 semirigid ureteroscopies (sURS) performed using the active guidewire with another 50 procedures conducted with a classic guidewire. We evaluated the difference in operating times, quality of endoscopic vision, periprocedural infections rate and stone-free rate. RESULTS: The use of active guidewire has considerably reduced the standardized operating times per unit stone-volume by about 39%. Vision quality has improved considerably thanks to the continuous flow in-and-out. Consequently, periprocedural infections decreased (3% vs 30%) and the stone-free rate rose from 86% to 92%. DISCUSSION AND CONCLUSIONS: Employing an "active guidewire" instead of the standard guidewire, the risk of complications related to high pressures and operating time is considerably lower, as well as better treatment quality thanks to the cleaner vision. This technique has proven to be safe as well as easy to apply, and in our belief is to be preferred whenever the ureter accepts without forcing, both the presence of the catheter and the semi-rigid 7 F ureteroscope.


Assuntos
Litotripsia , Ureter , Cálculos Ureterais , Humanos , Cálculos Ureterais/cirurgia , Ureteroscópios , Ureteroscopia
9.
Acta Gastroenterol Belg ; 84(4): 620-626, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34965044

RESUMO

Pain is the most frequent symptom in chronic pancreatitis (CP) and has an important impact on quality of life. One of its major pathophysiological mechanisms is ductal hypertension, caused by main pancreatic duct stones and/or strictures. In this article, we focus on extracorporeal shock wave lithotripsy (ESWL) as a treatment for main pancreatic duct stones, which have been reported in >50% of CP patients. ESWL uses acoustic pulses to generate compressive stress on the stones, resulting in their gradual fragmentation. In patients with radiopaque obstructive main pancreatic duct (MPD) stones larger than 5 mm, located in the pancreas head or body, ESWL improves ductal clearance, thereby relieving pain and improving quality of life. In case of insufficient ductal clearance or the presence of an MPD stricture, ESWL can be followed by endoscopic retrograde cholangiopancreatography (ERCP) to increase success rate. Alternatively, direct pancreaticoscopy with intracorporeal lithotripsy or surgery can be performed.


Assuntos
Cálculos , Litotripsia , Pancreatite Crônica , Cálculos/terapia , Colangiopancreatografia Retrógrada Endoscópica , Humanos , Pancreatite Crônica/complicações , Pancreatite Crônica/terapia , Qualidade de Vida , Resultado do Tratamento
10.
Vopr Kurortol Fizioter Lech Fiz Kult ; 98(6. Vyp. 2): 59-64, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34965716

RESUMO

The impaired renal blood flow is one of the main pathogenesis mechanisms of urolithiasis (UL) development. Therefore, the rehabilitation programs involving non-drug methods for abnormal renal blood flow, including those after extracorporeal shock wave lithotripsy (ECSWL), still play a significant role. It is due to ECSWL, despite being noninvasive, is often associated with renal trauma, leading to various disorders, including impaired blood flow and renal function. To prevent complications after extracorporeal lithotripsy, relieve pain, improve renal blood flow, relieve spasm and facilitate excretion of fragments of broken concrements, we applied a combined vacuum-interference therapy, exerting an analgesic, antispasmodic and vascular effect. OBJECTIVE: To study the combined vacuum-interference therapy effect on the renal blood flow in patients with urolithiasis after ECSWL. MATERIAL AND METHODS: Forty patients aged 33 to 64 years old with urolithiasis after ECSWL were included in the study. Patients were assigned into two groups by simple randomization. Starting the second day after ECSWL, along with drug therapy, the patients of the main group (n=20) received vacuum-interference therapy with the carrier frequency of 5 kHz, frequency range 80-150 Hz, and the vacuum of 0.3-0.4 bar for 15 min daily, 6-8 procedures in total. Patients in the control group (n=20) received antibacterial and anti-inflammatory drug therapy, the same as the main group. To evaluate the severity of impaired renal blood flow due to nephrolithotripsy, we studied renal blood flow by the basic hemodynamic characteristics of renal ultrasound dopplerography (USDG): renal blood flow indices at the level of renal, segmental, interlobar, and arch arteries, including measurement of systolic linear blood flow velocity (Vps) and diastolic blood flow velocity (Vsd), as well as pulsatility index (PI) and resistance index (RI). RESULTS: The ultrasound examination prior to ECSWL revealed a statistically significant increase in all studied parameters. Thus, Vsd in renal arteries was increased by 32.7% (p<0.01) and 17.8% (p<0.05), respectively; in segmental arteries by 14.5% (p<0.05) and 29.5% (p<0.05), respectively; in interlobar arteries by 14.5% (p<0.05) and 29.5% (p<0.05), respectively, and in the arcus arteriosus by 10.7% (p<0.05) and 21.4% (p<0.05), respectively; the renal vein blood flow was within the reference range. When assessing PI in UL patients before lithotripsy, a statistically significant increase in all studied indices was also observed: in the renal arteries by 19.0% (p<0.05), in the segmental arteries by 12.5% (p<0.05), and in the interlobar and arch arteries by 11.6% (p<0.05) and 11.8% (p<0.05), respectively. After the treatment course, the most pronounced change was observed in the patients of the main group, in which all indices differed from the reference values only by 3.5-8.3%. It is important to note an increase in linear velocity in the renal vein by 21.4% (p<0.05), indicating a significant improvement of renal blood flow due to improved venous outflow and increased arterial inflow in the renal arteries. In the control group patients, statistically significant improvement was observed only for systolic and diastolic blood flow velocity, as well as the renal vein blood flow velocity, which increased by 22.1% (p<0.05), 6.3% and 17.8% (p<0.05), respectively; the other parameters remained unchanged. When assessing PI and RI values after the treatment course, the most marked improvement was also observed in the main group of patients, in which all indices were close to the reference values (p<0.05). In the control group patients, the indices were 11.6-14.0% higher than reference values (p<0.05). CONCLUSION: According to obtained data, it was concluded that vacuum interference therapy has a pronounced vascular effect that promotes an earlier recovery of blood flow and normalization of the kidney function in patients with urolithiasis after extracorporeal lithotripsy and can be recommended for routine clinical practice.


Assuntos
Cálculos Renais , Litotripsia , Urolitíase , Adulto , Humanos , Cálculos Renais/terapia , Litotripsia/efeitos adversos , Pessoa de Meia-Idade , Artéria Renal , Urolitíase/terapia , Vácuo
11.
Urologiia ; (6): 40-46, 2021 Dec.
Artigo em Russo | MEDLINE | ID: mdl-34967163

RESUMO

INTRODUCTION: Despite the low invasiveness of percutaneous nephrolithotripsy, this surgery is not without complications. One of the most important stages of the operation, on which depends not only the success of the patient completely getting rid of calculus, but the likelihood of complications, is the puncture of the pelvic-pelvic system. PURPOSE: Determination of the effectiveness and security of the new less-traumatic puncture needle MG under experimental conditions. MATERIALS AND METHODS: A series of pork kidney punctures with a new less-traumatic needle MG and standard Chiba and Troakar needles (Coloplast A/S, Denmark) were performed under experimental conditions, followed by a comparative morphological assessment. The staining of the slides was performed with hematoxylin and eosin. For the purpose of additional assessment of the structures of the kidney punctured with a low-traumatic MG needle, a morphological assessment of the parenchyma stained with picrofuchsin according to Van Gieson was performed. RESULTS: On parenchymal slides with punctures with Chiba and Trocar needles, the passage places with multiple large fragments of desquamated (damaged) epithelium are visualized. On preparations of the parenchyma punctured with a less-traumatic needle MG, the place of passage of the needle is presented with clear contours. The damaged epithelium in the lumen of the formed defect is practically absent. With additional staining according to Van Gieson (magnification x200), the integrity of the full-blooded vessel adjacent to the limited focus of the needle MG was visualized. Output. The new less-traumatic puncture needle MG is an innovative development in urology. The design of the needle with an atraumatic mandrel-bulb atraumatic mandrel-bulb on a spring basis made it possible to significantly reduce the trauma to the structures of the kidney and perirenal tissues due to the bougienage effect.


Assuntos
Cálculos Renais , Litotripsia , Humanos , Rim , Agulhas , Punções
12.
J Endourol ; 35(S3): S22-S28, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34910608

RESUMO

Introduction: We present our initial experience using the Moses 2.0 system for flexible-ureteroscopy (f-URS) high-frequency renal stone dusting, including a step-by-step video guide of our clinical principles for dusting technique. Materials and Methods: Twelve consecutive patients undergoing f-URS with Moses 2.0 (Lumenis) for a single renal stone by a single surgeon at an ambulatory center were reviewed. Stone-free rates (SFRs) and Clavien grade complications were assessed. Operative steps with illustrative examples are provided in an accompanying video. Results: Mean (range) stone size and lithotripsy time were 10.4 (5.3-17.2) mm and 15.0 (5-26) minutes, respectively. Complete SFR and <2 mm residual fragments were 82% and 18%, respectively. One patient had a Clavien Grade 1 complication. Operative steps reviewed include instrumentation, stone control, laser settings, and stent omission criteria. The preferred laser settings for renal stone dusting were 0.2-0.3 J and 100-120 Hz. Limitation of this early experience study is the small sample size. Larger studies are needed to confirm our initial findings. Conclusions: Early experience of Moses 2.0 for f-URS renal stone dusting demonstrated effective and efficient laser lithotripsy in patients with renal stones <2 cm.


Assuntos
Cálculos Renais , Lasers de Estado Sólido , Litotripsia a Laser , Litotripsia , Humanos , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscópios , Ureteroscopia
13.
J Endourol ; 35(S3): S29-S36, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34910606

RESUMO

Introduction: This study aimed at answering three research questions: (1) Under the experimental conditions studied, what is the dominant mechanism of Holmium:YAG lithotripsy with or without pulse modulation? (2) Under what circumstances can laser pulse modulation increase crater volume of stone ablation per joule of emitted radiant energy? (3) Are BegoStone phantoms a suitable model for laser lithotripsy studies? Materials and Methods: The research questions were addressed by ablation experiments with BegoStone phantoms and native stones. Experiments were performed under three stone conditions: dry stones in air, hydrated stones in air, and hydrated stones in water. Single pulses with and without pulse modulation were applied. For each pulse mode, temporal profile, transmission through 1 mm water, and cavitation bubble collapse pressures were measured and compared. For each stone condition and pulse mode, stones were ablated with a fiber separation distance of 1 mm and crater volumes were measured using optical coherence tomography. Results: Pulses with and without pulse modulation had high (>80%) transmission through 1 mm of water. Pulses without pulse modulation generated much higher peak pressures than those with pulse modulation (62.3 vs 11.4 bar). Pulse modulation resulted in similar or larger craters than without pulse modulation. Trends in BegoStone crater volumes differed from trends in native stones. Conclusions: This results of this study suggest that the dominant mechanism is photothermal with possible photoacoustic contributions for some stone compositions. Pulse modulation can increase ablation volume per joule of emitted radiant energy, but the effect may be composition specific. BegoStones showed unique infrared ablation characteristics compared with native stones and are not a suitable model for laser lithotripsy studies.


Assuntos
Cálculos , Lasers de Estado Sólido , Litotripsia a Laser , Litotripsia , Hólmio , Humanos , Imagens de Fantasmas
14.
Arch Ital Urol Androl ; 93(3): 313-317, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34839636

RESUMO

INTRODUCTION: The purpose of this study is to report the stone free rate (SFR) and clinical complications in patients submitted to retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS: A total of 571 procedures of upper urinary stones treated using flexible ureteroscopy and holmium laser lithotripsy from January 2014 to February 2020 have been analyzed. Overall SFR was evaluated after 3 months following the procedure by means of a non-contrast computed tomography. Success was considered as stone-free status or ≤ 0.4 cm fragments. RESULTS: The overall SFR was 92.3% in group 1 (stone size: < 1 cm), 88.3% in group 2 (stone size: > 1 ≤ 2 cm), 56.7% in group 3 (stone size: 2-3 cm) and 69.6% in group 4 (multiple stones). Post-operative complications, according to the Clavien- Dindo (CD) classification system, were recorded in 32 (5.6%) procedures. The major complications recorded were: one case of subcapsular hematoma (SRH) associated with pulmonary embolism two days after the procedure (CD Grade IIIa) treated conservatively and one case of hemorrhagic shock 2 hour with multiple renal bleedings requiring urgent nephrectomy (CD Grade IVA). CONCLUSIONS: The RIRS is an effective and safe procedure with a high SFR significantly correlated with the stone size; at the same time, RIRS could be characterized by severe clinical complications that require rapid diagnosis and prompt treatment.


Assuntos
Cálculos Renais , Litotripsia a Laser , Litotripsia , Humanos , Rim , Cálculos Renais/cirurgia , Litotripsia a Laser/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Ureteroscopia/efeitos adversos
15.
Arch Ital Urol Androl ; 93(3): 330-335, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34839640

RESUMO

PURPOSE: We aim to review our experience of transperitoneal laparoscopic ureterolithotomy (TPLU) for proximal ureteric stone more than 15 mm. PATIENTS AND METHODS: Between June 2017 to December 2020, sixty patients with a history of unsuccessful Extracorporeal shock wave lithotripsy (ESWL) and/or failed ureteroscopy for impacted ureteral calculi more than 15 mm who accepted TPLU were enrolled in our study. The patients' demographic information and post-treatment results were gathered and analyzed, retrospectively. RESULTS: The patients' mean age was 46.25 ± 12.56 years. The mean size of the stone was 20.11 ± 4.76 mm. 37 (61.7%) patients had severe hydronephrosis (HDN) and 46 (76.7%) stones were radio-opaque. Almost all of the patients underwent TPLU by a single urologist. The mean operation time was 72.86 ± 6.07 minutes without intraoperative complication (only 3 stones had upward migration to the pyelocaliceal system). The main operative blood loss was 88.86 ml. The average length of stay in the hospital was 45.8 ± 8.11 hours. The stone free rate (SFR) at discharge was 57 (95%). The overall complication rate was 27 (45%). Regarding early complications, fever was found in 8 (13.3%) patients, and 3 patients (5%) had paralytic ileus. The rate of urine leak was 8.3%, and 8 (13.3%) patients required blood transfusions. In multivariate analysis, the multiple stones, bigger stone in size, incomplete SFR, longer duration of hospital admission, and severe HDN were associated with a high early complication rate (p = 0.05, 0.04, < 001, 0.03, and 0.01, respectively). CONCLUSIONS: TPLU is a harmless option for managing proximal ureteric stone as a primary procedure or salvage procedure with good outcomes and acceptable complication rates.


Assuntos
Laparoscopia , Litotripsia , Ureter , Cálculos Ureterais , Adulto , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ureter/cirurgia , Cálculos Ureterais/cirurgia , Ureteroscopia
16.
Zhonghua Yi Xue Za Zhi ; 101(44): 3637-3642, 2021 Nov 30.
Artigo em Chinês | MEDLINE | ID: mdl-34823280

RESUMO

Objective: To investigate the clinical indicators for preoperative prediction of impacted ureteral stones and analyze the predictive value of ureteral wall area(UWA). Methods: A total of 197 patients who underwent ureteroscopic lithotripsy due to ureteral stones at our institution from January to December 2020 were retrospectively analyzed. Preoperative patient age, gender, body mass index (BMI), history of hypertension, diabetes mellitus, side of stone, location of stone, maximum diameter of stone, CT value of stone, C-reactive protein (CRP), creatinine, renal pelvis diameter, ureteral wall thickness and UWA were collected. Patients were divided into impacted and non-impacted groups according to whether the stones were impacted intraoperatively. Univariate analysis was used to compare the differences in each clinical indicator between the two groups, and multivariate logistic regression was performed to analyze the independent predictors of impacted stones for those with differences. The receiver operating characteristic (ROC) curve was used to analyze the predictive power of each independent predictor, and the Delong test was used to analyze whether the difference in the area under the curve (AUC) of each independent predictor was statistically significant. Results: All 197 patients successfully completed the operation, aged 51 (36, 56) years; 137 males and 60 females. According to the results of ureteroscopy, they were divided into 82 cases of impacted ureteral stones and 115 cases of non-impacted ureteral stones. Univariate analysis showed that there were significant differences in maximum stone diameter, stone CT value, renal pelvis diameter, ureteral wall thickness and ureteral wall area between the two groups (P<0.05); There was no significant difference in age, gender, BMI, history of hypertension, diabetes, stone side, location of stone, CRP and creatinine (P>0.05). Multivariate logistic regression analysis showed that stone CT value (P<0.01), ureteral wall thickness (P<0.001) and ureteral wall area were independent predictors of impacted ureteral stones (P<0.001). The ROC curve was used to compare the predictive efficacy of independent predictors of stone CT value, ureteral wall thickness and ureteral wall area. The area under the ureteral wall area curve was the largest (AUC = 0.901, 95%CI: 0.859-0.943, P<0.001), followed by ureteral wall thickness (AUC = 0.799, 95%CI: 0.736-0.862, P<0.001) and stone CT value (AUC = 0.700, 95%CI: 0.626-0.775, P<0.001). By Delong test, there were significant differences in AUC between ureteral wall area and stone CT value (Z=4.527, P<0.001) and ureteral wall thickness (Z=3.407, P<0.001). The best predictive value of ureteral wall area was 79.6 mm2. The sensitivity and specificity of this critical value for predicting ureteral incarcerated calculi were 80.1% and 89.5%. Conclusions: The UWA, ureteral wall thickness as well as the CT value of stones were all independent predictors of impacted ureteral stones, and UWA had a better predictive value.


Assuntos
Litotripsia , Ureter , Cálculos Ureterais , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Cálculos Ureterais/terapia , Ureteroscopia
17.
Pan Afr Med J ; 39: 213, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34630825

RESUMO

Double-J (DJ) stents have been widely utilized in urological practice. They are commonly used to relieve ureteral obstruction. Serious complications may occur when stents are left in place for long periods of time. In the present paper, we report a patient with a neglected DJ stent that had been inserted for five years after uterus-tumor surgery and led to a bladder stone. We report a case of a female who presented a bladder stone with a right DJ stent in the pelvic cavity. The stone was evident in radiological examination in an incidental finding. The treatment was transurethral cystolithotripsy. This case reminds us of the necessity of providing enough information and appropriate knowledge pertaining to the insertion of a ureteral stent. Transurethral cystolithotripsy is one of the treatment methods and can be suggested as a definitive method in consideration that it is a clinically effective and safe intervention.


Assuntos
Litotripsia/métodos , Stents/efeitos adversos , Cálculos da Bexiga Urinária/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Ureter/patologia , Obstrução Ureteral/cirurgia , Cálculos da Bexiga Urinária/terapia
18.
Arch Esp Urol ; 74(8): 768-773, 2021 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-34605417

RESUMO

OBJECTIVE: Pneumatic lithotripsy (PL) and Ho: YAG laser lithotripsy (LL) are the most widely accepted methods in the endoscopic treatment of ureteral lithiasis. The objective is to compare efficacy and safety of pneumatic lithotripsy vs. Ho: YAG laser lithotripsy in the treatment of ureteral lithiasis. MATERIAL AND METHODS: Prospective, single-blind, multicenter study. Adult patients were recruited from August 2017 to March 2019, in 23 institutions throughout Argentina. Patient demographics, stone characteristics, presence of double J stent prior to the intervention, stonefree rate (SF) and postoperative complications were evaluated and analyzed. RESULTS: A total of 366 patients with ureteral lithiasis were included, 204 in the PL group and 162 in the LL group. The SF rate was significantly higher in the LL group (77% vs. 92%), OR 3 .43 (1.76 to 6.70). The complication rate was significantly lower in the LL group (9.8% vs. 2.5%), OR 0.23 (0.07 to 0.71). In the multivariate analysis, the use of Ho: YAG energy, the location of the lithiasis in the distal ureter, and the preoperative placement of double J stent, were found to be predictors of SF status. CONCLUSIONS: Ho: YAG laser lithotripsy has a higher stone-free rate and a lower complication rate compared to pneumatic lithotripsy.


Assuntos
Lasers de Estado Sólido , Litotripsia a Laser , Litotripsia , Cálculos Ureterais , Adulto , Hólmio , Humanos , Lasers de Estado Sólido/uso terapêutico , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento , Cálculos Ureterais/terapia , Ureteroscopia
19.
Arch Esp Urol ; 74(8): 774, 2021 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-34605418

RESUMO

Comparto plenamente estas conclusiones de este excelente trabajo. Por edad, he usadocasi todo y la verdad es que al llegar a nuestras manos el Láser Holmio se abrió un mundo nuevo,fácil y gratificante.Enhorabuena a los autores.


Assuntos
Litotripsia a Laser , Litotripsia , Cálculos Ureterais , Hólmio , Humanos , Masculino , Cálculos Ureterais/terapia
20.
Hinyokika Kiyo ; 67(9): 419-421, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34610707

RESUMO

We report a case of 2,8-dihydroxyadenine (DHA) urolithiasis in a 65-year-old male. He initially visited another institution because right hydronephrosis was revealed in a medical checkup. Computed tomography demonstrated radiolucent right renal stones. We performed percutaneous nephrolithotripsy and flexible transurethral lithotripsy and removed the stones successfully. An analysis of the stone fragments revealed 2,8-DHA urolithiasis. 2,8-DHA stones are relatively rare and caused by adenine phosphoribosyltransferase deficiency.


Assuntos
Cálculos Renais , Litotripsia , Urolitíase , Adenina , Adenina Fosforribosiltransferase/deficiência , Idoso , Humanos , Cálculos Renais/terapia , Masculino , Erros Inatos do Metabolismo , Urolitíase/diagnóstico por imagem
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