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1.
Urologiia ; (5): 114-118, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808644

RESUMO

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


Assuntos
Abscesso/tratamento farmacológico , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Cálculos Renais/terapia , Litotripsia/efeitos adversos , Pielonefrite/tratamento farmacológico , Ureteroscopia/efeitos adversos , Humanos , Nefrectomia , Pielonefrite/complicações , Pielonefrite/microbiologia , Federação Russa , Índice de Gravidade de Doença , Cálculos Urinários
2.
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
3.
Urologiia ; (3): 84-88, 2019 Jul.
Artigo em Russo | MEDLINE | ID: mdl-31356018

RESUMO

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


Assuntos
Complicações Intraoperatórias , Cálculos Renais , Litotripsia , Complicações Pós-Operatórias , Humanos , Cálculos Renais/terapia , Litotripsia/efeitos adversos , Estudos Retrospectivos
4.
Urologiia ; (1): 23-27, 2019 Apr.
Artigo em Russo | MEDLINE | ID: mdl-31184013

RESUMO

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


Assuntos
Cálculos Renais , Rim , Litotripsia a Laser , Litotripsia , Nefrolitíase , Adulto , Biomarcadores , Humanos , Rim/lesões , Cálculos Renais/terapia , Litotripsia/efeitos adversos , Litotripsia a Laser/efeitos adversos , Pessoa de Meia-Idade , Nefrolitíase/terapia
5.
J Cardiovasc Surg (Torino) ; 60(5): 557-566, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31241268

RESUMO

The standard of care for treating symptomatic peripheral arterial disease has been percutaneous transluminal angioplasty with or without stenting over the last couple of years. This endovascular treatment of claudicants or patients with critical limb ischemia has increased in numbers and has even surpassed open surgery. Our daily practice has evolved to an endovascular-first approach, especially in the femoropopliteal region, being the most frequently treated vessel. However, neointimal hyperplasia and elastic recoil leading to target lesion restenosis or occlusion after initial successful treatment is not uncommon. In recent years, drug-eluting technologies on balloons or stents have been investigated as a potential solution for this problem with excellent results compared to plain-old balloon angioplasty. Nonetheless in the majority of those trials, the bailout stenting rate increased with lesion complexity, albeit it in long or heavily calcified lesions due to flow-limiting dissections, elastic recoil or the calcium barrier preventing adequate drug uptake. There is a need for vessel preparation in order to ameliorate drug delivery, especially in complex lesions. Multiple devices are available to prepare even the most challenging lesions for drug uptake or stenting, by achieving maximal luminal gain and by minimizing dissections. This review aims to give an overview of the most common modalities for vessel preparation in the superficial femoral artery beside plain old balloon angioplasty together with an overview of the current literature of each device in the superficial femoral artery.


Assuntos
Angioplastia com Balão/instrumentação , Aterectomia/instrumentação , Fármacos Cardiovasculares/administração & dosagem , Stents Farmacológicos , Artéria Femoral , Litotripsia/instrumentação , Doença Arterial Periférica/terapia , Dispositivos de Acesso Vascular , Angioplastia com Balão/efeitos adversos , Aterectomia/efeitos adversos , Fármacos Cardiovasculares/efeitos adversos , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Litotripsia/efeitos adversos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Desenho de Prótese , Fatores de Risco , Resultado do Tratamento , Grau de Desobstrução Vascular
6.
J Urol ; 202(5): 986-993, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31112104

RESUMO

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


Assuntos
Cálculos Renais/terapia , Litotripsia/métodos , Feminino , Seguimentos , Hematoma/epidemiologia , Hematoma/etiologia , Hong Kong/epidemiologia , Humanos , Incidência , Rim/irrigação sanguínea , Cálculos Renais/diagnóstico , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
Int Urol Nephrol ; 51(6): 931-936, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30989563

RESUMO

OBJECTIVE: To evaluate efficiency and safety of adjunct tamsulosin and mirabegron therapy before semi-rigid ureteroscopy for ureteral stones. MATERIALS AND METHODS: In this prospective, randomized, single-blind and multicentric study, participants were randomized into three groups. Group 1 was the control, participants in Group 2 used tamsulosin, and those in Group 3 used mirabegron. Operations were performed 7 days after drug administration. In all clinics, a 6/7.5-Fr ureteroscope with a laser power source for lithotripsy was used. RESULTS: After excluding participants whose stones spontaneously passed, who discontinued medication due to adverse events and who were lost to follow-up, 186 participants were included in the final analysis. Mean age, gender, laterality, stone distribution and mean stone surface area were similar between groups. The number of participants requiring balloon dilatation was higher in the control group (23.8%) than in the tamsulosin (8.2%) and mirabegron (6.5%) groups (p = 0.006). Successful access rate was lower in the control group (81%) than in the tamsulosin (96.7%) and mirabegron (95.2%) groups (p = 0.003). Stone-free rate was lower in the control group (77.8%) than in the tamsulosin (90.2%) and mirabegron (95.2%) groups (p = 0.01). Complication rates were similar among groups. CONCLUSIONS: Tamsulosin or mirabegron use for 1 week before semi-rigid ureteroscope increases stone access and the stone-free rate. Tamsulosin or mirabegron can be used with safety and efficacy before ureteroscopy for ureteral stones.


Assuntos
Acetanilidas/uso terapêutico , Litotripsia/métodos , Tansulosina/uso terapêutico , Tiazóis/uso terapêutico , Cálculos Ureterais/terapia , Ureteroscopia , Agentes Urológicos/uso terapêutico , Acetanilidas/efeitos adversos , Adulto , Terapia Combinada , Feminino , Humanos , Litotripsia/efeitos adversos , Masculino , Estudos Prospectivos , Método Simples-Cego , Tansulosina/efeitos adversos , Tiazóis/efeitos adversos , Resultado do Tratamento , Ureteroscopia/efeitos adversos
8.
Medicina (Kaunas) ; 55(3)2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30813602

RESUMO

Background and Objectives: Remained or forgotten ureteral double-J stents may cause serious complications. Removing of an encrusted, forgotten stent can be challenging. We present our experience with heavily encrusted ureteral stents and discuss the endourologic treatment options as well as their effectivity. Materials and Methods: Eleven men and six women (mean 48.58 ± 14.48 years of age) with 18 encrusted forgotten stents (mean 16.4 ± 13.25 months of indwelling) were treated at our clinic. All patients underwent the operation after negative urine cultures were obtained. Their medical records were retrospectively reviewed and analyzed in terms of number of interventions required to remove the stent, operation time, complications, hospital stay and stone-free rate. Results: According to the Forgotten-Encrusted-Calcified (FECal) classification, the most common form of stent encrustation was grade III (64.7%) and 17.6% of the stents were fragmented. Four of 17 patients were initially treated with extracorporeal shock-wave lithotripsy. The patients required a mean of two endoscopic interventions for removing the encrusted stent and all stents were removed endoscopically in a single session. The mean operating time was 63.3 ± 41.8 minutes. Cystolithotripsy followed by ureteroscopy was the most common intervention (41.1%). Of the 17 patients, peroperative and postoperative complications were Clavien grade I in two, grade II in two and grade IIIb in one. The mean hospital stay was 1.3 ± 0.99 days. All patients were stone-free after a month of stent removal. Conclusions: The endourological removal of the encrusted forgotten stents in a single session is feasible and effective with a minimal morbidity. The treatment strategy should be to minimize the number of interventions.


Assuntos
Remoção de Dispositivo/efeitos adversos , Corpos Estranhos/cirurgia , Corpos Estranhos/terapia , Litotripsia/efeitos adversos , Nefrolitotomia Percutânea/efeitos adversos , Stents/efeitos adversos , Ureter/cirurgia , Ureteroscopia/efeitos adversos , Adulto , Idoso , Estudos de Viabilidade , Feminino , Corpos Estranhos/diagnóstico por imagem , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Stents/classificação , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ureter/diagnóstico por imagem , Cálculos Urinários/cirurgia , Adulto Jovem
9.
Medicine (Baltimore) ; 98(11): e14535, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30882621

RESUMO

To assess the clinical effect of miniaturized percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy lithotripsy (FURL) for the treatment of renal and proximal ureteral calculi of ≤2 cm.A retrospective analysis was carried out on clinical data of 106 patients with kidney or upper urethral calculi. Among these patients, 58 underwent the MPCNL, and 48 received FURL. Stone-free rates, operating time, blood loss, hemoglobin drop, length of hospital stay, complications, and renal damage indexes were compared.The stone removal rates of the FURL and MPCNL groups were 81.25% versus 87.93% (p > .05). Although operating time was significantly shorter in the MPCNL group, hospital stays were significantly shorter in the FURL group. In addition, pooled analysis showed that mean estimated blood loss was significantly higher in the PCNL group but the hemoglobin decline of the FURL group and PCNL group had no significant difference. The PCNL group had no significant difference in complications compared to the FURL group. Differences on the creatinine levels and urea nitrogen levels before the operation and after the operation were not statistically significant.FURL is an effective method for treating renal stone. FURL not only had a similar stone-free rate as compared to MPCNL but also was associated with less blood loss and more favorable recovery time. However, FURL had a longer operative time.


Assuntos
Cálculos Renais/cirurgia , Litotripsia/métodos , Nefrolitotomia Percutânea , Cálculos Ureterais/cirurgia , Ureteroscopia , Adulto , Idoso , Perda Sanguínea Cirúrgica , Feminino , Humanos , Cálculos Renais/patologia , Tempo de Internação , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cálculos Ureterais/patologia , Ureteroscopia/efeitos adversos
10.
PLoS One ; 14(2): e0211316, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30789937

RESUMO

OBJECTIVES: To perform a systematic review and network meta-analysis comparing stone-free rates following retrograde intrarenal surgery (RIRS), extracorporeal shock wave lithotripsy (SWL), and percutaneous nephrolithotomy (PCNL) treatments of renal stones. MATERIALS AND METHODS: Clinical trials comparing RIRS, SWL, and PCNL for treatment of renal stones were identified from electronic databases. Stone-free rates for the procedures were compared by qualitative and quantitative syntheses (meta-analyses). Outcome variables are shown as risk ratios (ORs) with 95% credible intervals (CIs). RESULTS: A total of 35 studies were included in this network meta-analysis of success and stone-free rates following three different treatments of renal stones. Six studies compared PCNL versus SWL, ten studies compared PCNL versus RIRS, fourteen studies compared RIRS versus SWL, and five studies compared PCNL, SWL, and RIRS. The quality scores within subscales were relatively low-risk. Network meta-analyses indicated that stone-free rates of RIRS (OR 0.38; 95% CI 0.22-0.64) and SWL (OR 0.12; 95% CI 0.067-0.19) were lower than that of PCNL. In addition, stone-free rate of SWL was lower than that of RIRS (OR 0.31; 95% CI 0.20-0.47). Stone free rate of PCNL was also superior to RIRS in subgroup analyses including ≥ 2 cm stone (OR 4.680; 95% CI 2.873-8.106), lower pole stone (OR 1.984; 95% CI 1.043-2.849), and randomized studies (OR 2.219; 95% CI 1.348-4.009). In rank-probability test, PCNL was ranked as No. 1 and SWL was ranked as No. 3. CONCLUSIONS: PCNL showed the highest success and stone-free rate in the surgical treatment of renal stones. In contrast, SWL had the lowest success and stone-free rate.


Assuntos
Cálculos Renais/cirurgia , Litotripsia , Nefrolitotomia Percutânea , Nefrostomia Percutânea , Humanos , Cálculos Renais/patologia , Litotripsia/efeitos adversos , Nefrolitotomia Percutânea/efeitos adversos , Nefrostomia Percutânea/efeitos adversos , Razão de Chances , Complicações Pós-Operatórias , Resultado do Tratamento
11.
BMJ Case Rep ; 12(2)2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30709885

RESUMO

We present our experience of two cases: one of a 28-year-old male patient who presented with recurrent episodes of urinary tract infection (UTI) with passage of pus flakes in urine and a history of open cystolithotomy about 10 months ago. The second patient was a 26-year-old woman who underwent bladder exploration for a retained Double-J stent about 10 months ago and presented with recurrent UTI. The first case was treated with open surgery and in the second case, the gauze piece was retrieved endoscopically.


Assuntos
Corpos Estranhos/complicações , Litotripsia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Stents/efeitos adversos , Infecções Urinárias/etiologia , Adulto , Lista de Checagem , Feminino , Humanos , Masculino , Ureter/cirurgia , Bexiga Urinária/cirurgia , Cálculos da Bexiga Urinária/cirurgia
12.
Digestion ; 100(1): 55-63, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30605901

RESUMO

BACKGROUND/AIMS: Our study aimed to evaluate the effect of oral litholysis in patients with chronic calcific pancreatitis (CCP) unresponsive to or ineligible for extracorporeal shock wave lithotripsy (ESWL) and endoscopic therapy. METHODS: Trimethadione, an antiepileptic agent, was administered orally at a dose of 0.6-0.9 g/day to 15 patients with this condition. Treatment outcome was evaluated by assessment of dissolution of the pancreatic stones on plain X-ray films and computed tomography scans of the upper abdomen. Plasma glucose, hemoglobin A1c, and body mass index (BMI) were also monitored throughout the therapy. RESULTS: Litholysis was observed in 13 out of 15 patients (86.7%) and was definite in 10 and partial in 3. Six patients had pancreatitis attacks during the therapy; 5 of whom showed definite litholysis and had only 1 mild attack. Of the 11 patients with normal or impaired glucose tolerance at baseline, none developed diabetes mellitus and all showed litholysis. BMI significantly increased in patients whose pancreatic stones dissolved. There was no vital organ impairment by trimethadione. CONCLUSION: Oral litholysis using trimethadione may represent a noninvasive and effective complementary treatment in patients with CCP unresponsive to or ineligible for ESWL and endoscopic therapy.


Assuntos
Cálculos/terapia , Pancreatite Crônica/terapia , Trimetadiona/administração & dosagem , Administração Oral , Adulto , Idoso , Carbonato de Cálcio/química , Cálculos/química , Cálculos/etiologia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia por Ressonância Magnética , Feminino , Humanos , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Ductos Pancreáticos/diagnóstico por imagem , Pancreatite Crônica/complicações , Pancreatite Crônica/diagnóstico por imagem , Recidiva , Resultado do Tratamento , Trimetadiona/efeitos adversos
13.
Int Urol Nephrol ; 51(2): 239-245, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30604235

RESUMO

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


Assuntos
Cálculos Renais , Rim/diagnóstico por imagem , Litotripsia , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Japão/epidemiologia , Cálculos Renais/diagnóstico , Cálculos Renais/epidemiologia , Cálculos Renais/terapia , Litotripsia/efeitos adversos , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Projetos de Pesquisa , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
14.
Asian J Endosc Surg ; 12(3): 341-343, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30239133

RESUMO

Renal arteriovenous fistula (AVF) is a rare but potentially severe and life-threatening entity. It can occur after various invasive renal interventions, including resection of a localized renal tumor, renal biopsy, percutaneous renal surgery, and even blunt injury of the kidney. The time of clinical presentation of a renal AVF is variable and may occur decades after the injury originally occurred. Here, we report a case of renal AVF induced by extracorporeal shock wave lithotripsy 11 years earlier in an asymptomatic 72-year-old woman. Given the patient's pre-existing hemodialysis dependence, retroperitoneoscopic nephrectomy was performed. On the basis of patient's clinical history, the location of the renal AVF, and the pathological diagnosis, we suggested that renal AVF was a late consequence of the injury to the intrarenal vessels induced by extracorporeal shock wave lithotripsy.


Assuntos
Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/cirurgia , Cálculos Renais/terapia , Litotripsia/efeitos adversos , Nefrectomia , Artéria Renal , Idoso , Feminino , Humanos
15.
J Laparoendosc Adv Surg Tech A ; 29(5): 627-630, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30418090

RESUMO

Background: The prevalence of urolithiasis is nearly 20% and patients with urolithiasis constitute an essential part of the patients referred to the urology clinic. Many parameters should be considered for the management of renal stones and authors recommend extracorporeal shockwave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), and percutaneous nephrolithotripsy (PNL), as treatment options. Among these techniques, SWL does not require general anesthesia, has 89% success rate for renal pelvic stones: 83% for upper caliceal stones, 84% for middle caliceal stones, and 68% for lower caliceal stones. In this study, we aimed to investigate whether the previously failed SWL treatment affects RIRS outcome. Methods: Patients who underwent RIRS for kidney stones between January 2012 and December 2017 in Diskapi Yildirim Beyazit Training and Research Hospital were reviewed retrospectively. Patients treated with primary RIRS (186 patients) were classified as Group 1. The outcomes of these patients were compared with those of 186 patients who underwent RIRS after failed SWL treatment using matched-pair analysis, and these patients were classified as Group 2. Results: The procedure success was defined as the sum of the stone-free and clinically insignificant residual fragments (CIRFs); final success rates were 90.3% and 91.9%, respectively. If we compare the final success rates, there was no statistically significant difference between both groups (P = .584). Conclusions: As a result, there is no negative effect of the previous unsuccessful SWL treatment on the RIRS success. Patients with CIRF should be followed up more carefully in terms of becoming symptomatic.


Assuntos
Instituições de Assistência Ambulatorial , Anestesia Geral , Cálculos Renais/cirurgia , Cálculos Renais/terapia , Litotripsia/efeitos adversos , Adulto , Idoso , Cistoscopia , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
16.
J Gastroenterol Hepatol ; 34(2): 466-473, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30552715

RESUMO

BACKGROUND AND AIM: Pancreatic extracorporeal shock wave lithotripsy (P-ESWL) is a first-line treatment for chronic pancreatitis (CP) patients with pancreatic stones. However, the performance of P-EWSL in geriatric patients remains unclear. We aimed to evaluate the safety and efficacy of P-ESWL for them. METHODS: This prospective study was conducted in painful CP patients who underwent P-ESWL. Patients aged over 65 years were included in geriatric group; patients aged under 65 years were assigned to control group. For the long-term follow-up investigation, geriatric patients were matched with patients from the control group in a 1:1 ratio. Primary outcomes were complications of P-ESWL and pain relief. Secondary outcomes included stone clearance, physical and mental health, quality of life score, changes in exocrine and endocrine pancreatic function, and survival. RESULTS: From March 2011 to March 2016, P-ESWL was performed in 1404 patients (72 in the geriatric group and 1332 in the control group). No significant differences were observed in complications of P-ESWL between the two groups (P = 0.364). Among the 67 (67/72, 93.1%) geriatric patients who underwent follow up for 4.02 years, complete pain relief was achieved in 53 patients, which was not significantly different from that of matched controls (54/70; P = 0.920). The death in the geriatrics was significantly higher (P = 0.007), but none of them were correlated with P-ESWL. CONCLUSIONS: P-ESWL is safe and effective for geriatric CP patients with pancreatic stones. It can promote significant pain relief and stone clearance and improve quality of life and mental and physical health.


Assuntos
Cálculos/terapia , Litotripsia , Pancreatite Crônica/terapia , Adulto , Fatores Etários , Idoso , Cálculos/diagnóstico , Feminino , Avaliação Geriátrica , Humanos , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pancreatite Crônica/diagnóstico , Estudos Prospectivos , Qualidade de Vida , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
17.
Urolithiasis ; 47(3): 297-301, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29947994

RESUMO

To assess the safety and efficacy of super-mini percutaneous nephrolithotomy (SMP) in the treatment of symptomatic lower pole renal stones (LPSs) after the failure of shockwave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS), we retrospectively evaluated 44 patients with symptomatic LPSs with previously failed SWL or RIRS and consequently underwent SMP from October 2014 to March 2016. The percutaneous renal access was performed 12-14F with C-arm fluoroscopy or ultrasonographic guidance. Stone disintegration was performed using either Holmium laser or pneumatic lithotripter. Perioperative parameters along with operations were assessed in detail. A total of 44 patients (mean age 49.1 ± 13.7 years) were included in the study. Stone size was 18.4 ± 6.0 mm (range 9-29), operative time was 63.9 ± 32.7 min (range 14-145) and hospital stay was 2.8 ± 1.2 days (range 1-5). The hemoglobin drop was 12.4 ± 8.8 g/L (range 0-31), and no patients required blood transfusion. Complete stone-free status was achieved in 40 (90.9%) patients. Clinically insignificant residual fragments were observed in three (6.8%) patients and only one (2.3%) patient had a 6 mm residual calculus. A total of three minor complications (urinary tract infection, hemorrhage resolved by hemostatics and renal colic requiring analgesics) were observed postoperatively. For symptomatic LPSs after the failure of SWL or RIRS, SMP is a safe and efficient auxiliary option and even might be an alternative to SWL or RIRS, while further considering the stone-free rates and stone-related events.


Assuntos
Cálculos Renais/cirurgia , Litotripsia/efeitos adversos , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Transfusão de Sangue/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Rim/cirurgia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Miniaturização , Nefrolitotomia Percutânea/efeitos adversos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Falha de Tratamento
18.
Urolithiasis ; 47(3): 279-287, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29557487

RESUMO

Transcutaneous electrical acupoint stimulation (TEAS) is an effective analgesic measure. We studied the analgesic effect of TEAS by applying it alone after ureteroscopic lithotripsy, rather than applying it as a supplementary analgesic measure. Participants (n = 120) scheduled to undergo ureteroscopic holmium laser lithotripsy, were enrolled and randomly assigned into Group T (TEAS n = 60) and Group C (Control, n = 60). The participants in Group T were treated with TEAS for postoperative analgesia. TEAS were implemented on bilateral Shenyu (BL23) and Yinlingquan (SP9) at the time backward and the time at 4, 8, 12 h postoperatively. TEAS was re-implemented three times on the target acupoints for the next 2 days. When TEAS failed to meet the analgesic effect, the participants were given tramadol hydrochloride tablets of 100 mg. Participants of Group C were given tramadol hydrochloride tablets for postoperative analgesia. The primary outcome of VAS scores at the time backward (T0), 4 h (T1), 12 h (T2), 24 h (T3), 48 h (T4) postoperatively and the amount of remedy for analgesic consumption within 48 h postoperatively were compared. The secondary outcome of adverse reactions and plasma concentrations of serotonin (5-HT) and substance P (SP) at T0, T1, T2, T3, T4 were detected, respectively. The VAS scores at T1, T2, T3, T4 postoperatively in two groups were lower than T0. Compared to group C, the VAS scores at T1 (3.68 ± 0.68 vs. 4.79 ± 0.82, P = 0.01), T2 (2.64 ± 0.72 vs. 3.92 ± 0.88, P = 0.03), T3 (2.21 ± 0.88 vs. 3.38 ± 0.74, P < 0.01) in Group T were lower, and total remedy of analgesic consumption was significantly lower (127.14 ± 28.46 vs. 415.27 ± 86.37, P < 0.01) within 48 h postoperatively. The plasma concentrations of 5-HT in Group T was lower than Group C at T1 (348.54 ± 138.49 vs. 418.69 ± 124.68, P = 0.03), T2 (324.28 ± 112.73 vs. 398.52 ± 114.53, P < 0.01), T4 (309.64 ± 129.09 vs. 388.46 ± 115.36, P = 0.04) postoperatively and concentrations of SP at T1 (59.38 ± 24.68 vs. 78.93 ± 26.32, P < 0.01), T2 (49.36 ± 25.55 vs. 66.49 ± 23.57, P = 0.02), T3 (42.19 ± 24.36 vs. 64.15 ± 28.16, P = 0.04), T4 (39.26 ± 19.88 vs. 54.64 ± 20.62, P = 0.02) postoperatively were also lower than Group C. Meanwhile, the occurrences of vertigo (6.7 vs. 18.3%, P < 0.01), nausea and vomiting (11.7 vs. 21.7%, P < 0.01), constipation (10.0 vs. 20.0%, P = 0.03) in Group T were also lower. Application of TEAS alone was associated with effective alleviation of postoperative pain, reduction of postoperative analgesics consumption, decrease of plasma concentration of algogenic substance and the incidence of adverse reactions after ureteroscopic lithotripsy.


Assuntos
Litotripsia/efeitos adversos , Manejo da Dor/métodos , Dor Pós-Operatória/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Ureteroscopia/efeitos adversos , Pontos de Acupuntura , Idoso , Analgésicos/administração & dosagem , Feminino , Humanos , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Estimulação Elétrica Nervosa Transcutânea/efeitos adversos , Resultado do Tratamento , Ureteroscopia/métodos
19.
Urolithiasis ; 47(3): 273-278, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29484468

RESUMO

Allograft lithiasis is a rare urologic complication of renal transplantation (RT). Our aim is to present our experience with minimally invasive surgical treatment of allograft lithiasis in our series of live-donor renal transplant recipients. In a retrospective analysis of 3758 consecutive live-donor RTs performed in our center between November 2009 and January 2017, the results of minimally invasive surgery for the treatment of renal graft lithiasis diagnosed at follow-up were evaluated. Twenty-two (0.58%) patients underwent minimally invasive surgery for renal graft lithiasis. The mean age was 41.6 years, and duration between RT and surgical intervention was 27.3 months (range 3-67). The mean stone size was 11.6 mm (range 4-29). Stones were located in the urethra in 1, bladder in 2, ureter in 9, renal pelvis in 7 and calices in 3 patients. Surgical treatment included percutaneous nephrolithotomy in 1, cystoscopic lithotripsy in 3, flexible ureteroscopic lithotripsy in 6 and rigid ureteroscopic lithotripsy in 12 patients. No major complications were observed. One patient (4.5%) who underwent flexible ureteroscopy developed postoperative urinary tract infection. All patients were stone-free except two (9%) patients who required a second-look procedure after flexible ureteroscopic lithotripsy for residual stones. Stone recurrence was not observed in any patient during a mean follow-up duration of 30.2 months (range 8-84). Renal transplant lithiasis is uncommon and minimally invasive surgical treatment is rarely performed for its treatment. Endourological surgery may be performed safely, effectively and with a high success rate in these patients.


Assuntos
Transplante de Rim/efeitos adversos , Litotripsia/efeitos adversos , Nefrolitíase/cirurgia , Nefrolitotomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Adulto , Aloenxertos/patologia , Aloenxertos/cirurgia , Feminino , Seguimentos , Humanos , Rim/patologia , Rim/cirurgia , Litotripsia/instrumentação , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Nefrolitíase/patologia , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscópios , Adulto Jovem
20.
Int J Urol ; 26(2): 172-183, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30575154

RESUMO

Urinary stone disease, or urolithiasis, is a very common disease with increasing prevalence and incidence. With the advancement of endoscopic techniques, the treatment outcomes of ureteroscopy (or transureteral lithotripsy) and percutaneous nephrolithotomy are continuously improving. In recent years, there have been many new developments in the field, including new endoscopy design, more effective auxiliary tools, improvement in treatment protocols, introduction of robotic technology, combining both ureteroscopy and percutaneous nephrolithotomy (endoscopic combined intrarenal surgery or transureteral lithotripsy-assisted percutaneous nephrolithotomy), improvement in laser technology, and so on. All these new inputs will further improve the treatment efficacy and safety of the procedures, thus benefiting our patients. In the present review, we briefly go through the main steps of ureteroscopy and percutaneous nephrolithotomy, with a concise description and application of these new advances.


Assuntos
Litotripsia/métodos , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/prevenção & controle , Ureteroscopia/métodos , Urolitíase/terapia , Humanos , Litotripsia/efeitos adversos , Litotripsia/instrumentação , Litotripsia/tendências , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/tendências , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Ureteroscopia/efeitos adversos , Ureteroscopia/instrumentação , Ureteroscopia/tendências
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