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1.
J Ayub Med Coll Abbottabad ; 31(3): 351-354, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31535504

RESUMO

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


Assuntos
Cálculos Renais/terapia , Litotripsia , Humanos , Litotripsia/instrumentação , Litotripsia/métodos , Litotripsia/estatística & dados numéricos , Catar , Stents , Resultado do Tratamento
2.
Urology ; 133: 103-108, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31377258

RESUMO

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


Assuntos
Cálculos Renais/terapia , Litotripsia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino , Medicare , Estados Unidos
3.
Arch Ital Urol Androl ; 91(2)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266277

RESUMO

OBJECTIVES: The present study was carried out to evaluate the effectiveness of medical therapy with potassium citrate in preventing calculosis complicating Medullary Sponge Kidney (MSK) without renal acidification defects. MATERIALS AND METHODS: In a open, uncontrolled, retrospective analysis, 49 MSK patients with nephrolithiasis without renal tubular acidosis, underwent a complete metabolic evaluation and received potassium citrate therapy 4-6 g/day. The course of stone disease before and after citrate therapy was determined in each patient from a combination of clinical history, past records, radiographs and kidney ultrasound. The rate of new stone formation/pt/yr, of endourological and extracorporeal procedures, of urinary tract infection (UTI) and number of hospitalization before and after medical treatment were calculated. RESULTS: Metabolic anomalies (hypercalciuria, hypocitraturia, hyperuricuria and hyperoxaluria) were present in 83% of the patients. Follow-up before and after alkali citrate therapy was comparable (4.7+/-1.4 and 4.9+/-1.7 years respectively). Medical treatment significantly reduced rates of stone formation from 2.0+/-1.0 to 0.2+/-0.5 pt/yr, ureteroscopy (URS) from 0.9+/0.8 to 0.4+/-0.5 pt/yr, extratracoporeal lithotripsy (ESWL) from 1.1+/-0.8 to 0.4+/-0.6 pt/yr, urinary tract infections (UTIs) from 0.8+/-1.2 to 0.3+/-0.5 pt/yr and hospitalization from 1.1+/-0.6 to 0.2+/-0.3 pt/yr, p < 0.001. This effect was observed also in MSK patients without metabolic anomalies. In 35 patients the asymptomatic disappearance of calcium stones was also observed. CONCLUSIONS: Our study documents the effectiveness of potassium citrate therapy in preventing neprolithiasis in MSK patients also in the absence of distal tubular acidosis. It suggests that in MSK patients alkali citrate may promote calcium stone dissolution by oral administration.


Assuntos
Cálculos Renais/prevenção & controle , Rim em Esponja Medular/tratamento farmacológico , Nefrolitíase/prevenção & controle , Citrato de Potássio/uso terapêutico , Adolescente , Adulto , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Litotripsia/estatística & dados numéricos , Masculino , Rim em Esponja Medular/fisiopatologia , Pessoa de Meia-Idade , Citrato de Potássio/administração & dosagem , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscopia/estatística & dados numéricos , Infecções Urinárias/epidemiologia , Adulto Jovem
4.
Urolithiasis ; 47(2): 165-170, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29696300

RESUMO

There is a lack of studies looking at the longitudinal follow-up of patients with cystine stones. We wanted to assess the journey of cystinuric patients through our specialist metabolic stone clinic to improve the understanding of episodes, interventions and current outcomes in this patient cohort. After ethical approval, all patients who attended our metabolic stone clinic from 1994 to 2014 with at least one cystine stone episode were included in our study. Data were retrospectively analysed for patient demographics, stone episodes or intervention, clinical parameters and patient compliance. Over a period of 21 years, 16 patients with a median age of 15.5 years underwent a mean follow-up of 8.6 years (1-21 years). The mean number of surgical interventions was 3.1 (1-8/patient), but patients who were stone free after their first treatment had lower recurrences (p = 0.91) and lower number of interventions during their follow-up (2.7/patient, compared to those who were not stone free at 4/patient). During their follow-up period, patients with < 3 interventions had a significantly better renal function than those with ≥ 3 surgical interventions (p = 0.04). Additionally, linear regression analysis showed that eGFR was demonstrated to decline with increasing numbers of stone episodes (r2 = 0.169). It was also noted that patients who began early medical management remained stone free during follow-up compared to those who had medical management after ≥ 2 stone episodes, of whom all had a recurrent episode. Our long-term longitudinal study of cystine stone formers highlights that patients who are stone free and receive early metabolic stone screening and medical management after their initial presentation have the lowest recurrence rates and tend to preserve their renal function. Hence, prompt referral for metabolic assessment, and the stone and fragments entirely removed (SaFER) principles are key to preventing stone episodes and improving long-term function.


Assuntos
Cistinúria/metabolismo , Cálculos Renais/cirurgia , Litotripsia/estatística & dados numéricos , Nefrolitotomia Percutânea/estatística & dados numéricos , Ureteroscopia/estatística & dados numéricos , Adolescente , Adulto , Criança , Cistinúria/urina , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Cálculos Renais/epidemiologia , Cálculos Renais/metabolismo , Cálculos Renais/urina , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
5.
BJU Int ; 123(3): 485-492, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30253029

RESUMO

OBJECTIVES: To evaluate the long-term outcomes of patients undergoing observation of asymptomatic renal calculi and identify factors associated with stone-related events. PATIENTS AND METHODS: Patients with asymptomatic renal calculi electing active surveillance of their stones were retrospectively reviewed. Patients underwent annual ultrasonography and clinical visits with standardised questions regarding the development of symptoms or complications from calculi. Spontaneous stone passage, stone growth, development of stone-related symptoms, and requirement for intervention during follow-up were deemed as stone-related events. RESULTS: Between 2007 and 2017, 293 patients were reviewed to evaluate the natural history of asymptomatic renal calculi. The mean follow-up was 4.2 years. Overall incidences of spontaneous passage, stone growth, development of stone-related symptoms, and requirement of intervention were 32.1%, 16.7%, 28.3% and 12.3%, respectively. Stones >5 mm and lower pole stones were significantly less likely to pass spontaneously. Patients with diabetes mellitus (DM), hyperuricaemia or non-lower calyceal stone were more likely to experience stone growth. Stones >5 mm or non-lower pole stones were more likely to become symptomatic. Significant predictors of surgical intervention were stone size (>5 mm) and patients' age (>60 years). Primary therapy was extracorporeal shockwave lithotripsy in 33 patients and flexible ureteroscopy in three. CONCLUSION: The natural history of asymptomatic renal stones rarely requires intervention, although they do have a slightly higher rate of symptomatic events and growth over the intermediate term. In particular, patients with stones >5 mm, DM, hyperuricaemia, or non-lower calyceal stones are at higher risk of developing stone-related events, and should therefore be recommended for regular follow-up.


Assuntos
Cálculos Renais/diagnóstico por imagem , Litotripsia/estatística & dados numéricos , Ultrassonografia , Conduta Expectante , Adulto , Doenças Assintomáticas , Feminino , Seguimentos , Humanos , Cálculos Renais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Tempo
6.
Surg Endosc ; 32(12): 4742-4748, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30298446

RESUMO

BACKGROUND: LTCBDE combined with or without modified techniques is safe and efficacious for the management of gallstones and concomitant, even large, common bile duct (CBD) stones. METHODS: To describe the surgical indications and procedure strategies of laparoscopic transcystic common bile duct exploration (LTCBDE), a retrospective analysis of 205 patients with concomitant gallstones and CBD stones treated using LTCBDE between June 2008 and June 2015 was performed. Clinical data on disease characteristics, methods for cystic duct incision and CBD stone extraction (with or without laser lithotripsy), and surgical outcomes were collected and reviewed. RESULTS: CBD stones were successfully cleared in all patients. No patient was converted to choledochotomy or laparotomy. The cystic duct diameter ranged 3-8 mm, and 85 patients with cystic duct diameter ≥ 5 mm. The mean time for CBD stone extraction was 25.3 min, with the operative time ranged from 63 to 170 min. Lithotripsy was used in 74 (36.1%) patients among which 26 patients with cystic duct diameter ≥ 5 mm. Estimated blood loss during surgery was 10-120 ml per patient, and no intra-operative blood transfusions were needed. The mean postoperative hospital stay was 5.1 (range 3-7) days, and postoperative complications developed in seven patients. No bile duct injury, stricture, remnant, recurrent stones, or other adverse events were observed during the mean follow-up of 8 months. CONCLUSIONS: Based on preoperative MRCP and intra-operative IOC findings about cystic duct diameter, the diameter of CBD, CBD stone size, we summarized and proposed the surgical indications and suitable techniques and strategies during LTCBDE.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar , Ducto Cístico , Cálculos Biliares/cirurgia , Laparoscopia , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Procedimentos Cirúrgicos do Sistema Biliar/métodos , China , Ducto Cístico/patologia , Ducto Cístico/cirurgia , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação , Litotripsia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
J Endourol ; 32(7): 603-607, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29732915

RESUMO

INTRODUCTION: Advances in flexible ureteroscope design and accessory instrumentation have allowed for more challenging cases to be treated ureteroscopically. Here, we evaluate our experience with ureteroscopy (URS) for the management of large renal calculi (≥2 cm) and provide a concise review of recent reports. METHODS: A retrospective review was undertaken of all URS cases between 2004 and 2014 performed by the endourologic team at a single academic tertiary care institution. We identified patients with at least one stone ≥2 cm managed with retrograde URS. Stone size was defined as the largest linear diameter of the index stone. Small diameter flexible ureteroscopes were used primarily with holmium laser. Patient demographics, intraoperative data, and postoperative outcomes were evaluated. RESULTS: We evaluated 167 consecutive patients who underwent URS for large renal stones ≥2 cm. The initial reason for choosing URS included patient preference (29.5%), failure of other therapies (8.2%), anatomic considerations/body habitus (30.3%), and comorbidities (28.8%). Mean patient age was 55.5 years (22-84). The mean stone size was 2.75 cm with mean number of procedures per patient of 1.65 (1-6). The single session stone-free rate was 57.1%, two-stage procedure stone-free rate was 90.2% and three-stage stone-free rate was 94.0%. Access sheaths were used in 47% of patients. An association was identified between stone size and patient outcomes; smaller stones correlated with decreased number of procedures. Postoperative complications were minor. CONCLUSIONS: Single or multi-stage retrograde ureteroscopic lithotripsy is a safe and effective mode of surgical management of large renal calculi. Total stone burden is a reliable predictor of the need for a staged procedure and of stone-free rate.


Assuntos
Cálculos Renais/cirurgia , Litotripsia/estatística & dados numéricos , Ureteroscopia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Cálculos Renais/patologia , Lasers de Estado Sólido , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Ureteroscopia/estatística & dados numéricos , Adulto Jovem
8.
Int J Urol ; 25(4): 373-378, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29648701

RESUMO

OBJECTIVES: To assess epidemiological and chronological trends of upper urinary tract stones in Japan in 2015. METHODS: Patients with a first episode of upper urinary tract stones in 2015 were enrolled in this nationwide survey. The study included all hospitals approved by the Japanese Board of Urology, therefore covering most of the hospitals where urologists practice in Japan. The annual incidence and composition of urolithiasis were evaluated by age and sex. These results were compared with the previous results of the nationwide surveys from 1965 to 2005 to analyze temporal trends. RESULTS: The estimated annual incidence of a first-episode upper urinary tract stone in 2015 was 137.9 (191.9 in men and 86.9 in women) per 100 000. The estimated age-standardized first-episode upper urinary tract stone incidence in 2015 was 107.8 (150.6 in men and 63.3 in women) per 100 000, which did not represent a significant increase since 2005. An equivalent incidence was observed in patients aged >50 years, whereas a reduced incidence was observed in patients aged <50 years in both sexes. The proportion of patients who received percutaneous nephrolithotomy and/or ureteroscopy increased by approximately fivefold in the past 10 years. CONCLUSIONS: The steady increase in the annual incidence of upper urinary tract stones since 1955 leveled off in 2015. The current results show novel trends in the incidence and treatment modalities in the nationwide surveys of urolithiasis in Japan.


Assuntos
Utilização de Instalações e Serviços/tendências , Hospitais/tendências , Litotripsia/tendências , Nefrolitotomia Percutânea/tendências , Cálculos Urinários/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Hospitais/estatística & dados numéricos , Humanos , Incidência , Lactente , Recém-Nascido , Japão/epidemiologia , Litotripsia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/estatística & dados numéricos , Fatores Sexuais , Inquéritos e Questionários/estatística & dados numéricos , Cálculos Urinários/cirurgia , Adulto Jovem
9.
BJU Int ; 122(2): 263-269, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29675983

RESUMO

OBJECTIVES: To evaluate the outcomes of patients with incidentally detected asymptomatic calyceal stones on active surveillance, and to identify risk factors for stone-related adverse events (AEs). PATIENTS AND METHODS: In this retrospective case series, we identified all renal units with non-contrast computed tomography diagnosed asymptomatic calyceal stones in a single reference centre between August 2005 and August 2016. Primary endpoints were spontaneous stone passage and need for stone-related surgical intervention. The secondary endpoints were stone-related symptoms and AEs. Cox proportional hazards models were used. RESULTS: We identified 301 renal units from 238 adult patients. The median average age of the study group was 56 years, with two-thirds consisting of males. The mean average cumulative stone size was 10.8 mm. At the end of the study, 58.8% of renal units with stones remained on surveillance with a median follow-up of 63 months. Overall, 26.6% of patients proceeded to surgical intervention with the majority secondary to pain with no stone relocation (30%) or stone relocation to the ureter with or without pain (25%). Over the 5-year period, 14.6% of stones passed spontaneously. On analysis of the secondary endpoints, 39.5% had a stone-related AE (either symptoms and/or need for surgical intervention). Younger patients (aged <50 years), and those with stone growth >1 mm annually were significantly more likely to have an AE (P = 0.012 and P = 0.006, respectively). The risk of an AE during surveillance at 1, 3, and 5 years was 3.4%, 18.9%, and 30.7% respectively. CONCLUSIONS: Long-term conservative approaches for asymptomatic renal stones are an effective management option with ~60% of renal units remaining on active surveillance in >5 years of follow-up. Appropriate counselling with careful patient selection is advocated, as younger patients and those with evidence of stone growth were found to be at greatest risk of an adverse outcome.


Assuntos
Cálculos Renais/patologia , Cálculos Ureterais/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Achados Incidentais , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/terapia , Litotripsia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/estatística & dados numéricos , Remissão Espontânea , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Cálculos Ureterais/diagnóstico por imagem , Cálculos Ureterais/terapia , Ureteroscopia/estatística & dados numéricos , Conduta Expectante/estatística & dados numéricos , Adulto Jovem
10.
J Urol ; 199(5): 1277-1282, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29180300

RESUMO

PURPOSE: To help rein in surgical spending there is growing interest in the application of payment bundles to common outpatient procedures like ureteroscopy and shock wave lithotripsy. However, before urologists can move to such a payment system they need to know where episode costs are concentrated. MATERIALS AND METHODS: Using claims data from Michigan Value Collaborative we identified patients who underwent ureteroscopy or shock wave lithotripsy at hospitals in Michigan from 2012 to 2015. We then totaled expenditures for all relevant services during the 30-day surgical episodes of these patients and categorized component payments (ie those for the index procedure, subsequent hospitalizations, professional services and postacute care). Finally we quantified the variation in total episode expenditures for ureteroscopy and shock wave lithotripsy across hospitals, examining drivers of this variation. RESULTS: A total of 9,449 ureteroscopy and 6,446 shock wave lithotripsy procedures were performed at 62 hospitals. Among these hospitals there was threefold variation in ureteroscopy and shock wave lithotripsy spending. The index procedure accounted for the largest payment difference between high vs low cost hospitals (ureteroscopy $7,936 vs $4,995 and shock wave lithotripsy $4,832 vs $3,207, each p <0.01), followed by payments for postacute care (ureteroscopy $2,207 vs $1,711 and shock wave lithotripsy $2,138 vs $1,104, each p <0.01). Across hospitals the index procedure explained 68% and 44% of the variation in episode spending for ureteroscopy and shock wave lithotripsy, and postacute care payments explained 15% and 28%, respectively. CONCLUSIONS: There exists substantial variation in ambulatory surgical spending across Michigan hospitals for urinary stone episodes. Most of this variation can be explained by payment differences for the index procedure and for postacute care services.


Assuntos
Assistência Ambulatorial/economia , Custos e Análise de Custo/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Cálculos Urinários/cirurgia , Assistência Ambulatorial/métodos , Assistência Ambulatorial/estatística & dados numéricos , Gastos em Saúde/tendências , Humanos , Litotripsia/economia , Litotripsia/métodos , Litotripsia/estatística & dados numéricos , Michigan , Ureteroscopia/economia , Ureteroscopia/métodos , Ureteroscopia/estatística & dados numéricos , Cálculos Urinários/economia
11.
J Endourol ; 32(4): 297-303, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29256629

RESUMO

INTRODUCTION: Retropulsion, defined as unintended migration of a stone under the influence of the fragmentation device in ureteroscopy (URS) procedures, occurs in 2% to 60% of the cases. Antiretropulsive devices (ARDs) have been studied in experimental and small clinical studies. The current study aims at describing the worldwide usage of ARD and the outcomes related to their usage. METHODS: The Clinical Research Office of the Endourological Society URS Global Study enrolled 11,885 patients who underwent URS and stone fragmentation for ureteral and/or renal stones. Of the 11,885 treated patients, 9877 were treated for ureteral stones, and data were available on stone migration and ARD use. RESULTS: Of all procedures, 14.5% were performed with the use of an ARD. Less stone migration (-2.0%; p = 0.050), higher stone-free rates (SFRs) (2.8%; p < 0.001), and shorter length of stay (-4.7%; p = 0.001) were observed in the antiretropulsive group. CONCLUSIONS: When an ARD is used during URS, less migration, higher SFRs, and shorter length of hospital stay are observed. This effect is independent from baseline differences and corrected for other treatment characteristics.


Assuntos
Saúde Global/estatística & dados numéricos , Complicações Intraoperatórias/prevenção & controle , Cálculos Renais/cirurgia , Litotripsia/métodos , Cálculos Ureterais/cirurgia , Ureteroscopia/métodos , Idoso , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Tempo de Internação , Litotripsia/efeitos adversos , Litotripsia/instrumentação , Litotripsia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sociedades Médicas , Resultado do Tratamento , Ureteroscopia/instrumentação
12.
Urolithiasis ; 46(4): 357-361, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28608037

RESUMO

The purpose of the study was to present our experience of retaining encrusted ureteral stents (EUS) and discuss the effectiveness of 4.5/6.5F ureteroscope (URS) in the procedure. The data of patients with EUS in our center from January 2012 to December 2016 were retrospectively analyzed. The inclusion criterion was ureteral stents that required intervention above the ureteral orifice to retain and was proved to be encrusted. Impacted stents would be removed by ureteroscope lithotripsy (URL) via 8/9.8F or 4.5/6.5F URS. Percutaneous nephrolithotomy (PCNL) then be the further step if URL failed. 46 cases of EUS were treated in 36 patients from January 2012 to December 2016 in our institution. All subjects consisted of 18 males and 18 females; the average age was 49.81 ± 16.40 years (range 5-86). The mean time from stent insertion to encrustation was 9.28 ± 17.15 months (range 1-120). URL was performed in 44 cases (95.7%), including 19 cases (41.3%) by 8/9.8F URS and 25 cases (54.4%) by 4.5/6.5F URS due to the conventional URS's failure to get into ureteral orifice or further part of ureter. Two patients (4.3%) underwent PCNL due to the inseparable circle developed by the intra-renal segment of encrusted stents. None of the patients underwent extracorporeal shock wave lithotripsy (ESWL) and open surgery. All stents were eventually removed without blood transfusion or ureteral injury, except three cases with post-operative fever. All procedures were performed under one-session anesthesia. URL by 4.5/6.5F ureteroscope might increase the success rate of retaining encrusted ureteral stents remarkably, and then reduce the possibility of PCNL effectively.


Assuntos
Remoção de Dispositivo/métodos , Litotripsia/métodos , Complicações Pós-Operatórias/epidemiologia , Stents/efeitos adversos , Ureteroscopia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/instrumentação , Remoção de Dispositivo/estatística & dados numéricos , Feminino , Humanos , Litotripsia/efeitos adversos , Litotripsia/instrumentação , Litotripsia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Falha de Tratamento , Ureter/cirurgia , Ureteroscópios/efeitos adversos , Ureteroscópios/estatística & dados numéricos , Ureteroscopia/efeitos adversos , Ureteroscopia/instrumentação , Ureteroscopia/estatística & dados numéricos , Adulto Jovem
13.
Actas Urol Esp ; 42(1): 33-41, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28587845

RESUMO

OBJECTIVE: To describe the trends in the current management of urolithiasis in the Confederación Americana de Urología (CAU) setting to recognise patterns of clinical practice and identify educational needs. MATERIAL AND METHOD: An online survey was created with 31 multiple-choice questions (Spanish and Portuguese) through www.caunet.org, which revealed demographic data, patterns of clinical practice and approaches for specific clinical conditions. RESULTS: A total of 463 practitioners from Brazil, Mexico, Argentina, Spain, Colombia, Chile and other countries (3.96% of the members of CAU) completed the survey. All participants performed some type of urolithiasis treatment: 98.5% performed semirigid ureteroscopy (URS), 83.8% performed percutaneous nephrolithotomy (PCNL), 78.2% performed flexible URS, and 67.2% performed extracorporeal lithotripsy. The youngest physicians tended to perform PCNL (P<.001), and the proportion of users of flexible URS was greater in the Portuguese countries (P=.037). The main energy source was laser (60.7%). Small-calibre PCNL was performed by 15.3% of the respondents, more often in university hospitals (P<.01) and by older practitioners (P<.01). Only 3.2% of the respondents used percutaneous access to the kidney guided exclusively by ultrasound, especially the older practitioners (P<.001). The supine position was used by 40.4% of the respondents, more often in Spain (P<.001) and in the university setting (P=.017). PCNL without nephrostomy was practiced by 3.9% of the respondents. For flexible URS, 19.2% of the respondents did not use ureteral access sheaths, and the older practitioners preferred thinner calibre sheaths (P<.001). CONCLUSIONS: The management of lithiasis in the CAU setting follows a profile similar to that recognised in the European and American clinical guidelines, although there are interesting variations based on the practitioner's age and preferences. We identified potential areas for improvement in small-calibre PCNL and ultrasound-guided puncture.


Assuntos
Pesquisas sobre Serviços de Saúde , Urolitíase/terapia , Urologia/tendências , Gerenciamento Clínico , Humanos , América Latina/epidemiologia , Litotripsia/métodos , Litotripsia/estatística & dados numéricos , Nefrolitotomia Percutânea/estatística & dados numéricos , Portugal/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Utilização de Procedimentos e Técnicas , Sociedades Médicas , Espanha/epidemiologia , Ureteroscopia/métodos , Ureteroscopia/estatística & dados numéricos , Urolitíase/epidemiologia , Urolitíase/cirurgia , Urologia/métodos
14.
Hypertension ; 70(4): 721-728, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28827478

RESUMO

Although shock wave lithotripsy is minimally invasive, earlier studies argued that it may increase patients' subsequent risk of hypertension and diabetes mellitus. This study evaluated the association between shock wave lithotripsy and new-onset hypertension or diabetes mellitus. The Taiwanese National Health Insurance Research Database was used to identify 20 219 patients aged 18 to 65 years who underwent the first stone surgical treatment (shock wave lithotripsy or ureterorenoscopic lithotripsy) between January 1999 and December 2011. A Cox proportional model was applied to evaluate associations. Time-varying Cox models were applied to evaluate the association between the number of shock wave lithotripsy sessions and the incidence of hypertension or diabetes mellitus. After a median follow-up of 74.9 and 82.6 months, 2028 and 688 patients developed hypertension in the shock wave lithotripsy and ureterorenoscopic lithotripsy groups, respectively. Patients who underwent shock wave lithotripsy had a higher probability of developing hypertension than patients who underwent ureterorenoscopic lithotripsy, with a hazard ratio of 1.20 (95% confidence interval, 1.10-1.31) after adjusting for covariates. The risk increased as the number of shock wave lithotripsy sessions increased. However, the diabetes mellitus risk was similar in the shock wave lithotripsy and ureterorenoscopic lithotripsy groups. Furthermore, the hazard ratio did not increase as the number of shock wave lithotripsy sessions increased. Shock wave lithotripsy consistently increased the incidence of hypertension on long-term follow-up. Therefore, alternatives to urolithiasis treatment (eg, endoscopic surgery or medical expulsion therapy) could avoid the hypertension risk. Furthermore, avoiding multiple sessions of shock wave lithotripsy could also evade the hypertension risk.


Assuntos
Hipertensão , Litotripsia , Efeitos Adversos de Longa Duração/prevenção & controle , Urolitíase/terapia , Adulto , Feminino , Seguimentos , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/etiologia , Incidência , Litotripsia/efeitos adversos , Litotripsia/métodos , Litotripsia/estatística & dados numéricos , Efeitos Adversos de Longa Duração/diagnóstico , Masculino , Pessoa de Meia-Idade , Serviços Preventivos de Saúde/métodos , Modelos de Riscos Proporcionais , Fatores de Risco , Taiwan/epidemiologia
15.
Urolithiasis ; 45(6): 563-572, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28233025

RESUMO

OBJECTIVE: To analyze the current evidence on the use of ureteroscopy (URS) and extracorporeal shock wave lithotripsy (ESWL) for the management of obstructing ureteral stones in emergent setting. METHODS: A systematic literature review was performed up to June 2016 using Pubmed and Ovid databases to identify pertinent studies. The PRISMA criteria were followed for article selection. Separate searches were done using a combinations of several search terms: "laser lithotripsy", "ureteroscopy", "extracorporeal shock wave lithotripsy", "ESWL", "rapid", "immediate", "early", "delayed", "late", "ureteral stones", "kidney stones", "renal stones". Only titles related to emergent/rapid/immediate/early (as viably defined in each study) versus delayed/late treatment of ureteral stones with either URS and/or ESWL were considered for screening. Demographics and operative outcomes were compared between emergent and delayed lithotripsy. RevMan review manager software was used to perform data analysis. RESULTS: Four studies comparing emergent (n = 526) versus delayed (n = 987) URS and six studies comparing emergent (n = 356) versus delayed (n = 355) SWL were included in the analysis. Emergent URS did not show any significant difference in terms of stone-free rate (91.2 versus 90.9%; OR 1.04; CI 0.71, 1.52; p = 0.84), complication rate (8.7% for emergent versus 11.5% for delayed; OR 0.94; CI 0.65, 1.36; p = 0.74) and need for auxiliary procedures (OR 0.85; CI 0.42, 1.7; p = 0.85) when compared to delayed URS. Emergent ESWL was associated with a higher likelihood of stone free status (OR 2.2; CI 1.55, 3.17; p < 0.001) and a lower likelihood of need for auxiliary maneuvers (OR 0.49; CI 0.33, 0.72; p < 0.001) than the delayed procedure. No differences in complication rates were noticed between the emergent and delayed ESWL (p = 0.37). CONCLUSIONS: Emergent lithotripsy, either ureteroscopic or extracorporeal, can be offered as an effective and safe treatment for patients with symptomatic ureteral stone. If amenable to ESWL, based on stone and patient characteristics, an emergent approach should be strongly considered. Ureteroscopy in the emergent setting is mostly reserved for distally located stones. The implementation of these therapeutic approaches is likely to be dictated by their availability.


Assuntos
Litotripsia/métodos , Cálculos Ureterais/terapia , Obstrução Ureteral/terapia , Ureteroscopia/métodos , Adulto , Emergências , Feminino , Humanos , Litotripsia/efeitos adversos , Litotripsia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Cálculos Ureterais/complicações , Obstrução Ureteral/etiologia , Ureteroscopia/efeitos adversos , Ureteroscopia/estatística & dados numéricos
16.
Arch. esp. urol. (Ed. impr.) ; 70(1): 147-154, ene.-feb. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-160329

RESUMO

Objetivo: El objetivo del siguiente trabajo es mostrar la situación actual en lo referente a dos técnicas quirúrgicas para el tratamiento de la litiasis renal, CRIR (Cirugia Retrógrada Intrarrenal) y NLPC (Nefrolitotomía Percutánea), sobre todo en lo referente a litiasis de mayor tamaño. Para ello revisamos la literatura al respecto y añadimos la experiencia de nuestro centro en relación a ambas técnicas. Por otro lado, también se analiza el papel de CRIR frente a técnicas percutáneas en litiasis de menor tamaño. Métodos: Revisión de los resultados descritos en la literatura y la experiencia de nuestro centro. Ofrecemos nuestra opinión en base a esta revisión y experiencia propia, en lo referente a las indicaciones de la CRIR en estos casos. Resultados/conclusiones: La CRIR es una técnica segura y eficaz, con una tasa de éxito similar a NLPC si se asume la posibilidad de retratamiento en litiasis >2cm. Su baja tasa de complicaciones, la rápida recuperación postoperatoria y la corta estancia hospitalaria hacen de esta técnica una alternativa terapéutica a la NLPC en este tipo de pacientes. En comparación con técnicas percutáneas de menor invasividad que los accesos clásicos de 24 ó 30 Ch. (mini o microPERC), la CRIR ofrece una mayor tasa libre de litiasis que estas técnicas. Si además, consideramos que la CRIR se acompaña de menor estancia hospitalaria, riesgo de sangrado, aún sin encontrar diferencias significativas en la tasa de complicaciones globales, podríamos considerar la CRIR como tratamiento endourológico de primera línea en las litiasis <2cm (AU)


Objectives: The objective of this article is to show the current situation regarding two surgical techniques for the treatment of renal lithiasis, RIRS (Retrograde intrarenal surgery) and PCNL (Percutaneous nephrolithotomy), specially concerning the larger size stones. We perform a literature review on the topic and add the experience with both techniques at our center. Besides, we also analyze the role of RIRS in comparison with the percutaneous techniques in smaller size lithiasis. Methods: We review the results obtained in the literature and our experience. We offer our opinion in reference to the indications of RIRS in these cases based on such review and our experience. Results/conclusions: RIRS is a safe and effective technique, with a similar success rate to PCNL if one assumes the possibility of retreatment in stones >2cm. Its low complication rate, fast postoperative recovery and short hospital stay make this technique a therapeutic alternative to PCNL in this type of patients. Compared with percutaneous techniques less invasive than classical 24 to 30 Ch. accesses (miniperc or microperc), RIRS offers a higher stone free rate. If we also consider that RIRS is associated with shorter hospital stay and lower bleeding risk, even without significant differences in the global complication rate we could consider RIRS as the first line endourological treatment in stones <2cm (AU)


Assuntos
Humanos , Nefrostomia Percutânea/estatística & dados numéricos , Litotripsia/estatística & dados numéricos , Endoscopia/estatística & dados numéricos , Nefrolitíase/cirurgia , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
17.
J Endourol ; 31(6): 547-556, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28095709

RESUMO

INTRODUCTION: Numerous studies have reported on regional or national trends of stone disease treatment. However, no article has yet examined the global trends of intervention for stone disease. METHODS AND MATERIALS: A systematic review of articles from 1996 to September 2016 for all English language articles reporting on trends of surgical treatment of stone disease was performed. Authors were contacted in the case of data not being clear. If the authors did not reply, data were estimated from graphs or tables. Results were analyzed using SPSS version 21, and trends were analyzed using linear regression. RESULTS: Our systematic review yielded 120 articles, of which 8 were included in the initial review. This reflected outcomes from six countries with available data: United Kingdom, United States, New Zealand, Australia, Canada, and Brazil. Overall ureteroscopy (URS) had a 251.8% increase in total number of treatments performed with the share of total treatments increasing by 17%. While the share of total treatments for percutaneous nephrolithotomy (PCNL) remained static, the share for extracorporeal shockwave lithotripsy and open surgery fell by 14.5% and 12%, respectively. There was significant linear regression between rising trends of total treatments year on year for URS (p < 0.001). CONCLUSION: In the last two decades, the share of total treatment for urolithiasis across the published literature has increased for URS, stable for PCNL, and decreased for lithotripsy and open surgery.


Assuntos
Urolitíase/epidemiologia , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Saúde Global , Humanos , Litotripsia/estatística & dados numéricos , Nefrolitotomia Percutânea/estatística & dados numéricos , Ureteroscopia/estatística & dados numéricos , Urolitíase/cirurgia , Procedimentos Cirúrgicos Urológicos/tendências
18.
Urolithiasis ; 45(4): 393-399, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27633053

RESUMO

To assess the outcomes of percutaneous nephrolithotomy (PCNL) in bilateral staghorn calculi in pediatric patients, we have performed a retrospective analysis. Staghorn calculus is defined as stone that fills a greater part of the pelvic-caliceal system. Still, in developing countries, patients may present with staghorn calculus. PCNL is the preferred treatment modality for staghorn calculus both in adult and children. Our study included fifty-one pediatric patients (<15 years) of bilateral staghorn calculi from 2004 to 2015. Staged PCNL was done after 2-3 days if needed and opposite side PCNL was performed after 10-14 days. Fifty-one patients with bilateral staghorn renal calculi underwent PCNL. The mean age of the study group was 10.25 ± 2.13 (range 3-15). Mean stone burden was 778.3 + 613.4 (range 231-3850 mm2). Forty-five patients underwent single puncture, twenty-two patients underwent double punctures whereas six patients underwent triple punctures during first session PCNL procedure. Most common puncture location was through the superior calyx (58.82 %). The mean operating time was 77.25 + 30.21 (range 58-145). After the first session PCNL, the success rate was 76.47 %. Thirteen patients (17 renal units) underwent relook PCNL and seven patients underwent ESWL. Overall complication noted in twenty-four (47.05 %) cases. Most of the complications were minor grade. Percutaneous nephrolithotomy for staghorn calculus in children needs expertise. PCNL in B/L staghorn renal calculus in children is safe and effective. B/L staghorn renal calculi with compromised renal function have higher chance of complications including bleeding.


Assuntos
Litotripsia/estatística & dados numéricos , Nefrolitotomia Percutânea/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Cálculos Coraliformes/cirurgia , Centros de Atenção Terciária/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Índia/epidemiologia , Cálices Renais/diagnóstico por imagem , Cálices Renais/cirurgia , Masculino , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Nefrostomia Percutânea/efeitos adversos , Nefrostomia Percutânea/métodos , Nefrostomia Percutânea/estatística & dados numéricos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Cálculos Coraliformes/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia , Urografia
19.
J Coll Physicians Surg Pak ; 26(11): 908-911, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27981926

RESUMO

OBJECTIVE: To determine a difference in the stone-free-rate among different renal locations in children after extracorporeal shockwave lithotripsy (ESWL). STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Urology Department, Shifa International Hospital, Islamabad, Pakistan, from January 2007 to June 2015. METHODOLOGY: The study included children who underwent ESWL, divided into three groups based on location of stones in kidney as group A (lower pole stones), group B (upper and mid pole stones) and group C (renal pelvis stone), respectively. ESWL was done by standard technique using Storz Modulith SLX lithotripter 3rd generation. Data was collected by chart review. SPSS version 16 was used for data analysis. RESULTS: Among 76 children with mean age of 7.55 ±4.16 years, 55 (72.4%) were males whereas 21 (27.6%) were females. Mean stone size was 1.08 ±0.59 cm. There were 34, 17 and 25 cases in groups A, B and C, respectively. Post- ESWL stone-free-rate was 47% in lower pole stones, 70.58% in upper and mid pole stones, and 68% in renal pelvis stones. Hematuria was seen in one patient from each group, sepsis in two patients from each of the mid pole/upper pole and lower pole group, while Steinstrasse in one patient from each group. CONCLUSION: ESWL is a safe and effective way of treating renal stones in all poles in pediatric population.


Assuntos
Cálculos Renais/patologia , Cálculos Renais/terapia , Litotripsia/métodos , Litotripsia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Pelve Renal/patologia , Litotripsia/efeitos adversos , Masculino , Paquistão , Medição de Risco/métodos , Resultado do Tratamento , Cálculos Urinários/terapia
20.
Arch. esp. urol. (Ed. impr.) ; 69(7): 405-415, sept. 2016. ^f405^l415
Artigo em Espanhol | IBECS | ID: ibc-155661

RESUMO

Objetivo: En el presente artículo se revisa y resume nuestro quehacer en el tratamiento de niños con urolitiasis en estos 30 años y se realiza un análisis en base a los resultados y aspectos de interés de acuerdo con la experiencia nacional e internacional. Método: Estudio estadístico descriptivo restropectivo en los 30 años de nuestra unidad en los que hemos asumido el tratamiento de 178 niños aquejados de urolitiasis en los que se han realizado 221 intervenciones, incluidas Litotricias por Ondas de Choque, Ureterorrenoscopia y Nefrolitectomía Percutánea. Conclusiones: De la experiencia acumulada podríamos concluir que la ESWL en niños en nuestro medio es la primera elección en litiasis renal y de uréter proximal y medio, y que aquellas de 2 a 3cm son susceptibles de ser tratadas exitosamente sin maniobras complementarias o tratamientos mixtos exceptuando las litiasis de cistina que es la que ofreció mayores problemas de fragmentación. Así mismo, la utilización de catéteres doble J aumenta la demanda de ESWL por calcificaciones del mismo e imposibilidad de extracción endoscópica y deben ser valorados individualmente tanto el beneficio de su colocación como la expectativa temporal de permanencia. La URS para nosotros es la elección en litiasis de uréter bajo y en algunos casos uréter medio y proximal, permitiendo tratamientos simultáneos, como la dilatación ureteral, o diagnósticos insospechados. Concretamente el ureteroscopio rígido permite alternativas terapéuticas coadyuvantes a la ESWL con alto poder resolutivo y de maniobrabilidad. En cuanto a la URS flexible creemos que nuestros buenos resultados con la ESWL y la URS rígida, incluso combinadas, y por ende también el balance coste-beneficio, han influido en su menor empleo para litiasis renales. En unidades de ámbito general como la nuestra la NLP combinada en niños ha tenido indicación en casos complejos excepcionales y la cirugía abierta o laparos- @ cópica no fue imperativa en ningún caso (AU)


Objetive: The aim of the present article is to summarize the results we obtained treating children with urolithiasis over the last 30 years and to perform an analysis on the basis of the these results and relevant details according to national and international experience. Methods: Retrospective and descriptive statistical analysis of the 30 year experience in our clinics. The study was performed with a sample size of 178 children treated with urolithiasis that underwent 221 procedures. These procedures include ESWL, ureterorenoscopy (URS) and percutaneous nephrolithotomy (PCNL). Conclusions: We conclude in this study that ESWL in children was the most appropriate procedure for renal and proximal and middle-third ureteral lithiasis. Kidney stones measuring 2 to 3 cm can be treated without additional procedures or combined approaches. In contrast cystine stones caused the major problems for fragmentation. Moreover, the use of double J catheters increased the need for ESWL when catheter calcification occurred and endoscopic removal was impossible. The benefits of this method must be individually assessed both for the benefit of the temporary placement as well as for the expectation of permanence. We conclude that URS is the best choice for distal-third ureteral lithiasis and some cases of proximal and middle-third ureteral lithiasis. This enables for simultaneous treatments, ureteral dilatation and unexpected diagnoses. In particular, rigid ureteroscopy offers adjuvant options to ESWL with great therapeutic potential and easy handling. In consequence, to our good results and cost-benefit balance using ESWL and rigid URS (even combined), the use of flexible URS for renal lithiasis has been reduced. In general community units like ours, the combined PCNL has been indicated for particular complex cases, and open or laparoscopic surgery was not necessary in any case (AU)


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Urolitíase/epidemiologia , Litotripsia/estatística & dados numéricos , Ureteroscopia/estatística & dados numéricos , Estudos Retrospectivos , Urolitíase/cirurgia , Comorbidade
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