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1.
Actas urol. esp ; 43(9): 474-479, nov. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185248

RESUMO

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


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


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Cálculos Ureterais/diagnóstico , Cálculos Ureterais/cirurgia , Ureteroscopia/métodos , Litotripsia/métodos , Ureter/patologia , Ureter/cirurgia , Cateteres
2.
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
5.
Khirurgiia (Mosk) ; (6): 60-64, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317942

RESUMO

AIM: To evaluate the efficacy of the most common endoscopic transpapillary interventions for choledocholithiasis in randomized controlled trial. MATERIAL AND METHODS: There were 90 patients with choledocholithiasis who were randomized into 3 groups: main, clinical comparison 1, clinical comparison 2. In the main group A (n=30), patients underwent endoscopic partial papillosphincterotomy combined with balloon dilatation, in the group of clinical comparison 1 (n=30) - endoscopic papillosphincterotomy, in the group of clinical comparison 2 (n=30) - endoscopic papillosphincterotomy with mechanical lithotripsy. RESULTS: The greatest number of complications (38%) was observed in the group of clinical comparison 2. Less morbidity was noted in the group of clinical comparison 1 (19%). Minimum number of complications was observed in the main group (6%). Acute pancreatitis was diagnosed in groups of clinical comparison 1 and 2 as a rule, whereas only 3% of patients had this complication in the main group. Cholangitis was predominantly observed in the group of clinical comparison 2, in other groups this complication occurred in 3% of patients. Bleeding was observed only in the groups of clinical comparison 1 and 2 (10 and 13%, respectively). Loss of the lithotripter rope (3%) was detected only in the group of clinical comparison 2. CONCLUSION: Endoscopic partial papillosphincterotomy with balloon dilatation is advisable for choledocholithiasis due to minimal risk of intra- and postoperative complications.


Assuntos
Coledocolitíase/cirurgia , Esfinterotomia Endoscópica/métodos , Coledocolitíase/terapia , Dilatação/efeitos adversos , Dilatação/instrumentação , Humanos , Litotripsia/métodos , Esfinterotomia Endoscópica/efeitos adversos , Resultado do Tratamento
6.
BMC Urol ; 19(1): 61, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277626

RESUMO

BACKGROUND: One of the greatest challenges presented with RIRS is the potential for movement of the stone within the operative field associated with diaphragm and chest respiratory excursions due to mechanical ventilation. To overcome this challenge, we propose in this pilot study a new general anesthesia technique combining high frequency jet ventilation (HFJV) with small volume mechanical ventilation (SVMV). Data regarding safety, feasibility and surgeons' impression was assessed. METHODS: Patients undergoing RIRS for kidney stones from November 2017 to May 2018 were prospectively recruited to participate in the study. In each case after the beginning of general anesthesia (GA) with mechanical ventilation (MV) surgeons were asked to assess the mobility of the operative field and conditions for laser lithotripsy according to the developed questionnaire scale. The questionnaire consisted of 5 degrees of assessment of kidney mobility and each question was scored from 1 to 5, 1 being very mobile (extremely poor conditions for dusting) and 5 completely immobile (Ideal conditions for dusting). After the assessment GA was modified with combined respiratory support (CRS), reducing tidal volume and respiratory rate (small volume mechanical ventilation, SVMV) and applying in the same time transcatheter high frequency jet ventilation (HFJV) inside the closed circuit. After beginning of CRS, surgeons were once again asked to assess the mobility of the operative field and the conditions for laser lithotripsy. Main ventilation parameters were recorded and compared in both regimens. RESULTS: A total of 38 patients were included in the study. The mean age was 49 (range 45-53) with a mean stone size of 10 mm (range 10-14) and Hounsfield unit of 1060 (range 930-1190). All patients underwent successful RIRS and no intraoperative complications occurred throughout the duration of the study. A statistically significant difference between ventilation parameters prior to and after CRS institution was detected in all cases, however their clinical impact was negligible. Despite this, assessment via the questionnaire scale point values varied significantly before and after the application of CRS and were 2.3 (2.1; 2.6) and 3.8 (3.7; 4.0) respectively (p < 0.001). CONCLUSIONS: The novel combined respiratory approach consisting of HFJV and SVMV appears to provide better conditions for stone dusting through reduced respiratory kidney motion and is not associated with adverse health effects or complications. TRIAL REGISTRATION: NCT03999255 , date of registration: 25th June 2019 (retrospectively registered).


Assuntos
Anestesia Geral/métodos , Cálculos Renais/cirurgia , Litotripsia/métodos , Respiração Artificial/métodos , Anestesia Geral/normas , Feminino , Humanos , Cálculos Renais/diagnóstico , Litotripsia/normas , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Respiração Artificial/normas
7.
BMC Urol ; 19(1): 71, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31357972

RESUMO

BACKGROUND: In this case report, giant calculus in the urethral diverticulum was found through ureteroscopy investigation, the pneumatic lithotripsy combined with ultrasound lithotripsy (PLCUL) was successfully performed to break down this rare and giant urethral calculus in the diverticulum without open surgery. CASE PRESENTATION: A 82-year-old male presented to the urology department, complaining of frequent urination and dysuria. One giant, dark brown stone (6.5 × 6 × 5.5 cm) was revealed in the diverticulum of the anterior urethra using combination of local ultrasound, pelvic Computer Tomography (CT) and Magnetic Resonance Imaging (MRI). The stone was then successfully broken down via the PLCUL, and the emptied anterior urethral diverticulum was left untreated. In the 18 months' follow-up, no new calculus was found in urethral tract, anterior diverticula became gradually smaller, eventually disappeared. CONCLUSION: In the treatment of giant calculus in the urethral diverticulum, this case report provides an effective method of lithotripsy in the clinical trials.


Assuntos
Divertículo/diagnóstico por imagem , Divertículo/terapia , Litotripsia/métodos , Uretra/diagnóstico por imagem , Doenças Uretrais/diagnóstico por imagem , Doenças Uretrais/terapia , Idoso de 80 Anos ou mais , Humanos , Masculino , Cálculos Urinários/diagnóstico por imagem , Cálculos Urinários/terapia
8.
J Invasive Cardiol ; 31(6): E143-E147, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31158810

RESUMO

We present the first case series using Shockwave Intravascular Lithotripsy (S-IVL; Shockwave Medical), a novel coronary calcium modification device, in patients with heavily calcified unprotected left main (LM) coronary artery disease (CAD). Decisions regarding surgical vs percutaneous revascularization in LM-CAD patients are based on anatomical complexity and perceived surgical risk. In this series, we present the use of S-IVL in a patient with LM-CAD with multivessel disease who declined surgery, a patient with an isolated LM-CAD and severe cardiomyopathy, and a late nonagenarian patient where surgical revascularization was not an option.


Assuntos
Doença da Artéria Coronariana/terapia , Vasos Coronários/diagnóstico por imagem , Litotripsia/métodos , Calcificação Vascular/terapia , Idoso de 80 Anos ou mais , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Calcificação Vascular/diagnóstico
9.
JSLS ; 23(2)2019.
Artigo em Inglês | MEDLINE | ID: mdl-31223226

RESUMO

Background and Objectives: The purpose of this study was to compare two methods (transperitoneal laparoscopic ureterolithotomy [TLU] and a combination of ureteroscopic lithotripsy [UL] with retrograde intrarenal surgery [RIRS]) designed for the treatment of large proximal ureteral calculi so that their associated complications and stone-free rates could be assessed. Methods: A total of 100 patients from three different hospitals who were diagnosed with large upper ureteral stones (≥15 mm) were treated via TLU (n = 48) or UL-RIRS (n = 52). They were treated between March 2012 and May 2014. The study compared the complications, success rate, patient characteristics, and the operation time between the two groups. Results: The immediate stone clearance rate after a single session was higher in the TLU group than in the UL-RIRS group (100% vs 73.1%, P = .005). However, there was no significant difference in the stone-free rates between the two groups three months after the last procedure was performed (100% vs 96.1%, P = .655). Regarding patients with a history of early-failure extracorporeal shock-wave lithotripsy, there was no significant difference in the stone-free rate between the two groups three months after the last procedure (100% vs 94.4%, P > .05). Further, overall complication rates between the groups were not statistically different (P = .261). Conclusion: This study demonstrates that TLU is an effective and safe procedure to treat large impacted upper ureteral stones. When compared to UL-RIRS, TLU showed equivalent efficacy and safety, though there were failed first-line treatments.


Assuntos
Laparoscopia , Litotripsia/métodos , Cálculos Ureterais/terapia , Ureteroscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
10.
Pan Afr Med J ; 32: 109, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31223399

RESUMO

Extracorporeal shock wave lithotripsy-related pain is the largest limiting factor in this technique. Our study aimed to compare the effectiveness of different types of analgesics for pain management used during ESWL sessions. We conducted a prospective study of 300 patients with urinary lithiasis justifying ESWL treatment. The patients were randomized to three groups: group I, included 100 patients who received intramuscular injection of 2cc of physiological saline solution (placebo), group II included 100 patients who received intramuscular injection of ketoprofen 100mg while group III included 100 patients who received lidocaine and prilocaine topical cream. Visual Analog Scale (VAS) was used to assess pain 10 minutes after and at the end of the session. Mean VAS score 10 minutes after and at the end of ESWL session was 3.7 and 4.91 respectively. There was no significant difference among the three groups with respect to: epidemiological data (age, sex, BMI, patient's history) and the characteristics of the renal stone (side, size, location, presence or not of double-J ureteral catheter). Eleven patients in the Group I terminated treatment early, with a significant difference compared to the other groups (p=0.003). VAS score 10 minutes after and at the end of ESWL session was statistically higher in Group I compared to Groups II and III (p < 0.001). Moreover, ESWL session was significantly more effective in Groups (II and III) compared to Group I (p<0.001). Pain treatment is necessary during ESWL sessions. Two painkillers molecules were assessed, which showed good pain control as well as an increase in the effectiveness of lithotripsy.


Assuntos
Analgésicos/administração & dosagem , Cálculos Renais/terapia , Litotripsia/métodos , Dor/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Feminino , Humanos , Cetoprofeno/administração & dosagem , Combinação Lidocaína e Prilocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Medição da Dor , Estudos Prospectivos , Adulto Jovem
11.
Pan Afr Med J ; 32: 110, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31223400

RESUMO

This study aims to discuss the role of open surgery in the treatment of renal lithiasis, including coralliform stones, with the advent of new less invasive techniques. We report a series of 53 cases of coralliform stones whose data were collected in our Hospital during a period of 7 years, from January 2011 to January 2018. The patients underwent open nephrolithotomy by lombotomy. The mean post-operative length of stay was 10 days. The immediate and early postoperative outcomes were simple in 36 patients, 6 patients underwent blood transfusion, 2 had severe sepsis in the postoperative period, 5 had infection of the wall and 4 had urinary fistula, secondarily managed by endoscopic drainage. Residual stones were found in 9 cases (16.9%). Stones were essentially treated by extracorporeal lithotripsy. Late outcomes were characterized by renal atrophy in 2 patients, lithiasic recurrence in 9 patients, an improvement in creatinine clearance in 9 patients and a slight worsening in 5 patients. Open surgery presents the risk of multiple complications and it is not recommended for first-line treatment of renal lithiasis. However it is important to determine which patients would benefit from open nephrolithotomy.


Assuntos
Cálculos Renais/cirurgia , Litotripsia/métodos , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Transfusão de Sangue/estatística & dados numéricos , Drenagem/métodos , Endoscopia/métodos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Sepse/epidemiologia , Resultado do Tratamento , Fístula Urinária/epidemiologia
12.
Minerva Urol Nefrol ; 71(4): 365-372, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31086132

RESUMO

Over the last four decades, extracorporeal shockwave lithotripsy (ESWL) has been used as an effective technique to treat kidney and ureteral stones. Nowadays, ESWL still plays a role in stone treatment and is a primary treatment option in different guidelines. New technologies are now available to endourologists, but this procedure remains valid. This narrative review will shortly illustrate the history of ESWL and its clinical applications, limits, and specific uses.


Assuntos
Cálculos Renais/terapia , Litotripsia/métodos , Litotripsia/tendências , Cálculos Ureterais/terapia , Humanos
13.
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
14.
Urol J ; 0(0): 4955, 2019 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-31087322

RESUMO

PURPOSE: The aim of this study is to evaluate the impact of different pulse energy settings on dusting efficiency in flexible ureteroscopic lithotripsy (fURSL) for the treatment of upper urinary tract calculi. MATERIALS AND METHODS: Data of 88 consecutive patients who underwent fURSL for upper urinary tract calculi by a single surgeon in our department From August 2017 to August 2018 were reviewed retrospectively. Lumenis Power Suite 100W lithotripter with a 200 ?m laser fiber was used to comminute stones. According to energy settings, patients were divided into three groups- low energy group (LE: 0.3-0.6J), middle energy group (ME: 0.7-1.0J), high energy group (HE: 1.1-1.5J). Frequency was set at 30Hz in all patients. ANOVA and Chi square tests were applied to compare the difference of the mean lithotripsy and operation time, early stone-free rate (eSFR), overall stone-free rate (oSFR) and complication rate. RESULTS: A total of 32, 36 and 20 patients were included in the LE, ME and HE groups, respectively. There was no difference in the age, gender distribution or in any other stone characteristics among the three groups. The mean lithotripsy time of LE, ME, HE was 10.9±7.6, 16.1±7.0, 23.0±15.0 min respectively. The mean operation time of the three groups was 16.9±7.7, 22.3±7.1, 29.2±14.9 min respectively. There were significant differences on the mean lithotripsy time (P=0.002) and the mean operation time (P=0.001) among the three groups. The stone-free rate was 31.8% and 87.5% respectively in eSFR and oSFR. No statistical significance was detected among the three groups in terms of the eSFR (P=0.89), oSFR (P=0.86), and complication rate (P=0.97). CONCLUSION: In fURSL with dusting, low energy (0.3-0.6J) is more efficient than middle (0.7-1.0J) and high energy (1.1-1.5J). As energy increased, dusting efficiency decreased dramatically. Consequently, we recommend low pulse energy (0.3-0.6J) as the optimal dusting strategy for fURSL.


Assuntos
Cálculos Renais/cirurgia , Lasers de Estado Sólido/uso terapêutico , Litotripsia/métodos , Cálculos Ureterais/cirurgia , Ureteroscopia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscópios
15.
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
16.
Artigo em Alemão | MEDLINE | ID: mdl-30999351

RESUMO

The diagnosis of obstructive urolithiasis in small ruminants frequently results in a multitude of decisions that have to be made by the consulted practitioner. Factors that influence the decision for therapy (or euthanasia) are the type of the animal's use, economic aspects and specific options of the veterinarian practice as well as emotional aspects depending on the owners of small ruminants kept as companion animals. The present article aims to present the currently available methods of therapy to facilitate a decision by the practicing veterinarian based on the present state of the science. Naturally, the individual method of choice may differ from the scientific point of view depending on the practitioner's evaluation.


Assuntos
Doenças das Cabras/terapia , Doenças dos Ovinos/terapia , Urolitíase/veterinária , Amputação/veterinária , Animais , Cistotomia/veterinária , Cabras , Litotripsia/métodos , Litotripsia/veterinária , Litotripsia a Laser/veterinária , Masculino , Pênis/cirurgia , Ovinos , Cirurgia Plástica/veterinária , Uretra/cirurgia , Obstrução Uretral/etiologia , Obstrução Uretral/terapia , Obstrução Uretral/veterinária , Bexiga Urinária/cirurgia , Cateterismo Urinário/instrumentação , Cateterismo Urinário/métodos , Cateterismo Urinário/veterinária , Urolitíase/complicações , Urolitíase/terapia
17.
Intern Med ; 58(15): 2125-2132, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30996182

RESUMO

Objective We examined the safety and efficacy of endoscopic stone removal for choledocholithiasis in elderly patients ≥90 years of age with native papilla and compared the outcomes with those in patients 75-89 years of age. Methods This multicenter retrospective study included 569 patients 75-89 years of age and 126 patients ≥90 years of age who had native papilla and underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis at 3 institutions in Japan between April 2012 and March 2018. The main outcomes assessed were the incidence of post-ERCP complications during hospitalization and outcomes of ERCP in patients ≥90 years of age. Results Biliary cannulation and subsequent endoscopic sphincterotomy, endoscopic balloon dilation, and endoscopic large balloon dilation were successful in 97.7% of patients 75-89 years of age and in 98.4% of patients ≥90 years of age. There was no significant difference in the incidence of post-ERCP complications between patients 75-89 years of age and those ≥90 years of age (7.7% vs. 9.5%, respectively; p=0.47). Although the rate of use of mechanical lithotripter was not significantly different, the rate of complete stone removal in patients ≥90 years of age was lower than that in patients 75-89 years of age (81.0% vs. 94.9%, respectively; p<0.001). In all cases with incomplete stone removal in both groups, permanent biliary stent placement was successful. Conclusion ERCP for choledocholithiasis in elderly patients ≥90 years of age is a safe and effective procedure; however, endoscopists should select appropriate strategies after considering each patient's medical condition and background.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Coledocolitíase/cirurgia , Idoso Fragilizado , Cálculos Biliares/cirurgia , Litotripsia/métodos , Esfinterotomia Endoscópica/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Japão , Masculino , Estudos Retrospectivos , Resultado do Tratamento
18.
Artigo em Alemão | MEDLINE | ID: mdl-31013525

RESUMO

OBJECTIVE: Description of clinical experience with two different lithotripsy modalities for treatment of urethral stones in dogs. MATERIAL AND METHODS: Retrospective analysis (October 2016 - November 2017) of medical records from dogs with urinary stones that underwent transurethral pneumatic or laser lithotripsy. RESULTS: In 28 male and 5 female dogs, either pneumatic lithotripsy (39 %) or laser lithotripsy (61 %) was performed. In the urethra, stone free rates of 100 % in females and over 85 % in males could be achieved using either fragmentation modality. In 3 of 28 (11 %) male dogs, after fragmentation of urethral stones, urethral patency was impaired because of endoscopically suspected polypoid urethritis requiring urethrostomy. In 8 out of 28 (29 %) male dogs and in 1 of 5 (20 %) female dogs, an additional lithocystotomy was necessary to achieve stone-free status in the lower urinary tract. CONCLUSION AND CLINICAL RELEVANCE: Transurethral pneumatic or laser lithotripsy of urinary stones is a successful procedure in dogs. Major pathological conditions of the urethral mucosa may require further surgical or interventional methods for the restoration of a functional urethra.


Assuntos
Doenças do Cão/terapia , Litotripsia a Laser/veterinária , Litotripsia/veterinária , Doenças Uretrais/veterinária , Cálculos Urinários/veterinária , Animais , Cães , Feminino , Litotripsia/métodos , Masculino , Registros/veterinária , Estudos Retrospectivos , Doenças Uretrais/terapia , Cálculos Urinários/terapia
19.
J Invasive Cardiol ; 31(5): E73-E75, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31034437

RESUMO

We present the first cases of Shockwave intravascular lithotripsy (S-IVL; Shockwave Medical), a novel coronary calcium modification device, being used in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI). The 3 presented cases include an upfront use of S-IVL in a right coronary artery, an in-stent restenosis, and a community cardiac arrest/STEMI equivalent where S-IVL was used as a bail-out technique to facilitate stent delivery in a tortuous calcified vessel.


Assuntos
Vasos Coronários , Litotripsia , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Calcificação Vascular/cirurgia , Idoso , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Vasos Coronários/cirurgia , Eletrocardiografia/métodos , Desenho de Equipamento , Humanos , Litotripsia/instrumentação , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Resultado do Tratamento
20.
Urol Clin North Am ; 46(2): 207-213, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30961854

RESUMO

Percutaneous nephrolithotomy is the treatment of choice for large renal stones. Larger, straight access tracts allow for use of rigid pneumatic and ultrasonic lithotripsy devices. Through advanced technologies, more efficient fragmentation has become possible, allowing for a variety of treatment options depending on stone location, size, and composition. As novel methods of lithotripsy enter the clinical sphere, it is a requirement that the operating urologist understand the available surgical options and the associated mechanisms used to best treat their patients. This article discusses the mechanisms of basic pneumatic and ultrasonic devices, and examines the data regarding current and novel combination lithotrites.


Assuntos
Litotripsia/instrumentação , Litotripsia/tendências , Terapia por Ultrassom/instrumentação , Ar Comprimido/uso terapêutico , Gases/uso terapêutico , Humanos , Invenções/tendências , Litotripsia/métodos , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/métodos , Nefrolitotomia Percutânea/tendências , Terapia por Ultrassom/métodos , Terapia por Ultrassom/tendências
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