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1.
Urologe A ; 58(11): 1304-1312, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31506761

RESUMO

The increase of medical knowledge and technical innovations together with the demographic change represent a challenge for the new conception of guidelines and clinical studies. The present S2k guidelines, which are exclusively concerned with kidney and ureteral stones, should support the treatment of urolithiasis in hospitals and private practices and provide information on urolithiasis for patients. Increasing interdisciplinary collaboration in stone treatment is also demonstrated in the number of professional and working groups participating in the update of the new guidelines. The present S2k guidelines emerged from a consensus process and demonstrate the current recommendations in step with actual practice. They provide decision-making guidance for diagnostics, treatment and metaphylactic measures based on expert opinions and available published fundamental evidence from the literature.


Assuntos
Litotripsia/normas , Guias de Prática Clínica como Assunto , Ureteroscopia/normas , Urolitíase/cirurgia , Procedimentos Cirúrgicos Urológicos/normas , Urologia/normas , Tratamento por Ondas de Choque Extracorpóreas , Humanos , Cálculos Renais , Nefrolitotomia Percutânea , Resultado do Tratamento , Cálculos Ureterais , Urolitíase/diagnóstico , Urolitíase/prevenção & controle , Procedimentos Cirúrgicos Urológicos/instrumentação
2.
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
3.
Urolithiasis ; 46(1): 3-17, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29177561

RESUMO

It is well recognized that the popularity of extracorporeal shock wave lithotripsy (SWL), despite its non-invasive character, has decreased during recent years. This is partly explained by the technological achievements in endoscopy and urologists' enthusiasm for such procedures. Another explanation is that many urologists have been insufficiently successful with SWL. The latter effect might to some extent be a result of the performance of the lithotripter used, but in too many cases, it is evident that the principles of how shock wave lithotripsy should be carried out are poorly applied. The purpose of this article is to emphasize some important aspects on how SWL best should be used. Based on decades of experience, it stands to reason that success with SWL does not come automatically and attention has to be paid to all details of this technique.


Assuntos
Cálculos Renais/terapia , Litotripsia/métodos , Litotripsia/normas , Humanos , Litotripsia/efeitos adversos , Guias de Prática Clínica como Assunto
4.
BMC Urol ; 17(1): 50, 2017 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-28662708

RESUMO

BACKGROUND: There are three minimally invasive methods for the management of large upper impacted ureteral stones: mini-percutaneous nephrolithotomy (MPCNL), transurethral ureteroscope lithotripsy (URSL), and retroperitoneal laparoscopic ureterolithotomy (RPLU). This study aimed to compare MPCNL, URSL, and RPLU, and to evaluate which one is the best choice for large upper impacted ureteral stones. METHODS: Between January 2012 and December 2015, at the Department of Urology, Huai'an First People's Hospital, 150 consecutively enrolled patients with a large upper impacted ureteral stone (>15 mm) were included. The patients were randomly divided (1:1:1) into the MPCNL, URSL, and RPLU groups. The primary endpoint was success of stone removal measured 1 month postoperatively and the secondary endpoints were intraoperative and postoperative parameters and complications. RESULTS: Fifteen patients needed auxiliary ESWL after URSL, and 3 patients after MPCNL, but none after RPLU. The stone clearance rate was 96% (48/50) in the MPCNL group and 72% (33/46) in the URSL group. In the RPLU group the stones were completely removed and the stone clearance rate was 100% (48/48) (P = 0.021 vs. URSL; P = 0.083 vs. MPCNL). Operation-related complications were similar among the three groups (all P > 0.05). Hospital stay was shorter in the URSL group compared with MPCNL (P = 0.003). Operation time was the shortest with URSL and the longest with MPCNL (all P < 0.05). CONCLUSIONS: MPCNL and RPUL are more suitable for upper ureteral impacted stones of >15 mm. URSL could be considered if the patient is not suitable for general anesthesia, or the patient requests transurethral uretroscopic surgery. TRIAL REGISTRATION: This study was registered with the Chinese Clinical Trial Registry (Registration number: ChiCTR-INR-17011507 ; Registration date: 2017-5-22).


Assuntos
Laparoscopia/normas , Litotripsia/normas , Nefrolitotomia Percutânea/normas , Cálculos Ureterais/cirurgia , Ureteroscopia/normas , Adulto , Feminino , Seguimentos , Humanos , Laparoscopia/efeitos adversos , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Resultado do Tratamento , Cálculos Ureterais/diagnóstico , Cálculos Ureterais/epidemiologia , Ureteroscopia/efeitos adversos
5.
Arch Esp Urol ; 70(1): 113-123, 2017 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-28221146

RESUMO

OBJECTIVE: An update of the new treatment strategies in extracorporeal lithotripsy as a valid therapeutic alternative in the management of urinary calculi. METHODS: We performed a search and review of the most recent literature which responded to the terms "best practices", "update", "optimization", "practice pattern" in lithotripsy. Only articles written in English or Spanish were selected. RESULTS: The use of a stepwise voltage ramping during extracorporeal lithotripsy with or without pause before the first rise of energy, a decreased delivery rates and the use of a higher number of shock waves per session are shown as alternatives to improve the effectiveness with optimum safety profile. CONCLUSIONS: Extracorporeal lithotripsy is still an effective and minimally invasive treatment, and it has an important role in the treatment of urolithiasis. New treatment strategies are being developed to increase the effectiveness with a similar safety profile.


Assuntos
Litotripsia/métodos , Urolitíase/terapia , Protocolos Clínicos , Humanos , Litotripsia/normas , Fenômenos Físicos , Resultado do Tratamento
6.
J Endourol ; 31(2): 191-197, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27863458

RESUMO

PURPOSE: Standardized bench testing of the new ShockPulse™ intracorporeal lithotripter was performed against three commercially available lithotripsy systems to determine differences and nuances in performance. MATERIALS AND METHODS: The ShockPulse intracorporeal lithotripter was tested against the LUS-2™, CyberWand,™ and EMS LithoClast™ in a standardized bench setting using hard (Ultracal-30) and soft (plaster of Paris) stone phantoms. An in vitro kidney model was used to record the time needed to fragment stone samples into retrievable-sized pieces. The time needed to fully comminute and evacuate stone samples was also recorded. The efficacy of each device at various applied pressures was determined using a hands-free apparatus, which was used to apply 1.0, 1.5, and 2.0 pounds of fixed force. RESULTS: For hard and soft stones, the time needed to create retrievable fragments was similar among all systems (p = 0.585). The ShockPulse was significantly faster than the LUS-2 and LithoClast at fully fragmenting and evacuating stone samples (p = 0.046), while the CyberWand was significantly slower than all three systems at this task (p = 0.001). When fixed forces were applied to a large stone phantom, the ShockPulse and CyberWand were significantly faster than the LUS-2 and LithoClast (p < 0.0001). When groups of smaller stones were tested, the ShockPulse was significantly faster at 1.0 pound (p < 0.001) and 1.5 pounds (p < 0.002) of force. At 2.0 pounds, no differences were observed (p = 0.09). CONCLUSIONS: The ShockPulse is equally as effective and, in some circumstances, more effective than the three commercially available devices against which it was tested in an in vitro setting.


Assuntos
Cálculos Renais/terapia , Litotripsia/instrumentação , Nefrostomia Percutânea/instrumentação , Humanos , Litotripsia/normas , Nefrostomia Percutânea/normas , Duração da Cirurgia , Imagens de Fantasmas , Padrões de Referência
7.
Kathmandu Univ Med J (KUMJ) ; 15(60): 343-346, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-30580354

RESUMO

Background Urolithiasis is the third most common disease of the urinary tract after urinary tract infections and pathologic conditions of prostate. Debate is ongoing regarding the effectiveness of Extracorporeal Shock Wave Lithotripsy (ESWL) and ureterorenoscopic lithotripsy (URSL) in the management of ureteral stones. Objective We aim to compare the efficacy of Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Lithotripsy in the management of upper ureteric stones in terms of stone clearance. Method This prospective hospital based study included patients with upper ureteric calculus managed with Ureterorenoscopic Lithortripsy with Double J stenting or Extracorporeal Shock Wave Lithotripsy at Dhulikhel Hospital, Kathmandu University Hospital from August 2014 to July 2015. Stone size, stone clearance, number of sittings, complications and need of other procedure were recorded. Result There were 90 patients with upper ureteric calculus. Among these patients, 45 patients underwent Extracorporeal Shock Wave Lithotripsy and 45 patients underwent Ureterorenoscopic Lithotripsy. There was no difference in male/female ratio, age and stone diameter between two groups (p>0.05). Total stone-free ratio was 88.9% (40/45) for Extracorporeal Shock Wave Lithotripsy and 82.2% (37/45) for URSL, partial fragmentation requiring shift of modality of treatment was 8.88% (4/45) for Extracorporeal Shock Wave Lithotripsy and 13.33% (6/45) for Ureterorenoscopic Lithotripsy. Failure of procedure was noted in 11.1% in Extracorporeal Shock Wave Lithotripsy group and 17.8% in URSL group In the Extracorporeal Shock Wave Lithotripsy group, 8.89% (4 out of 45) patients required Ureterorenoscopic Lithotripsy for complete stone clearance. Complete stone clearance could not be achieved in 2.23% (1 out of 45) patient with both Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Lithotripsy and had to undergo open ureterolithotomy. Conclusion Both Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Lithotripsy are equally effective in the management of upper ureteric calculus with no significant difference in age, male/female ratio, stone diameter and stone free ratio.


Assuntos
Litotripsia/métodos , Cálculos Ureterais/terapia , Ureteroscopia , Adulto , Gerenciamento Clínico , Feminino , Hospitais Universitários , Humanos , Litotripsia/normas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Próstata/patologia , Resultado do Tratamento
8.
Int J Surg ; 36(Pt D): 676-680, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27890653

RESUMO

INTRODUCTION: Shock wave lithotripsy (SWL) is a well - established treatment option for urolithiasis. The technology of SWL has undergone significant changes in an attempt to better optimize the results while reducing failure rates. There are some important limitations that restrict the use of SWL. In this review, we aim to place these advantages and limitations in perspective, assess the current role of SWL, and discuss recent advances in lithotripsy technology and treatment strategies. METHODS: A comprehensive review was conducted to identify studies reporting outcomes on ESWL. We searched for literature (PubMed, Embase, Medline) that focused on the physics of shock waves, theories of stone disintegration, and studies on optimising shock wave application. Relevant articles in English published since 1980 were selected for inclusion. RESULTS: Efficacy has been shown to vary between lithotripters. To maximize stone fragmentation and reduce failure rates, many factors can be optimized. Factors to consider in proper patient selection include skin - to - stone distance and stone size. Careful attention to the rate of shock wave administration, proper coupling of the treatment head to the patient have important influences on the success of lithotripsy. CONCLUSION: Proper selection of patients who are expected to respond well to SWL, as well as attention to the technical aspects of the procedure are the keys to SWL success. Studies aiming to determine the mechanisms of shock wave action in stone breakage have begun to suggest new treatment strategies to improve success rates and safety.


Assuntos
Litotripsia/normas , Guias de Prática Clínica como Assunto , Urolitíase/terapia , Humanos , Litotripsia/métodos , Seleção de Pacientes
9.
Urologe A ; 55(10): 1297-1301, 2016 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-27596847

RESUMO

The treatment of urolithiasis is still one of the most frequent tasks in the daily urological practice. Driven by the technological developments, patient demands and also personal experiences of urologists, many interventional treatment options have been established. To identify the most suitable treatment option, it is of utmost importance to consider not only stone size and localization but also the individual situation of the patient and the published evidence, which despite all efforts often lags behind the technical and clinical reality.


Assuntos
Litotripsia/normas , Nefrostomia Percutânea/normas , Assistência Centrada no Paciente/normas , Guias de Prática Clínica como Assunto , Ureteroscopia/normas , Urolitíase/terapia , Terapia Combinada/normas , Medicina Baseada em Evidências/normas , Humanos , Radiologia/normas , Resultado do Tratamento , Urolitíase/diagnóstico , Urologia/normas
10.
Biomed Res Int ; 2016: 3850461, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27493955

RESUMO

Extracorporeal Shock Wave Therapy (ESWT) is a conservative treatment modality with still growing interest in musculoskeletal disorders. This narrative review aims to present an overview covering 20-year development in the field of musculoskeletal ESWT. Eight historical paradigms have been identified and put under question from a current perspective: energy intensity, focus size, anesthesia, imaging, growth plates, acuteness, calcifications, and number of sessions. All paradigms as set in a historical consensus meeting in 1995 are to be revised. First, modern musculoskeletal ESWT is divided into focused and radial technology and the physical differences are about 100-fold with respect to the applied energy. Most lesions to be treated are easy to reach and clinical focusing plays a major role today. Lesion size is no longer a matter of concern. With the exception of nonunion fractures full, regional, or even local anesthesia is not helpful in musculoskeletal indications. Juvenile patients can also effectively be treated without risk of epiphyseal damage. Further research is needed to answer the question about if and which acute injuries can be managed effectively. Treatment parameters like the number of sessions are still relying on empirical data and have to be further elucidated.


Assuntos
Fraturas Ósseas/terapia , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Ablação por Ultrassom Focalizado de Alta Intensidade/normas , Litotripsia/métodos , Litotripsia/normas , Doenças Musculoesqueléticas/terapia , Ablação por Ultrassom Focalizado de Alta Intensidade/efeitos adversos , Litotripsia/efeitos adversos , Narração , Guias de Prática Clínica como Assunto , Medição de Risco , Resultado do Tratamento
11.
J Endourol ; 30(9): 1017-21, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27405967

RESUMO

INTRODUCTION AND OBJECTIVE: The manufacturer for the Storz Modulith SLX-F2 lithotripter recommends treatment head exchange after 1.65 million shocks. However, there is no documentation describing longevity of the treatment head with continued usage. The objective of this study is to determine whether there is a difference in stone fragmentation effectiveness with the treatment head at the beginning versus the end of its treatment life. METHODS: We conducted a retrospective chart review of 200 patients-50 consecutive patients treated immediately preceding, and following, two separate treatment head exchanges. Primary outcome measures were stone-free rate (no stone), total stone fragmentation (any decrease in size), and fragmentation rate ≤4 mm (decrease in size with largest residual fragment ≤4 mm), based on most recent follow-up imaging post shockwave. RESULTS: There were no baseline characteristic differences between the pre-exchange and postexchange groups with respect to first time lithotripsy for the stone (85% vs. 77%), stone location, preoperative stenting (3% vs. 4%), mean stone density (912 hounsfield units [HU] vs. 840 HU), mean stone size (9.0 mm vs. 8.1 mm), stone location, and mean number of shocks delivered (3105 vs. 3089). Mean time to follow-up was 2.7 weeks in both groups, with most follow-up imaging consisting of a kidney ureter bladder X-ray (87% pre-exchange vs. 85% postexchange). Stone free (34% vs. 27%), total stone fragmentation (76% vs. 76%), fragmentation ≤4 mm (48% vs. 42%), re-treatment rates (38% vs. 51%), and complication rates (6% vs. 7%), were not statistically different between the pre and postexchange groups, respectively. CONCLUSIONS: Exchanging the Storz Modulith F2 lithotripter head at the manufacturer recommended 1.65 million shocks does not affect the stone-free or fragmentation rate. If the manufacturer's recommendation for treatment head longevity is based on clinical outcomes, then there is likely room to extend this number without affecting treatment efficacy.


Assuntos
Cálculos Renais/terapia , Litotripsia/instrumentação , Cálculos Ureterais/terapia , Adulto , Idoso , Intervalo Livre de Doença , Análise de Falha de Equipamento , Feminino , Humanos , Cálculos Renais/patologia , Litotripsia/normas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Cálculos Ureterais/patologia
12.
Urologe A ; 55(7): 904-22, 2016 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-27325405

RESUMO

Every tenth German citizen will suffer from at least one urinary calculus during the lifetime. The diagnostics, treatment and follow-up treatment of urolithiasis are, therefore, part of the daily routine practice for all urologists in hospitals and private practices as well as in many other disciplines, such as general practitioners, internists, nephrologists and pediatricians. Although the diagnostics and therapy have experienced substantial alterations over the last 10 years, the possibilities of metabolic diagnostics and secondary prevention for patients at risk are, unfortunately and unjustly, in many places very poorly represented. The present S2k guidelines, which for the first time were established in an interdisciplinary consensus process, represent the current practical recommendations and, whenever possible, use tables and algorithms in order to facilitate easy reference in the routine daily work. Last but not least, this greatly simplifies the measures for metaphylaxis.


Assuntos
Litotripsia/normas , Guias de Prática Clínica como Assunto , Ureteroscopia/normas , Urolitíase/diagnóstico , Urolitíase/terapia , Urologia/normas , Técnicas de Diagnóstico Urológico/normas , Medicina Baseada em Evidências , Alemanha , Humanos , Resultado do Tratamento , Ultrassonografia/normas
13.
PLoS One ; 11(2): e0149333, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26890006

RESUMO

PURPOSE: Shock-wave lithotripsy (SWL) is accepted as the first line treatment modality for uncomplicated upper urinary tract stones; however, validated prediction models with regards to stone-free rates (SFRs) are still needed. We aimed to develop nomograms predicting SFRs after the first and within the third session of SWL. Computed tomography (CT) information was also modeled for constructing nomograms. MATERIALS AND METHODS: From March 2006 to December 2013, 3028 patients were treated with SWL for ureter and renal stones at our three tertiary institutions. Four cohorts were constructed: Total-development, Total-validation, CT-development, and CT-validation cohorts. The nomograms were developed using multivariate logistic regression models with selected significant variables in a univariate logistic regression model. A C-index was used to assess the discrimination accuracy of nomograms and calibration plots were used to analyze the consistency of prediction. RESULTS: The SFR, after the first and within the third session, was 48.3% and 68.8%, respectively. Significant variables were sex, stone location, stone number, and maximal stone diameter in the Total-development cohort, and mean Hounsfield unit (HU) and grade of hydronephrosis (HN) were additional parameters in the CT-development cohort. The C-indices were 0.712 and 0.723 for after the first and within the third session of SWL in the Total-development cohort, and 0.755 and 0.756, in the CT-development cohort, respectively. The calibration plots showed good correspondences. CONCLUSIONS: We constructed and validated nomograms to predict SFR after SWL. To the best of our knowledge, these are the first graphical nomograms to be modeled with CT information. These may be useful for patient counseling and treatment decision-making.


Assuntos
Cálculos Renais/diagnóstico , Cálculos Renais/terapia , Litotripsia/métodos , Cálculos Urinários/diagnóstico , Cálculos Urinários/terapia , Adulto , Idoso , Estudos de Coortes , Terapia Combinada , Feminino , Humanos , Litotripsia/normas , Masculino , Pessoa de Meia-Idade , Prognóstico , Reprodutibilidade dos Testes , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
Eur Urol ; 69(3): 475-82, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26344917

RESUMO

CONTEXT: Management of urinary stones is a major issue for most urologists. Treatment modalities are minimally invasive and include extracorporeal shockwave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PNL). Technological advances and changing treatment patterns have had an impact on current treatment recommendations, which have clearly shifted towards endourologic procedures. These guidelines describe recent recommendations on treatment indications and the choice of modality for ureteral and renal calculi. OBJECTIVE: To evaluate the optimal measures for treatment of urinary stone disease. EVIDENCE ACQUISITION: Several databases were searched to identify studies on interventional treatment of urolithiasis, with special attention to the level of evidence. EVIDENCE SYNTHESIS: Treatment decisions are made individually according to stone size, location, and (if known) composition, as well as patient preference and local expertise. Treatment recommendations have shifted to endourologic procedures such as URS and PNL, and SWL has lost its place as the first-line modality for many indications despite its proven efficacy. Open and laparoscopic techniques are restricted to limited indications. Best clinical practice standards have been established for all treatments, making all options minimally invasive with low complication rates. CONCLUSION: Active treatment of urolithiasis is currently a minimally invasive intervention, with preference for endourologic techniques. PATIENT SUMMARY: For active removal of stones from the kidney or ureter, technological advances have made it possible to use less invasive surgical techniques. These interventions are safe and are generally associated with shorter recovery times and less discomfort for the patient.


Assuntos
Urolitíase/cirurgia , Procedimentos Cirúrgicos Urológicos/normas , Urologia/normas , Humanos , Laparoscopia/normas , Litotripsia/normas , Nefrostomia Percutânea/normas , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Stents , Resultado do Tratamento , Ureteroscopia/normas , Cateterismo Urinário/normas , Urolitíase/diagnóstico , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/instrumentação
15.
Urologe A ; 54(9): 1277-82, 2015 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-26223953

RESUMO

BACKGROUND: Following its introduction in the 1980s extracorporeal shock wave lithotripsy (SWL) became the gold standard for therapy of ureteral and renal calculi. The research data published during the last decade suggest a paradigm shift to endourological techniques. OBJECTIVES: The purpose of this study was to compare whether the suggested loss of status for SWL corresponds with actual real-life treatment in Germany. A further aim was to assess the quality of SWL therapy in German hospitals. MATERIALS AND METHODS: The board of the German Society for Shock Wave Lithotripsy (DGSWL) sent a questionnaire to 306 urological departments in Germany, which encompassed medical, technical and organizational topics in the therapy of ureteral and renal calculi. A total of 99 (33%) questionnaires were returned. CONCLUSION: With the exception of a few departments, non-invasive SWL still plays a major role in the treatment of urolithiasis and a loss of the gold standard status is not in sight. The performance of SWL in German hospitals is carried out at a high level of quality. To maintain and optimize this status a structured SWL training and adherence to clinical practice guidelines are needed.


Assuntos
Pesquisas sobre Serviços de Saúde , Litotripsia/estatística & dados numéricos , Litotripsia/normas , Padrões de Prática Médica/estatística & dados numéricos , Urolitíase/epidemiologia , Urolitíase/terapia , Alemanha/epidemiologia , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências
16.
J Urol ; 194(2): 418-23, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25661296

RESUMO

PURPOSE: Management of ureteral stones remains controversial. To determine whether optimizing the extracorporeal shock wave lithotripsy delivery rate would improve the treatment of solitary ureteral stones we compared the outcomes of 2 delivery rates in a prospective randomized trial. MATERIALS AND METHODS: From July 2010 to October 2012, 254 consecutive patients were randomized to extracorporeal shock wave lithotripsy at a shock wave delivery rate of 60 and 90 pulses per minute in 130 and 124, respectively. The primary study end point was the stone-free rate at 3-month followup. Secondary end points were stone disintegration, treatment time, complications and the rate of secondary treatments. Descriptive statistics were used to compare end points between the 2 groups. The adjusted OR and 95% CI were calculated to assess predictors of success. RESULTS: The stone-free rate at 3 months was significantly higher in patients who underwent extracorporeal shock wave lithotripsy at a shock wave delivery rate of 90 pulses per minute than in those who received 60 pulses per minute (91% vs 80%, p = 0.01). Patients with proximal (100% vs 83%, p = 0.005) and mid ureteral stones (96% vs 73%, p = 0.03) accounted for the observed difference but not those with distal ureteral stones (81% vs 80%, p = 0.9, respectively). Treatment time, complications and the rate of secondary treatments were comparable between the 2 groups. On multivariable analysis the shock wave delivery rate of 90 pulses per minute, proximal stone location, stone density, stone size and an absent indwelling Double-J® stent were independent predictors of success. CONCLUSIONS: Optimizing the extracorporeal shock wave lithotripsy delivery rate can achieve excellent results for ureteral stones.


Assuntos
Gerenciamento Clínico , Litotripsia/estatística & dados numéricos , Litotripsia/normas , Cálculos Ureterais/terapia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Resultado do Tratamento
18.
Urologe A ; 52(8): 1135-45; quiz 1146-8, 2013 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-23860670

RESUMO

The natural course of untreated, asymptomatic calyceal calculi has not yet been clearly defined regarding disease progression and risk of surgical interventions. The decision for an active treatment of calyceal calculi is based on stone composition, stone size and symptoms. Extracorporeal shockwave lithotripsy (ESWL) has a low complication rate and is recommended by the current guidelines of the German (DGU) and European (EAU) Associations of Urology as a first-line therapy for the treatment of calyceal stones <2 cm in diameter. However, immediate removal of stones is not achieved with ESWL. The primary stone-free rates (SFR) after ESWL depend on stone location and stone composition and can show remarkable differences. Minimally invasive procedures, such as percutaneous nephrolitholapaxy and ureteroscopy are alternatives for the treatment of calyceal stones which have low morbidity and high primary SFR when performed in centres of excellence.


Assuntos
Cálculos Renais/diagnóstico , Cálculos Renais/terapia , Litotripsia/normas , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Guias de Prática Clínica como Assunto , Ureteroscopia/normas , Urologia/normas , Humanos , Litotripsia/efeitos adversos
19.
J Urol ; 190(4): 1260-7, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23538240

RESUMO

PURPOSE: The optimal frequency of shock wave lithotripsy in urolithiasis has not been well determined. MATERIALS AND METHODS: A search of MEDLINE, Web of Science and the Cochrane Library was performed. All randomized controlled trials including articles and meeting abstracts that compared the effects of different frequencies (120, 90 and 60 shock waves per minute) of shock wave lithotripsy were included in analysis. The review process followed the guidelines of the Cochrane Collaboration. RESULTS: Nine randomized controlled trials including 1,572 cases were identified. Overall success rates and success rates for large stones (greater than 10 mm) were significantly lower in the 120 vs 60 (p <0.001 and p = 0.002, respectively) and in the 120 vs 90 (p <0.001 and p = 0.02, respectively) shock waves per minute groups, but similar between the 90 and 60 shock waves per minute groups. Treatment duration was significantly shorter in the 120 vs 60, 120 vs 90 and 90 vs 60 shock waves per minute groups (all p <0.001). Success rates for small stones (less than 10 mm), complication rates and total shock waves had no significant differences among the 3 groups. CONCLUSIONS: Decreasing the frequency from 120 to 60 shock waves per minute increased overall success rates. While the treatment duration of 60 shock waves per minute was much greater, 90 shock waves per minute seemed to be optimal, especially for large stones. A frequency of 120 shock waves per minute might still be recommended for small stones.


Assuntos
Litotripsia/normas , Urolitíase/terapia , Humanos , Litotripsia/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Urol Clin North Am ; 40(1): 59-66, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23177635

RESUMO

The treatment of kidney stone disease has changed dramatically over the past 30 years. This change is due in large part to the arrival of extracorporeal shock wave lithotripsy (ESWL). ESWL along with the advances in ureteroscopic and percutaneous techniques has led to the virtual extinction of open surgical treatments for kidney stone disease. Much research has gone into understanding how ESWL can be made more efficient and safe. This article discusses the parameters that can be used to optimize ESWL outcomes as well as the new concepts that are affecting the efficacy and efficiency of ESWL.


Assuntos
Litotripsia/normas , Urolitíase/terapia , Humanos , Resultado do Tratamento
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