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1.
Urologiia ; (5): 48-52, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808632

RESUMO

OBJECTIVE: to evaluate the nephroprotective effect of lercanidipine, its effect on the dynamics of creatinine clearance and blood cytokine levels in patients with nephrolithiasis with obstructive uropathy during renal drainage. MATERIAL AND METHODS: 66 patients were included in the study with concretions of the pelvic segment and the presence of obstruction according to instrumental methods of examination. In order to prevent the occurrence of infectious complications before lithotripsy patients the first stage was performed installation of nephrostomic drainage, followed by antibacterial, anti-inflammatory therapy. Patients were divided into 2 groups: the first (33 patients) received standard therapy, the second (33 people) additionally received lercanidipine at a dose of 10 mg per day for 1 month. Determined the concentration of IL-8, VEGF, MCP-1, G-CSF and GM-CSF in the blood serum by the method of solid-phase ELISA. The glomerular filtration rate was calculated using the CKD-EPI formula. All studies were performed at the preoperative stage, on 7, 14, 21 and 28 days after renal drainage. RESULTS: In the appointment of lercanidipine, there was a more rapid decrease in levels of IL-8, VEGF, MS-1, GM-CSF in serum (21 days), and an improvement in renal function, compared with the group that did not receive nephroprotective therapy. CONCLUSION: The administration of lercanidipine may contribute to a more rapid recovery of renal function and normalization of blood cytokine levels. This drug can be used in the complex treatment of patients with nephrolithiasis with obstructive uropathy.


Assuntos
Bloqueadores dos Canais de Cálcio/uso terapêutico , Citocinas/sangue , Di-Hidropiridinas/uso terapêutico , Rim/efeitos dos fármacos , Nefrolitíase/cirurgia , Fármacos Neuroprotetores/uso terapêutico , Urolitíase/cirurgia , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Bloqueadores dos Canais de Cálcio/administração & dosagem , Di-Hidropiridinas/administração & dosagem , Taxa de Filtração Glomerular , Humanos , Fármacos Neuroprotetores/administração & dosagem , Resultado do Tratamento
2.
Int Braz J Urol ; 45(5): 965-973, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31626519

RESUMO

OBJECTIVE: We aimed to evaluate the results of laparoscopic pyeloplasty with concomitant pyelolithotomy and compare results with a cohort of patients undergoing laparoscopic pyeloplasty without pyelolithotomy. MATERIALS AND METHODS: We retrospectively reviewed records of 43 patients undergoing transperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty between December 2012 and July 2018 at our department. Eighteen patients (42%) underwent laparoscopic pyeloplasty with concomitant pyelolithotomy. The results of patients with renal stones were compared with 25 matched patients undergoing laparoscopic pyeloplasty without concomitant renal stones. Demographic data, operative and stone parameters were compared between the groups. RESULTS: The groups were similar regarding to demographic characteristics. All operations were completed laparoscopically with no conversions to open surgery. In 3 cases without renal stones and 15 cases with renal stones, transposition of the ureter due to crossing vessels was performed. The mean stone size was 13±5.24 mm, and the median number of stones was 1 (1-18). The success of laparoscopic pyeloplasty with and without pyelolithotomy was 93.3% and 92.9%, respectively, as confirmed by negative diuretic renogram at postoperative 3rd months. Overall stone-free rate after laparoscopic pyelolithotomy was 93.3%. Mean operative time was 222.6765.71 minutes vs. 219.11±75.63 minutes for the pyeloplasty with concomitant pyelolithotomy vs. pyeloplasty, respectively (p=0.88). CONCLUSIONS: Laparoscopic pyeloplasty with concomitant pyelolithotomy is a safe and effective intervention with associated good cosmetic results and high stone-free rates without significant increase in operative time or complications.


Assuntos
Pelve Renal/cirurgia , Laparoscopia/métodos , Nefrolitíase/cirurgia , Nefrotomia/métodos , Obstrução Ureteral/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Hidronefrose/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrolitíase/patologia , Duração da Cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodos , Adulto Jovem
3.
BMC Urol ; 19(1): 58, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272430

RESUMO

BACKGROUND: The use of ureteral access sheath (UAS) during ureteroscopy is controversial. We aimed to explore practice patterns of UAS during ureteroscopy for nephrolithiasis among endourologists worldwide. METHODS: A 15-question survey was designed using the SurveyMonkey® platform. The questions covered the background and professional experience of the potential respondents, indications for UAS insertion, UAS caliber and possible complications associated with its use. The questions were anonymously tabulated in order to determine practice patterns of UAS during ureteroscopy for nephrolithiasis among endourologists. The survey was then distributed via e-mail to all the Endourological Society members. RESULTS: 216 members responded. 99.53% of the respondents practice as endourologists, 63.4% are fellowship trained and 74.4% are at least 6 years post-fellow. 73.2% practice in an academic facility. 77.3% perform at least 100 ureteroscopies annually. 46 and 76% routinely use UAS for the treatment of ureteral and kidney stones, respectively. In both cases, the 12/14 access sheath is the most common. 42% use UAS in primary ureteroscopy. 90.3% believe that a double J stent insertion is not mandatory prior to UAS insertion. 79.1% think the use of UAS does not increase postoperative complications rate, and if the latter does encounter, then most likely it is either a ureteral stricture (93.2%) or pain (48%). CONCLUSIONS: UAS is commonly used by highly skilled endourologists during ureteroscopy. 12/14 UAS is mostly used. Ureteral stricture and post-operative pain are proposed as possible complications following UAS introduction, however pre-stenting is not mandatory as overall low complication rate is expected.


Assuntos
Nefrolitíase/cirurgia , Inquéritos e Questionários , Ureter/cirurgia , Ureteroscopia/métodos , Urologistas , Humanos , Cálculos Renais/diagnóstico , Cálculos Renais/cirurgia , Nefrolitíase/diagnóstico , Ureter/patologia , Cálculos Ureterais/diagnóstico , Cálculos Ureterais/cirurgia , Ureteroscopia/normas , Urologistas/normas
4.
J Vasc Access ; 20(5): 567-569, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31190613

RESUMO

INTRODUCTION: Vascular access for hemodialysis is a key factor in every patient dependent on this treatment. Maintaining a central venous catheter can be a good choice when all the other options have been exhausted, but unwanted and rare complications may arise from longer catheter dwell time. CASE REPORT: We describe a case of a 65-year-old woman undergoing hemodialysis treatment since 1986 after a bilateral nephrectomy due to complicated nephrolithiasis. Her last access, two Tesio® tunneled cuffed catheters implanted via the right internal jugular vein functioned correctly for 14 years without complications, and so, was not replaced in the meantime. She was referred to our hospital due to a rupture in a catheter lumen, which was corrected conservatively by creating a more proximal tunnel and excising the affected area. A few weeks later, a new rupture in the same lumen was identified, so the catheter was replaced with angiographic control. The catheter was frail, so upon its removal, the tip fractured and remained in the right ventricle, being swiftly removed by an endovascular snare without complications. DISCUSSION: This case reports two rare complications associated with catheter handling and identifies a possible technique for conservative resolution of a lumen rupture.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Falha de Equipamento , Veias Jugulares , Nefrectomia , Nefrolitíase/cirurgia , Diálise Renal/efeitos adversos , Diálise Renal/instrumentação , Idoso , Remoção de Dispositivo/métodos , Procedimentos Endovasculares , Desenho de Equipamento , Feminino , Humanos , Veias Jugulares/diagnóstico por imagem , Flebografia , Fatores de Tempo , Resultado do Tratamento
5.
Urol Clin North Am ; 46(2): 265-272, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30961859

RESUMO

Patients with nephrolithiasis are exposed to significant quantities of ionizing radiation with the potential to cause secondary malignancy. This risk is magnified by the high recurrence rate of nephrolithiasis. In this article, we identify the risks of ionizing radiation as they pertain to patients with nephrolithiasis. We then identify evidence-based techniques for mitigating patient radiation exposure in the preoperative, intraoperative, and postoperative settings. Key factors include limiting the use of computed tomographic imaging, appropriate modulation of fluoroscopy settings, and minimizing rates of stone recurrence.


Assuntos
Cálculos Renais/diagnóstico por imagem , Doses de Radiação , Exposição à Radiação/efeitos adversos , Exposição à Radiação/prevenção & controle , Lesões por Radiação/prevenção & controle , Fluoroscopia/efeitos adversos , Humanos , Cuidados Intraoperatórios/efeitos adversos , Cálculos Renais/cirurgia , Nefrolitíase/diagnóstico por imagem , Nefrolitíase/cirurgia , Cuidados Pós-Operatórios/efeitos adversos , Lesões por Radiação/etiologia , Fatores de Risco , Tomografia Computadorizada por Raios X/efeitos adversos
6.
Urol Clin North Am ; 46(2): 273-285, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30961860

RESUMO

This article reviews new advances in ultrasound technology for urinary stone disease. Recent research to facilitate the diagnosis of nephrolithiasis, including use of the twinkling signal and posterior acoustic shadow, have helped to improve the use of ultrasound examination for detecting and sizing renal stones. New therapeutic applications of ultrasound technology for stone disease have emerged, including ultrasonic propulsion to reposition stones and burst wave lithotripsy to fragment stones noninvasively. The safety, efficacy, and evolution of these technologies in phantom, animal, and human studies are reviewed herein. New developments in these rapidly growing areas of ultrasound research are also highlighted.


Assuntos
Litotripsia/métodos , Nefrolitíase/diagnóstico por imagem , Nefrolitíase/cirurgia , Terapia por Ultrassom/métodos , Ultrassonografia/métodos , Humanos , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Cálculos Urinários/diagnóstico por imagem , Cálculos Urinários/cirurgia
7.
Urol Clin North Am ; 46(2): 303-313, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30961862

RESUMO

Diagnosis, treatment, and follow-up are all influential in determining the overall cost to the health care system for kidney stones. New innovations in the field of nephrolithiasis have been abundant, including disposable ureteroscopes, ultrasound-guided approaches to percutaneous nephrolithotomy, and advanced laser lithotripters. Identifying cost-effective treatment strategies encourages practitioners to be thoughtful about providing value-based high-quality care and remains on important principle in the treatment of urinary stone disease.


Assuntos
Análise Custo-Benefício , Cálculos Renais/economia , Cálculos Renais/cirurgia , Efeitos Psicossociais da Doença , Assistência à Saúde/economia , Diagnóstico por Imagem/economia , Equipamentos Descartáveis/economia , Custos de Cuidados de Saúde , Humanos , Invenções/economia , Cálculos Renais/epidemiologia , Cálculos Renais/prevenção & controle , Terapia a Laser/economia , Terapia a Laser/instrumentação , Litotripsia/economia , Nefrolitíase/economia , Nefrolitíase/epidemiologia , Nefrolitíase/prevenção & controle , Nefrolitíase/cirurgia , Nefrolitotomia Percutânea/economia , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/métodos , Fibras Ópticas/economia , Ureteroscopia/economia , Ureteroscopia/instrumentação
8.
Actas urol. esp ; 43(3): 111-117, abr. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-181168

RESUMO

Contexto y objetivos: El tratamiento de primera elección para litiasis > 2 cm es la nefrolitotomía percutánea (NLP), dejando a la ureteroscopia flexible (URS-F) como una segunda opción. En la presente revisión se evaluaron la tasa libre de litiasis y las complicaciones de ambas técnicas en el tratamiento de litiasis de tamaño entre 2 y 3 cm. Material y métodos: Revisión sistemática de estudios que compararon las dos técnicas. Fueron excluidos aquellos estudios que no fueran comparativos, los realizados en población pediátrica o con litiasis menores de 2 cm o mayores de 3 cm. Dos investigadores realizaron independientemente la búsqueda, obteniendo 5 estudios que abarcaban un total de 815 pacientes: 252 pertenecieron al grupo de URS-F y 563 al de NLP. Cuatro fueron retrospectivos y uno fue prospectivo no aleatorizado. Resultados: La tasa libre de litiasis osciló entre el 47,0 y el 95,0% para la URS-F y entre el 87,0 y el 100% para la NLP. La tasa de complicaciones fue del 8,8-29,0% en la URS-F y del 11,9-27,0% en la NLP. La URS-F requirió un número mayor de procedimientos y tuvo un menor descenso de hemoglobina y ascenso de creatinina en comparación con la NLP. Conclusiones: La tasa libre de litiasis fue mayor en la NLP, aunque la URS-F podría alcanzar unos resultados comparables a expensas de realizar varios procedimientos. Ambas técnicas tienen una frecuencia de complicaciones similar, pero con más alteraciones analíticas posquirúrgicas en el grupo de NLP


Context and objectives: The first-line treatment for > 2 cm lithiasis is percutaneous nephrolithotomy (PNL), leaving flexible ureteroscopy (FURS) as a second option. In the present review, the stone-free rate and the complications of both techniques were evaluated in the treatment of 2-3 cm stones. Material and methods: Systematic review of studies that compared both techniques. Studies that were not comparative, as well as those carried out in the paediatric population or with < 2 cm or > 3 cm stones, were excluded. Two researchers independently performed the investigation, obtaining 5 studies that made up a total of 815 patients: 252 belonged to the FURS group and 563 to the PNL group. Four studies were retrospective, and one was non-randomised prospective. Results: Stone-free rate ranged between 47.0% and 95.0% for the FURS and between 87.0% and 100% for the PNL. The complication rate was 8.8-29.0% in the FURS and 11.9-27.0% in the PNL. FURS required a greater number of procedures, and had a lower decrease in haemoglobin and creatinine rise compared to PNL. Conclusions: The stone-free rate was higher for PNL, although the FURS could reach comparable results at the expense of performing several procedures. Both techniques have a similar frequency of complications, but the PNL has more postsurgical analytical alterations


Assuntos
Humanos , Nefrolitíase/cirurgia , Nefrolitotomia Percutânea/métodos , Ureteroscopia/métodos , Complicações Pós-Operatórias , Estudos Retrospectivos , Estudos Prospectivos
10.
J Urol ; 201(4): 794-801, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30316895

RESUMO

PURPOSE: Imaging following surgical intervention for nephrolithiasis is important to define operative success and ensure the absence of silent obstruction. We assessed nationwide postoperative imaging patterns in children undergoing ureteroscopy and shock wave lithotripsy. MATERIALS AND METHODS: We reviewed the MarketScan® Commercial Claims and Encounters database from 2007 to 2013 for patients 1 to 18 years old undergoing ureteroscopy or shock wave lithotripsy. We assessed imaging exposure following index procedure within 90 days as a primary analysis and 180 days as a secondary analysis of the index procedure. Univariate and multivariate statistical analyses were performed to assess factors associated with undergoing postoperative imaging. RESULTS: A total of 4,251 children met inclusion criteria, of whom 1,647 had undergone shock wave lithotripsy and 2,604 had undergone ureteroscopy. Postoperative imaging was performed in 57.5% of the cohort, with a higher proportion of children undergong imaging following shock wave lithotripsy compared to ureteroscopy (73% vs 47.8%, p <0.001). Noncomputerized tomographic imaging modalities were most common following ureteroscopy (70.8%) and shock wave lithotripsy (84.6%). Younger children and those with complex medical conditions or complicated postoperative courses were more likely to undergo followup imaging. Computerized tomography was more commonly used in older children and females. At 180-day followup 63% of the cohort had undergone any imaging, again more frequently following shock wave lithotripsy (77.0%) vs ureteroscopy (45.0%). CONCLUSIONS: A large percentage of children with nephrolithiasis do not undergo followup imaging after shock wave lithotripsy, and even fewer undergo imaging after ureteroscopy. Most followup imaging is done within 90 days of surgery. Further work is needed to define appropriate postoperative imaging practices in this population.


Assuntos
Litotripsia , Nefrolitíase/diagnóstico por imagem , Nefrolitíase/cirurgia , Ureteroscopia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Cuidados Pós-Operatórios , Melhoria de Qualidade
11.
Urology ; 123: 64-69, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30195012

RESUMO

OBJECTIVE: To compare outcomes of patients undergoing single session bilateral ureteroscopy (SSBU) to those undergoing planned staged ureteroscopy (URS) for bilateral nephrolithiasis. While SSBU has the advantage of 1 anesthetic procedure, some may pursue a staged approach due to the potential higher risk of complications and patient discomfort with 2 ureteral stents. METHODS: We retrospectively identified patients undergoing SSBU and planned staged URS for nephrolithiasis between December 2007 and December 2014. Preoperative characteristics, intraoperative techniques, and postoperative outcomes were compared. Stone burden was calculated as cumulative stone diameter. Residual stone fragments were defined as any stone visible on postoperative imaging. RESULTS: Sixty-three patients underwent SSBU and 37 underwent planned staged URS. Both cohorts had a relatively large cumulative stone burden (30.9 mm vs 32.4 mm, P = .71). Total operative time was significantly longer for planned staged URS (139 vs 86 minutes, P <.0001). There were no significant differences in complications or emergency room visits between the 2 cohorts despite bilateral ureteral stents being placed in the majority of the SSBU cohort (73%). There were no differences in stone-free rates or the need for additional procedures. CONCLUSION: SSBU is safe and effective with overall shorter operative times and similar stone-free rates compared to planned staged URS. Bilateral ureteral stent placement did not increase the rate of unplanned emergency visits. For patients with bilateral nephrolithiasis, urologists should strongly consider SSBU to limit anesthetic exposure, overall operative time, and health care costs.


Assuntos
Nefrolitíase/cirurgia , Ureteroscopia/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrolitíase/patologia , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscopia/efeitos adversos
12.
Urolithiasis ; 47(3): 273-278, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29484468

RESUMO

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


Assuntos
Transplante de Rim/efeitos adversos , Litotripsia/efeitos adversos , Nefrolitíase/cirurgia , Nefrolitotomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Adulto , Aloenxertos/patologia , Aloenxertos/cirurgia , Feminino , Seguimentos , Humanos , Rim/patologia , Rim/cirurgia , Litotripsia/instrumentação , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Nefrolitíase/patologia , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscópios , Adulto Jovem
13.
Pain Med ; 19(suppl_1): S12-S18, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30203013

RESUMO

Background: Opioid misuse is a significant public health problem. As initial exposures to opioids are frequently encountered through the management of postoperative pain, we examined patterns of opioid prescribing following surgical treatment for nephrolithiasis. Methods: We identified patients with nephrolithiasis in the national Women Veterans Cohort Study (WVCS) who were treated surgically by diagnosis and procedure codes. Using standard conversion factors, we calculated the morphine milligram equivalent (MME) dose prescribed. We used descriptive statistics to characterize opioid prescription across management strategy and multivariable regression to examine clinical and demographic characteristics associated with dispensed dose. Results: We identified 22,609 patients diagnosed with kidney stones during 1999-2014, 1,976 of whom were treated surgically and 1,582 (80.1%) of whom received an opioid prescription. The median age was 39 years, and 1,366 (90%) were male; 1,314 (86.3%) were treated with ureteroscopy, 172 (11.3%) with extracorporeal shockwave lithotripsy, and 36 (2.4%) with percutaneous nephrolithotomy. The median number of days supplied per opioid prescription (interquartile range) was 10 (5-14), and patients were dispensed a median of 180 (140-300) MME. A total of 6.4% of patients received ≥50 MME/d. On multivariable analysis, comorbid diagnosis of post-traumatic stress disorder (PTSD) was associated with higher total dispensed dose, whereas surgery type was not. Conclusions: We observed substantial variation in opioid prescribing following surgical treatment of nephrolithiasis. Although type of surgical intervention did not impact opioid dosing, patients with a diagnosis of PTSD were more likely to receive higher doses. This work can inform efforts to improve the safety and efficacy of postoperative opioid prescribing.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/normas , Cálculos Renais/cirurgia , Dor Pós-Operatória/prevenção & controle , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Veteranos , Adulto , Estudos de Coortes , Feminino , Humanos , Cálculos Renais/epidemiologia , Cálculos Renais/psicologia , Masculino , Pessoa de Meia-Idade , Nefrolitíase/epidemiologia , Nefrolitíase/psicologia , Nefrolitíase/cirurgia , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia
14.
Urology ; 120: 241-243, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29894776

RESUMO

We report the case of a 17-year-old male with Seckel syndrome and horseshoe kidneys which had a 7 mm kidney stone in the lower pole calyx of the right moiety. The patient had a history of rotoscoliosis with 60° dextroconvex curvature and hepatic steatosis. Attempted ureteroscopy was unsuccessful due to stone location and anatomy. Percutaneous nephrolithotomy was ultimately required. This case highlights the difficulties of endoscopic treatments of renal calculi in patients with abnormal renal anatomy and dysmorphia. To our knowledge, this is the first reported case of nephrolithiasis in a patient with Seckel syndrome and horseshoe kidneys.


Assuntos
Nanismo/complicações , Rim Fundido/complicações , Microcefalia/complicações , Nefrolitíase/diagnóstico , Adolescente , Fígado Gorduroso/complicações , Rim Fundido/diagnóstico por imagem , Humanos , Masculino , Nefrolitíase/complicações , Nefrolitíase/cirurgia , Nefrolitotomia Percutânea , Tomografia Computadorizada por Raios X
15.
Actas urol. esp ; 42(5): 316-322, jun. 2018. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-174717

RESUMO

Objetivos: Evaluar la efectividad y seguridad de la nefrolitotomía percutánea bilateral simultánea realizada en pacientes afectados de litiasis renales bilaterales. Material y métodos: Estudio prospectivo, período de septiembre de 2012 a noviembre de 2016. Se incluyeron pacientes diagnosticados de litiasis renales bilaterales por TC abdominal. Técnica quirúrgica posición en prono, punción renal guiada por fluoroscopia y dilatación del tracto hasta 24Ch. Se revisaron las características demográficas y de las litiasis, la tasa libre de litiasis, el éxito clínico, las complicaciones y el seguimiento. Resultados: Durante el período de estudio, se realizaron 732 nefrolitotomías percutáneas. Dieciocho pacientes (36 unidades renales; 2,5%), 13 hombres y 5 mujeres con una mediana de edad de 58 años y un rango intercuartílico (RIC) de 40-66. Tamaño de la litiasis mediana de 228 mm2 (RIC 134-389), tiempo operativo mediana de 150 min (RIC 97-180) y una estancia hospitalaria mediana de 5 días (RIC 5-15). La tasa libre de litiasis fue del 80%. Se reportaron litiasis residuales en 8 unidades renales (22,2%) que requirieron técnicas complementarias para su completa resolución, 4 litotricias extracorpóreas por ondas de choque, una ureterolitotomía por laparotomía, 2 ureteroscopias y un segundo procedimiento. Complicaciones mayores incluyeron 4 hemorragias manejadas mediante embolización por angiografía. Mediana de seguimiento 36 meses (rango 26-46). Conclusiones: La nefrolitotomía percutánea bilateral simultánea es un procedimiento eficaz y seguro en pacientes afectados con cálculos renales bilaterales. Es un desafío quirúrgico que debe realizarse en pacientes seleccionados y en centros con experiencia


Objectives: To evaluate the effectiveness and safety of simultaneous bilateral percutaneous nephrolithotomy performed in patients affected with bilateral renal calculi. Materials and methods: This is a prospective study from September 2012 to November 2016. Patients diagnosed of bilateral kidney stones with abdominal CT scan were included. Surgical technique prone position, renal puncture guided by fluoroscopy and tract dilation up to 24Ch. We reviewed demographic and stone characteristics, stone free rate, clinical success, complications and follow-up. Results: During the study period, 732 percutaneous nephrolithotomies were performed. Eighteen patients were included (36 renal units, 2.5%), 13 men and 5 women, with a median age of 58 years and an interquartile range (IQR) of 40-66. Median stone burden was 22 8mm2 (IQR 134-389); median operative time, 150 minutes (IQR 97-180); and median hospital stay, 5 days (IQR 5-15). Stone free rate was 80%. Residual calculi were encountered in 8 renal units (22.2%) and required other complementary techniques for their complete tesolution 4 external shockwave lithotripsies, one open ureterolithotomy, 2 ureteroscopies and one second look. Major complications included 4 cases of severe hemorrhage managed with angiographic embolization. The median follow-up was 36 months (range 26-46). Conclusions: Simultaneous bilateral percutaneous nephrolithotomy is an effective and safe procedure in patients affected with bilateral renal calculi. It is a surgical challenge that should be performed in selected patients and in centers with experience


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Nefrostomia Percutânea/métodos , Resultado do Tratamento , Nefrolitíase/diagnóstico por imagem , Nefrolitíase/cirurgia , Cálculos Renais/diagnóstico por imagem , Estudos Prospectivos , Cálculos Renais/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos
16.
Can J Urol ; 25(2): 9238-9244, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29680000

RESUMO

INTRODUCTION: To determine the clinical yield of stone culture in patients undergoing percutaneous nephrolithotomy (PCNL), and to identify patients who may benefit from this test. MATERIALS AND METHODS: We queried our database for all patients who underwent PCNL from 2005 to 2017, from whom urine culture (UC) and stone culture (SC) were obtained. Study endpoint was systemic inflammatory response syndrome (SIRS) within 48 hours of PCNL. Risk factors for SIRS and for stone colonization with highly resistant pathogens were evaluated. Based on UC and SC results, we determined the proportion of patients in whom SC may alter the treatment, had SIRS occurred, with respect to the initial empiric treatment. RESULTS: The study group comprised of 512 patients with a median age of 53, of whom 323 (63%) were male. Positive UC were found in 137 (26.7%) patients, and positive SC in 117 (22.8%) patients. UC did not identify pathogens isolated from SC in 66 (12.8%) patients. Postoperative SIRS occurred in 50 (9.8%) patients. On multivariate analysis only SC was associated with postoperative SIRS. SC pathogens resistance rates ranged from 67% for treatment with 2nd generation cephalosporins to 9% for treatment with meropenem, and may alter the choice of antibiotics in 73 to 12 patients (14.2%-2.3% of the whole cohort), respectively. CONCLUSIONS: In similar and earlier studies, we found substantial discordance between SC and UC results, and an association between stone colonization and SIRS. However, the practical yield of this test varies with the type of antibiotic given, and is limited when broad spectrum antibiotic is used.


Assuntos
Cuidados Intraoperatórios/métodos , Cálculos Renais/química , Cálculos Renais/cirurgia , Nefrolitíase/cirurgia , Nefrolitotomia Percutânea/métodos , Síndrome de Resposta Inflamatória Sistêmica/patologia , Adulto , Idoso , Análise de Variância , Antibioticoprofilaxia/métodos , Estudos de Coortes , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nefrolitíase/diagnóstico por imagem , Nefrolitotomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/terapia , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Medição de Risco , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Resultado do Tratamento
17.
Pol Merkur Lekarski ; 44(260): 49-53, 2018 Feb 23.
Artigo em Polonês | MEDLINE | ID: mdl-29498366

RESUMO

The improvement of surgical care requires transparent, consistent and accurate reports concerning surgical outcomes which are assessed and documented in a standardized manner. No consensus has yet been reached as to how to define and assess postoperative complications with regard to the specificity of urological procedures. Therefore, the comparison of data from different centres is difficult. The modified Clavien-Dindo classification allows for a more uniform analysis of surgical complications. This study analyses the occurrence of perioperative complications after percutaneous nephrolithotomy assessed on the basis of the aforementioned classification. AIM: The aim of this study was to analyse perioperative complications with the use of modified Clavien-Dindo classification. Obtained results were compared with those from the multicentre Endourological Society Percutaneous Nephrolithotomy Global Study. MATERIALS AND METHODS: This retrospective analysis involved 201 patients who underwent percutaneous nephrolithotomy during the period from 01.01.2013 to 31.12.2016. We assessed the frequency of complication and the characteristics of deposits. The modified Clavien- Dindo classification was used here. The surgery was performed by one operator in one centre. RESULTS: In 83.08% of patients normal postoperative course was reported. In case of 12.44%, there were minor deviations from the standard intraoperative and postoperative course. 2,49% of patients required transfusions of red blood cell (Clavien II) after the procedure. Less than 1.5% of patients required surgical, endoscopic or radiological intervention under local anaesthesia (Clavien IIa) and one patient required such intervention under general anaesthesia (Clavien IIb). Serious complications were not reported. The most common complications were as follows: low-grade fever (15.42%), fever (5.97%) and bleeding (3.48%). Among the least frequent complications there were: injuries of renal pelvis or ureter 2.99%, residual stones (1.99%), urinary leakage (1.49%), urinary retention (0.995%), arteriovenous fistula (0.497%). CONCLUSIONS: Percutaneous nephrolithotomy is a highly effective treatment of stones removal from the kidney. It is characterized by a small percentage of serious complications, especially when it is performed by an experienced operator. The modified Clavien-Dindo classification of complications is useful in monitoring and comparing the results obtained for this procedure.


Assuntos
Nefrolitíase/cirurgia , Nefrolitotomia Percutânea/efeitos adversos , Complicações Pós-Operatórias , Adolescente , Adulto , Idoso , Feminino , Febre/etiologia , Hemorragia/etiologia , Humanos , Rim/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
18.
J Pediatr Urol ; 14(3): 245.e1-245.e6, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29580730

RESUMO

INTRODUCTION: Successful surgical therapy for pediatric upper urinary tract calculi (UUTC) minimizes the need for repeat surgical interventions. However, staged procedures, whether planned or unplanned, are sometimes necessary. We assessed predictors of repeat intervention for children with UUTC using a nationwide administrative dataset. METHODS: Using the Pediatric Health Information System (PHIS) dataset, we assessed children with UUTC undergoing shock wave lithotripsy (SWL) or ureteroscopy (URS) for an index stone from January 2010 to June 2015. Primary outcome was additional treatment for nephrolithiasis within 90 days. Patient and procedural variables were assessed as potential risks for retreatment. Multivariable logistic regression models were used to compare the risk of retreatment adjusting for potential confounding factors. RESULTS: A total of 2788 patients undergoing URS (2,216, 79.5%) and SWL (572, 20.5%) were identified. SWL, stenting at the index operation without pre-index stenting, chronic comorbidities, renal calculi, and age <5 years were independent risk factors for retreatment. Use of ureteral stenting, most commonly employed in URS, was also a strong predictor of retreatment. Odds for reintervention, adjusted by multivariate modeling, are shown in the Figure. CONCLUSIONS: Adjusting for measured confounders, SWL is associated with a 2.6-fold higher risk of repeat stone-related interventions. Additional patient-related factors also increase likelihood of retreatment. Intra-operative stent placement is a strong predictor of retreatment, perhaps serving as a marker for complex cases or planned staged procedures. Prospective studies are needed to assess comparative effectiveness of SWL and URS and improve mono-therapeutic success for children with UUTC.


Assuntos
Sistemas de Informação em Saúde/estatística & dados numéricos , Nefrolitíase/cirurgia , Complicações Pós-Operatórias/epidemiologia , Reoperação/efeitos adversos , Medição de Risco/métodos , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Incidência , Lactente , Masculino , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
19.
J Urol ; 199(2): 500-507, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28941916

RESUMO

PURPOSE: The study of diagnostic imaging after procedural intervention for nephrolithiasis is limited. We sought to characterize actual national imaging patterns and longitudinal trends after ureteroscopic or shock wave lithotripsy. MATERIALS AND METHODS: We analyzed the MarketScan® database and identified a nationally representative sample of insured, employed patients, 17 to 64 years old who underwent ureteroscopic or shock wave lithotripsy for nephrolithiasis between 2007 and 2014. Patients were excluded from study if they lacked at least 1 year of postoperative database enrollment or underwent a repeat nephrolithiasis procedure of any type within 90 days after the initial procedure. We identified and tracked postoperative imaging modalities by medical billing codes. RESULTS: We identified 101,554 patients treated with ureteroscopy, of whom 55% and 39% underwent no postoperative imaging within 3 and 12 months, respectively. Of the 101,590 patients treated with shock wave lithotripsy 23% and 16% underwent no postoperative imaging within 3 and 12 months, respectively. Abdominal x-ray was the most common imaging modality after either procedure type. Ultrasound use increased with time while computerized tomography decreased. In about 25% of ureteroscopy and shock wave lithotripsy cases at least 1 postoperative computerized tomography was done within a year. Female gender and older age were associated with higher imaging rates. Ultrasound was more commonly performed in the northeast region and in more densely populated areas. CONCLUSIONS: A notable portion of patients treated with ureteroscopy and a smaller percent treated with shock wave lithotripsy do not undergo any followup imaging within 1 year. In the majority who undergo imaging abdominal x-ray is done, precluding the ability to screen for hydronephrosis or silent obstruction in almost 75% of patients treated with ureteroscopy.


Assuntos
Litotripsia , Nefrolitíase/diagnóstico por imagem , Cuidados Pós-Operatórios/métodos , Padrões de Prática Médica/tendências , Adolescente , Adulto , Bases de Dados Factuais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Nefrolitíase/cirurgia , Cuidados Pós-Operatórios/estatística & dados numéricos , Cuidados Pós-Operatórios/tendências , Padrões de Prática Médica/estatística & dados numéricos , Radiografia Abdominal , Tomografia Computadorizada por Raios X , Ultrassonografia , Estados Unidos , Ureteroscopia , Adulto Jovem
20.
Urology ; 114: 49-55, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29288788

RESUMO

OBJECTIVE: To determine the efficacy of intercostal nerve block and nephrostomy tract infiltration (NTI) with ropivacaine in patients undergoing tubeless percutaneous nephrolithotomy (TPCNL). MATERIALS AND METHODS: From February 2015 to March 2017, a total of 226 patients undergoing TPCNL were enrolled. After excluding 130 patients who failed to meet the inclusion criteria, a total of 96 eligible patients were randomized into 3 groups: group I, control group (n = 32); group II, intercostal nerve block with 15 mL of 0.5% ropivacaine and epinephrine (n = 32); and group III, NTI with 20 mL of 0.25% ropivacaine and epinephrine (n = 32). Pain status was assessed at postoperative 2, 8, and 24 hours and at discharge by visual analog scale score at rest (RVAS) and on deep breathing and coughing. RESULTS: Patient demographics and perioperative data between groups were comparable except for length of stay. Mean RVAS scores at postoperative 2 and 8 hours for group III were significantly less than those for group I (RVAS at 2 hours: 2.6 vs 4.9, P = .001; RVAS at 8 hours: 1.7 vs 3.3, P = .007). Mean RVAS scores at postoperative 24 hours had borderline significance (P = .050) among the 3 groups. Differences in mean deep breathing and coughing scores among groups were statistically significant (P = .002) only in the first 2 hours. All postoperative complications (5.4%, 5 per 92) were of grade 1 and not significantly different among groups. CONCLUSION: NTI is safe and effective in alleviating early postoperative pain for patients who underwent TPCNL.


Assuntos
Nervos Intercostais/efeitos dos fármacos , Nefrolitíase/diagnóstico por imagem , Nefrolitotomia Percutânea/métodos , Nefrostomia Percutânea/métodos , Bloqueio Nervoso/métodos , Ropivacaina/administração & dosagem , Adulto , Idoso , Análise de Variância , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrolitíase/cirurgia , Nefrostomia Percutânea/instrumentação , Medição da Dor , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/prevenção & controle , Posicionamento do Paciente/métodos , Prognóstico , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Ultrassonografia Doppler/métodos
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