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1.
J Biol Regul Homeost Agents ; 33(5 Suppl. 1): 39-44, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31630712

RESUMO

Urolithiasis is a well-known condition that can affect any part of the urinary tract. With a rate of 3-5% the incidence of upper urinary tract for long has been higher in adults (1-3), but recently it has increased among children reaching 3,3% . Indeed, more than 1% of all urinary stones are seen in patients aged less than 18 years (4). Pediatric urolithiasis is endemic in Turkey and Far East and it is probably due to malnutrition and racial factors (5). The spontaneous stone passage is more likely in children than in adults, indeed ureteral calculi spontaneously pass into 41-63% of children (1). Rate of stone passage depends on size and stone location in the urinary system. Stones sized less than 5 mm have a passage rate ranging from 40% to 98%, whilst stones > 5 mm have between 55% and 50% (6). In the last decade, the use of alpha blockers has proven well efficacious in helping spontaneous passage of distal ureteric stones in adults (7-9). The latest EAU guidelines support their use in adults while remain vague about their use in children because of unclear safety and efficacy (4). In search of evidence supporting or not the use of medical expulsive therapy in children we reviewed the literature dealing with the management of urolithiasis in pediatric patients. The primary aim of the present study was to evaluate the efficacy of medical expulsive therapy (MET), defined as stone expulsion rate, with a-blockers compared to a control group. The secondary aim was to assess the safety, defined as side effects rate, of MET compared to a control group.


Assuntos
Cálculos Ureterais/terapia , Urolitíase/terapia , Antagonistas Adrenérgicos alfa/uso terapêutico , Criança , Pré-Escolar , Humanos
2.
Emerg Med Clin North Am ; 37(4): 637-648, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563199

RESUMO

Renal colic is a common complaint that presents to the emergency department. It is estimated that 13% of men and 7% of women will develop a renal stone. There is a high probability of recurrence, with 50% within 5 years. Computed tomographic scan of the abdomen and pelvis without contrast and the ultrasound of the kidneys, ureters, and bladder are the common diagnostic imaging modalities used for diagnosis. Initial treatment includes analgesics and medical expulsive therapy. Most of the patients will pass their stone spontaneously within 3 days. The remaining 20% will require urologic intervention.


Assuntos
Cálculos Renais/diagnóstico , Cálculos Ureterais/diagnóstico , Humanos , Cálculos Renais/terapia , Nefrolitíase/diagnóstico , Nefrolitíase/terapia , Cálculos Ureterais/terapia , Urolitíase/diagnóstico , Urolitíase/terapia
4.
Urology ; 133: 109-115, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376474

RESUMO

OBJECTIVE: To measure decisional quality, physician loyalty, and treatment preference in patients diagnosed with urolithiasis, a "preference-sensitive" condition, to identify areas of improvement to be addressed by a targeted shared decision-making intervention. METHODS: We identified patients who presented for an initial consultation for urolithiasis from March 2016 to May 2017. Patients completed a 24-item patient experience questionnaire after the consultation which assessed decisional quality domains, physician loyalty, and treatment preference. We summarized treatment preferences before and after the consultation and described the changes. RESULTS: Among the total of 113 patients who met inclusion criteria, 78 (69%) patients chose to participate. Thirty-six (46%) of those patients had evidence of decisional conflict and 42 (54%) did not. Only 1 in 5 patients experiencing decisional conflict reported knowing the benefits and risks of each treatment option. Patients with decisional conflict reported lower perceived shared decision-making, treatment satisfaction, and urolithiasis knowledge. Physician loyalty was lower among patients with decisional conflict as well. Thirty-nine percent of them were 'Promoters' of their urologist, compared to 71% of patients without decisional conflict. Sixty-four percent of patients without decisional conflict identified a treatment preference before consultation, while only 17% of patients who experienced decisional conflict were able to do so. CONCLUSION: Many patients with urolithiasis experience decisional conflict and are unsure of their preferences when making a treatment choice. Uncertainty can correlate with low physician loyalty after consultation. This population may benefit from a shared decision-making intervention that improves decisional quality while incorporating patient-specific preferences.


Assuntos
Tomada de Decisões , Participação do Paciente , Preferência do Paciente , Urolitíase/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Adulto Jovem
5.
Int Urol Nephrol ; 51(7): 1129-1135, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31089946

RESUMO

PURPOSE: To determine the value of 24-h urine osmolality (UOsm) as a representative index of adequate hydration and predictor of stone recurrence in patients with urolithiasis. METHODS: Medical records of consecutive patients presenting with renal or ureteric stones between 1994 and 2017 were retrospectively reviewed. Patients were grouped according to the results of 24-h UOsm (low ≤ 564 mOsm/kg H2O, high > 564 mOsm/kg H2O). Metabolic parameters and risk of stone recurrence were compared between the two groups. RESULTS: The low urine concentration group were more likely to be older, to be female, and to have a lower body mass index and higher glomerular filtration rate than the high concentration group (each P < 0.005). A positive correlation was seen between 24-h UOsm and urinary calcium, sodium, uric acid, and magnesium excretion and 24-h specific gravity; a negative correlation was seen with 24-h urine volume. Stone-forming constituents, such as calcium and uric acid, were significantly higher in the high urine concentration group. Kaplan-Meier estimates showed that the low urine concentration group had a significantly longer stone recurrence-free period than the high urine concentration group (log-rank test, P < 0.001). In multivariate Cox regression analyses, 24-h UOsm was seen to be an independent risk factor for stone recurrence. CONCLUSIONS: UOsm is a promising approach to assessing hydration and predicting stone recurrence in patients with urolithiasis. Maintaining UOsm < 564 mOsm/kg H2O may reduce the risk of stone recurrence.


Assuntos
Estado de Hidratação do Organismo , Prevenção Secundária/métodos , Urolitíase , Fatores Etários , Índice de Massa Corporal , Correlação de Dados , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Concentração Osmolar , República da Coreia , Medição de Risco/métodos , Fatores Sexuais , Urinálise/métodos , Urolitíase/diagnóstico , Urolitíase/metabolismo , Urolitíase/prevenção & controle , Urolitíase/terapia
6.
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
7.
J Pak Med Assoc ; 69(3): 426-431, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30890841

RESUMO

Extracorporeal shock wave lithotripsy (ESWL) can cause depression and anxiety for patients with urolithiasis. We evaluated the frequency of anxiety and depression in patients of urolithiasis undergoing ESWL. Thirty patients scheduled for ESWL were enrolled in Diyarbakir State Hospital, Turkey. VAS-A, APAIS, BDS and BAS scores were recorded. The patients comprised 23 males and 7 females (M/F: 3.3/1 with a mean age of 31.03 } 10.84 years. The mean VAS-A were 5.46 } 1.71. The pre-procedural anxiety were 100% (VAS-A>0) and depression of 56.6% of patients. The statistically significant difference was observed in total APAIS scores betweeen male and females. (p=0.41) There was no significant difference between the groups in terms of gender and marital status (p< 0.05), Positive and statistically significant correlation was found between anxiety level (APAISa) and requirement of knowledge (APAISk) (p< 0.05). We found that depression and anxiety rates were high in patients with ESWL procedure.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Litotripsia/psicologia , Urolitíase/terapia , Adolescente , Adulto , Ansiedade/psicologia , Estudos Transversais , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Turquia , Adulto Jovem
8.
Arch Esp Urol ; 72(1): 25-35, 2019 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-30741650

RESUMO

OBJECTIVES: Studying the psychosocial sphere of patients who undergo any treatment allows to have more information about its repercussion and can help the choice of an appropriate and personalized treatment. Due to the absence of specific instruments at present, the objective is to design and validate a health questionnaire regarding the treatment received with ESWL. METHODS: It was carried out in 6 phases using a sampleof 50 patients treated with ESWL in 2015 in ourcenter, whom we interviewed by telephone. In phase1 the items were proposed based on bibliographic review,in phase 2 those that scored below 7 were eliminatedaccording to the evaluation from 0 to 10 on theitems made by specialists. In phase 3, values of 1 to 5were assigned to each item and those with correctedcorrelation more than 0.2 and not significant (p>0.05)discriminant power with U-Mann Whitney were eliminated.In phase 4 the reliability of the questionnaire waschecked with two indexes (Cronbach's alpha and twoGuttman's halves). In phase 5, the factor analysis withVarimax rotation was performed to calculate the constructvalidity and in stage 6, the scores were analyzedto establish reference values. RESULTS: 50 patients (32 men, 18 women). Medianage 59 years (27-79). In phase 1, 35 items were proposed,9 of which were eliminated in phase 2. The initialquestionnaire with 26 items was distributed, with 18being eliminated in phase 3. The final questionnaire wasformed with 8 items. In phase 4 the results of Cronbach'salpha and Guttman's two halves index were 0.44 and0.323 respectively. In phase 5 after factor analysis, wefound 4 factors with 2 items each (background, impactof the acute picture, post-treatment, quality of life) able toexplain 71.19% of the variance. The median scores ofthe scale, extreme values and quartiles studied in phase6 were respectively: P50: 17 (minimum-maximum 9-25),P25: 14 and P75: 20. CONCLUSIONS: The study carried out has provided anew instrument for assessing satisfaction after treatmentwith ESWL with adequate reliability and validity values.Future studies will be necessary to contrast its true clinicalusefulness.


Assuntos
Litotripsia , Urolitíase , Feminino , Humanos , Masculino , Satisfação Pessoal , Qualidade de Vida , Reprodutibilidade dos Testes , Inquéritos e Questionários , Urolitíase/terapia
9.
Vet Clin North Am Small Anim Pract ; 49(2): 157-174, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30736892

RESUMO

Nephroliths are often clinically silent. When non-obstructive and of an amenable stone type, dissolution should be attempted. When problematic, nephrolithotomy can be considered. Depending on stone type, size, and species, extracorporeal shockwave lithotripsy or endoscopic nephrolithotomy are preferred techniques. Obstructive ureterolithiasis should be addressed immediately to preserve kidney function. Because of decreased morbidity and mortality and versatility for all causes, interventional techniques for kidney decompression are preferred by the authors. Proper training and expertise in these interventional techniques should be acquired before performing them on clinical patients for the best possible outcomes.


Assuntos
Doenças do Gato/terapia , Doenças do Cão/terapia , Sistema Urinário , Urolitíase/veterinária , Animais , Gatos , Cães , Litotripsia/veterinária , Urolitíase/terapia , Medicina Veterinária
10.
Urolithiasis ; 47(4): 357-363, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30805669

RESUMO

Higher blood pressures (mean systolic difference 16.8 mmHg) when compared to matched individuals are already reported in patients with calcium urolithiasis. We present the prevalence of hypertension and renal impairment in patients with cystinuria from our specialist single centre. We analysed our prospective database of adult patients with cystinuria who attend our cystinuria service. This included details of the medical and operative management of their disease. Descriptive statistics were used to analyse and present the data. 120 patients were included with a median age of 40 (19-76) years, 66 were male (55%) and 54 were female (45%). 54/120 patients (45%) were taking medications to prevent stone formation. 78% (94/120) patients reported having undergone one or more stone-related procedure. 59% (55/94) of these having required at least one PCNL or open procedure during their lifetime. Prevalence of hypertension was 50.8% (61/120), and double in males compared to females (62.1% vs. 37.0%, P = 0.0063). Mean baseline creatinine was 88.2 (49-153) µmol/l and eGFR was 77.6 (32-127) ml/min/1.73 m2. When categorized by CKD stage, only 24.6% (27% vs. 21%, M vs. F) patients had normal renal function (being an eGFR > 89 ml/min/1.73 m2). 57.6% patients were CKD stage 2 and 17.8% CKD stage 3. Females had a slightly greater incidence of renal impairment. All patients who have previously undergone a nephrectomy (n = 10) or have a poorly functioning kidney (n = 19) have renal impairment (CKD stage 2 or 3). Incidence of hypertension in patients with cystinuria is 51%, with a male preponderance. Only 25% of patients with cystinuria have normal renal function. This highlights the long-term cardiovascular and renal risks that the metabolic effects of cystinuria pose, in addition to the challenges of managing recurrent urolithiasis in a young population.


Assuntos
Cistinúria/complicações , Hipertensão/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Urolitíase/epidemiologia , Adulto , Idoso , Feminino , Taxa de Filtração Glomerular , Humanos , Hipertensão/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Recidiva , Insuficiência Renal Crônica/etiologia , Estudos Retrospectivos , Fatores Sexuais , Resultado do Tratamento , Urolitíase/etiologia , Urolitíase/terapia , Adulto Jovem
11.
Med Hypotheses ; 124: 101-104, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30798901

RESUMO

Urinary stone disease has an increasing prevalence across the globe, and endoscopic treatment modalities have replaced open surgery. Percutaneous nephrolithotomy (PCNL) is a successful, safe and reliable minimally invasive method in the treatment of renal stones, especially big (≥2 cm) or complex ones. Gaining access is the most critical step of this procedure, which can affect the rest of the operation. Although previously described techniques, eye of the needle and triangulation techniques, are being used for gaining access, urologists (especially novice ones) can still have problems during this step. Some navigation concepts have been developed in order to make the access safer, easier and more successful, however, none of them has been incorporated in daily routine practice till now because of either complicated techniques or requirement of sophisticated equipment. Our hypothesis is that the access point, direction angle and access angle in order to touch a stone during PCNL can be calculated by the data obtained from the computed tomography images with the help of mathematical formulations, namely the theorem of the cosine.


Assuntos
Nefrolitotomia Percutânea/métodos , Cálculos Urinários/terapia , Urolitíase/terapia , Endoscopia/métodos , Humanos , Rim , Cálculos Renais/terapia , Modelos Teóricos , Nefrostomia Percutânea/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Cálculos Urinários/diagnóstico por imagem
12.
Arch. esp. urol. (Ed. impr.) ; 72(1): 25-35, ene.-feb. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181057

RESUMO

Objetivo: Estudiar la esfera psicosocial de los pacientes que se someten a algún tratamiento permite tener más información sobre la repercusión del mismo y puede ayudar a la elección de un tratamiento adecuado y personalizado. Debido a la ausencia de instrumentos específicos actualmente, el objetivo es diseñar y validar un cuestionario de salud en pacientes tratados con LEOC. Material y métodos: Se realizó en 6 fases utilizando una muestra de 50 pacientes tratados con LEOC en 2015 en nuestro centro, a los que entrevistamos por vía telefónica. En la fase 1 se propusieron ítems a partir de revisión bibliográfica. En la fase 2 se eliminaron los que puntuaban por debajo de 7 según la valoración de 0-10 sobre los ítems efectuada por especialistas en la materia. En la fase 3 se asignaron valores de 1 a 5 a cada ítem y se eliminaron aquellos cuya correlación corregida fuera mayor de 0,2 y cuya potencia discriminante con U-Mann Whitney no fuera significativa (p>0,05). En la fase 4 se comprobó la fiabilidad del cuestionario con dos índices (alfa de Cronbach y dos mitades de Guttman). En la fase 5 se realizó el análisis factorial con rotación Varimax para el cálculo de la validez de constructo. Finalmente, en la fase 6 se tipificaron de las puntuaciones para establecer valores de referencia. Resultados: 50 pacientes (32 hombres, 18 mujeres). Mediana edad 59 años (27-79). Fase 1: 35 ítems propuestos. Fase 2: 9 ítems eliminados. Distribución de cuestionario con 26 ítems. Fase 3: 18 ítems eliminados. Cuestionario final constituido por 8 ítems. Fase 4: valores de fiabilidad del cuestionario (alfa de Cronbach 0,44 e índice por técnica de dos mitades de Guttman 0,323). Fase 5: análisis factorial hallando 4 factores con 2 ítems cada uno (antecedentes, repercusión del cuadro agudo, post-tratamiento, calidad de vida) capaces de explicar el 71,19% de la varianza. Fase 6: mediana puntuación 50:17(mínimo-máximo 9-25), P25:14 y P75:20. Conclusiones: El trabajo realizado ha proporcionado un nuevo instrumento de evaluación de salud tras tratamiento con LEOC con valores de fiabilidad y validez adecuados. Serán necesarios futuros estudios para contrastar su verdadera utilidad clínica


Objectives: Studying the psychosocial sphere of patients who undergo any treatment allows to have more information about its repercussion and can help the choice of an appropriate and personalized treatment. Due to the absence of specific instruments at present, the objective is to design and validate a health questionnaire regarding the treatment received with ESWL. Methods: It was carried out in 6 phases using a sample of 50 patients treated with ESWL in 2015 in our center, whom we interviewed by telephone. In phase 1 the items were proposed based on bibliographic review, in phase 2 those that scored below 7 were eliminated according to the evaluation from 0 to 10 on the items made by specialists. In phase 3, values of 1 to 5 were assigned to each item and those with corrected correlation more than 0.2 and not significant (p>0.05) discriminant power with U-Mann Whitney were eliminated. In phase 4 the reliability of the questionnaire was checked with two indexes (Cronbach’s alpha and two Guttman's halves). In phase 5, the factor analysis with Varimax rotation was performed to calculate the construct validity and in stage 6, the scores were analyzed to establish reference values. Results: 50 patients (32 men, 18 women). Median age 59 years (27-79). In phase 1, 35 items were proposed, 9 of which were eliminated in phase 2. The initial questionnaire with 26 items was distributed, with 18 being eliminated in phase 3. The final questionnaire was formed with 8 items. In phase 4 the results of Cronbach’s alpha and Guttman’s two halves index were 0.44 and 0.323 respectively. In phase 5 after factor analysis, we found 4 factors with 2 items each (background, impact of the acute picture, post-treatment, quality of life) able to explain 71.19% of the variance. The median scores of the scale, extreme values and quartiles studied in phase 6 were respectively: P50: 17 (minimum-maximum 9-25), P25: 14 and P75: 20. Conclusions: The study carried out has provided a new instrument for assessing satisfaction after treatment with ESWL with adequate reliability and validity values. Future studies will be necessary to contrast its true clinical usefulness


Assuntos
Humanos , Masculino , Feminino , Litotripsia/métodos , Urolitíase/terapia , Satisfação Pessoal , Qualidade de Vida , Reprodutibilidade dos Testes , Inquéritos e Questionários
13.
Int J Urol ; 26(2): 185-191, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30332713

RESUMO

OBJECTIVES: The objective of the present study was to investigate the usefulness of three-dimensional images of stones to measure mean stone density for predicting the outcome of shock wave lithotripsy. METHODS: We retrospectively identified 239 patients who underwent shock wave lithotripsy with pretreatment non-contrast computed tomography. We automatically measured the mean stone density of three-dimensional images of stones using a high-functional viewer. For comparison, mean stone density was also measured by two previously reported techniques using both the abdominal windows and the bone windows on the axial slice at the level of the largest diameter of the stone. We compared the outcome predictive power after the first treatment with outcomes according to measurement by four other methods. We also carried out logistic regression analysis, including mean stone density measured by three-dimensional images. RESULTS: The single treatment success rate was 48.5%. The effect size (14.148) of the mean stone density measured by three-dimensional images was higher than those of the other four manual methods. In addition, the area under the curve (0.6330) of the mean stone density measured by three-dimensional images was significantly higher than those of the other methods. Increasing stone volume (P = 0.002) and increasing mean stone density measured by three-dimensional images (P = 0.023) were significant independent predictors of the treatment outcome on multivariate analysis. CONCLUSIONS: This is the first study to compare the predictive powers for shock wave lithotripsy outcome of various mean stone density measuring methods. There is an indication that mean stone density automatically measured by three-dimensional images of stones is more useful than other measuring methods for predicting outcomes of shock wave lithotripsy.


Assuntos
Imagem Tridimensional/métodos , Litotripsia/métodos , Urolitíase/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Urolitíase/terapia
14.
Int J Urol ; 26(2): 172-183, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30575154

RESUMO

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


Assuntos
Litotripsia/métodos , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/prevenção & controle , Ureteroscopia/métodos , Urolitíase/terapia , Humanos , Litotripsia/efeitos adversos , Litotripsia/instrumentação , Litotripsia/tendências , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/tendências , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Ureteroscopia/efeitos adversos , Ureteroscopia/instrumentação , Ureteroscopia/tendências
15.
PLoS One ; 13(11): e0205159, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30388123

RESUMO

PURPOSE: The miniaturization of instruments has had an impact on stone management. The aims of this study were to highlight surgeon preferences among Retrograde Intra Renal Surgery (RIRS), Regular, Mini-, UltraMini- and Micro- Percutaneous Nephrolithotomy (PCNL) for urolithiasis and to compare the effectiveness and safety of these techniques in a real-life setting. METHODS: A 12-item survey regarding endourological techniques was conducted through Survey Monkey among attendees of the 2013 European Association of Urology Section of Urolithiasis meeting. We asked responders to share data from the last 5 cases they performed for each technique. Procedures were stratified according to stone size and the centres' surgical volume. Techniques were compared in terms of effectiveness and safety. Analyses were performed on the overall group and a subgroup of 1-2 cm stones. RESULTS: We collected data from a total of 420 procedures by 30, out of 78, urologists who received the survey (response rate 38%): 140 RIRS, 141 Regular-PCNL (>20 Ch), 67 Mini-PCNL (14-20 Ch), 28 UltraMini-PCNL (11-13 Ch) and 44 Micro-PCNL (4,8-8 Ch). Techniques choice was influenced by stone size and the centre's surgical volume. Effectiveness and safety outcomes were influenced by stone size, independently of the technique. The stone-free rate was significantly lower in Micro-PCNL compared to Regular-PCNL. This was not confirmed for 1-2 cm stones. All techniques presented a lower complication rate than Regular-PCNL, with Mini-PCNL being the most protective technique compared to Regular-PCNL. CONCLUSIONS: Stone size seems to drive treatment choice. Miniaturized PCNL techniques are widely employed for 1-2 cm stones, in particular in higher surgical volume centres. Mini-PCNL and RIRS are growing in popularity for stones > 2 cm. Mini-PCNL seems to be a good compromise, being the most effective and safe procedure among PCNL techniques. RIRS is characterized by satisfactory stone-free and low complication rates.


Assuntos
Sociedades Médicas , Inquéritos e Questionários , Urolitíase/patologia , Urolitíase/terapia , Urologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea , Resultado do Tratamento , Urolitíase/cirurgia , Adulto Jovem
16.
Scand J Urol ; 52(5-6): 453-458, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30451054

RESUMO

BACKGROUND: In contrast to treatment with oral or intramuscular analgesics, extracorporeal shock wave lithotripsy (E.S.W.L.) can be performed with patients under sedation too. Besides the advantage of increased shock energy, patients tend to have more constant breathing excursions and are more idle during treatment, potentially increasing the stone-free ratio (S.F.R.) after treatment. METHODS: This study presents the results of 310 patients who underwent 400 E.S.W.L. procedures under sedation, with a stationary lithotripter. RESULTS: After one procedure, the S.F.R. was 54.8% (170/310). A second treatment was successful in 42.1% (32/76), a third treatment in 21.4% (3/14). Therefore, 66.1% (205/310) of patients eventually became stone-free. Kidney stones were successfully treated in 65.4% (161/246), ureteral stones in 68.8% (44/64) of cases. Patients with stones ≤15 mm were successfully treated in 67.4% (194/288), patients with stones >15 mm in 50% (11/22) of cases. Considering each procedure individually, 45.3% (181/400) of procedures were successful after 3 weeks. Extending follow-up to 3 months is important, since 26.7% of stones (24/90) eventually still disappeared, increasing S.F.R. to 51.3% after one procedure. Complications occurred after 5.5% E.S.W.L.-procedures. CONCLUSIONS: E.S.W.L. is a well-tolerated, non-invasive procedure that produces reasonable stone clearance of both upper and lower urinary tract calculi. Performing the procedure whilst patients are intravenously sedated results in an acceptable S.F.R. Strong selection based on unfavourable factors could increase the chance on successful treatment and spare patients a pointless procedure. However, considering E.S.W.L.'s elegant nature, sometimes a more tolerant approach seems justifiable.


Assuntos
Sedação Profunda/métodos , Cálculos Renais/terapia , Litotripsia/métodos , Cálculos Ureterais/terapia , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Anestésicos Intravenosos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Propofol/uso terapêutico , Remifentanil/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento , Urolitíase/terapia
17.
J Vet Intern Med ; 32(6): 2105-2114, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30307649

RESUMO

BACKGROUND: Obstructive urolithiasis is a common disease associated with a guarded prognosis in small ruminants. HYPOTHESIS/OBJECTIVE: The results of physical examination, laboratory analyses, and clinical management of male small ruminants presented to 2 referral clinics were investigated to identify variables significantly associated with disease outcome, so as to provide better recommendations to animal owners regarding the management of these patients. ANIMALS: Two-hundred ten small ruminants (130 sheep and 80 goats) with confirmed diagnosis of obstructive urolithiasis. METHODS: Clinical findings (including diagnostic imaging) and laboratory results of the 210 animals were reviewed, and relevant information regarding clinical and laboratory variables recorded upon admission and clinical management was retrieved. The association of the different variables with nonsurvival was investigated by univariable and multivariable logistic regression models. RESULTS: Only 39% of all patients considered for treatment and 52% of those undergoing tube cystostomy survived to be released from the clinic. Nonsurvival was strongly associated with a very poor clinical condition upon presentation, obesity, castration, and evidence of uroperitoneum. Among blood variables, abnormal PCV, severely increased serum creatinine concentrations, and increased activity of the creatine kinase were associated with increased risk of nonsurvival. Presence of signs of colic or macroscopic appearance of urine was not significantly associated with outcome. CONCLUSIONS AND CLINICAL IMPORTANCE: The prognosis of obstructive urolithiasis was guarded with survival rates of 39% (overall) to 52% (after tube cystostomy). Intact young males with normal body condition presented early in the course of disease had the best chances of survival.


Assuntos
Doenças das Cabras/mortalidade , Doenças dos Ovinos/mortalidade , Urolitíase/veterinária , Animais , Doenças das Cabras/patologia , Doenças das Cabras/terapia , Cabras , Masculino , Orquiectomia/veterinária , Fatores de Risco , Ovinos , Doenças dos Ovinos/patologia , Doenças dos Ovinos/terapia , Obstrução Uretral/mortalidade , Obstrução Uretral/patologia , Obstrução Uretral/terapia , Obstrução Uretral/veterinária , Urolitíase/mortalidade , Urolitíase/patologia , Urolitíase/terapia
18.
Zhonghua Wai Ke Za Zhi ; 56(10): 725-728, 2018 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-30369148

RESUMO

Over the past few years, the prevalence of urinary stones has been gradually increasing, which imposes heavy burden of diseases on medical systems and people's health worldwide. Fortunately, a series of innovations in clinical management of urolithiasis have increased our response capacity to urinary stones. This article summarizes recent original innovations, performance optimization, and collaborative progress in the fields of diagnosis, pharmacotherapy, and surgical procedures of urinary stones. These innovations and corresponding application in clinical setting have the potential to facilitate the clinical management of urolithiasis and protect people from urolithiasis-associated injuries.


Assuntos
Urolitíase , Humanos , Urolitíase/terapia
19.
Zhonghua Wai Ke Za Zhi ; 56(10): 729-732, 2018 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-30369149

RESUMO

Endoscopic surgery has become the most common urological procedure for calculus in upper urinary tract. However, the widespread usage of minimally invasive endoscopic techniques failed to end the occurrence of perioperative complications, especially some fatal complications. The most severe complication of urolithiasis related endoscopic procedure is urosepsis, which is closely related to the backflow of irrigation fluid induced by the high pressure of renal pelvic during the procedure. By controlling the perfusion and drainage during the operation, the liquid backflow can be reduced effectively, thus may reduce the spread of infectious toxins and pathogens, and incidence of infectious complications can be controlled accordingly. In this article, the pathophysiology of urinary obstruction, the backflow which caused by elevated renal pelvic pressure and its subsequent pathophysiological changes, the control of intra-renal gressure and the prevention of urosepsis will be reviewed. The important range of intra-renal pressure and the major steps for pressure control during the operation is emphasized.


Assuntos
Rim , Urolitíase , Humanos , Rim/fisiopatologia , Pelve Renal , Pressão , Urolitíase/terapia
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