Technological innovations in shock wave lithotripsy.

INTRODUCTION: Since 1980, extracorporeal shock wave lithotripsy (SWL) has been employed in the treatment of urolithiasis, offering noninvasive alternatives to surgical techniques. In addition to being limited by the size and location of the stones, its efficacy is influenced by several factors. Despite the advancement of other surgical techniques, SWL could maintain its position with new improvements. Our objective is to review the existing literature on the latest advances in the extracorporeal treatment of lithiasis. MATERIAL AND METHODS: A non-systematic literature review was carried out from 2017 to 2023 to obtain 26 articles on three different emerging technologies in extracorporeal lithotripsy: Burst Wave Lithotripsy (BWL), Histotripsy, and Microbubble Lithotripsy (ML). RESULTS: The BWL uses sinusoidal bursts of US waves delivered at lower and higher frequencies than conventional SWL. Its mechanism of action generates a higher quality fragmentation (fine fragments) instead of generating tensile stresses for stone fracture resulting in larger fragments, as in traditional SWL. Studies in pigs and humans have shown effective fragmentation with a good safety profile. Based on High Intensity Focused Ultrasound (HIFU) technology, histotripsy fragments tissue through cavitation. Good in vitro results have been shown, but the formation of microbubbles between the stone and ultrasound waves hinders the progress of this technique. Microbubble Lithotripsy (ML) combines microbubbles and ultrasound for safe and effective stone fragmentation. In vitro and pig results are promising. This technique can help optimize treatments and reduce energy levels. CONCLUSIONS: Technological innovation is not only being applied to endourological techniques, but also to ESWL. New techniques such as BWL, histotripsy and ML are promising, with good results in the research phase.

In vivo aneuploidization during the expansion of renal adenocarcinoma.

BACKGROUND/AIMS: A correlation has been observed between DNA ploidy and other prognostic parameters such as tumor stage and grade. The present study evaluates tumor aneuploidization during renal adenocarcinoma expansion and growth. METHODS: A total of 252 renal tumors were analyzed between 1969 and 2001. Evaluated variables were age, TNM, Fuhrman classification, histology, size and DNA. A tumor was homogeneous when all the samples were diploid or aneuploid, and a heterogeneous tumor was the coexistence of aneuploid and diploid samples, or all-aneuploid with different aneuploid clones. RESULTS: A total of 224 tumors were included (coefficient of variation <8). The DNA study classified 129 (57.6%) as diploid and 95 (42.4%) as aneuploid. The percentage of aneuploid tumors increased significantly with the pathological stage. Both aneuploid patterns were also significantly more frequent in advanced pathological stages. Tumors with multiple aneuploid clones (n = 17) were significantly more frequent in tumors measuring `4 cm. Both aneuploid patterns showed no differences in survival (p = 0.83), indicating that the heterogeneous pattern probably represents an intermediate step between diploid and homogeneous aneuploid tumor status. CONCLUSIONS: The aneuploid pattern is more common in more advanced stages of the disease, with no clear correlation to primary tumor size. This suggests gradual aneuploidization with tumor expansion and growth.

Comparative analysis of direct and indirect costs of two minimally invasive techniques for the treatment of renal/ureteral calculi smaller than 2 cm. / Análisis comparativo de costes directos e indirectos de dos técnicas mínimamente invasivas, para el tratamiento de la litiasis renoureteral menor de 2 cm.

OBJECTIVE: To perform a comparative analysis of indirect and direct costs of two minimally invasive techniques (extracorporeal shock wave lithotripsy (ESWL) vs. ureteroscopy with holmium laser (URS/RIRS)) for the treatment of renal/ureteral calculi smaller than 2 cm. MATERIAL AND METHODS: Prospective, comparative, non-randomized study of 84 patients treated for kidney stones smaller than 2 cm between January and December 2016. Of these, 38 (45.67%) were treated with ESWL (18 renal lithiasis and 20 ureteral lithiasis) and 46 (54.32%) with URS/RIRS (22 renal lithiasis and 24 ureteral lithiasis). A total of 19 (41.3%) patients in the URS/RIRS group and 15 (39.5%) patients in the ESWL group were actively working before treatment. The variables analyzed were sex, age, number and size of lithiasis, time (days) off from work due to treatment, estimate of indirect cost due to labor productivity loss and direct treatment costs including follow-up (total number of procedures, ancillary care, visits and diagnostic tests). The 2015 Wage Structure Survey (INE) was used to estimate the indirect cost. In addition, the «Work Productivity and Activity Impairment¼ (WPAI) questionnaire was also used to determine the level of perceived productivity loss. RESULTS: The mean number of sessions until lithiasis resolution was achieved was 2.57 for the ESWL group and 1.04 for the URS. The mean number of days off from work in the URS group was 7.16 days and 3.18 (p = 0.034) in the ESWL group. The total indirect costs resulting from productivity loss were EUR 621.55 and EUR 276.05 for the URS and ESWL, respectively. Direct costs in the ESWL group were EUR 1,382.9 and EUR 2,317.71 in the URS group. The level of work impairment perceived by patients undergoing URS was 18.88% and 21.33% in the ESWL group. The degree of impairment for performing activities of daily living was 24.44% in the URS and 15% in ESWL. CONCLUSIONS: The ESWL technique requires a higher number of sessions for the resolution of kidney stones under 2 cm, but it has a lower impact on total costs and on the perceived degree of affectation.

Predictive factors of infectious complications in the postoperative of percutaneous nephrolithotomy. / Factores predictores de complicaciones infecciosas en el postoperatorio de la nefrolitotomía percutánea.

OBJECTIVE: Infectious complications (IC) following percutaneous nephrolithotomy surgery (PCNL) can be life-threatening. Our objective was to analyse preoperative predictors of IC in PCNL. MATERIALS AND METHODS: A total of 203 patients who underwent PCNL were included in a prospective study between January 2013 and February 2016. A postoperative IC was defined as urinary infection/pyelonephritis, systemic inflammatory response syndrome or sepsis. The variables analysed were age, gender, number, size(cm) and side of stone; Hounsfield units,diabetes (insulin dependent or not), preoperative culture, isolated bacteria, multitract, bodymass index and surgical time (min). A multivariate forward stepwise (logistic regression) was performed. RESULTS: IC occurred in 30 patients (14.8%): 9 (4.4%) had urinary infection, 14 (6.9%) systemic inflammatory response syndrome and 7 (3.5%) sepsis. In addition, 13 (43.3%) had negative preoperative urine culture, 15 (50%) positive and in 2 (6.7%) was not available. On the logistic regression analysis, stone size (cm), insulin dependent diabetes and female sex were independently associated with increased risk of IC (odds ratio [OR] 1.03, 14.6 and 7.8, respectively; P=.0001). CONCLUSIONS: Patients with large stone burdens, insulin diabetes condition and female gender, should be counselled properly regarding postoperative infection risks and closely followed up to diagnose IC (specially sepsis) soon enough. Negative preoperative urine culture seems not reliable enough to exclude an infectious complication according to our results.

[PSA and hK2 in the diagnosis of prostate cancer]. / PSA y hK2 en el diagnóstico de cancer de próstata.

Serum markers for prostate carcinoma are widely applied for the purpose of early detection of cancer and the differentiation between benign and malignant disease, for the pre-treatment staging of detected prostatic cancers, and for the monitoring of prostate cancer after curative or palliative therapies. Since its discovery in 1979, serum PSA has been the most powerful marker of prostate cancer, but, when used alone, PSA is not sufficiently sensitive or specific to consider it an ideal tool for the early detection or staging of prostate cancer. To optimize the use of PSA, the concepts of PSA velocity, PSA density, and age-related PSA values were developed. Moreover, the molecular forms of PSA, especially the percentage of free PSA, seem to be useful tools for the detection of prostate cancer in men with slightly elevated total PSA. Human kallikrein 2 (hK2), a serine protease closely related to PSA that also is expressed predominantly in the prostate, is a new complementary marker to PSA for early detection of prostate cancer. In this review, we examine PSA testing and its effectiveness in the diagnosis of prostate cancer. Further, we also evaluate recent literature regarding the use of hk2.

[Prognostic factors for disease progression in patients with renal cell carcinoma]. / Análisis de los factores pronósticos de progresión tumoral en el adenocarcinoma renal.

INTRODUCTION: More than 40% of patients with renal cell carcinoma present with disease progression after surgery. The objective of the current study was to identify a clinically useful set of prognostic factors that would correlate significantly with the capacity of progression. MATERIAL AND METHODS: The authors studied 252 patients with renal cell carcinoma who underwent radical nephrectomy. Followup ranged from 12-246 months (median 36 months). Several morphologic parameters of the tumors were considered. DNA content was analyzed by flow cytometry and tumor size was determined from the surgical specimen. A Cox proportional hazards regression model was used to identify significant independent prognostic factors for disease progression. RESULTS: A total of 224 out of 252 were available for suitable histograms. Of the 224 patients, 95 (42.4%) were aneuploid tumors, 106 (47.2%) were organ-confined renal cell carcinoma and 87 (39.74%) presented disease progression. At 5 and 10 years of followup, disease free survival was found to be 66.31% and 62.23%, respectively. Univariate analysis revealed that DNA ploidy, Furhman grade and stage (TNM) had a statistically significant predictive value for disease progression. Survival univariate analysis found a worse probability of survival for aneuploid tumors, grade III-IV tumors, non organ-confined tumors and conventional and undiferentiated tumors. Using multivariate survival analyses, Furhman grade, stage (TNM) and DNA ploidy were the only independent prognostic factors. So, the probability of death for aneuploid tumor was 1.7 times higher than for diploid tumors. CONCLUSIONS: Stage, DNA content and Furhman grade were the only significant independent predictors of disease progression. Tumoral size and histological type did not provide more additional information.

[Indications, results and techniques of permanent prostate brachytherapy for localized prostate cancer]. / Braquiterapia de baja tasa en el tratamiento del cáncer de próstata localizado.

INTRODUCTION AND OBJECTIVE: Prostate brachytherapy is a first-line therapeutic approach for localized prostate cancer in selected patients. We present our experience in brachytherapy and a thorough review of the literature. MATERIALS AND METHODS: A review of the literature and evaluation of patient's selection was done. Furthermore the implantation technique, oncological results according to the different risk groups and acute and chronic complications were also analyzed. RESULTS: The biochemical relapse-free 10 year survival rate was 87-96% in low risk tumours and 63-86% in intermediate risk tumours. A total of 3-24% underwent urinary retention that required TURP in 0-8,7%. Other complications were urinary incontinence in 0-6,7%, proctitis in 0-15,5%, erectile dysfunction in 6,3-30%, rectal ulcer/fistula in 0-5,4%. CONCLUSIONS: Prostate brachytherapy is a safe and effective treatment in low and intermediate risk patients with prostate cancer.

[Incidental renal cancer in young adults: clinical and histopathological findings]. / Cancer renal incidental en pacientes menores de 40 años: hallazgos clinicos e histopatológicos.

OBJECTIVE: to evaluate the clinical and pathological renal cancer (CR) characteristics in our series of tumours, analyzing its impact in the group of age less than 40 years. MATERIAL AND METHODS: We studied 294 patients with CR. The pathologic characteristics were analyzed and DNA ploidy pattern of the surgical pieces were done in 252 patients. The patients were divided in two groups based on age, greater or less to 40 years, well then clinical and pathologic characteristics were compared between. RESULTS: Of all patients, 26 of 294 patients (8,94%) were included in the young age group (less to 40 years). We did not found differences between both groups comparing stage, tumoral volume, treatment realized or DNA ploidy pattern, but in nuclear grade with more aggressive tumours in young people (p=0,0018), without differences in recurrence-free survival or actuarial disease specific survival rate. CONCLUSIONS: The findings in our study indicate that the natural history and outcome of the RC is similar in both older and younger patients. Therefore, in our opinion, the management of CR in young people should be established with independence of the age.

Is extracorporeal shock wave lithotripsy a current treatment for urolithiasis? A systematic review. / ¿Es la litotricia extracorpórea por ondas de choque en la actualidad un tratamiento vigente para el tratamiento de la litiasis urinaria? Revisión sistemática.

INTRODUCTION: Technological advances have prompted a change in the management of urolithiasis. Endourological techniques are gaining importance because they are highly effective treatments. The aim of this study was to answer the question of whether extracorporeal shock wave lithotripsy (ESWL) is still a competitive alternative compared with other therapeutic modalities. ACQUISITION OF EVIDENCE: We conducted a literature search of articles published in the past 5 years. We identified 12 randomized and comparative studies and assessed the methodology and results of the study variables. We performed a narrative synthesis of the included studies. To summarise the variables, we used the mean and standard deviation for continuous variables and absolute numbers and percentages for the qualitative variables. ANALYSIS OF THE EVIDENCE: Of the studies reviewed, 7 evaluated the various treatments for nephrolithiasis and 5 evaluated the treatments for ureteral lithiasis. At the renal level, a stone-free rate of 33.33-91.5% at 3 months was reached with ESWL, while a rate of 90.4-100% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. At the ureteral level, a stone-free rate of 73.5-82.2% at 3 months was reached with ESWL, while a rate of 79-94.1% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. CONCLUSION: There is a lack of homogeneity among the published studies. ESWL is a minimally invasive treatment that with an appropriate technique and patient selection achieves high effectiveness, thus maintaining an important role at this time.

Shockwave lithotripsy with music: Less painful and more satisfactory treatment. / Litotricia por ondas de choque con música: un tratamiento menos doloroso y más satisfactorio.

INTRODUCTION: The objective of this study was to determine whether listening to music during a session of extracorporeal shockwave lithotripsy (ESWL) improves patients' pain. MATERIAL AND METHOD: A simple, blind randomisation was undertaken of patients with kidney and ureter stones attending an ESWL session of 7,000 waves for the first time, between September and December 2014. One group was given music and the other was not. The age, gender, location of stones (kidney/ureter) were recorded and 2questionnaires: pre ESWL (questionnaire A) and postESWL (questionnaire B). Each questionnaire contained a question about anxiety and another question on pain on the Likert scale (0-10). Questionnaire B also had a question on satisfaction and comfort (Likert 0-10). Other variables included heart rate, respiratory rate, systolic and diastolic blood pressure on wave 2,000, 5,000 and 7,000, reason for halting the procedure, total pethidine (mg), secondary analgesia, energy (J) and frequency (Hz). Bivariate analysis using the Student's t-test, X2/Fisher test and a multiple linear regression model. RESULTS: The sample comprised 95 patients, with a mean age of 52 (±13) years, 35 (36.84%) females, 60 (63.2%) males. A total of 25 (26.3%) ureter stones and 70 (73.7%) kidney stones. A number of 42 (44.2%) patients were given music. There were no differences between the demographic variables or questionnaire A scores. Satisfaction and pain were better on questionnaire B with music. CONCLUSION: Music can reduce pain and improve patient satisfaction in ESWL treatment. More studies are required to confirm this effect.

[Traumatic testicular dislocation]. / Dislocación testicular postraumática.

Testicular dislocation is an uncommon injury after blunt scrotal trauma (with only 150 cases reported) that must be properly diagnosed and treat in order to avoid a testicular atrophy. We presented a case report of traumatic dislocation of right testicle after a motorcycle accident. This type of testicular injury should be included in the whole evaluation of every polytrauma patient and usually requires a surgical treatment. The aim of this report is to clarify some aspects of the management of such rare entity.

[Leiomyoma of renal pelvis]. / Leiomioma de pelvis renal.

Renal leiomyoma are uncommon mesenchymal tumours, which can arise from any organ of the genitourinary tract with smooth muscle cells. The diagnostic imaging techniques available can not differentiated easily leiomyoma from other malignant renal masses. Since preoperative diagnosis cannot be made, management usually involves radical nephrectomy as in the case described. After treatment, prognosis is excellent.

[Evaluation of pT3a stage in the current classification for renal cancer]. / Evaluación del estudio pT3a de la actual clasificación TNM del cáncer renal.

OBJECTIVE: We assessed the prognostic value of a stage pT3a diagnosis based on perirrenal fat infiltration. MATERIAL AND METHODS: A series of 300 patients diagnosed of renal cell carcinoma (CCR) between 1992 and 2001 were retrospectively analyzed. Focusing on pT3a tumors as defined by perirrenal fat infiltration, a group of 92 patients (91,08%) regardless lymph node involvement (Nall) were included. Patients with distant metastases were excluded. In patients with pT3a Nall M0 tumors, tumour size was a significant parameter predicting survival. The most significant cut-off value for tumor size based on ROC curve was 5,5 cm. Therefore two groups were defined (up to 5,5 cm or greater than 5,5 cm) and actuarial survival were compared between both groups. RESULTS: No significant differences were found comparing actuarial survival of selected pT3a and tumour size less than 5,5 cm with pT1 and pT2 tumors. After classifying selected pT3a less than 5,5 cm as pT1, multivariate analysis showed no differences regarding to prognostic variables before and after classification. Subsequently multivariate analysis showed that modified T stage was an independent significant predictor of cancer specific actuarial survival. CONCLUSIONS: Perirrenal fat infiltration in renal cell carcinoma should not be used to assign T category. In our series grading tumors pT3a lesser than 5,5 cm as pT1/pT2 TNM stage does not affect their prognostic value.

[Renal cancer in elderly: clinical and histopathological findings]. / Cáncer renal incidental en pacientes de edad geriátrica: hallazgos clínicos e histopatológicos.

OBJECTIVE: to evaluate the clinical and pathological characteristics of the CCR in our series of tumors, analyzing its impact in the group of age greater than 65 years. MATERIAL AND METHODS: 300 patients with renal adenocarcinoma (CCR) were studied. In 252, ploidy pattern of DNA and pathologic characteristics of the surgical pieces were done. According to the criteria of the Spanish Society of Geriatrics, the patients were divided in two groups based on the age, greater and smaller of 65 years. The clinical and pathologic characteristics were compared between both groups. RESULTS: 103 of the 300 patients (33.3%) were included in the geriatric group. We did not found differences between both groups comparing stage, tumoral volume or treatment realized, but found differences in DNA ploidy pattern, recurrences and survey. CONCLUSIONS: The RCC in the elderly has a few clinical and pathological characteristics similar to the rest of patients in our series. Nevertheless differences exist in the average and actuarial survival, which is minor in the patient of more than 65 years, cause the percentage of detected aneuploidies and number of recurrences in not confined tumors in this group of age.

[Impact in the quality of life of the patients with double J catheter.] / Impacto en la calidad de vida de los pacientes con catéter doble J.

OBJECTIVE: Double J ureteral stents are frequently used to allow free diuresis from the kidney to the bladder, but their presence has a major impact on patient's quality of life (QoL). Our aim is to describe such impact, and to describe possible solutions that can alleviate the symptoms associated with their use. METHODS: Systematic search in bibliographic sources including Cochrane library, UpToDate, Pubmed, Tripdatabase, selecting publications between 2000- 2015, and also the EAU European guidelines (2016). Studies that assessed QoL with double J stents and possible solutions were selected. RESULTS: We included 6 qualitative studies on QoL, 6 clinical trials of double J catheters new designs, and 3 systematic reviews. Most studies used the USSQ (QoL) questionnaire and main problems are described, being storage symptoms and pain the most frequent and important. Possible solutions include modifications in design and composition of the catheter and specially, the use of alpha-blockers and anticholinergics to improve QoL. CONCLUSION: Double J stents have an important symptomatic impact that impairs QoL. They should be used under appropriate indication; their duration should be limited and we must employ all the technological and pharmacological approaches to mitigate their effects.

[Role of chronic prostatic infiltrate from specimens of prostate biopsy in total and free PSA determination]. / Influencia de la inflamación crónica prostática en muestras de biopsia sextante en los niveles séricos de PSA total y PSA libre.

PURPOSE: To analyze the influence in total serum PSA (PSA(t)) and free PSA (PSA(1)) of chronic inflammatory patterns from prostate biopsy specimens of non-symptomatic patients. PATIENTS AND METHODS: 518 non-symptomatic patients underwent ultrasonography and prostatic biopsy for PSA(t) > 4 ng/mL and/or DRE suspicious of malignancy. Those with a negative biopsy were divided into two subgroups: patients with benign prostatic lesions (LBP) and patients with chronic inflammatory signs (SIC). RESULTS: 456 patients (88.03%) were biopsied for elevated PSA(t) or/and DRE suspicious of malignancy in 62 patients (11.97%). Mean volume in patients with LBP was 54cc, while 51cc was the mean volume in patients with histological pattern of chronic inflammatory infiltrate. Mean PSA(t) in patients with LBP was 9.43 (IC 95% +/- 7.8) and 8.8 (IC 95% +/- 5.73) in SIC's group patients. CONCLUSIONS: The presence of SIC has no significant influence in the eventual value of PSA(1) y PSA(t) in a selected population. As a result of that finding data from serum PSA can be reliably evaluated even in the presence of SIC in biopsy specimens.

[Endoscopic treatment of pielo-uretheral lithiasis with Holmium-YAG laser. Two years of experience]. / Tratamiento endoscópico de la litiasis pieloureteral mediante láser Holmium-YAG. Dos años de experiencia.

OBJECTIVE: To show the efficiency and safety of Holmium laser in the treatment of pyeloureteral lithiasis, based on our own experience since the introduction of this source of energy in our department. MATERIAL AND METHODS: From January 2002 to February 2004, we have carried out 198 ureterorenoscopies using Holmium laser to treat lithiasis located in the upper urinary tract. In all cases, a previous radiological study demonstrated the stone. Follow-up, where the efficacy of the treatment was assessed, was done with a scout x-ray after 3-4 weeks. We evaluated the localization and features of the lithiasis, technical aspects, results and complications of our series. RESULTS: The most common localization of the lithiasis was the pelvic ureter (59%), with the number of treated cases in both the iliac and lumbar ureter being similar (16%). 70% of the lithiasis had a size between 0.5 and 1.5 cm, and 15% showed a diameter bigger than 1.5 cm. In 61.8% of cases, laser lithotripsy was carried out under spinal anaesthesia, being the average of the pulses used 2532 (confidence interval 95%), using a working power of 1 J in all cases. The overall efficacy of the procedure in terms of size and localization was 95.5%. The complication rate was scarce (2.19%). CONCLUSIONS: Holmium laser lithotripsy is a very effective and safe procedure since in our experience it is 95.5% efficient for pyeloureteral lithiasis treatment and has a low rate of complications.

[Predictive value of progression of muscularis mucosae and percentage G3 cells in vesical TIG3 tumours]. / Valor predictivo de progresin de la muscularis mucosae y del porcentaje de células G3 en tumores vesicales T1G3.

INTRODUCTION AND OBJECTIVE: Vesical tumor T1G3 constitutes the border between the superficial tumor and the infiltrante tumor. Some of these tumors do not respond to BCG and progress, with cystectomy that present poor results, patients who would benefit from a precocious and aggressive treatment if we could identify them in an preinvasive stage. New predictive factors try to select to these tumors, being little the works that consider anatomo-pathological meticulous study (substanding of the T1 in T1a and T1b and percentage of present G3 cells in the tumor). Our objective is to analyze the value of these anatomo-pathological considerations like predictive factors of progression. MATERIAL AND METHODS: Retrospective study of a series of 91 patient affection of vesical tumor T1G3 with initial treatment by means of RTU and BCG. We analyzed 12 variables. The new predictive factors: the level of invasion respect to muscularis mucosae and the percentage of G3 cells. By means of logistic regression analisys we establish the independent pronostic factors for tumoral progression. RESULTS: A total of 31 patients presented infiltration of detrusor, passing away 17 of tumoral cause, after an average time of pursuit of 57.8 +/- 28.2 months. In 8 cases (9%) the substanding could not be determined. The rate of progression for T1a tumors was of 20% (8/40) and for T1b 53% (23/43). Presented independent predictive value of progression the multiplicity (odds: 7.26), the size (odds: 2.14), the presence of Cis (odds: 1.42) and the subestanding (odds: 6.81). CONCLUSION: The substanding is a predictive factor of progression clinically useful in vesical tumors T1G3, reason why we considered habitual clinical introduction.

Analysis of the safety profile of treatment with a large number of shock waves per session in extracorporeal lithotripsy.

OBJECTIVE: To assess the safety of increasing the number of waves per session in the treatment of urolithiasis using extracorporeal lithotripsy. MATERIAL AND METHODS: Prospective, comparative, nonrandomized parallel study of patients with renoureteral lithiasis and an indication for extracorporeal lithotripsy who were consecutively enrolled between 2009 and 2010. We compared group I (160 patients) treated on schedule with a standard number of waves/session (mean 2858,3±302,8) using a Dornier lithotripter U/15/50 against group II (172 patients) treated with an expanded number of waves/session (mean, 6728,9±889,6) using a Siemens Modularis lithotripter. The study variables were age, sex, location, stone size, number of waves/session and total number of waves to resolution, stone-free rate (SFR) and rate of complications (Clavien-Dindo classification). Student's t-test and the chi-squared test were employed for the statistical analysis. RESULTS: The total rate of complications was 11.9% and 10.46% for groups I and II, respectively (P=.39). All complications were minor (Clavien-Dindo grade I). The most common complications were colic pain and hematuria in groups I and II, respectively, with a similar treatment intolerance rate (P>.05). The total number of waves necessary was lower in group II than in group I (P=.001), with SFRs of 96.5% and 71.5%, respectively (P=.001). CONCLUSION: Treatment with an expanded number of waves per session in extracorporeal lithotripsy does not increase the rate of complications or their severity. However, it could increase the overall effectiveness of the treatment.

[Secondary vesical amyloidosis]. / Amiloidosis vesical secundaria.

The bladder involvement is a very unusual fact in systemic amyloidosis. The distinction of primary and systemic amyloidosis disease with bladder involvement (secondary bladder amyloidosis) is important to the urologist. Secondary amyloidosis of the bladder is a rare disease entity (approximately 20 cases published). We document a case of a woman with a large history of rheumatoid arthritis who developed severe macrohematuria. Diagnosis was done by biopsy that revealed amyloidosis, and it was confirmed with an immunohistochemical staining of the specimens that defined the process as amyloid AA (secondary amyloidosis).