Litiasis urinaria. Presente y futuro

Place of extracorporeal shockwave lithotripsy in the treatment of urolithiasis in the region of Gharb Chrarda Bni Hssen (Morocco)

The extracorporeal shockwave lithotripsy (ESWL) is a minimally invasive therapeutic approach which has been widely used through the last years. The aim of this study was to evaluate the effectiveness of ESWL in the treatment of nephrolithiasis in Gharb Chrarda Bni Hssen area (North of Morocco). A retrospective study of 590 patients with urinary stone was conducted between February 2009 and January 2013 in the Centre of Lithotripsy Anoual Clinic Kenitra. The treatment consisted in one or several sessions of ESWL. Evaluation of efficiency was based on radiological examinations using abdominal echography during the consultation with the urologist after the last session. There were 306 males and 184 females aged 17-79 years. The medium size of stone was 12.3 ± 5 mm. The average number of sessions and shock waves were 4 and 2490, respectively. The shockwave session was continued until stone fragmentation was observed when 4000 shocks were given. Failure of stone fragmentation or the presence of fragments larger than 4 mm were indications of repeat ESWL sessions. 92% of patient stones were completely cleared (p < 0,05%). The majority of patients were asymptomatic. This data show that the ESWL is extremely successful in treating human kidney stone. It is the first line of choice as a treatment modality for this pathology by the population of this area.

Calcium renal lithiasis: metabolic diagnosis and medical treatment

Calcium renal lithiasis is a frequent condition that affects the worldwide population and has a high recurrence rate. Different metabolic changes may trigger the onset of calcium stone disorders, such as hypercalciuria, hyperoxaluria, hyperuricosuria, hypocitraturia and others. There are also other very prevalent disorders that are associated with calcium calculi, such as arterial hypertension, obesity and loss of bone mineral density. A correct diagnosis needs to be obtained through examining the serum and urinary parameters of mineral metabolism in order to carry out adequate prevention and treatment of this condition. Once the metabolic diagnosis is known, it is possible to establish dietary and pharmacological treatment that may enable monitoring of the disease and prevent recurrence of stone formation. Some advances in treating this pathological condition have been made, and these include use of sodium alendronate in patients with calcium renal lithiasis and osteopenia/osteoporosis, or use of a combination of a thiazide with a bisphosphonate. In summary, calcium renal lithiasis often requires multidrug treatment with strict control and follow-up of patients.