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Laranjo Tinoco C, Coutinho A, Cardoso A, Araújo AS, Matos R, Anacleto S, Mota P. Efficacy and safety of fluoroless ureteroscopy and retrograde intrarenal surgery for the treatment of urolithiasis: A comparative study. Actas Urol Esp 2023; 47:535-542. [PMID: 37207987 DOI: 10.1016/j.acuroe.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/22/2023] [Accepted: 03/26/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) are traditionally guided by fluoroscopy, but the risks of exposure to ionizing radiation may present a matter of concern for patients and urologists. The aim of this study was to evaluate the efficacy and safety of fluoroless URS and RIRS compared with conventional fluoroscopy-guided procedures for the treatment of ureteral and renal stones. MATERIAL AND METHODS Patients treated with URS or RIRS for urolithiasis between August 2018 and December 2019 were retrospectively evaluated and grouped according to the use of fluoroscopy. Data was collected from individual patient records. The main outcomes were stone-free rate (SFR) and complications, compared between the fluoroscopy and fluoroless groups. A subgroup analysis by type of procedure (URS and RIRS) and a multivariate analysis to identify predictors of residual stones were conducted. RESULTS A total of 231 patients met the inclusion criteria: 120 (51.9%) in the conventional fluoroscopy group and 111 (48.1%) in the fluoroless group. No significant differences were found between groups regarding SFR (82.5% vs 90.1%, p=.127) or postoperative complication rate (35.0% vs 31.5%, p=.675). In the subgroup analysis these variables did not present significant differences, regardless of the procedure considered. In the multivariate analysis the fluoroless technique was not an independent predictor of residual lithiasis (OR 0.991; 95% IC 0.407-2.411; p=.983), when adjusted for procedure type, stone size and stone number. CONCLUSION URS and RIRS can be done without fluoroscopic guidance in selected cases, without affecting the efficacy or safety of the procedure.
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Affiliation(s)
| | - A Coutinho
- Urology Department, Hospital de Braga, Braga, Portugal
| | - A Cardoso
- Urology Department, Hospital de Braga, Braga, Portugal
| | - A S Araújo
- Urology Department, Hospital de Braga, Braga, Portugal
| | - R Matos
- Urology Department, Hospital de Braga, Braga, Portugal
| | - S Anacleto
- Urology Department, Hospital de Braga, Braga, Portugal
| | - P Mota
- Urology Department, Hospital de Braga, Braga, Portugal; School of Medicine, University of Minho, Braga, Portugal; Centro Clínico Académico (2CA-Braga), Braga, Portugal
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Castro Henríquez E. [Metabolic Stone assessment: Underused tool and how to implement it on daily practice.]. ARCH ESP UROL 2021; 74:823-834. [PMID: 34726618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Nephrolithiasis is a highly prevalent disease presenting itself mostly at a working age, which leads to a great economic burden on health system. Kidney Stone disease should be viewed as a systemic disorder,associated with or predictive of hypertension, insulin resistance, chronic kidney disease and cardiovasculardamage. According to current guidelines and evidence,a full screening of risk factors for kidney stones and for cardiovascular damage should be recommended in all cases of kidney stone disease, yet it is rarely performed, and a real-world clinical practice is lacking. The aim of this narrative literature is to serve as guidance for a patient-tailored dietary suggestion after a clinical and biochemistry evaluation, with limited resources, and still offer a rational management of kidney stone patients. Meta-analysis, systematic review, experimental studies, case-control plus high-impact factor journals PubMed and EMBASE, on the topic were included. Search criteria included metabolic profile, metabolic work-up, kidney stone, urolithiasis between 2010 and 2020.
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Morales-Martínez A, Melgarejo-Segura MT, Cano-García MDC, Gutiérrez-Tejero F, Arrabal-Martín M, Arrabal-Polo MÁ. [Assessment of radiopaque kidney stone treatment: Combination of extracorporeal shock wave lithotripsy and Fagolitos Plus®. Preliminary case control description.]. ARCH ESP UROL 2021; 74:489-493. [PMID: 34080568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The nutritional supplement called Fagolitos plus® contains hydroxycitric acid as main component, in addition to zinc, magnesium, vitamin A and vitamin B6. It is necessary to study new molecules as chemolytic treatment in calcium lithiasis or that facilitate its fragmentation with the help of other instrumental treatments. OBJECTIVE The objective of this study is to evaluate the effectiveness of the combined treatment of Fagolitos plus® and extracorporeal lithotripsy in the fragmentation of the lithiasis. MATERIAL AND METHODS Retrospective case-control study includes 88 patients with lithiasis. Group 1: Treated with 1 session of extracorporeal lithotripsy and Fagoliths plus®. Group 2: Treated with 1 session of extracorporeal lithotripsy. The variables analyzed were: Age, sex, body mass index, maximum diameter of the stone, area of the stone, hounsfield units of the stone measured by axial tomography, location of the stone, result after 1 session of extracorporeal wave lithotripsy shock [complete fragmentation, partial fragmentation (presence of a fragment greater than 5 mm) and absence of fragmentation (same size of the lithiasis)], adverse effects that occurred after taking Fagolitos plus®, days of treatment with Fagolitos plus® and energy shock wave applied to lithiasis. Results were analyzed with SPSS 20.0, p≤0.05. RESULTS The mean age of the patients included in the study is 53.81 ± 12.62 years in group 1 compared to 56.53 ± 12.37 years in group 2, p=0.31. According to the distribution by sex, there were no statistically significant differences (p=0.5), including 24 men and 24 women in group 1 and 23 men and 17 women in group 2. The mean of body mass index of the patients in group 1 was 28.39 ± 2.27 kg/m2 in group 1 versus 28.39 ± 3.03 kg/m2 in group 2, p=0.9. The maximum diameter of the stone was 11.5 ± 3.91 mm in group 1 compared to 13.15 ± 5.49 mm in group 2, p=0.1. The area of the lithiasis measured by tomography was 104.74 ± 70.56 mm2 in group 1 compared to 141.91 ± 80.95 mm2 in group 2, p=0.3. The Hounsfield units measured by tomography of the lithiasis in group 1 was 1061.98 ± 213.68 compared to 1143.15 ± 172.24 in group 2, p=0.06. Relation to fragmentation, complete fragmentation was observed in 66.7% of group 1 patients, compared to 41% of group 2 patients (p=0.02), between 20-30 days after the first session of Extracorporeal Lithotripsy evaluated by means of a simple X-ray of the Abdomen. CONCLUSIONS The administration of Fagolitos plus® concomitant to extracorporeal lithotripsy could increase its effectiveness in lithiasis fragmentation, requiring clinical trials and prospective studies to confirm these findings.
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Affiliation(s)
- Ana Morales-Martínez
- Servicio de Urología. Hospital Universitario Clínico San Cecilio. Granada. España
| | | | | | | | - Miguel Arrabal-Martín
- Servicio de Urología. Hospital Universitario Clínico San Cecilio. Granada. España. Instituto IBS Granada. Granada. España
| | - Miguel Ángel Arrabal-Polo
- Servicio de Urología. Hospital Universitario Clínico San Cecilio. Granada. España. Instituto IBS Granada. Granada. España
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Kanashiro A, Angerri O. [Urinary pH relevance on urolithiasis management.]. ARCH ESP UROL 2021; 74:102-111. [PMID: 33459626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Urinary pH is a factor that influences in urinary lithogenesis. It can condition the heterogeneous nucleation of calcium oxalate and the crystallization or dissolution of other substances such as uricacid, cystine and phosphates. Its exact and precise measurement is a tool to guide the treatment and prevention. The most accurate way to measure the pH is to use a glass electrode and a pH-meter, but this device is used in hospital's environment and is not portable. Test strips are not adequate for proper measurement. Recently, a portable and electronic device for measuring urinary pH has shown greater precision and accuracy in the measurement of urinary pH, with good acceptance by patients. METHOD We carried out a bibliographic search inPUBMED and EMBASE using the terms "URINARY pH", "Lithiasis", "Uro-Lihitiasis", "Urinary Stone", "Urinary pH measurement", in order to compile articles, books, abstracts and the most relevant clinical guides in English and Spanish on this topic. RESULTS We select a total of 66 articles, 3 books, an abstract of a study unpublished presented at the American urology congress and the European Guidelines on urolithiasis on the effect of pH on the formation and prevention of urolithiasis. Four articles deal specifically with the effect of urinary pH on urolithiasis, 5 articles deal with a new portable electronic device for measuring urinary pH, 5 articles dealt with the measurement of urinary pH with test strips and 1 article dealt with the modification of urinary pH to reduce fouling of double J catheters, 2 articles deal about the urinary acidification with oral methionine. The selected abstract deals with the new portable device for measuring urinary pH in cystinuric patients. The 3 selected books have specific sections where the role of urinary pH in urolithiasis is discussed. Finally, in the European Urology Guidelines, the control of urinary pH is emphasized in the sections of prevention of urolithiasis formation, treatment of uric lithiasis, infectious/non-infectious phosphocalcic and cystine. CONCLUSIONS Urinary pH is a recognized factor in the scientific-urological community for the study, monitoring, treatment and prevention of lithiasic patients. Urinary pH measurement is a very useful tool, but test strips are not suitable for pH measurement and medical decision making. Currently, several studies have evaluated a new device to achieve the measurement of urinary pH effectively and easily by the patient, keeping urinary pH innon-lithogenic ranges with the association of medical and non-medical treatments, and good acceptability from the patients.
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Affiliation(s)
| | - Oriol Angerri
- Servicio de Urología. Fundació Puigvert. Barcelona. España
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Torrecilla Ortiz C, Colom Feixas S, Cuadrado JM. [Quality of life for ureteral stone patients (diversion).]. ARCH ESP UROL 2021; 74:145-156. [PMID: 33459631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The high prevalence and incidence of urinary stone disease, the severity of its symptoms, its high recurrence rate and resulting healthcare costs, make urolithiasis a chronic disease with significant impact on healthcare services and patient quality of life. There are several general tools available to assess health related quality of life in patients with chronic illnesses, as wellas some specific ones directed to urinary stone disease, such as the ureteral stent symptom questionnaire. Patient swith an obstructive ureteral stone or those indwelling aureteral stent, often present symptoms that may affecttheir quality of life considerably. Patient education and counselling regarding stent-related symptoms, as well as medical treatment, may help improve their perception of quality of life.
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Affiliation(s)
| | - Sergi Colom Feixas
- Unidad de Endourología y Litiasis. Hospital Universitari Bellvitge. Barcelona. España
| | - José Maria Cuadrado
- Unidad de Endourología y Litiasis. Hospital Universitari Bellvitge. Barcelona. España
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Keller EX, Traxer O. SuperPulsed Thulium fiber laser: The ultimate laser for lithotripsy? ARCH ESP UROL 2020; 73:767-776. [PMID: 33025921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The SuperPulsed Thulium fiber laser has recently become available to the urologist. It can be safely and efficiently applied to humans for the purposes of laser lithotripsy. Particularly, this innovative technology overcomes the main limitations of Holmium:YAG lasers, which had been the principal source of energy for lithotripsy over the past decades. The SuperPulsed Thulium fiber laser allows a broader range of pulse energy (0.025 to 6.0 J), pulse frequency (up to 2000 Hz) and pulse duration (0.05 to 12 ms), as well as smaller operating laser fibers (50-150 μm core), compared to Holmium:YAG lasers. The laser emission at 1940 nm leads to a four-fold higher energy absorption in water, which ensures precise lithotripsy and a high degree of safety. Multiple comparative in vitro studies suggest a 1.5 to 4 times faster stone ablation rate in favor of the SuperPulsed Thulium fiber laser, when compared to Holmium:YAG lasers. It has also been shown to generate particularly fine stone dust, and electronic pulse modulation allows superior stone stabilization. The SuperPulsed Thulium fiber laser, like the Holmium:YAG laser, has been repeatedly reported thermodynamically safe, provided that a minimal irrigation flow (10-15 ml/min) and relatively low average power (≤ 25 W) is maintaining throughout the lithotripsy process. These new standards are particularly advantageous for fine and rapid ureteroscopic stone dusting, and open paths that were not been amenable to the Holmium:YAG laser.
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Affiliation(s)
- Etienne Xavier Keller
- Department of Urology. University Hospital Zurich. University of Zurich. Zurich. Switzerland
| | - Olivier Traxer
- Sorbonne Université. Service d'Urologie. AP-HP. Hôpital Tenon. Paris. France. Sorbonne Université. Groupe de Recherche Clinique sur la Lithiase Urinaire. Hôpital Tenon. Paris. France
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Campodonico F, Calcagno T, Bacigalupo L, La Camera A, Durante A, Introini C. [Flexible cystoscope for the treatment of urinary stones in intestinal reservoirs.]. ARCH ESP UROL 2019; 72:965-967. [PMID: 31697258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Stones are common mid- and long-term complications in urinary diversions built with bowel. However the reservoir intestinal loops can lead to difficult endoscopic approach. METHODS We report two challenging cases with unfavourable anatomy successfully treated by gently handling a flexible cystoscope in a low pressure system. RESULTS One patient with stones in a continent pouch was cleaned up with a grasping basket through the efferent umbilical limb. Another patient with an orthotopic ileal neobladder not accessible by rigid cystoscope due to high pelvic floor was treated with holmiun laser lithotripsy. CONCLUSIONS Urologists should consider the versatility of flexible cystoscope to obviate the need for percutaneous lithotripsy or open lithotomy.
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Affiliation(s)
- Fabio Campodonico
- Department of Abdominal Surgery. Urology Unit. EO Ospedali Galliera. Genova. Italy
| | - Tiziana Calcagno
- Department of Abdominal Surgery. Urology Unit. EO Ospedali Galliera. Genova. Italy
| | | | - Anna La Camera
- Department of Abdominal Surgery. Urology Unit. EO Ospedali Galliera. Genova. Italy
| | - Antonio Durante
- Department of Abdominal Surgery. Urology Unit. EO Ospedali Galliera. Genova. Italy
| | - Carlo Introini
- Department of Abdominal Surgery. Urology Unit. EO Ospedali Galliera. Genova. Italy
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Spinelli MG, Palmisano F, Zanetti SP, Boeri L, Gadda F, Talso M, Dell'Orto PG, Montanari E. Spontaneous upper urinary tract rupture caused by ureteric stones: A prospective high-volume single centre observational study and proposed management. ARCH ESP UROL 2019; 72:590-595. [PMID: 31274124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To evaluate incidence, clinical, radiological and laboratory features of spontaneous upper urinary tract rupture (s-UUTR) due to ureteric stones and discuss their management. METHODS Out of 1629 patients admitted to the Emergency Department (ED) for renal colic from January 2015 to December 2016 and studied by kidney US and contrast enhanced CT (CECT), 31 patients had a s-UUTR categorized in 3 stages: a) local spread, b) free fluid, c) urinoma. Presentation, therapeutic procedures and outcomes were registered. RESULTS S-UUTR is reported in 1.9% of renal colic. The stone was most commonly identified at the vesicoureteric junction (VUJ) (61.3%) and mean (standard deviation, SD) stone size was 5.71 mm (2.31). S-UUTR was most frequently located in a calyx (54.84%). 26 patients (83.87%) had a clinical presentation of a renal colic, 3 cases (9.68%) had an atypical presentation and 2 (6.45%) presented an acute abdomen. In 26 cases a J-J stent (83,87%) was placed, 3 patients underwent primary ureteroscopic lithotripsy (9.67%); in 1 patient (3.23%) a nephrostomy was inserted and in 1 case (3.23%) active surveillance was adopted. Cases who underwent sole urinary derivation were revaluated after 30 days: ureteroscopic lithotripsy was performed in 48.15% of the cases; extracorporeal shock wave lithotripsy in 3.7%; in 22.2% of cases a CT demonstrated the spontaneous expulsion of the stone. 7 patients were lost at follow-up. The patient undergoing an active surveillance spontaneously expelled the stone. CONCLUSIONS S-UUTR is a rare radiological sign of a renal colic most commonly located in a calyceal fornix. A high incidence of s-UUTR is caused by small distal ureteral stones in which a spontaneous passage is reasonable. Clinical presentation usually does not arise the suspicion of s-UUTR. In our experience, most patients were actively treated with good results but a conservative approach can be offered in selected cases.
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Affiliation(s)
- Matteo Giulio Spinelli
- Department of Urology. IRCCS Ca' Granda Ospedale Maggiore Policlinico. University of Milan. Milan. Italy
| | - Franco Palmisano
- Department of Urology. IRCCS Ca' Granda Ospedale Maggiore Policlinico. University of Milan. Milan. Italy
| | - Stefano Paolo Zanetti
- Department of Urology. IRCCS Ca' Granda Ospedale Maggiore Policlinico. University of Milan. Milan. Italy
| | - Luca Boeri
- Department of Urology. IRCCS Ca' Granda Ospedale Maggiore Policlinico. University of Milan. Milan. Italy
| | - Franco Gadda
- Department of Urology. IRCCS Ca' Granda Ospedale Maggiore Policlinico. University of Milan. Milan. Italy
| | - Michele Talso
- Department of Urology. IRCCS Ca' Granda Ospedale Maggiore Policlinico. University of Milan. Milan. Italy
| | - Paolo Guido Dell'Orto
- Department of Urology. IRCCS Ca' Granda Ospedale Maggiore Policlinico. University of Milan. Milan. Italy
| | - Emanuele Montanari
- Department of Urology. IRCCS Ca' Granda Ospedale Maggiore Policlinico. University of Milan. Milan. Italy
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García Nieto VM, Luis Yanes MI, Tejera Carreño P, Perez Suarez G, Moraleda Mesa T. The idiopathic hypercalciuria reviewed. Metabolic abnormality or disease? Nefrologia 2019; 39:592-602. [PMID: 31160051 DOI: 10.1016/j.nefro.2019.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 02/02/2019] [Accepted: 02/20/2019] [Indexed: 02/08/2023] Open
Abstract
Idiopathic hypercalciuria (IH) is defined as that clinical situation in which an increase in urinary calcium excretion is observed, in the absence of hypercalcemia and other known causes of hypercalciuria. In recent years, its diagnosis in pediatric age has been more frequent because it has been known that it can debut with very different symptoms, in the absence of kidney stone formation. The discovery of genetic hypercalciuric stone-forming rats has allowed us to glimpse the pathophysiological mechanism of IH since they show many data in common with humans with IH as normal levels of blood calcium, intestinal calcium hyperabsorption, increased bone resorption and a defect in the renal tubular calcium reabsorption. In 1993, it was shown that in these animals there is an increase in the number of vitamin D receptors (VDR) in the intestine, which favors an increase in the functional capacity of calcitriol-VDR complexes that explains the increase in intestinal transport of calcium. The same happens at the bone level producing a greater resorption. In our opinion, IH is a 'metabolic anomaly' or, better, an inheritable constitutive metabolic characteristic. In this sense, what patients with IH would inherit is the availability of having a greater number of VDRs in their cells than those with normal urinary calcium excretion. IH cannot be considered a sensu stricto disease, so pharmacological treatment must be individualized.
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Affiliation(s)
- Víctor M García Nieto
- Sección de Nefrología Pediátrica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España.
| | - María Isabel Luis Yanes
- Sección de Nefrología Pediátrica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - Patricia Tejera Carreño
- Sección de Nefrología Pediátrica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - German Perez Suarez
- Servicio de Nefrología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Teresa Moraleda Mesa
- Sección de Nefrología Pediátrica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
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Sarikaya S, Ebiloglu T, Selvi I, Faruk Bozkurt O, Senocak C. Retrograde intrarenal surgery or percutaneous nephrolithotomy: Which one is more effective for 1-2 cm renal stones in pediatric patients? ARCH ESP UROL 2019; 72:54-60. [PMID: 30741653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Urinary stone diseaseis less common in pediatric age group and it has anincreasing incidence. In this study, our hypothesis is toevaluate if one of the techniques, PNL or RIRS is superiorthan the other in terms of stone free status (SFR), fluoroscopytime (FT), operation time (OT), complication rate(CR), JJ stent insertion rate, and hospitalization duration(HD) in children. METHODS Between 2013 and 2016, 74 patients(under 18 years- old) were operated for the treatmentof renal stones between 1-2cm size. 37 patientswere male (50%) and 37 of them (50%) were female.The study shows the experience of a single center. Dataof the patients who underwent (surgery) were recorded. RESULTS SFR was not different in both groups in shortand long terms follow up, but hgb drop, FT, OT, andHD were detected to be worse in PNL group. Therewas lower complication rates for RIRS group comparing to PCNL group according to Clavien classification butgrade I complications were higher in RIRS group. CONCLUSION Although PNL is a cheaper treatmentmethod, RIRS has less creatinine change, less FT, lessOT, less CR, less HT with similar SFR for 1-2cm renalstones in children. Long term SFR were 83.8% for RIRSand 86.5% for PCNL. RIRS is a treatment of choice inchildren with 1-2 cm renal stones as it has more advantagesbut the costs must be considered.
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Affiliation(s)
- Selcuk Sarikaya
- Gulhane Research and Training Hospital. Department of Urology. Ankara. Turkey
| | - Turgay Ebiloglu
- Gulhane Research and Training Hospital. Department of Urology. Ankara. Turkey
| | - Ismail Selvi
- Kecioren Research and Training Hospital. Department of Urology. Ankara. Turkey
| | - Omer Faruk Bozkurt
- Kecioren Research and Training Hospital. Department of Urology. Ankara. Turkey
| | - Cagri Senocak
- Kecioren Research and Training Hospital. Department of Urology. Ankara. Turkey
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Angulo JC, Bernardo N, Zampolli H, Rivero MA, Dávila H, Gutiérrez J. Trends in the management of urolithiasis in Latin America, Spain and Portugal: results of a survey in the Confederación Americana de Urología (CAU). Actas Urol Esp 2018; 42:33-41. [PMID: 28587845 DOI: 10.1016/j.acuro.2017.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the trends in the current management of urolithiasis in the Confederación Americana de Urología (CAU) setting to recognise patterns of clinical practice and identify educational needs. MATERIAL AND METHOD An online survey was created with 31 multiple-choice questions (Spanish and Portuguese) through www.caunet.org, which revealed demographic data, patterns of clinical practice and approaches for specific clinical conditions. RESULTS A total of 463 practitioners from Brazil, Mexico, Argentina, Spain, Colombia, Chile and other countries (3.96% of the members of CAU) completed the survey. All participants performed some type of urolithiasis treatment: 98.5% performed semirigid ureteroscopy (URS), 83.8% performed percutaneous nephrolithotomy (PCNL), 78.2% performed flexible URS, and 67.2% performed extracorporeal lithotripsy. The youngest physicians tended to perform PCNL (P<.001), and the proportion of users of flexible URS was greater in the Portuguese countries (P=.037). The main energy source was laser (60.7%). Small-calibre PCNL was performed by 15.3% of the respondents, more often in university hospitals (P<.01) and by older practitioners (P<.01). Only 3.2% of the respondents used percutaneous access to the kidney guided exclusively by ultrasound, especially the older practitioners (P<.001). The supine position was used by 40.4% of the respondents, more often in Spain (P<.001) and in the university setting (P=.017). PCNL without nephrostomy was practiced by 3.9% of the respondents. For flexible URS, 19.2% of the respondents did not use ureteral access sheaths, and the older practitioners preferred thinner calibre sheaths (P<.001). CONCLUSIONS The management of lithiasis in the CAU setting follows a profile similar to that recognised in the European and American clinical guidelines, although there are interesting variations based on the practitioner's age and preferences. We identified potential areas for improvement in small-calibre PCNL and ultrasound-guided puncture.
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Caballero JP, Galán JA, Verges A, Amorós A, Garcia-Segui A. Micro-ureteroscopy: Initial experience in the endoscopic treatment of pelvic ureteral lithiasis. Actas Urol Esp 2015; 39:327-31. [PMID: 25443520 DOI: 10.1016/j.acuro.2014.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 08/22/2014] [Accepted: 08/25/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To present to report the first case of ureteral lithiasis resolved using a new endoscopic approach, which we call microureteroscopy (m-URS) and attempts to reduce the ureteral damage caused by conventional instrumentation. MATERIAL AND METHODS We selected a 53-year-old patient with a 16-mm calculus in the right distal ureter. For endoscopic access, we used a 4.8 Fr sheath from the microperc set and fragmented the stone with a 230-micron laser fiber. RESULTS Complete fragmentation of the stone was achieved. We placed a JJ catheter due to significant ureteral edema. The surgical time and postsurgical stay were 156minutes and 24hours, respectively. There were no complications, the requirements for analgesia were minimal, and the patient was free of residual stones. CONCLUSIONS The m-URS technique is feasible, simple and effective for the treatment of pelvic ureteral lithiasis in women and optimizes minimal invasion, with results that can be comparable to conventional endoscopic techniques in terms of ease of access and quality of endoscopic vision without affecting the resolution capacity. Larger studies and greater technological development is needed to define the definitive role of this procedure. Currently, its major limitations lie in the treatment of proximal ureter lithiasis and in the treatment of men. This technique could also be a viable alternative for pediatric patients.
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Affiliation(s)
- J P Caballero
- Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España.
| | - J A Galán
- Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España
| | - A Verges
- Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España
| | - A Amorós
- Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España
| | - A Garcia-Segui
- Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España
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Millán-Rodríguez F, Gavrilov P, Gracia-García S, Angerri-Feu O, Sánchez-Martín F, Villavicencio-Mavrich H. Implications of vitamin D deficiency in lithiasic patient and in general population. Actas Urol Esp 2015; 39:245-52. [PMID: 25086998 DOI: 10.1016/j.acuro.2014.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 06/07/2014] [Indexed: 10/25/2022]
Abstract
CONTEXT AND OBJECTIVE Vitamin D deficiency causes problems in mineral metabolism but also overall health. In first place a review of the topic was carried out. Then, in order to contextualize it in lithiasic patient, a study on Vitamin D deficiency and its possible relationship with impaired PTH levels is performed. EVIDENCES ACQUISITION A review of topics such as metabolism, epidemiology and the relationship of vitamin D deficiency with several pathologies was performed. Besides a multivariate analysis and a correlation study between vitamin D and PTH levels was conducted in 100 lithiasic patients. EVIDENCES SYNTHESIS We present a review of Vitamin D metabolism, receptors and functions, as well as about its valuation methodology and the treatment of its deficiency. Lithiasic patients show a higher vitamin D deficiency than general population. Vitamin D deficiency has been significantly associated with increased PTH levels. In addition, there is enough literature showing a relationship between vitamin D deficiency not only with bone disease, but also with multiple diseases. CONCLUSION vitamin D levels should be measured in all lithiasic patients, and those with vitamin D deficiency should be treated.
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