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1.
Article in English | WPRIM | ID: wpr-922356

ABSTRACT

PURPOSE@#To investigate the clinical value of urine interleukin-18 (IL-8), neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) for the early diagnosis of acute kidney injury (AKI) in patients with ureteroscopic lithotripsy (URL) related urosepsis.@*METHODS@#A retrospective study was carried out in 157 patients with urosepsis after URL. The patients were divided into AKI group and non-AKI group according to the Kidigo guideline and urine IL-8, NGAL and KIM-1 levels were detected by enzyme-linked immunosorbent assay at 0, 4, 12, 24 and 48 h after the surgery. Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic value of these three biomarkers for postoperative AKI.@*RESULTS@#The level of urine IL-8, NGAL and KIM-1 in AKI group was significantly higher than that in non-AKI group at 4, 12, 24 and 48 h (p < 0.01). The ROC analysis showed the combined detection of urine IL-8, NGAL and KIM-1 at 12 h had a larger area under curve (AUC) than a single marker (0.997, 95% CI: 0.991-0.998), and the sensitivity and specificity were 98.2% and 96.7%, respectively. Pearson correlation analysis showed that the levels of urine NGAL at 4, 12, 24 and 48 h in AKI patients were positively correlated with the levels of urine KIM-1 and IL-18 (p < 0.01).@*CONCLUSION@#AKI could be quickly recognized by the elevated level of urine IL-8, NGAL and KIM-1 in patients with URL-related urosepsis. Combined detection of the three urine biomarkers at 12 h after surgery had a better diagnostic performance, which may be an important reference for the early diagnosis of AKI.


Subject(s)
Acute Kidney Injury/etiology , Biomarkers , Early Diagnosis , Hepatitis A Virus Cellular Receptor 1 , Humans , Interleukin-18 , Interleukin-8 , Lipocalin-2 , Lithotripsy , Retrospective Studies , Ureteroscopy
3.
Int. braz. j. urol ; 47(1): 23-35, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1134321

ABSTRACT

ABSTRACT Purpose: To evaluate the efficacy of adjunctive medical expulsive therapy (MET) with tamsulosin for the promotion of stone fragments clearance for repeated extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: This meta-analysis was conducted by systematic search for randomized controlled trial (RCT) studies in PubMed/Medline, Scopus, Cochrane Library, Web of Science databases in January 2020, which compared tamsulosin with either placebo or non-placebo control for repeated ESWL. The primary endpoint was stone-free rate (SFR), the second endpoints were stone clearance time and complications. The quality assessment of included studies was performed by using the Cochrane System and Jadad score. Results: 7 RCTs were included in this meta-analysis. Tamsulosin provided higher SFR (for stones larger than 1cm, OR: 5.56, p=0.0003), except for patients with stones less than 1cm. For patients with renal stones (OR: 2.97, p=0.0005) or upper ureteral stones (OR: 3.10, p=0.004), tamsulosin can also provide a higher SFR. In addition, tamsulosin provided a shorter stone clearance time (WMD: −9.40, p=0.03) and lower pain intensity (WMD=-17.01, p <0.0001) and incidences of steinstrasse (OR: 0.37, p=0.0002). Conclusion: Adjunctive MET with tamsulosin is effective in patients with specific stone size or location that received repeated ESWL. However, no well-designed RCT that used computed tomography for the detection and assessment of residual stone fragments was found. More studies with high quality and the comparison between tamsulosin and secondary ESWL are needed in the future.


Subject(s)
Humans , Lithotripsy , Kidney Calculi/therapy , Ureteral Calculi/drug therapy , Sulfonamides/therapeutic use , Randomized Controlled Trials as Topic , Treatment Outcome , Tamsulosin
5.
Int. braz. j. urol ; 47(1): 64-70, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1134304

ABSTRACT

ABSTRACT Purpose: We aimed to compare the success and complication rates of the anterograde and retrograde Ureterorenoscopy (URS) for impacted upper ureteral stones in patients > 65 years of age. Materials and Methods: Data of 146 patients >65 years of age and underwent anterograde URS (n=68) in supine position or retrograde URS (n=78) for upper ureteral impacted stones>10 mm between January 2014 and September 2018 were collected prospectively. The groups were compared for success and complication rates, duration of operation, hospital stay, and ancillary procedures. Results: Anterograde and retrograde URS groups were similar for demographic and stone related characteristics. The success rate of the anterograde URS group was significantly higher than the retrograde URS group (97.1% vs. 78.2%, p=0.0007). The complication rates were similar for the two groups (p=0.86). Clavien grade I and II complications were observed in 3 patients in each group. The mean hemoglobin drop was 0.5 g/dL in the anterograde URS group and blood transfusion was not performed in any of the patients. The mean duration of operation was 41.2±12.5 minutes in the mini-PNL group and 59.6±15.1 minutes in the RIRS group and the difference was statistically significant (p=0.02). The median duration of hospitalization was 1 day for both groups. Conclusions: Performing anterograde URS in supine position provided better success rates and similar complication rates compared to retrograde URS. Based on these results anterograde URS shall be considered as one of the primary treatment options for management of impacted upper ureteral stones in the elderly population.


Subject(s)
Humans , Aged , Lithotripsy , Ureteral Calculi/surgery , Retrospective Studies , Treatment Outcome , Ureteroscopy , Length of Stay
6.
Int. braz. j. urol ; 46(6): 902-926, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134269

ABSTRACT

ABSTRACT Purpose Various surgical options are available for large proximal ureteral stones, such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL) and laparoscopic ureterolithotomy (LU). However, the best option remains controversial. Therefore, we conducted a network meta-analysis comparing various surgical treatments for proximal ureteral stones ≥10mm to address current research deficiencies. Materials and methods We searched PubMed, Ovid, Scopus (up to June 2019), as well as citation lists to identify eligible comparative studies. All clinical studies including patients comparing surgical treatments for proximal ureteral stones ≥10mm were included. A standard network meta-analysis was performed with Stata SE 14 (Stata Corp, College Station, TX, USA) software to generate comparative statistics. The quality was assessed with level of evidence according to the Oxford Centre for Evidence-based Medicine and risk of bias with the Cochrane Collaboration's Review Manager (RevMan) 5.3 software. Results A total of 25 studies including 2.888 patients were included in this network meta-analysis. Network meta-analyses indicated that LU and PCNL had better stone-free rates and auxiliary procedures. PCNL could result in major complications and severe bleeding. In initial stone-free rate, final stone-free rate, and auxiliary procedures results, SUCRA ranking was: LU> PCNL> URSL> ESWL. In Clavien Dindo score ≥3 complications, SUCRA ranking was: LU> ESWL> URSL> PCNL. In fever, SUCRA ranking was: ESWL> LU> URSL> PCNL. In transfusion, SUCRA ranking was: LU> URSL> ESWL> PCNL. In Cluster analysis, LU had the highest advantages and acceptable side effects. Considering the traumatic nature of PCNL, it should not be an option over URSL. ESWL had the lowest advantages. Conclusions LU have the potential to be considered as the first treatment choice of proximal ureteral stone ≥10mm.


Subject(s)
Humans , Male , Ureteral Calculi/surgery , Lithotripsy , Treatment Outcome , Ureteroscopy , Network Meta-Analysis , Nephrolithotomy, Percutaneous/adverse effects
8.
Medicina (B.Aires) ; 80(3): 241-247, jun. 2020.
Article in Spanish | LILACS | ID: biblio-1125075

ABSTRACT

La segunda parte del Consenso Argentino Intersociedades de Infección Urinaria incluye el análisis de situaciones especiales. En pacientes con sonda vesical se debe solicitar urocultivo solo cuando hay signo-sintomatología de infección del tracto urinario, antes de instrumentaciones de la vía urinaria o como control en pacientes post-trasplante renal. El tratamiento empírico recomendado en pacientes sin factores de riesgo es cefalosporinas de tercera generación o aminoglucósidos. Las infecciones del tracto urinario asociadas a cálculos son siempre consideradas complicadas. En caso de obstrucción con urosepsis, deberá realizarse drenaje de urgencia por vía percutánea o ureteral. En pacientes con stents o prótesis ureterales, como catéteres doble J, el tratamiento empírico deberá basarse en la epidemiología, los antibióticos previos y el estado clínico. Antes del procedimiento de litotricia extracorpórea se recomienda pesquisar la bacteriuria y, si es positiva, administrar profilaxis antibiótica según el antibiograma. Cefalosporinas de primera generación o aminoglúcosidos son opciones válidas. Se recomienda aplicar profilaxis antibiótica con cefalosporinas de primera generación o aminoglúcosidos antes de la nefrolitotomía percutánea. La biopsia prostática trans-rectal puede asociarse a complicaciones infecciosas, como infecciones del tracto urinario o prostatitis aguda, principalmente por Escherichia coli u otras enterobacterias. En pacientes sin factores de riesgo para gérmenes multirresistentes y urocultivo negativo se recomienda realizar profilaxis con amikacina o ceftriaxona endovenosas. En pacientes con urocultivo positivo, se realizará profilaxis según antibiograma, 24 horas previas a 24 horas post-procedimiento. Para el tratamiento dirigido de la prostatitis post-biopsia trans-rectal, los carbapenémicos durante 3-4 semanas son el tratamiento de elección.


The second part of the Inter-Society Argentine Consensus on Urinary Tract Infection (UTI) includes the analysis of special situations. In patients with urinary catheter, urine culture should be requested only in the presence of UTI symptomatology, before instrumentation of the urinary tract, or as a post-transplant control. The antibiotics recommended for empirical treatment in patients without risk factors are third-generation cephalosporins or aminoglycosides. UTIs associated with stones are always considered complicated. In case of obstruction with urosepsis, an emergency drainage should be performed via a percutaneous nefrostomy or ureteral stenting. In patients with stents or ureteral prostheses, such as double J catheters, empirical treatment should be based on epidemiology, prior antibiotics, and clinical status. Before the extracorporeal lithotripsy procedure, bacteriuria should be investigated and antibiotic prophylaxis should be administered in case of positive result, according to the antibiogram. First generation cephalosporins or aminoglycosides are valid alternatives. The use of antibiotic prophylaxis with first-generation cephalosporins or aminoglycosides before percutaneous nephrolithotomy is recommended. Transrectal prostatic biopsy can be associated with infectious complications, such as UTI or acute prostatitis, mainly due to Escherichia coli or other enterobacteria. In patients without risk factors for multiresistant bacteria and negative urine culture, prophylaxis with intravenous amikacin or ceftriaxone is recommended. In patients with positive urine culture, prophylaxis will be performed according to the antibiogram, from 24 hours before to 24 hours post-procedure. For the targeted treatment of post-transrectal biopsy prostatitis, carbapenems for 3-4 weeks are the treatment of choice.


Subject(s)
Humans , Male , Female , Urinary Tract Infections/etiology , Urinary Tract Infections/drug therapy , Consensus , Anti-Infective Agents, Urinary/therapeutic use , Argentina , Prostatitis/etiology , Prostatitis/drug therapy , Lithotripsy/adverse effects , Stents/adverse effects , Risk Factors , Nephrolithiasis/complications , Urinary Catheters/adverse effects , Nephrolithotomy, Percutaneous/adverse effects
9.
Rev. chil. cardiol ; 39(1): 34-38, abr. 2020. graf
Article in Spanish | LILACS | ID: biblio-1115447

ABSTRACT

Recently, intravascular lithoplasty (IVL) has been introduced as a novel technique for treating calcified intracoronary artery lesions. There are no reports of this intervention in Latin America. We report 2 cases in which IVL was successfully used to treat this type of coronary artery lesions.


Subject(s)
Humans , Male , Middle Aged , Coronary Artery Disease/therapy , Lithotripsy/methods , Atherectomy, Coronary/methods , Vascular Calcification/therapy , Angioplasty, Balloon, Coronary
10.
Rev. méd. Urug ; 36(1): 99-105, mar. 2020. tab, graf
Article in Spanish | LILACS, BNUY | ID: biblio-1094231

ABSTRACT

Resumen: La litotricia extracorpórea por ondas de choque para el tratamiento de la urolitiasis es un tratamiento ampliamente aceptado, pero no exento de complicaciones. La pancreatitis aguda que se desencadena inmediatamente posterior a este procedimiento es infrecuente, pero puede ser una complicación grave que amenaza la vida del paciente. La aparición aguda de dolor abdominal y vómitos en las horas posteriores al procedimiento, deben hacer al médico tratante sospechar esta complicación. Presentamos el caso de un paciente joven que luego de someterse a una sesión de litotricia para el tratamiento de una litiasis renal derecha instaló una pancreatitis aguda que requirió ingreso a terapia intensiva y que se suma a los escasos informes de casos publicados en la literatura médica.


Summary: Extracorporeal shock wave lithotripsy to treat urolithiasis is a widely aceptable treatment, although it may involve complications. Acute pancreatitis immediately after the procedures is rather unusual, but it may result in a serious life-threatening complication for patients. The appearance of severe pain and vomits a few hours after the procedure should make physicians suspicious of this complication. The study presents the case of a young patient who developed acute pancreatitis after undergoing lithotripsy to treat lithiasis in the right kidney, requiring his admission to the intensive care unit. This will add up to the scarce reports published in the medical literature.


Resumo: A litotrícia extracorpórea por ondas de choque para o tratamento da urolitíase é um tratamento amplamente aceito, mas não isento de complicações. A pancreatite aguda que se desencadeia imediatamente depois deste procedimento não é frequente, porém pode ser uma complicação grave que ameaça a vida do paciente. O surgimento súbito de dor abdominal e vómitos nas horas seguintes ao procedimento devem induzir à suspeita desta complicação. Apresentamos o caso de um paciente jovem que depois de uma sessão de litotrícia para o tratamento de uma litíase renal direita apresentou uma pancreatite aguda com posterior admissão a terapia intensiva; este caso se agrega aos poucos publicados na literatura médica.


Subject(s)
Pancreatitis , Lithotripsy/adverse effects
12.
Fisioter. Bras ; 21(1): 69-76, mar 8, 2020.
Article in Portuguese | LILACS | ID: biblio-1282722

ABSTRACT

Introdução: O objetivo desta pesquisa é demonstrar a redução do tônus muscular utilizando a terapia extracorpórea por ondas de choque e promover o retorno dos movimentos normais. Métodos: Foram escolhidos 10 pacientes idosos que apresentavam espasticidade, faixa etária entre 50 e 80 anos. Este estudo piloto utilizou 3 métodos: a escala de Ashworth, goniometro digital e o deslocamento do ventre muscular, antes e após as aplicações das ondas de choque. Aplicou-se uma corrente de pulso para verificar o deslocamento do ventre muscular, por meio de um laser marca LTM 165 classe 2 Stanley. O deslocamento foi medido por um sensor a laser. O equipamento de ortolitotripsia foi a Direx Integra, cuja dose/intensidade foi entre 1000 ciclos por segundo e 0,030 mJ/mm de energia em 12 gpm. Resultados: Na escala de Ashworth os resultados foram significativos (= 0,05). Na goniometria digital a abdução do ombro evoluiu em média 35° em 7 pacientes e 15° em 3 pacientes. (p > 0,05). Conclusão: Observa se que as ondas de choque não deixam os músculos hipotônicos, mas com tônus adequado. Os pacientes que obtiveram pouca melhora (15° goniometria) apresentaram micro-encurtamentos e não apresentam história de participação na fisioterapia regularmente. (AU)


Introduction: This research aims to show the reduction of muscular tonus by using extracorporeal shock wave lithotripsy in order to recover normal movements. Methods: 10 patients over 50 and under 80 years of age presenting spasticity participated in this pilot study, which used three methods: 1) the Ashworth scale, 2) the digital goniometer and 3) the dislocation of muscle tissue, before and after the shock waves. To check the dislocation of muscle tissue, a current pulse was applied, measured by a LTM 165 class 2 Laser. This approach is similar and consists of measuring the dislocation on a laser sensor basis. The Ortho-lithotripsy equipment used was a Direx Integra. The dose/intensity was 1000 cps ­ 0.030 mJ/mm². Results: We also observed a better quality of muscle contraction (Scale Ashworth p=0.05). At digital goniometry, the shoulder abduction developed 35° in 7 of the patients and 15° in 3 of them (p<0.05). Conclusion: The muscles do not become hypotonic with the shock waves treatment, (they present an adequate tonus). The patients who presented micro-shortening and did not undergo to regular physiotherapy showed a minor improvement (15° goniometry). (AU)


Subject(s)
Humans , Stroke , Muscle Spasticity , Lithotripsy , High-Energy Shock Waves
13.
ABCD arq. bras. cir. dig ; 33(1): e1491, 2020. graf
Article in English | LILACS | ID: biblio-1130506

ABSTRACT

ABSTRACT Introduction: Endoscopic removal of common bile duct stones has a high success rate ranging from 85% to 95%. Bile duct stones >15 mm are difficult and frequently require lithotripsy. Peroral cholangioscopy (POC) allows lithotripsy with similar success rates. Aim: To determine the efficacy and safety of cholangioscopy-guided lithotripsy used in the treatment of difficult to remove bile duct stones vs. conventional therapy. Methods: Search was based in Medline, Embase, Cochrane Central, Lilacs/Bireme. Studies enrolling patients referred for the removal of difficult bile duct stones via POC were considered eligible. Two analyses were carried out separately, one included randomized controlled trials (RCTs) and another observational studies. Results: Forty-six studies were selected (3 RTC and 43 observational). In the analysis there was no statistical significant difference between successful endoscopic clearance (RD=-0.02 CI: -0.17, 0.12/I²=0%), mean fluoroscopy time (MD=-0.14 CI -1.60, 1.32/I²=21%) and adverse events rates (RD=-0.06 CI: -0.14, 0.02/I²=0%), by contrast, the mean procedure time favored conventional therapy with statistical significance (MD=27.89 CI: 16.68, 39.10/I²=0%). In observational studies, the successful endoscopic clearance rate was 88.29% (CI95: 86.9%-90.7%), the first session successful endoscopic clearance rate was 72.7 % (CI95: 69.9%-75.3%), the mean procedure time was 47.50±6 min for session and the number of sessions to clear bile duct was 1.5±0.18. The adverse event rate was 8.7% (CI95: 7%-10.9%). Conclusions: For complex common bile duct stones, cholangioscopy-guided lithotripsy has a success rate that is similar to traditional ERCP techniques in terms of therapeutic success, adverse event rate and means fluoroscopy time. Conventional ERCP methods have a shorter mean procedure time.


RESUMO Introdução: A remoção endoscópica das litíases do ducto biliar comum tem alta taxa de sucesso variando de 85% a 95%. Litíases do ducto biliar >15 mm são difíceis e frequentemente requerem litotripsia. A colangioscopia peroral permite litotripsia com taxas de sucesso semelhantes. Objetivo: Determinar a eficácia e segurança da litotripsia guiada por colangioscopia no tratamento de litíases biliares difíceis em comparação à terapias convencionais guiadas por colangiopancreatografia retrógrada endoscópica. Método: Pesquisa na Medline, Embase, Cochrane Central, Lilacs/Bireme de estudos avaliando a eficácia da colangioscopia na remoção de cálculos biliares difíceis. Duas análises foram realizadas separadamente, uma incluiu ensaios clínicos randomizados (ECR) e outros estudos observacionais. Resultados: Quarenta e seis estudos foram selecionados (3 ECR e 43 observacionais). Na análise, não houve diferença estatisticamente significativa na taxa de extração litiásica total (RD=-0,02 IC: -0,17,0,12/I²=0%), tempo médio de fluoroscopia (MD=-0,14 CI -1,60, 1,32/I²=21%) e na taxa de eventos adversos (RD=-0,06 IC: -0,14, 0,02/I²=0%).Por outro lado, o tempo médio do procedimento favoreceu terapêuticas convencionais guiadas por CPRE com significância estatística (MD=27,89 IC: 16,68, 39,10/I²=0%). Nos estudos observacionais, a taxa do tratamento completo por endoscopia foi de 88,29% (IC95: 86,9% a 90,7%), a taxa de sucesso na primeira sessão foi de 72,7% (IC95: 69,9% a 75,3%), o tempo médio do procedimento foi de 47,50±6 min por sessão e o número de procedimentos necessários para remoção total da litíase foi de 1,5±0,18. A taxa de eventos adversos foi de 8,7% (IC95: 7% a 10,9%), com 0,5% considerado como severo. Conclusão: Para litíases biliares difíceis, a litotripsia guiada por colangioscopia tem taxa de sucesso semelhante às terapêuticas convencionais guiadas CPRE em termos de sucesso terapêutico, taxa de eventos adversos e tempo de fluoroscopia. As terapêuticas convencionais guiadas por CPRE têm tempo médio de procedimento menor.


Subject(s)
Humans , Lithotripsy , Gallstones , Lithotripsy, Laser , Cholangiopancreatography, Endoscopic Retrograde , Treatment Outcome
15.
Int. braz. j. urol ; 45(6): 1281-1282, Nov.-Dec. 2019.
Article in English | LILACS | ID: biblio-1056347

ABSTRACT

ABSTRACT Introduction and Objectives: We aim to present the use of 3D digital and physical renal model (1-5) to guide the percutaneous access during percutaneous nephrolithotripsy (PNL). Materials and Methods: We present the clinical case of a 30 years old man with left renal stone (25x15 mm). A virtual 3D reconstruction of the anatomical model including the stone, the renal parenchyma, the urinary collecting system (UCS) and the skeletal landmarks (lumbar spine and ribs) was elaborated. Finally, a physical 3D model was created with a 3D printer including the renal parenchyma, UCS and the stone. The surgeon evaluated the 3D virtual reconstruction and manipulated the printed model before surgery to improve the anatomical knowledge and to facilitate the percutaneous access. In prone position, combining ultrasound and fluoroscopy implemented by the preoperative anatomical planning based on the 3D virtual and printed model, an easy and safe access of the inferior calyx was achieved. Then, the patient underwent PNL using a 30 Fr Amplatz sheet with semi-rigid nephroscope and ultrasound energy to achieve a complete lithotripsy of the pelvic stone. Results: The procedure was safely completed with 1 single percutaneous puncture (time of puncture 2 minutes). Overall surgical time was 90 min. No intra and postoperative complications were reported. The CT scan performed before discharge confirmed a complete stone free state. Conclusion: The 3D-guided approach to PNL facilitates the preoperative planning of the puncture with better knowledge of the renal anatomy and may be helpful to reduce operative time and improve the learning curve.


Subject(s)
Humans , Male , Adult , Lithotripsy/methods , Kidney Calculi/surgery , Printing, Three-Dimensional , Models, Anatomic , Fluoroscopy/methods , Reproducibility of Results , Treatment Outcome , Ultrasonography, Interventional/methods , Operative Time , Kidney
16.
Rev. Assoc. Med. Bras. (1992) ; 65(11): 1329-1335, Nov. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057073

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Lithotripsy/methods , Urolithiasis/therapy , Time Factors , Lithotripsy, Laser , Evidence-Based Medicine , Lasers, Solid-State
17.
Int. braz. j. urol ; 45(2): 406-407, Mar.-Apr. 2019.
Article in English | LILACS | ID: biblio-1040055

ABSTRACT

ABSTRACT In complicated urinary tract infection with ureteral calculi, urinary diversion is inevitable. So, stenting or percutaneous drainage can be an option. In hemodynamically unstable patients, percutaneous drainage is superior to ureteral stenting (1). Once acute infection is controlled, definite treatment of the stone is necessary. According to a guideline, semirigid ureteroscopy is recommended for lower and mid - ureter stone and flexible ureteroscopy for upper ureter stone (2). Semi - rigid ureteroscopy can migrate stone to kidney, especially in upper ureter stone, lowering stone free rate (3). Not only flexible ureteroscopy creates additional costs but also is barely available in developing countries (4, 5). So, the authors would like to introduce anterograde irrigation - assisted ureteroscopic lithotripsy in patients with percutaneous nephrostomy. Retrograde irrigation was connected and flowed minimally enough to secure visual field. Once stone is noted, another saline irrigation, which is placed above 40 cm over the patient is connected to nephrostomy. Retrograde irrigation is disconnected from ureteroscope and the previous connected channel on ureteroscope is opened. Actual pressure detected by barometer from the opened channel of ureteroscope is usually about 30 cmH2 O while anterograde irrigation is administered in maximal flow, which means fully opened anterograde irrigation is not hazardous to kidney. There was no complication in 17 patients submitted to this method. Video shows advantages of our practice: clear visual field; reduced risk of stone migration into kidney; induced spontaneous passage of fragments without using instrumentation; and decreased operation time. In short, most of surgeons, even unexperienced, can perform an excellent procedure with less time consuming using our method.


Subject(s)
Humans , Nephrostomy, Percutaneous/methods , Lithotripsy/methods , Ureteral Calculi/surgery , Ureteroscopy/methods , Therapeutic Irrigation/methods , Lithotripsy/instrumentation
18.
Rev. bras. anestesiol ; 69(2): 131-136, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1003408

ABSTRACT

Abstract Background: Postoperative pain is the most common postoperative complication. This study was conducted to assess the effect of acetaminophen versus fentanyl on postoperative pain relief in patients who underwent urologic surgeries. Methods: This clinical trial was conducted on patients aged 18-65 years. Patients were randomly assigned to receive either 2000 mg acetaminophen (propacetamol) or 2 mcg.kg-1 fentanyl intravenously, 15 min before the end of surgery. The postoperative pain was evaluated every 6 h for 24 h using the Visual Analog Scale. Total morphine dose taken in 24 h and hemodynamic status were evaluated. Results: Eighty patients were enrolled into the trial. The mean score of pain in 6, 12, 18, and 24 h after surgery was lower in the acetaminophen group than in the fentanyl group but the difference was not statistically significant except in 12 and 18 h after surgery (p < 0.05). The amount of administered morphine was higher in the fentanyl group than in the acetaminophen group, but the difference was not statistically significant. The hemodynamic status including systolic and diastolic blood pressure and heart rates were nearly the same in the two groups but the SpO2 mean was significantly higher in the acetaminophen group than the fentanyl group. Conclusions: This trial indicated that intravenous acetaminophen is as effective as intravenous fentanyl in pain relief after urologic surgeries (transurethral lithotripsy).


Resumo Justificativa: A dor pós-operatória é a complicação mais comum no período pós-operatório. Este estudo foi realizado para avaliar o efeito de acetaminofeno versus fentanil no alívio da dor pós-operatória em pacientes submetidos a cirurgias urológicas. Métodos: Este ensaio clínico foi realizado com pacientes cujas idades variou entre 18 e 65 anos. Os pacientes foram randomicamente designados para receber 2.000 mg de acetaminofeno (propacetamol) ou 2 mcg.kg-1 de fentanil por via intravenosa 15 min antes do final da cirurgia. A dor pós-operatória foi avaliada a cada 6 horas por 24 horas, utilizando a escala visual analógica. A dose total de morfina administrada em 24 horas e o estado hemodinâmico foram avaliados. Resultados: Oitenta pacientes foram incluídos no estudo. O escore médio de dor em 6, 12, 18 e 24 horas após a cirurgia foi menor no grupo acetaminofeno que no grupo fentanil, mas a diferença não foi estatisticamente significativa, exceto em 12 e 18 horas após a cirurgia (p < 0,05). A quantidade de morfina administrada foi maior no grupo fentanil que no grupo acetaminofeno, mas a diferença não foi estatisticamente significativa. O estado hemodinâmico, incluindo pressão arterial sistólica e diastólica e frequência cardíaca, foi quase o mesmo nos dois grupos, mas a média de SpO2 foi significativamente maior no grupo acetaminofeno que no grupo fentanil. Conclusões: Este estudo indicou que acetaminofeno intravenoso é tão eficaz quanto fentanil intravenoso no alívio da dor após cirurgias urológicas (litotripsia transuretral).


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Pain, Postoperative/drug therapy , Lithotripsy/methods , Fentanyl/administration & dosage , Analgesics, Opioid/administration & dosage , Acetaminophen/administration & dosage , Time Factors , Pain Measurement , Single-Blind Method , Analgesics, Non-Narcotic/administration & dosage , Administration, Intravenous , Middle Aged
19.
The Egyptian Journal of Hospital Medicine ; 76(7): 4553-4556, 2019. tab
Article in English | AIM, AIM | ID: biblio-1272774

ABSTRACT

Background: For shock wave lithotripsy has proven to be an effective, safe and truly minimally invasive option for the treatment of nephrolithiasis. Various technical factors as well as patient selection can impact the success of the procedure. Objective: The aim of this study was to identify the parameters on NCCT that may predict the success of shock wave lithotripsy (SWL) in ureteral stones. Patients and Methods: 102 patients who underwent SWL for ureteral stones at sayed Galal University Hospital from January 2015 to August 2018 diagnosed by non-contrasted computed tomography were studied. The failure was defined as remnant stones ﻞ4 mm. We assessed age, sex, body mass index, stone size, location, skin-to-stone distance (SSD), presence of JJ and the presence of secondary signs (hydronephrosis, renal enlargement, perinephric fat stranding, and tissue rim sign). Results: 102 patients with success rate 61.8%, stone size, stone density were significantly associated with outcome of SWL. While SSD, JJ and secondary signs (hydronephrosis, perinephric fat stranding and tissue rim sign) were insignificant. On multivariate analysis, stone size and stone density were the independent factors affecting the outcome of SWL. Conclusions: The study demonstrated that stone size and density are significant and independent predictors of outcome in patients with upper ureteral stones. However SSD and signs of impaction still have to be evaluated


Subject(s)
High-Energy Shock Waves , Lithotripsy , Patient Outcome Assessment
20.
Article in Korean | WPRIM | ID: wpr-760177

ABSTRACT

Pancreatic calculi associated with chronic pancreatitis lead to severe abdominal pain, which significantly reduces the quality of life of patients. Pancreatic calculi, especially those that obstruct the main pancreatic duct and cause abdominal pain, are considered to be treated. First, if pancreatic calculi are located in the head or body and the size is less than 5 mm, endoscopic removal can be attempted. If the size is greater than 5 mm, extracorporeal shockwave lithotripsy may be performed first, and subsequent endoscopic removal may be considered depending on the results. If such treatment fails, pancreatoscopic lithotripsy or surgery should be considered. Pancreatic duct stenting may be used as a bridge therapy during this process.


Subject(s)
Abdominal Pain , Calculi , Head , Humans , Lithotripsy , Pancreatic Ducts , Pancreatitis, Chronic , Quality of Life , Stents
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