Two-shift operation mode can improve the efficiency and comfort of flexible ureteroscopic holmium laser lithotripsy for the treatment of renal calculi larger than 1. 5cm

ABSTRACT Purpose: To compare two-shift operation mode and single player mode different impact on surgical results and operator comfort in flexible ureteroscopic holmium laser lithotripsy for renal calculi larger than 1.5cm. Materials and Methods: From december 2017 to december 2018, 92 patients with renal calculi admitted to Qilu Hospital and were treated through flexible ureteroscopy. They were randomized in two-shift group (n=50) and single player group (n=42). The operative time, blood loss, hospitalization stay after operation, residual fragments (≥4mm) rate, fragmentation speed, postoperative complications and operator's fatigue score were compared. Results: There was no significant difference between two groups regarding age, gender, illness side, stone size, blood loss, operative time, postoperative hospitalization stay, complications, etc (p >0.05). The fragmentation speed was 44.5±20.0mm3/min in two-shift group compared with 34.2±17.3mm3/min in single player group (p=0.037). Residual fragments (≥4mm) rate after first surgery was 18% in two-shift group, while the residual fragments (≥4mm) rate was 40.5% after first surgery in single player group (p=0.017). The total fatigue score of two-shift group was 8.4 compared to 29.9 in single player group (p <0.001). Conclusion: In flexible ureteroscopic holmium laser lithotripsy for the treatment of renal calculi larger than 1.5cm, two-shift operation mode can raise the fragmentation speed and stone clearance rate, as well as significantly lower operator's fatigue level and improve operator's comfort.

Factors affecting fluoroscopy time during percutaneous nephrolithotomy: Impact of stone volume distribution in renal collecting system

ABSTRACT Purpose: To identify the factors increased fluoroscopy time during percutaneous nephrolithotomy and investigate the relationship between the 3D segmentation volume ratio of stone to renal collecting system and fluoroscopy time. Materials and Methods: Data from 102 patients who underwent percutaneous nephrolithotomy were analyzed retrospectively. Volume segmentation of both the renal collecting system and stones were obtained from 3D segmentation software with the images on CT data. Analyzed stone volume (ASV), renal collecting system volume (RCSV) measured and the ASV-to-RCSV ratio was calculated. Several parameters were evaluated for their predictive ability with regard to fluoroscopy time. Results: The stone-free rate was 55.9% after the percutaneous nephrolithotomy. Complications occurred in 31(30.4%) patients. The mean fluoroscopy time was 199.4±151.1 seconds. The fluoroscopy time was significantly associated with the ASV-to-RCSV ratio (p<0.001, r=0.614). The single tract was used in 77 (75.5%) cases while multiple tracts were used in 25 (24.5%) cases. Fluoroscopy time was significantly associated with multiple access (p<0.001, r=0.689). On univariate linear regression analysis, longer fluoroscopy time was related with increased stone size, increased stone volume, increased number of access, increased calyx number with stone, increased ASV-to-RCSV, increased operative time and decreased stone essence. On multivariate linear regression analysis, the number of access and the ASV-to-RCSV were independent predictors of fluoroscopy time during percutaneous nephrolithotomy. Conclusions: The distribution of the stone burden volume in the pelvicalyceal system is a significant predictor for prolonged fluoroscopy time during percutaneous nephrolithotomy. Measures to decrease FT could be beneficial in patients with a high ASV-to-RCSV ratio for precise preoperative planning.

Computed tomography window affects kidney stones measurements

ABSTRACT Objectives Measurements of stone features may vary according to the non-contrast computed tomography (NCCT) technique. Using magnified bone window is the most accurate method to measure urinary stones. Possible differences between stone measurements in different NCCT windows have not been evaluated in stones located in the kidney. The aim of this study is to compare measurements of kidney stone features between NCCT bone and soft tissue windows in patients submitted to retrograde intrarenal surgery (RIRS). Materials and Methods Preoperative and 90th postoperative day NCCT were performed in 92 consecutive symptomatic adult patients (115 renal units) with kidney stones between 5 mm to 20 mm (< 15 mm in the lower calyx) treated by RIRS. NCCT were evaluated in the magnified bone window and soft tissue window in three axes in a different time by a single radiologist blinded for the measurements of the NCCT other method. Results Stone largest size (7.92±3.81 vs. 9.13±4.08; mm), volume (435.5±472.7 vs. 683.1±665.0; mm3) and density (989.4±330.2 vs. 893.0±324.6; HU) differed between bone and soft-tissue windows, respectively (p<0.0001) 5.2% of the renal units (6/115) were reclassified from residual fragments > 2 mm on soft tissue window to 0-2 mm on bone window. Conclusion Kidney stone measurements vary according to NCCT window. Measurements in soft tissue window NCCT of stone diameter and volume are larger and stone density is lesser than in bone window. These differences may have impact on clinical decisions.

Comparison of supine and prone miniaturized percutaneous nephrolithotomy in the treatment of lower pole, middle pole and renal pelvic stones: A matched pair analysis

ABSTRACT Purpose We aimed to compare the outcomes of supine and prone miniaturized percutaneous nephrolithotomy (m-PNL) in the treatment of lower pole, middle pole and renal pelvic stones. Materials and Methods 54 patients who performed supine m-PNL between January 2017 and March 2018 and 498 patients who performed prone m-PNL between April 2015 and January 2018 were included in the study. Of the 498 patients, 108 matching 1: 2 in terms of age, gender, body mass index, American Association of Anesthesiology score, stone size, stone localization and hydronephrosis according to the supine m-PNL group were selected as prone m-PNL group. The patients with solitary kidney, upper pole stone, urinary system anomaly or skeletal malformation and pediatric patients (<18 years old) were excluded from the study. The success was defined as 'complete stone clearance' and was determined according to the 1st month computed tomography. Results The operation time and fluoroscopy time in supine m-PNL was significantly shorter than prone m-PNL group (58.1±45.9 vs. 80.1±40.0 min and 3.0±1.7 min vs. 4.9±4.5 min, p=0.025 and p=0.01, respectively). When post-operative complications were compared according to the modified Clavien-Dindo classification, overall and subgroup complication rates were comparable between groups. There was no significant difference between the groups in terms of the success rates (supine m-PNL; 72.2%, prone m-PNL; 71.3%, p=0.902). Conclusions Supine m-PNL procedure is more advantageous in terms of operation time and fluoroscopy time in the treatment of lower pole, middle pole and renal pelvic stones.

Can renal stone size and the use of the nephrolithometric system increase the efficacy of predicting the risk of failure of percutaneous nephrolithotripsy? / O tamanho do cálculo renal e o uso do sistema nefrolitométrico podem aumentar a eficácia de predizer o risco de falha de nefrolitotripsia percutânea?

ABSTRACT Objective : to verify the association of success rate of percutaneous lithotripsy, Guy score and size of the stone. Methods: one hundred patients submitted to percutaneous nephrolithotripsy were evaluated. All stones were classified according to Guy Score. Patient free of stone was considered when residual fragments were ≤2mm. Results: according to guy Score, 54% were score 1 (Group 1), 18% score 2 (Group 2), 15% score 3 (Group 3), and 13% score 4 (Group 4). Success was observed in 77.77% in Group 1, 27.77% in group 2, 26.6% in Group 3, and 7.69% in Group 4. In patients with Guy score 1, there was statistical significance of prediction of free stone rate when evaluated according to the size of the stone. Among groups 2, 3 and 4 there was no statistical significance, but it was observed a trend in relation to stone size, the bigger the higher the chance of residual fragments. Conclusion: nephrolithometry by Guy Score and size of the stone are single predictors of success of percutaneous nephrolithotripsy. Stone size may influence success rate of patients with Guy Score 1.

RESUMO Objetivo: verificar a associação entre taxa de sucesso de nefrolitotripsia percutânea, escore de Guy e tamanho do cálculo. Métodos: foram avaliados 100 pacientes submetidos à nefrolitotripsia percutânea. Todos os cálculos foram classificados de acordo com o escore de Guy. Consideramos o paciente livre de cálculos quando os fragmentos residuais fossem menores ou iguais a 2mm. Resultados: de acordo com o escore de Guy, 54% tinham escore 1 (Grupo 1), 18% escore 2 (Grupo 2), 15% escore 3 (Grupo 3) e 13% escore 4 (Grupo 4) . Houve resolução de 77,77% no grupo 1, de 27,77% no grupo 2, de 26,6% no grupo 3 e de 7,69% no grupo 4. Houve significância estatística para predição de taxa livre de cálculos entre os pacientes com escore de Guy 1 quando avaliados de acordo com o tamanho do cálculo. Entre os grupos 2, 3 e 4 não houve significância estatística, porém observamos tendência de que quanto maior o tamanho do cálculo, maior a chance de cálculo residual. Conclusão: a nefrolitometria pelo Escore de Guy e o tamanho do cálculo são preditores isolados para avaliação de sucesso da nefrolitotripsia percutânea. O tamanho do cálculo pode influenciar a taxa de sucesso de pacientes com Escore de Guy 1.

Flexible ureterorenoscopy in position or fusion anomaly: Is it feasible? / Ureterorrenolitotripsia flexível no tratamento de cálculos em rins anômalos: Qual a viabilidade?

Summary Objective: To analyze the results of flexible ureterorenoscopy (F-URS) with holmium laser in the treatment of kidney stones with ectopic and fusion anomalies (horseshoe kidney and rotation anomalies). Method: We reviewed data from 13 patients with fusion and ectopic renal anomalies that underwent F-URS from April 2011 to April 2017. We analyzed demographic and clinical data (age, gender, BMI, anatomical abnormality, location and dimension of the renal calculi) and perioperative data (method of treatment, stone-free rate, number of days with DJ catheter and perioperative complications). Results: The mean stone size was 12.23 +/- 5.43 mm (range 6-22mm), located in the inferior (58.33%) and middle (16.76%) calyceal units, renal pelvis (16.67%) and multiple locations (8.33%). All 13 patients were treated with Ho-Yag laser, using dusting technique (25%), fragmentation and extraction of the calculi (58.33%) and mixed technique (16.67%). We did not have any severe perioperative complication. After 90 days, nine patients (75%) were considered stone free. Conclusion: Our data suggest that F-URS is a safe and feasible choice for the treatment of kidney stones in patients with renal ectopic and fusion anomalies.

Resumo Objetivo: Analisar os resultados da ureterorrenolitotripsia flexível (ULT-F) no tratamento de cálculos em rins com anomalia de posição e de fusão (rins em ferradura e rins com vício de rotação). Método: Realizamos a coleta prospectiva dos dados de 13 pacientes com anomalias de fusão e de posição submetidos a ULT-F entre abril de 2011 e abril de 2017. Analisaram-se dados clínicos (idade, gênero, IMC, anormalidades anatômicas, dimensão e localização dos cálculos) e perioperatórios (método de tratamento do cálculo, índice de stone free, tempo de cateter DJ e complicações perioperatórias). Resultados: Nos 13 pacientes, os cálculos mediam em média 12,23 mm +/- 5,43 mm (variando de 6 a 22 mm), em sua maioria distribuídos em apenas um grupo calicinal (58.33% em grupo calicial inferior, 16.67% em grupo calicial médio, 16,67% em pelve e 8,33% em múltiplos cálices). Todos os pacientes foram tratados com utilização de laser Ho-Yag, com fragmentação e retirada de cálculos em sete casos (58,33%), pulverização em três casos (25%) e técnica mista em dois casos (16,67%). Não houve complicações intraoperatórias ou pós-operatórias graves. Após 90 dias, nove pacientes tornaram-se stone free (75%). Conclusão: A ULT-F apresenta-se como método seguro e eficaz no tratamento de litíase em rins com anomalia de posição e de fusão.

Predictive factors for flexible ureterorenoscopy requirement after rigid ureterorenoscopy in cases with renal pelvic stones sized 1 to 2 cm

PURPOSE: To evaluate the outcomes of rigid ureterorenoscopy (URS) for renal pelvic stones (RPS) sized 1 to 2 cm and to determine the predictive factors for the requirement for flexible URS (F-URS) when rigid URS fails. MATERIALS AND METHODS: A total of 88 patients were included into the study. In 48 patients, the RPS were totally fragmented with rigid URS and F-URS was not required (group 1). In 40 patients, rigid URS was not able to access the renal pelvis or fragmentation of the stones was not completed owing to stone position or displacement and F-URS was utilized for retrograde intrarenal surgery (RIRS) (group 2). The predictive factors for F-URS requirement during RIRS for RPS were evaluated. Both groups were compared regarding age, height, sex, body mass index, stone size, stone opacity, hydronephrosis, and previous treatments. RESULTS: The mean patient age was 48.6+/-16.5 years and the mean follow-period was 39+/-11.5 weeks. The overall stone-free rate in the study population was 85% (75 patients). In groups 1 and 2, the overall stone-free rates were 83% (40 patients) and 87% (35 patients), respectively (p>0.05). The independent predictors of requirement for F-URS during RIRS were male gender, patient height, and higher degree of hydronephrosis. CONCLUSIONS: Rigid URS can be utilized in selected patients for the fragmentation of RPS sized 1 to 2 cm with outcomes similar to that of F-URS. In case of failure of rigid URS, F-URS can be performed successfully in this group of patients.

Ultramini nephrostomy tract combined with flexible ureterorenoscopy for the treatment of multiple renal calculi in paediatric patients

PURPOSE: To assess the safety and efficacy of an ultramini nephrostomy tract, which we were using for the first time, combined with flexible ureterorenoscopy (URS) in the treatment of pediatric patients with multiple renal calculi. MATERIALS AND METHODS: Twenty pediatric patients (age, < or =6 years) underwent ultramini percutaneous nephrolithotomy (PCNL) combined with flexible URS. The group had multiple renal calculi, which were bilateral in 3 cases and were located in a total of 23 sites. The calculi were located in 2 calyces in 10 cases, scattered in more than 2 calyces in 7 cases, and limited to 1 calyx in 3 cases. The average patient age was 37.35 months (range, 14-68 months). The average stone diameter was 2.0 cm (range, 1-3.0 cm). In all patients, an ultramini nephrostomy tract was established under ultrasound guidance (dilated to F10) with simultaneous sheath placement. The flexible URS was placed into the collecting system during holmium laser lithotripsy. RESULTS: When ultramini PCNL was combined with flexible ureterorenoscopic holmium laser lithotripsy, the complete stone-free rate was 87% (20/23). The average level of hemoglobin decreased to 1.0 g/dL after the operation. No blood transfusions were needed. Levels of blood urea nitrogen, creatinine, and C-reactive protein were not significantly different before and after the operation. The average duration of hospitalization was approximately 4.85 days, and all cases were followed up for 6 to 12 months. No complications were found. CONCLUSIONS: Ultramini PCNL combined with flexible ureterorenoscopic holmium laser lithotripsy is a safe and effective treatment for children with multiple renal calculi.

Comparison of retrograde intrarenal surgery versus a single-session percutaneous nephrolithotomy for lower-pole stones with a diameter of 15 to 30 mm: A propensity score-matching study

PURPOSE: To investigate surgical outcomes between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) groups for a main stone sized 15 to 30 mm and located in the lower-pole calyx. MATERIALS AND METHODS: Patients who underwent PNL or RIRS for a main stone sized 15 to 30 mm and located in the lower-pole calyx were retrospectively reviewed. Each patient in the RIRS group was matched to one in the PNL group on the basis of calculated propensity scores by use of age, sex, body mass index, previous treatment history, stone site, maximum stone size, and stone volume. We compared perioperative outcomes between the unmatched and matched groups. RESULTS: Patients underwent PNL (n=87, 66.4%) or RIRS (n=44, 33.6%). After matching, 44 patients in each group were included. Mean patient age was 54.4+/-13.7 years. Perioperative hemoglobin drop was significantly higher and the hospital stay was longer in the PNL group than in the RIRS group. The operative time was significantly longer in the RIRS group than in the PNL group. Stone-free rates were higher and complications rates were lower in the RIRS group than in the PNL group without statistical significance. The presence of a stone located in the lower-anterior minor calyx was a predictor of stone-free status. CONCLUSIONS: RIRS and single-session PNL for patients with a main stone of 15 to 30 mm located in the lower-pole calyx showed comparable surgical results. However, RIRS can be performed more safely than PNL with less bleeding. Stones in the lower-anterior minor calyx should be carefully removed during these procedures.

The efficacy of radiographic anatomical measurement methods in predicting success after extracorporeal shockwave lithotripsy for lower pole kidney stones

Objectives To assess the impact of lower pole calyceal anatomy on clearace of lower pole stones after extracorporeal shockwave lithotripsy (ESWL) by means of a new and previously defined radiographic measurement method. Materials and Methods Sixty-four patients with solitary radiopaque lower pole kidney stones were enrolled in the study. Infundibulopelvic angle (IPA), infundibulotransverse angle (ITA), infundibular lenght(IL), and infundibular width (IW) were measured on the intravenous urographies which were taken before the procedure. Results 48 of 64 patients (75%) were stone-free after a follow-up period of 3 months. The IPA,ITA,IL and IW were determined as statistically significant factors, while age,gender and stone area were found to have no impact on clearance. Conclusion By the help of radiographic measurement methods related to lower pole kidney anatomy, appropriate patient selection and increment in success after ESWL may be achieved. .

Laparoscopic Stone Surgery With the Aid of Flexible Nephroscopy

PURPOSE: To report the outcome of laparoscopic pyelo- and ureterolithotomies with the aid of flexible nephroscopy. MATERIALS AND METHODS: A retrospective analysis was performed in 71 patients with complex renal stones or large and impacted proximal ureteral stones. Patients underwent laparoscopic pyelo- or ureterolithotomies with or without the removal of small residual stones by use of flexible nephroscopy between July 2005 and July 2010. Operative success was defined as no residual stones in the intravenous pyelogram at 12 weeks postoperatively. Perioperative results and surgical outcomes were analyzed. RESULTS: The patients' mean age was 54.7+/-13.7 years, and 53 males (74.6%) and 18 females (25.4%) were included. The mean maximal stone size was 19.4+/-9.4 mm. A total of 47 cases were complex renal stones and 24 cases were impacted ureteral stones. Mean operative time was 139.0+/-63.7 minutes. Stones were completely removed in 61 cases (85.9%), and no further ancillary treatment was needed for clinically insignificant residual fragments in 7 cases (9.9%). For complex renal stones, the complete stone-free rate and clinically significant stone-free rate were 80.9% and 93.6%, respectively. Multivariate analysis showed that the use of flexible nephroscopy for complex renal stones can reduce the risk of residual stones. A major complication occurred in one case, in which open conversion was performed. CONCLUSIONS: Laparoscopic stone surgery is a safe and minimally invasive procedure with a high success rate, especially with the aid of flexible nephroscopy, and is not associated with procedure-specific complications.

Anti-Urolithiatic Effect of Cow Urine Ark on Ethylene Glycol-Induced Renal Calculi

Purpose To investigate the anti-urolithiatic effect of cow urine ark (medicinal distilled cow urine) on ethylene glycol (EG) induced renal calculi. Materials and Methods 36 male Wistar rats were randomly divided into 6 equal groups. Group I animals served as vehicle control and received distilled water for 28 days. Group II to VI animals received 1% v/v EG in distilled water for 28 days. Group II served as EG control. Group III and IV (preventive groups) received cow urine ark orally for 28 days in doses of 1 mL/kg and 2 mL/kg, respectively. Group V and VI (treatment groups) received 1 mL/kg and 2 mL/kg cow urine ark orally, respectively from 15th to 28th days. 24-hour urine samples were collected on day 0 and 28. Urine volume and oxalate levels were measured. On day 28, blood was collected for biochemical parameters. Animals were sacrificed and kidneys were harvested, weighed and histopathologically evaluated for calcium oxalate (CaOx) crystals. To calculate the percentage of inhibition of mineralization, simultaneous flow static in-vitro model was used. Results EG significantly increased urine oxalate, serum creatinine, blood urea level; kidney weight and CaOx deposits. Provision of cow urine ark resulted in significantly lower levels of urine oxalate, serum creatinine, blood urea and CaOx depositions as compared to Group II. (p value < 0.05) It also significantly restored kidney weight. (p value < 0.05) Cow urine ark inhibited 40% and 35% crystallization of CaOx and calcium phosphate, respectively. Conclusion Cow urine ark is effective in prevention and treatment of EG induced urolithiasis in Wistar rats. .

Bilateral Single-Session Retrograde Intrarenal Surgery for the Treatment of Bilateral Renal Stones

Purpose The aim of the study was to evaluate the efficacy and safety of bilateral single-session retrograde intrarenal surgery in the treatment of bilateral renal stones. Materials and Methods: From December 2008 to February 2012, 42 patients who had undergone bilateral single-session retrograde intrarenal surgery (RIRS) and laser lithotripsy were included in the study. The procedures were performed in the lithotomy position on an endoscopy table under general anesthesia, beginning on the side in which the stone size was smaller. Plain abdominal radiography, intravenous urograms (IVU), renal ultrasonography (USG) and / or non-contrast tomography (CT) scans were conducted for all patients. The success rate was defined as patients who were stone-free or only had residual fragment less than 4 mm. Results A total of 42 patients (28 male, 14 female) with a mean age 39.2 ± 14.2 were included in the present study. The mean stone size was 24.09 ± 6.37 mm with a mean operative time of 51.08 ± 15.22 minutes. The stone-free rates (SFR) were 92.8% and 97.6% after the first and second procedures, respectively. The average hospital stay was 1.37 ± 0.72 days. In two patients (4.7%), minor complications (Clavien I or II) were observed, whereas no major complications (Clavien III-V) or blood transfusions were noted in the studied group. Conclusions Bilateral single-session RIRS and laser lithotripsy can be performed safely and effectively with a high success rate and low complication rate in patients with bilateral renal stones. .

Ureteroscopy in patients with coagulopathies is associated with lower stone-free rate and increased risk of clinically significant hematuria

PURPOSE: Patients with coagulopathy are at increased risk of peri-operative hemorrhage. The aim of the present study was to compare ureteroscopy (URS) in these high risk patients to those with normal bleeding profile. MATERIALS AND METHODS: Twelve patients with coagulopathies (Group I) undergoing 17 URS were included in the study [3 for biopsy of ureteral lesions and 9 for Holmium Laser Lithotripsy (HLL)]. A patient had Child B (MELD 11) cirrhosis, 6 patients were on warfarin, 3 patients on ASA, 1 patient on ASA and clopidogrel, and the last patient was on heparin. URS in Group I was performed without correction of coagulopathy. Group II consisted of 32 patients with normal bleeding profile who underwent 34 URS concurrently. RESULTS: Group I included 4 ureteral biopsies in 3 patients with suspicious ureteral lesions and 13 URS for HLL in 9 patients with nephrolithiasis. There were no significant differences between the two groups in terms of patient age, sex, percent of renal stones, median operative and fluoroscopy times. When compared with Group II, Group I had significantly larger median stone size (9.2 vs. 14.0 mm, p = 0.01) and significantly lower stone-free rate after first URS (94.1% vs. 69.2%, p = 0.04). However, after second URS, stone-free rates were comparable in both groups (92.3% vs. 100%, p = 0.9). Two (16.7%) patients with coagulopathy were readmitted due to gross hematuria. There were no post-operative complications in Group II. CONCLUSIONS: Although URS in selected patients with coagulopathies is safe, it is associated with significantly lower stone-free rates and higher readmissions due to gross hematuria.

Infecciones urinarias adquiridas en la comunidad: epidemiología a los antimicrobianos y opciones terapéuticas / Urinary infections acquired in community: epidemiology resistance to antibiotics and therapeutic options

Las infecciones del tracto urinario (ITU) constituyen uno de los principales motivos de consulta en el ámbito de atención primaria. En los últimos años se han producido cambios sustanciales en los patrones de sensibilidad de los principales patógenos urinarios, lo que ha condicionado cambios en el tratamiento empírico de éstas. El objetivo de este trabajo fue caracterizar las ITU en pacientes de la comunidad. La muestra estuvo conformada por 71 pacientes de ambos sexos mayores de 18 años. El género más afectado fue el femenino (80,28%). Los signos y síntomas más frecuentes fueron dolor lumbar, disuria y dolor abdominal. La presencia de cálculos renales fue el más importante factor predisponente (39,43%), seguido de la menopausia (23,94%). El 63,38% de los pacientes presentaron ITU previas. Escherichia coli fue el agente causal más frecuente (63,89%), seguido de Proteus mirabilis (6,94%). Las enterobacterias aisladas presentaron elevados niveles de resistencia a ampicilina, cefalotina y norfloxacina. El 51,52% de las enterobacterias presentaron resistencia a las fluoroquinolonas y en el 16,67% se demostró la producción de ß-lactamasas de espectro expandido (BLEE). La mayoría de los agentes causales fueron sensibles a la nitrofurantoína independientemente de la presencia de mecanismos de resistencia que afectan a otros grupos de antimicrobianos

Urinary tract infections (UTI) are one of the main reasons for consultation in primary care. In recent years, there have been substantial changes in susceptibility patterns for major urinary tract pathogens, which have conditioned changes in their empirical treatment. The aim of this study was to characterize UTI in patients from the community. The sample consisted of 71 patients of both sexes over 18 years of age. The most affected sex was the female (80.28%). The signs and symptoms were lumbar pain, dysuria and abdominal pain. The presence of kidney stones was the most important predisposing factor (39.43%), followed by menopause (23.94%); 63.38% of the patients had a previous UTI. Escherichia coli was the most common agent (63.89%), followed by Proteus mirabilis (6.94%). Isolates showed high levels of resistance to ampicillin, cephalothin and norfloxacin. 51.52% of the Enterobacteriaceae were resistant to fluoroquinolones and 16.67% showed production of extended spectrum ß-lactamases (ESBL). Most of the agents were susceptible to nitrofurantoin, regardless of the presence of resistance mechanisms affecting other antibiotic groups

Chemical and morphological analysis of kidney stones: a double-blind comparative study / Análise química e morfológica de cálculos renais: estudo comparativo duplo-cego

PURPOSE: To compare chemical to morphological kidney stone composition analysis based on a sample of 50 stones retrieved from patients at a nephrology service. METHODS: The chemical analysis was performed with a Bioclin® kit, while a 10-mm magnifying glass (10x; Prolabo, Paris, France) was employed in the morphological analysis. Findings obtained with the two methods were compared and classified as concordant (100 percent agreement), partly concordant (concordant for major components, discordant for minor components) or discordant (discordant for major components). RESULTS: In the chemical analysis, the most commonly observed major component was calcium (70 percent), followed by oxalate (66 percent), ammonium (56 percent), urate (28 percent) and carbonate (24 percent). In the morphological analysis, the most commonly observed major components were calcium phosphate and magnesium (32 percent each), followed by calcium oxalate monohydrate (24 percent), uric acid and urates (20 percent each), calcium oxalate dihydrate (18 percent) and cystine (6 percent). Infectious kidney stones were identified in 34 percent and 24 percent of cases by morphological and chemical analysis, respectively. Thirty-eight percent of the samples were classified as concordant, 52 percent were partly concordant and 10 percent were discordant. CONCLUSION: We suggest kidney stones be routinely submitted to both types of analysis for a better understanding of the mechanisms involved in lithogenesis.

OBJETIVO: Comparar a análise química com a análise morfológica de 50 cálculos urinários provenientes de pacientes em um serviço de nefrologia. MÉTODOS: A análise química foi realizada utilizando o kit da Bioclin®, enquanto que a morfológica foi realizada com auxílio de uma lupa de 10mm (Prolabo, Paris, France). A comparação entre as técnicas foi classificada em concordante (100 por cento de concordância), parcialmente concordante (componentes majoritários concordantes e minoritários discordantes) e discordante (discordância nos componentes majoritários). RESULTADOS: Na análise química os principais componentes majoritários foram cálcio (70 por cento), oxalato (66 por cento), amônio (56 por cento), urato (28 por cento) e carbonato (24 por cento). Na análise morfológica os principais componentes majoritários foram fosfato cálcico (PCa) e magnesiano-PCa (32 por cento), oxalato de cálcio monohidratado (24 por cento), ácido úrico e uratos (20 por cento), oxalato de cálcio dihidratado (18 por cento) e cistina (6 por cento). Cálculos de infecção foram identificados em 34 por cento e 24 por cento casos pela análise morfológica e química, respectivamente. Concordância total foi observada em 38 por cento, concordância parcial em 52 por cento e discordância em 10 por cento. CONCLUSÃO: Sugere-se a utilização simultânea das duas técnicas para melhor compreensão dos mecanismos litogênicos.

Disúria como manifestação inicial de hipercalciúria idiopática: relato de caso / Dysuria as an initial manifestation of idiopathic hypercalciuria: case report

Objetivo: descrever um caso de hipercalciúria associada a hematúria microscópica que teve disúria como queixa inicial. Descrição: escolar de 5 anos procurou o serviço de emergência com queixa de disúria. Os exames laboratoriais iniciais revelaram a presença de hematúria microscópica persistente e, durante a investigação ambulatorial, confirmara-se os diagnósticos / Objective: to report a case of hypercalciuria associated to microscopic hematuria in which dysuria was the initial complaint. Description: a five-year-old child sought the pediatric emercy service with dysuria. Initial laboratory exams revealed microscopic hematuria and the child was referred to the outpatient clinic, where the diagnosis of idiopathic hypercalciuria associated to hyperuricosuria was confirmed..

Stones associated renal pelvic malignancies.

BACKGROUND: The clinico-pathological characteristics of renal pelvic malignancies associated with stones were retrospectively analyzed. AIMS: The main objective was to define the biological behavior and prognostic factors for these malignancies. SETTINGS & DESIGN: The tumors were classified according to the pathological types. The clinical data, imaging features and pathological features were analyzed with relation to prognosis. MATERIAL AND METHODS: Eighteen cases of malignancies associated with stone disease were retrospectively studied. The institute review board permitted the study. RESULTS: High incidence (15/18) of squamous cell carcinoma (SCC) was noted. The prognosis in this group of patients was uniformly poor. The median survival time was 3.6 months in the SCC group, 7.5 months in the Transitional Cell Carcinoma (TCC) group and 24 months in the Adenocarcinoma (AC) group. Infectious and systemic symptoms were noted in the majority of the patients. Preoperative Imaging techniques revealed tumor in only 2 cases. Both underwent radical extirpation and the median survival is 18 months till date. In the other 16 patients, where the initial diagnosis was made only on histological analysis of incomplete nephrectomy specimens, the survival was 3.56 months. All patients had prolonged history of staghorn stone disease with associated non-functioning kidney. We found that the main prognostic factor was the stage of the disease. CONCLUSIONS: Malignancies associated with stone disease have insidious onset of clinical symptoms and need a high degree of suspicion to identify them pre-operatively. The grave prognosis associated with incomplete excision makes it imperative to diagnose them earlier.

Avaliaçäo de pacientes com litíase renal em regiäo de clima quente / Assessment of kidney stone patients in hot regions

O objetivo deste estudo é desenvolver um serviço de litíase renal e detectar as alteraçöes metabólicas associadas a essa doença em pacientes da cidade de Catanduva, Säo Paulo. Foram estudados 65 pacientes (40 mulheres e 25 homens), entre 1996 e 1999, com idade variando entre 18 e 67 anos. O protocolo utilizado consistiu de avaliaçäo clínica e exames complementares (bioquímica de imagem e dos principais elementos litogênicos plasmáticos e urinários). Para a análise dos resultados, foi utilizado o teste "t" de Student para amostras independentes e consideradas insignificantes quando p é menor que 0,05. Pelo menos, uma alteraçäo metabólica foi encontrada em 98,5 porcento dos casos avaliados.A reduçäo do volume urinário (77 porcento) foi a alteraçäo metabólica mais frequente, seguida pela hipocitratúria (62 porcento), hiperexcreçäo de ácido úrico (32 porcento), hipercalciúria (27 porcento), outras alteraçöes (8 porcento),e sem alteraçäo detectada (1,5 porcento). A detecçäo de, pelo menos, uma alteraçäo metabólica encontrada na grande maioria dos pacientes avaliados comprova a eficácia do protocolo aplicado nesse trabalho. O estudo sugere que a elevada prevalência de alteraçöes metabólicas associadas à litíase renal justifica a investigaçäo sistemática dos pacientes litiásicos. O estabelecimento de centros regionais com serviço de litíase renal deverá näo só favorecer aos pacientes dessas regiöes, bem como contribuir, no sentido epidemiológico, para um maior conhecimento dessa doença no Brasil.(au)