Diagnóstico e tratamento de litíase ureteral / Diagnosis and treatment of ureteral calculi

Pacientes com cálculo ureteral tipicamente apresentam cólica renal consequente à obstrução do trato urinário. Uma vez controlada a crise dolorosa, um plano terapêutico deve ser estabelecido. A tomografia computadorizada (TC) helicoidal de abdômen e pelve sem contraste endovenoso é o exame de imagem de eleição. O tratamento da litíase ureteral pode ser conservador ou interventivo.Bloqueadores alfa-adrenérgicos são as drogas mais utilizadas para o tratamento clínico expulsivo. Para cálculos com pequena probabilidade de eliminação espontânea devido ao seu tamanho e/ou localização, indica-se tratamento interventivo, realizado através de litotripsia extracorpórea por ondas de choque, endourologia ou excepcionalmente através de cirurgia, aberta ou laparoscópica. A urgência da intervenção é maior em casos de obstrução e infecção do trato urinário superior, impondo deterioração da função renal, dor ou vômitos, anúria ou severo grau de obstrução em rim único ou transplantado. A melhor modalidade terapêutica a ser empregada deve ser individualizada.

Patients with ureteral calculi typically present renal colic due to urinary tract obstruction. Once the acute pain is controlled a therapeutic plan should be established. The unenhanced CT is the best diagnostic test. Ureteral calculi treatment can be either clinical or interventive. Alpha-adrenergic blockers are the most frequently prescribed drugs for the so-called medical expulsion therapy. Stones with a low probability of spontaneous passage (on the basis of their size and location) should be treated using such interventions as extracorporeal shock wave lithotripsy, ureteroscopy, or open surgery, in selected cases. Urgent intervention is indicated for a patient with an obstructed, infected upper urinary tract, impending renal deterioration, intractable pain or vomiting, anuria, or high-grade obstruction in a solitary or transplanted kidney. The best therapeutic approach should be selected on an individual basis.

Tamsulosin and spontaneous expulsion of ureteral stones

ureteral stones have a high rate of spontaneous expulsion, especially when they are smaller than 6 mm. some medications including corticosteroids, Ca channel blockers and alpha-blocker have been used by some to enhance spontaneous stone passage. In this paper we evaluate the effect of Tamsulosin in spontaneous stone passage in a clinical trial study. We performed clinical trial study of 100 renal colic patients with lower ureteral stones and stone size less than 7 mm determined by CT scan, KUB or ultrasonography of UVJ region who didn't have UTI, intractable pain or any indications of immediate intervention during January 2006 and April 2007.50 of the patients got only standard regime of analgesics and 50 of them got standard regime and Tamsulosin [0.4 mg/d]. The stone expulsion rate was 60% [30/50 patients] for group A and 86% [43/50] for group B [P=0.01] with a mean expulsion time of 8.1 +/- 2.2 [range 3.5-12] and 5.1 +/- 2.7 days [range 1.8-10.5] [P=0.005]. Tamsulosin increase spontaneous stone passage and decrease expulsion time and analgesic use significantly

Litiasis ureteral en ectopia renal cruzada con fusión / Ureteral lithisasis in crossed renal ectopy with fusion

La ectopia renal cruzada es una anomalía renal congénita poco frecuente y en la mayoría de los casos se presenta con fusión de ambos riñones. Estos pacientes suelen permanecer asintomático hasta la 4ta. y 5ta. décadas y desarrollar entonces problemas de infecciones urinarias, litiasis, masa abdominal o dolor que simula un problema gastrointestinal. Presentamos el caso de litiasis ureteral aparecido en un paciente con ectopia renal con fusión descubierta en una ecografía por presentar episodios de hematuria microscópica.

Crossed Renal Ectopy is a little frequent congenital renal anomaly and, in most of the cases it presents fusion in both kidneys. These patients are almost always asymptomatic until the 4 th -5 th decade of their lives, and then develop urinary infections, litiasis, abdominal mass or pain seeming gastrointestinal problems. We present a case of ureteral lithiasis in a patient with renal ectopy with fusion, discovered by echography made for presenting episodes of microscopic hematury.