Value of Music and Nitrous Oxide for Pain Control during Extracorporeal Shock Wave Lithotripsy (ESWL).

OBJECTIVES: To compare the efficacy of 4 different analgesic regimens that include music and nitrous oxide during the treatment of renal lithiasis with ambulatory extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: A single-centre, longitudinal, prospective, randomized, open and parallel group study was conducted. Patients with renal lithiasis were included and were randomized to Group A (basal analgesia: midazolam (1 mg), fentanyl (0.05 mg) and dexketoprofen (50 mg)), Group B (basal analgesia and nitrous oxide), Group C (basal analgesia and music) and Group D (basal analgesia, nitrous oxide and music). For the measurement of pain, a visual analogue scale ranging from 0 (no pain) to 100 (maximum pain imaginable) was used. Patient satisfaction was assessed using a Likert questionnaire. The epidemiological data of the patients in terms of lithiasis, previous clinical and ESWL sessions, and pain measured with the VAS before, during (maximum) at the end of the session and at discharge were recorded. Data on complications were also collected, as was the patients' subjective evaluation of the treatment and their satisfaction. The ESWL procedure was performed with a Storz Modulith SLX-F2® lithotripter. A maximum of 4000 waves were applied at a frequency of 1.5 Hz. RESULTS: Eighty patients were included (20 per group). None of the analgesia guidelines proved to be superior to the others for pain control during the ESWL session. Patients younger than 50 years had significantly higher values for the maximum VAS. Only 13.75% of patients required rescue analgesia. A total of 77.5% described their experience as good, very good or excellent, regardless of the assigned group. CONCLUSIONS: The addition of nitrous oxide and/or music did not result in a statistically significant improvement over the basal analgesia regimen of midazolam, fentanyl and dexketoprofen; however, the degree of patient satisfaction was very high.

Value of Music and Nitrous Oxide for Pain Control during Extracorporeal Shock Wave Lithotripsy (ESWL)

Objectives: To compare the efficacy of 4 different analgesic regimens that include music and nitrous oxide during the treatment of renal lithiasis with ambulatory extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: A single-centre, longitudinal, prospective, randomized, open and parallel group study was conducted. Patients with renal lithiasis were included and were randomized to Group A (basal analgesia: midazolam (1 mg), fentanyl (0.05 mg) and dexketoprofen (50 mg)), Group B (basal analgesia and nitrous oxide), Group C (basal analgesia and music) and Group D (basal analgesia, nitrous oxide and music). For the measurement of pain, a visual analogue scale ranging from 0 (no pain) to 100 (maximum pain imaginable) was used. Patient satisfaction was assessed using a Likert questionnaire. The epidemiological data of the patients in terms of lithiasis, previous clinical and ESWL sessions, and pain measured with the VAS before, during (maximum) at the end of the session and at discharge were recorded. Data on complications were also collected, as was the patients’ subjective evaluation of the treatment and their satisfaction. The ESWL procedure was performed with a Storz Modulith SLX-F2® lithotripter. A maximum of 4000 waves were applied at a frequency of 1.5 Hz. Results: Eighty patients were included (20 per group). None of the analgesia guidelines proved to be superior to the others for pain control during the ESWL session. Patients younger than 50 years had significantly higher values for the maximum VAS. Only 13.75% of patients required rescue analgesia. A total of 77.5% described their experience as good, very good or excellent, regardless of the assigned group. Conclusions: The addition of nitrous oxide and/or music did not result in a statistically significant improvement over the basal analgesia regimen of midazolam, fentanyl and dexketoprofen; however, the degree of patient satisfaction was very high (AU)

Recidivant infective lithiasis: Is it possible to defeat them? / Litiasis infectivas recidivantes. ¿Es posible vencerlas?

Acidifying treatment and control of urinary pH may be an effective strategy to address recurrent lithiasic disease secondary to infective calculi. We present the case of a 39-year-old man with bilateral urolithiasis that led to episodes of complicated Reno ureteral colic.After undergoing multiple treatments by retrograde endourological surgery, he presented recurrence and progression of lithiasis disease, finally requiring percutaneous approach for treatment of a coralliform stone, after which he was free of lithiasis. It was then decided to start treatment with an acidifying oral supplement and home pH control by means of an electronic medical device as a complement to the surgeries he underwent, thus achieving stability of the disease, with absence of urinary tract infection or lithiasis recurrence.The patient, with poor adherence to previous treatments, presented in this case a correct follow-up of the treatment, as well as a high level of satisfaction with it.

El tratamiento acidificante y el control del pH urinario pueden constituir una estrategia eficaz para abordar la enfermedad litiásica recurrente secundaria a cálculos infectivos. Presentamos el caso de un varón de 39 años con urolitiasis bilaterales que le condicionaron episodios de cólicos renoureterales complicados.Tras ser sometido a múltiples tratamientos mediante cirugía endourológica retrógrada, presentó recidiva y progresión de enfermedad litiásica, precisando finalmente abordaje percutáneo para tratamiento de un cálculo coraliforme, tras lo cual queda libre de litiasis. Se decide entonces iniciar tratamiento con suplemento oral acidificante y control domiciliario de pH mediante dispositivo médico electrónico como complemento a las cirugías a las que fue sometido, logrando así estabilidad de enfermedad, con ausencia de cuadros de infección urinaria ni recidiva litiásica.El paciente, con mala adherencia a tratamientos previos, presentó en este caso un correcto seguimiento del tratamiento, así como elevado nivel de satisfacción con el mismo.

Litiasis infectivas recidivantes. ¿es posible vencerlas? / Recurrent infectious lithiasis. is it possible to beat them?

El tratamiento acidificante y el control del pHurinario pueden constituir una estrategia eficaz para abor-dar la enfermedad litiásica recurrente secundaria a cálcu-los infectivos. Presentamos el caso de un varón de 39 añoscon urolitiasis bilaterales que le condicionaron episodiosde cólicos renoureterales complicados. Tras ser sometidoa múltiples tratamientos mediante cirugía endourológicaretrógrada, presentó recidiva y progresión de enfermedadlitiásica, precisando finalmente abordaje percutáneo paratratamiento de un cálculo coraliforme, tras lo cual quedalibre de litiasis. Se decide entonces iniciar tratamiento consuplemento oral acidificante y control domiciliario de pHmediante dispositivo médico electrónico como comple-mento a las cirugías a las que fue sometido, logrando asíestabilidad de enfermedad, con ausencia de cuadros deinfección urinaria ni recidiva litiásica. El paciente, con mala adherencia a tratamientos previos,presentó en este caso un correcto seguimiento del tratamien-to, así como elevado nivel de satisfacción con el mismo.(AU)

Acidifying treatment and control of urinarypH may be an effective strategy to address recurrent lithia-sic disease secondary to infective calculi. We present thecase of a 39-year-old man with bilateral urolithiasis thatled to episodes of complicated Reno ureteral colic. Afterundergoing multiple treatments by retrograde endourolog-ical surgery, he presented recurrence and progression oflithiasis disease, finally requiring percutaneous approachfor treatment of a coralliform stone, after which he wasfree of lithiasis. It was then decided to start treatment withan acidifying oral supplement and home pH control bymeans of an electronic medical device as a complement tothe surgeries he underwent, thus achieving stability of thedisease, with absence of urinary tract infection or lithiasisrecurrence.The patient, with poor adherence to previous treatments,presented in this case a correct follow-up of the treatment,as well as a high level of satisfaction with it.(AU)