ABSTRACT
PURPOSE: To evaluate the efficacy and safety of increasing the energy dose in treating urinary lithiasis with extracorporeal lithotripsy through an expanded number of Shock Waves Per Session (SWPS). MATERIALS AND METHODS: a randomized, prospective, and comparative study was performed with patients with renal or ureteral lithiasis from 2011 to 2014. Two groups were studied: Group A (n = 136), treated with 3500 SWPS, and Group B (n = 171), subjected to an expanded treatment with 7000 SWPS. Patients were considered stone free when there was no lithiasis or it were less or equal to 4 mm after treatment. Variables related to the patient, stones, treatment, and complications were collected. RESULTS: The global SFR was 75.0% and 87.7% in Groups A and B, respectively (p = 0.004). In renal location, the SFR was higher in Group B (74.1% vs 90.7%, p = 0.003) regardless of the size. In the ureteral location, there were differences in the pelvic only (73.7% vs 95.2%). There were no differences in either the complication rate (27.2% vs 25.7%, p = 0.77), or the severity between the two groups. The variable "number of SWPS" was seen to be an independent predictor of the resolution of lithiasis, having the probability of resolving lithiasis 2.62 (CI 95% = 1.40-4.89) times greater when applying 7000 SWPS. CONCLUSION: In our study, increasing the energy dose applied through an expanded number of SWPS has been shown to be more effective than standard regimens with a similar safety profile. However, more clinical studies on different types of lithotripters are required to confirm these results.
Subject(s)
Kidney Calculi/therapy , Lithotripsy/methods , Ureteral Calculi/therapy , Female , High-Energy Shock Waves , Humans , Male , Middle Aged , Patient Safety , Prospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: An update of the new treatment strategies in extracorporeal lithotripsy as a valid therapeutic alternative in the management of urinary calculi. METHODS: We performed a search and review of the most recent literature which responded to the terms "best practices", "update", "optimization", "practice pattern" in lithotripsy. Only articles written in English or Spanish were selected. RESULTS: The use of a stepwise voltage ramping during extracorporeal lithotripsy with or without pause before the first rise of energy, a decreased delivery rates and the use of a higher number of shock waves per session are shown as alternatives to improve the effectiveness with optimum safety profile. CONCLUSIONS: Extracorporeal lithotripsy is still an effective and minimally invasive treatment, and it has an important role in the treatment of urolithiasis. New treatment strategies are being developed to increase the effectiveness with a similar safety profile.
Subject(s)
Lithotripsy/methods , Urolithiasis/therapy , Clinical Protocols , Humans , Lithotripsy/standards , Physical Phenomena , Treatment OutcomeABSTRACT
OBJETIVO: Actualizar las nuevas estrategias de tratamiento con litotricia extracorpórea (LEOC) como una alternativa terapéutica vigente en el manejo de la litiasis urinaria.MÉTODOS: Se ha realizado una revisión de la literatura más reciente cuya búsqueda respondía a los términos 'mejores prácticas', 'update', 'optimization', 'practicepattern' en litotricia. Sólo fueron seleccionadas aquellas escritas en lengua inglesa o española. RESULTADOS: La disminución de la frecuencia de liberación de las ondas de choque, la aplicación de un escalonamiento progresivo en la dosis aplicada con o sin pausa previo al primer ascenso de la energía, y la utilización de un mayor número de ondas de choque por sesión se muestran como alternativas que mejoran la efectividad con un perfil de seguridad óptimo para el paciente. CONCLUSIONES: La LEOC es un tratamiento efectivo y mínimamente invasivo, que mediante la aplicación de una técnica adecuada todavía tiene un papel relevante en el tratamiento de la litiasis urinaria. Nuevas estrategias de tratamiento en LEOC están siendo desarrolladas para aumentar la efectividad, sin incrementar los riesgos para el paciente
OBJECTIVE: An update of the new treatment strategies in extracorporeal lithotripsy as a valid therapeutic alternative in the management of urinary calculi. METHODS: We performed a search and review of the most recent literature which responded to the terms 'best practices', 'update', 'optimization', 'practice pattern' in lithotripsy. Only articles written in English or Spanish were selected. RESULTS: The use of a stepwise voltage ramping during extracorporeal lithotripsy with or without pause before the first rise of energy, a decreased delivery rates and the use of a higher number of shock waves per session are shown as alternatives to improve the effectiveness with optimum safety profile. CONCLUSIONS: Extracorporeal lithotripsy is still an effective and minimally invasive treatment, and it has an important role in the treatment of urolithiasis. New treatment strategies are being developed to increase the effectiveness with a similar safety profile
Subject(s)
Humans , Lithotripsy/methods , Nephrolithiasis/therapy , Nephrostomy, Percutaneous , Process Optimization , Patient SafetyABSTRACT
La endometriosis ureteral es una infrecuente localización de endometriosis profunda, que puede condicionar una grave disminución de la función renal de forma silenciosa. Se presenta el caso de una paciente con fibrosis peritoneal secundaria a endometriosis profunda, cuya inespecífica sintomatologia conllevó un retraso diagnóstico, permitiendo el desarrollo de hidronefrosis. Es necesario descartar la presencia de endometriosis profunda en mujeres en edad fértil con hidronefrosis de etiología desconocida.
Deep endometriosis rarely entails ureteral involvement. It may be responsible of asymptomatic loss of renal function. A 35-year-old woman, gravida 1, para 1, was managed for peritoneal fibrosis due to deep infiltrating endometriosis. The nonspecific symptoms let a delayed diagnosis and a subsequent hydronephrosis. It must be excluded the existence of deep endometriosis in women of childbearing age with hydronephrosis of unknown etiology.
