Identificación endoscópica de la composición de los cálculos urinarios: un estudio del Southeastern Group for Lithiasis Research (SEGUR 2) / Endoscopic identification of urinary stone composition: A study of South Eastern Group for Urolithiasis Research (SEGUR 2)

INTRODUCCIÓN Y OBJETIVOS: Evaluar la capacidad del endourólogo para evaluar la composición del cálculo mediante la observación de imágenes endoscópicas. MATERIALES Y MÉTODOS: Una serie de 20 videoclips de tratamientos endoscópicos de cálculos urinarios que también estaba disponible el resultado de la espectroscopia infrarroja se cargó en un sitio de YouTube accesible solo a miembros del South Eastern Group for Urolithiasis Research (SEGUR), a quienes se les preguntó para identificar la composición de los cálculos. RESULTADOS: Un total de 32 endourólogos de 9 países diferentes participaron en el estudio. El número promedio de detecciones correctas de participantes fue de 7,81 ± 2,68 (1-12). La precisión general fue del 39% (250 de 640 predicciones). Cálculos de dihidrato de oxalato de calcio se han detectado correctamente en el 69,8%, monohidrato de oxalato de calcio en el 41,8%, ácido úrico en el 33,3%, oxalato de calcio/ácido úrico en el 34,3% y cistina en el 78,1%. Las tasas de precisión para estruvita (15,6%), fosfato de calcio (0%) y oxalato de calcio/fosfato de calcio (9,3%) fueron bastante bajas. CONCLUSIONES: La observación del cálculo durante el procedimiento endoscópico no fue confiable para identificar la composición de la mayoría de los cálculos, aunque los cálculos de oxalato de calcio dihidrato y cistina pueden identificarse con buena precisión. Sin embargo, se debe alentar la presentación de fotos o videos de cálculo intacto y su estructura interna para implementar los resultados del análisis de cálculo después de la cirugía. Los endourólogos deben mejorar su capacidad de identificación visual de los diferentes tipos de cálculos

INTRODUCTION AND OBJECTIVES: To assess the surgeon's ability to evaluate the composition of the stone by observation of endoscopic images. MATERIALS AND METHODS: A series of 20 video clips of endoscopic treatments of urinary stones of which was also available the result of infrared spectroscopy was uploaded to a YouTube site accessible only to members of the South Eastern Group for Urolithiasis Research (SEGUR) who were asked to identify the composition of the stones. RESULTS: A total of 32 clinicians from 9 different countries participated in the study. The average number of correct detections of participants was 7.81 ± 2.68 (range 1-12). Overall accuracy was 39% (250 out of 640 predictions). Calcium oxalate dihydrate stones have been correctly detected in 69.8%, calcium oxalate monohydrate in 41.8%, uric acid in 33.3%, calcium oxalate/uric acid in 34.3% and cystine in 78.1%. Precision rates for struvite (15.6%), calcium phosphate (0%) and mixed calcium oxalate/calcium phosphate (9.3%) were quite low. CONCLUSIONS: Observation of the stone during the endoscopic procedure was not reliable to identify the composition of most stones although it gave some information allowing to identify with a good sensitivity calcium oxalate dihydrate and cystine stones. Nevertheless, photo or video reporting of the intact stone and its internal structure could should be encouraged to implement results of still mandatory post-operative stone analysis. Endourologists should improve their ability of visual identification of the different types of stones

Endoscopic identification of urinary stone composition: A study of South Eastern Group for Urolithiasis Research (SEGUR 2). / Identificación endoscópica de la composición de los cálculos urinarios: un estudio del Southeastern Group for Lithiasis Research (SEGUR 2).

INTRODUCTION AND OBJECTIVES: To assess the surgeon's ability to evaluate the composition of the stone by observation of endoscopic images. MATERIALS AND METHODS: A series of 20 video clips of endoscopic treatments of urinary stones of which was also available the result of infrared spectroscopy was uploaded to a YouTube site accessible only to members of the South Eastern Group for Urolithiasis Research (SEGUR) who were asked to identify the composition of the stones. RESULTS: A total of 32 clinicians from 9 different countries participated in the study. The average number of correct detections of participants was 7.81 ± 2.68 (range 1-12). Overall accuracy was 39% (250 out of 640 predictions). Calcium oxalate dihydrate stones have been correctly detected in 69.8%, calcium oxalate monohydrate in 41.8%, uric acid in 33.3%, calcium oxalate/uric acid in 34.3% and cystine in 78.1%. Precision rates for struvite (15.6%), calcium phosphate (0%) and mixed calcium oxalate/calcium phosphate (9.3%) were quite low. CONCLUSIONS: Observation of the stone during the endoscopic procedure was not reliable to identify the composition of most stones although it gave some information allowing to identify with a good sensitivity calcium oxalate dihydrate and cystine stones. Nevertheless, photo or video reporting of the intact stone and its internal structure could should be encouraged to implement results of still mandatory post-operative stone analysis. Endourologists should improve their ability of visual identification of the different types of stones.

Risk of radiation exposure to medical staff involved in interventional endourology.

The aim is to estimate the possibility the new annual dose limit for eye lens to be exceeded and to study the impact of protective shield. Radiation exposure to medical personnel was evaluated with EDD-30 dosemeter in positions of operating surgeon, assisting doctor and nurse. At the operator's typical position for diagnosis and treatment of the urinary tract, the lens dose rates were 0.9 mSv h(-1) and 0.06 mSv h(-1) without and with lead shield. At the operator's position typical for percutaneous intervention dose rates were 1.9 and 0.02 mSv h(-1), respectively. At typical workload, the annual eye lens dose to the main operator without protective screen was estimated to be 29 mSv. With lead screen, operator lens dose can be reduced by a factor of 15-95 according to the procedure. Installation and use of lead screen and use of lead glasses were recommended to the endourology medical team.

[A multicenter comparative observation on the effectiveness and the rapidness of the effect of Cystostop Rapid versus antibiotic therapy in patients with uncomplicated cystitis].

UNLABELLED: The currently available treatment for uncomplicated urinary tract infections includes only antibiotics and chemotherapeutic agents. Experience in the management of acute uncomplicated infections using non-antibiotic products is very limited. The aim of this observation was to study to what extent the response to Cystostop Rapid would be more rapid and more effective compared to antibiotic therapy in patients with acute uncomplicated urinary bladder infections. The secondary objective was to determine the time to improvement of cystitis symptoms following the start of treatment, as well as the duration of patients' disablement. A total of 158 female subjects were included, assessed microbiologically, and evaluated for incidence and severity of symptoms, before the start of treatment and after completion of treatment. A visual analogue scale was used for patient self-assessment of the severity of symptoms, the improvement of symptoms, as well as the time to improvement of symptoms. RESULTS: 158 females, eligible according to the inclusion criteria of the study, were allocated to one of the two groups according to time of enrollment: Group A included 86 subjects: assigned to Cystostop Rapid for 3 days and administered according to the manufacturer's recommended regimen; and Group B included 72 women: assigned to ciprofloxacin 500 mg twice daily for 3 days according to the Product Registration File with the BDA. The clinical and microbiological effectiveness of Cystostop Rapid was comparable to that of ciprofloxacin, providing a two-fold more rapid improvement of cystitis symptoms, at a mean time to improvement of 24 hours (p < 0.02) versus 46 hours for ciprofloxacin. Clinical improvement within 48 hours of Cystostop Rapid regimen occurred in 97% (p < 0.02) of patients, vs. 65.3% of patients on ciprofloxacin. Improvement of symptoms within 12 hours was reported in 36% of patients on Cystostop Rapid vs. 5.5% of patients in the ciprofloxacin group (p < 0.02). No adverse events or intolerability to the therapy were reported throughout the course of the study.

Exposure to patient during interventional endourological procedures.

The purpose of this work is to study doses to patients undergoing interventional endourological procedures. The study was performed in a modern Clinic of Endourology and Shockwave Lithotripsy, equipped with two dedicated X-ray systems. The following information was recorded for each patient: type of the procedure, patient age, fluoroscopy time, number of images acquired and patient dose in air kerma-area product, P(KA), measured with KAP-meters integrated in the X-ray units. Eleven types of procedures were included. From the collected sample of 429 patients for all procedures, the mean fluoroscopy time varied between 0.2 and 4 min. The highest values of mean P(KA) 457 and 590 cGy cm(2) were found for percutaneous nephrolithotripsy and ureteroscopy, respectively. The mean values of P(KA) for rest of the procedures investigated were between 58 and 398 cGy cm(2). Individual patient doses varied between 2 and 2440 cGy cm(2) and fluoroscopy time--between 0.1 and 13.7 min. The first study in interventional endourology in Bulgaria demonstrated big variations in patient doses depending on the type and the complexity of procedure, operator's experience and exposure modes.

[Padua ileal bladder--surgical technique for bladder replacement with continent ileal reservoir]. / Padua Ileal Blader--khirurgichna tekhnika za zamestvane na pikochniia mekhur s kontinenten rezervoar ot ileum.

A new technique for detubularized and originally reshaped ileal total bladder replacement following radical cystectomy for bladder cancer is described. The operative method is named "Padua ileal bladder". For first time it is described by Prof. Pagano et al., from the Institute of Urology, Padua University, Italy. The operative method was performed on a patient with invasive bladder carcinoma. The result was evaluated clinically, radiologically and urodinamically with follow-up from 6 months. The patient had perfect daytime and nighttime continence. The reservoir features were: high capacity of 550 ml, low pressure of 17 cm H2O and 30-50 cm H2O at the micturation. There was no ureteral reflux and we achieved complete emptying of the bladder using abdominal straining and perineal relaxation.

[The current diagnosis of tumors of the upper urinary tract]. / Suvremenna diagnoza na tumorite na gorniia urinaren trakt.

The treatment results and survivorship of patients with upper urinary tract tumors (UUTT) are largely dependent on the early diagnosis of the lesions. Twenty-eight patients presenting UUTT are studied and treated in the Clinic of Urology over the period 1987 through 1995. The diagnostic protocol includes both standard radiographic and cytological techniques, and endoscopic methods allowing for visualization and histopathological characterization of the neoplasm. The diagnostic relevance of the various methods and their efficacy are assayed, with emphasis on the necessity of their use in the differential diagnosis. The diagnostic approach described contributes to mace precise early diagnosis with preoperative determination of the degree of tumor differentiation which has an essential practical bearing on the choice of operative procedure and prognosis of the disease.

[Transrenal endopyelotomy is an alternative to surgical pyeloplasty]. / Transrenalnata endopielotomiia e alternativa na khirurgichnata pieloplastika.

Over the period 1990-1992, a total of 372 patients with hydronephrosis undergo treatment in the Clinical Center of Urology at the Faculty Alexander Hospital--Sofia Twelve of them are treated after the method of Davis, and 12 patients treated by endopyelotomy are subjected to follow-up study in collaboration with the Department of Urology and Nephrology-Higher Medical Institute, Sofia. As the result of 24 operative interventions the underlying cause of the condition is eliminated, and urinary drainage successfully restored. According to literature data the contraindications for operation include: very broad kidney pelvis and long strictures of the pyeloureteral segment; in the authors' opinion the presence of aberrant blood vessels should be also considered as a contraindication because in such cases the underlying cause cannot be removed. As shown by comparative assessment of the two methods, endopyelotomy has superiorities over surgical pyeloplasty owing to the fact that it is atraumatic, readily tolerated by patients and economically beneficial in the treatment of hydronephrosis, contributing to avoid the complications of surgical pyeloplasty; the complications of endopyelotomy are uncommon and lend themselves readily to conservative management with a positive outcome.

[The clinical and microbiological study of the preparation perfloxacin in treating urologic infections]. / Klinichno i mikrobiologichno prouchvane na preparata pefloksatsin pri lechenie na uroinfektsiite.

Experience with Pefloxacin treatment of thirty-nine patients presenting urinary tract infection, over the period 1992-1993, is shared. The drug is administered per os at dosage--800 mg, divided in two doses given at 12-hour intervals. As shown by the results of assaying the clinical symptoms, laboratory indicators and microbiological findings in the urine, the therapeutic effect is very good. A clinical cure is recorded in 76 cases (92 per cent), and healing of the bacteriological agent--in 92.31 per cent. Side effects are rarely observed and mildly manifested. The results of Pefloxacin treatment warrant the assumption that the drug synthesized is encouraging, suitable for both out- and inpatient treatment of urinary tract infections, and therefore it should be introduced in the daily routine practice.

[The treatment of coralliform kidney calculosis with extracorporeal lithotripsy, percutaneous lithotripsy and ureteroscopy]. / Lechenie na koraliformenata bubrechna kalkuloza s ekstrakorporalna litotripsiia, perkutanna litotripsiia i ureteroskopiia.

Experience is recorded with the combined treatment of 53 patients with coralliform renal calculosis. Combined application of bypass lithotripsy (BLT), percutaneous lithotripsy (PLT) and ureterorenoscopy (URS) is an alternative to open surgical intervention. Depending on the size, form and position of the calculus, the degree of destruction of the residual concrements, combined therapy was applied, as follows: 17 patients--PLT and BLT, 7 patients--PLT, BLT and URS, 7 patients--URS and BLT, 13 patients--BLT and URS, 8 patients--BLT and URS. Very good results were obtained--complete cure in 51 patients (96.2 per cent), which encourage the authors to recommend the three methods for routine application in the treatment of coralliform renal calculosis.

[Treatment of ureteral stricture using balloon dilatation]. / Lechenie na strikturite na uretera chrez balonna dilatatsiia.

Balloon dilatation is a new method in endourological treatment of diseases of the urogenital system. Personal experience is recorded with the treatment of ureter strictures by balloon dilatation. Thirteen patients were treated. In 10 the strictures were congenital and in 3 acquired. Fifteen dilatations on the pyeloureteral segment and the distal portion of the ureter were performed. The method is practicable, low traumatic and is well tolerated by the patients. The limited experience does not allow general inferences to be made for the early and late results of application of balloon dilatation. Its advantages however allow to recommend its wide acceptance for treatment of strictures of the ureter in all of its segments.