Valoración del impacto de la tasa libre de litiasis en los resultados de la evaluación metabólica / Is stone free status really necessary for metabolic evaluation following stone removal procedures?

Objetivo Evaluar si la tasa libre de litiasis afecta a los resultados del estudio metabólico en pacientes con alto riesgo de litiasis recidivante tras tratamiento completo mediante ureteroscopia. Pacientes y métodos Un total de 78 pacientes sometidos a cirugía retrógrada intrarrenal (CRIR) para el tratamiento de litiasis fueron incluidos en este estudio. Cuatro semanas después del tratamiento, los casos se dividieron en dos grupos en base a los resultados de la tomografía computarizada sin contraste (TCSC). Los casos del grupo 1 (n=54) presentaban una tasa libre de litiasis del 100% y los del grupo 2 (n=24) presentaban litiasis residuales en el riñón. Cuatro semanas después de la ureteroscopia flexible (URF) se realizó un análisis completo de orina de 24h a todos los pacientes de ambos grupos, para detectar los factores de riesgo implicados en la litogénesis. Los resultados del estudio metabólico (orina de 24h y suero) se compararon entre los dos grupos. Resultados La evaluación preoperatoria en orina y suero de los factores de riesgo asociados a la formación de cálculos no reveló diferencias estadísticas entre los dos grupos. El análisis comparativo de los factores de riesgo implicados en la formación de la litiasis mediante pruebas de orina de 24h tampoco reveló diferencias estadísticamente significativas entre los resultados preoperatorios y postoperatorios en los casos del grupo 2 con cálculos residuales. Tampoco se observaron diferencias significativas entre las medias de las variables séricas preoperatorias y postoperatorias de ambos grupos. Conclusiones Según nuestros resultados, y dada la similitud de los hallazgos obtenidos en los estudios metabólicos de los casos con y sin litiasis residual, la tasa libre de litiasis puede no constituir un factor imprescindible para la realización del estudio metabólico detallado (suero y orina de 24h) tras las intervenciones endourológicas para la extracción de los cálculos renales. (AU)

Objective To evaluate the impact of stone free status on the outcomes of metabolic evaluation in recurrent stone formers after ureteroscopic stone removal. Patients and methods A total of 78 patients undergoing retrograde intrarenal surgery (RIRS) for renal stones were included and cases were divided into two groups after 4 weeks based on the NCCT findings. While cases in the Group 1 (n=54) was completely stone free, cases in Group 2 (n=24) had residual fragments in the kidney. A full 24-hour urine analysis for relevant stone forming risk factors has been performed after 4 weeks following the fURS procedures in all patients of both groups. Outcomes of metabolic evaluation (24-hour urine and serum) have been comparatively evaluated in both groups. Results Evaluation of the preoperative serum and urine stone forming risk factors revelaed no statistical difference in both groups. Comparative evaluation of the 24-hour urinary stone forming risk factors also revealed no statistically significant difference between preoperative and postoperative findings in cases of Group 2 with residual stones. Last but not least, no significant difference was observed between the mean preoperative and postoperative serum variables between two groups. Conclusions Our results show that in the light of the similar metabolic evaluation outcomes obtained in cases with and without residual fragments, ‘stone free status’ may not be an essential factor to perform a detailed metabolic evaluation (24-hour urine analysis and serum parameters) after endourological stone removal procedures. (AU)

Is stone free status really necessary for metabolic evaluation following stone removal procedures?

OBJECTIVE: To evaluate the impact of stone free status on the outcomes of metabolic evaluation in recurrent stone formers after ureteroscopic stone removal. PATIENTS AND METHODS: A total of 78 patients undergoing retrograde intrarenal surgery (RIRS) for renal stones were included and cases were divided into two groups after 4 weeks based on the NCCT findings. While cases in the Group 1 (n = 54) was completely stone free, cases in Group 2 (n = 24) had residual fragments in the kidney. A full 24-h urine analysis for relevant stone forming risk factors has been performed after 4 weeks following the fURS procedures in all patients of both groups. Outcomes of metabolic evaluation (24-h urine and serum) have been comparatively evaluated in both groups. RESULTS: Evaluation of the preoperative serum and urine stone forming risk factors revelaed no statistical difference in both groups. Comparative evaluation of the 24-h urinary stone forming risk factors also revealed no statistically significant difference between preoperative and postoperative findings in cases of Group 2 with residual stones. Last but not least, no significant difference was observed between the mean preoperative and postoperative serum variables between two groups. CONCLUSIONS: Our results show that in the light of the similar metabolic evaluation outcomes obtained in cases with and without residual fragments, 'stone free status' may not be an essential factor to perform a detailed metabolic evaluation (24-h urine analysis and serum parameters) after endourological stone removal procedures.

¿Cómo afecta la técnica de punción al riesgo de sangrado intraoperatorio durante la nefrolitotomía percutánea? Ensayo aleatorizado prospectivo / How does puncture modality affect the risk of intraoperative bleeding during percutaneous nephrolithotomy? A prospective randomized trial

Introducción y objetivos: Evaluar los posibles efectos de dos técnicas diferentes de punción renal (guiada por ecografía [GE] o guiada por fluoroscopia [GF]) sobre el riesgo de hemorragia intraoperatoria durante la nefrolitotomía percutánea (NLPC).Material y métodosUn total de 130 pacientes con puntuaciones de la escala de Guy de 1-2 fueron asignados prospectivamente a los grupos de punción GE y punción GF mediante aleatorización simple. Se excluyeron del estudio los pacientes que sufrieron rotura pielocalicial durante la cirugía y los que necesitaron múltiples accesos. Aparte de los pasos relacionados con la punción, todos los demás pasos del procedimiento de NLPC fueron realizados con técnicas similares por un único cirujano. Se compararon las características de los pacientes, los datos quirúrgicos y los resultados postoperatorios.ResultadosUn total de 10 pacientes fueron excluidos del estudio debido a una complicación intraoperatoria tras la punción. Los datos demográficos de los pacientes y las características de los cálculos fueron similares entre los dos grupos (p>0,05). La media del descenso de hemoglobina fue significativamente mayor en el grupo GF (1,7g/dl) en comparación con el grupo GE (1,3g/dl) (p<0,01). La duración media de la exposición a la radiación fue significativamente mayor en el grupo GF (p<0,001). El tiempo quirúrgico total, el número de intentos para una punción exitosa, la duración de la estancia hospitalaria y la tasa libre de cálculos fueron similares entre los grupos (p>0,05). Asimismo, las demás complicaciones clasificadas según la escala modificada de Clavien-Dindo fueron similares entre los grupos (p>0,05).ConclusiónLa punción guiada por ecografía (GE) proporciona niveles significativamente menores de descenso de hemoglobina y tiempo de exposición a la radiación en comparación con el procedimiento guiado por fluoroscopia (GF). (AU)

Introduction and objectives: To evaluate the possible effects of two different renal puncture techniques (ultrasound-assisted [US-assisted], fluoroscopic-guided [FG]) on the intraoperative hemorrhage risk during percutaneous nephrolithotomy (PCNL).Material and methodsA total of 130 patients with Guy stone scores of 1-2 were prospectively allocated to US-assisted and FG puncture groups by simple randomization. Patients with intraoperative pelvicalyceal rupture and the ones requiring multiple accesses were excluded from the study. Apart from the puncture steps, all other steps of the PCNL procedure were performed with similar techniques by a single surgeon. Patient characteristics, operative data, and postoperative outcomes were compared.ResultsA total of 10 patients were excluded from the study due to intraoperative complications after puncture. Patient demographics and stone characteristics were similar between the two groups (P>.05). Mean hemoglobin drop was meaningfully greater in the FG group (1.7g/dL) when compared with US-assisted group (1.3g/dL) (P<.01). The mean duration of radiation exposure was significantly higher for the FG (P<.001). Total operative time, number of attempts for a successful puncture, length of hospital stay, and stone free rates were similar between the groups (P>.05). In addition, the remaining complications classified according to the modified Clavien-Dindo grading system were similar between groups (P>.05).ConclusionUS-assisted puncture provides significantly decreased level of hemoglobin drop and radiation exposure time when compared with FG. (AU)

How does puncture modality affect the risk of intraoperative bleeding during percutaneous nephrolithotomy? A prospective randomized trial.

INTRODUCTION AND OBJECTIVES: To evaluate the possible effects of two different renal puncture techniques (ultrasound-assisted [US-assisted], fluoroscopic-guided [FG]) on the intraoperative hemorrhage risk during percutaneous nephrolithotomy (PCNL). MATERIAL AND METHODS: A total of 130 patients with Guy stone scores of 1-2 were prospectively allocated to US-assisted and FG puncture groups by simple randomization. Patients with intraoperative pelvicalyceal rupture and the ones requiring multiple accesses were excluded from the study. Apart from the puncture steps, all other steps of the PCNL procedure were performed with similar techniques by a single surgeon. Patient characteristics, operative data, and postoperative outcomes were compared. RESULTS: A total of 10 patients were excluded from the study due to intraoperative complications after puncture. Patient demographics and stone characteristics were similar between the two groups (p > 0.05). Mean hemoglobin drop was meaningfully greater in the FG group (1.7 g/dL) when compared with US-assisted group (1.3 g/dL) (p < 0.01). The mean duration of radiation exposure was significantly higher for the FG (p < 0.001). Total operative time, number of attempts for a successful puncture, length of hospital stay, and stone free rates were similar between the groups (p > 0.05). In addition, the remaining complications classified according to the modified Clavien-Dindo grading system were similar between groups (p > 0.05). CONCLUSION: US-assisted puncture provides significantly decreased level of hemoglobin drop and radiation exposure time when compared with FG.

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.

Role of Complementary Medicine (Music, Acupuncture, Acupressure, TENS and Audio-Visual Distraction) in Shockwave Lithotripsy (SWL): A Systematic Review From EAU Sections of Urolithiasis (EULIS) and Uro-Technology (ESUT).

We performed a systematic review to look at the role of alternative or complementary medicine such as music, acupressure, acupuncture, transcutaneous electrical nerve stimulation (TENS) and audiovisual distractions to decrease analgesia requirement and alleviate anxiety during SWL. Twenty-three papers(2439 participants) were included: Music (n = 1056.6%), Acupuncture (n = 517.7%), Acupressure (n = 13.8%), TENS (n = 617.2%), and audiovisual distraction (n = 14.6%). Most of the studies showed that complementary therapy, lowered pain, and anxiety with higher patient satisfaction and willingness to undergo the procedure. With its feasibility and convenience, urological guidelines need to endorse it, and more should be done to promote its use in outpatient urological procedures.

¿Podría el espesor de la pared ureteral afectar a los parámetros intra y postoperatorios de la ureteroscopia para el tratamiento de piedras ureterales proximales? / Could ureteral wall thickness have an impact on the operative and post-operative parameters in ureteroscopic management of proximal ureteral stones?

Objetivo: Evaluar la relación del espesor de la pared ureteral (EPU) con el éxito y los parámetros relacionados con la ureteroscopia para el tratamiento de cálculos ureterales proximales. Pacientes y métodos: Se incluyó a 82 pacientes con cálculos ureterales proximales y se dividieron en 2 subgrupos de acuerdo con el grosor de la pared ureteral: un grupo con 38 pacientes, EPU > 5 mm, y el segundo con 44, EPU < 5mm. Se evaluaron los siguientes parámetros: tamaño de la piedra, grado de hidronefrosis, diámetro de la luz ureteral proximal, el EPU y los datos demográficos de los pacientes. Se realizó ureteroscopia semirrígida con láser Ho-YAG y se evaluó el posible impacto del EPU sobre las tasas de éxito y los parámetros relacionados con el procedimiento. Resultados: La media de edad de los pacientes y el tamaño de los cálculos fueron 47,55 ± 1,78 años y 8,17 ± 0,29 mm, respectivamente. Con respecto al impacto del valor del EPU sobre los parámetros mencionados anteriormente, la tasa libre de cálculos una semana después del procedimiento fue mayor en el grupo 2 y la tasa de fragmentos residuales, así como la necesidad de colocación de catéter doble J, fueron más altas en el grupo 1. Adicionalmente, la duración media del procedimiento fue significativamente más larga en el grupo 1 y se observaron alteraciones patológicas en la pared ureteral significativamente mayores en estos casos (p = 0,0243). Conclusiones: El EPU es un factor útil al predecir el éxito del tratamiento ureteroscópico y otros parámetros relacionados con el procedimiento para los cálculos ureterales proximales. Con este enfoque, se podría realizar un plan operativo más adecuado, con mayores tasas de éxito, menos complicaciones y procedimientos adicionales

Aim: To evaluate the possible impact of stone impaction in terms of ureteral wall thickness (UWT) on the success and procedure related parameters of ureteroscopic management in proximal ureteral calculi. Patients and methods: 82 patients with proximal ureteric stones were included and were divided into 2 subgroups where UWT was > 5 mm in 38 cases; and < 5 mm in 44 cases. Stone size, degree of hydronehrosis, diameter of proximal ureteral luz, UWT and patient's demographics were evaluated. Semi-rigid ureteroscopy with Ho-YAG laser was performed and the possible impact of UWT as an objective parameter for stone impaction on the success rates and procedure related parameters was evaluated. Results: Mean patient age and stone size values were 47.55 ± 1.78 years and 8.17 ± 0.29 mm respectively. Regarding the impact of UWT value at the stone site for the parameters mentioned above stone free rates particularly at 1-week after the procedure was higher in group 2 and the rate of residual fragments as well as the need for double J stent placement was higher in group 1. Additionally, mean duration of the procedures was significantly longer in Group 1 during which pathologic alterations were significantly higher in ureteral wall at stone site were observed in these cases (P = .0243). Conclusions: UWT may be used to predict the success of ureteroscopic management and other procedure related parameters for proximal ureteral stones in an effective manner. With this approach a more rational operative plan with higher success rates, limited complications and auxiliary procedures could be made

Resultados de LEOCH con o sin catéter para el tratamiento de cálculos en la pelvis renal: un estudio aleatorizado / Effect of JJ stent on outcomes of extracorporeal shock wave lithotripsy treatment of moderate sized renal pelvic stones: A randomized prospective study

Objetivo: Evaluar el efecto de la colocación del catéter doble J en el tratamiento con LEOCH de los cálculos en la pelvis renal de tamaño moderado (15-25 mm). Materiales y métodos: Entre enero de 2016 y diciembre de 2017, se incluyó en el estudio a un total de 152 pacientes adultos que serían tratados con LEOCH por un solo cálculo radiopaco localizado en la pelvis renal. Se excluyeron los pacientes con riñón solitario, anomalía congénita, anomalía del sistema esquelético, cirugía previa del tracto urinario, hidronefrosis (grado 2 o superior), infección del tracto urinario sin tratar, trastorno hemorrágico y sospecha de embarazo. Los 114 pacientes restantes se dividieron aleatoriamente en 2 grupos: cateterizados y no cateterizados. Veintidós pacientes cuyo cálculo no pudo fragmentarse después de 3 sesiones consecutivas también fueron excluidos del estudio. Un total de 92 pacientes (54 no cateterizados y 38 cateterizados) se incluyeron en el análisis final. Resultados: No hubo diferencias significativas entre los grupos respecto a edad, sexo, índice de masa corporal, grosor parenquimal renal, hidronefrosis, distancia piel-cálculo, unidades Hounsfield y tamaño del cálculo. El éxito fue significativamente mayor en el grupo cateterizado que en el grupo no cateterizado (71 vs. 39%; p = 0,002). En pacientes libres de cálculos, el número de visitas al servicio de urgencias y el consumo de analgésicos fue significativamente menor en el grupo cateterizados que en el grupo no cateterizados (p < 0,001 y p < 0,001, respectivamente). En pacientes no libres de cálculos, el consumo de analgésicos fue significativamente menor en el grupo cateterizados que en el grupo no cateterizados (p = 0,004). Conclusiones: La colocación de catéter antes del tratamiento con LEOCH para cálculos en la pelvis renal de tamaño moderado tiene algunas ventajas en términos de éxito, visitas al servicio de urgencias y consumo de analgésicos

Purpose: To evaluate the effect of JJ stents on SWL treatment of moderate (15-25mm) renal pelvic stones. Materials and methods: Between January 2016 and December 2017, a total of 152 adult patients who were planned to undergo SWL for a single radiopaque renal pelvic stone were included in the study. Patients with solitary kidney, congenital abnormality, skeletal tract abnormalities, previous urinary system surgery, hydronephrosis (grade 2 or more), untreated urinary tract infection, bleeding disorder, and suspected pregnancy were excluded. The remaining 114 patients were randomly divided into two groups; non-stented and stented. Twenty-two patients whose stone could not be fragmented despite 3 consecutive sessions were also excluded from the study. A total of 92 patients (54 non-stented and 38 stented) were included in the final analysis. Results: There was no significant difference in terms of age, sex, body mass index, renal parancyhimal thickness, hydronephrosis, skin-to-stone distance, Hounsfield units, and stone size between the groups. Success was significantly higher in the stented group than in the non-stented group (71% vs. 39%, P = .002). In stone-free patients, the number of emergency department visits and analgesic tablet consumption was significantly lower in the stented group than in the non-stented group (P < .001 and P < .001, respectively). In non- stone-free patients, analgesic tablet consumption was significantly lower in the stented group than in the non-stented group (P = .004). Conclusions: Pre-stenting before SWL treatment of moderate sized renal pelvic stones has some advantages in terms of success, emergency service visits, and analgesic tablet consumption

Effect of JJ stent on outcomes of extracorporeal shock wave lithotripsy treatment of moderate sized renal pelvic stones: A randomized prospective study. / Resultados de LEOCH con o sin catéter para el tratamiento de cálculos en la pelvis renal: un estudio aleatorizado.

PURPOSE: To evaluate the effect of JJ stents on SWL treatment of moderate (15-25mm) renal pelvic stones. MATERIALS AND METHODS: Between January 2016 and December 2017, a total of 152 adult patients who were planned to undergo SWL for a single radiopaque renal pelvic stone were included in the study. Patients with solitary kidney, congenital abnormality, skeletal tract abnormalities, previous urinary system surgery, hydronephrosis (grade 2 or more), untreated urinary tract infection, bleeding disorder, and suspected pregnancy were excluded. The remaining 114 patients were randomly divided into two groups; non-stented and stented. Twenty-two patients whose stone could not be fragmented despite 3 consecutive sessions were also excluded from the study. A total of 92 patients (54 non-stented and 38 stented) were included in the final analysis. RESULTS: There was no significant difference in terms of age, sex, body mass index, renal parancyhimal thickness, hydronephrosis, skin-to-stone distance, Hounsfield units, and stone size between the groups. Success was significantly higher in the stented group than in the non-stented group (71% vs. 39%, P=.002). In stone-free patients, the number of emergency department visits and analgesic tablet consumption was significantly lower in the stented group than in the non-stented group (P<.001 and P<.001, respectively). In non- stone-free patients, analgesic tablet consumption was significantly lower in the stented group than in the non-stented group (P=.004). CONCLUSIONS: Pre-stenting before SWL treatment of moderate sized renal pelvic stones has some advantages in terms of success, emergency service visits, and analgesic tablet consumption.

Could ureteral wall thickness have an impact on the operative and post-operative parameters in ureteroscopic management of proximal ureteral stones? / ¿Podría el espesor de la pared ureteral afectar a los parámetros intra y postoperatorios de la ureteroscopia para el tratamiento de piedras ureterales proximales?

AIM: To evaluate the possible impact of stone impaction in terms of ureteral wall thickness (UWT) on the success and procedure related parameters of ureteroscopic management in proximal ureteral calculi. PATIENTS AND METHODS: 82 patients with proximal ureteric stones were included and were divided into 2subgroups where UWT was> 5mm in 38 cases; and <5mm in 44 cases. Stone size, degree of hydronehrosis, diameter of proximal ureteral luz, UWT and patient's demographics were evaluated. Semi-rigid ureteroscopy with Ho-YAG laser was performed and the possible impact of UWT as an objective parameter for stone impaction on the success rates and procedure related parameters was evaluated. RESULTS: Mean patient age and stone size values were 47.55±1.78 years and 8.17±0.29mm respectively. Regarding the impact of UWT value at the stone site for the parameters mentioned above stone free rates particularly at 1-week after the procedure was higher in group 2 and the rate of residual fragments as well as the need for double J stent placement was higher in group 1. Additionally, mean duration of the procedures was significantly longer in Group 1 during which pathologic alterations were significantly higher in ureteral wall at stone site were observed in these cases (P=.0243). CONCLUSIONS: UWT may be used to predict the success of ureteroscopic management and other procedure related parameters for proximal ureteral stones in an effective manner. With this approach a more rational operative plan with higher success rates, limited complications and auxiliary procedures could be made.

Supermini nefrolitotomía percutánea para cálculos renales menores de 25 mm en pacientes pediátricos: ¿podría ser una alternativa a la litotricia por ondas de choque? / Super-mini percutaneous nephrolithotomy for renal stone less than 25 mm in pediatric patients: Could it be an alternative to shockwave lithotripsy?

Objetivo: Evaluar la eficacia de 2 técnicas diferentes, la litotricia por ondas de choque (LOC) frente a la supermini nefrolitotomía percutánea (SMP), en términos de éxito y tasas de complicaciones en cálculos renales pediátricos de tamaño < 25 mm. Pacientes y métodos: Se incluyeron un total de 219 niños (edades comprendidas entre uno y 17 años) sometidos a 2 modalidades de tratamiento diferentes (LOC vs. SMP) para cálculos renales < 25 mm. Dependiendo del tipo de procedimiento aplicado, los niños se dividieron en 2 grupos diferentes: grupo 1 (n = 108), formado por niños tratados con LOC, y grupo 2 (n = 111), integrado por niños tratados con SMP. Todos los parámetros relacionados con el tratamiento (tasas libres de cálculos, número de sesiones, duración del tratamiento, hospitalización, presencia de fragmentos residuales, complicaciones así como la necesidad de intervenciones adicionales) se observaron y evaluaron entre 2 grupos de forma comparativa. Resultados: La evaluación de nuestros datos ha demostrado claramente que el porcentaje de fragmentos residuales fue significativamente mayor en los casos sometidos a procedimiento de LOC en comparación con SMP. Aunque LOC requirió varias sesiones bajo anestesia general en un cierto porcentaje de los casos (54,6%), SMP tuvo éxito en una sesión en todos los casos. Por último, pero no por ello menos importante, además de las tasas de complicaciones menores similares observadas en ambos grupos de casos, no se observó ninguna complicación grave y ningún caso requirió transfusión de sangre después de estos 2 procedimientos, sin tasas significativas de descenso en los niveles de hemoglobina. Conclusiones: Aunque la LOC sigue siendo la modalidad de tratamiento preferida para la mayoría de los cálculos renales en niños por su naturaleza segura y no invasiva, la modalidad de SMP puede aplicarse como una alternativa valiosa en esta población específica de pacientes por sus excelentes tasas de ausencia de cálculos obtenidas en una sesión única y tasas de complicaciones aceptables en el manejo invasivo mínimo de cálculos < 25 mm

Aim: To evaluate the efficacy of 2 different techniques: shock wave lithotripsy (SWL) vs. super-mini percutaneous nephrolithotomy (SMP), in terms of success as well as complication rates in pediatric renal stones sizing < 25 mm. Patients and methods: A total of 219 children (aging between 1-17 years) undergoing 2 different treatment modalities (SWL vs. SMP) for kidney stones < 25 mm were included. Depending on the type of the procedure applied, children were divided into 2 different groups: group 1 (n = 108), children treated with SWL, and group 2 (n = 111), children treated with SMP. All treatment related parameters (stone free rates, number of sessions, treatment duration, hospitalization, presence of the residual fragments, complications as well as the need for additional interventions) were noted and evaluated between 2 groups in a comparative manner. Results: Evaluation of our data have clearly demonstrated that the percentage of residual fragments after SWL was significantly higher when compared with SMP. Although SWL required several sessions under general anesthesia in a certain per cent of the cases (54.6%), SMP was successful in one session in all of the cases. Last but not least, in addition to the similar minor complication rates observed in both group of cases, no major complication observed in any case and no case in both groups again required blood transfusion after these 2 procedures with no significant drop rates in hemoglobin levels. Conclusions:Although SWL is still the preferred treatment modality for the majority of kidney stones in children due to its safe and non-invasive nature, SMP modality may be applied as a valuable alternative in this specific patient population for its excellent stone free rates obtained in a single session and acceptable complication rates in the minimal invasive management of stones < 25 mm

Super-mini percutaneous nephrolithotomy for renal stone less than 25mm in pediatric patients: Could it be an alternative to shockwave lithotripsy? / Supermini nefrolitotomía percutánea para cálculos renales menores de 25mm en pacientes pediátricos: ¿podría ser una alternativa a la litotricia por ondas de choque?

AIM: To evaluate the efficacy of 2 different techniques: shock wave lithotripsy (SWL) vs. super-mini percutaneous nephrolithotomy (SMP), in terms of success as well as complication rates in pediatric renal stones sizing<25mm. PATIENTS AND METHODS: A total of 219 children (aging between 1-17 years) undergoing 2 different treatment modalities (SWL vs. SMP) for kidney stones<25mm were included. Depending on the type of the procedure applied, children were divided into 2 different groups: group 1 (n=108), children treated with SWL, and group 2 (n=111), children treated with SMP. All treatment related parameters (stone free rates, number of sessions, treatment duration, hospitalization, presence of the residual fragments, complications as well as the need for additional interventions) were noted and evaluated between 2 groups in a comparative manner. RESULTS: Evaluation of our data have clearly demonstrated that the percentage of residual fragments after SWL was significantly higher when compared with SMP. Although SWL required several sessions under general anesthesia in a certain per cent of the cases (54.6%), SMP was successful in one session in all of the cases. Last but not least, in addition to the similar minor complication rates observed in both group of cases, no major complication observed in any case and no case in both groups again required blood transfusion after these 2 procedures with no significant drop rates in hemoglobin levels. CONCLUSIONS: Although SWL is still the preferred treatment modality for the majority of kidney stones in children due to its safe and non-invasive nature, SMP modality may be applied as a valuable alternative in this specific patient population for its excellent stone free rates obtained in a single session and acceptable complication rates in the minimal invasive management of stones<25mm.

Retrograde intrarenal surgery in the management of pediatric cystine stones.

OBJECTIVE: To investigate the efficacy and safety of retrograde intrarenal surgery (RIRS) in the treatment of pediatric cystine stones. STUDY DESIGN: Data of the pediatric patients who underwent RIRS for kidney stones were retrospectively evaluated. A total of 14 children with cystine stones managed with RIRS were identified. In addition to the patient demographics and stone characteristics, all retrospectively obtained operative data were evaluated and discussed in detail, with an emphasis on the success and complication rates. RESULTS: Mean age of the 14 cases was 10.9 ± 2.2 years (range: 7-15). Mean stone size was 13.6 ± 2.4 mm (range: 10-18) (Summary table). Of these stones, four were located in the renal pelvis, three were in the lower, three were in the middle and the remaining four were located in upper calyx. Ureteral access sheath was used in 12 (85.7%) patients. The double-J ureteral stent was placed pre-operatively in one case and was inserted postoperatively in 12 cases. Mean operation time was 38.2 ± 7.2 min (range: 30-50). Complications were observed in two cases: mild ureteral laceration in the first and fever on the second postoperative day in the second patient. All of the patients were stone free on sonographic evaluation at the 4-week follow-up evaluation. Although potassium citrate treatment was initiated in 11 patients, tiopronin treatment was initiated in four patients for recurrence prophylaxis during long-term follow-up. During a mean follow-up period of 25.7 ± 5.2 months, stone recurrence was noted in one patient. DISCUSSION: Treatment of patients with cystine stones is challenging, due to high risk of rapid recurrence in the presence of residual fragments. Besides allowing complete stone clearance in all cases in the current series, RIRS is a highly reproducible method that can be safely performed, even in recurrences. The major limitations of the current study were low number of patients and short follow-up period. CONCLUSION: The results clearly indicated that RIRS is a safe treatment modality in the management of pediatric cystine stones.

Impact of gender on success and complication rates after ureteroscopy.

PURPOSE: To investigate the impact of gender differences on treatment success, intraoperative and postoperative complications in patients undergoing ureteroscopy (URS). MATERIALS AND METHODS: A prospectively maintained database of 927 consecutively performed ureteroscopies on solitary ureteral stones in four different centers was retrospectively analyzed. Stones were detected with preoperative computed tomography scans or intravenous urography imaging. Patients received intravenous antibiotics as perioperative prophylaxis. Patients with symptomatic urinary tract infections (UTI) prior to surgery were excluded. Follow-up was up to 2 weeks after URS or stent removal. RESULTS: Two hundred and eighty-six women and 641 men were included in this study. Mean stone size was 9 mm (range 2-35 mm). A double-J stent was placed in 240 (83 %) women and 527 (82 %) men at the end of surgery (p = 0.075). There was no significant gender difference in terms of stent dislocation (p = 0.239). Two hundred and fifty-one women (87 %) and 564 men (87 %) were stone-free after the first procedure (p = 0.917). Intraoperative complications were observed in 14 (4.8 %) women and 37 (5.9 %) men (p = 0.313). Severe UTI presenting with fever (>38 °C) and requiring prolonged hospitalization with parenteral antibiotics were observed in 11 (3 %) women and 8 (1 %) men postoperatively. This difference was statistically significant (p = 0.025). CONCLUSION: No significant differences between female and male patients harboring ureteral stones with respect to intraoperative complications were detected. Although stone characteristics were comparable between groups, a small number of women had significantly more severe UTI's postoperatively. Our current therapy regimen for URS seems to be efficient and safe both for females and males.

Escitalopram treatment for premature ejaculation has a negative effect on semen parameters.

The aim of this study was to determine the impact of long-term escitalopram treatment on semen parameters of patients with lifelong premature ejaculation (PE). Between November 2008 and January 2010, patients admitted to urology outpatient clinic with a self-reported complaint of PE were evaluated. Medical and sexual history of patients were recorded and patients with lifelong PE (a total of 25 patients) who met the International Society of Sexual Medicine definition were asked to record their intravaginal ejaculatory latency time (IELT) for 1 month, complete Premature Ejaculation Diagnostic Tool (PEDT) questionnaire and give semen samples. Afterwards, patients received 10 mg escitalopram daily for 12 weeks and were invited for control visits at first and third month of treatment. During control visits, PEDT was administered again whereas IELTs were recorded and semen samples were re-examined. PEDT scores, arithmetic means of IELTs and results of semen analyses, which were recorded at baseline, first and third month were compared. At the third month of treatment, a significant increase in mean IELTs and a significant decrease in PEDT scores were detected. However there was a significant decrease in sperm concentration, motility and morphology when compared with the baseline semen measures. Daily escitalopram treatment effects the semen parameters of patients with lifelong PE. Further investigations with larger series are needed to see whether other serotonin reuptake inhibitors have similar side effects and to expose the exact mechanism underlying it. Different treatment modalities should be suggested to patients who desire fertility.

Treatment of ureteral calculi with semirigid ureteroscopy: where should we stop?

OBJECTIVES: To evaluate the efficacy of semirigid ureteroscopy in the management of ureteral stones located in different parts of the ureter. METHODS: 1,503 patients were treated with semirigid ureteroscopy. All ureteral stones were either removed only by a basket catheter or disintegrated by pneumatic lithotripsy. Success rates, auxiliary procedures, complication rates and operation time were comparatively evaluated according to stone location. RESULTS: Overall, mean stone size and age were 12.1 +/- 3.7 mm and 43.2 +/- 9.72 years, respectively. While 1,416 patients (94.2%) were completely stone-free, the procedure was unsuccessful in 87 cases (5.8%). The success rate was relatively low in the proximal ureter (71.7%) when compared with the mid (94.8%) and distal ureter (98.9%) (p = 0.021). Mean operation time was 25.4 +/- 11.7 min. Longer duration of operation and higher complication rate were found in proximal ureteral calculi. Stone migration to the kidney and hematuria were the main reasons of failure in the proximal ureter and ureteral stenting was needed for 56.4% of patients with upper ureteral stone. CONCLUSIONS: Semirigid ureteroscopy can be the treatment of choice in lower and midureteral stones. However, it is an invasive and less successful treatment modality for proximal ureteral stones with relatively high complication rates.

Double-blind, placebo-controlled, randomized clinical trial of sublingual or intramuscular piroxicam in the treatment of renal colic. A comparative study.

AIMS: To investigate the therapeutic effect of the fast-dissolving dosage form (FDDF) of sublingual piroxicam on renal colic compared with the intramuscular (IM) injection form of the same agent in a randomized, double-blind, placebo-controlled clinical trial. METHODS: 80 patients were assigned to one of two treatment groups: Group 1 received 40 mg piroxicam FDDF sublingual tablets and IM injection of 2 ml distilled water. Group 2 received an IM injection of 40 mg piroxicam and two sublingual tablets of placebo. At baseline and 30 min after the medication, vital signs were recorded and the pain intensity was evaluated by the patient using a numeric rating scale. RESULTS: The overall efficacy of the treatment was 90%. There was no significant difference with respect to the required rescue treatment (p = 0.328), pain relapse within 24 h (p = 0.434) and the decrease in vital signs and numeric rating scale in both groups (p > 0.05). CONCLUSION: The piroxicam FDDF tablet was found to be as effective as the IM injection form of the same agent in the treatment of renal colic. The FDDF is a good alternative to the parenteral form because of its earlier onset of action and ease of self-administration which increases patient compliance.

Ureteroscopic management of ureteral calculi in children.

PURPOSE: To evaluate the efficacy and safety of rigid ureteroscopy for the treatment ureteral calculi in children. PATIENTS AND METHODS: Between January 2002 and January 2006, 16 boys and 25 girls with an average age of 9.5 years (range 3-15 years) were treated with a 95F rigid ureteroscope for stones 4 to 10 mm (mean 5.6 mm) in 46 renoureteral units (RUUs), and the results were evaluated. The stones were located in the upper ureter in 4 RUUs, the middle ureter in 15, and the lower ureter in 27. Dilatation of a tight ureteral orifice was necessary in 17 cases (36.9%). RESULTS: On examination during ureteroscopy, all calculi were well fragmented, and in 33 patients (94%), stone fragments were removed directly. Stones were fragmented with pneumatic lithotripsy in 23 RUUs and removed by forceps with or without fragmentation in the remaining 23. Whereas the treatment was successful in 36 children (87.8%), it was unsuccessful in 5 (12.2%) secondary to bleeding and mucosal injury in 3 children (7%; 1 middle- and 2 upper-ureteral stones) and severe ureteral stenosis with kinking in 2 (4.8%; 1 middle- and 1 upper-ureteral stone) children. In two other cases, although the fragments in the upper portion of the ureter could be reached with the ureteroscope, the stones migrated into the renal collecting system during pneumatic lithotripsy and were treated successfully with subsequent SWL (4.8%). At the end of the procedure, a 4.8F Double-J stent was left in place in 9 cases. There were no serious complications, and the children were not specifically evaluated for postoperative vesicoureteral reflux. Follow-up ranged from 1 to 36 months with an average duration of 22.4 months. CONCLUSION: With the aid of the experience gained in the adult population and careful instrumentation, we believe that, in skilled hands, rigid ureteroscopy can be applied in a safe and efficient manner for stones located in different portions of the pediatric ureter.

Pediatric urolithiasis: etiology, specific pathogenesis and medical treatment.

Pediatric urolithiasis is an endemic disease in certain parts of the world, namely Turkey and the Far East. As a recurrent pathology which may reveal functional as well and morphologic changes in the urinary tract, environmental factors together with urogenital abnormalities should be evaluated thoroughly in each patient. The aims of management should be complete clearance of stones, treatment of urinary tract infections, preservation of renal function and prevention of stone recurrence. In addition to certain minimally invasive stone removal procedures, treatment of pediatric urolithiasis requires a detailed metabolic evaluation in all patients on an individual basis. Obstructive pathologies have to be corrected immediately and children with a positive family history should be followed carefully with respect to a high likelihood of stone re-growth and recurrence. Although specific management of each metabolic abnormality seems to be the key factor in the medical management of stone disease, as general advice each child should be forced to adequate fluid intake which will reveal the urine volume increase in accordance with the body mass index. Moreover, medical therapeutic agents which increase urine citrate levels should be encouraged.