Aplicación de tecnologías móviles (m-Salud) y salud electrónica (e-Salud) en el manejo y en la prevención de la litiasis renal: revisión sistemática / Mobile and eHealth technologies in the management and prevention of nephrolithiasis: A systematic review

Introducción La litiasis renal (LR) es una enfermedad urológica común, que a menudo requiere de cuidados a largo plazo. Las tecnologías de salud móvil (m-Salud) y salud electrónica (e-Salud) tienen el potencial de mejorar el manejo de las enfermedades crónicas e impactar sobre los patrones de la conducta. Para evaluar la aplicabilidad de estas herramientas en la mejora del tratamiento y la prevención de la LR, nos propusimos evaluar los datos actuales sobre el uso, los beneficios y las limitaciones de la m-Salud y la e-Salud en la LR. Métodos Se realizó una revisión sistemática de los estudios de investigación primaria sobre m-Salud y e-Salud en la evaluación y tratamiento de la LR. Dos investigadores independientes examinaron las citas por título y resumen para determinar su pertinencia y, a continuación, se realizó una revisión del texto completo para obtener un resumen descriptivo de los estudios. Resultados Se incluyeron 37 artículos para el análisis. Las principales áreas de interés fueron: 1) botellas de agua «inteligentes» y aplicaciones de dispositivos móviles para el seguimiento del consumo de líquidos, que mostraron un aumento de la ingesta en la mayoría de los estudios; 2) plataformas de seguimiento de stent ureterales, que mejoraron la tasa de stent retenidos a largo plazo; 3) clínicas virtuales para el tratamiento de la LR, las cuales han mejorado el acceso, han reducido costes y han mostrado resultados satisfactorios; 4) plataformas de endoscopia para teléfonos inteligentes, que ofrecieron una buena calidad de imagen respecto a sus costes en entornos de recursos limitados, y 5) información sobre la LR en línea para pacientes, la cual generalmente se caracterizó por ser de mala calidad y/o precisión, particularmente en YouTube®. La mayoría de los estudios eran pruebas de concepto o estudios de intervención de un solo brazo, con una evaluación limitada de la eficacia o de los resultados clínicos a largo plazo. Conclusiones ... (AU)

Introduction Kidney stone disease (KSD) is a common urological condition that often requires long-term care. Mobile health (mHealth) and eHealth technologies have the potential to enhance chronic disease management and behavioral change. To assess opportunities to apply these tools to improve KSD treatment and prevention, we aimed to assess current evidence on the use, benefits, and limitations of mHealth and eHealth in KSD. Methods We performed a systematic review of primary research studies of mHealth and eHealth in the evaluation and management of KSD. Two independent researchers screened citations by title and abstract for relevance, then full-text review was performed for descriptive summary of the studies. Results A total of 37 articles were included for analysis. Primary domains of evidence included: 1) “smart” water bottles and mobile-device apps for tracking fluid consumption, which showed increased intake in most studies; 2) ureteral stent tracking platforms, which improved the rate of long-term retained stents; 3) virtual stone clinics, which have been suggested to increase access, lower costs, and have satisfactory outcomes; 4) smartphone-based endoscopy platforms, which offered cost-effective image quality in resource-limited settings; 5) patient information about KSD online, which was typically characterized as poor quality and/or accuracy, particularly on YouTube. Most studies were proof-of-concept or single-arm intervention designs, with limited assessment of effectiveness or long-term clinical outcomes. Conclusions Mobile and eHealth technologies have significant real-world applications to KSD prevention, intervention, and patient education. A lack of rigorous effectiveness studies currently limits evidence-based conclusions and incorporation in clinical guidelines. (AU)

Mobile and eHealth technologies in the management and prevention of nephrolithiasis: A systematic review.

INTRODUCTION: Kidney stone disease (KSD) is a common urological condition that often requires long-term care. Mobile health (mHealth) and eHealth technologies have the potential to enhance chronic disease management and behavioral change. To assess opportunities to apply these tools to improve KSD treatment and prevention, we aimed to assess current evidence on the use, benefits, and limitations of mHealth and eHealth in KSD. METHODS: We performed a systematic review of primary research studies of mHealth and eHealth in the evaluation and management of KSD. Two independent researchers screened citations by title and abstract for relevance, then full-text review was performed for descriptive summary of the studies. RESULTS: A total of 37 articles were included for analysis. Primary domains of evidence included: 1) "smart" water bottles and mobile-device apps for tracking fluid consumption, which showed increased intake in most studies; 2) ureteral stent tracking platforms, which improved the rate of long-term retained stents; 3) virtual stone clinics, which have been suggested to increase access, lower costs, and have satisfactory outcomes; 4) smartphone-based endoscopy platforms, which offered cost-effective image quality in resource-limited settings; 5) patient information about KSD online, which was typically characterized as poor quality and/or accuracy, particularly on YouTube. Most studies were proof-of-concept or single-arm intervention designs, with limited assessment of effectiveness or long-term clinical outcomes. CONCLUSIONS: Mobile and eHealth technologies have significant real-world applications to KSD prevention, intervention, and patient education. A lack of rigorous effectiveness studies currently limits evidence-based conclusions and incorporation in clinical guidelines.

El bloqueo del plano del músculo erector espinal antes de la litotricia extracorpórea por ondas de choque reduce el tiempo de fluoroscopia y facilita el tratamiento de la litiasis renal: estudio prospectivo aleatorizado / Erector spinae plane block prior to extracorporeal shock wave lithotripsy decreases fluoroscopy time and promise a comfortable procedure for renal stones: a prospective randomized study

Introducción y objetivos Comparar la eficacia del bloqueo del plano del erector espinal (BPEE) y el diclofenaco sódico intramuscular (IM) en términos del manejo del dolor y su impacto sobre el estado libre de cálculos en pacientes sometidos a litotricia extracorpórea de ondas de choque (LEOCh). Pacientes y materiales El estudio incluyó a pacientes sometidos a LEOCh por litiasis renal en nuestro centro. Los pacientes fueron asignados aleatoriamente a los grupos de BPEE (Grupo 1: n = 31) y de 75 mg de diclofenaco sódico IM (Grupo 2: n = 30). Se registraron los datos demográficos de los pacientes, el tiempo de fluoroscopia durante la LEOCh, el número de focalizaciones, el total de disparos administrados, el voltaje, las tasas libre de cálculos (TLC), el método de analgesia, el número de sesiones de LEOCh, la puntuación de la Escala Visual Analógica (EVA) la localización de los cálculos, el tamaño máximo de los cálculos, el volumen de los cálculos y las unidades Hounsfield (UH). Resultados Un total de 61 pacientes fueron incluidos en el estudio. No hubo diferencias estadísticamente significativas entre los dos grupos en cuanto al tamaño, el volumen y la densidad de los cálculos, la duración de la LEOCh, el total de disparos administradas, el voltaje, el índice de masa corporal (IMC), el estado libre de cálculos y la localización de los cálculos. El tiempo de fluoroscopia y el número de veces que fue necesario focalizar el cálculo fueron significativamente inferiores en el grupo 1 con respecto al grupo 2 (p:0,002, p:0,021, respectivamente). La puntuación EVA fue significativamente inferior en el grupo 1 en comparación con el grupo 2 (p<0,001). Conclusiones Observamos que la puntuación EVA del grupo BPEE era menor que la del grupo de diclofenaco sódico IM y, aunque no de manera estadísticamente significativa, conseguimos una tasa libre de cálculos más alta en la primera sesión en el grupo BPEE. ... (AU)

Introduction and Objectives To compare the efficacy of erector spinae plane block (ESPB) and intramuscular (i.m.) diclofenac sodium in regard to pain management and impact on stone-free status in patients undergoing SWL. Patients or Materials The study included patients who underwent SWL for kidney stones in our institution. The patients were randomly assigned to the ESPB (Group 1: n = 31) and i.m. 75 mg diclofenac sodium (Group 2: n = 30) groups. The demographic data of the patients, fluoroscopy time during SWL, number of need of targeting, total shocks given, voltage, stone free rates (SFR), analgesy method, number of SWL sessions, VAS score, stone location, maximum stone size, stone volume and Hounsfield unit (HU) were also recorded. Results A total of 61 patients were included the study. There was no statistically significant difference between the two groups according to stone size, volume and density, SWL duration, total shocks given, voltage, BMI, stone-free status and stone location. Fluoroscopy time and number of need for stone targeting were significantly lower in group 1 than group 2 (p:0.002, p:0.021, respectively). The VAS score was significantly lower for group 1 compared to group 2 (p<0.001). Conclusions We observed that the VAS score was lower in the ESPB group compared to i.m. diclofenac sodium group and although it was not statistically significant, we achieved a higher rate of stone-free status in the first session in ESPB group. Most importantly, the patients in the ESPB group were exposed to less fluoroscopy and radiation. (AU)

Erector spinae plane block prior to extracorporeal shock wave lithotripsy decreases fluoroscopy time and promise a comfortable procedure for renal stones: A prospective randomized study.

INTRODUCTION AND OBJECTIVES: To compare the efficacy of erector spinae plane block (ESPB) and intramuscular (i.m.) diclofenac sodium in regard to pain management and impact on stone-free status in patients undergoing SWL. PATIENTS AND MATERIALS: The study included patients who underwent SWL for kidney stones in our institution. The patients were randomly assigned to the ESPB (Group 1: n = 31) and i.m. 75 mg diclofenac sodium (Group 2: n = 30) groups. The demographic data of the patients, fluoroscopy time during SWL, number of need of targeting, total shocks given, voltage, stone free rates (SFR), analgesy method, number of SWL sessions, VAS score, stone location, maximum stone size, stone volume and Hounsfield unit (HU) were also recorded. RESULTS: A total of 61 patients were included the study. There was no statistically significant difference between the two groups according to stone size, volume and density, SWL duration, total shocks given, voltage, BMI, stone-free status and stone location. Fluoroscopy time and number of need for stone targeting were significantly lower in group 1 than group 2 (p = 0.002, p = 0.021, respectively). The VAS score was significantly lower for group 1 compared to group 2 (p < 0.001). CONCLUSIONS: We observed that the VAS score was lower in the ESPB group compared to i.m. diclofenac sodium group and although it was not statistically significant, we achieved a higher rate of stone-free status in the first session in ESPB group. Most importantly, the patients in the ESPB group were exposed to less fluoroscopy and radiation.

¿Son suficientes los nomogramas actuales para predecir los resultados de la litotricia por ondas de choque? / Are the current nomograms sufficient to predict shockwave lithotripsy outcomes?

Introducción y objetivos: Investigar los factores que afectan los resultados del tratamiento con LEOCH, validar tres nomogramas actuales (Kim JK, Triple D y S3HoCKwave) y comparar la capacidad predictiva de los nomogramas para los resultados de la LEOCH en los cálculos del tracto urinario superior.Pacientes y métodosSe revisaron retrospectivamente las historias clínicas de los pacientes con cálculos renales y ureterales proximales tratados con LEOCH entre marzo de 2013 y octubre de 2020. Se analizaron los factores que afectan al éxito de LEOCH con un análisis de regresión logística multivariante y se compararon los tres sistemas de puntuación con el área bajo la curva (AUC).ResultadosNuestro estudio incluyó un total de 580 pacientes. La tasa global de eliminación de cálculos fue del 61% y 144/580 pacientes (24,8%) estaban libres de cálculos tras una sesión. En el análisis de regresión logística multivariante, la ubicación del cálculo en el cáliz superior (OR: 2,988; IC 95%: 1,350-6,612; p=0,007), en el cáliz medio (OR: 3,036; IC 95%: 1,472-6,258; p=0,003) y en el cáliz inferior (OR: 2,131; IC 95%: 1,182-3,839; p=0,012), así como el número de cálculos (OR: 1,663; IC 95%: 1,140-2,425; p=0,008), el diámetro máximo del cálculo (OR: 1,156; IC 95%: 1,098-1,217; p<0,001) y el valor máximo de unidades Hounsfield (OR: 1,001; IC 95%: 1,001-1,002; p<0,001) fueron factores de riesgo independientes del fracaso de LEOCH. Las AUC de las puntuaciones Kim JK, Triple D y S2HoCKwave para predecir el éxito de la LEOCH fueron de 0,678, 0,548 y 0,626, respectivamente (AU)

Introduction and objectives: To investigate factors affecting SWL outcomes, validate three current nomograms (Kim JK, Triple D and S3HoCKwave) and compare the predictive ability of the nomograms for SWL outcomes in upper urinary tract stones.Patients and methodsMedical records of patients with renal and proximal ureteral stones treated with SWL between March 2013 and October 2020 were retrospectively reviewed. Factors affecting SWL success were analyzed with multivariate logistic regression analysis and the three predictive scoring systems compared with the area under the curve (AUC).ResultsA total of 580 patients were included in our study. The overall stone free rate was 61% and 144/580 patients (24.8%) were stone free after one session. In multivariate logistic regression analysis, stone location at upper calyx (OR:2.988; 95%Cl: 1.350–6.612; p=0.007), middle calyx (OR:3.036; 95%Cl: 1.472–6.258; p=0.003), and lower calyx (OR:2.131; 95%Cl: 1.182–3.839; p=0.012), as well as number of stones (OR:1.663; 95%Cl: 1.140–2.425; p=0.008), maximum diameter of stone (OR:1.156; 95%Cl: 1.098–1.217; p<0.001) and maximum Hounsfield Unit (OR:1.001; 95%Cl: 1.001–1.002; p<0.001) were independent risk factors of SWL failure. The AUCs of the Kim JK, Triple D and S2HoCKwave scores for predicting SWL success were 0.678, 0.548, and 0.626 respectively.ConclusionsStone location, number, maximal diameter, and maximum HU were independent predictive factors for SWL outcome in the treatment of upper urinary tract stones. Current nomograms, Kim JK nomogram, Triple D score and S3HoCKwave score can predict treatment success after SWL, but all of them have poor discrimination according to AUC analysis. (AU)

Are the current nomograms sufficient to predict shockwave lithotripsy outcomes?

INTRODUCTION AND OBJECTIVES: To investigate factors affecting SWL outcomes, validate three current nomograms (Kim JK, Triple D and S3HoCKwave) and compare the predictive ability of the nomograms for SWL outcomes in upper urinary tract stones. PATIENTS AND METHODS: Medical records of patients with renal and proximal ureteral stones treated with SWL between March 2013 and October 2020 were retrospectively reviewed. Factors affecting SWL success were analyzed with multivariate logistic regression analysis and the three predictive scoring systems compared with the area under the curve (AUC). RESULTS: A total of 580 patients were included in our study. The overall stone free rate was 61% and 144/580 patients (24.8%) were stone free after one session. In multivariate logistic regression analysis, stone location at upper calyx (OR:2.988; 95%Cl: 1.350-6.612; p = 0.007), middle calyx (OR:3.036; 95%Cl: 1.472-6.258; p = 0.003), and lower calyx (OR:2.131; 95%Cl: 1.182-3.839; p = 0.012), as well as number of stones (OR:1.663; 95%Cl: 1.140-2.425; p = 0.008), maximum diameter of stone (OR:1.156; 95%Cl: 1.098-1.217; p < 0.001) and maximum Hounsfield Unit (OR:1.001; 95%Cl: 1.001-1.002; p < 0.001) were independent risk factors of SWL failure. The AUCs of the Kim JK, Triple D and S2HoCKwave scores for predicting SWL success were 0.678, 0.548, and 0.626 respectively. CONCLUSIONS: Stone location, number, maximal diameter, and maximum HU were independent predictive factors for SWL outcome in the treatment of upper urinary tract stones. Current nomograms, "Kim JK nomogram", "Triple D score" and "S3HoCKwave score" can predict treatment success after SWL, but all of them have poor discrimination according to AUC analysis.

Urolitiasis en el embarazo: avances en las modalidades de imagen y evaluación de las tendencias actuales en los abordajes endourológicos / Urolithiasis in pregnancy: Advances in imaging modalities and evaluation of current trends in endourological approaches

Objetivo Dados los desafíos inherentes al diagnóstico y tratamiento de las mujeres embarazadas con urolitiasis, nos proponemos revisar las modalidades de imagen y el manejo endourológico actual de estas pacientes. Materiales y métodos se realizó una revisión de la literatura disponible sobre la urolitiasis en el embarazo. Esto incluyó la evaluación, el diagnóstico por imágenes y las opciones terapéuticas. Las bases de datos en las que se realizó la búsqueda fueron Google Scholar y PubMed. Se examinaron un total de 346 resúmenes. Tras aplicar los criterios de inclusión y exclusión quedaron 42 publicaciones: 18 estudios retrospectivos, 10 revisiones o metaanálisis, 8 conjuntos de directrices, 5 ensayos de control aleatorizados y una cohorte prospectiva. Resultados Iniciamos nuestra revisión con la literatura disponible sobre la seguridad y eficacia de las modalidades de imagen en la planificación quirúrgica de la urolitiasis en pacientes embarazadas. Esto incluye la ecografía renal, la radiografía abdominal, la tomografía computarizada y la resonancia magnética. Mientras que la tomografía computarizada puede suponer una exposición mayor a la radiación, con posibles problemas de seguridad, la resonancia magnética, aunque es una prueba menos sensible, parece ser más segura. A continuación se describen la seguridad, la eficacia y los resultados de diversas intervenciones quirúrgicas para la urolitiasis en pacientes embarazadas, como son la colocación de un stent ureteral, la nefrostomía percutánea, la ureteroscopia, la litotricia extracorpórea por ondas de choque y la nefrolitotomía percutánea. La ureteroscopia es un abordaje más seguro, pero la nefrolitotomía percutánea ofrece tasas mayores de ausencia de cálculos. Utilizando un enfoque basado en la evidencia, proponemos un algoritmo para el manejo de las mujeres embarazadas con cólico renal (AU)

Objective Given the challenges involved in diagnosis and treatment of pregnant women with urolithiasis, we aim to review the imaging modalities and current endourological management of these patients. Materials and methods We performed a review of the available literature on urolithiasis in pregnancy. This included evaluation, diagnostic imaging, and therapeutic options. The databases we searched from included Google Scholar and PubMed. A total of 346 abstracts were screened. After our inclusion/exclusion criteria were met, we were left with 42 sources: 18 retrospective studies, 10 reviews/meta-analyses, 8 sets of guidelines, 5 randomized control trials, and one prospective cohort. Results We begin our review with the literature available on the safety and efficacy of imaging modalities in the surgical planning for urolithiasis in pregnant patients. This includes renal ultrasound, abdominal x-ray, computed tomography scan, and magnetic resonance imaging. While computed tomography may result in an added radiation exposure, with possible safety concerns, magnetic resonance imaging seems to be safer, however a less sensitive test. We next describe safety, efficacy, and outcomes of various surgical interventions for urolithiasis in pregnant patients. This encompasses ureteral stenting, percutaneous nephrostomy, ureteroscopy, extracorporeal shock wave lithotripsy, and percutaneous nephrolithotomy. Ureteroscopy is a safer approach, but percutaneous nephrolithotomy offers higher stone-free rates. Using an evidence-based approach, we propose an algorithm for management of the pregnant women with renal colic. Conclusion Management of the pregnant women with suspected urolithiasis is a unique challenge for healthcare providers. A multi-disciplinary approach should be taken to optimize outcomes through an evidence-based approach (AU)

Urolithiasis in pregnancy: Advances in imaging modalities and evaluation of current trends in endourological approaches.

OBJECTIVE: Given the challenges involved in diagnosis and treatment of pregnant women with urolithiasis, we aim to review the imaging modalities and current endourological management of these patients. MATERIALS AND METHODS: We performed a review of the available literature on urolithiasis in pregnancy. This included evaluation, diagnostic imaging, and therapeutic options. The databases we searched from included Google Scholar and PubMed. A total of 346 abstracts were screened. After our inclusion/exclusion criteria were met, we were left with 42 sources: 18 retrospective studies, 10 reviews/meta-analyses, 8 sets of guidelines, 5 randomized control trials, and 1 prospective cohort. RESULTS: We begin our review with the literature available on the safety and efficacy of imaging modalities in the surgical planning for urolithiasis in pregnant patients. This includes renal ultrasound, abdominal x-ray, computed tomography scan, and magnetic resonance imaging. While computed tomography may result in an added radiation exposure, with possible safety concerns, magnetic resonance imaging seems to be safer, however a less sensitive test. We next describe safety, efficacy, and outcomes of various surgical interventions for urolithiasis in pregnant patients. This encompasses ureteral stenting, percutaneous nephrostomy, ureteroscopy, extracorporeal shock wave lithotripsy, and percutaneous nephrolithotomy. Ureteroscopy is a safer approach, but percutaneous nephrolithotomy offers higher stone-free rates. Using an evidence-based approach, we propose an algorithm for management of the pregnant women with renal colic. CONCLUSION: Management of the pregnant women with suspected urolithiasis is a unique challenge for healthcare providers. A multi-disciplinary approach should be taken to optimize outcomes through an evidence-based approach.

Efficacy of ultra-mini percutaneous nephrolithotomy and retrograde intrarenal surgery in the treatment of 2-3 cm lower calyceal stones / Eficacia de la nefrolitotomía percutánea ultramini y la cirugía intrarrenal retrógrada en el tratamiento de cálculos caliceales inferiores de 2-3 cm

Abstract We aimed to compare the efficacy and safety of ultra-mini percutaneous nephrolithotomy (UMP) and retrograde intrarenal surgery (RIRS) for the management of lower calyceal stones. A group of 136 patients with a single lower calyceal stone (2-3 cm in diameter) was divided into the UMP or RIRS groups. The average operation time in the RIRS group was significantly longer than that in the UMP group, and the intraoperative blood loss in the former was markedly less than that in the latter. Besides, in the RIRS group, the decreased value of postoperative Hb was obviously lower, the postoperative hospital stay was evidently shorter, and the total hospitalization expenses were markedly less than those in UMP group were. Moreover, the success rate of the first-stage lithotripsy in the UMP group was notably higher than that in RIRS group. The RIRS group had an obviously lower VAS score but a markedly higher BCS score than the UMP group six hours after surgery. At 24 h after operation, the levels of serum CRP, TNF-α and IL -6 in patients in both groups were remarkably increased, and they were evidently lower in the RIRS group than those in the UMP group were. Three days after surgery, the levels of serum CRP, TNF-α and IL -6 were notably lower in the UMP group than those in RIRS group were. RIRS and UMP are safe and effective in the treatment of 2-3 cm lower calyceal stones. The first-stage UMP is characterized by a high stone-free rate (SFR), short operation time and low postoperative infection risk, while RIRS is associated with less blood loss and low total expenses.

Resumen Nuestro objetivo fue comparar la eficacia y seguridad de la nefrolitotomía percutánea ultramini (UMP) y la cirugía intrarrenal retrógrada (CRIR) en el manejo quirúrgico de los cálculos caliceales inferiores. Un grupo de 136 pacientes con un solo cálculo calicial inferior (2-3 cm de diámetro) se dividió en un grupo UMP o un grupo CRIR. El tiempo de operación promedio en el grupo CRIR fue significativamente más largo que en el grupo UMP, y la pérdida de sangre intraoperatoria en el primero fue marcadamente menor que en el segundo. Además, en el grupo CRIR, el valor disminuido de la Hb postoperatoria fue obviamente menor, la estancia hospitalaria postoperatoria fue evidentemente más corta y los gastos totales de hospitalización fueron notablemente menores que los del grupo UMP. Además, la tasa de éxito de la litotricia de primera etapa en el grupo UMP fue notablemente más alta que en el grupo CRIR. El grupo CRIR tuvo una puntuación VAS obviamente más baja pero una puntuación BCS marcadamente más alta que el grupo UMP a seos horas después de la operación. A las 24 h después de la operación, los niveles séricos de PCR, TNF-α e IL -6 en los pacientes de ambos grupos aumentaron notablemente y fueron evidentemente más bajos en el grupo CRIR que en el grupo UMP. Tres días después de la operación, los niveles séricos de PCR, TNF-α e IL -6 fueron notablemente más bajos en el grupo UMP que en el grupo CRIR. Los procedimientos CRIR y el UMP son seguros y eficaces en el tratamiento de cálculos caliciales inferiores de 2-3 cm. El UMP de primera etapa se caracteriza por tener una tasa libre de cálculo (SFR) alta, un tiempo de operación corto y un riesgo de infección posoperatorio bajo, y el RIRS se caracteriza por una menor pérdida de sangre y gastos totales bajos.

Efecto in vitro de 2 compuestos bioactivos, el ácido gálico y el galato de metilo, sobre la urolitiasis / In vitro effects of 2 bioactive compounds, gallic acid and methyl gallate, on urolithiasis

Introducción y objetivos: El objetivo de este estudio fue evaluar el papel de 2 compuestos fenólicos naturales ampliamente distribuidos, el ácido gálico (AG) y el galato de metilo (GM), en un modelo in vitro de urolitiasis, utilizando la metodología de formación de cristales de oxalato de calcio, el tipo más común de cálculos urinarios o renales.Material y métodosLos compuestos AG y GM fueron sometidos a actividades de «anticristalización» en diferentes concentraciones (0,003-0,03mg/mL), y la cantidad y morfología de los cristales se determinó por microscopia después de 60min.ResultadosEl AG inhibió alrededor del 44-57% de la formación total de cristales de cristales de oxalato de calcio, mientras que el GM inhibió alrededor del 48,35%, en comparación con las muestras expuestas al vehículo (agua destilada; grupo de control negativo). La exposición a AG y GM inhibió la formación de cálculos de tipo monohidrato, considerada la categoría de cristales más común y dañina. Los compuestos también disminuyeron la absorbancia, lo que a su vez está relacionado con una reducción de la agregación y precipitación de cristales de oxalato de calcio.ConclusionesEn conjunto, este estudio muestra, por primera vez, que el AG y el GM son compuestos prometedores con propiedades antiurolitiásicas, brindando nuevas perspectivas para futuros estudios in vivo del potencial de estos compuestos en el tratamiento y/o prevención de los cálculos urinarios o renales. (AU)

Introduction and objectives: This study aimed to evaluate the role of 2 widely distributed natural phenolic compounds, gallic acid (GA) and methyl gallate (MG), in an in vitro model of urolithiasis, by using the methodology of calcium oxalate crystals formation, which is the most common type of urinary or kidney stones.Material and methodsThe compounds GA and MG were subjected to anti-crystallization activities in different concentrations (0.003-0.03mg/mL), and the quantity and morphology of crystals were determined by microscopy after 60min.ResultsGA inhibited about 44-57% of the total calcium oxalate crystals formation, while MG inhibited about 48.35%, when compared to vehicle-exposed samples (distilled water; negative control group). GA and MG exposure inhibited monohydrate type calculi formation, which is considered the most common and harmful crystal category. The compounds also decreased absorbance, which in turn is related to reduced calcium oxalate crystals aggregation and precipitation.ConclusionsAltogether, this study shows, for the first time, that GA and MG are promising compounds with antiurolithiatic properties, opening new perspectives for future in vivo evaluations of the potential of these compounds in the treatment and/or prevention of urinary or kidney stones. (AU)

In vitro effects of two bioactive compounds, gallic acid and methyl gallate, on urolithiasis.

INTRODUCTION AND OBJECTIVES: This study aimed to evaluate the role of two widely distributed natural phenolic compounds, gallic acid (GA) and methyl gallate (MG), in an in vitro model of urolithiasis, by using the methodology of calcium oxalate (CaOx) crystals formation, which is the most common type of urinary or kidney stones. MATERIAL AND METHODS: The compounds GA and MG were subjected to anti-crystallization activities in different concentrations (0.003-0.03 mg/mL), and the quantity and morphology of crystals were determined by microscopy after 60 min. RESULTS: GA inhibited about 44-57% of the total CaOx crystals formation, while MG inhibited about 48.35%, when compared to vehicle-exposed samples (distilled water; negative control group). GA and MG exposure inhibited monohydrate type calculi formation, which is considered the most common and harmful crystal category. The compounds also decreased absorbance, which in turn is related to reduced CaOx aggregation and precipitation. CONCLUSIONS: Altogether, this study shows, for the first time, that GA and MG are promising compounds with antiurolithiatic properties, opening new perspectives for future in vivo evaluations of the potential of these compounds in the treatment and/or prevention of urinary or kidney stones.

In vitro effects of 2 bioactive compounds, gallic acid and methyl gallate, on urolithiasis. / Efecto in vitro de 2 compuestos bioactivos, el ácido gálico y el galato de metilo, sobre la urolitiasis.

INTRODUCTION AND OBJECTIVES: This study aimed to evaluate the role of 2 widely distributed natural phenolic compounds, gallic acid (GA) and methyl gallate (MG), in an in vitro model of urolithiasis, by using the methodology of calcium oxalate crystals formation, which is the most common type of urinary or kidney stones. MATERIAL AND METHODS: The compounds GA and MG were subjected to anti-crystallization activities in different concentrations (0.003-0.03mg/mL), and the quantity and morphology of crystals were determined by microscopy after 60min. RESULTS: GA inhibited about 44-57% of the total calcium oxalate crystals formation, while MG inhibited about 48.35%, when compared to vehicle-exposed samples (distilled water; negative control group). GA and MG exposure inhibited monohydrate type calculi formation, which is considered the most common and harmful crystal category. The compounds also decreased absorbance, which in turn is related to reduced calcium oxalate crystals aggregation and precipitation. CONCLUSIONS: Altogether, this study shows, for the first time, that GA and MG are promising compounds with antiurolithiatic properties, opening new perspectives for future in vivo evaluations of the potential of these compounds in the treatment and/or prevention of urinary or kidney stones.

The effect of renal localization on the fate of clinically insignificant residual fragments after retrograde intrarenal surgery: A prospective 1-year follow-up study. / El efecto de la localización renal en el destino de los fragmentos residuales clínicamente insignificantes después de la cirugía intrarrenal retrógrada: Un estudio prospectivo de seguimiento de 1 año.

OBJECTIVES: Even after a successful retrograde intrarenal surgery (RIRS), clinically insignificant residual fragments (CIRF) could not pass from the kidney. We aimed to find out the differences on the fate of CIRF according to being in the lower pole or other renal localizations. METHODS: 81 patients whose stones were fragmented completely by RIRS were subdivided into two groups as group 1 (lower pole with 41 patients) and group 2 (upper pole, midpole, and renal pelvis with 40 patients). Basal characteristics, urine culture, and renal stone screening were evaluated before and 1-year later from the surgery. RESULTS: While the number of stone-free patients was less and patients with CIRF ≤4 mm was higher in the lower pole stone group 1-year later from the surgery, there was no statistical difference between the two groups (p=0.158, p=0.136). The number of patients whose CIRFs regrew was 46.3% in group 1 and, 52.5% in group 2. A positive correlation was detected between preoperative stone size and first-year maximal residual fragment size in group 1. Linear regression analysis suggested that preoperative stone size is a predictor of the postoperative first-year residual fragment size in group 1. CONCLUSIONS: We observed that almost the half of the CIRFs in all renal localizations regrew and became symptomatic. There is an effect of the stone size on the residual fragment size while performing RIRS for particularly the lower pole renal stones. Patients with CIRF are needed to be followed-up more closely regardless of the renal localization in order to assess the requirement of retreatment.

OBJETIVOS: Incluso después de una cirugía intrarrenal retrógrada exitosa (CRIR), fragmentos residuales clínicamente insignificantes (FRCI) no pudieron pasar del riñón. Nuestro objetivo fue conocer las diferencias en el destino del FRCI según esten en el polo inferior u otras localizaciones renales.MATERIAL Y MÉTODOS: 81 pacientes cuyos cálculos se fragmentaron completamente por CRIR se subdividieron en dos grupos: grupo 1 (polo inferior con 41 pacientes) y grupo 2 (polo superior, polo medio y pelvis renal con 40 pacientes). Las características basales, urocultivo y cribado de cálculos renales se evaluaron antes y un año después de la cirugía. RESULTADOS: Mientras que el número de pacientes sin cálculos fue menor y los pacientes con FRCI ≤4 mm fue mayor en el grupo de cálculos del polo inferior 1 año después de la cirugía, no hubo diferencia estadística entre los dos grupos (p=0,158, p=0,136). El número de pacientes cuyo FRCI volvió a crecer fue del 46,3% en el grupo 1 y del 52,5% en el grupo 2. Se detectó una correlación positiva entre el tamaño del cálculo preoperatorio y el tamaño máximo del fragmento residual del primer año en el grupo 1. El análisis de regresión lineal sugirió que el tamaño del cálculo preoperatorio es un predictor del tamaño del fragmento residual del primer año posoperatorio en el grupo 1. CONCLUSIÓNES: Observamos que casi la mitad de los FRCI en todas las localizaciones renales volvieron a aparecer y se volvieron sintomáticos. Hay un efecto del tamaño del cálculo sobre el tamaño del fragmento residual mientras se realiza la CRIR, en particular, para los cálculos renales del polo inferior. Es necesario realizar un seguimiento más detenido de los pacientes con FRCI independientemente de la localización renal para evaluar la necesidad de retratamiento.

El efecto de la localización renal en el destino de los fragmentos residuales clínicamente insignificantes después de la cirugía intrarrenal retrógrada: un estudio prospectivo de seguimientode 1 año / The effect of renal localization on the fate of clinically insignificant residual fragments after retrograde intrarenal surgery: a prospective follow-up study 1 year

Objetivos: Incluso después de una cirugía intrarrenal retrógrada exitosa (CRIR), fragmentosresiduales clínicamente insignificantes (FRCI) no pudieron pasar del riñón. Nuestro objetivo fue conocer lasdiferencias en el destino del FRCI según esten en el poloinferior u otras localizaciones renales.Material y métodos: 81 pacientes cuyos cálculosse fragmentaron completamente por CRIR se subdividieron en dos grupos: grupo 1 (polo inferior con 41pacientes) y grupo 2 (polo superior, polo medio y pelvis renal con 40 pacientes). Las características basales,urocultivo y cribado de cálculos renales se evaluaronantes y un año después de la cirugía.Resultados: Mientras que el número de pacientes sincálculos fue menor y los pacientes con FRCI ≤4 mm fuemayor en el grupo de cálculos del polo inferior 1 añodespués de la cirugía, no hubo diferencia estadística entre los dos grupos (p=0,158, p=0,136). El número depacientes cuyo FRCI volvió a crecer fue del 46,3% enel grupo 1 y del 52,5% en el grupo 2. Se detectó unacorrelación positiva entre el tamaño del cálculo preoperatorio y el tamaño máximo del fragmento residual delprimer año en el grupo 1. El análisis de regresión linealsugirió que el tamaño del cálculo preoperatorio es unpredictor del tamaño del fragmento residual del primeraño posoperatorio en el grupo 1.Conclusiones: Observamos que casi la mitad delos FRCI en todas las localizaciones renales volvierona aparecer y se volvieron sintomáticos. Hay un efectodel tamaño del cálculo sobre el tamaño del fragmentoresidual mientras se realiza la CRIR, en particular, paralos cálculos renales del polo inferior. Es necesario realizar un seguimiento más detenido de los pacientes conFRCI independientemente de la localización renal paraevaluar la necesidad de retratamiento.(AU)

Objetives: Even after a successful retrograde intrarenal surgery (RIRS), clinically insignificantresidual fragments (CIRF) could not pass from the kidney.We aimed to find out the differences on the fate of CIRFaccording to being in the lower pole or other renal localizations.Methods: 81 patients whose stones were fragmentedcompletely by RIRS were subdivided into two groups asgroup 1 (lower pole with 41 patients) and group 2 (upper pole, midpole, and renal pelvis with 40 patients).Basal characteristics, urine culture, and renal stonescreening were evaluated before and 1-year later fromthe surgery.Results: While the number of stone-free patients wasless and patients with CIRF ≤4 mm was higher in the lower pole stone group 1-year later from the surgery, therewas no statistical difference between the two groups(p=0.158, p=0.136). The number of patients whoseCIRFs regrew was 46.3% in group 1 and, 52.5% ingroup 2. A positive correlation was detected betweenpreoperative stone size and first-year maximal residualfragment size in group 1. Linear regression analysis suggested that preoperative stone size is a predictor of thepostoperative first-year residual fragment size in group 1.Conclsions: We observed that almost the half ofthe CIRFs in all renal localizations regrew and becamesymptomatic. There is an effect of the stone size on theresidual fragment size while performing RIRS for particularly the lower pole renal stones. Patients with CIRF areneeded to be followed-up more closely regardless of therenal localization in order to assess the requirement ofretreatment.(AU)

Urinary stone diagnosis. Morphologic and composition analysis. / Diagnóstico de la litiasis renal a través del cálculo. Estudio morfocomposicional.

Analysis of urinary stones is an essential step in establishing the diagnosis and treatment of the stone patient. In fact, the need for an exhaustive study of the stones increases as the relationships between the type of stone and the etiological factors that predispose to this disease become evident. The enumeration (qualitative or quantitative) of the major components that make up the kidney stone (calcium oxalate monohydrate, calcium oxalate dihydrate, uric acid, calcium phosphates, cystine), which is obtained by the most commonly used analytical method, infrared spectroscopy (IR), is no longer enough to guide the urologist on the etiology of the disease. Only a detailed structural analysis and macro and micro components can provide key information on the etiology of the stone, and therefore, on the possible causes that have led to its formation. This study should conclude with a report that is provided to the Urologist. Obtaining this report involves a detailed study, sample by sample, which involves the systematic handling of stereoscopic microscopy, IR spectroscopy and scanning electron microscopy (SEM) with energy dispersive X-raymicroanalysis (EDAX).

El análisis de los cálculos urinarios es un paso esencial para establecer el diagnóstico y tratamiento del paciente litiásico. De hecho, la necesidad de un estudio exhaustivo de los cálculos aumenta a medida que se evidencian las relaciones entre la tipologíadel cálculo y los factores etiológicos que predisponen a esta enfermedad. La relación de los componentes mayoritario sque componen el cálculo renal (oxalato cálcico monohidrato, oxalato cálcico dihidrato, ácido úrico, fosfatos cálcicos, cistina), que se obtiene por el método analítico generalmente más utilizado, la espectroscopía infrarroja (IR), ya no es suficiente para orientar al urólogo sobre la etiología de la enfermedad. Únicamente un detallado análisis estructural y de macro y micro componentes permite aportar información clave sobre el origen del cálculo, y por tanto, de las posibles causas que han inducido a su formación. Este estudio debe concluir con un informe que se suministra al Urólogo. La obtención de este informe supone un estudio en detalle, muestra a muestra, que implica el manejo sistemático de microscopía estereoscópica, espectroscopía IR y microscopía electrónica de barrido (SEM) con microanálisis por energía dispersiva de rayos X (EDAX).

Association between dietary pattern and metabolic disorders in children and adolescents with urolithiasis / Associação entre o padrão alimentar e distúrbios metabólicos em crianças e adolescentes com urolitíase

Abstract Objective: To describe the dietary patterns and occurrence of metabolic disorders in children and adolescents with urolithiasis treatment at a referral hospital in southern Brazil in order to learn the features of urolithiasis in this population to better develop preventive actions. Methods: Descriptive study conducted between 2016 and 2017 in a tertiary care referral hospital. Fourty patients aged 2-19 years old with urolithiasis proven by imaging were included. Clinical and dietary data were obtained through interviews and medical records. For statistical analyses, the chi-squared test was performed. Results: 40 individuals were analyzed. Mean age at diagnosis was 7.2 ± 4 years. 25% were overweight or obese. 95% had metabolic disorders, hypocitraturia being the predominant type. Protein intake was adequate in all participants and carbohydrate intake, in 70% of them; 37.5% had lipid intake above recommended and 65% had low fiber intake. The mean daily sodium intake was 2.64 g (±1.74), with 55% of participants ingesting more than the recommended amount. A total of 52.5% had low potassium intake, with a mean of 4.79 g/day (±2.49). Calcium intake was adequate in 27.5%. No significant differences were identified in relation to mean daily consumption among participants with or without the various metabolic disorders. Conclusion: Pediatric urolithiasis is often accompanied by metabolic disorders; therefore, metabolic evaluation should be part of the diagnostic process and subsequent analysis of these patients' dietary patterns, helping to optimize treatment and prevent recurrences and complications.

Resumo Objetivo: Descrever o padrão alimentar e a ocorrência de distúrbios metabólicos em crianças e adolescentes portadoras de urolitíase acompanhadas em hospital de referências no sul do Brasil a fim de conhecer as particularidades da urolitíase nessa população para melhor desenvolver ações de prevenção. Métodos: Estudo observacional descritivo realizado entre 2016 e 2017 em centro de referência em atenção terciária. Foram selecionados 40 pacientes de dois a 19 anos com urolitíase comprovada por exame de imagem. Dados clínicos e alimentares foram obtidos através de prontuário e entrevista. Para análise estatística, utilizou-se o teste qui-quadrado. Resultados: Foram analisados 40 indivíduos, 55% masculinos. Idade média ao diagnóstico 7,2 ± 4 anos; 25% tinham sobrepeso ou obesidade; 95% tinham distúrbios metabólicos, predominou a hipocitratúria. O consumo proteico e de carboidratos foi adequado em 100% e 70% dos participantes, respectivamente, 37,5% apresentaram ingestão de lipídeos acima do recomendado e 65% apresentaram ingestão de fibras alimentares abaixo do recomendado. O consumo diário médio de sódio foi de 2,64 g (± 1,74), com 55% acima do recomendado; 52,5% apresentaram baixa ingestão de potássio com média de 4,79 g/dia (± 2,49). O consumo de cálcio foi adequado em 27,5%. Não foram identificadas diferenças significativas em relação ao consumo médio diário dos nutrientes entre os participantes com ou sem os diversos distúrbios metabólicos. Conclusões: A urolitíase pediátrica é frequentemente acompanhada de distúrbios metabólicos, o que confirma a necessidade de avaliação metabólica adequada ao diagnóstico e análise do padrão alimentar a fim de identificar erros alimentares, aprimorar o tratamento desses distúrbios e prevenir recorrências e complicações.

Influence of socioeconomic disparities, temperature and humidity in kidney stone composition / Influência de disparidades socioeconômicas, temperatura e umidade na composição de cálculos renais

Abstract Introduction: Large variations in demographic, economic and environmental factors might influence the worldwide distribution of urolithiasis, but scarce data are available concerning their associations with stone composition. We aimed to evaluate the frequency and composition of kidney stones and their associations with temperature, humidity, and human development index (HDI). Materials and Methods: A total of 1,158 stones from distinct patients (47±14 years old, male/female 2:1) were included. The mean annual temperature and relative humidity of each town were considered separately. Results: Calcium oxalate monohydrate (COM) was disclosed in 38.8% of patients, calcium oxalate dihydrate (COD) in 22.1%, mixed COD/apatite in 9.4%, pure apatite in 1.9%, brushite in 1.8%, struvite in 8.3%, pure uric acid in 11.1%, mixed uric acid/COM in 5.6%, and cystine/rare types in 0.8%. Mean HDI of all pooled cities was 0.780±0.03. However, people living in HDI<0.800 regions had twice the odds of having a struvite stone versus those living in HDI>0.800 (OR=2.14, 95% CI 1.11-4.11). Furthermore, a progressive increase in the struvite stones frequency from 4.5 to 22.8% was detected from HDI>0.800 through HDI<0.700. No significant difference for other stone types was disclosed. Separate logistic regression models assessed the association of each stone composition with gender, temperature, humidity and HDI as covariates. Conclusion: Patients living in low HDI areas are more prone to develop struvite stones, possibly due to lower access to healthcare. Temperature and humidity did not represent a specific risk factor for any stone type in the present sample.

Resumo Introdução: Grandes variações em fatores demográficos, econômicos e ambientais podem influenciar a distribuição mundial da urolitíase, mas há muito pouco dado disponível sobre suas associações com a composição do cálculo renal. Nosso objetivo foi avaliar a frequência e composição dos cálculos renais e suas associações com temperatura, umidade e índice de desenvolvimento humano (IDH). Materiais e Métodos: Foram incluídos 1.158 cálculos de pacientes distintos (47 ± 14 anos, masculino / feminino 2:1). A temperatura média anual e a umidade relativa de cada cidade foram consideradas separadamente. Resultados: O oxalato de cálcio monohidratado (COM) foi detectado em 38,8% dos pacientes; oxalato de cálcio dihidratado (COD) em 22,1%; mistos de COD/apatita em 9,4%; apatita pura em 1,9%; brushita em 1,8%; estruvita em 8,3%, ácido úrico puro em 11,1%; mistos de ácido úrico /COM em 5,6% e cistina/tipos raros em 0,8%. O IDH médio de todas as cidades em conjunto foi de 0,780 ± 0,03. No entanto, indivíduos que vivem em regiões com IDH <0,800 apresentaram duas vezes a razão de chances de ter cálculo de estruvita do que aqueles que vivem em cidades com IDH > 0,800 (OR = 2,14; IC 95% 1,11-4,11). Além disso, um aumento progressivo na frequência de cálculos de estruvita de 4,5 para 22,8% foi detectado em IDH> 0,800 até IDH <0,700. Não foi observada nenhuma diferença significante para outros tipos de cálculos. Modelos separados de regressão logística foram utilizados para avaliar a associação de cada tipo de cálculo com gênero, temperatura, umidade e IDH como covariáveis. Conclusão: Pacientes que vivem em áreas com baixo IDH são mais propensos a desenvolverem cálculos de estruvita, possivelmente devido ao menor acesso à assistência médica. A temperatura e a umidade não representaram um fator de risco específico para qualquer tipo de cálculo na presente amostra.

Association between dietary pattern and metabolic disorders in children and adolescents with urolithiasis.

OBJECTIVE: To describe the dietary patterns and occurrence of metabolic disorders in children and adolescents with urolithiasis treatment at a referral hospital in southern Brazil in order to learn the features of urolithiasis in this population to better develop preventive actions. METHODS: Descriptive study conducted between 2016 and 2017 in a tertiary care referral hospital. Fourty patients aged 2-19 years old with urolithiasis proven by imaging were included. Clinical and dietary data were obtained through interviews and medical records. For statistical analyses, the chi-squared test was performed. RESULTS: 40 individuals were analyzed. Mean age at diagnosis was 7.2±4 years. 25% were overweight or obese. 95% had metabolic disorders, hypocitraturia being the predominant type. Protein intake was adequate in all participants and carbohydrate intake, in 70% of them; 37.5% had lipid intake above recommended and 65% had low fiber intake. The mean daily sodium intake was 2.64g (±1.74), with 55% of participants ingesting more than the recommended amount. A total of 52.5% had low potassium intake, with a mean of 4.79g/day (±2.49). Calcium intake was adequate in 27.5%. No significant differences were identified in relation to mean daily consumption among participants with or without the various metabolic disorders. CONCLUSION: Pediatric urolithiasis is often accompanied by metabolic disorders; therefore, metabolic evaluation should be part of the diagnostic process and subsequent analysis of these patients' dietary patterns, helping to optimize treatment and prevent recurrences and complications.

Uso de cateter doble J en ureteroscopias por litiasis ureteral / Use of double catheter J in ureteroscopies by ureteral litiasis

RESUMEN Se presenta serie prospectiva no randomizada de pacientes tratados con Ureteroscopia por litiasis ureteral. Se compara el uso de catéter doble J para evaluar diferencia en complicaciones postoperatorias. Se incluyen finalmente a 110 pacientes que cumplen con el seguimiento. Se observa diferencia significativa entre ambos grupos en relación a la presencia de colico renal post operatorio a favor del grupo sin cateter 33 por ciento v/s 0 por ciento . Las complicaciones menores son más frecuentes en el grupo con catéter. La mayoría de los pacientes tolero el catéter a pesar de las molestias. Se aconseja su uso paradisminuir esta complicación.(AU)

ABSTRACT: We present a non-randomized prospective series of patients treated with Ureteroscopy due to ureteral lithiasis. The use of a double J catheter is compared to evaluate the difference in postoperative complications. Finally, 110 patients who comply with the follow-up are included. A significant difference was observed between both groups in relation tothe presence of post-operative renal colic versus the group without catheter 33 pertcent v / s 0 pertcent . Minor complications are more frequent in the catheter group. Most patients tolerated the catheter despite the discomfort. Its use is advised to reduce this complication.(AU)

Litíase urinária / Urinary lithiasis

A litíase urinária pode ser considerada uma doença crônica pela sua taxa de recorrência de 50% dos casos em até 10 anos de seguimento clínico. Como uma urgência médica, a ocorrência da cólica renoureteral manifestada pela súbita obstrução do trato urinário leva muitos pacientes ao pronto atendimento hospitalar e em determinadas situações com elevado risco quando associado à infecção do trato urinário e insuficiência renal.Elaboramos uma completa revisão sobre o assunto abordando desde a sua fisiopatologia até como realizar o tratamento atual da doença litiásica e sua prevenção.