Successful Treatment of Ureteral Obstructive Lithiasis by Ureterotomy in a Domestic Hen.

A 2-year-old domestic hen was presented for a 15-day history of intermittent left leg lameness. The owners also observed a decrease in egg quality during that period. Physical examination of the bird revealed a generalized weakness with a flattened pale comb. Neurological evaluation of the left leg found a proprioceptive deficit with no loss of pain sensitivity. Whole body radiographic images showed a marked reduction of abdominal detail, a large amount of "grit" (mineral opacity) in the ventriculus, intestinal dilation, and a metallic foreign body (nail) in the digestive tract. Abnormal results from a plasma biochemistry panel were hypercalcemia, hypertriglyceridemia, hyperglobulinemia, hypophosphatemia, increased creatine kinase, and decreased uric acid. After initial stabilization of the patient, a computed tomographic scan was obtained, which revealed multiple right-sided ureteral calculi, the largest of which measured 10 mm in diameter, and changes compatible with cystic right renal nephrosis. Suspected compensatory enlargement of the left kidney was also observed. Considering the renal lesion and associated neurological limb impairment, surgery was recommended and approved by the owner. A right lateral approach was used for the coeliotomy, and a ureterotomy was performed to remove all calculi. Analysis of the ureteral stones confirmed they were 100% uric acid salts. The hen fully recovered left leg function 1 week postsurgery. Urolithiasis is well described in hens, but surgical treatment is uncommon. This report describes the successful removal of ureteral stones by ureterotomy in a domestic hen.

Determining whether previous SWL for ureteric stones influences the results of ureteroscopy as the second-line treatment: A clinical study.

The purpose of the study was to establish whether shock wave lithotripsy (SWL) is a potential harmful first-line treatment for ureteric stones where ureteroscopy (URS) is necessary as a second-line treatment. Medical records of patients with ureteric stones who underwent either URS as the only therapy applied or SWL followed by URS over two years were retrospectively evaluated. In total, 158 patients were included: 79 patients in Group A (no SWL) and 79 in Group B (prior SWL before URS). There was no difference in major complications, Group A had higher stone-free rates, Group B had higher rates of ureteral edema and similar intraoperative ureteral lesions. In conclusion, the failure of SWL for lumbar or pelvic ureteral lithiasis does not appear to have a negative effect on the rate of intraoperative complications or the success rate of semi-rigid retrograde URS for this category of calculi, with the same safety profile as first-line endourological intervention.

[Medical expulsive treatment for ureteral stones.] / Tratamiento médico expulsivo de la litiasis ureteral.

INTRODUCTION: Medical Expulsive Treatment (MET) for ureteral stones has been questioned for the last few years. OBJECTIVES: The main goal of our study is to define the indications of MET, the different drugs that are used and their effectiveness and to propose a follow-up strategy. Secondary objectives include the effectiveness of MET in some special subgroups such as pregnant women and children and to assess aspects of MET cost-effectiveness compared with other options for ureteral lithiasis treatment (ureterorenoscopy or extracorporeal shock wave lithotripsy). MATERIAL AND METHODS: We have reviewed the most relevant clinical trials and meta-analysis evaluating the impact of the different drugs available for MET. For the research we used some keywords like "medical expulsive treatment/therapy", "ureteral lithiasis", "urolithiasis", "effectiveness", "alpha-blockers" and "calcium-antagonists". MEDLINE database was used for there search (using the portal web Pubmed). RESULTS: Highest quality studies currently availables how significant methodological limitations leading to heterogeneous and restricted evidence, which is only applicable to patients and lithiasis with specific conditions. Nevertheless, in general terms, it seems that MET can play a certain role in the expulsion of lithiasis ≥ 5mm y ≤ 10 mm located in the distal ureter, although it has not been possible to demonstrate that any of the drugs used may have special superiority in terms of effectiveness. In pregnancy and children, the recommendations of MET are also irregular. Finally, MET seemsto be an alternative cost-effective compared to active options of treatment. CONCLUSIONS: Higher quality clinical trials are needed to reliably advice MET. With the current evidence, it appears that MET can improve the expulsion of distal ureteral lithiasis ≥ 5 mm and ≤ 10 mm, even though we have not found differences between the drugs that are available for MET.

INTRODUCCIÓN: El Tratamiento Médico Expulsivo (TME) para litiasis ureterales ha sido puesto en cuestión durante los últimos años. OBJETIVOS: El objetivo principal de nuestro trabajo es definir las indicaciones del TME, los fármacos empleados y su efectividad y proponer un esquema de seguimiento. Los objetivos secundarios son analizar la efectividad del TME en algunos subgrupos especiales de la población como son las embarazadas y los niños y valorar aspectos de coste-efectividad del TME en comparación con otras opciones de tratamiento de litiasis ureterales (ureterorrenoscopia o litotricia extracorpórea por ondas de choque). MATERIAL Y MÉTODOS: Hemos realizado una revisión de los ensayos clínicos y metaanálisis de mayor relevancia que valoran la efectividad de los diferentes fármacos disponibles para el TME. Para la búsqueda bibliográfica hemos utilizado algunos términos como medical expulsive treatment/therapy", "ureteral lithiasis", "urolithiasis","effectiveness", "alpha-blockers" y "calcium-antagonists",siendo la principal base de datos consultada MEDLINE (a través del portal web PubMed). RESULTADOS: Aún los estudios de mayor calidad presentan importantes limitaciones metodológicas, lo que condiciona que la evidencia obtenida sea heterogénea y restringida a pacientes y litiasis que cumplan determinadas condiciones. En líneas generales, el TME puede tener cierto papel en la expulsión de litiasis de tamaño ≥5 mm y ≤10 mm localizadas en uréter distal, aunqueno se ha logrado demostrar que alguno de los fármacos utilizados pueda tener especial superioridad en términos de efectividad. En gestantes y niños las indicaciones delTME tampoco estan estandarizadas. Por último, el TME en comparación con opciones de tratamiento, parece ser una alternativa más coste-efectiva y la preferida por los pacientes según estudios sobre QoL. CONCLUSIONES: Es necesario realizar ensayos clínicos de mayor calidad para poder indicar el TME con unmayor nivel de evidencia. Con la evidencia actual, parece que el TME puede favorecer la expulsión de litiasis localizadas en uréter distal y con un tamaño ≥5 mm y ≤10 mm. A pesar de ello no se han podido encontrar diferencias entre las distintas opciones farmacológicas disponibles.

Comparative analysis of direct and indirect costs of two minimally invasive techniques for the treatment of renal/ureteral calculi smaller than 2 cm. / Análisis comparativo de costes directos e indirectos de dos técnicas mínimamente invasivas, para el tratamiento de la litiasis renoureteral menor de 2 cm.

OBJECTIVE: To perform a comparative analysis of indirect and direct costs of two minimally invasive techniques (extracorporeal shock wave lithotripsy (ESWL) vs. ureteroscopy with holmium laser (URS/RIRS)) for the treatment of renal/ureteral calculi smaller than 2 cm. MATERIAL AND METHODS: Prospective, comparative, non-randomized study of 84 patients treated for kidney stones smaller than 2 cm between January and December 2016. Of these, 38 (45.67%) were treated with ESWL (18 renal lithiasis and 20 ureteral lithiasis) and 46 (54.32%) with URS/RIRS (22 renal lithiasis and 24 ureteral lithiasis). A total of 19 (41.3%) patients in the URS/RIRS group and 15 (39.5%) patients in the ESWL group were actively working before treatment. The variables analyzed were sex, age, number and size of lithiasis, time (days) off from work due to treatment, estimate of indirect cost due to labor productivity loss and direct treatment costs including follow-up (total number of procedures, ancillary care, visits and diagnostic tests). The 2015 Wage Structure Survey (INE) was used to estimate the indirect cost. In addition, the «Work Productivity and Activity Impairment¼ (WPAI) questionnaire was also used to determine the level of perceived productivity loss. RESULTS: The mean number of sessions until lithiasis resolution was achieved was 2.57 for the ESWL group and 1.04 for the URS. The mean number of days off from work in the URS group was 7.16 days and 3.18 (p = 0.034) in the ESWL group. The total indirect costs resulting from productivity loss were EUR 621.55 and EUR 276.05 for the URS and ESWL, respectively. Direct costs in the ESWL group were EUR 1,382.9 and EUR 2,317.71 in the URS group. The level of work impairment perceived by patients undergoing URS was 18.88% and 21.33% in the ESWL group. The degree of impairment for performing activities of daily living was 24.44% in the URS and 15% in ESWL. CONCLUSIONS: The ESWL technique requires a higher number of sessions for the resolution of kidney stones under 2 cm, but it has a lower impact on total costs and on the perceived degree of affectation.

[Treatment of uretero-renal stones with shock wave lithotripsy. Results and complications with the dornier gemini emse 220f-XXP.] / Tratamiento de la litiasis reno-ureteral con litotricia extracorpórea con ondas de choque. Resultados y complicaciones con el equipo Dornier Gemini EMSE 220f-XXP.

OBJECTIVES: Extracorporeal shock wave lithotripsy is a minimally invasive therapeutic option for the treatment of renal-ureteral lithiasis. The aim of this study was to analyze the results and complications of shock wave extracorporeal lithotripsy treatment with the Dornier Gemini® Generator EMSE 220f-XXP device in patients with renal and ureteral lithiasis. MATERIAL AND METHODS: Retrospective study including 377 patients with renal or ureteral lithiasis with indication for treatment with extracorporeal shock wave lithotripsy. The following variables were analyzed, age, sex, body mass index, lithiasis size, lithiasis location, presence of urinary diversion, number of lithotripsy sessions, number of shock waves, fluoroscopy time, wave energy, applied focal energy coefficient, efficiency coefficient, lithiasic fragmentation, lithiasic clearance, residual lithiasis, presence of lithiasis and complications. The results were analyzed with SPSS 17.0 considering statistical significance p≤0.05. RESULTS: Of the 377 patients, 213 were men and 164 women, with a mean age of 51.28 ± 12.77 years. The mean size of the stones in maximum diameter was 11.77 ± 6.13 mm. Lithiasis fragmentation occurred in 81.9% of cases, with a percentage of residual lithiasis after the first session of 58.7% and a total or partial expulsion rate of lithiasis fragments of 68.3%, with global success at the end of sessions of lithotripsy of 69.8%. The overall Efficiency Ratio was 0.42, higher in upper calyx 0.51 and lower in medium calyx 0.35, with significant differences (p<0.05). The only differences were found in relation to the success of lithotripsy treatment (75% versus 64.6%, p=0.02), according to lithiasis size (≤10 mm maximum diameter in comparison to >10 mm). In patients with a DJ catheter there is a higher percentage of residual lithiasis (p=0.006). CONCLUSIONS: Treatment with extracorporeal lithotripsy in small lithiasis and in well-selected patients obtains good results with a low rate of complications regardless of sex and body mass index.

OBJETIVOS: La litotricia extracorpórea por ondas de choque es una opción terapéutica mínimamente invasiva para el tratamiento de las litiasis reno-ureterales. El objetivo de este trabajo es analizar los resultados y complicaciones del tratamiento con litotricia extracorpórea con ondas de choque con el dispositivo de última generación Dornier Gemini® generador EMSE 220f-XXP en pacientes con litiasis renal y ureteral. MATERIAL Y MÉTODOS: Estudio retrospectivo en el que se incluyen 377 pacientes con litiasis renal o ureteral con indicación de tratamiento con litotricia extracorpórea con ondas de choque. Se analizan las siguientes variables que incluyen la edad, sexo, índice de masa corporal, tamaño litiásico, localización de la litiasis, presencia de derivación urinaria, número de sesiones de litotricia, número de ondas de choque, tiempo de escopia, energía de las ondas, coeficiente de energía focal aplicada, coeficiente de eficiencia, fragmentación litiásica, expulsión litiásica, litiasis residual, presencia de calle litiásica y complicaciones. Se analizan los resultados con programa SPSS 17.0 considerando significación estadística p≤0,05. RESULTADOS: De los 377 pacientes, 213 fueron hombres y 164 mujeres, con edad media 51,28 ± 12,77 años. El tamaño medio de las litiasis en diámetro máximo fue de 11,77 ± 6,13 mm. Se produce fragmentación de la litiasis en el 81,9% de los casos, con un porcentaje de litiasis residual tras la primera sesión de 58,7% y una tasa de expulsión total o parcial de fragmentos litiásicos del 68,3%, con un éxito global al finalizar las sesiones de litotricia del 69,8%. El Coeficiente de Eficiencia global fue de 0,42, más elevado en cáliz superior 0,51 y más bajo en cáliz medio 0,35, con diferencias significativas (pencontradas se observan según tamaño litiásico (≤10 mm de diámetro máximo con respecto a >10mm) en relación al éxito del tratamiento con litotricia (75% versus 64,6%, catéter DJ existe un mayor porcentaje de litiasis residual (p=0,006). CONCLUSIÓN: El tratamiento con litotricia extracorpórea en litiasis de pequeño tamaño y en pacientes bien seleccionados obtiene buenos resultados con un bajo índice de complicaciones independientemente del sexo y del índice de masa corporal.

[Giant hydronephrosis associated with ureterocele complicated by ureteral lithiasis]. / Hydronéphrose géante sur urétérocèle compliquée de lithiase urétérale.

Giant hydronephrosis is defined as an extensive dilation of the pyelocaliceal cavities occupying a large part of the abdominal cavity or as a dilation filled up with more than a liter of urine overflowing the median line. This is due, more often, to pyelo-ureteral junction syndrome. Obstruction due to ureterocele complicated by lithiasis is a very rare cause of giant hydronephrosis. We here report the case of a 45-year old patient with a history of right lumbar pain which hadn't been investigated, presenting with abdominal mass evolving over the last few years associated with intermittent constipation. Clinical examination showed asymmetrical abdominal distension with dullness above the median line. Ultrasound showed multi-compartmentalized fluid-filled mass occupying all the right abdominopelvic region and pressing the digestive structures. Uroscanner showed right giant ureteropyelocaliceal dilation (pyelon measuring 15.2cm) completely eroding the renal parenchyma with absence of contrast agent excretion, upstream of ureterocele complicated by a stone measuring 2cm. Laparoscopic nephroureterectomy was performed. Post-operative suites were simple.

Socioeconomic evaluation of the treatment of ureteral lithiasis.

BACKGROUND AND AIM: This study attempts to estimate the socioeconomic differences between three major alternatives for the management of upper and lower ureteral lithiasis. MATERIAL AND METHODS: Two hundred and forty patients with upper and lower ureteral lithiasis, have been studied retrospectively, divided in six equal groups of forty. These patients have been treated either by extracorporeal shockwave lithotripsy (SWL), or with ureteroscopy with semirigid ureteroscope and the use of pneumatic lithoclast, or with ureteroscopy with flexible ureteroscope and the use of Holmium YAG Laser. For cost calculation, the reimbursement fee paid by insurance to the hospital was taken into account. For the estimation of the social burden, the length of hospital stay and the number of outpatient visits have been included as countable parameters. RESULTS: The percentage of effective stone removal for upper ureter was 81.0% for SWL, 62.5% for ureteroscopy with semirigid ureteroscope and the use of pneumatic lithoclast and, 82.5% for ureteroscopy with flexible ureteroscope and the use of Holmium YAG Laser. The same percentages for lower ureter were 82.5%, 92.5% and 97.5% respectively. The cost of stone removal for both the upper and lower ureter using extracorporeal lithotripsy was significantly higher compared to the other two procedures (median cost for upper ureter 828 € vs 474.50 € and 396 € respectively, and for lower ureter 826 € vs 396 € and 271 €, p<0.001). Regarding the social aspect, SWL is mainly an outpatient procedure, requiring a short hospital stay (for upper ureter 1.63 vs 2.48 and 2.45 respectively and for lower ureter 1.35 vs 2.43 and 2.13days), but needing more and prevailing clinic visits (for upper ureter 1.43 vs 1.45 and 1 respectively and for lower ureter 1.45 vs 1.15 and 0.55 visitsgive numbers, compare), both in outpatient and in accident and emergency (A&E) department. CONCLUSION: The increase in the expenses with regard to health management indicates the necessity of cost accounting the health programs including the medical procedures as a means to improve the relation between cost and benefit.

Resultados de la litotricia extracorpórea utilizando el litotritor MODULITH SLX-MX (STORZ) para el tratamiento de la litiasis ureteral / Results of the shock waves extracorporeal lithotripsy using the MODULITH SLX-MX (STORZ) lithotriptor for treatment or ureteral lithiasis

INTRODUCCIÓN. La litiasis del uréter constituye una gran preocupación para los médicos debido a que frecuentemente ocasiona una uropatía obstructiva y el deterioro progresivo de la función renal ipsolateral, estado patológico de alta prevalencia, por lo que los hospitales con frecuencia no pueden dar solución quirúrgica con la celeridad necesaria. El objetivo de esta investigación fue conocer los resultados de la litotricia extracorpórea por ondas de choque (LEC) con el litotritor MODULITH SLX-MX (STORZ) para el tratamiento de la litiasis ureteral. MÉTODOS. Se incluyeron 598 pacientes con litiasis radiopaca del uréter, atendidos en el Hospital Hermanos Ameijeiras entre enero de 2007 y diciembre de 2008. Se conformaron 4 grupos según la localización del cálculo: en la unión pieloureteral (UPU) (96), uréter lumbar (UL) (263), iliaco (UI) (40), pelviano (UP) (199) y se analizó su relación con la superficie litiásica, sesiones de tratamiento, maniobras complementarias previas a la litotricia, aplicación de procedimientos auxiliares posteriores, resolución definitiva por otra técnica quirúrgica y eficacia terapéutica. La colimación se realizó por fluoroscopia. RESULTADOS. El mayor número de cálculos se localizó en el uréter lumbar, y en segundo lugar, en el uréter pelviano. El tamaño medio de la litiasis fue de 0,8 ± 0,5233 cm2, en rango de 0,09-4 cm2. La media de sesiones utilizadas fue de 1,24 ± 0,531, rango de 1-4. Se realizaron maniobras complementarias previas en 72 pacientes (12,04 por ciento) y la más utilizada fue la nefrostomía percutánea (40; 6,6 por ciento). Después de la LEC fue necesaria la conversión a otro procedimiento para la solución del 4,68 por ciento de los casos. La LEC fue eficaz en el 95,32 por ciento, con mejores resultados en el UP (96,99 por ciento) y peores en el UI (92,50 por ciento). CONCLUSIONES. Los resultados fueron buenos utilizando el litotritor MODULITH SLX-MX (STORZ). Los mejores resultados se obtuvieron en el uréter pelviano y en general es posible considerar la LEC como la primera opción terapéutica de la litiasis ureteral(AU)

INTRODUCTION. Ureter lithiasis is a concern for physicians because frequently provokes an obstructive uropathy and a progressive deterioration of ipsilateral renal function and a high prevalence of pathological state that is why the hospitals can not give a surgical solution as quickly as possible. The objective of present research was to know the results of the shock waves extracorporeal lithotripsy (SWEL) using the MODULITH SLX-MX (STORZ) lithotriptor for treatment or ureteral lithiasis. METHODS. In present research 598 patients presenting with ureter radiopaque lithiasis, seen in the Hermanos Ameijeiras Clinical Surgical Hospital from January, 2007 to December, 2008, divided into four groups according to the calculus localization: in pyeloureteral joint (PUJ) (96), lumbar ureter (LU) (263), iliac joint (IJ) (40), pelvic joint (PJ) (199) analyzing its relationship with lithiasis surface, treatment sessions, complementary manoeuvres previous to lithotripsy, application of subsequent auxiliary procedures, definite resolution using other surgical technique and therapeutical effectiveness. Collimation was carried out by fluoroscopy. RESULTS. Most of calculi were located in the lumbar ureter and in the second place in pelvic ureter. The mean size of lithiasis was of 0,8 ± 0,5233 cm2 in the rank of 0,09-4 cm2. The mean of sessions used was of 1,24 ± 0,531, in the rank of 0,09-4 cm2. The mean of sessions used was of 1,24 ± 0,531, rank of 1-4. In 72 patients 12,04 percent) previous complementary manoeuvres were carried out and the more used one was the percutaneous nephrostomy (40; 6,6 percent). After SWEL it was necessary the conversion to other procedure for solution of 4,68 percent of the cases. The SWEL was effective in the 95,32 percent with better results in the UP (96,99 percent) and with worse results in the IJ (92,50 percent). CONCLUSIONS. The results were good using the MODULITH SLX-MX (STORZ) lithotriptor. The better results were obtained in the pelvic ureter and in general, it is possible to consider the SWEL as the first therapeutical choice of ureteral lithiasis(AU)

Resultados de la litotricia extracorpórea utilizando el litotritor MODULITH SLX-MX (STORZ) para el tratamiento de la litiasis ureteral / Results of the shock waves extracorporeal lithotripsy using the MODULITH SLX-MX (STORZ) lithotriptor for treatment or ureteral lithiasis

La litiasis del uréter constituye una gran preocupación para los médicos debido a que frecuentemente ocasiona una uropatía obstructiva y el deterioro progresivo de la función renal ipsolateral, estado patológico de alta prevalencia, por lo que los hospitales con frecuencia no pueden dar solución quirúrgica con la celeridad necesaria. El objetivo de esta investigación fue conocer los resultados de la litotricia extracorpórea por ondas de choque (LEC) con el litotritor MODULITH SLX-MX (STORZ) para el tratamiento de la litiasis ureteral. Se incluyeron 598 pacientes con litiasis radiopaca del uréter, atendidos en el Hospital Hermanos Ameijeiras entre enero de 2007 y diciembre de 2008. Se conformaron 4 grupos según la localización del cálculo: en la unión pieloureteral (UPU) (96), uréter lumbar (UL) (263), iliaco (UI) (40), pelviano (UP) (199) y se analizó su relación con la superficie litiásica, sesiones de tratamiento, maniobras complementarias previas a la litotricia, aplicación de procedimientos auxiliares posteriores, resolución definitiva por otra técnica quirúrgica y eficacia terapéutica. La colimación se realizó por fluoroscopia. El mayor número de cálculos se localizó en el uréter lumbar, y en segundo lugar, en el uréter pelviano. El tamaño medio de la litiasis fue de 0,8 ± 0,5233 cm², en rango de 0,09-4 cm². La media de sesiones utilizadas fue de 1,24 ± 0,531, rango de 1-4. Se realizaron maniobras complementarias previas en 72 pacientes (12,04 por ciento) y la más utilizada fue la nefrostomía percutánea (40; 6,6 por ciento). Después de la LEC fue necesaria la conversión a otro procedimiento para la solución del 4,68 por ciento de los casos. La LEC fue eficaz en el 95,32 por ciento, con mejores resultados en el UP (96,99 por ciento) y peores en el UI (92,50 por ciento). Los resultados fueron buenos utilizando el litotritor MODULITH SLX-MX (STORZ)...(AU)

Ureter lithiasis is a concern for physicians because frequently provokes an obstructive uropathy and a progressive deterioration of ipsilateral renal function and a high prevalence of pathological state that is why the hospitals can not give a surgical solution as quickly as possible. The objective of present research was to know the results of the shock waves extracorporeal lithotripsy (SWEL) using the MODULITH SLX-MX (STORZ) lithotriptor for treatment or ureteral lithiasis. In present research 598 patients presenting with ureter radiopaque lithiasis, seen in the Hermanos Ameijeiras Clinical Surgical Hospital from January, 2007 to December, 2008, divided into four groups according to the calculus localization: in pyeloureteral joint (PUJ) (96), lumbar ureter (LU) (263), iliac joint (IJ) (40), pelvic joint (PJ) (199) analyzing its relationship with lithiasis surface, treatment sessions, complementary manoeuvres previous to lithotripsy, application of subsequent auxiliary procedures, definite resolution using other surgical technique and therapeutical effectiveness. Collimation was carried out by fluoroscopy. Most of calculi were located in the lumbar ureter and in the second place in pelvic ureter. The mean size of lithiasis was of 0,8 ± 0,5233 cm² in the rank of 0,09-4 cm². The mean of sessions used was of 1,24 ± 0,531, in the rank of 0,09-4 cm². The mean of sessions used was of 1,24 ± 0,531, rank of 1-4. In 72 patients 12,04 percent) previous complementary manoeuvres were carried out and the more used one was the percutaneous nephrostomy (40; 6,6 percent). After SWEL it was necessary the conversion to other procedure for solution of 4,68 percent of the cases. The SWEL was effective in the 95,32 percent with better results in the UP (96,99 percent) and with worse results in the IJ (92,50 percent). CONCLUSIONS. The results were good using the MODULITH SLX-MX (STORZ) lithotriptor...(AU)