Treatment of bladder stones without associated prostate surgery: results of a prospective study.

OBJECTIVES: To assess the effectiveness of noninvasive bladder lithiasis treatment without associated prostate surgery to know whether bladder lithiasis is an absolute indication for prostate surgery. METHODS: Fifty patients with bladder lithiasis were entered in a prospective trial and were treated with extracorporeal shock wave lithotripsy if lithiasis was smaller than 4 cm2. Independent of the presence or absence of bladder outlet obstruction, in no case was prostate surgery associated. The variables studied were the effectiveness of the treatment, changes in the International Prostate Symptom Score (IPSS), and the subsequent need for desobstructive prostate surgery. The statistical study was performed using Student's t test and the proportional hazards model. RESULTS: Bladder lithiasis was successfully eliminated in 93% of the cases (in 77% of them with a single extracorporeal shock wave lithotripsy session). The mean IPSS decreased from 17.7 to 9.7 points (P = 0.0001) after lithiasis elimination. After a mean follow-up of 22 months, a mere 8% of the patients needed subsequent prostate surgery because their IPSS had increased to 20 points or more. The sole prognostic factor for the need for ensuing prostate surgery was the pretreatment IPSS score (P = 0.042). CONCLUSIONS: Noninvasive management of bladder lithiasis with no associated prostate surgery is highly efficient and results in marked symptomatic improvement. Furthermore, the number of patients needing subsequent prostate surgery was very low at mid-term follow-up. Because of all of the above, the existence of bladder lithiasis is not an absolute indication for prostate surgery.

Urodynamic findings before and after noninvasive management of bladder calculi.

OBJECTIVES: To determine the most frequent urodynamic observations associated with bladder calculi, and to assess whether the presence of calculi alters these observations. PATIENTS AND METHODS: Fifty patients with bladder stones were included in a prospective study in which two urodynamic tests were used, one at inclusion and another once the patient was stone- free after treatment by noninvasive methods (mainly extracorporeal shockwave lithotripsy). RESULTS: The results from the urodynamic evaluation with the stone in the bladder were: bladder outlet obstruction in 51%, detrusor overactivity in 68%, detrusor under-activity in 10%, and a normal study in 18%. There were no significant differences between the urodynamic study before or after treatment in maximum flow rate and postvoid residual volume, detrusor overactivity and detrusor pressure at maximum flow. CONCLUSIONS: Conversely to what has been accepted for years, bladder calculi are not always associated with bladder outlet obstruction and the urodynamic results are not influenced by the presence of bladder stones during the urodynamic testing.

[Assisted extraction using extracorporeal lithotripsy of the calcified ureteral catheter overlooked for 2 years]. / Extracción asistida mediante litotricia extracorpórea de un catéter ureteral calcificado olvidado 2 años.

A 45 year old man with a 2 year forgotten left double-pigtail ureteric stent was referred to our hospital. Because of distal calcifications, the stent could not be removed by means of a cystoscopy. So, extracorporeal wave lithotripsies were performed and then the stent were easily removed in two fragments by cystoscopy and ureteroscopy.

Extracción asistida mediante litotricia extracorpórea de un catéter ureteral calcificado olvidado 2 años / Extracorporeal wave lithotripsy assisted drawing of a calcified ureteral stent left out for two years

Se presenta el caso de un varón de 45 años que llevaba olvidado durante 2 años un catéter ureteral doble J izquierdo. El catéter presentaba ambos extremos calcificados no pudiéndose extraer mediante cistoscopia y pinzas. Se realizaron sesiones de litotricia extracorpórea en ambos extremos consiguiéndose la fragmentación de la litiasis y posteriormente pudo ser extraído en dos trozos mediante cistoscopia y ureteroscopia (AU)

A 45 year old man with a 2 year forgotten left double-pigtail ureteric stent was referred to our hospital. Because of distal calcifications, the stent could not be removed by means of a cystoscopy. So, extracorporeal wave lithotripsies were performed and then the stent were easily removed in two fragments by cystoscopy and ureteroscopy (AU)

[Treatment of bladder lithiasis with shock-wave extracorporeal lithotripsy]. / Tratamiento de la litiasis vesical mediante litotricia extracorpórea por ondas de choque.

PURPOSE: To evaluate the effectiveness and the prognostic factors of the bladder stones (BS) treatment by means of extracorporeal shock wave lythotripsy (ESWL). METHODS: 183 patients with BS treated using ESWL were retrospectively analysed. Independent variables were: gender, age, obstruction, BS size, BS number and amount of waves. Dependent variable was total BS resolution. Statistical analysis was provided by Cox's regression multivariate analysis, Kaplan-Meier analysis and the t Student test. RESULTS: Total effectiveness of the treatment was 73%. Initial BS size was the only prognostic factor on multivariate analysis (p = 0.0035) with smaller stones obtaining the best results (log rank p = 0.00001): 92% of effectiveness in BS smaller than 1 cm2, 73% in 1-2 cm2, 57% in 2-3 cm2 and 42% in larger than 3 cm2. BS mean size decreased 2 cm2 after the first ESWL (p = 0.00001). CONCLUSIONS: Initial BS size was the only prognostic factor of resolution. Total effectiveness was 73% and it highly increased in BS smaller than 2 cm2.

Tratamiento de la litiasis vesical mediante litotricia extracorpórea por ondas de choque / Bladder stone treatment with extracorporeal shock wave lithotripsy

FUNDAMENTO: Valorar la eficacia y los factores pronósticos de éxito del tratamiento de la litiasis vesical (LV), mediante litotricia extracorpórea por ondas de choque (LEOC). MÉTODOS: Estudio retrospectivo de 183 pacientes afectos de LV tratados mediante LEOC. Las variables independientes estudiadas fueron sexo, edad, obstrucción, tamaño de la LV, número de LV y número de ondas. La variable dependiente fue la desaparición total de la LV. Estudio de los factores pronósticos mediante análisis multivariante por regresión de Cox, y análisis de Kaplan-Meier. Variación del tamaño de la LV estudiada mediante la prueba t de Student. RESULTADOS: Eficacia global del 73 por ciento. El análisis multivariante mostró que el único factor pronóstico fue el tamaño inicial de la litiasis (p = 0,0035). A menor tamaño de la LV mejor resultado (log rank p = 0,00001): eficacia del 92 por ciento en las LV menores de 1 cm 2 , 73 por ciento entre 1-2 cm 2 , 57 por ciento de 2-3 cm 2 y 42 por ciento en mayores de 3 cm 2 . Disminución media del tamaño de la LV tras la primera sesión de LEOC de 2 cm 2 (p = 0,0001). CONCLUSIONES: El único factor pronóstico fue el tamaño inicial de la LV. La eficacia global de la técnica es del 73 por ciento, aumentando considerablemente en LV menores a 2 cm 2 (AU)