The Use of a Virtual Reality Device (HypnoVR) During Extracorporeal Shockwave Lithotripsy for Treatment of Urinary Stones: Initial Results of a Clinical Protocol.

OBJECTIVE: To assess the impact of a Virtual Reality Device (VRD, HypnoVR, Strasbourg, France) on patient-reported pain and anxiety during extracorporeal shockwave lithotripsy (ESWL). MATERIALS AND METHODS: We enrolled 30 patients submitted to ESWL for urinary stones. Patients with either epilepsy or migraine were excluded. ESWL procedures were performed using the same lithotripter (Lithoskop; Siemens, AG Healthcare, Munich, Germany) at a frequency of 1 Hz delivering 3000 shock waves per procedure. The VRD was installed and started 10 minutes before the procedure. Tolerability of pain and treatment-related anxiety represented the primary efficacy outcomes and were evaluated using: (1) a visual analogue scale (VAS), (2) the short version of the McGill pain questionnaire (MPQ), and (3) the short version of the surgical fear questionnaire (SFQ). Secondary outcomes were VRD ease of use and patient satisfaction. RESULTS: Median (IQR) age was 57 (51-60) years and body mass index (BMI) was 23 (22-27) kg/m2. Median (IQR) stone size was 7 (6-12) mm with a median (IQR) density of 870 (800-1100) HU. Stone location was kidney in 22 (73%), and ureter in 8 (27%) patients. Median (IQR) extra time for installation was 6.5 (4-8) minutes. Overall, 20 (67%) patients were at their first ESWL treatment. Side effects were experienced by only 1 patient. Comprehensively, 28 (93%) patients would recommend and would use VRD again during ESWL. CONCLUSION: VRD application during ESWL is safe and feasible. The initial report from patients is positive in terms of pain and anxiety tolerance. Further comparative studies are needed.

Tratamiento farmacológico de la litiasis renal / Medical treatment of renal stones

INTRODUCCIÓN: La prevalencia de la patología litiásica se estima en un 5% al 15%, con una clara tendencia al aumento en los países industrializados. Los pacientes con episodios recurrentes de litiasis renal presentan un riesgo aumentado de enfermedad renal crónica que puede potencialmente limitar su expectativa de vida. OBJETIVO: Revisión y síntesis de las opciones terapéuticas recomendadas para la prevención en la recurrencia de cálculos urinarios basadas en el tipo de cálculo o alteración urinaria en orina de 24 horas, según las guías clínicas y publicaciones recientes. CONCLUSIONES: Medidas dietéticas y farmacológicas han demostrado una reducción de hasta el 60% en la recurrencia de episodios clínicos cuando son dirigidas según el tipo de cálculo y los resultados de los estudios metabólicos. El aumento en la prevalencia mundial de esta patología y el potencial riesgo de enfermedad renal crónica en pacientes recurrentes, justifican la necesidad de ampliar los conocimientos fisiopatológicos que precipitan la formación de litiasis urinarias para el desarrollo de nuevos tratamientos más eficaces en la prevención de esta enfermedad

INTRODUCTION: Prevalence of urolitiasis is estimated between 5-15% with a clear trend to increasing in the industrialized countries. Stone recurrent patients show an increased risk of chronic renal disease which can potentially limit their life expectancy. OBJECTIVE: A review and summary of the different recommended treatment options to prevent urinary stone recurrence based on the type of calculi or urinary metabolic alterations in 24 h urine, according to recent guidelines and publications. CONCLUSIONS: Dietetic and pharmacologic measures, when addressed depending on the type of stone and results of metabolic evaluation have shown a decrease up to 60% of the recurrent clinical events. The increase of prevalence worldwide and the potential risk of chronic kidney disease in these patients clearly justify the need of increasing physiopathologic knowledge leading urolithiasis formation in order to develop new and more effective drugs for its prevention

Medical treatment of renal stones. / Tratamiento farmacológico de la litiasis renal.

INTRODUCTION: Prevalence of urolithiasisis estimated between 5-15% with a clear trend to increasing in the industrialized countries. Stone recurrent patients show an increased risk of chronic renal disease which can potentially limit their life expectancy. OBJECTIVE: A review and summary of the different recommended treatment options to prevent urinary stone recurrence based on the type of calculi or urinary metabolic alterations in 24 h urine, according to recent guidelines and publications. CONCLUSIONS: Dietetic and pharmacologic measures, when addressed depending on the type of stone and results of metabolic evaluation have shown a decrease up to 60% of the recurrent clinical events. The increase of prevalence worldwide and the potential risk of chronic kidney disease in these patients clearly justify the need of increasing physiopathologic knowledge leading urolithiasis formation in order to develop new and more effective drugs for its prevention.

INTRODUCCIÓN: La prevalencia de lapatología litiásica se estima en un 5% al 15%, con unaclara tendencia al aumento en los países industrializados. Los pacientes con episodios recurrentes de litiasis renal presentan un riesgo aumentado de enfermedad renal crónica que puede potencialmente limitar su expectativade vida.OBJETIVO: Revisión y síntesis de las opciones terapéuticas recomendadas para la prevención en la recurrencia de cálculos urinarios basadas en el tipo de cálculo o alteración urinaria en orina de 24 horas, según las guías clínicas y publicaciones recientes.CONCLUSIONES: Medidas dietéticas y farmacológicas han demostrado una reducción de hasta el 60% en la recurrencia de episodios clínicos cuando son dirigidas según el tipo de cálculo y los resultados de los estudios metabólicos. El aumento en la prevalencia mundial de esta patología y el potencial riesgo de enfermedad renal crónica en pacientes recurrentes, justifican la necesidad de ampliar los conocimientos fisiopatológicos que precipitan la formación de litiasis urinarias para el desarrollo de nuevos tratamientos más eficaces en la prevención de esta enfermedad.