Validez actual de la litotricia extracorpórea como tratamiento de primera línea de la litiasis / Is extracorporeal lithotripsy a first-line treatment for urinary stones today?

Objetivo Evaluar la eficacia y complicaciones de la litotricia extracorpórea por ondas de choque (LEOCh) como tratamiento de primera línea de la litiasis renal y ureteral. Métodos Estudio observacional retrospectivo de todos los pacientes tratados con litotricia en un centro de tercer nivel entre enero de 2014 y enero de 2021. Se recogieron las características de los pacientes, de la litiasis, y las complicaciones y resultados de la LEOCh. Se realizó una regresión logística multivariante de los factores asociados a la reducción del tamaño litiásico. También se llevó a cabo un análisis estadístico de los factores asociados a la necesidad de tratamiento adicional tras la LEOCh y de los factores asociados a las complicaciones. Resultados Se incluyeron 1.727 pacientes. El tamaño litiásico medio fue de 9,5 mm. En 1.540 (89,4%) pacientes se observó la reducción del tamaño litiásico. En el análisis multivariante, el tamaño (OR=1,13; p=0,00), la localización de la litiasis en el uréter (OR=1,15; p=0,052) y el número de ondas (p=0,002; OR=1,00) utilizadas en la LEOCh son los factores asociados a la reducción del tamaño litiásico. Un total de 665 pacientes (38,5%) precisaron tratamiento adicional tras la litotricia. Los factores asociados a la necesidad de retratamiento fueron el tamaño litiásico (OR=1.131; p=0,000), el número de ondas (OR=1.000; p=0,000) y la energía administrada (OR=1.005; p=0,000). En 153 pacientes (8,8%) se produjeron complicaciones tras la LEOCh. Se encontró una asociación estadísticamente significativa entre el tamaño de la litiasis (p=0,024; OR=1.054) y la derivación urinaria previa (p=0,004; OR=0,571). Conclusión La litotricia sigue siendo eficaz como tratamiento de primera línea para la litiasis reno-ureteral, con un bajo porcentaje de complicaciones. (AU)

Objective To evaluate the efficacy and complications of extracorporeal lithotripsy (SWL) as a first-line treatment for renal and ureteral stones. Methods Retrospective and observational study of all the patients treated with lithotripsy in a third level center between January 2014 and January 2021; characteristics of the patients, the stones, complications and results of SWL is recollected. Multivariate logistic regression of the factors associated with stone size reduction was performed. A statistical analysis of the factors associated with additional treatment after SWL and factors associated with complications is also executed. Results 1727 patients are included. Stone mean size was 9,5 mm. 1540 (89.4%) patients presented reduction in stone size. In multivariate analysis, stone size (OR=1.13; P=0.00), ureteral location of the lithiasis (OR=1.15; P=0.052) and number of waves (P=0.002; OR=1.00) used in SWL are the factors associated with reduction of stone size. Additional treatment after lithotripsy was needed in 665 patients (38.5%). The factors associated with the need for retreatment were stone size (OR=1.131; P=0.000), number of waves (OR=1.000; P=0.000), energy (OR=1.005; P=0.000). 153 patients (8.8%) suffered complications after SWL. A statistically significant association was found between the size of the lithiasis (P=0.024, OR=1.054) and the previous urinary diversion (P=0.004, OR=0.571). Conclusion Lithotripsy remains an effective treatment as the first line of therapy for reno-ureteral lithiasis with a low percentage of complications. (AU)

¿Cómo calcular el volumen litiásico y cuál es su aplicación quirúrgica? / How to estimate stone volume and its use in stone surgery: A comprehensive review?

Objetivo Las guías actuales para el tratamiento intervencionista sugieren el diámetro acumulativo de la litiasis (DAL) como factor decisivo en la elección del tratamiento quirúrgico óptimo (ureteroscopia [URS], litotricia extracorpórea por ondas de choque [LEOCh] y nefrolitotomía percutánea [NLPC]). El volumen litiásico (VL) se ha introducido recientemente para obtener una estimación más precisa de la carga litiásica. El objetivo de esta revisión es resumir los métodos disponibles para calcular el VL y su aplicación quirúrgica. Material y métodos En diciembre de 2022 se realizó una revisión sistemática de la literatura mediante búsquedas en las bases de datos Embase, Cochrane y Pubmed. Los artículos se consideraron elegibles si describían la medición del VL o la tasa libre de litiasis (TLL) tras diferentes modalidades de tratamiento (LEOCh, URS, NLPC) o la expulsión espontánea, basándose en la medición del VL. Dos revisores evaluaron de forma independiente la elegibilidad y la calidad de los artículos y realizaron la extracción de datos. Resultados En total se incluyeron 28 estudios. Todos los estudios utilizaron diferentes técnicas para calcular el VL. La medición automática del volumen pareció ser más precisa que la estimación del volumen. Los estudios in vitro mostraron que la medición automática del volumen se ajustaba más al volumen real de la litiasis, con una menor variabilidad interobservador. A diferencia de la NLPC y la LEOCh, en la URS se observó que el VL era un mejor predictor de mejor la TLL que el diámetro litiásico mayor o el diámetro acumulativo en litiasis >20mm. Conclusiones Calcular el VL —de forma manual o automática— es factible, y probablemente se ajuste más a la carga litiásica real. Aunque en el caso de las litiasis grandes tratadas mediante cirugía intrarrenal retrógrada el VL parece predecir mejor la TLL, la superioridad del VL en todas las cargas litiásicas y para todos los tipos de tratamiento está aún por demostrar. ... (AU)

Objective Current interventional guidelines refer to the cumulative stone diameter to choose the appropriate surgical modality (ureteroscopy (URS), extracorporeal shockwave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL)). The stone volume (SV) has been introduced recently, to better estimate the stone burden. This review aimed to summarize the available methods to evaluate the SV and its use in urolithiasis treatment. Material and methods A comprehensive review of the literature was performed in December 2022 by searching Embase, Cochrane and Pubmed databases. Articles were considered eligible if they described SV measurement or the stone free rate after different treatment modalities (SWL, URS, PCNL) or spontaneous passage, based on SV measurement. Two reviewers independently assessed the eligibility and the quality of the articles and performed the data extraction. Results In total, 28 studies were included. All studies used different measurement techniques for stone volume. The automated volume measurement appeared to be more precise than the calculated volume. In vitro studies showed that the automated volume measurement was closer to actual stone volume, with a lower inter-observer variability. Regarding URS, stone volume was found to be more predictive of stone free rates as compared to maximum stone diameter or cumulative diameter for stones >20mm. This was not the case for PCNL and SWL. Conclusions Stone volume estimation is feasible, manually or automatically and is likely a better representation of the actual stone burden. While for larger stones treated by retrograde intrarenal surgery, stone volume appears to be a better predictor of SFR, the superiority of stone volume throughout all stone burdens and for all stone treatments, remains to be proven. Automated volume acquisition is more precise and reproducible than calculated volume. (AU)

How to estimate stone volume and its use in stone surgery: a comprehensive review.

OBJECTIVE: Current interventional guidelines refer to the cumulative stone diameter to choose the appropriate surgical modality (ureteroscopy [URS], extracorporeal shockwave lithotripsy [ESWL] and percutaneous nephrolithotomy [PCNL]). The stone volume (SV) has been introduced recently, to better estimate the stone burden. This review aimed to summarize the available methods to evaluate the SV and its use in urolithiasis treatment. MATERIAL AND METHODS: A comprehensive review of the literature was performed in December 2022 by searching Embase, Cochrane and Pubmed databases. Articles were considered eligible if they described SV measurement or the stone free rate after different treatment modalities (SWL, URS, PCNL) or spontaneous passage, based on SV measurement. Two reviewers independently assessed the eligibility and the quality of the articles and performed the data extraction. RESULTS: In total, 28 studies were included. All studies used different measurement techniques for stone volume. The automated volume measurement appeared to be more precise than the calculated volume. In vitro studies showed that the automated volume measurement was closer to actual stone volume, with a lower inter-observer variability. Regarding URS, stone volume was found to be more predictive of stone free rates as compared to maximum stone diameter or cumulative diameter for stones >20 mm. This was not the case for PCNL and SWL. CONCLUSIONS: Stone volume estimation is feasible, manually or automatically and is likely a better representation of the actual stone burden. While for larger stones treated by retrograde intrarenal surgery, stone volume appears to be a better predictor of SFR, the superiority of stone volume throughout all stone burdens and for all stone treatments, remains to be proven. Automated volume acquisition is more precise and reproducible than calculated volume.

Is extracorporeal lithotripsy a first-line treatment for urinary stones today?

OBJECTIVE: To evaluate the efficacy and complications of extracorporeal lithotripsy (SWL) as a first-line treatment for renal and ureteral stones METHODS: Retrospective and observational study of all the patients treated with lithotripsy in a third level center between January 2014 and January 2021; characteristics of the patients, the stones, complications and results of SWL is recollected. Multivariate logistic regression of the factors associated with stone size reduction was performed. A statistical analysis of the factors associated with additional treatment after SWL and factors associated with complications is also executed. RESULTS: 1727 patients are included. Stone mean size was 9,5mm. 1540 (89.4%) patients presented reduction in stone size. In multivariate analysis, stone size (OR=1.13; p=0.00), ureteral location of the lithiasis (OR=1.15; p=0.052) and number of waves (p=0.002; OR=1.00) used in SWL are the factors associated with reduction of stone size. Additional treatment after lithotripsy was needed in 665 patients (38.5%). The factors associated with the need for retreatment were stone size (OR=1.131; p=0.000), number of waves (OR=1.000; p=0.000), energy (OR=1.005; p=0.000). 153 patients (8.8%) suffered complications after SWL. A statistically significant association was found between the size of the lithiasis (p=0.024, OR=1.054) and the previous urinary diversion (P=0.004, OR=0.571). CONCLUSION: Lithotripsy remains an effective treatment as the first line of therapy for reno-ureteral lithiasis with a low percentage of complications.

Litotricia extracorpórea por ondas de choque (LEOCh) Para litiasis de grupo calicial inferior: ¿cómo predecir el éxito del tratamiento? / Extracorporeal shock wave lithotripsy for lower calyx stones: Predicting treatment success

Introducción El uso de la litotricia extracorpórea por ondas de choque (LEOCh) en litiasis de grupo calicial inferior (GCI) se asocia con una alta tasa de fragmentos residuales. Nuestro objetivo es analizar la efectividad y complicaciones del tratamiento con LEOCh en litiasis de GCI. Métodos Revisión retrospectiva de pacientes con litiasis en GCI tratadas con LEOCh entre enero 2014 y diciembre del 2020. Se determina anatomía favorable del GCI mediante longitud infundibular, ancho infundibular y ángulo infundibulopélvico. Se considera fracaso de LEOCh la presencia de fragmentos >3mm en radiografía simple, TC o ecografía a los 3 meses del procedimiento. Análisis de complicaciones, procedimientos auxiliares y factores de riesgo asociados con hematoma perirrenal. Análisis estadístico mediante software SPSS. Resultados En total, 512 pacientes con litiasis en GCI fueron tratados con LEOCh. El 80,3% de los pacientes tenía anatomía GCI favorable. La tasa libre de litiasis (TLL) fue 70,5%. Las principales complicaciones fueron: calle litiásica (5 pacientes) e infección del tracto urinario (3 casos). Se describen 10 hematomas perirrenales (2%). La toma de antiagregantes mostró asociación estadística con el riesgo de hematoma perirrenal (p=0,004). Mediante regresión logística binaria se demuestra asociación entre anatomía desfavorable del GCI (p=0,000), tamaño de litiasis (p=0,001), número de ondas de choque (p=0,003), energía aplicada (p=0,038) y necesidad de tratamiento adicional tras LEOCh. Conclusiones El tratamiento con LEOCh puede ser considerado de primera elección en litiasis de GCI. El tamaño de la litiasis, anatomía calicial desfavorable, número de ondas de choque y energía utilizadas pueden predecir la necesidad de retratamiento. (AU)

Introduction The use of extracorporeal shock wave lithotripsy (ESWL) for lower calyx stones is associated with a high rate of residual fragments. Our aim is to analyse the effectiveness and complications of ESWL for lower calyx stones. Methods Retrospective review of patients with lower renal calyx stones treated with ESWL between January-2014 and December-2020. Measurement of infundibular length, infundibular width and infundibulopelvic angle in lower renal pole to determine favourable anatomy. ESWL failure: fragments >3mm detected in plain abdominal film, CT scan and/or renal ultrasound 3 months after treatment. Complications after ESWL, auxiliary procedures along with risk factors associated with perirenal haematoma were analysed. SPSS statistical software was used. Results 512 patients with lower calyx stones were treated with ESWL. 80.3% of patients had a favourable anatomy. Overall stone-free rate was 70.5%. Regarding main complications after ESWL, stainstrasse was described in 5 patients and urinary tract infection in 3 patients. 10 perirenal haematomas (2%) were reported. Statistical association was found between antiplatelet treatment and the risk of perirenal haematoma (p=0.004). Logistic binary regression proved the association between unfavourable anatomy of the lower renal pole (p=0.000), size of the stone (p=0.001), number of shock waves (p=0.003), energy applied (p=0.038) and the need for additional treatment after ESWL. Conclusions ESWL can still be considered as the initial treatment option for lower renal pole stones. The size of the stone, an unfavourable anatomy of the lower renal calyx, number of shock waves and energy applied can help predict the need for additional treatment. (AU)

[Coronary lithotripsy in calcified lesions: fragmented calcium]. / Litotricia coronaria en lesiones calcificadas: fragmentando el calcio.

Background: Complex calcified coronary lesions are a frequent finding during percutaneous coronary intervention, representing for decades a challenge and limitation in patients with indication of revascularization, due to suboptimal angiographic results, high incidence of perioperative complications and long-term adverse events despite the multiple strategies employed, such as the use of cutting balloon, high-pressure balloons or rotational or orbital atherectomy, interventions with limitations that have hindered its routine use, recently a new plaque modification technique known as coronary intravascular lithotripsy has burst into the treatment of this complex entity, which consists in the use of a specially modified balloon for the emission of pulsatile mechanical energy (sonic pressure waves) that allows modifying the calcified plate. Clinical case: By presenting a series of clinical cases and reviewing the literature, our initial experience is presented, key elements are summarized and discussed in the understanding of this new intervention technique necessary for decision making. Conclusion: Coronary intravascular lithotripsy is projected as a promising technique for the modification and preparation of superficial and deep calcified coronary lesions, through microfractures that allow the apposition and effective expansion of the stent, strategy that according to different trials (Disrupt CAD series, SOLSTICE assay) and records presents a high efficiency and good safety profile, data consistent with our initial experience.

Introducción: las lesiones coronarias calcificadas complejas son un hallazgo frecuente durante el intervencionismo coronario percutáneo, han representado durante décadas un desafío y limitante en pacientes con indicación de revascularización, debido a resultados angiográficos subóptimos, alta incidencia de complicaciones perioperatorias y eventos adversos a largo plazo a pesar de las múltiples estrategias empleadas, como el uso de balones de corte, balones de alta presión o la aterectomía rotacional u orbital, intervenciones con limitantes que han dificultado su uso rutinario. Recientemente, una nueva técnica de modificación de placa conocida como litotricia intravascular coronaria ha irrumpido en el tratamiento de esta compleja entidad, la cual consiste en la utilización de un balón especialmente modificado para la emisión de energía mecánica pulsátil (ondas de presión sónicas) que permite modificar la placa calcificada. Caso clínico: mediante la presentación de una serie de casos clínico y revisión de literatura se presenta nuestra experiencia inicial, se resume y discuten elementos claves en el entendimiento de esta nueva técnica de intervencionismo necesarios para la toma de decisiones. Conclusión: la litotricia intravascular coronaria se proyecta como una técnica prometedora para la modificación y preparación de lesiones coronarias calcificadas superficiales y profundas, mediante microfracturas que permiten la aposición y expansión efectiva del stent; estrategia que de acuerdo con diferentes ensayos (serie Disrupt CAD, ensayo SOLSTICE) y registros presenta una eficacia alta y buen perfil de seguridad, datos concordantes con nuestra experiencia inicial.

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)

Effectiveness of extracorporeal shock wave lithotripsy in urolithiasis patients under 2 years of age.

OBJECTIVE: In this study, we present our extracorporeal shock wave lithotripsy (ESWL) outcomes in urolithiasis patients under the age of two. MATERIALS AND METHODS: The procedure was performed with patients < 2 years of age sedated, under anesthesia using ketamine and Dormicum (midazolam), in the supine position. Fragmentation was evaluated by fluoroscopy after the procedure. RESULTS: A total of 74 procedures were performed on 65 kidneys. One patient with bilateral stones had two sessions of ESWL on the right side; three sessions of ESWL were performed in one patient with a unilateral stone, and two sessions were performed in seven patients with unilateral stones. All other patients underwent one session of ESWL. As post-procedural complications, hematuria was observed in 14 patients (12 mild and 2 significant), and vomiting occurred in 1 patient. Ureterorenoscopy was performed in 5 patients, and percutaneous nephrolithotomy in 6 patients due to a failed procedure. CONCLUSION: As a result, ESWL treatment is effective and has advantages such as a short hospitalization time, good reproducibility, cost-effectiveness, and a low rate of complications. Therefore, we recommend ESWL as the first-line treatment for renal and proximal ureteral stones in infants < 2 years of age.

OBIETIVO: En este estudio, presentamos nuestros resultados de ESWL en pacientes con urolitiasis menores de dos años. MATERIALES Y MÉTODOS: El procedimiento se realizó con pacientes menores de dos años sedados, bajo anestesia con ketamina y Dormicum (midazolam), en posición supina. La fragmentación se evaluó mediante fluoroscopia después del procedimiento. RESULTADOS: Se realizaron total de 74 procedimientos en 65 riñones. Un paciente con cálculos bilaterales tuvo dos sesiones de ESWL en el lado derecho; se realizaron tres sesiones de LEOC en un paciente con litiasis unilateral y dos sesiones en siete pacientes con litiasis unilateral. Todos los demás pacientes se sometieron a una sesión de ESWL. Como complicaciones post-procedimiento se observó hematuria en 14 pacientes (12 leves y 2 significativas) y vómitos en 1 paciente. Se realizó URS en 5 pacientes y NLP en 6 pacientes debido a un procedimiento fallido. CONCLUSIONES: Como resultado, el tratamiento de la ESWL es efectivo y tiene ventajas como un tiempo de hospitalización corto, buena reproducibilidad, costo-efectividad y baja tasa de complicaciones. Por tanto, recomendamos la ESWL como tratamiento de primera línea para cálculos renales y ureterales proximales en bebés < 2 años de edad.

Extracorporeal shock wave lithotripsy for lower calyx stones: predicting treatment success.

INTRODUCTION: The use of extracorporeal shock wave lithotripsy (ESWL) for lower calyx stones is associated with a high rate of residual fragments. Our aim is to analyse the effectiveness and complications of ESWL for lower calyx stones. METHODS: Retrospective review of patients with lower renal calyx stones treated with ESWL between January-2014 and December-2020. Measurement of infundibular length, infundibular width and infundibulopelvic angle in lower renal pole to determine favourable anatomy. ESWL failure: fragments >3 mm detected in plain abdominal film, CT scan and/or renal ultrasound 3 months after treatment. Complications after ESWL, auxiliary procedures along with risk factors associated with perirenal haematoma were analysed. SPSS statistical software was used. RESULTS: 512 patients with lower calyx stones were treated with ESWL. 80.3% of patients had a favourable anatomy. Overall stone-free rate was 70.5%. Regarding main complications after ESWL, stainstrasse was described in 5 patients and urinary tract infection in 3 patients. 10 perirenal haematomas (2%) were reported. Statistical association was found between antiplatelet treatment and the risk of perirenal haematoma (p = 0.004). Logistic binary regression proved the association between unfavourable anatomy of the lower renal pole (p = 0.000), size of the stone (p = 0.001), number of shock waves (p = 0.003), energy applied (p = 0.038) and the need for additional treatment after ESWL. CONCLUSIONS: ESWL can still be considered as the initial treatment option for lower renal pole stones. The size of the stone, an unfavourable anatomy of the lower renal calyx, number of shock waves and energy applied can help predict the need for additional treatment.

Validación externa de los sistemas de puntuación actuales y desarrollo de un nuevo sistema de puntuación para la predicción de la tasa libre de cálculos tras la cirugía intrarrenal retrógrada en pacientes con un diámetro acumulado del cálculo de 2-4 cm / External validation of the current scoring systems and development of a novel scoring system to predict stone-free rates after retrograde intrarenal surgery in patients with cumulative stone diameter of 2-4 cm

Objetivo Nuestro objetivo principal es realizar la validación externa de los sistemas de puntuación actuales para predecir el estado libre de cálculos (ELC) después de la cirugía intrarrenal retrógrada (CRIR) para cálculos renales de 2-4 cm y desarrollar un nuevo sistema de puntuación reexaminando los posibles factores predictivos relacionados con el ELC. Métodos Se evaluaron retrospectivamente los pacientes que recibieron CRIR para el tratamiento de cálculos renales con diámetro acumulado de 2-4 cm, entre enero de 2017 y marzo de 2021. Los cálculos residuales ≤ 2 mm se definieron como clínicamente insignificantes, y estos casos se consideraron como ELC. Se examinaron los posibles factores predictivos relacionados con el ELC mediante el análisis de regresión logística multivariante. Se elaboró un nomograma y se creó un sistema de puntuación utilizando variables predictivas independientes. Mediante el análisis ROC se evaluó la capacidad de predicción de los sistemas de puntuación actuales y del recién desarrollado. Resultados Los sistemas de puntuación existentes resultaron insuficientes para predecir el ELC (AUC < 0,660 en todos los casos). Se identificaron como predictores independientes del ELC el área de superficie (OR: 0,991, p < 0,001), la densidad (OR: 0,998, p < 0,001), el número (OR: 0,365, p = 0,033) y la localización de los cálculos (p = 0,037). Utilizando estos marcadores predictivos, se desarrolló un nuevo sistema de puntuación cuyos resultados oscilan entre 4 y 15. El valor AUC de este sistema de puntuación fue de 0,802 (0,734-0,870). Conclusión Los sistemas de puntuación RUSS, S-ReSC y RIRS y el nomograma de Ito no lograron predecir el ELC en cálculos de > 2 cm. Nuestro nuevo sistema de puntuación tuvo una capacidad predictiva del ELC mayor en cálculos de > 2 cm, en comparación con los otros sistemas de puntuación (AU)

Objective Our primary aim is to perform the external validation of the current scoring systems in predicting stone-free status (SFS) after retrograde intrarenal surgery (RIRS) for renal stones 2-4 cm and develop a novel scoring system by re-examining possible predictive factors related to SFS. Methods Patients who underwent RIRS due to renal stones with a cumulative stone diameter of 2-4 cm between January 2017 and March 2021 were retrospectively screened. Residual stones ≤ 2 mm were defined as clinically insignificant, and these cases were considered to have SFS. Possible predictive factors related to SFS were examined using the multivariate logistic regression analysis. A nomogram and a scoring system were developed using independent predictive variables. The prediction ability of the previous and the new scoring system were evaluated with the ROC analysis. Results The existing scoring systems were found to be insufficient in predicting SFS (AUC < 0.660 for all). The independent predictors of SFS were identified as stone surface area (OR: 0.991, p < 0.001), stone density (OR: 0.998, p < 0.001), number of stones (OR: 0.365, p = 0.033), and stone localization (p = 0.037). Using these predictive markers, a new scoring system with a score ranging between 4 and 15 was developed. The AUC value for this scoring system was 0.802 (0.734-0.870). Conclusion The RUSS, S-ReSC and RIRS scoring systems and Ito's nomogram failed to predict SFS in stones > 2 cm. The SFS predictive ability of our new scoring system was higher in > 2 cm stones compared to the other scoring systems (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.

Clinical characteristics, treatments, and outcomes of dificult biliary stones in a reference hospital in Colombia

The local experience and the success rate of different available treatments for dificult biliary stones in Colombia are poorly described. We made an observational study reporting patients treated for dificult biliary stones, at Hospital Universitario San Ignacio in Bogotá, Colombia between January 2015, and November 2021. Clinical characteristics, endoscopic retrograde cholangiopancreatography (ERCP) findings, and outcomes are presented. Additionally, the success rates of Endoscopic Sphincterotomy Plus Large Balloon Dilation (ESLBD), Mechanical Lithotripsy (ML), temporary stenting (TS), cholangioscopy-guided laser lithotripsy (CGLL), and surgery are described. A total of 146 patients were included (median age 69 years, IQR 58.5-78.5, 33.8% men). The median stone diameter was 15 mm (IQR 10 - 18 mm). One stone was presented in 39.9%, two stones in 18.2%, and ≥3 stones in the remaining stone. A 67.6% disproportion rate was observed between the stone and distal common bile duct. Successful stone extraction was achieved in 56.2% in the first procedure, 22.6% in the second, 17.1% in the third, 3.4% in the fourth, and 0.7% in the fifth procedures. The successful extraction rates were 56.8% for ESLBD, 75% for ML, 23.4% for TS, 57.7% for CGLL, and 100% for surgery. Endoscopic management of dificult stones is usually successful, although it usually requires 2 or more ERCPs procedures. The surgical requirements were low. ESLBD is an effective technique unlike TS. Few patients required advanced techniques such as ML or CGLL. Endoscopic procedures are associated with a low rate of complications.

La tasa de éxito de diferentes tratamientos de Cálculo Biliar Difícil (CBD) en Colombia no está descrita. Hemos realizado un estudio descriptivo observacional sobre el tratamiento de CBD en el Hospital Universitario San Ignacio en Bogotá, Colombia entre enero 2015 y noviembre 2021. Se presentan las características clínicas, hallazgos en la Colangiopancreatografía Retrógrada Endoscópica (CPRE) y desenlaces asociados. Adicionalmente, se describe la tasa de éxito de los pacientes tratados mediante esfinterotomía asociada a dilatación endoscópica con balón grande (EDEBG), litotripsia mecánica (LM), stent temporal (ST), litotripsia con láser guiada por colangioscopia (LLGC) y cirugía. 146 pacientes fueron incluidos (Mediana de edad 69 años, RIC 58,6-78,5). 33,8% eran hombres. La mediana del tamaño del CBD fue de 15 mm (RIC 10-18 mm). 39,9% tenían un solo cálculo, 18,2% tenían 2 y el resto ≥3 cálculos. 67,6% tenían desproporción entre el cálculo y el colédoco distal. La extracción exitosa se logró en 56,2% en el primer procedimiento, 22,6% en el segundo, 17,1% en el tercero, 3,4% en el cuarto y 0,7% en el quinto procedimiento. La tasa de extracción exitosa fue de 56,8% con EDEBG, 75% con LM, 23,4% con ST, 57,7% con LLGC y 100% con cirugía. El manejo endoscópico del CBD es usualmente exitoso. Sin embargo, requiere usualmente ≥2 CPRE. El tratamiento quirúrgico no es común. EDEBG es una técnica efectiva a diferencia del ST. Pocos pacientes requirieron técnicas avanzadas como LM o LLGC. Los métodos endoscópicos presentan una baja tasa de complicaciones.

External validation of the current scoring systems and derivation of a novel scoring system to predict stone free rates after retrograde intrarenal surgery in patients with cumulative stone diameter of 2-4 cm.

OBJECTIVE: Our primary aim is to perform the external validation of the current scoring systems in predicting stone-free status (SFS) after retrograde intrarenal surgery (RIRS) for renal stones 2-4 cm and develop a novel scoring system by re-examining possible predictive factors related to SFS. METHODS: Patients who underwent RIRS due to renal stones with a cumulative stone diameter of 2-4 cm between January 2017 and March 2021 were retrospectively screened. Residual stones ≤2 mm were defined as clinically insignificant, and these cases were considered to have SFS. Possible predictive factors related to SFS were examined using the multivariate logistic regression analysis. A nomogram and a scoring system were developed using independent predictive variables. The prediction ability of the previous and the new scoring system were evaluated with the ROC analysis. RESULTS: The existing scoring systems were found to be insufficient in predicting SFS (AUC < 0.660 for all). The independent predictors of SFS were identified as stone surface area (OR: 0.991, p < 0.001), stone density (OR: 0.998, p < 0.001), number of stones (OR: 0.365, p = 0.033), and stone localization (p = 0.037). Using these predictive markers, a new scoring system with a score ranging between 4 and 15 was developed. The AUC value for this scoring system was 0.802 (0.734-0.870). CONCLUSION: The RUSS, S-ReSC and R.I.R.S. scoring systems and Ito's nomogram failed to predict SFS in stones >2 cm. The SFS predictive ability of our new scoring system was higher in >2 cm stones compared to the other scoring systems.

¿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.

Modelo novedoso basado en los parámetros de la tomografía para predecir el éxito de la litotricia por ondas de choque en los cálculos ureterales de diferentes localizaciones / A novel model using computed tomography parameters to predict shock wave lithotripsy success in ureteral stones at different locations

ObjetivoIncorporar los parámetros basados en la tomografía computarizada sin contraste (TCSC) a las características de los cálculos y de los pacientes comúnmente asociadas con el éxito de la litotricia por ondas de choque (LEOCH) para evaluar la efectividad de este nuevo modelo en la predicción del éxito de LEOCH en cálculos ureterales únicos situados en diferentes localizaciones.Materiales y métodosSe revisaron retrospectivamente los datos de los pacientes tratados con LEOCH por un único cálculo ureteral entre enero de 2017 y enero de 2019. Los parámetros basados en la TCSC se evaluaron junto con los parámetros demográficos de los pacientes y las características de los cálculos. Los parámetros basados en TCSC incluyeron la presencia o ausencia de hidronefrosis, trabeculación de la grasa perirrenal, edema periureteral, diámetro del uréter proximal, grosor de la pared ureteral (GPU) en el sitio del cálculo ureteral. Se utilizó el método de regresión logística para desarrollar un modelo predictivo útil. Posteriormente, se utilizó la curva ROC para determinar los puntos de corte, y se desarrolló un sistema de puntuación para la predicción del éxito de LEOCH.ResultadosLa tasa libre de cálculos fue del 77,1% (267/346) en toda la cohorte. El análisis univariante reveló que la edad, el volumen de los cálculos, la densidad, la trabeculación perirrenal, el diámetro del uréter proximal y el GPU se asociaron con el éxito de la LEOCH. En el análisis multivariante, la localización del cálculo ureteral proximal, el volumen del cálculo, la densidad y el GPU fueron predictores independientes del éxito de la LEOCH. La fórmula utilizada en el análisis de regresión logística fue: 1/[1+exp {-8,856+0,008(volumen del cálculo)+0,002 (densidad del cálculo)+0,673 (GPU)+1026 (cálculo ureteral proximal)}]. Las puntuaciones de 0, 1, 2, 3 y 4 se asociaron con un 97,8%, 83,4%, 60,8%, 33,2% y 11,1% de éxito, respectivamente, en el modelo de predicción basado en estos parámetros.

ObjectiveTo combine non-contrast computerized tomography (NCCT)-based parameters with stone and patient characteristics that are already known to affect shock wave lithotripsy (SWL) success and assess this novel model's effectiveness in predicting SWL success for single ureteral stones in different locations.Materials and methodsData of patients treated by SWL for a single ureteral stone between January 2017 and January 2019 were retrospectively reviewed. Demographic parameters of patients and stone characteristics were combined with NCCT-based parameters. NCCT-based parameters included the presence or absence of hydronephrosis, perinephric stranding, periureteral edema, diameter of the proximal ureter, ureteral wall thickness (UWT) at ureteral stone site. The logistic regression method was used for the development of a useful predictive model. Subsequently, the receiver operating curve was used to determine cut-off levels, and a scoring system was developed for prediction of SWL success.ResultsStone-free rate was 77,1% (267/346) in the entire cohort. Univariate analysis revealed that age, stone volume, density, perinephric stranding, diameter of proximal ureter, and UWT, were associated with SWL success. In multivariate analysis, proximal ureteral stone location, stone volume, density, and UWT were independent predictors of SWL success. The formula used during logistic regression analysis was: 1/[1+exp {-8.856+0.008(stone volume)+0.002 (stone density)+0.673 (UWT)+1026 (proximal ureteral stone)}]. The scores of 0, 1, 2, 3 and 4 were associated with 97,8%, 83,4%, 60,8%, 33,2% and 11,1% success rates, respectively, in the prediction model based on these parameters.ConclusionWe conclude that our model can facilitate decision-making for SWL treatment of ureteral stones in different locations (AU)

Dispositivos de modificación de placa en oclusiones coronarias crónicas totales: estudio PLACCTON / Plaque modification in calcified chronic total occlusions: the PLACCTON study

Introducción y objetivos: La calcificación grave está presente en más del 50% de las oclusiones coronarias crónicas totales (OCT) tratadas mediante intervención percutánea. Nuestro objetivo fue describir el uso contemporáneo de los dispositivos de modificación de placa (DMP) en este contexto. Métodos: Los pacientes se incluyeron en el Registro Ibérico de OCT de forma prospectiva y consecutiva (32 centros de España y Portugal), de 2015 a 2020. Se compararon en función del uso o no de DMP. Resultados: Se incluyó a 2.235 pacientes, en 1.900 de los cuales se logró cruzar con éxito la lesión con guía. Se utilizó al menos un DMP en un 7% (134 pacientes) y más de uno en 24 pacientes (1%). Los DMP seleccionados fueron: aterectomía rotacional (35,1%), litotricia (5,2%), láser (11,2%), balones de corte (27,6%), balones OPN (2,9%) o combinaciones de más de uno (18%). Se utilizaron DMP en pacientes más ancianos, con mayor riesgo cardiovascular y puntuaciones Syntax y J-CTO más elevados. Esta mayor complejidad se asoció con procedimientos más prolongados, pero similar longitud total de stent (52 frente a 57mm; p=0,105). Cuando la guía cruzó con éxito la oclusión, la tasa de éxito final del procedimiento fue del 87,2%, pero se incrementó al 96,3% cuando se utilizaron DMP (p=0,001). Por el contrario, los DMP no se asociaron con mayor tasa de complicaciones en el procedimiento (3,7 frente a 3,2%; p=0,615). Pese al peor perfil de riesgo basal, a los 2 años de seguimiento no hubo diferencias en la tasa de supervivencia (94,3% DPM frente a no-DMP: 94,3% no-DPM, respectivamente, p=0,967). Conclusiones: Cuando la guía cruzó con éxito una OCT, la tasa de uso de los DMP fue del 7% y se asoció a una tasa de éxito final del procedimiento significativamente mayor. Los resultados a medio plazo fueron comparables cuando se precisaron DMP pese a su mayor riesgo basal, lo que sugiere que un mayor uso adecuado de estas técnicas en este contexto (AU)

Introduction and objectives: Severe calcification is present in> 50% of coronary chronic total occlusions (CTOs) undergoing percutaneous intervention. We aimed to describe the contemporary use and outcomes of plaque modification devices (PMDs) in this context. Methods: Patients were included in the prospective, consecutive Iberian CTO registry (32 centers in Spain and Portugal), from 2015 to 2020. Comparison was performed according to the use of PMDs. Results: Among 2235 patients, wire crossing was achieved in 1900 patients and PMDs were used in 134 patients (7%), requiring more than 1 PMD in 24 patients (1%). The selected PMDs were rotational atherectomy (35.1%), lithotripsy (5.2%), laser (11.2%), cutting/scoring balloons (27.6%), OPN balloons (2.9%), or a combination of PMDs (18%). PMDs were used in older patients, with greater cardiovascular burden, and higher Syntax and J-CTO scores. This greater complexity was associated with longer procedural time but similar total stent length (52 vs 57mm; P=.105). If the wire crossed, the procedural success rate was 87.2% but increased to 96.3% when PMDs were used (P=.001). Conversely, PMDs were not associated with a higher rate of procedural complications (3.7 vs 3.2%; P=.615). Despite the worse baseline profile, at 2 years of follow-up there were no differences in the survival rate (PMDs: 94.3% vs no-PMDs: 94.3%, respectively; P=.967). Conclusions: Following successful wire crossing in CTOs, PMDs were used in 7% of the lesions with an increased success rate. Mid-term outcomes were comparable despite their worse baseline profile, suggesting that broader use of PMDs in this setting might have potential technical and prognostic benefits (AU)

A novel model using computed tomography parameters to predict shock wave lithotripsy success in ureteral stones at different locations.

OBJECTIVE: To combine non-contrast computerized tomography (NCCT)-based parameters with stone and patient characteristics that are already known to affect shock wave lithotripsy (SWL) success and assess this novel model's effectiveness in predicting SWL success for single ureteral stones in different locations. MATERIALS AND METHODS: Data of patients treated by SWL for a single ureteral stone between January 2017 and January 2019 were retrospectively reviewed. Demographic parameters of patients and stone characteristics were combined with NCCT-based parameters. NCCT-based parameters included the presence or absence of hydronephrosis, perinephric stranding, periureteral edema, diameter of the proximal ureter, ureteral wall thickness (UWT) at ureteral stone site. The logistic regression method was used for the development of a useful predictive model. Subsequently, the receiver operating curve was used to determine cut-off levels, and a scoring system was developed for prediction of SWL success. RESULTS: Stone-free rate was 77,1% (267/346) in the entire cohort. Univariate analysis revealed that age, stone volume, density, perinephric stranding, diameter of proximal ureter, and UWT, were associated with SWL success. In multivariate analysis, proximal ureteral stone location, stone volume, density, and UWT were independent predictors of SWL success. The formula used during logistic regression analysis was: 1/[1 + exp {-8.856 + 0.008 (stone volume) + 0.002 (stone density) + 0.673 (UWT) + 1026 (proximal ureteral stone)}]. The scores of 0, 1, 2, 3 and 4 were associated with 97,8%, 83,4%, 60,8%, 33,2% and 11,1% success rates, respectively, in the prediction model based on these parameters. CONCLUSION: We conclude that our model can facilitate decision-making for SWL treatment of ureteral stones in different locations.

Plaque modification in calcified chronic total occlusions: the PLACCTON study.

INTRODUCTION AND OBJECTIVES: Severe calcification is present in> 50% of coronary chronic total occlusions (CTOs) undergoing percutaneous intervention. We aimed to describe the contemporary use and outcomes of plaque modification devices (PMDs) in this context. METHODS: Patients were included in the prospective, consecutive Iberian CTO registry (32 centers in Spain and Portugal), from 2015 to 2020. Comparison was performed according to the use of PMDs. RESULTS: Among 2235 patients, wire crossing was achieved in 1900 patients and PMDs were used in 134 patients (7%), requiring more than 1 PMD in 24 patients (1%). The selected PMDs were rotational atherectomy (35.1%), lithotripsy (5.2%), laser (11.2%), cutting/scoring balloons (27.6%), OPN balloons (2.9%), or a combination of PMDs (18%). PMDs were used in older patients, with greater cardiovascular burden, and higher Syntax and J-CTO scores. This greater complexity was associated with longer procedural time but similar total stent length (52 vs 57mm; P=.105). If the wire crossed, the procedural success rate was 87.2% but increased to 96.3% when PMDs were used (P=.001). Conversely, PMDs were not associated with a higher rate of procedural complications (3.7 vs 3.2%; P=.615). Despite the worse baseline profile, at 2 years of follow-up there were no differences in the survival rate (PMDs: 94.3% vs no-PMDs: 94.3%, respectively; P=.967). CONCLUSIONS: Following successful wire crossing in CTOs, PMDs were used in 7% of the lesions with an increased success rate. Mid-term outcomes were comparable despite their worse baseline profile, suggesting that broader use of PMDs in this setting might have potential technical and prognostic benefits.

[Pneumatic lithotripsy vs Holmium: YAG Laser lithotripsy for the treatment of ureteral stones.] / Litotricia neumática vs. litotricia láser Ho: YAG en el tratamiento de la litiasis ureteral.

OBJECTIVE: Pneumatic lithotripsy (PL) and Ho: YAG laser lithotripsy (LL) are the most widely accepted methods in the endoscopic treatment of ureteral lithiasis. The objective is to compare efficacy and safety of pneumatic lithotripsy vs. Ho: YAG laser lithotripsy in the treatment of ureteral lithiasis. MATERIAL AND METHODS: Prospective, single-blind, multicenter study. Adult patients were recruited from August 2017 to March 2019, in 23 institutions throughout Argentina. Patient demographics, stone characteristics, presence of double J stent prior to the intervention, stonefree rate (SF) and postoperative complications were evaluated and analyzed. RESULTS: A total of 366 patients with ureteral lithiasis were included, 204 in the PL group and 162 in the LL group. The SF rate was significantly higher in the LL group (77% vs. 92%), OR 3 .43 (1.76 to 6.70). The complication rate was significantly lower in the LL group (9.8% vs. 2.5%), OR 0.23 (0.07 to 0.71). In the multivariate analysis, the use of Ho: YAG energy, the location of the lithiasis in the distal ureter, and the preoperative placement of double J stent, were found to be predictors of SF status. CONCLUSIONS: Ho: YAG laser lithotripsy has a higher stone-free rate and a lower complication rate compared to pneumatic lithotripsy.

OBJETIVO: La litotricia neumática (LN) y láser Ho: YAG (LH) son los métodos más aceptados en el tratamiento endoscópico de la litiasis ureteral. El objetivo es comparar eficacia y seguridad de la litotricia neumática vs. litotricia láser Ho: YAG en el tratamiento de la litiasis ureteral.MATERIAL Y MÉTODOS: Estudio prospectivo, simple ciego, multicéntrico. Se incluyeron pacientes adultos que se sometieron a tratamiento de litiasis ureteral, desde agosto de 2017 a marzo de 2019, en 23 instituciones nacionales. Las variables analizadas incluyeron: datos demográficos, tamaño y ubicación del lito, presencia de catéter doble J previo al procedimiento, tasa libre de litiasis (LL) y de complicaciones. RESULTADOS: Se incluyeron un total de 366 pacientes con litiasis ureteral, 204 en el grupo LN y 162 en el grupo LH. La tasa libre de litiasis fue significativamente superior en el grupo LH (77% vs. 92%), OR 3,43 (1,76 a 6,70) y la tasa de complicaciones fue significativamente menor en el grupo LH (9,8% vs. 2,5%), OR 0,23 (0,07 a 0,71). En el análisis multivariado, la utilización de la energía Ho: YAG, la ubicación de la litiasis en uréter distal y la colocación preoperatoria de catéter doble J, resultaron ser factores predictores del estado LL.CONCLUSIÓN: La litotricia láser Ho: YAG presenta una mayor tasa libre de litiasis y una menor tasa de complicaciones, en comparación con la litotricia neumática.