[Analysis of calculi in the era of extracorporeal lithotripsy. (13th National Meeting of Urolithiasis and Urinary Endoscopy)].
Explore the source record for details and available documents.
Algorithms↗
Biomedical subjects
M Arrabal Martín
Publications and source records attributed to M Arrabal Martín.
[Effect of potassium citrate in the prophylaxis of urinary lithiasis].
OBJECTIVE: The physiologic effects of potassium citrate on urinary solubility have led to their use to facilitate stone passage after lithotripsy. The aim of our study is to evaluate the foregoing effects and the efficacy of long-term treatment with potassium citrate to prevent stone recurrence in patients undergoing extracorporeal shock wave lithotripsy. METHODS: A prospective study was conducted on 100 patients with calcium oxalate or calcium phosphate nephrolithiasis that had undergone treatment by extracorporeal shock wave lithotripsy (ESWL). The patients were divided into 4 groups: patients that were stone-free treated with potassium phosphate (25 cases) or fluid diet (25 cases) and patients with persistent residual lithiasis treated with potassium citrate (25 cases) or fluid diet (25 cases). Calculi were classified according to the changes observed during the study compared with the pre-study status as stable (no changes from the pre-study status, with or without residual stone), increased (increase in number or size of the residual stone or recurrence), and decreased (decrease in number or size or passage of the residual stone). RESULTS: Of the 50 patients treated with potassium citrate, 35 (70%) remained stable, 10 cases (20%) showed a decrease and 5 (10%) showed an increase. Of the 50 patients on fluid diet, 19 (38%) remained stable throughout the study, 4 (8%) showed a decrease and 27 (54%) showed an increase in stone size or number. The number of stone recurrence throughout the study in the 100 patients was 25 (25%); of these, 8 were in patients treated with potassium citrate and 17 of those that did not receive potassium citrate. CONCLUSIONS: Potassium citrate therapy has been found to be statistically significantly effective in the control of post-lithotripsy residual stone and stone recurrence.
Adolescent↗
[Effect of thiazide therapy in the prophylaxis of calcium lithiasis].
OBJECTIVE: To analyze the role of thiazide therapy in the prevention of recurrent calcium nephrolithiasis, considering the hypocalciuric action of this drug. METHODS: A prospective study before and after treatment, with a 3-year follow-up, was carried out on 150 patients with recurrent calcium renal stone. The patients were divided into three groups: (A) no treatment, (B) treatment with thiazide 50 mg/day and (C) treatment with thiazide and potassium citrate. The treated groups were randomly assigned to the treatment arms. Control analytical tests and radiological assessments were performed regularly. RESULTS: Excellent results were achieved with thiazide therapy in regard to stone recurrence and changes in residual stone in comparison to the group of untreated patients (group A). The most common metabolic disorder was absorptive hypercalciuria type I. Most of the patients showed a single metabolic disorder. The side effects were generally not relevant. CONCLUSIONS: Thiazides should be considered as the first line of treatment in absorptive and excretory hypercalciuria. We believe that in unselected patients with calcium stone, thiazide therapy can be effective in its prevention. It is important to take into account the possible side effects of the drug and supplementation with potassium citrate for thiazide-induced hypocitraturia.
Benzothiadiazines↗
[Historical, epidemiologic, and therapeutic profile of urolithiasis].
Explore the source record for details and available documents.
Humans↗
[Urinary glycosaminoglycans after extracorporeal shock wave lithotripsy in patients with kidney lithiasis].
OBJECTIVE: Extracorporeal shock wave lithotripsy (ESWL) is a technique that is not free of adverse effects. Renal changes detected during complementary exploratory procedures have been described, although these are minimal, resolve within a few days, do not present clinical manifestations and are not detected on ultrasound in most of the cases. For this reason, we studied a marker for renal injury, the urinary excretion of glycosaminoglycans (GAG) in patients with renal calculi, before, immediately after and 30 days following ESWL. The novelty of the study lies in that we have classified the patients with calculi according to the degree of renal function before ESWL, since it is recognized that the obstructive features of lithiasis can cause some degree of renal impairment. METHODS: Urinary GAG was quantified according to the colorimetric method described by Pennock. RESULTS: Urinary GAG levels were found to be lower in patients with renal calculi and preserved renal function than in healthy control subjects. In the presence of renal failure, these levels are elevated due to the obstructive nephropathy caused by calculi. Urinary GAG significantly increased post-ESWL in patients with renal lithiasis and preserved renal function or renal failure. At 30 days post-ESWL, GAG returned to pre-test levels. CONCLUSIONS: Quantification of urinary GAG is a useful biochemical method in the evaluation of renal parenchymal injury produced by ESWL.
Adult↗
[Distal ureteral lithiasis. ESWL versus ambulatory URS].
OBJECTIVE: To present the results achieved in the treatment of 1802 distal ureteral stones treated at the Lithotripsy Unit of the San Cecilio University Hospital over the last 10 years (1990-2000). METHODS: Stones were treated by extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy (URS). ESWL was the initial treatment in 81% of the cases (1460 calculi) and URS in the remaining 19% (342 stones). URS was performed for complication or failed ESWL (102 stones) and ESWL was performed for failed URS, basically due to stone migration (24 stones). Ureterolithotomy was required on 7 occasions. Sedation-analgesia with fentanyl and midazolam was routinely used in URS. Sedation was required in only 55% of the ESWL procedures. RESULTS: Elective ESWL resolved 93% of the cases, a percentage which is similar to that achieved with URS as first treatment. The ESWL retreatment rate was 1.3. URS was successful in 98% of the cases of failed ESWL. CONCLUSIONS: There are two treatment modalities for stones in the distal ureter: ESWL and URS. We advocate the use of outpatient URS with sedation preferably in the female patient, impacted stones, obstructive uropathy, stones larger than 2 cm and radiotransparent stones.
Ambulatory Care↗
[Renal cell carcinoma in patient with situs inversus and Kartagener syndrome].
A case of a adenocarcinoma renal in a patient with situs inversus complete to which was associated bronchiectasis and chronic sinusitis (kartagener's syndrome) is reported. It is the third case described in the international literature of a renal cells carcinoma in a patient with situs inversus totalis and the first in patient the one which has the triada classic of the kartagener's syndrome plus sterility. The tumor was discovered in a way incidental upon accomplishing a TAC toracoabdominal and was solved through nefrectomia for lumbotomy approach.
Adult↗
[Extracorporeal lithotripsy in Spain in the 20th. Century].
INTRODUCTION: In November of 1998, the Spanish Association of Urology decides to carry out a study on the lithotripsy in Spain, through the Group of Work in Lithiasis Urinary, with the objective of knowing the n(o) and distribution of Units and the real situation of the extracorporeal litotripsy for shock waves, in connection with other complementary methods or therapeutic alternatives. METHODOLOGY: We remit to all the Units of Lithotripsy a record of collection of data: Characteristic of the unit, no. of sick, localization of the calculi, complications, evolution and personal comments. RESULTS: 63 units of lithotripsy have participated in the study, at the moment 3 of them don't work and 23 belong to the Public Sanitary System. The Spanish population belong to 39,848,000 inhabitants, distributed in 17 autonomous communities, there is a lithotripsy unit for each 660,000 Spaniards. 264,875 sick people have been treated, they present synchronous bilateral lithiasis, 18,276 (6.9%) and a new treatment for relapse of calculi has been carried out in 18,592 sick people. The treated calculi are located at renal level in 60% of the cases, ureteral, 39% and vesical, 1%. The expelled, deposited or not expelled lithiasis residue corresponds to 9%, 6.8% and 6% respectively, and to 21.8% in total. CONCLUSIONS: After the analysis of these data, it is observed with evidence that in Spain, each million of inhabitants generate 602 cases of lithiasis/year, susceptible of being treated with shock waves. The distribution of resources decreases the complementary expenses: displacements, derivation temporary urinary, prevention infection urinary, analgesic, etc.
Health Care Surveys↗
[Renoureteral malformation and lithiasis. Therapeutic approach].
OBJECTIVE: To analyze our results in the treatment of calculi in renoureteral malformations with extracorporeal shock wave lithotripsy (ESWL) alone and the efficacy of ESWL and adjuvant methods in the resolution of calculi in different types of renoureteral malformations. METHODS: The study comprised 141 cases of renoureteral malformations with urinary calculi; 68 were renal, 69 ureteral and 4 in the Bricker urinary diversion. All patients had been diagnosed by IVP and treated by ESWL. These patients were compared with a control group of 125 patients with calculi and a normal renoureteral system that were treated similarly. RESULTS: The malformations accounted for 2.61% of the 5,400 patients that had been treated in our unit from 1990-1998. The mean number of sessions for the patients with malformations was 1.5 versus 1.2 for the control group. The results of treatment were significantly lower for the group of patients with renal malformations than for the control group (54% vs. 87.2%, respectively). Similar results were obtained for the group of patients with ureteral malformations and the control group (87% vs. 75%). CONCLUSIONS: ESWL can be the first treatment option for calculi in patients with renal malformations, although they should be individually evaluated for status of the excretory system, urinary flow dynamics and size of the calculus in order to select the best treatment option. In patients with ureteral malformations, the same criteria utilized for those with a normal excretory system should be applied.
Adult↗
[Efficacy of radiotherapy for upper urinary tract tumor following radical surgery].
OBJECTIVE: To determine the efficacy of postoperative irradiation for locoregional tumor recurrence and in the prevention of distant metastasis in patients with upper urinary tract tumor treated by radical surgery. METHODS: 51 urothelial tumors of the upper urinary tract, most of which had been treated by radical surgery (nephroureterectomy with resection of bladder cuff were analyzed. Since 1989 an adjuvant postoperative radiotherapy protocol (55 Gy) has been included for high grade and stage tumors. Tumor staging was done according to the Jewett-Marshall classification and the Mostoffi cytological grading. RESULTS: Of the total number of cases analyzed, 16 received postoperative irradiation; of these, 5 (31%) showed recurrence. The recurrence rate was 47% for those treated by radical surgery alone. In patients with stage C tumors, 5 out of 12 cases (41.6%) showed recurrence. The recurrence rate was higher (83%) for patients with stage C tumors treated by radical surgery alone. CONCLUSIONS: Adjuvant postoperative radiotherapy is advocated for high grade and stage upper urinary tract tumors. This therapeutic approach has been found to reduce the number of recurrences and, consequently, morbidity. Although the overall survival rate did not increase, a larger series may show more consistent results in this regard.
Adolescent↗
[Treatment of lithiasis in patients with one kidney by extracorporeal shock wave lithotripsy].
OBJECTIVE: To describe the efficacy of extracorporeal shock wave lithotripsy in the treatment of lithiasis in patients with solitary functioning kidney. METHODS: The study comprised 56 patients with solitary kidney that had been treated by extracorporeal shock wave lithotripsy. These patients had a solitary kidney for the following reasons: 30 had undergone nephrectomy due to lithiasis, 11 had lost renal function arising from lithiasis, 9 had undergone nephrectomy for other pathologies and 6 had renal agenesis. Nine stone variables and treatment were analyzed. The same variables were analyzed and compared for statistical significance in a representative sample of 125 lithiasic patients with two kidneys who were treated by ESWL. RESULTS: Patients with solitary kidney frequently had a single calculus of < or = 1 cm located in calyces, unobstructive and did not require complementary endourological procedures. The mean number of shock waves was 8535. The psot-lithotripsy success rate was 82.1%; 98.2% had no complications. Comparison of these variables in both groups of patients showed statistically significant differences for stone location, indication for complementary endourological procedures and the number of shock waves utilized. CONCLUSIONS: In our view, ESWL is the treatment of choice in patients with lithiasis in a solitary kidney due to its high success rate and low morbidity. Stringent criteria must be employed before indicating prior endourological procedures to preserve the patency of the excretory tract and to minimize the risk of ureteral obstruction.
Adult↗
[Determining factors in the success of the treatment of ureteral lithiasis by ESWL].
Shock-wave extracorporeal lithotripsy (SWEL) is admittedly the choice method for most ureteral calculi (UC). Treatment of 1.674 UC was carried out with a Lithostar (Siemens). Endourologic support manoeuvres (ESM) were used in 11.7% patients. To determine their statistical influence on treatment's result variables such as site, size, calculus density, obstruction and functionality of the renal unit, as well as presence of ureteral malformation, were analyzed. With an average of 1.3 sessions (9100 waves) success rate was 91.8% cases. Only the variables of size, obstruction and function showed statistical significance, thus identifying through a multistep logistic regression test the subgroup of calculi less likely to succeed (calculi > 1 cm2, with severe uropathy and functional annulment or delay). Complication were rare (7.5%) and minimally relevant. We conclude than SWEL is the first choice treatment for UC regardless the location. Ureteroscopy (UR) should be considered as the first option particularly in distal (iliopelvic ureter), obstructive calculi and those of difficult radiological study.
Adolescent↗
[The urologist facing the 21st century].
Explore the source record for details and available documents.
Adult↗
[Renal hematomas secondary to extracorporeal shockwave lithotripsy].
OBJECTIVE: 0.6% of the patients submitted to extracorporeal shock wave lithotripsy (ESWL) present symptomatic renal hematoma that can permanently alter renal function and morphology. The present study analyzes the risk factors, types of renal hematoma secondary to shock waves and treatment. METHODS: The study comprised 9 patients with ESWL-induced renal hematoma that had been diagnosed by renal ultrasound and/or urography. Patient evaluation included CT and an isotopic renogram. Two patients had associated arterial hypertension and ischemic coronary heart disease treated with antiaggregants. In 4 patients the renal calculi had produced partial obstruction of the urinary tract. RESULTS: In 4 patients the ESWL-induced renal hematoma was less than 1/3 of the renal volume and did not alter renal function. These patients have been classified as having type I renal hematoma and have been successfully managed conservatively. In 5 patients the hematoma was more than 1/3 of the renal volume and renal function was impaired. These patients have been classified as having type II renal hematoma. Spontaneous reabsorption of the hematoma facilitated recovery of renal function in one patient, two had persistent hematoma and progressive renal function impairment, and the remaining two patients underwent delayed evacuation of the hematoma on days 30-45. Decompression renal surgery preserved renal function of the two kidneys. CONCLUSION: Advanced arteriosclerosis, arterial hypertension, primary coagulation disorders or secondary to antiaggregation therapy and obstruction of the urinary tract increase the risk of ESWL-induced renal hematoma. Renal hematoma following ESWL has been classified as type I or type II. In the latter, renal decompression surgery facilitates recovery of renal function.
Hematoma↗
[Laparoscopic treatment of the symptomatic renal cyst: the indications and a bibliographic review].
OBJECTIVES: The indications and usefulness of laparoscopic renal cystectomy are analyzed. METHODS: Five patients with symptomatic or recurrent simple renal cyst were submitted to laparoscopic cystectomy; section of the posterior peritoneum, dissection of the cyst, puncture-aspiration and resection of the cyst wall. RESULTS: Complete removal of the cyst wall was achieved with minimum morbidity, the cyst and symptoms disappeared and the hospital stay was short. There was one case of hematoma in the lumbar fossa that resolved with conservative management. CONCLUSIONS: Laparoscopic resection of the cyst wall appears to be a useful therapeutic approach for symptomatic or recurrent simple renal cysts.
Adult↗
[Oxalate: its role in lithogenesis and composition of calcium oxalate lithiasis].
UNLABELLED: A prospective study was conducted on 374 patients with urinary lithiasis, aiming to analyze the participation of oxalate in the lithogenesis and composition of the calcium oxalate calculi, alone or associated to other factors. METHODOLOGY: Metabolic urinary study of the patient and analysis of calculi with infrared spectrography and optical microscopy. RESULTS: 26.3% patients had hyperoxaluria and 77.5% of the calculi contain calcium oxalate; these are 167 cases of calcium oxalate, 110 of oxalate and calcium phosphate and 13 cases of mixed calcium oxalate and uric acid lithiasis. 43.4% patients with pure monohydrate calcium oxalate calculi have hypercalciuria, 22.6% hyperoxaluria and 19% hyperuricosuria. Dihydrated calcium oxalate calculi are related to high hypercalciuria in 65% cases and to significant hyperoxaluria in 35% cases. 45% patients present a single lithogenic factor, either hypercalciuria (49.6%), hyperoxaluria (20.6%), hyperuricosuria (13.74%), hypocitraturia (9%), urinary infection (1.5%), A.T.R. (2.25%) or acid oliguria (3%).
Calcium Oxalate↗
[Granulated potassium citrate in the prevention of calcium oxalate lithiasis].
Since the approval of potassium citrate for the treatment of urolithiasis, there are many patients in other countries who have benefited from this drug. This paper describes the biochemical changes and tolerance seen in fifteen patients treated for one month with granulated potassium citrate. Some significant changes are observed in serum potassium and creatinine, and in urinary pH, citrate and potassium. Tolerance was good. Our results confirm that potassium citrate is an effective, easy to use, and well tolerated drug for the prophylaxis of oxalocalcium lithiasis.
Calcium Oxalate↗
[Biochemical effects of potassium citrate in the treatment of calcium oxalate lithiasis].
The serum and urinary biochemical changes observed one month and six months after oral potassium citrate therapy (600 mEq/day) in 119 patients with calcium oxalate calculi were compared with those of 16 untreated cases with lithiasis. The patients that received treatment were previously divided into two groups: group A comprised 61 hypocitraturic patients and group B comprised 58 patients with other urinary disorders who were normo or hypocitraturic. The urinary pH increased by approximately half a point in both treated groups. In group A calciuria increased slightly from 180 +/- 8 to 216 +/- 10 mg/24 h but remained within the normal ranges. Creatinuria, oxaluria, uricosuria and diuresis showed no changes. Citraturia increased very significantly in both groups and more markedly in the hypocitraturic group of patients (from 198 +/- 13 to 476 +/- 35 mg/24 h). The LRC (lithogenic risk coefficient = Ca/Cit x Diu) dropped by 50%. The patients tolerated the treatment regimen well; of the 119 treated patients, only 11 abandoned treatment due to GI intolerance.
Adult↗