RESUMEN
Since the publication of the latest recommendations of the Lithiasis Comity of the French Association of Urology (CLAFU) on the management of ureteral and renal stones, practices have evolved. This text provides an update for the treatment of kidney stones. It is especially the important advances in the field of laser-ureterorenoscopy that changed practices. Percutaneous nephrolithotomy has been enriched by technical modifications and extracorporeal shockwave lithotripsy confirmed its predominant place in the first line of treatment. For stones less than 20mm, extracorporeal lithotripsy remains the standard, but in some cases the possibility of recommending a flexible ureterorenoscopy is possible in first line. For stones more than 20mm, percutaneous nephrolithotomy is the standard treatment, but optional flexible ureteroscopy and extracorporeal lithotripsy are possible. The treatment carried out, collect the stone fragments for a morpho-constitutional analysis and achieve a metabolic evaluation is necessary, to investigate etiologic and give dietary advices to prevent recurrence.
Asunto(s)
Cálculos Renales/terapia , Femenino , Francia , Humanos , Trasplante de Riñón , Laparoscopía , Litotricia , Riñón Esponjoso Medular/complicaciones , Nefrostomía Percutánea , Selección de Paciente , Embarazo , Complicaciones del Embarazo , Obstrucción Ureteral/etiología , Obstrucción Ureteral/terapia , Ureteroscopía , Derivación UrinariaRESUMEN
The Lithiasis Committee of the French Association of Urology (CLAFU) aimed to update the current knowledge about urolithiasis. This update will be divided into four parts: 1) general considerations; 2) the management of ureteral stones; 3) the management of kidney stones; 4) metabolic assessment and medical treatment of urolithiasis. Recent technicals advances helped the urologists to improve stones management: new extracorporeal shockwave lithotripsy (ESWL) devices, new flexible ureterorenoscopes, development of laser fragmentation. ESWL, semi-rigid and flexible ureteroscopy and the percutaneous nephrolithotomy (PCNL) remain currently the main therapeutic options. The first part of this update deals with the description and classification of stones, preoperative assessment, post-operative management and clinical follow-up. Main criteria of therapeutic choices are stone location, stone composition and stone size. Stone composition is assessed with infrared spectrophotometry analysis and its hardness is correlated with U.H. density on CT scan assessment. Preoperative assessment consists in urinary cytobacteriological examine, urinary PH, blood creatininemia, hemostasis. Low-dose CT scan is recommended before urological treatment. The result of the treatment must be done 1 or 3 months later with plain abdominal film and ultrasonography. Medical management of urolithiasis will be based on stone composition, metabolic and nutritional evaluation. Treatment success is definited by absence of residual fragments. Annual follow-up is recommended and based either on plain abdominal film and ultrasonography or low-dose CT scan.
Asunto(s)
Litotripsia por Láser , Nefrolitiasis/terapia , Nefrostomía Percutánea , Ureterolitiasis/terapia , Ureteroscopía , Urología , Adulto , Congresos como Asunto , Francia , Humanos , Litotripsia por Láser/instrumentación , Litotripsia por Láser/métodos , Nefrolitiasis/diagnóstico , Nefrostomía Percutánea/instrumentación , Nefrostomía Percutánea/métodos , Guías de Práctica Clínica como Asunto , Cuidados Preoperatorios/métodos , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento , Ureterolitiasis/diagnóstico , Ureteroscopía/instrumentación , Ureteroscopía/métodosRESUMEN
UNLABELLED: The flexible ureterorenoscopy coupled with photovaporisation LASER (USSR-L) for the treatment of kidney kidney is a modern tool whose place is under evaluation. METHODS: Its place has been assessed in France in 2010 by the Committee of urolithiasis of the French Association of Urology (CLAFU). A practice survey among 27 experts concerned the following decision criteria: comorbid patient's supposed nature of the calculation, anatomy of the urinary tract of the patient. This investigation has been proposed to calculate the size not exceeding 20mm, for a calculation of size greater than 20mm and for multiple calculations kidney. RESULTS: Fourteen experts responded. The criteria for the USSR-The first line were: morbid obesity (BMI>30), anticoagulation or anti platelet aggregation, calculations Hard (UH>1000, cystine stones), calculations within diverticular caliceal calculations below, the failure of a first treatment or the wish of the patient. CONCLUSION: The URS-SL was a first-line treatment validated regardless of size and number of kidney stones, when ESWL and PCNL were contraindicated or when their predictable results were poor (hard stones/morbid obesity/lower pole stones) or when stone access is difficult (intradiverticular). It was also the treatment of choice after the failure of a first treatment (ESWL/PCNL).
Asunto(s)
Cálculos Renales/terapia , Litotripsia por Láser/métodos , Ureteroscopios , Ureteroscopía/métodos , Anciano , Índice de Masa Corporal , Francia , Encuestas de Atención de la Salud , Humanos , Litotripsia por Láser/instrumentación , Obesidad/complicaciones , Guías de Práctica Clínica como Asunto , Reproducibilidad de los Resultados , Factores de Riesgo , Encuestas y Cuestionarios , Resultado del Tratamiento , Ureteroscopía/instrumentación , UrologíaRESUMEN
OBJECTIVE: Retrospective evaluation of the efficacy and morbidity of simultaneous bilateral percutaneous nephrolithotomy (SB-PCNL). METHODS: From January 1993 to July 2009, 60 patients have undergone SB-PCNL over a series of 1709 PCNL. Thirty men and 30 women, mean age 45 years old (13-78), were treated for bilateral renal stones (120 kidneys) of 1177 mm(2) (268-4972 mm(2)); 25 were complete staghorn stones. RESULTS: Operating time for the first side of PCNL was 80 min (30-270) and 45 min (10-90) for the opposite side. Overall OR occupation was 188 min (90-360). Forty-five patients were stone free after one session; 15 patients (25%) have a complementary treatment to be stone free: five PCNL (one bilateral); eight ESWL (four with JJ stent) and two flexible ureteroscopy. No blood transfusion was required. Renal function was unchanged at 1 month. Clavien grade for complications were as follows: two grade IIIb, one grade IVa and one grade IVb. Hospitalization stay was 4±4.9 days (2-35) taking account of two major sepsis (one pulmonary and one septicemia). CONCLUSION: SB-PCNL was well tolerated with comparable morbidity and efficacy to PCNL performed on each side in two separate sessions. Nevertheless, SB-PCNL has to be performed for selected patients in expert centers.
Asunto(s)
Cálculos Renales/cirugía , Nefrostomía Percutánea/métodos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nefrostomía Percutánea/efectos adversos , Estudios Retrospectivos , Adulto JovenRESUMEN
INTRODUCTION: The goal of this prospective study was to characterize ureteral stents encrustation in stone formers. MATERIAL AND METHODS: We report the results of a study based on 658 double-J stents (412 men and 246 women) collected from patients with in situ urinary calculi. The mean age was 48.2+/-16.0 years without differences between genders. Ureteral stent encrustation was analysed by infrared spectroscopy. Results are expressed according to the main component. RESULTS: The mean indwelling time was 73.5+/-73.2 days. The main component in stent encrustations was calcium oxalate (43.8%), essentially the monohydrate form (27.1%), followed by proteins (27.4%), calcium phosphates (16.4% with 8.4% brushite), and uric acid (5.2%). Struvite, detected on 49 stents, was the main component in 2.4% of cases. Significant differences according to gender and age were found: calcium oxalate monohydrate, which represented 24.5% in 20 to 29 years old men class increased to 37.0% in 50 to 59 years class and then decreased in older patients. Calcium oxalate dihydrate increased with age up to 70 years in women while it felt dramatically in man beyond 50 years old. Brushite was more abundant in young men (20.4% in patients aged 20-29 years) and was decreasing beyond this age while it remained in stable proportion for all age classes in women. Increasing prevalence of uric acid encrustations with age was observed, especially in men beyond the age of 70 years. Mineral encrustations increased with the indwelling time, the part of mineral being preponderant after 15 days: 7,3% of the stents had become massively encrusted within 113 days mean period. The comparison between biomaterials showed that silicone stents were significantly less encrusted than polyurethane stents. CONCLUSION: Stent encrustation constitutes a serious complication of ureteral stent use in stone formers. Lithogenic factors should be considered for the prevention of stent encrustation in these patients.