RESUMEN
PURPOSE: Clinical studies produce conflicting results on pain relief for shock wave lithotripsy (SWL). We performed a systematic review and meta-analysis to compare non-steroidal anti-inflammatory drugs (NSAIDs) and opioids in pain relief for SWL powered by an electromagnetic generator. MATERIAL AND METHODS: A search of MEDLINE and EMBASE was performed and all randomized controlled trials comparing NSAIDs and opioids in pain relief for SWL using modern electromagnetic lithotripters were included in the analysis. Data from 3 trials (244 patients) were pooled. The primary outcome measure was adequate analgesia, defined as "if no additional pain relief was used". The difference in the proportion of patients with adequate anesthesia was compared between the NSAIDs and opioids groups as an odds ratio and odds ratio were pooled across the 3 trials with a fixed effects model. RESULTS: There was no statistically significant difference between using NSAIDs and opioids for pain relief during SWL using modern electromagnetic lithotripters (odds ratio 0.886, 95% CI 0.446-1,760, p = 0.730). CONCLUSIONS: Our analysis shows that in relieving pain during SWL using modern electromagnetic lithotripters NSAIDs are as effective as opioids.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Cálculos Renales/terapia , Litotricia/efectos adversos , Dolor/tratamiento farmacológico , Humanos , Litotricia/instrumentación , Litotricia/métodos , Oportunidad Relativa , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
PURPOSE: Clinical studies produce conflicting results on pain relief for shock wave lithotripsy (SWL). We performed a systematic review and meta-analysis to compare non-steroidal anti-inflammatory drugs (NSAIDs) and opioids in pain relief for SWL powered by an electromagnetic generator. MATERIAL AND METHODS: A search of MEDLINE and EMBASE was performed and all randomized controlled trials comparing NSAIDs and opioids in pain relief for SWL using modern electromagnetic lithotripters were included in the analysis. Data from 3 trials (244 patients) were pooled. The primary outcome measure was adequate analgesia, defined as "if no additional pain relief was used". The difference in the proportion of patients with adequate anesthesia was compared between the NSAIDs and opioids groups as an odds ratio and odds ratio were pooled across the 3 trials with a fixed effects model. RESULTS: There was no statistically significant difference between using NSAIDs and opioids for pain relief during SWL using modern electromagnetic lithotripters (odds ratio 0.886, 95 percent CI 0.446-1,760, p = 0.730). CONCLUSIONS: Our analysis shows that in relieving pain during SWL using modern electromagnetic lithotripters NSAIDs are as effective as opioids.
Asunto(s)
Humanos , Analgésicos Opioides/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Cálculos Renales/terapia , Litotricia/efectos adversos , Dolor/tratamiento farmacológico , Litotricia/instrumentación , Litotricia/métodos , Oportunidad Relativa , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
INTRODUCTION: Management of urolithiasis in morbidly obese patients is usually associated with higher morbidity and mortality compared to non-obese patients. In morbidly obese patients, since the kidney and stone are at a considerable distance from the skin (compared to non-obese patients) difficulty may be found in positioning the patient so that the stone is situated at the focal point of the lithotripter. OBJECTIVE: To evaluate the outcomes and cost-efficiency of extracorporeal shock wave lithotripsy (ESWL) in the treatment of renal pelvicalyceal stones sized between 6 and 20 mm in morbidly obese patients. MATERIALS AND METHODS: Using various aids, such as mobile overtable module, extended shock pathway and abdominal compression 37 patients with body mass index more than 40 kg/m2 were treated using the Siemens Lithostar-plus third generation lithotripter. The size of renal pelvicalyceal stones was between 6 and 20 mm. Treatment costs for shock wave lithotripsy were calculated. RESULTS: The overall stone free rate at 3 months of 73% was achieved. The mean number of treatments per patient was 2.1. The post-lithotripsy secondary procedures rate was 5.4%. No complications, such as subcapsular haematoma or acute pyelonephritis were recorded. The most effective (87% success rate) and cost-efficient treatment was in the patients with pelvic stones. The treatment of the patients with low caliceal stones was effective in 60% only. The cost of the treatment of the patients with low calyceal stones was in 1.8 times higher than in the patients with pelvic stones. CONCLUSION: We conclude that ESWL with the Siemens Lithostar-plus is the most effective and cost-efficient in morbidly obese patients with pelvic stones sized between 6 and 20 mm. 87% success rate was achieved. The increased distance from the skin surface to the stone in those patients does not decrease the success rate provided the stone is positioned in the focal point or within 3 cm of it on the extended shock pathway. ESWL should not be considered as the first line of treatment in the morbidly obese patients with low caliceal stones where the stone was positioned more than 1 cm from the focal point on the extended shock pathway.
Asunto(s)
Cálculos Renales/terapia , Litotricia/métodos , Obesidad Mórbida/complicaciones , Adolescente , Adulto , Anciano , Índice de Masa Corporal , Análisis Costo-Beneficio , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Litotricia/economía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: Management of urolithiasis in morbidly obese patients is usually associated with higher morbidity and mortality compared to non-obese patients. In morbidly obese patients, since the kidney and stone are at a considerable distance from the skin (compared to non-obese patients) difficulty may be found in positioning the patient so that the stone is situated at the focal point of the lithotripter. OBJECTIVE: To evaluate the outcomes and cost-efficiency of extracorporeal shock wave lithotripsy (ESWL) in the treatment of renal pelvicalyceal stones sized between 6 and 20 mm in morbidly obese patients. MATERIALS AND METHODS: Using various aids, such as mobile overtable module, extended shock pathway and abdominal compression 37 patients with body mass index more than 40 kg/m2 were treated using the Siemens Lithostar-plus third generation lithotripter. The size of renal pelvicalyceal stones was between 6 and 20 mm. Treatment costs for shock wave lithotripsy were calculated. RESULTS: The overall stone free rate at 3 months of 73 percent was achieved. The mean number of treatments per patient was 2.1. The post-lithotripsy secondary procedures rate was 5.4 percent. No complications, such as subcapsular haematoma or acute pyelonephritis were recorded. The most effective (87 percent success rate) and cost-efficient treatment was in the patients with pelvic stones. The treatment of the patients with low caliceal stones was effective in 60 percent only. The cost of the treatment of the patients with low calyceal stones was in 1.8 times higher than in the patients with pelvic stones. CONCLUSION: We conclude that ESWL with the Siemens Lithostar-plus is the most effective and cost-efficient in morbidly obese patients with pelvic stones sized between 6 and 20 mm. 87 percent success rate was achieved. The increased distance from the skin surface to the stone in those patients does not decrease the success rate provided the stone is positioned in the focal point or within 3 cm of it on the extended shock pathway. ESWL should not be considered as the first line of treatment in the morbidly obese patients with low caliceal stones where the stone was positioned more than 1 cm from the focal point on the extended shock pathway.
Asunto(s)
Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cálculos Renales/terapia , Litotricia/métodos , Obesidad Mórbida/complicaciones , Índice de Masa Corporal , Análisis Costo-Beneficio , Costos de la Atención en Salud/estadística & datos numéricos , Litotricia/economía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The paper presents the International system of overall score estimation of symptoms and life quality for patients with benign prostatic hyperplasia and reviews the results of this system application for objective diagnosis and evaluation of the efficacy of the treatment (chemotherapy, transurethral resection, transvesicular adenomectomy, transrectal hyperthermia, YAG-Nd laser prostatectomy) in 250 patients with benign prostatic hyperplasia. The fault of the system is the absence of specific recommendations for rating objective test results. The authors propose their variant of estimation of prostatic volume, maximal urination rate, residual urine.
Asunto(s)
Cooperación Internacional , Hiperplasia Prostática/diagnóstico , Calidad de Vida , Índice de Severidad de la Enfermedad , Diagnóstico Diferencial , Humanos , Masculino , Federación de RusiaRESUMEN
Renal carcinoma and urolithiasis combine rather rarely. Postnephrectomy patients often consult the urologist when the condition is serious because of complications resultant from uroliths in the contralateral kedney. In view of solitary kidney, progressive chronic pyelonephritis, associated chronic renal failure surgical treatment of the condition becomes risky and necessitates individual approach to choice of therapeutic policy and definition of indications to urolithiasis treatment in patients after nephrectomy for renal carcinoma. This includes the decision whether to perform nephrolithiasis before or after nephrectomy and whether to attempt any surgery in the absence of urolithiasis clinical symptoms.
Asunto(s)
Neoplasias Renales/cirugía , Cálculos Urinarios/cirugía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Riñón/diagnóstico por imagen , Neoplasias Renales/diagnóstico , Masculino , Persona de Mediana Edad , Nefrectomía , Radiografía , Ultrasonografía , Cálculos Urinarios/diagnósticoRESUMEN
The material gained in the urological clinic of the Moscow Regional Research Clinical Institute covers 2000 cases of uroliths treated with extracorporeal lithotripsy (ECL) for 4 years. Factors implicated in the treatment outcomes, measures to prevent ECL complications, recommendations for ECL regimens in different clinical forms are specified.
Asunto(s)
Litotricia , Cálculos Urinarios/terapia , Adulto , Femenino , Humanos , Litotricia/métodos , Masculino , Tomografía Computarizada por Rayos X , Cálculos Urinarios/complicaciones , Cálculos Urinarios/diagnóstico por imagen , UrografíaRESUMEN
The paper reviews the experience of the urological clinic in the treatment of 106 children with urolithiasis. The necessity of careful pretreatment examination to reject associated anomaly of the upper urinary tracts as a cause of lithogenesis is emphasized. Surgical treatment and extracorporeal lithotripsy which has proved highly effective against uroliths in children are considered.
Asunto(s)
Cálculos Urinarios/diagnóstico , Adolescente , Niño , Preescolar , Femenino , Humanos , Litotricia , Masculino , Ultrasonografía , Cálculos Urinarios/terapia , Sistema Urinario/diagnóstico por imagen , Sistema Urinario/cirugía , UrografíaAsunto(s)
Carcinoma de Células Renales/diagnóstico , Neoplasias Renales/diagnóstico , Vena Cava Inferior/patología , Carcinoma de Células Renales/irrigación sanguínea , Femenino , Humanos , Neoplasias Renales/irrigación sanguínea , Imagen por Resonancia Magnética , Invasividad Neoplásica , Tomografía Computarizada por Rayos XRESUMEN
The article analyses experience in the management of about 1,500 patients with urolithiasis who underwent in- and out-patient treatment at the Urological Clinic of the Moscow Regional Scientific Research Clinical Institute in 1990-1993. Indications were determined for applying lithotripsy in patients with stones in anomalous kidneys, in cases of a solitary kidney, and children with urolithiasis. The tactics of management of large kidney stones is described. The use of endoscopic methods of treatment (percutaneous and transurethral) is evaluated. Modern methods of urolithiasis treatment were applied instead of an open operation in 90% of patients.
Asunto(s)
Cálculos Renales/terapia , Litotricia/métodos , Adolescente , Adulto , Anciano , Niño , Preescolar , Endoscopía , Femenino , Humanos , Cálculos Renales/diagnóstico , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Therapeutic results of remote lithotripsy have been analyzed for 1016 patients with urolithiasis. The authors also focus on specific features of remote lithotripsy in anomalous stones, in nephroliths on the single and transplanted kidney, in location of the stone in the ureter. The efficacy of the procedure is reviewed in pediatric patients. Satisfactory results were achieved in 962 patients (95%). Remote lithotripsy is considered to be a valuable component of combined treatment of urolithiasis replacing successfully open surgery in 95% of the cases.
Asunto(s)
Litotricia , Cálculos Urinarios/terapia , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Riñón/anomalías , Riñón/diagnóstico por imagen , Litotricia/métodos , Masculino , Persona de Mediana Edad , Radiografía , Recurrencia , Cálculos Ureterales/diagnóstico por imagen , Cálculos Ureterales/terapia , Cálculos Urinarios/diagnóstico por imagenRESUMEN
Computed tomography was performed before and after telelithotripsy to evaluate changes in renal parenchyma induced by the procedure in 34 patients with nephroliths. Piezolith-2300 lithotriptor ("Wolf", FRG) was employed. The images showed no serious parenchymal injuries or paranephric hematomas, on the one hand, but density changes in the parenchyma, on the other hand. These were of 3 types: focal reduction in 3, diffuse reduction in 4 and diffuse increase of the density in 2 patients. As shown by comparison with literature data, telelithotripsy on "Piezolith-2300" causes minimal changes in renal parenchyma and perirenal fat. In view of this, the procedure is recommended for wide clinical and outpatient practice.
Asunto(s)
Tejido Adiposo/diagnóstico por imagen , Riñón/diagnóstico por imagen , Litotricia/instrumentación , Tomografía Computarizada por Rayos X , Tejido Adiposo/fisiopatología , Adolescente , Adulto , Estudios de Evaluación como Asunto , Femenino , Humanos , Riñón/fisiopatología , Cálculos Renales/diagnóstico por imagen , Cálculos Renales/fisiopatología , Cálculos Renales/terapia , Litotricia/efectos adversos , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
To evaluate cardiac effects of shock waves, 40 patients with uroliths (10 subjects with and 30 without arrhythmia) were examined during their exposure to remote electropiezolithotripsy (Piezolith-2300 unit). Arterial pressure and ECG were registered before, during (upon 1500 and 3000 impulses) and after the session. Except a slight deceleration of the heart rate, no cardiac disorders significant clinically were reported.