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      Tratamiento de la litiasis piélica con el litotritor MODULITH SLX-MX (STORZ) Translated title: Treatment of the pyelic lithiasis using the MODULITH SLX-NX (STORZ) lithotriptor

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          Abstract

          INTRODUCCIÓN. La litiasis urinaria es una enfermedad de alta prevalencia y recurrencia, a la que los hospitales no pueden dar solución quirúrgica con la celeridad necesaria. La litotricia extracorpórea por ondas de choque (LEC) es la primera opción de tratamiento y las tasas de resolución fluctúan del 33 al 90 %. El objetivo de este estudio fue analizar nuestros resultados con la utilización del litotritor MODULITH SLX-MX (STORZ) para el tratamiento monoterápico de la litiasis de la pelvis renal. MÉTODOS. Se incluyeron pacientes con litiasis piélica que no hubieran recibido otro tratamiento. Se conformaron 4 grupos según la superficie litiásica y se relacionaron con la terapéutica (sesiones, ondas de choque, energía, complicaciones, aplicación de procedimientos auxiliares, maniobras complementarias y evolución). RESULTADOS. El mayor número de pacientes tenía cálculos de hasta 2 cm², y más del 92 % fueron resueltos con una sola sesión. Más del 94 % no presentó complicaciones y no se necesitaron procedimientos auxiliares en más del 97 % de los casos. CONCLUSIONES. Se lograron buenos resultados en más del 97 % de los casos mediante LEC monoterápica de la litiasis piélica de hasta 4 cm² utilizando el litotritor MODULITH SLX-MX (STORZ). Los mejores resultados se obtuvieron en los cálculos de hasta 3 cm² y más del 99 % de éstos correspondieron a los cálculos de hasta 2 cm². Las ventajas de este equipo se deben, sobre todo, a su alta eficacia y al hecho de que logra una fragmentación fina que facilita la eliminación total de los cálculos. Por esta razón, se consigue una alta tasa de resolución, sin restos de la litiasis en más del 97 % de los casos y con un mínimo de maniobras complementarias.

          Translated abstract

          INTRODUCTION. The urinary lithiasis is a disease with a high prevalence and recurrence and the hospitals can not give a surgical solution as quickly as possible. The shock waves extracorporeal lithotripsy (SWEL) is the first choice of treatment and the resolution rates fluctuate from 33 to 90%. The objective of present study was to analyze our results using the MODULITH SLX-MX (STORZ) lithotriptor for the monotherapy of renal pelvis lithiasis. METHODS. The patients presenting with pyelic lithiasis and any other treatment were included in study that were divided into four groups according the lithiasis surface and were related to therapeutics (sessions, chock waves, energy, complications and application of auxiliary procedures, complementary manoeuvres and course). RESULTS. Most of patients had 2 cm² calculi and more than the 92% were solved with only one session. More than 94% had not complications without auxiliary procedures in more than 97% of the cases. CONCLUSIONS. It was possible to obtain good results in more than 97% of the cases using monotherapy-SWEL of pyelic lithiasis of 4 cm² using the MODULITH SLX-MX (STORZ) lithotriptor. The better results were obtained in calculi of 3 cm² and more than the 99% belongs to calculi of 2 cm². The advantages of this device were mainly due to its high effectiveness level and to fact that it achieves a fine fragmentation allowing the total removal of calculi. Thus, it is possible to obtain a high rate resolution without rests of lithiasis in more than 97% of the cases and with a minimum of complementary manoeuvres.

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          Adult urolithiasis in a population-based study in Iran: prevalence, incidence, and associated risk factors.

          The aim of this study was to determine the prevalence, incidence, and risk factors of adult urolithiasis in Iran. A total of 8,413 persons aged over 14 years enrolled in this cross-sectional study. They were questioned on the occurrence of urinary stones during their lifetime (prevalence) and on acute urolithiasis in 2005 (incidence) by 62 general practitioners. The subjects were randomly identified from 30 counties of Iran. Data on risk factors for urolithiasis including age, race, education, body mass index, hypertension, and current use of medication were also obtained by self-administered questionnaire. Of the 7,649 participants who provided information, 5.7% (436) [95% confidence interval (CI) 4.2-5.4], reported urinary stones. The prevalence increased from 0.9% in adults aged 15-29 years to 8.2% in those aged 60-69 years (test for trend, P = 0.001). Urolithiasis was slightly more frequent and persisted in males (6.1%) than females (5.3%) giving a male-to-female ratio of 1.15:1 [odds ratio (OR) 1.03; 95% CI 0.64-1.36; P = 0.814]. The annual incidence of urolithiasis in 2005 was 145.1. The average cumulative recurrence rate was 16% after 1 year, 32% after 5 years, and 53% after 10 years. Urinary stones were more in number among men and women who lived in south central and southwest counties, with odds increasing from west to east and from north to south. A positive association was found between urolithiasis and obesity (OR 1.74; 95% CI 1.21-2.31; P = 0.04), diuretic use (OR 1.62; 95% CI 1.18-2.70; P = 0.03), hypertension (OR 1.88; 95% CI 1.26-2.18; P = 0.04), unemployment (OR 2.10; 95% CI 1.43-2.14; P = 0.04), consumption of tea (OR 1.64; 95% CI 1.32-2.62; P = 0.03), consumption of cola (OR 1.49; 95% CI 1.23-2.19; P = 0.02), and meat consumption (OR 1.38; 95% CI 1.29-2.21; P = 0.02). This study provides a quantitative estimate of the prevalence, incidence, and main risk factors for adult urolithiasis in the Iranian population. Further studies are warranted in order to determine the incidence and prevalence of urolithiasis in different ethnic groups.
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            A multivariate analysis of risk factors associated with subcapsular hematoma formation following electromagnetic shock wave lithotripsy.

            Subcapsular or perinephric hematoma is one of the most frequent and potentially serious complications of extracorporeal shock wave lithotripsy (SWL). We determined the incidence of and risk factors for renal hematomas following electromagnetic shock wave lithotripsy. Between February 1999 and August 2003, 570 SWL treatments were performed using a Modulith SLX electromagnetic lithotriptor (Storz, St. Louis, Missouri). A total of 415 of these treatments in 317 patients were performed for stones in the renal pelvis or calices and these treatment episodes represent the study group reported. Treatment episodes were reviewed from a prospective institutional review board approved registry and analyzed for patient age, gender, body mass index, mean arterial pressure at induction, stone location, total number of shock waves and peak shock wave intensity. Following these 415 episodes subcapsular or perinephric hematomas developed in 17 patients for an overall incidence of 4.1%. The probability of hematoma after shock wave lithotripsy increased significantly as patient age at treatment increased, such that the probability of hematoma was estimated to be 1.67 times greater for each 10-year incremental increase in patient age. None of the other variables analyzed were significantly related to the incidence of hematoma formation at the 0.05 level. The incidence of renal hematoma formation following electromagnetic SWL for renal calculus was 4.1%. The probability of hematoma increased significantly with increasing patient age but it was not associated with increasing mean arterial pressure at treatment. These findings are in contrast to previous reports of hematoma associated with electrohydraulic SWL. These differences may be a consequence of the smaller focal zone and higher peak pressure associated with Storz Modulith electromagnetic SWL and, just as importantly, a consequence of the difference in the manner in which blood pressure was defined.
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              Comparison of results and morbidity of percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy.

              Two new therapies, percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy, are revolutionizing the treatment of upper urinary tract calculi. We report the success and morbidity rates in 110 patients undergoing percutaneous nephrostolithotomy and 982 patients treated with extracorporeal shock wave lithotripsy. Staghorn calculi were excluded from this series. The over-all success rate (free of stones plus small asymptomatic residual fragments) was comparable with both modalities (percutaneous nephrostolithotomy 98 per cent and extracorporeal shock wave lithotripsy 95 per cent), although the presence of residual fragments was more common in kidneys treated with extracorporeal shock wave lithotripsy (24 versus 7 per cent). Patient morbidity as measured by temperature elevation, length of postoperative stay, pain and blood loss was significantly less (p less than 0.05) with extracorporeal shock wave lithotripsy than with percutaneous nephrostolithotomy. Re-treatment rates were similar with both procedures, and tended to increase in relation to increasing stone size and stone number. Post-treatment ancillary procedures (cystoscopy and stone manipulation, and percutaneous nephrostomy) were used more frequently with extracorporeal shock wave lithotripsy. Because of its efficacy and low morbidity, we conclude that extracorporeal shock wave lithotripsy is the treatment of choice for upper urinary tract calculi less than 2 cm. in diameter. However, percutaneous nephrostolithotomy will continue to have a primary role in the management of larger stones and cystine stones, and it will be used as a secondary procedure after unsuccessful extracorporeal shock wave lithotripsy treatments. In addition, because of the complimentary nature of these 2 new technologies certain complex stones, such as staghorn calculi, may be handled best by a combination of the 2 techniques.
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                Author and article information

                Journal
                cir
                Revista Cubana de Cirugía
                Rev Cubana Cir
                Editorial Ciencias Médicas (Ciudad de la Habana, , Cuba )
                0034-7493
                1561-2945
                September 2010
                : 49
                : 3
                Affiliations
                [01] La Habana orgnameHospital Hermanos Ameijeiras Cuba
                Article
                S0034-74932010000300003 S0034-7493(10)04900303
                b3919bb1-74ac-4ca1-a475-b8a1f91601bd

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 16 March 2010
                : 23 December 2009
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 0
                Product

                SciELO Cuba

                Categories
                ARTICULOS ORIGINALES

                Pyelic lithiasis,extracorporeal lithotripsy,SWEL,MODULITH SLX-MX (STORZ) lithotriptor,Litiasis piélica,litotricia extracorpórea,LEC,litotritor MODULITH SLX-MX (STORZ)

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