Renal parenchyma injury after percutaneous nephrolithotomy tract dilatations in pig and cadaveric kidney models

Altres ajuts: This study was partially funded by Rocamed®, who financed the acquisition of the cadaveric kidneys from the Ecole Européenne de Chirurgie (Paris).Miniaturization of instruments has changed the paradigms of percutaneous nephrolithotomy (PCNL). To date, however, few studies have analyzed the possible renal trauma generated by PCNL tract dilation. The purpose of this study is to evaluate and compare systematically the renal injury of all PNCL dilation techniques in pork kidneys (PK) and cadaveric kidney models (CK). Twelve dilation devices were tested (from 4.8 to 30 French (Fr)) including micro- and mini- PCNL kits, the Alken dilation set, 20 and 30 ATM balloons and the Amplatz set. Each device was tested six times in PK and CK. Morphologic analysis of tract defects of the different models and dilators were made measuring the longest axis and the area of renal parenchymal damage. When comparing the PK and CK dilation tract areas to the device areas, major differences were seen with the 20 ATM 30 Fr balloon (p = 0.0001 and 0.008) respectively, the sequential Amplatz dilation to 30 Fr (p = 0.0005 and 0.0006) respectively, and the Alken 30 FR dilation (p = 0.012 and 0.02) respectively. The 30 Fr dilations were 32.76 mm 2 (mean) larger than the instruments themselves, while the ≤24 Fr dilations were 11.6 mm 2 (mean) larger than the instruments themselves. When comparing devices and tract areas, the dilation tract area exceeded device area by 11.6 mm 2 at dilations up to 24 Fr vs. 32.76 mm 2 with dilations of 30 Fr. Overall, PK had significantly larger injuries than CK models

Predictors of Clinical Outcomes of Flexible Ureterorenoscopy with Holmium Laser for Renal Stone Greater than 2 cm

Objective. To evaluate the clinical outcome of flexible ureterorenoscopy (F-URS) with holmium laser in managing renal stone greater than 2 cm. Patients and Methods. Records of 120 patients (123 renal units) with renal stone greater than 2 cm who underwent F-URS with holmium laser iwere evaluated. The mean stone size was 26.3 mm. Patient and stone characteristics, perioperative outcomes and complications were evaluated. The outcome was determined at 4 weeks on plain radiograph (KUB) and Non-contrast CT scan (NCCT). Follow-up visit was up to 6 months to evaluate the clinical outcome and patients symptoms. Results. Stone burden was an independent predictor of FURS results. After first session of treatment, success rate was obtained in 72 renal units (58.5%). On the other hand, significant residual fragment was encountered in 51 renal units (41.5%). This was improved with “staged-therapy” to 87% and 96.7% after second and third session of treatment, respectively. Complications were recorded. They were managed in proper manner accordingly. Conclusion. This is an attractive, safe and effective technique. It is an ideal option for low volume complex stone with average burdens of 2 to 3 cm. Patient should be informed and consented about staged-therapy

Stone composition independently predicts stone size in 18,029 spontaneously passed stones

PURPOSE To evaluate whether the size of spontaneously passed stones (SPS) may be associated with clinical parameters. METHODS A search for SPS was conducted in our electronic stone database, comprising data on stones analyzed over the last 33 years at our institution. Adults with upper urinary tract stones were included. Cases with stenotic urinary tract disease or past history of anastomotic urinary tract surgery were excluded. Stone size expressed as maximal stone diameter (MSD) and stone volume (SV) was compared between groups by one-way ANOVA. Logistic regression analyses were performed to identify predictors of MSD ≥ 6 mm. RESULTS Overall mean MSD and SV for 18,029 SPS was 4.1 mm and 11.5 mm$^{3}$, respectively, and significantly differed between stone composition groups (p < 0.001). The lowest mean MSD and SV were found for calcium oxalate monohydrate (3.6 mm and 9.0 mm$^{3}$, respectively) and the highest mean MSD and SV were found for struvite (7.9 mm and 61.0 mm$^{3}$, respectively). Stone composition and increasing age were found to be independent predictors of MSD ≥ 6 mm (both p < 0.001). Sex differentiation did not contribute as a predictor of MSD ≥ 6 mm. CONCLUSIONS Stone composition and-to a lesser extent-age serve as independent predictors of size of spontaneously passed stones. Of particular importance, large spontaneously passed stones of ≥ 6 mm may be frequently found in cystine, brushite or struvite stone formers, whereas a minority of all calcium oxalate stones exceed that cutoff. Future studies shall evaluate these parameters as possible predictors of spontaneous stone passage

Evolution of endourology and flexible ureterorenoscopy, can they be useful to urologists to clarify stone composition and morphology?

International audienceIntroduction: During the last two decades, there has been great advancement in the technology and performance of flexible ureterorenoscopy. Endoscopes are smaller and the new digital technology offers a fantastic endoscopic definition. This manuscript is a state-of-the-art describing the endoscopic equipment evolution and usefulness. Moreover, we raise the interest to perform a better description of the endoscopic stone appearance according to different stone compositions, in order to offer a better morpho-constitutional analysis. Methods and results: A revision of the literature was performed to describe the evolution of the endoscopic equipment used in flexible ureterorenoscopy. Currently, there is no data that evaluate the usefulness of endoscopic stone pictures, video and description during flexible ureterorenoscopy to evaluate if there is an advantage in the final morpho-constitutional analysis. Conclusion: Urologists should know the development in the field of flexible ureter-orenoscopy and the equipment available to accommodate them during the procedures. Clinical trials are needed in order to evaluate the role of endoscopic evaluation or video during flexible ureterorenoscopy in determining the morpho-constitutional analysis of stones, which could be associated with specific metabolic anomalies

Comparaison in vitro de l’efficacité statique ou dynamique des lasers Holmium :YAG et thulium fibré pour la lithotritie endocorporelle : impact de la vitesse de déplacement

La vitesse optimale de déplacement (VOD) de la fibre laser pour réaliser la pulvérisation lithiasique est une variable inconnue à ce jour, autant pour le laser thulium fibré (TFL) que pour le laser Holmium :YAG (Ho :YAG). L’objectif était de déterminer in vitro la VOD de la fibre laser lors d’une lithotritie endocorporelle en fonction des paramètres laser avec le TFL et l’Ho :YAG, au moyen des volumes d’ablation (VA).Bourse de Recherche AFU 201

Incremento del IVA a telefonía móvil

El pasado primero de marzo de 2012, el presidente de la Asociación de la Industria Móvil de Colombia Asomóvil, Rodrigo Lara Restrepo, explicó que las empresas que prestan servicios de telefonía móvil en Colombia, permanecen a la espera de la publicación de la sentencia por parte de la Corte Constitucional, la cual reduciría 4 puntos del IVA al servicio de telefonía celular y pasaría del 20% a la tarifa general. Este impuesto había sido incrementado Mediante la Ley No. 788 del 27 de diciembre de 2002, la cual expide normas en materia tributaria y penal del orden nacional y territorial, en su artículo No. 35, parágrafo 2, la cual se incluye un aumento en el impuesto al valor agregado aplicado a la telefonía celular, la cual pasa del 16% al 20% y comienza a regir a partir del 1º de enero de 2003.Pregrad

Analyse in vitro de l’efficacité de la lithotritie laser : quel modèle utiliser ?

L’étude in vitro de la lithotritie laser (LL) utilise des calculs humains (CH) ou synthétiques (CS). Devant l’augmentation de la pulvérisation laser (Dusting), peu d’échantillons humains sont disponibles. Les CS sont donc privilégiés, confectionnés par mélange d’eau et de plâtre, avec la problématique de leur réhydratation lors des LL. L’objectif était de comparer les volumes d’ablation (VA) entre CS homogènes (CSHo) ou hétérogènes(CSHe), et par rapport au poids ablaté (PA).Bourse de Recherche AFU 201

Consultation on UTUC, Stockholm 2018 aspects of risk stratification: long-term results and follow-up

Purpose: To summarize current knowledge on upper urinary tract carcinoma (UTUC) regarding risk stratification, long-term results, and follow-up. Methods: A scoping review approach was applied to search literature in Pubmed, Web of Science, and Embase. Consensus was reached through discussions at Consultation on UTUC, September 2018, Stockholm. Results: To optimize oncological outcome considering both cancer-specific survival (CSS) and overall survival (OS), it is essential to identify pre- and postoperative prognostic factors. In low-risk UTUC, kidney-sparing surgery (KSS) and radical nephroureterectomy (RNU) offer equivalent CSS, whereas RNU may result in poorer OS due to nephron loss. For more aggressive tumours, undergrading can lead to insufficient treatment. The strongest prognostic factors are tumour stage and grade. Determining grade is best achieved by ureterorenoscopy (URS) with focal samples, biopsy and cytology. Staging is more difficult but can be indirectly achieved by multiphase computed tomography urography (CTU) or tumour grade determined by cytology and histopathology. Patients treated with KSS should be monitored closely with regular follow-ups (URS and CTU). Conclusion: KSS should be offered in low-risk UTUC when feasible, whereas RNU is the treatment of choice in organ-confined high-risk UTUC. Intravesical recurrence (IVR) is common after RNU, but a single postoperative dose of mitomycin instillation decreases IVR. Endourological management has high local and bladder recurrence rates; however, its effect on CSS or overall survival OS is unclear. RNU is associated with significant risk of chronic kidney disease. Careful selection of patients and risk stratification are mandatory, and patients should be followed according to strict protocols

The Role of Virtual Cystoscopy, after Multidetector Computed Tomography Imaging Reconstruction without the Use of Contrast Medium, in the Diagnosis and Evaluations of Bladder Tumors: Preliminary Study

Introduction. Although conventional cystoscopy is considered to be the gold standard for diagnosis and follow-up of bladder tumors, it remains an invasive and costly procedure. With the advent of the multidetector CT (MDCT) scanners supported by specialized software virtual cystoscopy (VC) is possible. We assess the role of VC in diagnosing and evaluating bladder lesions. Materials and Methods. Between September 2010 and October 2011, 25 consecutive patients with cystoscopically confirmed bladder tumor underwent VC. The radiologists involved in this prospective study were blinded to the exact findings. After draining any residual urine with a catheter, the bladder was retrogradely insufflated with 200–600 cc of air. No intravenous or intravesical contrast was used. MDCT scan was performed in supine and prone positions and three-dimensional reconstruction of the urinary bladder was performed. Results. The examination was well tolerated by all patients with no complications. In total, 43 lesions were detected both with conventional cystoscopy and VC. Tumor size measured by CT ranged from 3 to 80 mm in diameter. The pathological report revealed noninvasive transitional cell carcinomas in all cases. Conclusion. VC has promising results in detecting exophytic bladder lesions. In the future it could be part of the diagnostic algorithm for bladder tumors