A new approach to urinary stone analysis according to the combination of the components: experience with 7949 cases

ObjectiveTo evaluate a new approach to urinary stone analysis according to the combination of the components.Materials and methodsA total of 7949 stones were analysed and their main components and combinations of components were classified according to gender and age. Statistical analysis was performed using the chi-square test.ResultsCalcium oxalate monohydrate (COM) was the most frequent component in both males (39%) and females (37.4%), followed by calcium oxalate dihydrate (COD) (28%) and uric acid (URI) (14.6%) in males and by phosphate (PHO) (22.2%) and COD (19.6%) in females (p = 0.0001). In young people, COD and PHO were the most frequent components in males and females respectively (p = 0.0001). In older patients, COM and URI (in that order) were the most frequent components in both genders (p = 0.0001). COM is oxalate dependent and is related to diets with a high oxalate content and low water intake. The progressive increase in URI with age is related mainly to overweight and metabolic syndrome. Regarding the combinations of components, the most frequent were COM (26.3%), COD + Apatite (APA) (15.5%), URI (10%) and COM + COD (7.5%) (p = 0.0001).ConclusionsThis study reports not only the composition of stones but also the main combinations of components according to age and gender. The results prove that stone composition is related to the changes in dietary habits and life-style that occur over a lifetime, and the morphological structure of stones is indicative of the aetiopathogenic mechanisms.     

Role of twinkling artifact in characterization of urinary calculi

IntroductionStone characterization is becoming important before decision of treatment such as percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL). Some studies have reported that the twinkling artifact (color-flow ultrasonography artifact) may be useful to detect urinary stones. This study aims to determine whether the presence or absence of the twinkling artifact is correlated with the chemical composition of the stones.Material and methodPatients with renal stones > 0.5 cm were included in a prospective study. Sixty patients were examined with x-ray film, intravenous pyelography, non-contrast computerized tomography, and color and spectral doppler ultrasonography. The artifact was considered grade 1 when occupied only one portion of the acoustic shadowing and when the artifact occupied the entire acoustic shadowing was considered grade 2. Patients with stones smaller than 2 cm were treated with SWL and patients with stones larger than 2 cm were treated with PCNL.ResultsNo artifact (grade 0) was detected in 11 subjects, grade 1 in 25 and grade 2 in 24. Significant relationship was found between the increase in twinkling artifact and stone size (p < 0.001). When the relation between the composition of the stones and the twinkling artifact was analyzed, artifact was detected nearly in all of the calcium oxalate dihydrate and calcium phosphate stones; whereas the artifact was detected in more than half of the calcium oxalate monohydrate and uric acid stones. In ESWL group it was observed that as the grade of the twinkling artifact increases, the number of required ESWL sessions decreases (p < 0.001). In PCNL group twinkling artifact was found in all of the patients (100%) with roughly surfaced stones.ConclusionThe roughness of stone surface is the most important factor in terms of formation of the twinkling artifact in kidney stones. This artifact can be of use in anticipating the breakability of the stones of those patients to be treated with applied ESWL. One might anticipate that cases where the size of the stone is larger than 2 cm but no twinkling artifact is detected are calcium oxalate monohydrate, which is one of the stones with highest level of breakability.     

Retrograde intrarenal surgery (RIRS). Technical complement for cases of acute lithiasis

IntroductionWashing the renal cavities using minipercutaneous surgery shaft is an ideal technical procedure for retrograde intrarenal surgery (RIRS) when lithiasic fragmentation is significant or if the anatomy of the renal cavities may obstruct the spontaneous elimination of fragments.Materials and methodswe performed 37 RIRS on 35 patients with renal lithiasis (14 men, 21 women) with a mean age of 56 (range 33-72) years, divided into two groups in accordance with the size of their kidney stones. Group A, 23 patients with lithiasis <1.5 cm; Group B, 12 cases with lithiasis >1.5 cm. 28 patients had a single kidney stone and 7 had multiple stones. Approach: Flexible uretrorenoscopy, 7.5 Fr (Flex-X(®, Karl Storz) by means of a ureteral access sheath. Holmium laser lithotripsy (Calculase®, Karl Storz) using 200 and 365 micrometer fibres. Fragment extraction with 1.7 Fr nitinol baskets (N-gage, Cook). In cases of significant fragmented stone burden, the renal cavities were washed with low-pressure fluid irrigation using a ureteral access sheath, which was collected together with the stone fragments carried by the “mini-perc” sheath (Ultrax-x® 18Fr, Cook; Rusch, 14 Fr) placed under radiologic and endoscopic control at the level of the calyx-papilla selected for fragment drainage.Resultsthe mean diameter for group A was 9.13 (range 5-13) mm and 20.25 (range 16-28) mm for group B. The overall mean operating time was 81 (range 30-160) min. Group A required 66.43 ± 35.18 min. and group B 107.5 ± 46.73 min. (p = 0.006). The rate of absence of stones immediately after surgery was 83.2%, 93.1% at 3 months (95.6% for A and 83.3% for B; p = 0.217). In no case was ureteral stenosis observed as a result of the use of ureteral access sheaths. In 7 group B patients (58.3%) with acute lithiasis and/or alteration in their pyelocaliceal anatomy, we performed active lavage of the renal cavities applying the aforementioned percutaneous technique. The mean post-surgery hospital stay was 2.1 (range 1-4) days. There were post-surgery complications (Clavien 1) in 7 patients (20%). Two patients required a second FURS.ConclusionsRIRS can be effective treatment for renal lithiasis >1.5 cm. Lavage of the renal cavities helps to eliminate stone fragments, reducing the possibility of retreatment.     

¿Son suficientes los nomogramas actuales para predecir los resultados de la litotricia por ondas de choque?

Introduction and objectivesTo investigate factors affecting SWL outcomes, validate three current nomograms (Kim JK, Triple D and S3HoCKwave) and compare the predictive ability of the nomograms for SWL outcomes in upper urinary tract stones.Patients and methodsMedical records of patients with renal and proximal ureteral stones treated with SWL between March 2013 and October 2020 were retrospectively reviewed. Factors affecting SWL success were analyzed with multivariate logistic regression analysis and the three predictive scoring systems compared with the area under the curve (AUC).ResultsA total of 580 patients were included in our study. The overall stone free rate was 61% and 144/580 patients (24.8%) were stone free after one session. In multivariate logistic regression analysis, stone location at upper calyx (OR:2.988; 95%Cl: 1.350–6.612; p = 0.007), middle calyx (OR:3.036; 95%Cl: 1.472–6.258; p = 0.003), and lower calyx (OR:2.131; 95%Cl: 1.182–3.839; p = 0.012), as well as number of stones (OR:1.663; 95%Cl: 1.140–2.425; p = 0.008), maximum diameter of stone (OR:1.156; 95%Cl: 1.098–1.217; p < 0.001) and maximum Hounsfield Unit (OR:1.001; 95%Cl: 1.001–1.002; p < 0.001) were independent risk factors of SWL failure. The AUCs of the Kim JK, Triple D and S2HoCKwave scores for predicting SWL success were 0.678, 0.548, and 0.626 respectively.ConclusionsStone location, number, maximal diameter, and maximum HU were independent predictive factors for SWL outcome in the treatment of upper urinary tract stones. Current nomograms, Kim JK nomogram, Triple D score and S3HoCKwave score can predict treatment success after SWL, but all of them have poor discrimination according to AUC analysis.     

Improving Stone Clearance After Extracorporeal Shock Wave Lithotripsy in Urolithiasis Patients by a Special Terpene Combination (Rowatinex): Results of a Placebo-Controlled, Randomized Trial

BackgroundExtracorporeal shockwave lithotripsy (ESWL) is the first-choice treatment for most renal stones. Rowatinex^®, a special terpene combination, has been used therapeutically in the supportive treatment of urolithiasis and for assistance in the expulsion of stones of the renal system for many years.ObjectiveThe aim of the study was to investigate the safety and efficacy of Rowatinex^® in the treatment of patients with urolithiasis after ESWL.Design, setting, and participantsIn a randomized, double-blinded, placebo-controlled, multicenter trial, 222 patients with clinically unapparent kidney or ureter stones who had undergone complication-free ESWL were included between June 2003 and December 2006. The study consisted of a 12-wk active treatment phase and a 2-wk follow-up phase. All patients underwent physical examination, and diagnosis of kidney stones was made by x-ray, intravenous pyelogram (IVP), or ultrasound at weeks 1, 4, 8, and 12 as well as after 2 wk of follow-up.InterventionPatients were randomized to receive either 3 × 2 Rowatinex^® capsules per day or placebo.MeasurementsThe primary end point was the rate of stone-free patients (without any fragments) after 12 wk of treatment.Results and limitationsSignificantly more patients treated with the terpene combination were stone free at the end of the study compared to placebo (intention-to-treat [ITT]—verum vs placebo: 72 patients [67.9%] vs 49 patients [50.0%]; p = 0.0009; per-protocol [PP]—verum vs placebo: 69 patients [78.4%] vs 48 patients [52.2%]; p = 0.0004). The treatment was even more effective when analyzed with respect to the size of the treated stone. In addition, the terpene combination treatment significantly reduced the median time to stone-free status (ITT—placebo vs verum: 85.0 d vs 56.0 d; p = 0.0061; PP—placebo vs verum: 85.0 d vs. 49.5 d; p = 0.0028). Tolerability was excellent.ConclusionsThe terpene combination Rowatinex^® was found to be an efficacious, well-tolerated, and safe treatment for eliminating calculi fragments generated by ESWL compared to placebo.     

The epidemiology of fractures of the proximal ulna

IntroductionThe aim of our study was to report the epidemiological characteristics of fractures of the proximal ulna.MethodsFrom our prospective trauma database of 6872 fractures, we identified all acute fractures of the proximal ulna from a 1-year period between July 2007 and June 2008. Age, gender, mode of injury, fracture classifications, associated injuries and treatment were the factors documented and analysed.ResultsThere were 78 fractures of the proximal ulna with a mean age of 57 years (15–97). Males (n = 35) sustained their fracture at a significantly younger age than females (p = 0.041), with no gender predominance seen (p = 0.365). The overall fracture distribution was a unimodal older male and unimodal older female type-F curve. The most common mode of injury was a simple fall from standing height (n = 52, 67%), with younger patients more likely to sustain their injuries following a high-energy mechanism such as sports or a motor vehicle collision (p < 0.001). Seventeen (22%) patients sustained associated injuries to the ipsilateral limb, with an associated proximal radial fracture most frequent (n = 13, 17%). Open fractures were seen in five (6.4%) patients. A total of 64 patients had a fracture of the olecranon, with the Mayo 2A most frequently seen (n = 47, 60%).ConclusionsFractures of the proximal ulna are fragility fractures that predominantly occur in elderly patients. Given the number of elderly patients sustaining these injuries, research is needed to determine the role of non-operative treatment for these fractures, particularly in patients with multiple co-morbidities and low functional demands.     

Advanced age is associated with poorer bladder cancer-specific survival in patients treated with radical cystectomy

ObjectiveBladder cancer (BCa) is a disease of older persons, the incidence of which is expected to increase as the population ages. There is controversy, however, regarding the outcomes of radical cystectomy (RC), the gold standard treatment of high-risk BCa, in patients of advanced chronological age. The aim of our study was to assess the impact of patient age on pathological characteristics and recurrence-free and disease-specific survival following RC.MethodsThe records of 888 consecutive patients who underwent RC for transitional cell carcinoma (TCC) were reviewed. Age at RC was analyzed both as a continuous (yr) and categorical (≤60 yr old, n = 240; 60.1–70 yr old, n = 331; 70.1–80 yr old, n = 266; >80 yr old, n = 51) variable. Logistic regression and survival analyses were performed.ResultsHigher age at RC, analyzed as a continuous or categorical variable, was associated with extravesical disease and pathological upstaging (all p < 0.02). Older patients were less likely to receive postoperative chemotherapy (≤60 yr: 32% vs. >80 yr: 14%, p = 0.008). In both pre- and postoperative multivariate models, higher age at RC as a categorical variable was associated with BCa-specific survival (p < 0.05). Patients >80 yr old had a significantly greater risk of disease recurrence than patients aged ≤60 yr (p < 0.05).ConclusionGreater patient age at the time of RC for BCa is independently associated with adverse outcomes. Better understanding of factors associated with postoperative outcomes in this growing segment of the population is necessary. Prospective corroboration and further refinement of similar analyses in other large datasets is needed.     

Surgical therapy of lithiasis in horseshoe kidney

ObjectiveTo present our centre‘s experience in the surgical treatment of lithiasis in patients with horseshoe kidney.Material and methodsFrom October 2007 to March 2011 we treated 10 patients with renal lithiasis in their horseshoe kidneys. Retrospectively, we reviewed the symptoms, medical and surgical history, the characteristics of the stones (size, location, composition) and treatments that were carried out. In all the cases, the study was carried out by CT, with volume reconstruction and with an angiographic study. A percutaneous nephrolithotomy (PCNL) or an endoscopic retrograde intrarrenal surgery (RIRS) was carried out, depending on the size and location of the stone.ResultsThree percutaneous nephrolithotomies were carried out (2 on staghorn lithiasis stones, 1 pseudocoraliform stone) with a combined rigid and flexible single-access nephroscopy. In one case there was haemorrhage that required treatment by selective embolization. In the rest, RIRS was carried out, all with stones < 30 mm in their greatest diameter without any complications. The mean surgical times were 120 (60-180) minutes for the percutaneous route and of 105 (65-160) minutes for the retrograde route. In all the cases the treatment achieved a complete elimination of the stones or remains of less than 5 mm.ConclusionsThe treatment of renal lithiasis in horseshoe kidneys is complex, given their peculiar anatomy. The usual surgical techniques can be reproduced in these cases with good results. We opt for PCNL in complete staghorn stone and pseudocoraiform stones, whereas RIRS is a valid option in cases with stones < 3 cm.     

Obesity as risk factor for lithiasic recurrence

ObjectivesObese patients may have special characteristics in the urinary stones formed, as the body mass index (BMI) may also be a predictive factor in lithiasic recurrence. We aim to evaluate and compare the lithiasic characteristics according to the different BMI categories, also considering the likelihood of lithiasic recurrence in presence of age and gender covariables.Material and methodsRetrospective, cross-sectional analysis on 346 lithiasic patients, 96 (27.7%) had low-normal weight, 151 (43.6%) overweight, and 99 (28.6%) obesity. The Chi-square and ANOVA tests were used. Survival analysis for the calculation of likelihood of lithiasic recurrence (yes/no) was made based on time on 158 patients in whom complete resolution of the initial stone was achieved by the Kaplan Meier method. Comparisons between the different categories of BMI were made using the log-Rank, Breslow and Tarone-Ware tests. Multivariate analysis was also made with the Cox regression model, introducing the covariables of age and gender.ResultsA significant growing linear tendency has been demonstrated between multiplicity and BMI (p = 0.03). The variables size and composition did not show significant differences between the groups. Median follow-up of 158 patients included in the survival analysis was 1866 days (95% CI 1602.5-2129.5). Eighteen (11.4%) of them recurred, without finding significant differences between groups: 4 low-normal weight (9.8%), 10 overweight (14.1%) and 4 obese (8.7%). The multivariate analysis also did not show a significant influence of the BMI on lithiasic recurrence (p = 0.86; HR =1.06; 95% CI: 0.56-2.03).ConclusionA significant influence of BMI was shown on lithiasic multiplicity on diagnosis, although not on lithiasic recurrence based on time. It seems to be necessary to carry out studies in larger samples to calculate the true influence of BMI on lithiasic recurrence.     

Anatomical factors predicting lower calyceal stone clearance after extracorporeal shockwave lithotripsy

ObjectiveTo determine the role of the lower pole infundibular parameters as predictors of stone clearance following extracorporeal shock wave lithotripsy (ESWL).Subjects and methodsBetween March 2001 and February 2004, 243 renal units in 239 patients with isolated lower calyceal stones were treated by ESWL. Stone-free status was assessed after 3 months by plain X-ray abdomen and a kidney ultrasound scan. Persistent stone fragments ≥6 months after the completion of treatment was defined as residual stone. Radiogaphic parameters were obtained from intravenous urography (IVU). SPSS version 15.0 was utilized for all statistical analysis.ResultsThe median age of all patients was 38 years (range: 20–70 years). The male to female ratio was 2.1:1.The mean stone size was 1.3 ± 0.7 cm. Overall, 144 renal units (60.9%) had undergone one or two sessions of ESWL, 43 (17.7%) 3, while 46 (18.9%) ≥4 sessions, with mean of 2.1 sessions.Stone-free rates differed significantly between favorable and unfavorable infundibular length (IL), and infundibular width (IW) (p value = 0.01, p = 0.0001, respectively). Infundibulopelvic (IP) angle had no statistically significant effect on stone-free rate (p = 0.1).The effect of stone size on stone-free rate in two groups revealed better overall results in favorable anatomy group than in unfavorable group in stone sizes, 0.5–1.0 cm, 1.1–1.5 cm, 1.6–2 cm and 2.1–2.5 cm (76.7%, 87.5%, 100%, and 56.2% vs. 41.1%, 55.5%, 66.6%, and 50%; p = 0.04, 0.10, 0.10, 0.80, respectively).ConclusionsThis study shows that lower infundibular length and width are significant anatomical factors in determining stone clearance following ESWL treatment of lower calyceal stones and these should be assessed before planning the treatment for lower calyceal stones.     

Effects of pelvic floor muscle training on quality of life of a group of women with urinary incontinence: randomized controlled trial

ObjectiveTo evaluate the effects of Kinesiotherapy on function and level of pressure of pelvic floor muscle and quality of life (QOL) of a group of women with urinary incontinence (UI).Materials and methodsThis is a randomized controlled pilot trial. Thirty women (age 60.87 ± 9.05 years) were evaluated, before and after 12 weeks of treatment, for urinary loss, pelvic floor muscle function and pressure; and quality of life (QOL). Volunteers were randomly allocated into two groups: Kinesiotherapy Group and Control Group. The Kinesiotherapy Group protocol consisted of 12 1-hour sessions with exercises to strengthen pelvic floor muscle and information for UI. The Control Group did not receive any treatment during the corresponding time. The data were analyzed by non-parametric Wilcoxon and Mann-Whitney test. The significance level was 5%.ResultsThe Kinesiotherapy Group presented a significant improvement in urinary loss (p = 0.053), pelvic floor muscle function (p < 0.006) and pressure (p = 0.0014) and in some domains of Kin?s Health Questionnaire for QOL assessment: incontinence impact (p = 0.034), limitations of daily activities (p = 0.025), sleep and disposition (p = 0.018) and also gravity domains (p = 0.004). No differences were found in the control group for any variables.ConclusionThe protocol to strengthen the pelvic floor muscle used by the Kinesiotherapy Group was effective to improve the UI, QOL, function and pressure of pelvic floor muscle contraction.     

Single-session extracorporeal shock wave lithotripsy for urinary calculi: factors predicting success after three weeks of follow-up

IntroductionThe aim of this study was to identify predictive factors of success following a single-session of shock wave lithotripsy (SWL) at 3 weeks of follow-up in our center.Material and methodsThe medical records of 116 patients with solitary urinary calculi who underwent single-session SWL in our department between October 2007 and August 2009 were reviewed. All preoperative unenhanced computed axial tomographies were reviewed by two radiologists blinded to clinical outcome. Success was defined as complete clearance or the persistence of fragments ≤ 2 mm on a plain film at 3 weeks of follow-up. The impact of clinical and radiological factors on success was assessed by univariate and multivariate analyses.ResultsThe single-session SWL success rate at 3 weeks was 49.1%. Stone size <8 mm, stone area < 30 mm², stone location (mid- and distal ureter), stone density <1000 HU and intraoperative fragmentation showed a significant association with SWL success in the univariate analysis (p < 0.05). Stone area (OR 2.9), ureteral stone location (OR 3.4) and intraoperative fragmentation (OR 4.2) were the only predictors of success in the multivariate analysis.ConclusionsStone area and ureteral stone location provide important information when deciding about the indication of a SWL in a patient with stone disease. However, successful resolution of only half of the cases after a single session at 3 weeks in our series undermines the relevance of informing patients about the potential need for additional treatment.     

Adjuvant alpha adrenergic blockers: Are they equally efficient for renal and upper ureteral calculi disintegrated by shock wave lithotripsy?

ObjectivesTo evaluate the effects of tamsulosin on stone clearance and analgesic requirements after shock wave lithotripsy (SWL) for solitary renal and upper ureteral calculi.Patients and methodsA prospective randomized placebo controlled study was carried out on 126 patients who underwent SWL for solitary radio-opaque renal or upper ureteral calculi ≤20 mm. Patients were randomized into two groups receiving either 0.4 mg of tamsulosin (GT) or placebo (GP). SWL was performed 3-weekly until patients became stone-free or for a maximum of 3 months. Analgesics were used on demand and pain was evaluated by a visual pain scale.ResultsRenal stones represented 55.6% and 66.7% for GT and GP, respectively (p = 0.27). Mean renal and ureteral stone size were (12.3 ± 1.8 mm vs. 11.5 ± 2.3 mm, p = 0.14) and (9.7 ± 2.6 mm vs. 8.6 ± 1.7 mm, p = 0.1) for the GT and GP, respectively. GT required fewer SWL sessions for ureteral (1.2 vs. 1.6, p = 0.02) and renal stones (1.8 vs. 2.3, p = 0.08). Stone-free rate (SFR) was higher in GT for upper ureteral stones (96.4% vs. 66.7%, p = 0.01) and renal pelvis stones at a cutoff size >10 mm (p = 0.01). The mean time of stone clearance was significantly lower in GT (4.2 ± 1.9 weeks vs. 7.5 ± 2.3 weeks, p = 0.001) for ureteral stones. Attacks of renal colic were more frequent in GP (82.5% vs. 44.4%, p = 0.04) with increased demand for analgesia (p = 0.04). Steinstrasse was recorded in 3 and 7 patients of the GT and GP, respectively (p = 0.32).ConclusionTamsulosin facilitates clearance of upper ureteral stone fragments after SWL and decreases the analgesic requirements. These effects were not similarly evident for renal stones.     

Meta-analysis of predictive factors and outcomes for failure of non-operative management of blunt splenic trauma

BackgroundThis study aimed to analyse predictive factors and outcomes of failure of non-operative management (NOM) following blunt splenic trauma.MethodsA systematic review of the literature was performed for studies comparing failed NOM (fNOM) to successful NOM (sNOM) in adults (≥16 years). The main endpoints were fNOM and associated mortality. Between-study heterogeneity was assessed. Meta-analysis of high quality studies, identified using the Newcastle–Ottawa Scale, was performed using fixed or random models.ResultsFour prospective and 21 retrospective studies were included. From 24,615 unselected patients, 3025 experienced fNOM (12%, range 4–52%). Meta-analysis of the high quality studies revealed that mortality was significantly higher with fNOM in unselected age groups (odds ratio 1.93, 95% confidence interval 1.04–3.57, p = 0.04, I² = 0%), in those <55 years old (OR 3.42, 95% CI 1.73–6.77, p = 0.02, I² = 0%) and in those ≥55 years old (OR 2.65, 95% CI 1.20–5.82, p = 0.02, I² = 0%). There was a significant improvement in sNOM following introduction of angioembolisation protocols (OR 0.26, 95% CI 0.13–0.53, p < 0.002, I² = 51%), although these five studies were non-randomised. American Association for the Surgery of Trauma injury grades 4–5, the presence of moderate or large haemoperitoneum, increasing injury severity score and increasing age were all significantly associated with increased risk of fNOM. fNOM led to significantly longer intensive care unit and overall lengths of stay.ConclusionsfNOM leads to increased resource use and increased mortality. Methods of preventing fNOM, such as angioembolisation, warrant further assessment. Patients with increasing age, AAST scores and moderate or large haemoperitoneums may benefit from closer monitoring.     

Clinical expression, but not disease outcome, may vary according to age at disease onset in psoriatic spondylitis

ObjectivesTo investigate whether the clinical expression and disease outcome in psoriatic spondylitis (PsS) may vary according to age at disease onset.MethodsThis study included 70 patients from a unique outpatient spondylitis clinic followed on a regular basis with a standard protocol. Patients were diagnosed with PsS according to ESSG criteria plus radiographic sacroiliitis (SI). Outcome parameters included: disease activity, functional evaluation, radiological damage, mobility restriction, and enthesitis score. Patients were divided into those with disease onset before 40 years (young-onset PsS) and those with onset over this age (late-onset PsS). Clinical features and outcome parameters were compared between groups.ResultsThere were 44 men and 26 women. Thirty-nine (M:F ratio 1.8) patients had disease onset before 40 years and 31 (M:F ratio 1.6) over this age. HLA-B27 correlated with PsS susceptibility (34% vs 7%, RR 6.4, p < 0.0004), but it was found over-represented in young-onset PsS compared to late-onset cases (51% vs 13%, p = 0.001). Young-onset cases tended to have a higher frequency of family history (26% vs 13%), bilateral SI (62% vs 29%, p = 0.013), isolated axial pattern (31% vs 13%), and enthesitis (54% vs 29%, p = 0.09). In late-onset PsS there was a higher frequency of unilateral SI (71% vs 38%, p = 0.013), polyarthritis (45% vs 23%, p = 0.022), and silent axial disease (32% vs 10%, p = 0.022). Outcome parameters were similar between groups.ConclusionsClinical picture but not outcome parameters, varies according to age at disease onset in PsS. The correlation between HLA-B27 and young-onset PsS supports the notion that disease susceptibility and disease expression are not driven by the same gene in this entity.     

Estado de los marcadores de fase aguda y estrés oxidativo en los enfermos con litiasis de la vía urinaria

ObjectiveThis present study has aimed to assess the state of acute phase markers and oxidative stress in patients with kidney stones.Material and methodsA prospective study was carried out on 100 patients with kidney stones and 25 healthy controls. Albumin, ß2 microglobulin, Gamma-glutamyl transpepsidase, Lactate dehydrogenase, Tumor necrosis factor alpha, Interleukin 1 and Interleukin-6 were evaluated as acute phase markers and lipid peroxidation products, Superoxide dismutase and Glutathione peroxidase levels acted as oxidative stress markers.ResultsAn increase in renal cell damage markers as expressed by the ß2 microglobulin (p = 0.04), albumin (p = 0.004), Lactate dehydrogenase (p = 0.001) and Gamma glutamyl transpepsidasa (p = 0.01) was observed in the patient group. There was a direct correlation between levels of ß2microglobulin and stone size (r = 0.3, p = 0.03). The association between stone size and cytokine activation was observed to be stronger in patients with staghorn calculi. In these patients, Tumor necrosis factor alpha (p = 0.011), Interleukin 1 (p = 0.004) and Interleukin 6 (p = 0.004) were significantly higher. Patients with stones in the urinary tract showed data of significantly higher oxidative stress, expressed as an increase in levels of lipid peroxidation products (p = 0.03) and a decrease in the antioxidant activity of Superoxide dismutase (p = 0.03) and Glutathione peroxidase (p = 0.002).ConclusionsPatients undergoing urolithiasis showed an elevation of acute phase markers, associated with oxidative stress as expressed by an increase in lipid peroxidation products and a decrease in the antioxidant enzyme activity.     

¿Debe emplearse de manera sistemática el cateterismo ureteral en los implantes renales?

ObjectiveTo assess if the systematic use of double J ureteral catheters in ureteroneocystostomies of kidney transplants reduces the rate of complications.Materials and methodsNon-randomized prospective, comparative study of parallel groups in 194 kidney transplants. We established two equal groups, 111 patients with double J catheter and another of 83 catheter-free patients. We studied the incidence of complications between both groups by means of a univariate comparative study (X2 test)and a multivariate analysis (logistic regression).ResultsIn the catheter group, the overall complications appeared in 22.2% as opposed to 43.3% of the catheter-free group (p = 0.04). Depending on the ureteral transplant, complications appeared in 38.12% of the Paquin type reimplantation as opposed to the 20.3% in Lich-Gregoir (p = 0.09). There was evidence of 1 (0.9%) urinary fistula in the catheter group as opposed to 5 (6%) in the catheter-free group (p = 0.08), and 3 (2.7%) ureterovesical anastomosis stricture in the group with catheter against 7 (8.4%) of the catheter-free group (p = 0.13). The multivariate analysis showed that not using the catheter increases the risk of suffering complications related to reimplantation (OR: 2.55; IC 95%, 1.37-4.75). The risk of fistula increased significantly when a catheter was not placed (OR 9.19, IC 95%, 1.01-84.7). There were no differences between the two groups as regards urinary tract infections; there were 3 (2.7%) in the catheter group and 1 (1.2%) in the catheter-free group (p = 0,63).ConclusionsThe placement of a double J catheter reduces complications related to ureteral reimplantation without increasing the morbidity associated with their use.     

Outcomes of percutaneous nephrolithotomy versus open stone surgery for patients with staghorn calculi

ObjectivesAdvances in shock wave lithotripsy and endourological procedures have markedly limited the need for open surgery in the treatment of renal stones. We retrospectively compared the clinical outcomes of percutaneous nephrolithotomy (PNL)-based therapy with open stone surgery (OSS) to treat staghorn stones.Materials and methodsHospital and office charts, operative records, and radiographic studies of all patients undergoing OSS (Group 1, 11 patients) and PNL (Group 2, 61 patients) for the treatment of large staghorn calculi from 2007 to 2013 were reviewed. Only patients with stones ≥ 10 cm² in area were included. Patient characteristics, stone burden, indications, and surgical outcomes between the two procedures were compared. Stone-clearance was confirmed using postoperative kidney, ureter, bladder X-rays.ResultsThere were no differences between the two groups in patient demographics, stone size, estimated blood loss, and mean renal function level change, however, there were statistically significant differences in mean operative time (282.1 ± 54.5 minutes vs. 156.6 ± 41.2 minutes, p < 0.001), mean hospital stay (10.3 ± 1.8 days vs. 6.2 ± 2.7 days, p < 0.001), postoperative stone-clearance rate (97.5% vs. 76.1 ± 23.9%, p < 0.001), and number of procedures per patient (1.6 vs. 2.8, p < 0.001) between the OSS and PNL group.ConclusionBoth OSS and PNL are viable options for the management of staghorn stones. Considering the lower postoperative complication rate and need for auxiliary treatment, we suggest that OSS is more suitable for staghorn stones with large burdens. OSS should still be considered as a valid treatment for patients with complex staghorn calculi, although PNL is a less invasive treatment option in most cases.     

25 hydroxyvitamin D serum levels influence adequate response to bisphosphonate treatment in postmenopausal osteoporosis

It remains unclear whether vitamin D sufficiency optimizes response to bisphosphonate (BP) treatment in postmenopausal osteoporosis. We evaluated the role and possible mechanisms of vitamin D in adequate response to standard BP treatment for postmenopausal osteoporosis.MethodsWe included 120 postmenopausal osteoporotic women (aged 68 ± 8 years) receiving BP (alendronate or risedronate) at their annual follow-up, performing complete anamnesis, including treatment adherence, use of vitamin D supplements, and previous falls and fractures during the last year. We analyzed the evolution of bone mineral density (BMD) during this period and serum PTH and 25 hydroxyvitamin D (25(OH)D) and urinary NTx levels. Patients were classified as inadequate responders to antiosteoporotic treatment based on BMD loss > 2% and/or the presence of fragility fractures during the last year.ResultsThirty percent of patients showed inadequate response to BP treatment, with significantly lower levels of 25(OH)D (22.4 ± 1.3 vs. 26.6 ± 0.3 ng/ml, p = 0.01), a higher frequency of 25(OH)D levels < 30 ng/ml (91% vs. 69%, p = 0.019) and higher urinary NTx values (42.2 ± 3.9 vs. 30.9 ± 2.3 nM/mM, p = 0.01). Patients with 25(OH)D > 30 ng/ml had a greater significant increase in lumbar BMD than women with values < 30 ng/ml (3.6% vs. 0.8%, p < 0.05). The probability of inadequate response was 4-fold higher in patients with 25(OH)D < 30 (OR, 4.42; 95% CI, 1.22–15.97, p = 0.02).ConclusionsInadequate response to BP treatment is frequent in postmenopausal women with osteoporosis as is vitamin D insufficiency, despite vitamin D supplementation. Maintenance of 25(OH)D levels > 30 ng/ml is especially indicated for adequate response to BP treatment.