Lecciones aprendidas sobre el manejo de la urolitiasis tras los perjuicios causados por la COVID-19: un ejemplo de adaptación en un centro de alto volumen

IntroductionThe aim was to determine the impact of COVID-19 pandemic on urolithiasis presentation and management.MethodsIn this retrospective study, we comparatively evaluated urgent and elective procedures due to urolithiasis during the early 8 months of the COVID-19 pandemic (March 1, 2020, to October 31, 2020) compared to the same period a year before, and between waves. Fisher's exact test, Student's t-test, chi-square test and Mann-Whitney U test were used to compare the patients’ characteristics and outcomes between the 2 periods and waves.ResultsFive hundred and thirty procedures were included. The overall numbers of surgical procedures due to urolithiasis were similar between pre-pandemic and pandemic periods. Regarding elective surgery, our data draw attention to the increased complication rate in the pandemic times, but no statistically significant differences in terms of types of procedures and need for complementary treatments were observed. We noted that patterns of presentation of complicated renal colic were different during COVID-19 pandemic, with a higher number of days after the onset of symptoms and a higher proportion of patients presenting acute kidney injury. Furthermore, a significant increase of creatinine levels at presentation in first wave was detected, and a growth in the number of urgent procedures after the first wave was noted, owing to the delay in urolithiasis treatment and diagnosis.ConclusionsThe COVID-19 pandemic has negatively affected both urgent and elective management of urolithiasis. Lessons about the management of urolithiasis in this context should be learned to avoid fatal complications and improve standards of care.     

偏光显微镜诊断早期尿石病

目的：尿石发生早期难以确诊，本研究对有临床症状但影像学阴性的肾内微结石探索早期的诊断方法。方法：用乙二醇制作大白鼠草酸钙尿石动物模型，用偏光显微镜对模型动物的尿沉渣和对30例已确诊尿石患者的尿沉渣进行比较，观察尿沉渣中的红细胞、管型和晶体类型，找出其中相同的组分作为诊断指标；尿石患者用叶金胶囊治疗。结果：模型动物及尿石患者的尿沉渣中多数有晶化红细胞、少数有晶体管型，并伴有大量晶体。动物模型晶体可见一水、二水草酸钙晶，十字型晶或无定型尿酸晶。尿石患者晶体特点同时有微晶、亦可见晶体铸型。30例尿石患者口服叶金胶囊，其中有8例排出小结石或镜下结石。结论：用偏光显微镜诊断早期尿石病，方法简单可靠，具有可行性。     

基于 EQ-5D 效用值积分体系的尿石症患者健康相关生活质量研究

目的：了解和评估尿石症患者生活质量现状，并分析其影响因素。 方法：采取便利抽样法，选取在天津市某三级甲等医院泌尿外 科接受住院治疗的 189 例尿石症患者作为研究对象，使用欧洲五维度生活质量（EQ-5D）量表进行调查，采用单因素分析和多因素广 义线性模型分析患者生活质量的影响因素。 结果：189 例尿石症住院患者在疼痛/不舒服和焦虑/沮丧维度出现的问题最多，健康效用 值为 0.942（0.893，1.000）；年龄、性别、是否携带输尿管支架、是否疼痛以及是否合并慢性病是生活质量的影响因素（P＜0.05）。 结论：尿 石症患者生活质量还有待提高，应了解结石患者受影响的因素，制定科学合理的干预方案,给予针对性的措施。     

Nephrolithiasis in two patients on iron chelation therapy: A case report

Drug-induced nephrolithiasis can arise from insoluble components within medications or crystallization of metabolites due to changes in metabolism and urinary pH. The connection between drugs utilized for iron chelation therapy (ICT) and nephrolithiasis is not well understood. In this report, we describe two pediatric patients diagnosed with nephrolithiasis while undergoing treatment with the chelating agents deferasirox, deferiprone, and deferoxamine for iron overload secondary to repeat blood transfusion.     

Validación externa de los sistemas de puntuación actuales y desarrollo de un nuevo sistema de puntuación para la predicción de la tasa libre de cálculos tras la cirugía intrarrenal retrógrada en pacientes con un diámetro acumulado del cálculo de 2-4 cm

ObjectiveOur primary aim is to perform the external validation of the current scoring systems in predicting stone-free status (SFS) after retrograde intrarenal surgery (RIRS) for renal stones 2-4 cm and develop a novel scoring system by re-examining possible predictive factors related to SFS.MethodsPatients who underwent RIRS due to renal stones with a cumulative stone diameter of 2-4 cm between January 2017 and March 2021 were retrospectively screened. Residual stones ≤ 2 mm were defined as clinically insignificant, and these cases were considered to have SFS. Possible predictive factors related to SFS were examined using the multivariate logistic regression analysis. A nomogram and a scoring system were developed using independent predictive variables. The prediction ability of the previous and the new scoring system were evaluated with the ROC analysis.ResultsThe existing scoring systems were found to be insufficient in predicting SFS (AUC < 0.660 for all). The independent predictors of SFS were identified as stone surface area (OR: 0.991, p < 0.001), stone density (OR: 0.998, p < 0.001), number of stones (OR: 0.365, p = 0.033), and stone localization (p = 0.037). Using these predictive markers, a new scoring system with a score ranging between 4 and 15 was developed. The AUC value for this scoring system was 0.802 (0.734-0.870).ConclusionThe RUSS, S-ReSC and RIRS scoring systems and Ito's nomogram failed to predict SFS in stones > 2 cm. The SFS predictive ability of our new scoring system was higher in > 2 cm stones compared to the other scoring systems.