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Over the last decade, urinary lithiasis` prevalence has dramatically increased due to diet and lifestyle changes, growing 10,6% and 7,1% in men and women respectively. Extracorporeal shock wave lithotripsy has lost relevance in current practice due to endoscopic device development and unpredictability of results. Instrument miniaturization is leading to an increase of the percutaneous approach of increasingly smaller stones, while most flexible ureteroscopes durability and digitalization has allowed urologists to address larger stones. So that, decision algorithm is now impossible to define, but what is clear is that ESWL has declined worldwide. Can it disappear as a urinary lithiasis treatment modality? If we don ́t improve appropriate candidate selection and optimize disintegration efficiency, guidelines are going to replace the more “boring” ESWL by popular and more attractive endoscopes. Shock wave technology has evolved in the last two decades, however lithotripsy fundamental principle has not changed. ESWL has passed the test of time and centers dedicated to stone treatment should have a lithotripter in order to offer an appropriate balance in different options for different clinical situations. New developments will be focused on improvements in location (in-line navigation systems; Vision track system) and automatic ultrasound location on a robotic arm; monitoring and stone fixation, implementation of different focal sizes with new acoustic lenses, multitask working stations that allow endourological approach, coupling control (avoiding microbubbles) and low cost devices for different applications. On the other hand, optimizing outcomes by: slower pulse rates, ramping strategies and patient selection with soft stones, short stone-skin distance, low BMI and favorable collecting system anatomy, allow us to achieve better outcomes in shock wave treatments. SWL still represents a unique non invasive method of stone disease treatment with no anesthesia and low complication rates; and a high proportion of stones could still be treated with shock waves and remains among patient`s first options. This update objective has been to review the evolution, identify shock wave new developments and clarify their impact on our daily practice in urinary stones treatment.
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OBJECTIVE: The aim of our study is to demonstrate that intravesical administration of the association chondroitin sulfate (CS) and hyaluronic acid (HA), according to our treatment schedule, is a benefit for women with recurrent urinary tract infections (RUTI), not only from a clinical point of view, but also reducing recurrences.METHODS: This is a study of 28 women diagnosed with RUTI, with a positive culture, and compatible symptoms; they underwent treatment according to the protocol of intravesical instillations of the combination CS 2%-1 gr + HA 1.6%-800 mg.To evaluate the effectiveness of the treatment, symptoms improvement, reduction of the number of episodes of urinary tract infection and quality of life were considered.RESULTS: In our series, we can observe an improvement of the quality of life assessed by PG-I, 66% after 12 months. It was seen that 55.6% of the patient`s urine cultures became negative, while 44.4% had episodes of urinary infection, but with lower baseline symptoms intensity.DISCUSSION: Patients included in the protocol of instillation improved significantly their quality of life; in addition, to a considerable extent new urinary infections were not presented, being milder when they presented.
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OBJECTIVE: Epidemiological data onurolithiasis in Spain have appeared in publicationsespecially local and regional level, with few referralsto Spanish national territory. The aim of this paper isto review and systematize the epidemiological datapublished on urolithiasis in Spain.METHODS: We reviewed publications in nationaland international scientific journals, meetings andconferences, and research reports (1977-2016).PubMed search (indexed papers) and manualbibliography search (not indexed works) wereperformed. Bibliometric data evaluated: Year ofpublication, geographic area, number of cases, sample type, study design and publishing format. Demographicsystematization of data: age, age and frequencydistribution by gender, family history, social stratum,profession, place of residence, ethnics, seasonality anddietary habits.RESULTS: Publications revised: 79 corresponding to 56main authors. Selected publications with original data:42 (2 composed by Part I and II, and 2 composedby paper and thesis), corresponding to 35 authors.Bibliometric and demographic data of all publicationsare displayed in tables, sorted by variables.CONCLUSIONS: The comprehensive review of studieson epidemiology in Spain constitutes a solid basis forfuture research about epidemiology of urolithiasis.
Case Report
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OBJECTIVE: We present an unusual case ofemphysematous cystitis with multiple septic embolisms toseveral organs.METHOD AND RESULTS: Case description and selectionof related pictures. Review of the existing literature.CONCLUSIONS: Emphysematous cystitis is a rarecondition but potentially severe. Prognosis depends on arapid diagnosis and treatment.
Case Report
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OBJECTIVE: The inflammatory myofibroblastic tumor (IMT) is a neoplasia with intermediate biological potential, infrequent, with an unpredictable clinical prognosis and a low recurrence rate after an effective treatment. We report two cases of IMT with genitourinary localization, being this entity`s publications infrequent. Both presented with little symptomatology, leading to multiple differential diagnosis. The surgical treatment was chosen and pathologic result confirmed the diagnosis. CONCLUSION: This entity must be considered as a true malignant neoplasm with aggressive local behavior. The gold standard management is complete surgical resection, with low recurrence rate after it. A new oncological monitoring scheme is proposed, upon the lack of an active surveillance algorithm after treatment.
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Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease and also for Chronic Kidney Disease. A high body mass index is one of the strongest risk factors for new-onset Chronic Kidney Disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing Chronic Kidney Disease in the long-term. The incidence of obesity-related glomerulopathy has increased ten-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that makes preventive behaviors an affordable option.
