• MeSH
• analgetika farmakologie   klasifikace   terapeutické užití   MeSH
• antirevmatika farmakologie   klasifikace   terapeutické užití   MeSH
• lidé MeSH
• litotripse metody   MeSH
• močové kameny diagnóza   farmakoterapie   klasifikace   MeSH
• perkutánní nefrolitotomie metody   MeSH
• renální kolika diagnóza   etiologie   MeSH
• ultrasonografie metody   MeSH
• urografie metody   MeSH
• urolitiáza * diagnostické zobrazování   diagnóza   farmakoterapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Different international associations have proposed their own guidelines on urolithiasis. However, the focus is primarily on an overview of the principles of urolithiasis management rather than step-by-step technical details for the procedure. The International Alliance of Urolithiasis (IAU) is releasing a series of guidelines on the management of urolithiasis. The current guideline on shockwave lithotripsy (SWL) is the third in the IAU guidelines series and provides a clinical framework for urologists and technicians performing SWL. A total of 49 recommendations are summarized and graded, covering the following aspects: indications and contraindications; preoperative patient evaluation; preoperative medication; prestenting; intraoperative analgesia or anesthesia; intraoperative position; stone localization and monitoring; machine and energy settings; intraoperative lithotripsy strategies; auxiliary therapy following SWL; evaluation of stone clearance; complications; and quality of life. The recommendations, tips, and tricks regarding SWL procedures summarized here provide important and necessary guidance for urologists along with technicians performing SWL. PATIENT SUMMARY: For kidney and urinary stones of less than 20 mm in size, shockwave lithotripsy (SWL) is an approach in which the stone is treated with shockwaves applied to the skin, without the need for surgery. Our recommendations on technical aspects of the procedure provide guidance for urologists and technicians performing SWL.

• MeSH
• kvalita života MeSH
• ledviny MeSH
• lidé MeSH
• litotripse * metody   MeSH
• močové kameny * terapie   MeSH
• urolitiáza * terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• směrnice pro lékařskou praxi MeSH

PURPOSE: We sought to determine which treatment between flexible ureteroscopy and shock wave lithotripsy has a better stone-free rate in pediatric patients (<18 years) with renal or proximal ureteric stones (<2 cm). Subanalysis for all outcomes for randomized controlled trials only. MATERIALS AND METHODS: Using PubMed, Web of Science, and the Cochrane database, we identified studies (randomized clinical trials and prospective comparative nonrandomized studies) published until August 2022 reporting surgical outcomes of pediatrics patients undergoing flexible ureteroscopy and shock wave lithotripsy with renal or proximal ureteric stones <2 cm (PROSPERO ID: CRD42022378790). Only randomized controlled trials were considered for meta-analysis. Stone-free rate, operative time, and complications were analyzed. Analysis was performed in R. RESULTS: A total of 6 studies identified, of which 3 were randomized clinical trials and 4 had data on renal stones. A total of 669 patients were analyzed. Mean age ranged from 4.4 to 12.4 years. The shock wave lithotripsy group presented a range of stone-free rate between 21 and 90% while the flexible ureteroscopy group presented a range of stone-free rates between 37% and 97%. Meta-analysis of randomized controlled trials only (n=302) demonstrated significantly higher stone-free rate in flexible ureteroscopy vs shock wave lithotripsy (RR = 1.17, 95% CI: 1.04-1.33, P = 0.01), operative time (mean difference = +16.4 minutes, 95% CI: 7.3-25.5, P < 0.01) and hospital stay (mean difference = +0.25 days, 95% CI: 0.14-0.36, P < 0.001). But no difference in fluoroscopy exposure time (mean difference = -21.0 seconds, 95% CI: -42.6 to 0.56, P = 0.07), Clavien I-II (RR = 1.23, 95% CI: 0.71-2.12, P = 0.45) or Clavien III-V complications (RR = 1.04, 95% CI: 0.32-3.42, P = 0.95). CONCLUSIONS: Flexible ureteroscopy has a significantly higher stone-free rate than shock wave lithotripsy, with no difference in complication rate or fluoroscopy exposure time, and significantly higher operative times and hospital stay. However, the current evidence base for this is weak and further randomized trials are needed.

• MeSH
• dítě MeSH
• kameny v močovodu * terapie   MeSH
• ledvinové kameny * terapie   etiologie   MeSH
• lidé MeSH
• litotripse * škodlivé účinky   MeSH
• močové kameny * etiologie   MeSH
• předškolní dítě MeSH
• prospektivní studie MeSH
• ureteroskopie škodlivé účinky   MeSH
• urologie * MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• předškolní dítě MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH

CONTEXT: No algorithm exists for structured follow-up of urolithiasis patients. OBJECTIVE: To provide a discharge time point during follow-up of urolithiasis patients after treatment. EVIDENCE ACQUISITION: We performed a systematic review of PubMed/Medline, EMBASE, Cochrane Library, clinicaltrials.gov, and reference lists according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Fifty studies were eligible. EVIDENCE SYNTHESIS: From a pooled analysis of 5467 stone-free patients, we estimated that for a safety margin of 80% for remaining stone free, patients should be followed up using imaging, for at least 2 yr (radiopaque stones) or 3 yr (radiolucent stones) before being discharged. Patients should be discharged after 5 yr of no recurrence with a safety margin of 90%. Regarding residual disease, patients with fragments ≤4 mm could be offered surveillance up to 4 yr since intervention rates range between 17% and 29%, disease progression between 9% and 34%, and spontaneous passage between 21% and 34% at 49 mo. Patients with larger residual fragments should be offered further definitive intervention since intervention rates are high (24-100%). Insufficient data exist for high-risk patients, but the current literature dictates that patients who are adherent to targeted medical treatment seem to experience less stone growth or regrowth of residual fragments, and may be discharged after 36-48 mo of nonprogressive disease on imaging. CONCLUSIONS: This systematic review and meta-analysis indicates that stone-free patients with radiopaque or radiolucent stones should be followed up to 2 or 3 yr, respectively. In patients with residual fragments ≤4 mm, surveillance or intervention can be advised according to patient preferences and characteristics, while for those with larger residual fragments, reintervention should be scheduled. PATIENT SUMMARY: Here, we review the literature regarding follow-up of urolithiasis patients. Patients who have no stones after treatment should be seen up to 2-3 yr, those with large fragments should be reoperated, and those with small fragments could be offered surveillance with imaging.

• MeSH
• dospělí MeSH
• lidé MeSH
• litotripse * škodlivé účinky   MeSH
• následné studie MeSH
• propuštění pacienta MeSH
• urolitiáza * diagnostické zobrazování   chirurgie   MeSH
• urologie * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH

PURPOSE OF REVIEW: To discuss the most recent surgical lasers that have been made available to us and to evaluate their potential in performing en bloc resection of nonmuscle invasive bladder cancer. RECENT FINDINGS: Laser en bloc resection of bladder tumors (ERBT) can be performed with a number of laser systems including Ho:YAG, GreenLight, diode, Tm:YAG and thulium fiber lasers (TFL). The data that is currently available suggests that the water-targeting devices (utilizing water as a primary chromophore - Ho:YAG, Tm:YAG, TFL) may have a number of advantages over hemoglobin-targeting systems (potassium titanyl phosphate:YAG, lithium triborate:YAG). One recent addition to the surgical armamentarium Moses effect enhanced Ho:YAG and the TFL (being able to work both in quasi-continuous and SuperPulsed modes) necessitates careful discussion and comparison with the other available devices. SUMMARY: The majority of available lasers have proven to be safe to use and compared to electrocautery allow for lower rates of obturator nerve reflex and result in fewer bleeding complications. The minimal penetration depth and decreased peak power of Tm:YAG and TFLs render them the devices of choice when it comes to ERBT. Unfortunately, more studies on ERBT with TFL are needed in order for us to make a sound assessment of the respective pros and cons.

• MeSH
• laserová litotripse * MeSH
• lasery pevnolátkové * škodlivé účinky   MeSH
• lidé MeSH
• nádory močového měchýře * patologie   chirurgie   MeSH
• thulium MeSH
• voda MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

OBJECTIVE: Analysis of the effect of technical factors, i.e. the type of stone targeting and shock wave generator, on ESWL efficacy. Evaluation of secondary outcomes to determine an optimal strategy for performing the procedure. PATIENTS AND METHOD: In the period from 01/2016 to 07/2021, we analyzed data from patients indicated for ESWL for nephrolithiasis and proximal or distal ureterolithiasis. This was a tricenter retrospective study to evaluate stone-free rates (SFR) while taking into account the number of ESWL sessions in four selected groups of patients with comparable characteristics. A patient is considered stone-free in the absence of residual lithiasis or with an asymptomatic residue of up to 2 mm. The real-time ultrasound-guided (USG) arm consisted of a group of 120 patients on the electromagnetic STORZ SLK lithotripter in the period from 02/2017 to 02/2020. A total of three comparison arms with x-ray guidance were created: A: 68 patients between 01/2016 and 03/2017 on the Medilit 7 electrohydraulic lithotripter. B: 72 patients from 04/2017 to 10/2017 on the Sonolith i-sys electroconductive lithotripter (EDAP). C: 120 patients from 03/2018 to 07/2021 on the STORZ SLK electromagnetic lithotripter. By comparing the US and x-ray guidance using the STORZ SLK lithotripter, the effect of targeting when using an identical device (electromagnetic generator) was evaluated. By comparing the arms A, B, and C, the efficacy in different types of generators - electromagnetic, electroconductive, electrohydraulic - was assessed when the same type of targeting (fluoroscopy) was used. The secondary parameters that were monitored included: the rate of use of auxiliary techniques in stone management; radiation exposure for the patient and/or operator; analgesic consumption; and the time required to perform the procedure. RESULTS: When US versus x-ray guidance was compared in an electromagnetic lithotripter, SFRs of 90% vs. 85% (P=0.329), i.e. statistically comparable results, were obtained. By comparing electromagnetic, electroconductive, and electrohydraulic generators with fluoroscopy, SFRs of 85%, 88.9%, and 88.2% were obtained, respectively (P=0.727). When the degree of need for intraoperative analgesic administration was assessed, the electromagnetic generator was found to have a significantly lower consumption (20.8% vs. 30.6% vs. 48.5%) (P=0.0005). Values less than 1095 HU and 108.5 mm were shown to be optimal cut-off values for stone density and skin-to-stone distance, respectively. CONCLUSION: Based on our comparative analysis, the noninferiority of US stone targeting was demonstrated compared to fluoroscopic targeting. No significant differences in ESWL efficacy were found using electrohydraulic, electroconductive or electromagnetic shock wave generators. With the electromagnetic lithotripter, there was a significantly lower analgesic consumption than with the electrohydraulic type.

• MeSH
• analgetika MeSH
• ledvinové kameny * terapie   MeSH
• lidé MeSH
• litotripse * metody   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

V čase prebiehajúcej koronavírusovej pandémie sa často stretávame s pacientmi s covid pozitivitou a závažným nálezom na koronárnych tepnách. Problémoví sú najmä pacienti, ktorí vyžadujú kardiochirurgickú liečbu. U týchto pacientov je dôležitá multidisciplinárna diskusia s posúdením únosnosti operačného výkonu a zvážením najvhodnejšieho prístupu vzhľadom na vyššie mortalitné riziko operačnej liečby. V práci prezentujeme prípad vysokorizikovej covid pozitívnej symptomatickej pacientky s akútnym koronárnym syndrómom, s kritickým kalcifikovaným postihnutím hlavného kmeňa ľavej koronárnej tepny. Pacientka bola nevhodná na kardiochirurgickú liečbu a bola riešená perkutánnou koronárnou intervenciou s použitím ľavokomorovej mechanickej podpory a intravaskulárnej litotripsie.

At the time of the ongoing coronavirus pandemic, we are encountering patients who are Covid-19 positive and have severe coronary artery disease. Patients requiring cardiac surgery are particularly challenging. A multidisciplinary discussion aimed at assessing surgery tolerability and considering the most appropriate approach is important given the higher risk of surgical mortality. We report a case of a high-risk Covid-19 positive symptomatic female patient with an acute coronary syndrome and a critical calcified stenosis of the main stem of the left coronary artery. This patient was not suitable for cardiac surgery and she underwent a percutaneous coronary intervention using a left ventricular mechanical support system and intravascular lithotripsy.

• MeSH
• akutní koronární syndrom chirurgie   MeSH
• COVID-19 komplikace   MeSH
• komorbidita MeSH
• koronární angioplastika * metody   MeSH
• laserová litotripse metody   MeSH
• lidé MeSH
• rizikové faktory MeSH
• senioři MeSH
• vaskulární kalcifikace chirurgie   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• arteriální okluzní nemoci diagnóza   terapie   MeSH
• ateroskleróza diagnóza   komplikace   terapie   MeSH
• CT angiografie MeSH
• dolní končetina patologie   MeSH
• lidé MeSH
• litotripse metody   MeSH
• onemocnění periferních arterií terapie   MeSH
• randomizované kontrolované studie jako téma MeSH
• senioři MeSH
• vaskulární kalcifikace * diagnóza   terapie   MeSH
• výkony cévní chirurgie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH

Chronická pankreatitida (ChP) je vážným onemocněním, které výrazně ovlivňuje kvalitu života a může mít závažné dlouhodobé následky, jako jsou karcinom pankreatu nebo sekundární diabetes mellitus. Asociovaná exokrinní insuficience pankreatu vede k malnutrici s váhovým úbytkem, nicméně hlavním příznakem pacientů s ChP jsou abdominalgie, které jsou často velmi silné. Pokud v léčbě bolesti není úspěšná primární farmakologická terapie (substituce pankreatických enzymů, analgetika), může být CP řešena endoskopicky, pomocí litotrypse extrakorporální rázovou vlnou (ESWL – extracorporeal shockwave lithotripsy), jejich kombinací či chirurgicky. Zde prezentujeme případ pacienta s algickou obstruktivní ChP, u kterého jsme stav úspěšně řešili kombinací litotrypse extrakorporální rázovou vlnou a endoskopie.

Chronic pancreatitis (CP) is a serious condition with a great impact on the quality of life, and it can lead to some serious long-term consequences such as pancreatic cancer or secondary diabetes mellitus. Associated pancreatic exocrine insufficiency leads to malnutrition with weight loss; however, the main symptom of the disease is abdominal pain, often very severe. The primary treatment option for painful CP is pharmacotherapy (pancreatic enzyme replacement therapy, analgesics). If this is not effective, CP can be treated via endoscopy, extracorporeal shockwave lithotripsy (ESWL), their combination, or surgery. We present a case of painful chronic obstructive pancreatitis in a patient successfully treated with ESWL in combination with endoscopy.

• MeSH
• alkoholická pankreatitida MeSH
• cholangiopankreatografie endoskopická retrográdní MeSH
• chronická pankreatitida * terapie   MeSH
• diagnostické zobrazování MeSH
• diklofenak terapeutické užití   MeSH
• lidé MeSH
• litiáza * chirurgie   MeSH
• litotripse * přístrojové vybavení   škodlivé účinky   MeSH
• pirinitramid terapeutické užití   MeSH
• senioři MeSH
• výsledek terapie MeSH
• vývody pankreatu chirurgie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH

INTRODUCTION: Bladder stones (BS) are still endemic in children in developing nations and account for a high volume of paediatric urology workload in these areas. The aim of this systematic review is to comparatively assess the benefits and risks of minimally invasive and open surgical interventions for the treatment of bladder stones in children. METHODS: This systematic review was conducted in accordance with Cochrane Guidance. Database searches (January 1970- March 2021) were screened, abstracted, and assessed for risk of bias for comparative randomised controlled trials (RCTs) and non-randomised studies (NRSs) with >10 patients per group. Open cystolithotomy (CL), transurethral cystolithotripsy (TUCL), percutaneous cystolithotripsy (PCCL), extracorporeal shock wave lithotripsy (ESWL) and laparoscopic cystolithotomy (LapCL) were evaluated. RESULTS: In total, 3040 abstracts were screened, and 8 studies were included. There were 7 retrospective non-randomised studies (NRS's) and 1 quasi-RCT with 1034 eligible patients (CL: n=637, TUCL: n=196, PCCL: n=138, ESWL: n=63, LapCL n=0). Stone free rate (SFR) was given in 7 studies and measured 100%, 86.6%-100%, and 100% for CL, TUCL and PCCL respectively. CL was associated with a longer duration of inpatient stay than PCCL and TUCL (p<0.05). One NRS showed that SFR was significantly lower after 1 session with outpatient ESWL (47.6%) compared to TUCL (93.5%) and CL (100%) (p<0.01 and p<0.01 respectively). One RCT compared TUCL with laser versus TUCL with pneumatic lithotripsy and found that procedure duration was shorter with laser for stones <1.5cm (n=25, p=0.04). CONCLUSION: In conclusion, CL, TUCL and PCCL have comparable SFRs but ESWL is less effective for treating stones in paediatric patients. CL has the longest duration of inpatient stay. Information gathered from this systematic review will enable paediatric urologists to comparatively assess the risks and benefits of all urological modalities when considering surgical intervention for bladder stones.

• MeSH
• dítě MeSH
• kameny močového měchýře * chirurgie   MeSH
• lidé MeSH
• litotripse * metody   MeSH
• močový měchýř chirurgie   MeSH
• rozvojové země MeSH
• urologie * MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• systematický přehled MeSH