- 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
Možnost řešení objemné ureterokély v dětském věku. Prezentujeme kazuistiku chlapce, který byl na našem pracovišti operován pro ureterokélu s mnohočetnou ureterolitiázou.
The possibility of solving a bulky uretererocele in childhood. We present a case report of a boy who was operated on at our institution for ureterocele with multiple ureterolithiasis.
- MeSH
- diagnostické techniky urologické MeSH
- dítě MeSH
- endoskopie metody MeSH
- lidé MeSH
- nefrolitiáza terapie MeSH
- ureterokéla * diagnostické zobrazování diagnóza komplikace terapie MeSH
- urolitiáza diagnostické zobrazování terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem 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.
BACKGROUND: Prompt diagnosis and treatment of paediatric urolithiasis are required to avoid long term sequelae of renal damage. OBJECTIVE: To systematically review the literature regarding the diagnostic imaging modalities and treatment approaches for paediatric urolithiasis. STUDY DESIGN: PubMed, Science Direct, Scopus and Web of Science were systematically searched from January 1980-January 2019. 76 full-text articles were included. RESULTS: Ultrasound and Kidney-Ureter-Bladder radiography are the baseline diagnostic examinations. Non-contrast Computed Tomography (CT) is the second line choice with high sensitivity (97-100%) and specificity (96-100%). Magnetic Resonance Urography accounts only for 2% of pediatric stone imaging studies. Expectant management for single, asymptomatic lower pole renal stones is an acceptable initial approach, especially in patients with non-struvite, non-cystine stones<7 mm. Limited studies exist on medical expulsive therapy as off-label treatment. Extracorporeal shock wave lithotripsy (SWL) is the first-line treatment with overall stone free rates (SFRs) of 70-90%, retreatment rates 4-50% and complication rates up to 15%. Semi-rigid ureteroscopy is effective with SFRs of 81-98%, re-treatment rates of 6.3-10% and complication rates of 1.9-23%. Flexible ureteroscopy has shown SFRs of 76-100%, retreatment rates of 0-19% and complication rates of 0-28%. SFRs after first and second-look percutaneous nephrolithotomy (PNL) are 70.1-97.3% and 84.6-97.5%, respectively with an overall complication rate of 20%. Open surgery is seldom used, while laparoscopy is effective for stones refractory to SWL and PNL. Limited data exist for robot-assisted management. CONCLUSIONS: In the initial assessment of paediatric urolithiasis, US is recommended as first imaging modality, while non-contrast CT is the second option. SWL is recommended as first line treatment for renal stones <20 mm and for ureteral stones<10 mm. Ureteroscopy is a feasible alternative both for ureteral stones not amenable to SWL as well as for renal stones <20 mm (using flexible). PNL is recommended for renal stones >20 mm.
- MeSH
- dítě MeSH
- kameny v močovodu * terapie MeSH
- ledvinové kameny * terapie MeSH
- lidé MeSH
- litotripse * MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- ureteroskopie MeSH
- urolitiáza * diagnostické zobrazování terapie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- systematický přehled MeSH
Diagnostika urolitiázy je integrální a každodenní náplní činnosti urologa, vyžaduje však nezbytnou spolupráci s radiologem. CT vyšetření umožňuje nejen identifikovat skutečnou příčinu renální koliky, ale může i posoudit základní vlastnosti konkrementu - jeho velikost, počet, polohu, dále predikovat jeho složení, denzitu, homogenitu a posoudit tak účinnost plánované léčby. Článek si dává za cíl přiblížit základy CT vyšetření řadovému urologovi.
Diagnostics of urinary stones is an integral and everyday part of urologist´s activity. It requires essential cooperation with radiologist. CT enables not only the identification of the true cause of renal colic but it can also assess basic stone characteristic - size, number, location. Moreover, the CT scan can predict stone composition, its density, homogenity and predict the efficacy of the planned treatment. The aim of this article is to enlighten the basics of CT examination to ordinary urologist.
- MeSH
- dávka záření MeSH
- lidé MeSH
- počítačová rentgenová tomografie MeSH
- urolitiáza * diagnostické zobrazování terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Endourologie je moderní urologickou metodou, která je využívána k diagnostice a terapii, při zachování minimální invazivity. Využívá v maximální míře nejnovějších technologií z oblasti optiky a zpracování kovů a plastů. Z hlediska chirurgické léčby litiázy je možno rozdělit endoskopické výkony na endoluminální, vedené přirozenými tělními vstupy, a perkutánní. V souvislosti s léčbou litiázy není možno se nezmínit o extrakorporální litotrypsi rázovou vlnou. Endoskopické metody používané pro operační léčbu litiázy jsou perkutánní extrakce litiázy, semirigidní a flexibilní uretroskopie. V současné době pozorujeme mírný ústup v používání mimotělní rázové vlny, resp. zpřísnění indikací k této léčbě.
Endourology is a modern surgical approach used in both diagnostics and therapy with advantage of minimal invasiveness. It utilizes newest technologies in optical engineering and metal and plastics manufacturing. Endoscopic procedures used for stone treatment can be divided into two groups. Endoluminal procedures using natural orifices to approach the lithiasis including semirigid and flexibile ureteroscopy and percutaneous procedures like percutaneous nephrolithotomy (PCNL). It is also very important to mention extracorporeal shockwave lithotripsy (ESWL) which plays an important role in stone management. Although a shift towards endoscopic procedures and stricter limits for the ESWL indications are noticeable recently.
