extracorporeal shockwave lithotripsy Dotaz Zobrazit nápovědu
- MeSH
- kaménky patologie terapie MeSH
- lidé MeSH
- litotripse metody trendy využití MeSH
- rázové vlny s vysokou energií škodlivé účinky terapeutické užití MeSH
- urolitiáza terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Na urologické klinice FN v Hradci Králové jsme v letech 1993 - 1996 provedli extrakorporální litotrypsi ureterolitiázy u 172 nemocných s průměrným věkem 46,5 roku. Pacienti byli rozděleni do dvou skupin. První skupinu tvořilo 114 pacientů (66,3 %) se subrenální ureterolitiázou, a druhou skupinu 58 nemocných (33,7 %) s ureterolitiázou iuxtavezikální. U 56 nemocných (32,6 %) bylo nutno provést derivaci moči stentem event. punkční nefrostomickou drenáž pro obstrukcí konkrementem. Celková úspěšnost metody byla 96,4 % v subre¬ nální lokalizaci a 81,0 % u iuxtavezikální ureterolitiázy. U 15 nemocných (8,7 %) jsme museli zvolit alternativní řešení (URS, ev. extrakci konkrementu Dormiovým košíkem, Zeissovou kličkou).
At the Urological Clinic, Faculty Hospital Hradec Králové the authors performed extracorporeal lithotripsy in ureterolithiasis in 172 patients, mean age 46.5 years. The patients were divided into two groups. The first group was formed by 114 patients (66.3 %) with subrenal ureterolithiasis, the second group by 58 patients (33.7 %) with iuxtavesical ureterolithiasis. In 56 patients (32.6 %) derivation of urine had to be made by means of a stent or nephrostomic puncture drainage because of an obstruction by a concrement. The general success rate of the method was 96.4 % in the subrenal localization and 81 % in iuxtavesical ureterolithiasis. In 15 patients an alternate solution had to be sought (URS or extraction af the concrement by a Dormi basket, Zeiss loop).
- MeSH
- kameny v močovodu terapie MeSH
- lidé MeSH
- litotripse metody MeSH
- Check Tag
- lidé MeSH
- MeSH
- cholelitiáza terapie MeSH
- lidé MeSH
- litotripse MeSH
- Check Tag
- lidé MeSH
Cieľ: Porovnanie efektivity ESWL pri zemeriavaní konkrementov výhradne ultrasonografickom (USG) alebo flouroskopickom (RTG). Preukázenie minimálne ekvivalencie oboch modalít. Poukázanie na výhody ultrasonografického prístupu za účelom jeho širšieho a pružnejšieho využitia. Súbor pacientov a metóda: Retrospektívna bicentrická štúdia porovnáva stone free rates (SFRs) u troch selektovaných skupín pacientov s porovnateľnými charakteristikami, pričom ESWL bola prvou intervenciou k riešeniu nefrolitiázy, proximálnej alebo prevesikálnej ureterolitiázy. Za "stone free" je považovaný pacient s absenciu residuálnej litiázy alebo s asymptomatickým reziduom do 2 mm. Rameno s real time USG fokusáciou tvorí skupina 120 pacientov za obdobie 02/2017–02/2020 na elektromagnetickom litotryptore STORZ SLK. Do ramena s RTG zameriavaním spadajú dve skupiny: 72 pacientov v období 04/2017–10/2017 na elektrokonduktívnom litotryptore Sonolith-i-sys (EDAP) a 68 pacientov medzi 01/16–03/2017 na elektrohydraulickom litotryptore Medilit 7. Po pritom sledujeme nutnosť využitia auxiliárnych postupov a počet intervencí ESWL nutných pre kompletnú sanáciu konkrementu. Výsledky: Pri USG zameriavaní bola SFR na úrovni 90%. Primerný počet intervencí 1,3. RTG‑ -fokusácia: kumulatívne skupina Sonolith-i-sys plus Medilit 7: bola zistená hodnota SFR 90% pri 1,5 dobách. Signifikantný rozdiel v počte ESWL tak nebol zistený α = 0,105. Rovnaká situácia nastala pri porovnaní frekvencie prevedenia auxiliárneho postupu – zavedenia stentu alebo ureterorenoskopie α = 0,453, zatiaľ čo pri kumulatívnej radiačej záťaži je rozdiel signifikantný, podobne ako v prípade potreby analgetika bola taktiež signifikanatne nižšia (α < 0,001) u USG fokusácie. Miera prezencie operatéra pri intervencii bola signifikantne väčšia u USG ramena . Záver: Výsledky našej štúdie deklarujú rovnocennost' oboch zobrazovacích modalít z hľadiska efektivity. USG navigácia by mala byť predovšetkým s ohľadom na odbúranie radiačnej záťaže pre pacienta preferovanou formou zameriavania konkrementov pri realizácii ESWL.
Aim: Efficacy comparison of two localization techniques using ESWL – exclusively real time ultrasound or fluoroscopy. Demonstration of at least equivalence of both techniques. To publisize the advantages of real-time ultrasound guidance to encourage more departments in develop of this modality. Methods: This bicentric retrospective study compares stone free rates (SFRs) in three selected groups of patients with similar characteristics. Inclusion criteria: ESWL as primary intervention for nephrolithiasis, proximal or prevesical uretherolithiasis. The definition of stone free was a patient without any residual stone or the absence of fragments ≥ 2 mm. The arm with exclusively real-time USG targeting of urolithiasis contains a group of 120 patients, using electromagnetic lithotripter – STORZ SLK between 02/2017–02/2020. The fluroscopy- arm includes two groups: 72 patients, using electroconductive lithotripters: Sonolith-i-sys (EDAP) between 04–10/2017 and 68 patients, by using electrohydraulic lithotripter Medilit 7 between 01/2016–03/2017. Simultaneus evaluation of requisite for auxiliary techniques and number of sessions for complete stone-desintegration. Results: SFR was 90% in the USG-guided group. The avarage number of ESWL sessions was 1,3. SFR in the fluoroscopic arm: the group-Sonolith-i-sys plus the group Medilit 7 was 90%. The avarage number of ESWL sessions was 1,5. These results were not significantly different α = 0,105. The same result is shown on comparson of frequency of requirement for auxiliary techniques – DJ-stent insertion/ureterorenoscopy α = 0,453. Radiation exposure was the biggest difference between techniques, as well as analgesics requirement which were significantly lower in USG arm ( α < 0,001). The operator presence-time was significantly longer in USG – guided ESWL. Conclusion: Our study shows efficacy equivalence of outcomes of both localization modalities. Real-time USG guidance should be primarily used to reduce radation exposure for patients undergoing ESWL.
- MeSH
- lidé MeSH
- litotripse * metody MeSH
- radiační expozice MeSH
- retrospektivní studie MeSH
- ultrasonografie * MeSH
- urolitiáza terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- MeSH
- lidé MeSH
- litotripse metody MeSH
- žlučové kameny terapie MeSH
- Check Tag
- lidé 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
