Extracorporeal Lithotripsy Research Articles

Реабилитация пациентов после выполнения современных эндоурологических операций по поводу мочекаменной болезни

Numerous publications on the successful use of NefraDoz (Stada, Germany) in the metaphylaxis of urolithiasis after extracorporeal lithotripsy, and the prevention and treatment of infectious inflammatory diseases of the lower and upper urinary tracts, served as the rationale for a study aimed to evaluate the effectiveness and safety of long-term use of NefraDoz in patients after transurethral and percutaneous interventions performed for urological diseases. The study analyzed results of 116 transurethral and percutaneous endoscopic operations for urolithiasis performed in 62 men and 54 women aged 21 to 84 years from November to December 2017 at the D.D. Pletnev City Clinical Hospital. Depending on the localization of the stones, all patients were divided into three groups: kidney stones (n=68), ureteral stones (n=28), and bladder stones (n=21). In each group, patients were assigned either to receive (study group, n=50) or not to receive (control group, n=66) postoperative NefraDoz, which was administered at a dose of 1 capsule three times daily for one month. Patients in the control group (n=66) received standard antibacterial therapy for one month. The analysis included leukocyturia, 24-hour diuresis, the severity of the symptoms of the disease and the patients quality of life. The use of NefraDoz after transurethral lower urinary tract procedures, reduced the severity of irritative symptoms, improved the patients quality of life, reduced the number of patients with leukocyturia and increased 24-hour diuresis. The use of NefraDoz after upper urinary tract procedures improved the patients quality of life, reduced the number of patients with leukocyturia and increased 24-hour diuresis, and improved the clearance of residual fragments. There were no adverse events associated with NefraDoz. We have proved the advantage of using the NefraDoz complex in the rehabilitation of patients after endourologic procedures.

PUK20 - COST-UTILITY ANALYSIS OF EXTRACORPOREAL LITHOTRIPSY VERSUS URETERORENOSCOPY-HOLMIUM LASER FOR TREATMENT OF URINARY STONES

The objective od this study is to compare the cost-utility profile of ureterorenoscopy-holmium laser (URS) versus extracorporeal lithotripsy (ESWL) in the treatment of urinary stones smaller than 20mm. A total of 525 patients treated between 2012-2014 were included in the study. Of these, 229 (43.6%) were treated with URS and 296 (56.3%) with ESWL. For QALYs calculation, a sample of 78 patients (32 treated with ESWL and 46 with URS) were evaluated prospectively (January 2016-December 2016) using a quality of life survey (Euroqol 5QD-3L) before and after treatment. A Markov model (SWL + URS salvage vs primary URS) was constructed for the calculation of the quality of life in each possible state of the patient (lithiasis without double J stent, lithiasis with stent, free of lithiasis without stent and free of lithiasis with stent). A Monte Carlo simulation was performed as probabilistic sensitivity analysis to confirm the robustness of the results. Of the 525 patients, 345 (65.71%) were treated for renal lithiasis (41.7% by URS and 58.26% by SWL) and 180 for ureteral lithiasis (47.2% by URS and 52.7% by ESWL). Mean cost per patient treated with ESWL and URS 1.733,96 € and 2.337,31 € euros respectively. Renal stone-free rate was 91.7% for URS and 79.16% for ESWL and ureteral stone-free rate was 94% and 81%, respectively. The cost-utility analysis showed higher cost but incremental QALYS of 0.011 for URS, thus, the ICER was 50.829,82 €/QUALY, above the acceptability threshold. According to our results, ESWL showed to be a more efficient tool in cost-utility terms compared to URS in the treatment of reno-ureteral lithiasis smaller than 20 mm.

Ultrasound follow up: Is an undetected spontaneous expulsion of stone fragments a sign of extracorporeal shock wave treatment failure in kidney stones?

After extracorporeal lithotripsy (SWL), a spontaneous expulsion of fragments is often reported. The aim of this study is to demonstrate the presence of a stone free status or the presence of clinically insignificant residual fragments (CIRFs, defined as "asymptomatic, noninfectious, ≤ 3 mm fragments") in people with undetected spontaneous expulsion. Between May and September 2017, we performed a total of 87 treatments. The device used was a Storz Medical Modulith® SLK. All the patients were treated in prone position to reduce respiratory movements and underwent sonography before and four to eight weeks after the treatment. An in line ultrasound targeting was possible with all the stones. People lost to follow up or with ureteral stones were excluded. Patients were divided in groups according to gender, previous treatments, stone diameter and position. We enrolled 73 patients. 57 patients had a single stone and 16 multiple stones. A mean number of 3044 shock waves was administered with a maximum average energy of 0.68mj/mmq. At follow up, 41 patients (56.2%) were found stone free or with CIRFs. The association between undetected expulsion and the presence of CIRFs is considered to be not statistically significant (p = 0.89). Among patients with CIRFs, 25/41 didn't report expulsion. Taking in account the groups our population was divided in, according to gender (p = 0.36), previous treatments (p = 0.44), stone diameter (p = 0.28) and stone position (p = 0.35), the association between undetected spontaneous expulsion and presence of CIRFs was never statistically significant. An undetected spontaneous expulsion of stone fragments could not be considered a sign of SWL treatment failure. The association between undetected expulsion and presence of CIRFs is never statistically significant if gender of the patients, previous treatments, stone diameter and stone position are considered.

Tratamiento de la Litiasis Renal en Cáliz Inferior. Litotricia Extracorpórea Versus Cirugía Intrarrenal Retrógrada o Percutánea

Introduction: extracorporeal shockwave lithotripsy (SWL) is used in the 80-90% of the cases of renal lithiasis. Endourological techniques such as retrograde intrarenal surgery (RIRS) or percutaneous nephrolithotomy (PCNL) and its miniaturizations (miniperc) are gaining importance because they are highly effective treatments. Regarding the treatment of the nephrolithiasis of the lower pole, the extracorporeal lithotripsy presents worse results, but it still difficult to set up the indications to treat with a certain technique. The purpose of this review is to stablish the effectivity and safety profile of these techniques in the management of the lower renal pole lithiasis.

La lithotripsie extracorporelle : expérience d’un centre Sénégalais

ObjectivesEvaluate the efficacy of extracorporeal lithotripsy (ECL) in the management of urinary lithiasis. Patients and methodsRetrospective, descriptive and analytical study of 76 patients who underwent ECL in a center in Senegal from January 2013 to January 2016. The parameters studied were: age, sex, body mass index (BMI), Calculus characteristics, number of lithotripsy sessions, treatment outcomes and complications. ResultsThe mean age was 42, 7±10, 9 years. The male sex was predominant. The majority of patients had normal weight. CT showed calculus in all patients. Ureteral localization was the most frequent. Calculi with a size less than 10mm were the most numerous. Most patients had only a calculation. The majority of patients underwent between one and three ECL sessions. Patients with normal weight had their calculus fragmented with the least session. There was no correlation between the number of sessions and the size of the kidney stones (p=0, 19), while there was a correlation between the number of sessions and the size of the ureteral stones (p=0,008). Patients without residual fragments were more numerous (82, 9%). The success rate was better for the kidney stones of the upper and middle calyxes and better for the ureteral calculi of the pelvic ureter and the lumbar ureter. Transient hematuria was noted in all patients and six had a renal colic attack. ConclusionECL is effective in the management of the calculi of the upper urinary tract however; its results can still be improved.

Первоначальный опыт клинического применения тулиевой контактной литотрипсии в трансуретральном доступе в лечении мочекаменной болезни

The choice of an effective and safe method of disintegration of stones in upper and lower urinary tract is very important in the context of continuous scientific and technological progress. In current clinical urological practice, various lithotriptors with rigid and flexible probes are used for contact disintegration of stones, having both advantages and disadvantages. This study aimed to analyze the first results of the clinical application of the native Tm: fiber Urolaz laser (STA IRE-Polyus, Russia) for contact transurethral lithotripsy. The study comprised 56 patients who underwent transurethral contact thulium laser lithotripsy for 68 stones of the upper and lower urinary tracts between April and September 2017. Forty-four patients had kidney and ureteral stones, and twelve patients had urinary bladder stones. Twenty-four kidney stones were removed by retrograde intrarenal surgery using ureteral casing, flexible ureteropyeloscope and thulium laser, 32 stones in various ureteral segments - by rigid contact thulium laser ureterolithotripsy and 12 bladder stones - by thulium laser cystolithotripsy. The size of the upper urinary tract stones varied from 0.6 to 1.8 cm, bladder stones measured from 1.1 to 3.5 cm. Also, experimental studies were carried out to investigate the effects of the fiber thulium and holmium laser on the stone displacement and temperature environment during lithotripsy. Full stone fragmentation was achieved in 100% of patients. 47.7% of patients required additional lithoextraction of fragments; there was no retrograde migration of large stones. The mean duration of stone disintegration was 19 minutes. Postoperatively, 15.9% of patients had an exacerbation of pyelonephritis, which was successfully managed by conservative measures. The mean postoperative hospital stay was 2.4+/-1.1 days. At follow-up examination 4-6 weeks after surgery, one patient was found to have a residual symptomatic ureteral stone, which required extracorporeal short-wave lithotripsy. The experimental study showed that fiber thulium laser lithotripsy produced much less propulsion of artificial stone than Holmium laser lithotripsy. With the use of therapeutic power, neither of the lasers resulted in "dangerous" rises of the washing fluid temperature during stone disintegration. Using the universal thulium laser system "Urolaz" provides a significant improvement in the effectiveness of endourologic upper urinary tract interventions and significantly reduces the likelihood of intraoperative trauma and postoperative complications, which contributes to improving the quality of specialized urological care.

783 - Comparative analysis of lost productivity and costs, between extracorporeal lithotripsy treatment and endoscopic treatment for reno-ureteral lithiasis less than 2 cm

783 - Comparative analysis of lost productivity and costs, between extracorporeal lithotripsy treatment and endoscopic treatment for reno-ureteral lithiasis less than 2 cm

Study of the effect of Tamsulosin in the spontaneous expulsion of ureteric calculi

Background: To increase the expulsion rate and reduce the analgesic requirement, there is a great deal of enthusiasm for adjuvant pharmacological interventions which is non-invasive and cost-effective. Tamsulosin shortens hospital stay, decreases operative interference. Tamsulosin increases stone expulsion rate and decreases expulsion time and has been shown to be safe and cost effective. The aim was to study the effect of Tamsulosin in the spontaneous expulsion of calculi in the ureter and to study the side effects of use of Tamsulosin for ureteric stones. Patients and Methods: A prospective, randomized controlled study was conducted to compare the effect of Tamsulosin between two groups. This study included a total of 50 patients, 25 patients were chosen randomly and advised to take plenty of oral fluids and treated with NSAIDs (Diclofenac sodium) and the other 25 patients were treated with Tamsulosin (alpha blocker) 0.4mg HS for one month along with oral fluids and NSAIDs (Diclofenac sodium). The patients were then observed weekly and ultrasound scan was repeated after 15 days to look for any passage of calculi. If the stone was passed successfully, it was confirmed with ultrasonography. After one month if treatment failed, conservative management was discontinued and the patient was advised surgery. Independent t-test and Chi-square test' was the test of significance. Results: Majority of the patients were in the age group of 20-40 yrs. The mean size of the calculus was 7.18 mm on the right side and 6.62 mm on the left side. Out of the 25 patients who were on alpha 1 blocker (Tamsulosin) 16 patients had passed the calculi and 9 patients had no results with a success rate of 64%. In the 25 patients who were not on Tamsulosin 6 patients passed the calculi and 19 patients did not pass the calculi. Conclusion: Tamsulosin is an effective and safe drug in the management of calculi in the ureter and should be considered before ureteroscopy or extracorporeal lithotripsy for uncomplicated ureteral calculi.

Trends in the management of urolithiasis in Latin America, Spain and Portugal: Results of a survey in the Confederación Americana de Urología (CAU)

ObjectiveTo describe the trends in the current management of urolithiasis in the Confederación Americana de Urología (CAU) setting to recognize patterns of clinical practice and identify educational needs. Material and methodAn online survey was created with 31 multiple-choice questions (Spanish and Portuguese) through www.caunet.org, which revealed demographic data, patterns of clinical practice and approaches for specific clinical conditions. ResultsA total of 463 practitioners from Brazil, Mexico, Argentina, Spain, Colombia, Chile and other countries (3.96% of the members of CAU) completed the survey. All participants performed some type of urolithiasis treatment: 98.5% performed semirigid ureteroscopy (URS), 83.8% performed percutaneous nephrolithotomy (PCNL), 78.2% performed flexible URS, and 67.2% performed extracorporeal lithotripsy. The youngest physicians tended to perform PCNL (p<0.001), and the proportion of users of flexible URS was greater in the Portuguese countries (p=0.037). The main energy source was laser (60.7%). Small-caliber PCNL was performed by 15.3% of the respondents, more often in university hospitals (p<0.01) and by older practitioners (p<0.01). Only 3.2% of the respondents used percutaneous access to the kidney guided exclusively by ultrasound, especially the older practitioners (p<0.001). The supine position was used by 40.4% of the respondents, more often in Spain (p<0.001) and in the university setting (p=0.017). PCNL without nephrostomy was practiced by 3.9% of the respondents. For flexible URS, 19.2% of the respondents did not use ureteral access sheaths, and the older practitioners preferred thinner caliber sheaths (p<0.001). ConclusionsThe management of lithiasis in the CAU setting follows a profile similar to that recognized in the European and American clinical guidelines, although there are interesting variations based on the practitioner's age and preferences. We identified potential areas for improvement in small-caliber PCNL and ultrasound-guided puncture.

Multimodal management of forgotten encrusted ureteral stents

Background: Forgotten ureteral stents are seen in urologic practice because of ignorance of patients or failure of physician to counsel the patients. They can cause significant morbidity and pose a management and legal dilemma.Objectives: To evaluate the effi cacy and feasibility of different endourological approaches like percutaneous nephrolithotomy, ureteroscopic lithotripsy, cystolithotripsy and extracorporeal lithotripsy in the treatment of forgotten encrusted ureteral stents.Methods: Total 10 patients with forgotten encrusted double J stents from January 2013 to Nov 2015 were included. Mean age of the patients was 38.4 years (1.5 -5 years). All patients were evaluated for stent encrustation and associated stone burden by X-ray KUB and Intravenous Urography. Combined endourological procedures like percutaneous nephrolithotomy, ureteroscopic lithotripsy, cystolithotripsy and extracorporeal lithotripsy and even open surgery was done to remove these stents. The patients characteristics, indications for stenting, indwelling time, site of encrustation, hospital stay etc were all noted.Results: Total 10 patients presented with forgotten Double J stents. Out of three patients with large encrustations both in renal pelvis and urinary bladder, one patient underwent percutaneous nephrolithotomy and cystolithotripsy. Rest two patients underwent extracorporeal lithotripsy for two sessions for renal pelvic encrustation and cystolithotripsy for urinary bladder encrustation. Four patients underwent ureteroscopic and cystolithotripsy. Two patients in whom all fractured coils were in urinary bladder, underwent cystolithotripsy. All the stents were removed under C-arm fluoroscopic guidance. In one patient, open ureterotomy was done to remove the knotted stent.Conclusion: The use of Double J stent should be limited. The combination of various endourological techniques and extracorporeal lithotripsy can achieve effective stent and stone treatment with minimal morbidity and hospital stay.Journal of Kathmandu Medical College, Vol. 5, No. 4, Issue 18, Oct.-Dec., 2016, page: 116-119

Sialolithiasis removal under general anesthesia: A descriptive retrospective study in the maxillofacial surgery department in Lille University Hospital.

Since the beginning of the use of sialendoscopy and extracorporeal lithotripsy, recommendations have changed. The purpose of this retrospective study was to evaluate the efficiency of our treatment protocol, without a lithotripter, under general anaesthesia in the Stomatology and Maxillofacial Surgery Department of Lille University Hospital. The secondary goals were to evaluate patient tolerance and satisfaction. All patients treated with sialendoscopy alone, sialendoscopy with a combined surgical approach or a transoral approach (TOA) (sialolithotomy) between January 2013 and December 2015 were included. Efficiency was judged by the number and size of the extracted calculi compared to those found on the preoperative CTS, the symptoms mentioned during the one month postoperative examination and the recurrence within 6 months (telephone follow-up). Success was attained when the calculus was completely eliminated and the patient was symptom free after one month and without recurrence through six months. On the other hand, failure was attained when the calculus could not be completely removed, there was remaining debris, the patient was still symptomatic after one month or if there was a recurrence before six months. The sialendoscopy success rate was 78.57% for the submandibular gland and 92.3% for the parotid gland. We had a 100% success rate with the combined approach for the parotid gland, we had a 96.7% success rate with TOA and we had a 100% success rate with TOA assisted with sialendoscopy. Our results conform with the literature and prompt us to suggest a protocol without a lithotripter.

Management of renal transplant urolithiasis: a multicentre study by the French Urology Association Transplantation Committee.

Urolithiasis is rare among renal transplant recipients and its management has not been clearly defined. This multicentre retrospective study was organised by the Comité de Transplantation de l'Association Française d'Urologie (French Urology Association transplantation committee). Statistical analysis was performed with SPSS 19 software. Ninety-five patients were included in this study. Renal transplant urolithiasis was an incidental finding in 55% of cases, mostly on a routine follow-up ultrasound examination. One half of symptomatic stones were due to urinary tract infection and the other half were due to an episode of acute renal failure. The initial management following diagnosis of urolithiasis was double J stenting (27%), nephrostomy tube placement (21%), or watchful waiting (52%). Definitive management consisted of: watchful waiting (48%), extracorporeal lithotripsy (13%), rigid or flexible ureteroscopy (26%), percutaneous nephrolithotomy (11%) and surgical pyelotomy (2%). All transplants remained functional following treatment of the stone. The main limitation is the retrospective design. The incidence of lithiasis could be higher inkidneytransplantedpatients due toa possible anatomical or metabolical abnormalities.The therapeutic management of renal transplant urolithiasis appears to be comparable to that of native kidney urolithiasis.

95 - Comparative analysis of lost productivity between extracorporeal lithotripsy treatment and endoscopic treatment for reno-ureteral lithiasis less than 2 cm

95 - Comparative analysis of lost productivity between extracorporeal lithotripsy treatment and endoscopic treatment for reno-ureteral lithiasis less than 2 cm

Tendencias en el manejo de la litiasis urinaria en América Latina, España y Portugal: resultados de una encuesta en la Confederación Americana de Urología (CAU)

ObjectiveTo describe the trends in the current management of urolithiasis in the Confederación Americana de Urología (CAU) setting to recognise patterns of clinical practice and identify educational needs. Material and methodAn online survey was created with 31 multiple-choice questions (Spanish and Portuguese) through www.caunet.org, which revealed demographic data, patterns of clinical practice and approaches for specific clinical conditions. ResultsA total of 463 practitioners from Brazil, Mexico, Argentina, Spain, Colombia, Chile and other countries (3.96% of the members of CAU) completed the survey. All participants performed some type of urolithiasis treatment: 98.5% performed semirigid ureteroscopy (URS), 83.8% performed percutaneous nephrolithotomy (PCNL), 78.2% performed flexible URS, and 67.2% performed extracorporeal lithotripsy. The youngest physicians tended to perform PCNL (P<.001), and the proportion of users of flexible URS was greater in the Portuguese countries (P=.037). The main energy source was laser (60.7%). Small-calibre PCNL was performed by 15.3% of the respondents, more often in university hospitals (P<.01) and by older practitioners (P<.01). Only 3.2% of the respondents used percutaneous access to the kidney guided exclusively by ultrasound, especially the older practitioners (P<.001). The supine position was used by 40.4% of the respondents, more often in Spain (P<.001) and in the university setting (P=.017). PCNL without nephrostomy was practiced by 3.9% of the respondents. For flexible URS, 19.2% of the respondents did not use ureteral access sheaths, and the older practitioners preferred thinner calibre sheaths (P<.001). ConclusionsThe management of lithiasis in the CAU setting follows a profile similar to that recognised in the European and American clinical guidelines, although there are interesting variations based on the practitioner's age and preferences. We identified potential areas for improvement in small-calibre PCNL and ultrasound-guided puncture.

Peroral cholangiopancreatoscopy with the SpyGlass® system: what do we know 10 years later.

Smaller endoscopes and catheters have been developed that permit direct visualization of the bile and pancreatic ducts (cholangioscopy and pancreatoscopy, respectively). These endoscopes and catheters are passed through the working channel of a standard therapeutic duodenoscope during endoscopic retrograde cholangiopancreatography (ERCP). The SpyGlass Direct Visualization System (Boston Scientific Corp, Natick, MA, USA) is currently the most widely used and studied device. Cholangioscopy with intraductal lithotripsy has become an established modality in the treatment of difficult biliary lithiasis. When used in the evaluation of indeterminate biliary strictures by experienced endoscopists in recognizing intraductal pathology, it increases the diagnostic yield of tissue sampling. Pancreatoscopy is complementary to other imaging modalities in the evaluation of intraductal papillary mucinous neoplasms of the pancreas and is emerging as a sole or adjunctive therapy to extracorporeal shock wave lithotripsy for the treatment of main pancreatic duct stones. It remains investigational in the diagnosis of pancreatic adenocarcinoma. Complications specific to the performance of cholangiopancreatoscopy include cholangitis, which is related to intraductal fluid irrigation.

Analgesia, nivel de sedación y cambios hemodinámicos con dexmedetomidina y propofol en pacientes sometidos a litotricia extracorpórea: estudio prospectivo, aleatorizado y ciego

IntroductionThe anesthetic management of patients for extracorporeal lithotripsy has been very diverse, using procedural sedation, general and regional anesthesia, where the use of drugs such as adrenergic alpha-2 agonists and propofol have developed importance. ObjectiveCompare the analgesia, degree of sedation and hemodynamic changes between dexmedetomidine and propofol in patients undergoing extracorporeal lithotripsy. HypothesisPatients undergoing extracorporeal lithotripsy with sedation with dexmedetomidine will present greater hemodynamic stability and lower score in the analogous visual scale of pain during the intraoperative period than those receiving propofol. Methodis an experimental, prospective, comparative, bind and randomized clinical trial, to be determined the pain scale, degree of sedation and hemodynamic changes in 60 patients ASA I and II diagnosed with kidney stones. Two randomized groups: 30 patients were assigned to group 1 (dexmedetomidine) and 30 patients were assigned to group 2 (propofol). It was administered IV: group 1, loading dose of dexmedetomidine in 10minutes at 0.5mg/kg/h followed by a maintenance infusion between 0.2-0.5mg/kg/h; group 2, loading dose of propofol in 3-5minutes at rate of 6-9mg/kg/h followed by a maintenance infusion at 1.5-4.5mg/kg/h. ResultsBoth groups showed hemodynamic stability, the group 1 had oxygen saturation between 99-100% (p: 0.141), while in group 2 values ranged from 92-100% (p: 0.006). The sedation degree was effective in both groups (p: 0.016 and 0.026), with lower incidence of intraoperative pain in the dexmedetomidine group (p: 0.071 versus 0.024). ConclusionsDexmedetomidine and propofol are effective and safe medications that reduce pain, guarantee a good level of sedation and have hemodynamic stability during extracorporeal lithotripsy procedures.

The acoustic field of a spherical self-focusing Eisenmenger electromagnetic shockwave source (EMSE)

Shockwave sources are used in extracorporeal lithotripsy, pain therapy and a wide range of other medical applications. Typical lithotripter source pulses mostly achieve positive pressure amplitudes of ca. 35 to 100 MPa and tensile pressures amplitudes up to -20 MPa. Already 1962, Eisenmenger designed a plane electromagnetic source, which was further developed into a spherically shaped, self-focusing electromagnetic source (ca. 1991). We have one of his prototype sources (Membrane diameter 120 mm, focal distance 200 mm), which was measured according to the standard IEC61846. Focus and field measurements were done using a single-spot fiberoptic hydrophone and compared to a multi-spot optical hydrophone. Very low variations of the acoustic output were found (for the peak positive pressure and for the energy). Notably, in contrast to many other shockwave sources, the spherical EMSE provides steep shockwaves (10...20 ns risetime) in the focus at comparably low pressures (33...36 MPa), even at lower energy settings. Peak negative pressures were in the range of &amp;lt; -10 MPa. Focus and field measurements show the interesting properties of the spherical self-focusing EMSE, also in comparison to stronger focusing setups.

Role of tamsulosin in the management of lower ureteric stone at tertiary care hospital in Western Rajasthan, India

Background: Many minimally invasive interventional techniques as well as expectant treatments exist for the management of lower ureteric calculi.Methods: 100 patients [group A (50 patients) patients given capsule tamsulosin 0.4mg, 1 daily up to 4 weeks while group B (50 patients) patients given regularly practiced treatment without Tamsulosin] with distal ureteric stone included in the study. Study duration was 6 months and study performed at S.P. Medical College. Bikaner, Rajasthan, India.Results: Group A showed a statistically significant advantage in terms of the stone expulsion rate. 41 patients (82%) in group A and 30 patients (60%) in group B expelled stones. Overall patients in group A had mean expulsion time of 7.86 days, whereas in group B mean expulsion time was 18.64 days. In group A stone expulsion rate was higher as compared to group B. In group A only 12 (24%) patients experienced pain relapses whereas in group B 32 (64%) patients reported pain relapses. The diclofenac dosage required in group A was observed to be 1.62 tablets whereas in group B it was 2.6 tablets.Conclusions: It is concluded that tamsulosin should be considered for uncomplicated distal ureteral calculi before ureteroscopy or extracorporeal lithotripsy. Tamsulosin has been found to increase and hasten stone expulsion rates, decrease acute attacks by acting as a spasmolytic, reduces mean days to stone expulsion and decreases analgesic dose usage.

Modern management of paediatric obstructive salivary disorders: long-term clinical experience.

SUMMARYRecent technological improvements in head and neck field have changed diagnostic and therapeutic strategies for salivary disorders. Diagnosis is now based on colour Doppler ultrasonography (US), magnetic resonance (MR) sialography and cone beam 3D computed tomography (CT), and extra- and intracorporeal lithotripsy, interventional sialendscopy and sialendoscopy-assisted surgery are used as minimally invasive, conservative procedures for functional preservation of the affected gland. We evaluated the results of our long-term experience in the management of paediatric obstructive salivary disorders. The study involved a consecutive series of 66 children (38 females) whose obstructive salivary symptoms caused by juvenile recurrent parotitis (JRP) (n = 32), stones (n = 20), ranula (n = 9) and ductal stenosis (n = 5). 45 patients underwent interventional sialendoscopy for JRP, stones and stenoses, 12 a cycle of extracorporeal shockwave lithotripsy (ESWL), three sialendoscopy-assisted transoral surgery, one drainage, six marsupialisation, and two suturing of a ranula. Three children underwent combined ESWL and interventional sialendoscopy, and seven a secondary procedure. An overall successful result was obtained in 90.9% of cases. None of the patients underwent traditional invasive sialadenectomy notwithstanding persistence of mild obstructive symptoms in six patients. No major complications were observed. Using a diagnostic work-up based on colour Doppler US, MR sialography and cone beam 3D TC, children with obstructive salivary disorders can be effectively treated in a modern minimally-invasive manner by extracorporeal and intracorporeal lithotripsy, interventional sialendoscopy and sialendoscopy-assisted transoral surgery; this approach guarantees a successful result in most patients, thus avoiding the need for invasive sialadenectomy while functionally preserving the gland.

Sialendoscope-assisted transoral removal of hilo-parenchymal sub-mandibular stones: surgical results and subjective scores.

SUMMARYIt has been suggested that a conservative trans-oral approach to proximal and hilo-parenchymal submandibular stones (HPSMS) is a valid alternative to the more frequently used sialadenectomy. The aim of this study was to evaluate the surgical, ultrasonographic and patients' subjective outcomes of results of the trans-oral removal of HPSMS. Between January 2003 and September 2015, sialendoscope-assisted trans-oral surgery was used to remove symptomatic, large (> 7 mm), fixed and palpable HPSMS from 479 patients under general anaesthesia. All patients were followed clinically and ultrasonographically to investigate symptom relief and recurrence of stones, and were telephonically interviewed to assess saliva-related subjective outcomes with a questionnaire. Stones were successfully removed from 472 patients (98.5%); the seven failures (1.5%) concerned pure parenchymal stones. One year after the procedure, 408 patients (85.1%) were symptom free, 59 (12.3%) had recurrent obstructive symptoms and 12 (2.6%) had recurrent infections. Of the 54 patients who developed a recurrent stone (11.2%), 52 underwent a second procedure: 29 interventional sialendoscopies, two sialendoscope-assisted intra-corporeal pneumatic lithotripsy, eight secondary transoral surgery to remove residual stones, six a cycle of extra-corporeal lithotripsy and seven submandibular sialadenectomy. Most patients (75.2%) reported mild surgery-related pain. The symptoms of 454 patients (94.8%) improved after adjunctive treatment and, at the end of follow-up, the affected gland was preserved in 98.5% of patients. A sialendoscope-assisted trans-oral removal of large HPSMS is a safe, effective, conservative surgical procedure, and functional preservation of the main duct and parenchyma of the obstructed gland allows sialendoscopic access through the natural ostium in case of recurrence. Combining a trans-oral approach with other minimally invasive, conservative procedures ensures symptomatic relief and salivary duct system clearance in the majority of patients.