Eduardo Mazzucchi1, Miguel Srougi. 1. Setor de endourologia e litíase, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP.
Abstract
OBJECTIVE: To update some aspects of the diagnosis and management of urinary lithiasis. METHODS: A review of the main articles published in PubMed indexed journals was performed. RESULTS: The occurrence of urinary stones is higher among patients with body mass index above 30. Urinary stones are correctly diagnosed by non-contrast CT in 98% of the cases. SWL is the best method for treatment of renal stones smaller than 2 cm with tomographic density under 1000 HU except for stones located at the lower renal pole where the limit is 1 cm. PCNL reaches a stone-free rate between 60% and 100% for renal stones larger than 2 cm. Semirigid ureteroscopy renders patients with distal ureteral stones free in up to 94% of the cases compared to 74% of SWL. Regarding upper ureteral stones, ureteroscopy promotes stone-free rates between 77% and 91%and SWL between 41% and 82%. CONCLUSION: The link between urinary stones, obesity and diabetes mellitus is well established. Non-contrast CT is the gold standard for diagnosis of urinary stones. SWL is the mainstay in the treatment of renal stones with less than 2 cm and density under 1000 Hounsfield Units, except for lower pole calculi where the limit is 1 cm. PCNL is the preferred method for treatment of renal stones larger than 2 cm. Semirigid ureteroscopy is the method of election for lower ureteral stones; flexible ureteroscopy is reserved for upper ureteral or renal stones with less than 1.5 cm non responsive to SWL or for those patients with contraindications to PCNL.
OBJECTIVE: To update some aspects of the diagnosis and management of urinary lithiasis. METHODS: A review of the main articles published in PubMed indexed journals was performed. RESULTS: The occurrence of urinary stones is higher among patients with body mass index above 30. Urinary stones are correctly diagnosed by non-contrast CT in 98% of the cases. SWL is the best method for treatment of renal stones smaller than 2 cm with tomographic density under 1000 HU except for stones located at the lower renal pole where the limit is 1 cm. PCNL reaches a stone-free rate between 60% and 100% for renal stones larger than 2 cm. Semirigid ureteroscopy renders patients with distal ureteral stones free in up to 94% of the cases compared to 74% of SWL. Regarding upper ureteral stones, ureteroscopy promotes stone-free rates between 77% and 91%and SWL between 41% and 82%. CONCLUSION: The link between urinary stones, obesity and diabetes mellitus is well established. Non-contrast CT is the gold standard for diagnosis of urinary stones. SWL is the mainstay in the treatment of renal stones with less than 2 cm and density under 1000 Hounsfield Units, except for lower pole calculi where the limit is 1 cm. PCNL is the preferred method for treatment of renal stones larger than 2 cm. Semirigid ureteroscopy is the method of election for lower ureteral stones; flexible ureteroscopy is reserved for upper ureteral or renal stones with less than 1.5 cm non responsive to SWL or for those patients with contraindications to PCNL.
Authors: Francilayne Moretto Dos Santos; Aline Krampe Peres; Michel Roberto Mandotti; Luis Alberto Batista Peres Journal: Einstein (Sao Paulo) Date: 2017-12-18