کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
3873578 1598997 2008 5 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Endourological Management of Urolithiasis in Hepatically Compromised Patients
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی بیماری‌های کلیوی
پیش نمایش صفحه اول مقاله
Endourological Management of Urolithiasis in Hepatically Compromised Patients
چکیده انگلیسی

PurposeHepatic insufficiency is a medically debilitating disease state, resulting in coagulopathy, malnutrition and immunological suppression. Before and after liver transplantation patients are at increased risk for urolithiasis due to nutritional factors, acidosis and hyperoxaluria.Materials and MethodsWe retrospectively reviewed our experience with endourological procedures for nephrolithiasis in hepatic compromised patients awaiting transplants and recipients. A total of 16 patients, including 13 males and 3 females, with a mean age of 52.8 years (range 46 to 59) underwent a total of 24 endoscopic stone procedures at 23 anesthesia sessions. Procedures included 18 ureteroscopies (extraction with or without lithotripsy), 5 percutaneous nephrolithotomies and 1 cystoscopic stone manipulation. Of the patients 12 patients had significant hepatic insufficiency and were evaluated for transplantation. Four patients had a prior orthotopic liver transplant at surgery. The most common causes of cirrhosis were hepatitis C and ethanol abuse. Of 22 sessions 12 were preceded by the use of fresh frozen plasma, platelets, vitamin K, desmopressin or recombinant factor VIIa for reversing severe coagulopathy. In 4 patients procedures were preceded by transfusion for anemia.ResultsAll 24 procedures were successfully accomplished. Average hospital stay was 2.8 days (range 0 to 8) with 5 patients treated on an outpatient basis. A total of 52 calculi with a mean size of 10.7 mm (range 2 to 40) were treated. Of the 17 evaluated stone analyses 15 revealed pure or mixed calcium oxalate calculi, while the remaining 2 were struvite. Morbidity included 2 postoperative transfusions and 1 rehospitalization for urinary tract infection. One death was due to multisystem organ failure in a pretransplant patient who underwent bilateral ureteroscopy.ConclusionsEndourological procedures may be accomplished in this morbid group of patients. Mandatory preoperative medical evaluation, selective prehospitalization with supportive services and pre-stenting patients for passive ureteral dilation have led to successful endourological outcomes. Our experience has led us to adopt protocols and apply a team approach for the successful endoscopic management of urolithiasis in this complicated group of patients.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: The Journal of Urology - Volume 179, Issue 3, March 2008, Pages 976–980
نویسندگان
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