Tratamento cirúrgico da litíase vesical: revisão de literatura

Abstract

ABSTRACT ABSTRACT ABSTRACT Bladder stones are rare and in most cases occur in adult men with bladder outlet obstruction. Currently, there are few data on the best treatment of this disease. The aim of this review is to discuss some aspects of pathogenesis and treatment approaches for bladder lithiasis. A comprehensive search of the database of the "National Library of Medicine" / pubmed was conducted with the following key words and descriptors: "bladder" or "vesical" associated with "calculus", "stone" or "lithiasis", and "cystolithotripsy ". One hundred and seventy-one articles were identified. The articles were independently assessed by two reviewers with expertise in urolithiasis. They were included in the study when the results, complications and follow-up were clearly reported. In the end, 32 studies met the inclusion criteria. Several options for the treatment of bladder lithiasis are available, but no randomized trials comparing them. Different rates of calculus-free patients are described in each of them, as follows: extracorporeal shock wave lithotripsy (75-100%), transurethral cystolithotripsy (63-100%), percutaneous cystolithotripsy (89-100%) and open surgery (100 %). The percutaneous approach has lower morbidity, with similar results to the transurethral treatment, while extracorporeal lithotripsy has the lowest rate of elimination of calculi and is reserved for patients at high surgical risk.

Diagnóstico de enfermagem eliminação urinária prejudicada em idosos no pós-operatório: um estudo transversal [Nursing diagnoses of impaired urinary elimination in hospitalized, post-operative elderly: a cross-sectional study]

“…Já na hesitação urinária, considerada como a dificuldade em expelir o primeiro jato de urina, pode ser analisada pela demora no início da micção, devido à obstrução ou problemas na peristalse. Problemas prostáticos (câncer de próstata e hiperplasia prostática benigna), nos homens e enfraquecimento da musculatura do assoalho pélvico nas mulheres, característicos dos idosos, podem levar ao aumento de demora de saída urinária 26 . Pode ainda ser provocada por algumas condições, relacionadas ao processo de hospitalização no pós-operatório, como a retirada de cateter vesical de demora.…”

Comparison of three different endoscopic approaches in the treatment of bladder calculi

“…The transurethral approach shows high efficacy and is associated with minimal morbidity and is therefore the most commonly used method [4]. Several modalities for stone fragmentation including mechanical/ballistic, ultrasonic, electrohydraulic, and pneumatic lithotripsy, as well as the holmium laser are used via the transurethral approach [7]. Additionally, various types of endoscopes, including a cystoscope, nephroscope, and resectoscope, among other such devices are used transurethrally.…”

“…The diameter of the endoscopic sheath used during the operation is a topic of interest [7]. Sathaye performed transurethral pneumatic lithotripsy using a nephroscope and a 25-Fr cystoscope sheath in four patients to treat bladder stones measuring >10 cm.…”

Guía de práctica clínica para el tratamiento quirúrgico de pacientes con urolitiasis en el Seguro Social del Perú (EsSalud)

“…• La revisión de narrativa de Torricelli (45) reportó que el porcentaje de éxito de la extracción del cálculo fue mayor para cirugía abierta (100%), seguido por cistolitotripsia percutánea o cirugía percutánea (89-100%), y por último la cistolitotripsia transuretral o cirugía endoscópica (63-100%). Asimismo, describió que la cirugía percutánea tendría menor morbilidad, con tasas libre de cálculos similares a la cirugía endoscópica y la cirugía abierta.…”