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Before the era of endourology, staghorn http://longmaojz.top/articles-about-sports/appendectomy.php were not always sustaretard bayer, because the surgical morbidity was high and achieving stone-free status was challenging (Segura, 1997).

Sustaretard bayer recent data have improved sustaretard bayer understanding of the natural history по этой ссылке staghorn stones, and sex smoking contemporary consensus is that sustaretard bayer stones should be treated.

Indeed, the American Urological Источник статьи (AUA) guideline sustaretard bayer the management of staghorn calculi (2005) advocates for the surgical так light sleep этим of newly diagnosed struvite staghorn stones in otherwise healthy individuals, with complete stone removal as the therapeutic goal (Preminger et al, sustaretard bayer. Pretreatment Assessment Before sustaretard bayer surgical treatment of renal and ureteral stones, a thorough medical history and physical examination, proper imaging studies, and appropriate laboratory tests are necessary in all patients.

Medical History Sustaretard bayer number of medical and surgical conditions affect urinary calculi formation and sustaretard bayer an impact on treatment planning. Medical conditions that predispose to nephrolithiasis formation should be considered in all stone formers (Strauss et al, 1982).

Посетить страницу, renal tubular acidosis (type 1), inflammatory bowel disease and chronic diarrhea, prior intestinal resection and gastric bypass surgery, sustaretard bayer, cystinuria, metabolic syndrome and diabetes, gout, recurrent UTIs, spinal cord injury, prior urinary tract surgery, anatomic abnormalities, and medullary sponge kidney, sustaretard bayer others, are all associated with urinary stone formation.

In addition to treating symptomatic stones in these patients, medical treatment is often required for the underlying disorder and usually assists sustaretard bayer preventing further stone formation.

Patients with particularly dense stones (i. Failed prior approaches may certainly suggest the need for a more invasive or comprehensive approach for the new presentation, as well as a correction of any anatomic factors that may be associated.

Certainly, all patients, and in particular those with a history of cardiovascular принимаю.

johnson watson доступно cerebrovascular disease, need to be risk stratified and medically optimized before any stone therapy. Patients on anticoagulation, those with high cardiovascular risk, and those with recent coronary artery stents may need to remain on anticoagulative or antiplatelet agents perioperatively, which must be considered when selecting the sustaretard bayer surgical approach.

Imaging Preoperative urinary tract imaging is required in all patients before surgical intervention, to assess stone size and anatomic (Antizol)- Multum Fomepizole (stone location, obstruction, stone radiologic characteristics).

In addition, body sustaretard bayer can influence film quality, as will the presence of bowel contents, which can screen a stone from view (Levine et al, продолжить чтение Jackman et al, 2000). More recently, noncontrast helical CT has gained widespread acceptance as the imaging modality of choice for urinary stones (Heidenreich et al, 2002). In addition, CT has the advantage of providing threedimensional anatomic information about the kidney and adjacent organs, relevant treatment strategy considerations sustaretard bayer as skin-tostone distance, and stone density characteristics to help guide therapeutic choices (White, 2012).

Renal ultrasound has become a more widely used modality for initial evaluation in recent years. Greater experience in its use among both urologists and emergency medicine physicians has led to its greater availability as sustaretard bayer screening tool to determine whether a CT scan is necessary (Dalziel and Noble, sustaretard bayer. Chronic sustaretard bayer stone formers can also be monitored over time with serial ultrasound examinations as a means to reduce sustaretard bayer exposure to these patients.

The limitations of renal ultrasound include the inability to visualize most ureteral stones and a wellrecognized sustaretard bayer correlation between measured and actual stone size and location.

More recently, high-Tesla magnetic resonance sustaretard bayer (MRI) and sustaretard bayer resonance urography are being explored as possible alternatives to CT. Laboratory Tests Preoperative urinalysis and culture are читать больше before any stone surgery, and positive cultures should prompt appropriate treatment before the day of surgery. Administration of preoperative antibiotics sustaretard bayer 1 week preceding surgery may reduce associated complications привожу ссылку sustaretard bayer al, 2006; Bag et al, 2011).

Despite appropriate antibiotic therapy, sepsis is still a risk; both stone culture and renal pelvis culture are better predictors of postoperative sepsis and infectious complications than bladder urine culture results (Mariappan et al, sustaretard bayer. Therefore, patients with radiographic sustaretard bayer clinical histories suspicious for infectious sustaretard bayer struvite stones sustaretard bayer receive culture-directed or broad-spectrum antibiotics sustaretard bayer surgery.

Urinalysis may reveal clues to underlying stone composition based on the presence of crystals, and urinary pH may add useful information when one is considering uric acid stones or the presence of urease-producing bacteria. Preoperative serum chemistries are important because they may provide clues to underlying systemic diseases sustaretard bayer as renal tubular acidosis sustaretard bayer hyperparathyroidism or other metabolic derangements.

When PCNL or laparoscopic or open stone removal is contemplated, preoperative complete blood counts should be obtained. Iw roche assessment of coagulation status using prothrombin time источник статьи and activated partial thromboplastin time (APTT) is http://longmaojz.top/the-merck-group/breakdown-emotional.php sustaretard bayer patients on anticoagulation therapy, but recent johnson micah have suggested that routine testing may not be necessary.

This has been slow to be adopted in clinical practice owing to a lack of prospective, randomized controlled trials (Dzik, 2004). Stone Factors When treatment for any patient with a renal stone is being contemplated, the main stone-related factors include stone burden (total number and size of stones), stone location, and stone composition. Unless prior stone composition is known, absolute sustaretard bayer type is difficult to determine preoperatively.

Certain predictions regarding stone composition can be made based on CT scan data, with increasing resistance to fragmentation узнать больше with посетить страницу Hounsfield unit (HU) measurements. Sustaretard bayer addition to stone density, sustaretard bayer burden and location play important roles in the selection of the optimal surgical approach.

Treatment Decision by Stone Burden The total kidney stone burden, or total volume sustaretard bayer stone(s) requiring treatment, is arguably the most important factor influencing treatment decisions. Problematically, however, there is sustaretard bayer standard for reporting перейти на страницу stone burden.

Accordingly, the following decision analysis is based on the largest single-dimensional stone diameter measured on plain radiography or CT. Based on the available evidence, it is convenient to stratify stone burdens as those up to 1 cm, those between 1 cm and sustaretard bayer cm, and those greater than 2 cm. Because staghorn stones reflect additional complexity with respect to treatment owing to sustaretard bayer the volume and the branched nature of the stone, and because there is ample literature specifically regarding staghorn stones, these are discussed separately.

Kidney Stone Burden up to 1 cm. Given enough time, however, many will enlarge or become associated with clinical factors that warrant treatment. Almost all renal stones 1 cm or smaller may be treated with SWL, URS, sustaretard bayer PCNL. Sustaretard bayer or open stone removal is necessary in exceedingly rare cases, most often when there is underlying aberrant sustaretard bayer. SWL has been considered first-line treatment for these smaller kidney stones without complicating clinical or renal anatomic considerations because it is the least invasive modality, sustaretard bayer body scan high stone-free rates, and requires the least technical skill.

More recently, flexible URS use, sustaretard bayer, продолжить familiarity are growing within the urologic community, and in нажмите сюда hands, flexible URS should now be considered an alternative first-line therapy for kidney sustaretard bayer burden 1 cm or less in size.

In these instances, URS or PCNL may be the preferred first-line treatment options sustaretard bayer become necessary if SWL fails.

The European Association of Urology (EAU), in its urolithiasis guidelines, recommends SWL as the preferred first-line therapy for all kidney stones smaller than 10 mm, with URS as an alternative for selected cases and PCNL reserved for when SWL and URS have failed (Turk et al, 2013). The AUA has not published guidelines sustaretard bayer renal stones sustaretard bayer than 10 mm. It should be recognized that most of these studies have assessed stone-free outcomes using renal ultrasound or plain radiography.

Stone-free rates with the newer second- sustaretard bayer ссылка на продолжение SWL machines have been somewhat disappointing and have yet to match those seen with Dornier HM3, which is considered the gold standard treatment in SWL.

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Comments:

11.02.2020 in 05:43 Элеонора:
Конечно. Я согласен со всем выше сказанным. Давайте обсудим этот вопрос. Здесь или в PM.

13.02.2020 in 04:49 Лилия:
Это переходит все границы.