Complications and treatment aspects of urological stone surgery

Sammanfattning: ConclusionsPaper I: Complications in Extracorporeal Shock Wave Lithotripsy (ESWL): A cohort study, conclusion: We conclude that there are few complications to modern ESWL treatment. 1 Hz should be used to reduce complications (p=0.025). As there is no indication that 1Hz is less effective than 1.5 Hz, this strongly implies that 1 Hz should normally be the frequency used.Success rate with ESWL alone was high 71.8% (n=1324). Our data indicate that diabetes and larger stone size increase the risk of complications. The need for antiemetics during ESWL is a factor that deserves special consideration and further study. Distal stones seem to have a lower risk of complications (p=0.017).Paper II: A study of clinical complications and possible risk factors for stone surgery - a population based study, conclusions: URS in a modern setting provides excellent results with high SFR and low morbidity. Preoperative stone size <4mm showed 100 % SFR success rate (n=112). SFR for stones >4≤6 mm was 96.2 % (n=176), for stones >6≤10 mm 84.6 % (n=193), and for stones >10 mm was 68.2 % (n=30). Time of day, or the presence of a urological specialized operating nurse does not affect the risk of complications and we found no other significant risk factors for complications. Regarding bacteria, E. coli is the most common in preoperative cultures. In this study the risk of complications increases with age. We conclude that for patients >65 years this should be considered in preoperative counselling.Paper III: Percutaneous nephrolithotomy and modern aspects of complications and antibiotic treatment conclusions: Stone free rate was 65.6% (n=122) which is acceptable and comparable with other studies. This study has a total complication rate of 16%, with approximately 10% being severe. The most common complication of PCNL was infection at 60% (bleeding 5.4%, reoperation 1.6% and pain 0.5%). Our results regarding levels of E. faecalis in cultures, should be validated in a larger cohort, possibly with a higher rate of antibiotic resistance, before a change of guidelines regarding prophylactic antibiotics could be proposed. We conclude that the high prevalence of E. faecalis needs to be considered.Paper IV: Factors influencing stone free rate of Extracorporeal Shock Wave Lithotripsy (ESWL): A cohort study conclusions: We conclude that stone maximum size/stone volume and age have an impact on stone free rate after ESWL. We are puzzled by age being such a strong predictor for SFR, and this needs to be further investigated.