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Sample records for ureteral stones initial

  1. Semi-rigid ureteroscopy: Proximal versus distal ureteral stones

    PubMed Central

    Alameddine, Mahmoud; Azab, Mohamad M.; Nassir, Anmar A.

    2016-01-01

    Objective: To evaluate the safety and efficacy of semi-rigid ureteroscopy in proximal and distal ureteral stones, and to compare the operative and perioperative characteristics between the two stone groups. Materials and Methods: We retrospectively reviewed the medical records of patients who underwent semi-rigid ureteroscopy for management of ureteral stones at the International Medical Center between June 2007 and September 2012. All stones were fragmented using Holmium: yttrium-aluminum-garnet (YAG) laser lithotripter. Stones located above the pelvic brim are considered proximal and below it are distal. Results: One hundred and ninety-one patients were included. One hundred and three patients (54%) underwent ureteroscopy for proximal stones and 88 (46%) for distal stones. The stone size in the proximal group was 10 mm (±5.5) versus 8.6 mm (±5) in the distal group. The initial stone-free rate for proximal and distal calculi were 89–98.2%, respectively. The perioperative complication rate was higher in the proximal group 10% compared to the distal group which is 1.5% (P = 0.06). Both groups have the same average of hospital stay 1.2 days. Conclusion: Although there is a clinical difference between proximal and distal calculi groups in terms of complication and stone-free rates, this difference remained statistically insignificant (P = 0.06). Using a smaller caliber semi-rigid ureteroscopy combined with Holmium-YAG laser can be carried out as a day care procedure and showed a slightly higher risk in patients with proximal ureteral calculi which should be explained to the patient PMID:26834409

  2. Large proximal ureteral stones: Ideal treatment modality?

    PubMed Central

    Kadyan, B.; Sabale, V.; Mane, D.; Satav, V.; Mulay, A.; Thakur, N.; Kankalia, S. P.

    2016-01-01

    Background and Purpose: Ideal treatment modality for patients with large impacted proximal ureteral stone remains controversial. We compared laparoscopic transperitoneal ureterolithotomy (Lap-TPUL) and semirigid ureteroscopy for large proximal ureteric stones to evaluate their efficacy and safety. Patients and Methods: From November 2012 to December 2014, we enrolled 122 patients with large (≥1.5 cm) proximal ureteral stone in the study. Patients were randomly divided into two groups: Group A (60 patients), retrograde ureteroscopic lithotripsy using a semirigid ureteroscope; Group B (62 patients), transperitoneal LU (Lap-TPUL). Results: The overall stone-free rate was 71.6% and 93.5% for Group A and Group B respectively (P = 0.008). Auxiliary procedure rate was higher in Group A than in Group B (27.3% vs. 5.6%). The complication rate was 11.2% in Group B versus 25% in Group A. Mean procedure time was higher in laparoscopy group as compared to ureterorenoscopy (URS) groups (84.07 ± 16.80 vs. 62.82 ± 12.71 min). Hospital stay was 4.16 ± 0.67 days in laparoscopy group and 1.18 ± 0.38 days in URS group (P < 0.0001). Conclusion: Laparoscopic transperitoneal ureterolithotomy is a minimally invasive, safe and effective treatment modality and should be recommended to all patients of impacted large proximal stones, which are not amenable to URS or extracorporeal shock-wave lithotripsy or as a primary modality of choice especially if patient is otherwise candidate for open surgery. PMID:27141190

  3. Bilateral ureteric stones: an unusual cause of acute kidney injury.

    PubMed

    Sumner, Daniel; Rehnberg, Lucas; Kler, Aaron

    2016-01-01

    A 49-year-old man presented to the accident and emergency department, with a short history of vague abdominal pain, abdominal distension and two episodes of frank haematuria. A plain chest film showed dilated loops of large bowel and blood results on admission showed an acute kidney injury (stage 3). A diagnosis of bowel obstruction was made initially but a CT scan of the abdomen showed bilateral obstructing calculi. After initial resuscitation, the patient had bilateral ultrasound-guided nephrostomies and haemofiltration. He later underwent bilateral antegrade ureteric stenting. A decision will later be made on whether or not he is fit enough to undergo ureteroscopy and laser stone fragmentation. PMID:27030462

  4. Shock Wave Lithotripsy in Ureteral Stones: Evaluation of Patient and Stone Related Predictive Factors

    PubMed Central

    Yazici, Ozgur; Tuncer, Murat; Sahin, Cahit; Demirkol, Mehmet K.; Kafkasli, Alper; Sarica, Kemal

    2015-01-01

    ABSTRACT Purpose: To evaluate the patient and stone related factors which may influence the final outcome of SWL in the management of ureteral stones. Materials and Methods: Between October 2011 and October 2013, a total of 204 adult patients undergoing SWL for single ureteral stone sizing 5 to 15 mm were included into the study program. The impact of both patient (age, sex, BMI,) and stone related factors (laterality, location, longest diameter and density as CT HU) along with BUN and lastly SSD (skin to stone distance) on fragmentation were analysed by univariate and multivariate analyses. Results: Stone free rates for proximal and distal ureteral stones were 68.8% and 72.7%, respectively with no statistically significant difference between two groups (p=0.7). According to univariate and multivariate analyses, while higher BMI (mean: 26.8 and 28.1, p=0.048) and stone density values (mean: 702 HU and 930 HU, p<0.0001) were detected as statistically significant independent predictors of treatment failure for proximal ureteral stones, the only statistically significant predicting parameter for the success rates of SWL in distal ureteral stones was the higher SSD value (median: 114 and 90, p=0.012). Conclusions: Our findings have clearly shown that while higher BMI and increased stone attenuation values detected by NCCT were significant factors influencing the final outcome of SWL treatment in proximal ureteral stones; opposite to the literature, high SSD was the only independent predictor of success for the SWL treatment of distal ureteral stones. PMID:26401859

  5. Management of lower ureteric stones: a prospective study

    PubMed Central

    Morsi, Gamal A.M.; Beshir, Mansour S.M.; Soliman, Sheri S.; Galal, Hussein A.; Ortiz–Vanderdys, Cervando

    2013-01-01

    Objective To discuss the current concepts in lower ureteric stone management. Material and methods Between October 2008 and November 2010, 190 patients of both sexes and of different age groups with lower ureteric stones, underwent in situ extracorporeal shock wave lithotripsy (ESWL) (48 cases), ureterorenoscopy (URS) (120 cases) and open stone surgery (OSS) (22 cases). The patients’ clinical and radiological findings, as well as stone characteristics, were reviewed and correlated with the stone–free status. Results In the ESWL group, the operative time was 43.13 +22.5 min; the average number of sessions/patients was 1.5 sessions; the average number of SW/patients was 4500 SW/patients; the average energy was 16.5 kV; the average stone burden was 7.8/mm; the overall stone–free rate was 75% (36/48); and the average radiation exposure time was 3.5 min. In the URS group, the operative time was 49.21 +16.09 min; the average stone burden was 10.81mm; the overall stone–free rate was 97.5% (117/120); the average hospital stay was 3.99 days; and the average radiation exposure time was 0.75 min. In the OSS group, the operative time was 112.38 +37.1 min; the overall stone–free rate was 100% (22/22); and the average hospital stay was 9.74 days. Conclusion In the management of patients with lower ureteral stones, URS, SWL and OSS were considered acceptable treatment options. This recommendation was based on the stone–free results, morbidity and retreatment rates for each therapy. PMID:24757544

  6. Ureteral wall thickness at the impacted ureteral stone site: a critical predictor for success rates after SWL.

    PubMed

    Sarica, Kemal; Kafkasli, Alper; Yazici, Özgür; Çetinel, Ali Cihangir; Demirkol, Mehmet Kutlu; Tuncer, Murat; Şahin, Cahit; Eryildirim, Bilal

    2015-02-01

    The aim of the study was to determine the possible predictive value of certain patient- and stone-related factors on the stone-free rates and auxiliary procedures after extracorporeal shock wave lithotripsy in patients with impacted proximal ureteral calculi. A total of 111 patients (86 male, 25 females M/F: 3.44/1) with impacted proximal ureteral stones treated with shock wave lithotripsy were evaluated. Cases were retrieved from a departmental shock wave lithotripsy database. Variables analyzed included BMI of the case, diameter of proximal ureter and renal pelvis, stone size and Hounsfield unit, ureteral wall thickness at the impacted stone site. Stone-free status on follow-up imaging at 3 months was considered a successful outcome. All patients had a single impacted proximal ureteral stone. While the mean age of the cases was 46 ± 13 years (range 26-79 years), mean stone size was 8.95 mm (5.3-15.1 mm). Following shock wave lithotripsy although 87 patients (78.4%) were completely stone-free at 3-month follow-up visit, 24 (21.6%) cases had residual fragments requiring further repeat procedures. Prediction of the final outcome of SWL in patients with impacted proximal ureteral stones is a challenging issue and our data did clearly indicate a highly significant relationship between ureteral wall thickness and the success rates of shock wave lithotripsy particularly in cases requiring additional procedures. Of all the evaluated stone- and patient-related factors, only ureteral wall thickness at the impacted stone site independently predicted shock wave lithotripsy success. PMID:25417717

  7. Analysis of factors affecting spontaneous expulsion of ureteral stones that may predict unfavorable outcomes during watchful waiting periods: What is the influence of diabetes mellitus on the ureter?

    PubMed Central

    Choi, Taesoo; Choi, Seung-Kwon; Kim, Dong Soo; Lee, Dong-Gi; Min, Gyeong Eun; Jeon, Seung Hyun; Lee, Hyung-Lae; Jeong, In-Kyung

    2015-01-01

    Purpose The aim of our study was to evaluate the association of several factors with spontaneous stone expulsion, including ureteral stone characteristics (size, location, hydronephrosis, perinephric stranding), types of medications prescribed (?-blocker, low-dose steroid), and other possible demographic and health-history factors (gender, age, serum creatinine, underlying diabetes mellitus [DM], and hypertension). Materials and Methods A total of 366 patients with ureteral stones were enrolled. All patients underwent watchful waiting without any invasive procedures. Initial diagnoses of ureteral stones were confirmed by computed tomography scans, which were taken at approximately 1-month intervals to check for stone expulsion. Univariate and multivariate analyses were conducted to identify significant factors that contributed to stone expulsion. Results Among 366 patients, 335 patients (91.5%) experienced spontaneous stone passage during a mean follow-up period of 2.952.62 weeks. The patients were divided into two groups depending on the success of spontaneous stone passage. Univariate analyses revealed that stone location (p=0.003), stone size (p=0.021), and underlying DM (p<0.001) were significant predictors of stone passage. Multivariate analyses confirmed that stone size (p=0.010), stone location (p=0.008), and underlying DM (p=0.003) were independent predictive factors affecting stone passage. Conclusions Stone size, location, and underlying DM were confirmed to be significant predictive factors for spontaneous passage of ureteral stones. Urologists should consider active procedures, such as shock wave lithotripsy or ureteroscopy, rather than conservative management in patients presenting with proximally located stones, large ureteral stones, or underlying DM. PMID:26078843

  8. External Validation of the STONE Score, a Clinical Prediction Rule for Ureteral Stone: An Observational Multi-institutional Study

    PubMed Central

    Wang, Ralph C.; Rodriguez, Robert M.; Moghadassi, Michelle; Noble, Vicki; Bailitz, John; Mallin, Mike; Corbo, Jill; Kang, Tarina L.; Chu, Phillip; Shiboski, Steve; Smith-Bindman, Rebecca

    2015-01-01

    Study objective The STONE score is a clinical decision rule that classifies patients with suspected nephrolithiasis into low-, moderate-, and high-score groups, with corresponding probabilities of ureteral stone. We evaluate the STONE score in a multi-institutional cohort compared with physician gestalt and hypothesize that it has a sufficiently high specificity to allow clinicians to defer computed tomography (CT) scan in patients with suspected nephrolithiasis. Methods We assessed the STONE score with data from a randomized trial for participants with suspected nephrolithiasis who enrolled at 9 emergency departments between October 2011 and February 2013. In accordance with STONE predictors, we categorized participants into low-, moderate-, or high-score groups. We determined the performance of the STONE score and physician gestalt for ureteral stone. Results Eight hundred forty-five participants were included for analysis; 331 (39%) had a ureteral stone. The global performance of the STONE score was superior to physician gestalt (area under the receiver operating characteristic curve=0.78 [95% confidence interval {CI} 0.74 to 0.81] versus 0.68 [95% CI 0.64 to 0.71]). The prevalence of ureteral stone on CT scan ranged from 14% (95% CI 9% to 19%) to 73% (95% CI 67% to 78%) in the low-, moderate-, and high-score groups. The sensitivity and specificity of a high score were 53% (95% CI 48% to 59%) and 87% (95% CI 84% to 90%), respectively. Conclusion The STONE score can successfully aggregate patients into low-, medium-, and high-risk groups and predicts ureteral stone with a higher specificity than physician gestalt. However, in its present form, the STONE score lacks sufficient accuracy to allow clinicians to defer CT scan for suspected ureteral stone. PMID:26440490

  9. Predictive parameters for medical expulsive therapy in ureteral stones: a critical evaluation.

    PubMed

    Sahin, Cahit; Eryildirim, Bilal; Kafkasli, Alper; Coskun, Alper; Tarhan, Fatih; Faydaci, Gokhan; Sarica, Kemal

    2015-06-01

    To evaluate the predictive value of some certain radiological as well as stone-related parameters for medical expulsive therapy (MET) success with an alpha blocker in ureteral stones. A total 129 patients receiving MET for 5 to 10 mm ureteral stones were evaluated. Patients were divided into two subgroups where MET was successful in 64 cases (49.61%) and unsuccessful in 65 cases (50.39%). Prior to management, stone size, location, position in the ureter, degree of hydronephrosis, diameter of ureteral lumen proximal to the stone, ureteral wall thickness along with patient's demographics including body mass index (BMI) values were evaluated and recorded. The possible predictive values of these parameters for stone expulsion (and stone expulsion time) were evaluated in a comparative manner between two groups. The overall mean patient age and stone size values were 38.02 ± 0.94 years and 40.31 ± 1.13 mm(2), respectively. Regarding the predictive values of these parameters for MET-success, while stone size and localization, degree of hydronephrosis, proximal ureteral diameter and ureteral wall thickness were found to be highly predictive for MET-success, patients age, BMI values and stone density had no predictive value on this aspect. Our findings indicated that some stone and anatomical factors may be used to predict the success of MET in an effective manner. With this approach unnecessary use of these drugs that may cause a delay for stone removal will be avoided and the possible adverse effects of obstruction as well as stone-related clinical symptoms could be minimized. PMID:25820291

  10. Predictive Factors of the Outcome of Extracorporeal Shockwave Lithotripsy for Ureteral Stones

    PubMed Central

    Choi, Ji Woong; Song, Phil Hyun

    2012-01-01

    Purpose Extracorporeal Shock Wave Lithotripsy (ESWL) has shown successful outcomes for ureteral stones. We investigated predictive factors for failure of ESWL for treating ureteral stones. Materials and Methods A total of 153 patients who underwent ESWL between July 2006 and July 2009 for ureteral stones diagnosed by non-enhanced spiral computed tomography were divided into two groups: (group A, stone size ≤10 mm; and group B, stone size >10 mm). The failure was defined as remnant stones >4 mm. We assessed age, sex, body mass index, stone size, laterality, location, skin-to-stone distance (SSD), Hounsfield unit, and the presence of secondary signs (hydronephrosis, renal enlargement, perinephric fat stranding, and tissue rim sign). We analyzed predictive factors by using logistic regression in each group. Results The success rates were 90.2% and 68.6% in group A and B, respectively. In the univariate analysis of each group, stone size, SSD, and all secondary signs showed statistically significant differences in terms of the outcome of ESWL (p<0.05). In the multivariate logistic regression, stone size (odds ratio [OR], 50.005; 95% confidence interval [CI], 6.207 to 402.852) was an independent predictive factor in group A. The presence of perinephric fat standing (OR, 77.634; 95% CI, 1.349 to 446.558) and stone size (OR, 19.718; 95% CI, 1.600 to 243.005) were independent predictive factors in group B. Conclusions Stone size is an independent predictive factor influencing failure of ESWL for treating ureteral stones. In larger ureteral stones (>10 mm), the presence of perinephric fat stranding is also an independent predictive factor. PMID:22741053

  11. Functional aspects of silent ureteral stones investigated with MAG-3 renal scintigraphy

    PubMed Central

    2014-01-01

    Background To investigate functional aspects of silent ureteral stones with special focus on obstruction and its relationship to renal anatomy. The present study is the first investigation of renal excretory function in patients with silent ureteral stones. Methods Patients with primarily asymptomatic ureteral stones underwent a mercapto-acetyltriglycine (MAG-3) renal scintigraphy prior to treatment, in addition to anatomic evaluation of renal units and serum creatinine levels. The primary outcome measure was the presence or absence of obstruction. Secondary outcome measures were kidney anatomy, grade of hydronephrosis, location of stones, stone size, and serum creatinine levels. Results During a ten-year period, 14 patients (median age 52.6 years; range 37.3 to 80.7 years) were included in the study. The relative frequency of primarily asymptomatic ureteral stones among all patients treated for ureteral stones in the study period was 0.7%. Eleven renal units showed some degree of hydronephrosis while 3 kidneys were not dilated. On the MAG-3 scan, 7 patients had an obstruction of the ureter, 5 had no obstruction, and 2 had dysfunction of the kidney. A statistically significant correlation was established between the grade of obstruction and stone size (p = 0.02). Conclusions At the time of presentation, only 64.3% of the patients revealed an obstruction in the stone-bearing renal unit. The degree of hydronephrosis and renal function were very diverse in this subgroup of patients with ureteral stones. The onset of ureterolithiasis and the chronological sequence of obstruction remain unclear in patients who have never experienced symptoms due to their stones. PMID:24397735

  12. The Effect of Tamsulosin in the Medical Treatment of Distal Ureteral Stones

    PubMed Central

    Alizadeh, M.; Magsudi, M.

    2014-01-01

    Introduction: Renal stones are common disorders that affect approximately 5% to 10% of the population and the incidence of renal stones is rising. Treatment of ureteral stones is an important part of urologists and minimally invasive procedures such as ESWL and ureteroscopy effectiveness has been proven in various studies. However, these methods are not completely safe and are expensive and can be complicated. Purpose of this study is to evaluate the effectiveness of tamsulosin in the medical treatment of distal ureteral stones. Patients and methods: A total of 96 patients with distal ureteral stones or UVj are randomly divided into two study group (50 patients) and control group (46 patients). Patients in the control group allowed to freely consuming fluids (hydration) and indomethacin 100 mg PRN. Study group in addition to indomethacin and daily analgesic 0.4 mg tamsulosin was administered. All subjects in terms of analgesic dose, duration of expulsion and expulsion were studied. Results: Spontaneous expulsion of stone was occurred in 62.5% (30 patients out of 46) of control group patients and 82% (41 patients out of 50) that there was no significant difference (P>0.05). Average time to fix the stone in control group 4.7±8.03 days (range 2 to 28 days) and in the study group, 3.7±5.70 days (range 1 to 23 days) is significantly different (P>0.05). The average amount of analgesic consumption in the control group was 2.3±4.31and in the study group was 1.48±2.15 that showed significant differences (P<0.05). Conclusions: In this study, although the addition of tamsulosin to conservative treatment of distal ureteral stones in the distal ureteral stone expulsion showed no significant difference between the two groups, but the reduction in the duration of expulsion, reduce pain and reduce the need for analgesic has been beneficial. PMID:25363178

  13. After urgent drainage of an obstructed kidney by internal ureteric stenting; is ureteroscopic stone extraction always needed?

    PubMed Central

    Taha, Diaa-Eldin; Elshal, Ahmed M.; Zahran, Mohamed H.; Harraz, Ahmed M.; El-Nahas, Ahmed R.; Shokeir, Ahmed A.

    2015-01-01

    Objectives To assess the probability of spontaneous stone passage and its predictors after drainage of obstructed kidney by JJ stent, as insertion of an internal ureteric stent is often used for renal drainage in cases of calcular ureteric obstruction. Patients and methods Between January 2011 and June 2013, patients for whom emergent drainage by ureteric stents were identified. The patients’ demographics, presentation, and stone characteristics were reviewed. The primary endpoint for this study was stone-free status at the time of stent removal, where all patients underwent non-contrast spiral computed tomography (NCCT) before stent removal. Ureteroscopic stone extraction was performed for CT detectable ureteric stones at the time of stent removal. Potential factors affecting the need for ureteroscopic stone extraction at the time of stent removal were assessed using univariate and multivariate statistical analyses. Results Emergent ureteric stents were undertaken in 196 patients (112 males, 84 females) with a mean (SD) age of 53.7 (16.2) years, for renal obstruction drainage. At the time of stent removal, 83 patients (42.3%) were stone free; with the remaining 113 patients (57.7%) undergoing ureteroscopic stone extraction. On multivariate analysis, stone width [odds ratio (OR) 15.849, 95% confidence interval (CI) 2.83; P = 0.002) and radio-opaque stones (OR 12.035, 95% CI 4.65; P < 0.001) were independent predictors of the need for ureteroscopic stone extraction at the time of stent removal. Conclusion Spontaneous ureteric stone passage is possible after emergent drainage of an obstructed kidney by ureteric stenting. Stone opacity, larger stone width, and positive preoperative urine culture are associated with a greater probability of requiring ureteroscopic stone extraction after emergent drainage by ureteric stenting. PMID:26609444

  14. Flexible Ureteroscopy Can Be More Efficacious in the Treatment of Proximal Ureteral Stones in Select Patients

    PubMed Central

    Alkan, Erdal; Sarıbacak, Ali; Ozkanli, Ahmet Oguz; Basar, Mehmet Murad; Acar, Oguz; Balbay, Mevlana Derya

    2015-01-01

    Purpose. We aimed to compare and evaluate the outcomes and complications of two endoscopic treatment procedures, semirigid ureteroscopy (SR-URS) and flexible ureteroscopy (F-URS), in the treatment of proximal ureteral stones (PUS). Methods. SR-URS (group 1) was done on 68 patients whereas 64 patients underwent F-URS (group 2) for the treatment of PUS. Success rate was defined as the absence of stone fragments or presence of asymptomatic insignificant residual fragments < 2 mm. Outcomes and complications were recorded. Results. The differences were statistically not significant in age, gender, body mass index (BMI), and stone characteristics between groups. Mean ureteral stone size was 9.1 ± 0.4 mm and 8.9 ± 0.5 mm for groups 1 and 2. Mean operative time was 34.1 ± 1.5 min and 49.4 ± 2.3 min for groups 1 and 2 (p = 0.001). SFRs were 76.5% and 87.5% for groups 1 and 2 (p = 0.078). Two major complications (ureteral avulsion and ureteral rupture) occurred in group 1. Conclusion. F-URS is safer and less invasive than SR-URS in patients with PUS. There is no statistically significant difference in the efficacy of either technique. Nonetheless we recommend F-URS in the management of PUS as a first-line treatment option in select cases of proximal ureteral calculi. PMID:26617636

  15. Ureteral Stone Associated With a Middle Blind Ending of a Bifid Ureter

    PubMed Central

    Çalışkan, Selahattin

    2016-01-01

    A blind-ending bifid ureter is an anatomic variant of ureteral duplications. There are three forms of blind-ending bifid ureter, classified depending on their location. A proximal blind-ending bifid ureter is the most common subtype of this congenital anomaly. Most patients are asymptomatic and only show symptoms after the complication has occurred. These complications include stone formation, vesicoureteric reflux, and ureteral tumor. Intravenous urography is usually used to diagnose bifid ureter; voiding cystourethrography, photofluoroscopy, cineroentgenography, cystoscopy with retrograde pyelography, computed tomography (CT), multidetector CT, and magnetic resonance urographies are other imaging methods used. This is a case of a ureteral stone associated with a middle blind ending of a bifid ureter.

  16. Pulsed dye laser fragmentation of ureteral calculi: initial clinical experience.

    PubMed

    Dretler, S P; Watson, G; Parrish, J A; Murray, S

    1987-03-01

    The pulsed dye laser, emitting at wavelengths of 504 nm. for 1 microsecond. at a frequency of 5 Hz. transmitted via a 250 mu in diameter silicon-coated quartz fiber, was passed into the ureter through the working channel of a 9.5F rigid ureteroscope. Seventeen patients with ureteral calculi too large to be extracted directly, who were unable to be treated by extracorporeal shock wave lithotripsy or who otherwise would have required transureteral or percutaneous ultrasonic stone removal, underwent attempted stone fragmentation by pulsed dye laser application. Of the 17 calculi 16 were fragmented to spontaneously passable or easily extractable fragments. There was no significant ureteral injury, thermal or otherwise, attributable to laser energy action. At 3-month followup 15 of the 17 ureters had improved and 2 showed evidence of ureterscopic injury. The mechanism of stone fragmentation by laser is small volume "shock wave" formation. PMID:3820363

  17. Anuria in a 9-Month-Old Infant Resulting from Ureteral Cystine Stones

    PubMed Central

    2011-01-01

    Pediatric urolithiasis and calcular anuria in early infancy are rare. Cystine stones may develop in utero or during early infancy. We report the case of a female 9-month-old infant with obstructive anuria resulting from cystine stones in a single functioning unit. She presented to the emergency department owing to the absence of micturition for 3 days. Radiological investigations revealed four left ureteral stones and an atrophic right kidney resulting from a calcular obstruction. Her laboratory values were as follows: serum creatinine 6.7 mg/dl, Na 132 mEq/l, K 6 mg/dl, and hematocrit 32%. An urgent percutaneous nephrostomy tube was inserted into the left side for urinary drainage, and her serum levels of creatinine and K returned to normal within 3 days. A left ureterolithotomy was the final management. Stone analysis revealed pure cystine crystals. PMID:22025963

  18. Anuria in a 9-month-old infant resulting from ureteral cystine stones.

    PubMed

    Aboutaleb, Hamdy

    2011-09-01

    Pediatric urolithiasis and calcular anuria in early infancy are rare. Cystine stones may develop in utero or during early infancy. We report the case of a female 9-month-old infant with obstructive anuria resulting from cystine stones in a single functioning unit. She presented to the emergency department owing to the absence of micturition for 3 days. Radiological investigations revealed four left ureteral stones and an atrophic right kidney resulting from a calcular obstruction. Her laboratory values were as follows: serum creatinine 6.7 mg/dl, Na 132 mEq/l, K 6 mg/dl, and hematocrit 32%. An urgent percutaneous nephrostomy tube was inserted into the left side for urinary drainage, and her serum levels of creatinine and K returned to normal within 3 days. A left ureterolithotomy was the final management. Stone analysis revealed pure cystine crystals. PMID:22025963

  19. Efficacy of silodosin in the treatment of distal ureteral stones 4 to 10 mm in diameter

    PubMed Central

    Yuksel, Mustafa; Yilmaz, Serdar; Tokgoz, Husnu; Yalcinkaya, Soner; Baş, Serkan; Ipekci, Tümay; Yildiz, Ali; Ates, Nihat; Savas, Murat

    2015-01-01

    Purpose: Few studies have investigated the efficacy of silodosin, a recently introduced selective alpha 1-A adrenoceptor antagonist, in medical expulsive therapy (MET) for ureteral calculi. The results of these studies, which all evaluated the efficacy of 8 mg/day, indicate that silodosin is a potential treatment for ureteral calculi. This study investigated the efficacy of 4 mg/day of silodosin for MET of distal ureteral stones 4 to 10 mm in diameter. Material and Method: After 70 patients had been randomized into 2 groups of 35 patients each, both the control and experimental groups (groups 1 and 2, respectively) were advised to take 75 mg/day of diclofenacsodiumas needed for pain relief but only the experimental group to take 4 mg/day of silodosin. After 21 days, the groups were compared regarding the stone expulsion rate and duration, number of renalcolicepisodes, and analgesicdosage. Results: The median expulsion rates were 71.4% and 91.4% in groups 1 and 2, respectively, and the difference between them was significant (P=0.031). The median expulsion durations were 12.91±6.14 and 8.03±4.99 days, respectively, and the difference between them was significant (P<0.001). No significant differences were found regarding the median number of renal colic episodes or median analgesic dosage. While no patients in group 1 experienced side effects, 5 patients (14%) in group 2 experienced retrograde ejaculation. Conclusion: These results indicate that 4 mg/day of silodos in facilitates the expulsion of distal ureteral stones 4 to 10 mm in diameter but does not significantly reduce the number of renal colic episodes or analgesic dosage. PMID:26770537

  20. Silodosin vs tamsulosin in the management of distal ureteric stones: A prospective randomised study

    PubMed Central

    Elgalaly, Hazem; Sakr, Ahmed; Fawzi, Amr; Salem, Emad A.; Desoky, Esam; Shahin, Ashraf; Kamel, Mostafa

    2015-01-01

    Objectives To compare the efficacy of silodosin (8 mg) vs tamsulosin (0.4 mg), as a medical expulsive therapy, in the management of distal ureteric stones (DUS) in terms of stone clearance rate and stone expulsion time. Patients and methods A prospective randomised study was conducted on 115 patients, aged 21–55 years, who had unilateral DUS of ⩽10 mm. Patients were divided into two groups. Group 1 received silodosin (8 mg) and Group 2 received tamsulosin (0.4 mg) daily for 1 month. The patients were followed-up by ultrasonography, plain abdominal radiograph of the kidneys, ureters and bladder, and computed tomography (in some cases). Results There was a significantly higher stone clearance rate of 83% in Group 1 vs 57% in Group 2 (P = 0.007). Group 1 also showed a significant advantage for stone expulsion time and analgesic use. Four patients, two in each group, discontinued the treatment in first few days due to side-effects (orthostatic hypotension). No severe complications were recorded during the treatment period. Retrograde ejaculation was recorded in nine and three patients in Groups 1 and 2, respectively. Conclusion Our data show that silodosin is more effective than tamsulosin in the management of DUS for stone clearance rates and stone expulsion times. A multicentre study on larger scale is needed to confirm the efficacy and safety of silodosin. PMID:26966587

  1. Quantification of the Range of Motion of Kidney and Ureteral Stones During Shockwave Lithotripsy in Conscious Patients.

    PubMed

    Harrogate, Suzanne R; Yick, L M Shirley; Williams, James C; Cleveland, Robin O; Turney, Benjamin W

    2016-04-01

    Effective shockwave lithotripsy requires accurate targeting of the stone throughout the course of treatment. Stone movement secondary to respiratory movement can make this more difficult. In vitro work has shown that stone motion outside the focal region reduces the efficacy of stone fragmentation; however, there are few clinical data on the degree of stone movement in patients during treatment. To investigate this, X-ray fluoroscopic images of the kidney and ureteral stones at the upper and lower limits of the normal respiratory cycle were acquired during shock wave lithotripsy of 58 conscious patients, and stone excursion was calculated from these images. In addition, the respiration rate and patient perceived pain were recorded during the course of the treatment. It was found that stone motion secondary to respiration was 7.7 ± 2.9 mm for kidney stones and 3.6 ± 2.1 mm for ureteral stones-less than has been reported in studies with anesthetized patients. There was no significant change of motion over the course of treatment although pain was found to increase. These data suggest that stone motion in conscious patients is less than in anesthetized patients. Furthermore, it suggests that lithotripters with focal regions of 8 mm or greater should not suffer from a marked drop in fragmentation efficiency due to stone motion. PMID:26756226

  2. Ureteric stone in the presence of existing backache: lessons to learn.

    PubMed

    Zulkifli, M Z; Ho, C C K; Goh, E H; Praveen, S; Das, S

    2012-01-01

    Incidence of urolithiasis is on the rise due to climatic changes especially global warming.The pain due to presence of ureteric stone is a well known identity but many times it may be asymptomatic or even masked by concurrent presence of backache. In the present article, we describe the case of a 43-year-old male who came to the clinic for treatment of backache persisting for more than two years. The patient complained of backache two years back for which he was treated with analgesics and physiotherapy which relieved his pain. No X-ray was taken earlier because the attending clinician thought the backache to be musculo-skeletal in origin. Recently, one day a sudden episode of backache in the midst of night compelled him to seek medical treatment. However, this time a X-ray was performed and it showed the presence of calculi in the right upper pelvis of ureter which measured 1.9 cm vertically. An ultrasound confirmed the diagnosis. The patient was treated with two episodes of shock wave therapy which failed to crush the stone. A Double-J stent was inserted under general anaesthesia. The stone was crushed using a ureteroscope guided laser. The present case report describes how backache in professionals cannot be lightly attended. Even the characteristic groin to loin pain may be absent. All cases of backache should be properly investigated with an X-ray to rule out renal or ureteric calculi. PMID:22362229

  3. Predicting the mineral composition of ureteral stone using non-contrast computed tomography.

    PubMed

    Kawahara, Takashi; Miyamoto, Hiroshi; Ito, Hiroki; Terao, Hideyuki; Kakizoe, Manabu; Kato, Yoshitake; Ishiguro, Hitoshi; Uemura, Hiroji; Yao, Masahiro; Matsuzaki, Junichi

    2016-06-01

    We investigated the correlation between computed tomography (CT) density of ureteral stones and their mineral composition. A total of 346 patients who underwent ureteroscopic lithotripsy for calculi all fragments of which were acquired at a single institution from 2009 to 2011 were analyzed. The maximum and mean CT densities were measured preoperatively. A mineral analysis revealed calcium oxalate in 203 (58.7 %), mixed calcium oxalate and calcium phosphate in 78 (23.0 %), calcium phosphate in 18 (5.2 %), uric acid in 8 (2.3 %), struvite in 3 (0.9 %), and cysteine in 5 (1.4 %). The mean Hounsfield units (HUs) of the CT density were 1046 HUs in calcium oxalate, 1101 HUs in mixed calcium oxalate and calcium phosphate, 835 HUs in calcium phosphate, 549 HUs in uric acid, 729 HUs in struvite, and 698 HUs in cystine. The HUs in calcium oxalate were significantly higher than those in uric acid (p < 0.01) and struvite (p < 0.01). Those in monohydrate stones were significantly higher, compared with dehydrate stones (p < 0.05). We analyzed the largest number of stones than each published study to correlate their mineral composition and CT density. Calcium component stones showed significantly higher CT densities than other types. PMID:26427864

  4. Efficacy and Safety of Alfuzosin as Medical Expulsive Therapy for Ureteral Stones: A Systematic Review and Meta-Analysis

    PubMed Central

    Liu, Chenli; Zeng, Guohua; Kang, Ran; Wu, Wenqi; Li, Jiasheng; Chen, Kang; Wan, Show P.

    2015-01-01

    Background Alfuzosin has been widely used to treat benign prostatic hyperplasia and prostatitis, and is claimed to be a selective agent for the lower urinary tract with low incidence of adverse side-effects and hypotensive changes. Recently, several randomized controlled trials have reported using Alfuzosin as an expulsive therapy of ureteral stones. Tamsulosin, another alpha blocker, has also been used as an agent for the expulsive therapy for ureteral stones. It is unclear whether alfuzosin has similar efficacy as Tamsulosin in the management of ureteral stones. Objective To perform a systematic review and analysis of literatures comparing Alfuzosin with Tamsulosin or standard conservative therapy for the treatment of ureteral stones less than 10 mm in diameter. Methods A systematic literature review was performed in December 2014 using Pubmed, Embase, and the Cochrane library databases to identify relevant studies. All randomized and controlled trials were included. A subgroup analysis was performed comparing Alfuzosin with control therapy on the management of distal ureteral stones. Results Alfuzosin provided a significantly higher stone-free rate than the control treatments (RR: 1.85; 95% confidence interval [CI], 1.35–2.55; p<0.001), and a shorter stone expulsion time (Weighted mean difference [WMD]: -4.20 d, 95%CI, -6.19 to -2.21; p<0.001), but it has a higher complication rate (RR: 2.02; 95% CI, 1.30–3.15; p<0.01). When Alfuzosin was compared to Tamsulosin, there was no significant difference in terms of stone-free rate (RR: 0.90; 95% CI, 0.79–1.02; p = 0.09) as well as the stone expulsion time (WMD: 0.52 d, 95%CI, -1.61 to 2.64; p = 0.63). The adverse effects of Alfuzosin were similar to those of Tamsulosin (RR: 0.88; 95% CI, 0.61–1.26; p = 0.47). Conclusions Alfuzosin is a safe and effective agent for the expulsive therapy of ureteral stones smaller than 10 mm in size. It is more effective than therapeutic regiment without alpha blocker. It is equivalent to Tamsulosin in its effectiveness and safety profile. Adverse effects should always be kept in mind when use this class of drugs. PMID:26244843

  5. Ten-year experience in the management of distal ureteral stones greater than 10 mm in size

    PubMed Central

    DELL’ATTI, L.; PAPA, S.

    2016-01-01

    Aim Extracorporeal shock wave lithotripsy (ESWL) and semirigid ureteroscopy lithotripsy (URSL) have become standards of treatment for ureteral calculi. The aim of this retrospective study was to compare ESWL vs. URSL in terms of safety and efficacy for treatment of large distal ureteral stones ≥ 1cm. Patients and Methods This investigation assessed 637 patients with distal ureteral stones (10 to 15mm in size). 313 in the ESWL group were treated on an outpatient basis using the LithoDiamond machine without anaesthesia. URSL was performed in 324 patients with a 6–8 Fr semirigid ureterorenoscope and YAG laser under spinal anaesthesia. A successful outcome was defined as the patient being stone free 1 month after treatment. For all patients the parameters, including stone-free rate, operation time, complications, were inserted retrospectively in this study after review of medical records and operating room logs. Results The stone-free rate after URSL was 77.5% and 45.4% after ESWL treatment (p<0.001). The mean operative time between two groups was 74.7±9.8 for URSL group and 38.3±7.6 for ESWL group. The average number of office visits was 4.2 and 2.6 in patients treated with ESWL and URSL, respectively. Double j stents were inserted in 28.7% of patients. Twenty-one patients needed rehospitalisations for major complications. However, the differences in the overall complication rate were not statistically significant, with a rate of 16.3% for URSL and 14.4% for ESWL (p=0.246). Conclusion We have shown that URSL has enough safety and efficacy for the treatment of distal ureteral stones ≥ 1cm. URSL is associated with higher stone clearance rate as compared with ESWL. PMID:27142822

  6. Holmium Laser Lithotripsy with Semi-Rigid Ureteroscopy: A First-Choice Treatment for Impacted Ureteral Stones in Children?

    PubMed Central

    Adanur, Senol; Aydin, Hasan Riza; Ozkaya, Fatih; Ziypak, Tevfik; Polat, Ozkan

    2014-01-01

    Background We aimed to assess the effectiveness of semi-rigid ureteroscopy and holmium laser lithotripsy in the treatment of impacted ureteral stones in children. Material/Methods We evaluated a total of 32 children under the age of 18 years treated with ureteroscopic holmium laser lithotripsy for impacted ureteral stones between January 2005 and July 2013. Their stone-free state was defined as the absence of any residual stone on radiologic evaluation performed 4 weeks postoperatively. Complications were evaluated according to the modified Clavien classification. Result The mean patient age was 9.5±5.1 years (range 1–18 years). Seven (21.8%) of the stones were located in the proximal ureter, 9 (28.2%) were in the mid-ureter, and 16 (50%) were in the distal ureter. The mean stone size was calculated as being 10.46±3.8 mm2 (range 5–20). The stone-free rate was 93.75% (30/32 patients) following primary URS. Additional treatment was required for only 2 (6.25%) of the patients. After the procedure, a D-J stent was placed in all the patients. The total complication rate was 15.6% (5 patients). The 10 total complications in these 5 patients were 5 (15.6%) Grade I, 1 (3.1%) Grade II, 2 (6.25%) Grade IIIa, and 2 (6.25%) Grade IIIb. The mean follow-up period was 16.5 months (range 3–55). Conclusions For the treatment of impacted ureteral stones in children, holmium laser lithotripsy with semi-rigid ureteroscopy, with its low retreatment requirement and acceptable complication rates, is an effective and reliable method in experienced and skilled hands as a first-choice treatment approach. PMID:25415256

  7. Managing Small Ureteral Stones: A Retrospective Study on Follow-Up, Clinical Outcomes and Cost-Effectiveness of Conservative Management vs. Early Surgery

    PubMed Central

    Alevizopoulos, Aristeidis; Zosimas, Dimitrios; Piha, Lamprini; Hanna, Milad; Charitopoulos, Konstantinos

    2016-01-01

    Introduction The management of ureteral calculi has evolved over the past decades with the advent of new surgical and medical treatments. The current guidelines support conservative management as a possible approach for ureteral stones sized = 10 mm. Objectives We purport to follow the natural history of ureteral stones managed conservatively in this retrospective study, and attempt to ascribe an estimated health-care and cost-effectiveness, from presentation to time of being stone-free. Materials and methods 192 male and female patients with a single ureteral stone sized = 10 mm were included in this study. The clinical and cost-related outcome was analyzed for different stone sizes (0-4, 4-6 and 6-10 mm). The effectiveness of selected follow-up (FU) scans was also analyzed. Results Stone size was found to be related to the degree of hydronephrosis and to the likelihood of need for a surgical management. Conservative management was found to be clinically effective, as 88% of the patients did not require surgery for their stone. 96.1% of the patients with a stone 0-4mm managed to expel their ureteral stone. Bigger ureteral stones were found to be more costly. The cost-effectiveness of the single FU scans was found to be related to their efficiency, while the global cost-effectiveness of conservative management vs. early surgery was higher for smaller stones (26.8 vs. 17.32% for stones 0-4 vs. 6-10 mm). Conclusion Conservative management is clinically effective with a significant cost-benefit, particularly for the subgroup of stones sized 0-4 mm, where a need for FU scans is in dispute. PMID:26989370

  8. Ureteroscopy in proximal ureteral stones after shock wave lithotripsy failure: Is it safe and efficient or dangerous?

    PubMed Central

    Kilinc, Muhammet Fatih; Doluoglu, Omer Gokhan; Karakan, Tolga; Dalkilic, Ayhan; Sonmez, Nurettin Cem; Aydogmus, Yasin; Resorlu, Berkan

    2015-01-01

    Introduction: We assessed the effectiveness of ureteroscopy (URS) in proximal ureteral stones performed after shock wave lithotripsy (SWL) failure, and determined outcomes in terms of success rate, complications, and operation time. Methods: We analyzed data of patients with previous unsuccessful SWL (Group I) and the ones that did not have SWL or URS before (Group II) for proximal ureteral stones between December 2007 and August 2014. Group I included 346 patients who underwent complementary URS and Group II 209 patients who underwent primary URS. Success rates, operation time and complications were compared between groups. Results: Success rates of complementary and primary URS were 78.9% and 80.9%, respectively. The difference in success rates was not statistically significant between groups (p = 0.57). The complication rates of complementary URS was 12.1%, and 9.5% in primary URS (p = 0.49). No statistically significant differences were noted in terms of gender, age, stone size and side, or lithotripter type between groups. The mean operation time and need for balloon dilatation were higher in complementary URS group compared to the primary URS group, and the difference was statistically significant (p < 0.05). Conclusions: Complementary URS may be used safely after SWL failure in proximal ureteral stones. Its success rate and morbidities are similar to primary URS, except for longer operation time and an increased need for balloon dilatation. PMID:26664506

  9. Reduced time from diagnosis to stone-free status in patients with ureteral calculi.

    PubMed

    Khatami, Annelie; Rosengren, Kristina

    2016-04-18

    Purpose - The purpose of this paper is to describe an improvement project and its effects on decreasing the time from diagnosis to treatment for patients with kidney stones and to reduce the negative effects related to untreated stones at one hospital in western Sweden. Design/methodology/approach - A quantitative descriptive study based on Nolan's improvement model was used. The quality improvement effects were evaluated using statistical process control. Findings - Extracorporeal shock wave lithotripsy treatment's positive effects within 48 hours were described as efficiency (decreased waiting time) from diagnosis to treatment, even if a re-treatment was necessary. The results also showed a reduction in the usage of percutaneous nephropyelostomies as a treatment option. Research limitations/implications - This study includes data from one department at one hospital in one country. Comparative data include the time from acute radiological examination to final treatment but not total re-treatments, complications or time to up following radiological examination. However, the study was performed over one year and analyzed data from medical records in a systematic way. Practical implications - This study may inspire measuring and developing routines from diagnosis to treatment for patients who are transferred within different departments at one hospital. Social implications - By measuring the working process, resource use within a healthcare organization could be visualized. Planning and co-operation at different managerial levels are key factors for success when improvement projects are performed. Originality/value - Studies in improvement projects considering ureteral or kidney stones are generally lacking; thus, this study is important for improving the care of patients with this diagnose. PMID:27120506

  10. Derivation and validation of a clinical prediction rule for uncomplicated ureteral stone—the STONE score: retrospective and prospective observational cohort studies

    PubMed Central

    Bomann, Scott; Daniels, Brock; Luty, Seth; Molinaro, Annette; Singh, Dinesh; Gross, Cary P

    2014-01-01

    Objective To derive and validate an objective clinical prediction rule for the presence of uncomplicated ureteral stones in patients eligible for computed tomography (CT). We hypothesized that patients with a high probability of ureteral stones would have a low probability of acutely important alternative findings. Design Retrospective observational derivation cohort; prospective observational validation cohort. Setting Urban tertiary care emergency department and suburban freestanding community emergency department. Participants Adults undergoing non-contrast CT for suspected uncomplicated kidney stone. The derivation cohort comprised a random selection of patients undergoing CT between April 2005 and November 2010 (1040 patients); the validation cohort included consecutive prospectively enrolled patients from May 2011 to January 2013 (491 patients). Main outcome measures In the derivation phase a priori factors potentially related to symptomatic ureteral stone were derived from the medical record blinded to the dictated CT report, which was separately categorized by diagnosis. Multivariate logistic regression was used to determine the top five factors associated with ureteral stone and these were assigned integer points to create a scoring system that was stratified into low, moderate, and high probability of ureteral stone. In the prospective phase this score was observationally derived blinded to CT results and compared with the prevalence of ureteral stone and important alternative causes of symptoms. Results The derivation sample included 1040 records, with five factors found to be most predictive of ureteral stone: male sex, short duration of pain, non-black race, presence of nausea or vomiting, and microscopic hematuria, yielding a score of 0-13 (the STONE score). Prospective validation was performed on 491 participants. In the derivation and validation cohorts ureteral stone was present in, respectively, 8.3% and 9.2% of the low probability (score 0-5) group, 51.6% and 51.3% of the moderate probability (score 6-9) group, and 89.6% and 88.6% of the high probability (score 10-13) group. In the high score group, acutely important alternative findings were present in 0.3% of the derivation cohort and 1.6% of the validation cohort. Conclusions The STONE score reliably predicts the presence of uncomplicated ureteral stone and lower likelihood of acutely important alternative findings. Incorporation in future investigations may help to limit exposure to radiation and over-utilization of imaging. Trial registration www.clinicaltrials.gov NCT01352676. PMID:24671981

  11. A comparison of efficacies of holmium YAG laser, and pneumatic lithotripsy in the endoscopic treatment of ureteral stones

    PubMed Central

    Akdeniz, Ekrem; İrkılata, Lokman; Demirel, Hüseyin Cihan; Saylık, Acun; Bolat, Mustafa Suat; Şahinkaya, Necmettin; Zengin, Mehmet; Atilla, Mustafa Kemal

    2014-01-01

    Objective: We aimed to compare the effectiveness of holmium YAG laser and pneumatic lithotripsy in the treatment of ureteral stones. Material and methods: A total of 216 patients who had established indications of ureteroscopy between November 2011 and June 2012 were included in this study. Patients’ files were retrospectively reviewed by dividing cases as groups that underwent pneumatic (PL) or laser lithotripsy (LL) procedures. Age, sex, stone burden and localization, duration of follow-up, operative times were evaluated. Stone-free rates were evaluated by ureteroscopical examination, postoperative scout films and ultrasonography. Results: Group PL consisted of 109 and group LL of 107 patients. Median age was 43.93±15.94 years in Group PL and 46.15±14.54 years in Group LL. Male to female ratio, stone burden and localization were similar for both groups. Overall success rate was 89.9% in Group PL and 87.9% in Group LL, respectively (p<0.791). With the aid of additional procedures, success rate was 100% for both groups at the end of the first month. Groups were not different as for operative time, rate of insertion of an ureteral catheter and its removal time. Hospitalization period was apparently somewhat shorter in Group LL (p=0.00). Conclusion: Pneumatic lithotripsy can be as efficacious as laser lithotripsy and be used safely in the endoscopic management of ureteral stone. In comparison of both methods, we detected no differences as to operative time, success of operation and the time to removal of the catheter, however, hospitalization period was shorter in Group LL. PMID:26328167

  12. Ureterorenoscopic treatment of ureteral stones – influence of operator’s experience and skill on the procedure outcome

    PubMed Central

    Librenjak, Davor; Šitum, Marijan; Gugić, Dijana; Milostić, Kazimir; Duvnjak, Mario

    2011-01-01

    Aim To observe the influence of operating urologist’s education and adopted skills on the outcome of ureterorenoscopy treatment of ureteral stones. Methods The study included 422 patients (234 men, 55.4%) who underwent ureterorenoscopy to treat ureteral stones at the Urology Department of Clinical Hospital Center Split, Croatia, between 2001 and 2009. All interventions were carried out with a semi-rigid Wolf ureteroscope and an electropneumatic generator used for lithotripsy. The operating specialists were divided into two groups. The first group included 4 urologists who had started learning and performing endoscopic procedures at the beginning of their specialization and the second group included 4 urologists who had started performing endoscopic procedures later in their careers, on average more than 5 years after specialization. Results Radiology tests confirmed that 87% (208/238) of stones were completely removed from the distal ureter, 54% (66/123) from the middle ureter, and 46% (28/61) from the proximal ureter. The first group of urologists completed significantly more procedures successfully, especially for the stones in the distal (95% vs 74%; P = 0.001) and middle ureter (66% vs 38%; P = 0.002), and their patients spent less time in the hospital postoperatively. Conclusion Urologists who started learning and performing endoscopic procedures at the beginning of their specialization are more successful in performing ureteroscopy. It is important that young specialists receive timely and systematic education and cooperate with more experienced colleagues. PMID:21328721

  13. Does ureteral stenting matter for stone size? A retrospectıve analyses of 1361 extracorporeal shock wave lithotripsy patients

    PubMed Central

    Dogan, Cagatay; Can, Gulce Ecem; Tansu, Nejat; Erozencı, Ahmet; Onal, Bulent

    2015-01-01

    Introduction The aim of our study was to determine the efficacy of ureteral stents for extracorporeal shock wave lithotripsy (SWL) treatment of pelvis renalis stones and to compare the results and complications in stented and non-stented patients. Material and methods Between 1995 and 2011, 1361 patients with pelvis renalis stones were treated with SWL. Patients were subdivided into three groups according to stone burden: ≤1 cm2 (group 1; n = 514), 1.1 to 2 cm2 (group 2; n = 530) and >2 cm2 (group 3; n = 317). Each group was divided into subgroups of patients who did and did not undergo ureteral stent implantation before SWL treatment. The efficacy of treatment was evaluated by determining the effectiveness quotient (EQ). Statistical analysis was performed by chi-square, Fisher's exact and Mann-Whitney U tests. Results Of the 514, 530 and 317 patients in groups 1, 2 and 3 respectively, 30 (6%), 44 (8%) and 104 (33%) patients underwent auxiliary stent implantation. Steinstrasse rates did not differ significantly between stented and non-stented patients in each group. The EQ was calculated as 62%, 33% and 70% respectively in non-stented, stented and totally for group 1. This ratio calculated as 58%, 25% and 63% for group 2 and 62%, 26% and 47% for group 3. Stone-free rates were significantly higher for non-stented than for stented patients in groups 2 and 3. Conclusions Stone free rates are significantly higher in non-stented than in stented patients with pelvis renalis stones >1 cm2, whereas steinstrasse rates are not affected. PMID:26568882

  14. As low as reasonably achievable: Methods for reducing radiation exposure during the management of renal and ureteral stones

    PubMed Central

    Cabrera, Fernando; Preminger, Glenn M.; Lipkin, Michael E.

    2014-01-01

    Imaging for urolithiasis has evolved over the past 30 years. Currently, non-contrast computed tomography (NCCT) remains the first line imaging modality for the evaluation of patients with suspected urolithiasis. NCCT is a dominant source of ionizing radiation for patients and one of its major limitation. However, new low dose NCCT protocols may help to reduce the risk. Fluoroscopy use during operating room (OR) surgical procedures can be a substantial source of radiation for patients, OR staff and surgeons. It is important to consider the amount of radiation patients are exposed to from fluoroscopy during operative interventions for stones. Radiation reduction can be accomplished by appropriate selection of imaging studies and multiple techniques, which minimize the use of fluoroscopy whenever possible. The purpose of this manuscript is to review common imaging modalities used for diagnosing and management of renal and ureteral stones associated with radiation exposure. We also review alternatives and techniques to reduce radiation exposure. PMID:24497684

  15. Management of calcular anuria in adults caused by ureteric stones: By using of ureteroscopy and holmium laser

    PubMed Central

    Abdel-Kader, Mohammad S.

    2011-01-01

    Purpose To present our clinical outcomes in the management of anuria in adult patients caused by ureteral calculi by using of ureteroscopy and holmium laser. Materials and methods Nineteen patients presented with calcular anuria with ages between 19 and 48years. The presentation was anuria with serum creatinine levels of 25.5mg% (mean 3.5) and hyperkalemia in nine patients (5.26.1mmol/L). There were bilateral ureteric stones in 14 (73.7%) and unilateral in five (26.3%) with single functioning kidney. Thirty-three ureteroscopic procedures were performed for 19 patients including bilateral ureteroscopy in 14. Laser lithotripsy was delivered using holmium laser via 356?m laser fibre, with energy (11.2J) and pulse rate (10Hz). Post-operatively, monitoring of urine output, serum creatinine and K levels was done until normal values were obtained. Results Ureteroscopy was performed for all 19 patients (33 procedures), but laser lithotripsy was done successfully in 30 procedures. The operative time was 46min (2570). The successful fragmentation rate was (100%). The stone-free rate was 90.9%. There were mucosal abrasions in 6 (31.5%), and mild to moderate haematuria in 9 (47.4%), and high fever in two patients (10.5%). Serum creatinine and potassium levels returned to normal within 710days. Urine output gradually reached normal level within a week. Conclusions Ureteroscopy and holmium laser lithotripsy represent an effective and safe modality for the treatment of anuria caused by ureteral calculi. PMID:26579292

  16. A giant ureteric calculus

    PubMed Central

    Rathod, Rajiv; Bansal, Prashant; Gutta, Srinivas

    2013-01-01

    Ureteric stones are usually small and symptomatic. We present a case of a 35-year old female who presented with minimally symptomatic right distal ureteric calculus with proximal hydroureteronephrosis. Laparoscopic right ureterolithotomy was performed and a giant ureteric calculus measuring 11 cm Χ 1.5 cm, weighing 40 g was retrieved. PMID:24082453

  17. [Extracorporeal electromagnetic shock-wave lithotripsy. Initial results in the treatment of ureteral calculi in situ. A series of 50 consecutive cases].

    PubMed

    Conort, P; Ledenko, N; Léo, J P; Richard, F; Chatelain, C

    1990-01-01

    Electromagnetic shock waves are sufficiently powerful to break ureteral stones in situ under X-ray control. Fifty consecutive patients were treated for ureteral stones (20 lombar, 4 iliac, 26 pelvic); the average length was 7.5 mm; 48 times in one session, twice in two sessions. At 6 months, 98% of these patients were stone-free (with IVP control) and one patient was lost to follow-up. PMID:2360783

  18. Outcome of α-blockers, with or without methylprednisolone combination, in medical expulsive therapy for lower ureteric stones: A prospective randomised study

    PubMed Central

    Shabana, Waleed; Teleb, Mohamed; Dawod, Tamer; Abu Taha, Hisham; Abdulla, Alla; Shahin, Ashraf; Eladl, Mahmoud; Abo-Hashem, Safwat

    2016-01-01

    Objectives To compare the safety and efficacy of tamsulosin, alfuzosin, and their combinations with methylprednisolone, in the medical management of lower ureteric stones. Patients and methods Between September 2012 and June 2014, patients diagnosed with a single lower ureteric stone of ⩽10 mm (longest dimension) were enrolled. Patients with urinary tract infection, severe hydronephrosis, pregnancy, hypertension, diabetes, ulcer disease, or renal insufficiency were excluded. According to the medication added to the analgesic anti-inflammatory, patients were stratified into four groups, with 53 patients in each. Group I patients received tamsulosin 0.4 mg and those in Group II received tamsulosin 0.4 mg and methylprednisolone 8 mg. Group III patients received alfuzosin 10 mg and those in Group IV received alfuzosin 10 mg and methylprednisolone 8 mg. Treatment was continued until stone expulsion or to a maximum of 2 weeks. The patients’ demographics, stone criteria, and stone-free rates were calculated and analysed. Results The mean (SD) maximum stone dimension was 7.8 (1.5), 8.1 (1.3), 7.9 (1.6) and 8.0 (1.4) mm in Groups I, II, III and IV, respectively. Groups II and IV had significantly higher stone-free rates than Groups I and III (P < 0.05), whilst there were no statistically significant differences between Groups I and III or between Groups II and IV. There was no statistical difference among the four groups for the time to stone expulsion. Three patients in Group II and two patients in Group IV developed transient hyperglycaemia, which resolved after cessation of methylprednisolone. Conclusions The combination of alfuzosin or tamsulosin with methylprednisolone seems to be effective and safe for managing lower ureteric stones of <1 cm. PMID:26966586

  19. Extracorporeal shock waves lithotripsy versus retrograde ureteroscopy: is radiation exposure a criterion when we choose which modern treatment to apply for ureteric stones?

    PubMed Central

    Pricop, Catalin; Maier, Adrian; Negru, Dragos; Malau, Ovidiu; Orsolya, Martha; Radavoi, Daniel; Serban, Dragomir R.

    2014-01-01

    The aim of this study is to compare two major urological procedures in terms of patient exposure to radiation. We evaluated 175 patients, that were subjected to retrograde ureteroscopy (URS) and extracorporeal shock waves lithotripsy (ESWL) for lumbar or pelvic ureteral lithiasis, at two urological departments. The C-arm Siemens (produced in 2010 by Siemens AG, Germany) was used for ureteroscopy. The radiological devices of the lithotripters used in this study in the two clinical centers had similar characteristics. We evaluated patient exposure to ionizing radiation by using a relevant parameter, the air kerma-area product (PKA; all values in cGy cm2), calculated from the radiation dose values recorded by the fluoroscopy device. PKA depends on technical parameters that change due to anatomical characteristics of each case examined, such as body mass index (BMI), waist circumference, and stone location. For the patients subjected to ESWL for lumbar ureteral lithiasis the mean of PKA(cGy cm2) was 509 (SD=180), while for those treated for pelvic ureteral lithiasis the mean of PKA was 342 (SD=201). In the URS group for lumbar ureteral lithiasis, the mean of PKA (cGy cm2) was 892 (SD=436), while for patients with pelvic ureteral lithiasis, the mean of PKA was 601 (SD=429). The patients treated by URS had higher exposure to ionizing radiation dose than patients treated by ESWL. The risk factors of higher radiation doses were obesity, exposure time, and localization of the stones. PMID:25428680

  20. Comparative Efficacy of Tamsulosin Versus Tamsulosin With Tadalafil in Combination With Prednisolone for the Medical Expulsive Therapy of Lower Ureteric Stones: A Randomized Trial

    PubMed Central

    Kumar, Santosh; Agrawal, Swati; Singh, Shrawan Kumar

    2014-01-01

    Purpose To compare the safety and efficacy of tamsulosin and tamsulosin with the phosphodiesterase-5 inhibitor tadalafil in combination with prednisolone as medical expulsive therapies for lower ureteric stones. Materials and Methods Between July 2011 and December 2012, 62 adult patients presenting with distal ureteric stones sized 5 to 10 mm were randomized equally to treatment with tamsulosin (group A) or tamsulosin with tadalafil (group B). Therapy was given for a maximum of 6 weeks. In addition, patients in groups A and B were given 5-mg prednisolone once daily (maximum 1 week). The stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow-up and endoscopic treatment, and adverse effects of the drugs were noted. Statistical analyses were done by using Student t-test and chi-square test. Results There was a higher expulsion rate (83.9% in group B and 74.2% in group A) and a lower time to expulsion in both treatment groups than in historical controls used in earlier studies. However, these results were not statistically significant (p=0.349, p=0.074, respectively). Statistically significant differences were noted in hospitalization for colic and analgesic requirement, which were less in group B than in group A. There were no serious adverse events. Another important finding was improvement in erectile function in group B. Conclusions Medical expulsive therapy for distal ureteric stones using tamsulosin and tadalafil with prednisolone is safe and efficacious. Also, the prescription of tadalafil in cases of erectile dysfunction with the development of lower ureteric stones may provide additional advantages. PMID:24648875

  1. Initial Experience with the Resonance Metallic Stent for Antegrade Ureteric Stenting

    SciTech Connect

    Wah, Tze M. Irving, Henry C.; Cartledge, Jon

    2007-07-15

    Background and purpose. We describe our initial experience with a new metallic ureteric stent which has been designed to provide long-term urinary drainage in patients with malignant ureteric strictures. The aim is to achieve longer primary patency rates than conventional polyurethane ureteric stents, where encrustation and compression by malignant masses limit primary patency. The Resonance metallic double-pigtail ureteric stent (Cook, Ireland) is constructed from coiled wire spirals of a corrosion-resistant alloy designed to minimize tissue in-growth and resist encrustation, and the manufacturer recommends interval stent change at 12 months. Methods. Seventeen Resonance stents were inserted via an antegrade approach into 15 patients between December 2004 and March 2006. The causes of ureteric obstruction were malignancies of the bladder (n = 4), colon (n = 3), gynecologic (n = 5), and others (n = 3). Results. One patient had the stent changed after 12 months, and 3 patients had their stents changed at 6 months. These stents were draining adequately with minimal encrustation. Four patients are still alive with functioning stents in situ for 2-10 months. Seven patients died with functioning stents in place (follow-up periods of 1 week to 8 months). Three stents failed from the outset due to bulky pelvic malignancy resulting in high intravesical pressure, as occurs with conventional plastic stents. Conclusion. Our initial experience with the Resonance metallic ureteric stent indicates that it may provide adequate long-term urinary drainage (up to 12 months) in patients with malignant ureteric obstruction but without significantly bulky pelvic disease. This obviates the need for regular stent changes and would offer significant benefit for these patients with limited life expectancy.

  2. Is semirigid ureteroscopy sufficient in the treatment of proximal ureteral stones? When is combined therapy with flexible ureteroscopy needed?

    PubMed

    Turkan, Sadi; Ekmekcioglu, Ozan; Irkilata, Lokman; Aydin, Mustafa

    2016-01-01

    The goals of this study were to examine cases of proximal ureteral stones in which semirigid or flexible ureteroscopes alone were insufficient for endoscopic treatment, requiring the combination of both. A total of 137 patients were retrospectively evaluated. Holmium laser was used as the energy source for stone fragmentation. Each operation was begun with a 6/7.5 Fr semirigid ureteroscope (URS), and continued with a 7.5 Fr flexible URS in those procedures that failed to reach the stone or push-up. Double J stents were inserted into those patients in whom the flexible URS failed. Shock wave lithotripsy (SWL) or a repeat ureteroscopy (after 2-4 weeks) was planned in those patients who were considered to be treated unsuccessfully. The demographic features of the patients, stone sizes, treatment outcomes, need for additional treatment, complications, and the results of the postoperative 1-month early follow-up were evaluated. The mean age of the patients (77 males and 60 females) was 38 ± 6.7 years old, the mean stone size was 12.3 ± 3.7 mm, and the number of patients with persistent hydronephrosis was 86 (62.8 %). A stone-free diagnosis was achieved in a total of 124 patients (90.5 %), using a semirigid URS in 80 patients and a flexible URS in 44 patients. Treatment using a flexible URS was administered in 38 patients (27.7 %) due to push-up, and in 6 patients (4.3 %) because of the failure to advance the semirigid URS into the ureter. The treatment failed in 13 patients (9.4 %) despite the use of both methods. Treatment using low-caliber semirigid ureteroscopy and a holmium laser is possible, regardless of the stone size, in female patients without hydronephrosis. However, the need for combined treatment with flexible ureteroscopy is increased in male patients with hydronephrosis. PMID:26788442

  3. Sildenafil citrate as a medical expulsive therapy for distal ureteric stones: A randomised double-blind placebo-controlled study

    PubMed Central

    Shokeir, Ahmed A.; Tharwat, Mohamed A.; Abolazm, Ahmed Elhussein; Harraz, Ahmed

    2016-01-01

    Objective To study the effect of sildenafil citrate on spontaneous passage of distal ureteric stones (DUS). Patients and methods This was a randomised double-blinded placebo-controlled study of 100 patients with DUS. Inclusion criteria were: male, age 18–65 years, normal renal function, and a single radiopaque unilateral DUS of 5–10 mm. Patients were randomly allocated into two equal groups, one that received placebo and the other that received 50 mg sildenafil citrate once daily. Both investigators and patients were masked to the type of treatment. Patients self-administered the medication until spontaneous passage of the DUS. In patients where there was uncontrolled pain, fever, an increase in serum creatinine of >1.8 mg/dL, progressive hydronephrosis or no further progress after 4 weeks, a decision was taken for further treatment. Results In all, 47 and 49 patients were available for analysis in both the placebo and sildenafil citrate groups; respectively. Both groups were comparable for age and stone characteristics. Spontaneous expulsion occurred in 19 of 47 patients (40.4%) in the placebo group and in 33 of 49 (67.3%) in the sildenafil citrate group (P = 0.014). The mean time to stone expulsion was significantly shorter in the sildenafil citrate group (P < 0.001). A multivariable Cox proportional hazards model showed that receiving sildenafil citrate was the only independent factor that had a significant impact on stone passage with a hazard ratio of 2.7 (95% confidence interval 1.5–4.8; P < 0.001). Conclusion Sildenafil citrate enhances spontaneous passage of 5–10 mm DUS. PMID:26966585

  4. Is an excretory urogram mandatory in patients with small to medium-sized renal and ureteric stones treated by extra corporeal shock wave lithotripsy?

    PubMed Central

    Ather, M Hammad; Faruqui, Nuzhat; Akhtar, Sobia; Sulaiman, M Nasir

    2004-01-01

    Background An intravenous urogram (IVU) has traditionally been considered mandatory before treating renal and ureteric stones by extracorporeal shock wave lithotripsy (ESWL). This study was designed to see whether there is a difference in complications and the need for ancillary procedures in patients managed by ESWL for renal and ureteric calculi, according to preoperative imaging technique. Methods This retrospective study compared 133 patients undergoing ESWL from January 2001 to July 2002. Patients were divided into three groups according to the preoperative imaging technique used: i) IVU; ii) non-contrast enhanced helical computed tomography (UHCT); and iii) ultrasound (US) + X-ray kidney, ureter and bladder (KUB). The groups were matched in terms of age and gender, as well as location, side and size of stones. Results There was no statistically significantly difference for number of ESWL sessions, number of shock waves and use of ancillary procedures between the three groups. The stone-free rate was 98% for the IVU and UHCT groups, and 97% for the US + X-ray KUB group. Conclusions The complication rate and need for ancillary procedures was comparable across the three groups. Patients imaged by UHCT or US + X-ray KUB prior to ESWL for uncomplicated renal and ureteric stones do not require IVU. PMID:15115545

  5. Extracorporeal shock wave lithotripsy in the treatment of renal and ureteral stones.

    PubMed

    Torricelli, Fábio César Miranda; Danilovic, Alexandre; Vicentini, Fábio Carvalho; Marchini, Giovanni Scala; Srougi, Miguel; Mazzucchi, Eduardo

    2015-01-01

    The use of certain technical principles and the selection of favorable cases can optimize the results of extracorporeal shock wave lithotripsy (ESWL). The aim of this study is to review how ESWL works, its indications and contraindications, predictive factors for success, and its complications. A search was conducted on the Pubmed® database between January 1984 and October 2013 using "shock wave lithotripsy" and "stone" as key-words. Only articles with a high level of evidence, in English, and conducted in humans, such as clinical trials or review/meta-analysis, were included. To optimize the search for the ESWL results, several technical factors including type of lithotripsy device, energy and frequency of pulses, coupling of the patient to the lithotriptor, location of the calculus, and type of anesthesia should be taken into consideration. Other factors related to the patient, stone size and density, skin to stone distance, anatomy of the excretory path, and kidney anomalies are also important. Antibiotic prophylaxis is not necessary, and routine double J stent placement before the procedure is not routinely recommended. Alpha-blockers, particularly tamsulosin, are useful for stones >10mm. Minor complications may occur following ESWL, which generally respond well to clinical interventions. The relationship between ESWL and hypertension/diabetes is not well established. PMID:25909212

  6. A Case of Septic Shock caused by Achromobacter xylosoxidans in an Immunocompetent Female Patient after Extracorporeal Shock Wave Lithotripsy for a Ureteral Stone

    PubMed Central

    Lee, So Yon; Park, In Young; Park, So Yeon; Lee, Jin Seo; Kang, Goeun; Kim, Jae Seok

    2016-01-01

    Achromobacter xylosoxidans can cause various types of infections, but its infection in humans is rare. A. xylosoxidans has been reported as a rare etiological agent of infections including primary bacteremia, catheter-related bloodstream infection, endocarditis, otitis, and pneumonia, particularly in immunocompromised hosts. We encountered a case of septic shock caused by A. xylosoxidans in a 52-year-old, immunocompetent woman with no underlying disease, who received extracorporeal shock wave lithotripsy to remove a left upper ureteral stone. She was treated with antibiotics to which the organism was susceptible but died as a result of septic shock. PMID:27104016

  7. Mini percutaneous nephrolithotomy in the treatment of renal and upper ureteral stones: Lessons learned from a review of the literature

    PubMed Central

    Ferakis, Nikolaos; Stavropoulos, Marios

    2015-01-01

    The aim of this review is to present the most recent data regarding the indications of mini percutaneous nephrolithotomy (PCNL), the results and the complications of the method. Medline was searched from 1997 to January 2014, restricted to English language. The Medline search used a strategy including medical subject headings and free-text protocols. PCNL is a well-established treatment option for patients with large and complex renal calculi. In order to decrease morbidity associated with larger instruments like blood loss, postoperative pain and potential renal damage, a modification of the technique of standard PCNL has been developed. This is performed with a miniature endoscope via a small percutaneous tract (11–20 F) and was named as minimally invasive or mini-PCNL. This method was initially described as an alternative percutaneous approach to large renal stones in a pediatric patient population. Furthermore, it has become a treatment option for adults as well, and it is used as a treatment for calculi of various sizes and locations. However, the terminology has not been standardized yet, and the procedure lacks a clear definition. Nevertheless, mini-PCNL can achieve comparable stone-free rates to the conventional method, even for large stones. It is a safe procedure, and no major complications are reported. Although less invasiveness has not been clearly demonstrated so far, mini-PCNL is usually related to less blood loss and shorter hospital stay than the standard method. PMID:25837662

  8. Tamsulosin: Ureteral Stones (Distal)

    PubMed Central

    Rivard, Renée

    2015-01-01

    This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@ku.edu. PMID:25684798

  9. Efficacy and safety of Ho:YAG Laser Lithotripsy for ureteroscopic removal of proximal and distal ureteral calculi

    PubMed Central

    2014-01-01

    Background Laser lithotripsy is an established endourological modality. Ho:YAG laser have broadened the indications for ureteroscopic stone managements to include larger stone sizes throughout the whole upper urinary tract. Aim of current work is to assess efficacy and safety of Ho:YAG laser lithotripsy during retrograde ureteroscopic management of ureteral calculi in different locations. Methods 88 patients were treated with ureteroscopic Ho:YAG laser lithotripsy in our institute. Study endpoint was the number of treatments until the patient was stone-free. Patients were classified according to the location of their stones as Group I (distal ureteric stones, 51 patients) and group II (proximal ureteral stones, 37). Group I patients have larger stones as Group II (10.70 mm vs. 8.24 mm, respectively, P = 0.020). Results Overall stone free rate for both groups was 95.8%. The mean number of procedures for proximal calculi was 1.1 ± 0.1 (1–3) and for distal calculi was 1.0 ± 0.0. The initial treatment was more successful in patients with distal ureteral calculi (100% vs. 82.40%, respectively, P = 0.008). No significant difference in the stone free rate was noticed after the second laser procedure for stones smaller versus larger than 10 mm (100% versus 94.1%, P = 0.13). Overall complication rate was 7.9% (Clavien II und IIIb). Overall and grade-adjusted complication rates were not dependant on the stone location. No laser induced complications were noticed. Conclusions The use of the Ho:YAG laser appears to be an adequate tool to disintegrate ureteral calculi independent of primary location. Combination of the semirigid and flexible ureteroscopes as well as the appropriate endourologic tools could likely improve the stone clearance rates for proximal calculi regardless of stone-size. PMID:25107528

  10. The efficacy of tamsulosin vs. nifedipine for the medical expulsive therapy of distal ureteric stones: A randomised clinical trial

    PubMed Central

    Gandhi, Himesh R.; Agrawal, Chandrasekhar

    2013-01-01

    Objectives To assess and compare, in a randomised clinical trial, the efficacy of tamsulosin and nifedipine as medical expulsive therapy for distal ureterolithiasis. Patients and methods In all, 128 symptomatic patients with stones in the juxtavesical tract of the ureter were randomly divided into group 1 (64 patients) receiving oral nifedipine sustained-release 30 mg/day, and group 2 (64 patients) receiving tamsulosin 0.4 mg/day. Both groups received oral prednisolone 30 mg/day for 10 days and diclofenac 75 mg intramuscularly on demand. Patients were assessed by weekly ultrasonography with or with no abdominal computed tomography, during a follow-up of 4 weeks. The stone passage rate and time, analgesic use, hospitalisation and endoscopic interventions were evaluated. The results were analysed statistically using appropriate tests. Results The stone expulsion rate was 55% for group 1 and 80% for group 2 (P = 0.004). The mean stone size was 8.59 and 8.85 mm in groups 1 and 2, respectively. The mean expulsion time was 23 days for group 1 and 9 days for group 2 (P < 0.001). The mean number of diclofenac injections was 1.19 for group 1 and 0.42 for group 2 (P < 0.001). Eleven patients in group 1 vs. two in group 2 were hospitalised (P = 0.001). Twenty-six patients in group 1 and 13 in group 2 underwent ureteroscopy (P < 0.001). Conclusions Medical expulsive therapy with tamsulosin should be considered as a first-line treatment for index cases of distal ureterolithiasis with no complications. The use of tamsulosin provides better stone expulsion than does nifedipine. PMID:26558112

  11. Advances in Ureteral Stent Design

    NASA Astrophysics Data System (ADS)

    Denstedt, John D.

    2007-04-01

    Ureteral stents are commonly used in urolithiasis patients for relief of obstruction or in association with stone treatments such as ureteroscopy and extracorporeal shock wave lithotripsy. There are currently many different bulk materials and coatings available for the manufacture of ureteral stents, however the ideal material has yet to be discovered. All potential biomaterials must undergo rigorous physical and biocompatibility testing before commercialization and use in humans. Despite significant advances in basic science research involving biocompatibility issues and biofilm formation, infection and encrustation remain associated with the use of biomaterials in the urinary tract. There have been many significant advances in the design of ureteral stents in recent years and these will be highlighted along with a discussion of future aspects of biomaterials and use of stents in association with urolithiasis.

  12. Managing acute and chronic renal stone disease.

    PubMed

    Moran, Conor P; Courtney, Aisling E

    2016-02-01

    Nephrolithiasis, or renal stone disease, is common and the incidence is increasing globally. In the UK the lifetime risk is estimated to be 8-10%. On a population level, the increase in stone incidence, erosion of gender disparity, and younger age of onset is likely to reflect increasing prevalence of obesity and a Western diet with a high intake of animal protein and salt. Stones can be detected by a variety of imaging techniques. The gold standard is a non-contrast CT of kidneys, ureters and bladder (CT KUB) which can identify > 99% of stones. CT KUB should be the primary mode of imaging for all patients with colic unless contraindicated. In such instances, or if a CT KUB is not available, an ultrasound KUB is an alternative. This has advantages in terms of radiation exposure and cost, but is limited in sensitivity, particularly for ureteric stones. Once diagnosed, a plain film KUB can be used for follow-up of radiopaque stones. For most patients diclofenac is a reasonable first choice of analgesia, e.g. 50-100 mg rectally, or 75 mg IM. Opioid medication can worsen nausea and be less effective, but should be used if there is a contraindication to NSAIDs. A combination of diclofenac, paracetamol, and/or codeine regularly can provide adequate pain control in many cases. Failure of this analgesic combination should prompt consideration of secondary care support. If a ureteric stone < 5 mm in diameter is identified, the expectation is that this will pass without intervention. Initially medical management is still useful for stones between 5 and 10mm in diameter, but urology input is more likely to be necessary as up to 50% of these may require intervention. Stones that are >10 mm in diameter should be discussed with the urology service as they are unlikely to pass spontaneously. PMID:27032222

  13. The Initial Appearance of Ashlar Stone in Cyprus. éssues of Provenance and Use

    NASA Astrophysics Data System (ADS)

    Philokyprou, M.

    In Cyprus stone was the primary building material, either as rubble or in a dressed form (called ashlar), since the Neolithic period. Initially stone was used only as rubble but later during the Late Brone Age ashlar stone appeared for the first time on the island. The aim of this paper is the presentation of the results of a systematic research regarding the different types and uses of ashlar stone and the techniques followed during the Late Bronze Age in Cyprus in comparison with other Mediterranean areas. The macroscopic and microscopic examination of selected samples showed that sedimentary rocks of various geological formations were used as ashlars. One, two or even three different types of stones were transported from the quarries nearest to the settlements. Some characteristic methods of stone dressing, such as finishing only the visible faces and creating drafted margins around the face of the ashlar blocks, are to be found not only in Late Bronze Age settlements but also in more recent examples from the last two centuries. The choice of ashlar and the methods of construction can be related to social, religious and political factors and were not only based on aesthetic criteria and practical issues. Thus, the most impressive structural solutions were followed in the construction of temples and public buildings, whereas more simple methods can be observed in residential complexes.

  14. Management of stone disease in infants.

    PubMed

    Azili, Mujdem Nur; Ozturk, Fatma; Inozu, Mihriban; Çayci, Fatma Şemsa; Acar, Banu; Ozmert, Sengul; Tiryaki, Tugrul

    2015-11-01

    Evaluating and treating renal stone disease in infants are technically challenging. In this study, we evaluated the surgical treatment of renal stones in children under 1 year of age. We retrospectively reviewed the records of patients under 1 year old who were treated with ESWL, endourological or open surgical procedures for renal stone disease between January, 2009 and December, 2012. The patients' age, gender, stone size, stone location and number, complications, stone-free status, and postoperative complications were recorded. 19 of 121 infants with a mean age of 10.2 ± 3.07 months were treated with surgical procedures. Six (75%) of eight cystinuria patients required a surgical intervention. Retrograde endoscopic management was performed in thirteen patients (63.4%) as an initial surgical approach. There were three major (15.7%) complications. The rate of open surgical procedures was 31.6% (6 of 19 infants). The cutoff value of stone size for open surgery was 10 mm. There was a significant relationship between the conversion to open procedures and stone size, stone location, and symptom presentation especially the presence of obstruction (p < 0.05). After repeated treatments, the stone clearance rate of RIRS reached 84.6%. Retrograde intrarenal surgery is an effective and safe treatment method for renal stones in infants and can be used as a first-line therapy in most patients under 1 year old. This is especially important if an associated ureteral stone or lower pole stone that requires treatment is present and for patients with cystinuria, which does not respond favorably to ESWL. PMID:26036325

  15. A Case of Laparoscopic Ureteric Reimplantation in a Solitary Urinary System

    PubMed Central

    Pang, Karl H.; Miah, Saiful; Haynes, Mark D.; Oakley, Neil E.

    2015-01-01

    Ureteric strictures can be caused by traumatic pelvic surgery, urolithiasis and instrumentation. There are various treatment options for ureteric stricture, including laparoscopic ureteric reimplantation. A 56-year-old female with a history of chronic left pelviureteric junction obstruction presented with urosepsis secondary to right-sided urolithiasis. The patient had a left nephrectomy and developed right-sided ureteric stricture following repeated ureteroscopy to manage her stone disease. The treatment with ureteric stenting was unsuccessful. Here we present a case on the feasibility of laparoscopic reimplantation for ureteric stricture in a solitary kidney to preserve renal function and avoid further ureteroscopy or nephrostomies. PMID:25849673

  16. [Effects and side effects of ureteral stenting during extracorporeal shock wave lithotripsy].

    PubMed

    Kohri, K; Katayama, Y; Ishii, T; Kato, Y; Kurita, T; Mitsubayashi, S; Iguchi, M

    1990-10-01

    We retrospectively studied the effects and side effects of placing indwelling ureteral stents in 196 cases who underwent extracorporeal shock wave lithotripsy with a ureteral stent. The average period of ureteral stenting was approximately 22 days. Placing ureteral stents was mainly for large renal stones (79.3%), single kidney etc. There were no significant differences between the stunted and non-stunted patients with approximately 2 cm sized single renal stone with respect to the stone free rate, stone free period, and symptoms during stenting, which suggested that ureteral stenting might be unnecessary in those patients. High fever was highest in incidence of the symptoms and complications during stenting (17.2%). It occurred frequently in patients with infected stones or cystine stones. The percentages of pyrexia and stone street in patients using Towers type's stents were higher than those using the others. It was also shown that the bladder portions of the stents in patients using Towers peripheral ureteral stents were densely encased in calculous material and were very brittle. Fortunately the ureteral portions were removed intact. This study suggests that use of an indwelling ureteral stent may not contribute to the higher rate of being free of stones after the treatment of small to medium sized renal calculi, and that stents should be removed or changed early. PMID:2273707

  17. Ureteric colic: new trends in diagnosis and treatment

    PubMed Central

    Masarani, M; Dinneen, M

    2007-01-01

    The diagnostic approach to ureteric colic has changed due to the introduction of new radiological imaging such as non?contrast CT. The role of intravenous urography, which is regarded as the gold standard for the diagnosis of ureteric colic, is being challenged by CT, which has become the first?line investigation in a number of centres. The management of ureteric colic has also changed. The role of medical treatment has expanded beyond symptomatic control to attempt to target some of the factors in stone retention and thereby improve the likelihood of spontaneous stone expulsion. PMID:17621616

  18. Ureteral stenting with extracorporeal shock-wave lithotripsy.

    PubMed

    Cass, A S

    1992-05-01

    We reviewed the results of ureteral stent use with extracorporeal shock-wave lithotripsy (ESWL) in 3,096 patients with renal calculi less than 3 cm in diameter. The 2,595 patients with indwelling ureteral stents required lower total power (shocks x voltage) and less radiation and had a lower secondary procedure rate but a higher retreatment rate than the 501 patients without stents. However, the only statistically significant difference was in the average radiation dose in patients with or without stents and single stones no larger than 10 mm (16 vs. 18 rad). The hospital stay was one day or less in 98 percent of the patients in both groups. With an 80 percent follow-up rate at three months indwelling ureteral stents were associated with a higher stone-free rate in patients with a single stone but a lower stone-free rate in patients with multiple stones, compared with those treated without a stent. An indwelling ureteral stent may result in urinary frequency and bladder discomfort in some patients, and with no statistical difference in the results with or without a ureteral stent it is questionable whether or not the high use of an indwelling ureteral stent is justified in patients admitted for one day or less. PMID:1580036

  19. [Ureteral stenosis caused by pelvic actinomycosis].

    PubMed

    Gazaigne, J; Mornet, M; Mozziconacci, J G; Portal, B; Provendier, B

    1994-01-01

    The authors report a case of pelvic actinomycosis causing ureteral obstruction in a 30-year-old woman. An intra-uterine device being in place for 6 years is considered as the main cause. The treatment, which included a laparotomy for abscess drainage, an indwelling double pigtail ureteral stent and a 9 month antibiotherapy led to recovery after an initial relapse. PMID:7995966

  20. Kidney stone ablation times and peak saline temperatures during Holmium:YAG and Thulium fiber laser lithotripsy, in vitro, in a ureteral model

    NASA Astrophysics Data System (ADS)

    Hardy, Luke A.; Wilson, Christopher R.; Irby, Pierce B.; Fried, Nathaniel M.

    2015-02-01

    Using a validated in vitro ureter model for laser lithotripsy, the performance of an experimental Thulium fiber laser (TFL) was studied and compared to clinical gold standard Holmium:YAG laser. The Holmium laser (λ = 2120 nm) was operated with standard parameters of 600 mJ, 350 μs, 6 Hz, and 270-μm-core optical fiber. TFL (λ = 1908 nm) was operated with 35 mJ, 500 μs, 150-500 Hz, and 100-μm-core fiber. Urinary stones (60% calcium oxalate monohydrate / 40% calcium phosphate), of uniform mass and diameter (4-5 mm) were laser ablated with fibers through a flexible video-ureteroscope under saline irrigation with flow rates of 22.7 ml/min and 13.7 ml/min for the TFL and Holmium laser, respectively. The temperature 3 mm from tube's center and 1 mm above mesh sieve was measured by a thermocouple and recorded during experiments. Total laser and operation times were recorded once all stone fragments passed through a 1.5-mm sieve. Holmium laser time measured 167 +/- 41 s (n = 12). TFL times measured 111 +/- 49 s, 39 +/- 11 s, and 23 +/- 4 s, for pulse rates of 150, 300, and 500 Hz (n = 12 each). Mean peak saline irrigation temperatures reached 24 +/- 1 °C for Holmium, and 33 +/- 3 °C, 33 +/- 7 °C, and 39 +/- 6 °C, for TFL at pulse rates of 150, 300, and 500 Hz. To avoid thermal buildup and provide a sufficient safety margin, TFL lithotripsy should be performed with pulse rates below 500 Hz and/or increased saline irrigation rates. The TFL rapidly fragmented kidney stones due in part to its high pulse rate, high power density, high average power, and reduced stone retropulsion, and may provide a clinical alternative to the conventional Holmium laser for lithotripsy.

  1. Managing caliceal stones

    PubMed Central

    Gross, Andreas J.; Knipper, Sophie; Netsch, Christopher

    2014-01-01

    The natural course of untreated asymptomatic caliceal calculi has not been clearly defined, especially in terms of disease progression, and the indications for and outcomes of surgical intervention are not precise. Caliceal stones may remain asymptomatic but, in case of migration, ureteral calculi can cause acute ureteric colic with severe complications. The decision for an active treatment of caliceal calculi is based on stone composition, stone size and symptoms. Extracorporal shock-wave lithotripsy (ESWL) has a low complication rate and is recommended by the current guidelines of the European Association of Urology as a first-line therapy for the treatment of caliceal stones <2 cm in diameter. However, immediate stone removal is not achieved with ESWL. The primary stone-free rates (SFR) after ESWL depend on stone site and composition and, especially for lower pole calculi, the SFR differ widely from other caliceal stones. Minimally-invasive procedures including percutaneous nephrolithotomy and ureteroscopy are alternatives for the treatment of caliceal stones, associated with low morbidity and high primary SFR when performed in centers of excellence. PMID:24497690

  2. Ureteropyeloscopy and homium: YAG laser lithotripsy for treatment of ureteral calculi (report of 356 cases)

    NASA Astrophysics Data System (ADS)

    Wu, Zhong; Din, Qiang; Jiang, Hao-wen; Zen, Jing-cun; Yu, Jiang; Zhang, Yuanfang

    2005-07-01

    Objective: To evaluate the efficacy and safety of holmium YAG laser lithotripsy for the treatment of ureteral calculi. Methods: A total of 356 patients underwent ureteropyeloscopic lithotripsy using holmium YAG laser with a semirigid uretesopyeloscope, 93 upper, 135 middle, and 128 lower ureteral stones were treated. Results: The overall successful fragmentation rate for all ureteral stones in a single session achieved 98% (349/356). The successful fragmentation rate stratified by stone location was 95% 88/93 in the upper ureter, 99% (134/135) in the mid ureter , and 99%(127/128) in the distal ureter. 12 cases with bilateral ureteral stones which caused acute renal failure and anuria were treated rapidly and effectively by the holmium YAG laser lithotripsy. No complications such as perforation and severe trauma were encountered during the operations. 2 weeks 17months (with an average of 6.8 month ) follow up postoperatively revealed that the overall stone-free rate was 98%(343/349) and no ureteral stenosis was found. Conclusions Holmium YAG laser lithotripsy is a highly effective, minimally invasive and safe therapy for ureteral calculi. It is indicated as a first choice of treatment for patients with ureteral calculi, especially for the ones with mid- lower levels of ureteral calculi.

  3. The Role of Pharmacology in Ureteral Physiology and Expulsive Therapy

    NASA Astrophysics Data System (ADS)

    Jerde, Travis J.; Nakada, Stephen Y.

    2007-04-01

    Research in the field of ureteral physiology and pharmacology has traditionally been directed toward relaxation of ureteral spasm as a mechanism of analgesia during painful ureteral obstruction, most often stone-induced episodes. However, interest in this field has expanded greatly in recent years with the expanded use of alpha-blocker therapy for inducing stone passage, a usage now termed "medical expulsive therapy". While most clinical reports involving expulsive therapy have focused on alpha receptor or calcium channel blockade, there are diverse studies investigating pharmacological ureteral relaxation with novel agents including cyclooxygenase inhibitors, small molecule beta receptor agonists, neurokinin antagonists, and phosphodiesterase inhibitors. In addition, cutting edge molecular biology research is revealing promising potential therapeutic targets aimed at specific molecular changes that occur during the acute obstruction that accompanies stone disease. The purpose of this report is to review the use of pharmacological agents as ureteral smooth muscle relaxants clinically, and to look into the future of expulsive therapy by reviewing the available literature of ureteral physiology and pharmacology research.

  4. [A Case of Atazanavir Urolithiasis Diagnosed by Stone Analysis].

    PubMed

    Noma, Yasuhiro; Tambo, Mitsuhiro; Kitamura, Junji; Okegawa, Takatsugu; Nutahara, Kikuo

    2016-01-01

    A 70-year-old man was referred to our hospital for right back pain. His past history included human immunodeficiency virus infection, which had been treated with atazanavir for 7 years. Abdominal and pelvic computed tomographic scan showed right hydronephrosis due to a strongly suspected right ureteral radiolucent stone. He underwent indwelling of a right ureteral stent because of obstructive pyelonephritis due to the ureteral stone. After improvement of the pyelonephritis, he underwent transurethral ureterolithotripsy for the right ureteral stone. Stone analysis showed the atazanavir stone. He has been followed up for 8 months without evidence of recurrence. Herein, we report this rare case of an atazanavir stone in Japan, which was confirmed by calculus analysis, and present a review of the literature. PMID:26932333

  5. Use of ureteral access sheaths in ureteroscopy.

    PubMed

    Kaplan, Adam G; Lipkin, Michael E; Scales, Charles D; Preminger, Glenn M

    2016-03-01

    The ureteral access sheath (UAS) facilitates the use of flexible ureteroscopy, enabling improved minimally invasive management of complex upper urinary tract diseases. The UAS, which comes in a variety of diameters and lengths, is passed in a retrograde fashion, aided by a hydrophilic coating and other features designed to confer smooth passage into the ureter with sufficient resistance to kinking and buckling. Use of a UAS has the advantage of enabling repeated passage of the ureteroscope while minimizing damage to the ureter, thus improving the flow of irrigation fluid and visualization within the urethra with reductions in operative times, which improves both the effectiveness of the surgery and reduces the costs. Placement of the UAS carries an increased risk of ureteral wall ischaemia and injury to the mucosal or muscular layers of the ureter, and a theoretically increased risk of ureteral strictures. A ureteral stent is typically placed after ureteroscopy with a UAS. Endourologists have found several additional practical uses of a UAS, such as the percutaneous treatment of patients with ureteral stones, and solutions to other endourological challenges. PMID:26597613

  6. Ureteral stenting during extracorporeal shock wave lithotripsy: help or hindrance?

    PubMed

    Preminger, G M; Kettelhut, M C; Elkins, S L; Seger, J; Fetner, C D

    1989-07-01

    We retrospectively reviewed the outcome of extracorporeal shock wave lithotripsy in patients with renal calculi less than 3 cm. in size who were treated at a large multi-user lithotripsy center. Patients in whom indwelling ureteral stents were placed before lithotripsy treatment were subjected to higher levels of total power (shocks times voltage), yet the rate free of stones did not differ from those treated without a stent. In addition, the patients with internal ureteral stents experienced a significantly higher incidence of urinary urgency (43 versus 25 per cent) and hematuria (40 versus 23 per cent) than nonstented patients, respectively (p less than 0.05). Also, the duration of bladder discomfort was longer for stented patients (26 versus 13 per cent) as was the duration of urinary frequency (31 versus 16 per cent), compared to nonstented patients (p less than 0.05). The results suggest that use of an indwelling ureteral stent may not contribute to a higher rate free of stones for the treatment of small to medium sized renal calculi and, in fact, it may make the treatment more uncomfortable for the patient than performing lithotripsy without ureteral stenting. Of course, in selected cases (solitary kidney, large stone burden and aid in stone localization) ureteral stenting has a useful adjunctive role in extracorporeal shock wave lithotripsy. PMID:2733104

  7. Ureteric access sheath aided insertion of resonance metal ureteric stent

    PubMed Central

    Winter, Matthew; Strahan, Stephen; Wines, Michael

    2014-01-01

    Ureteral obstruction caused by malignancy is a challenging and often complicated problem for urologists. We present a novel technique of ureteric access sheath aided insertion of a Resonance metal ureteric stent in the setting of a difficult obstruction. PMID:24879725

  8. Genitourinary tuberculosis masquerading as a ureteral calculus

    PubMed Central

    Wong, Nathan; Hoag, Nathan A.; Jones, Edward C.; Rowley, Allen; McLoughlin, Martin G.; Paterson, Ryan F.

    2013-01-01

    The genitourinary tract is a common extrapulmonary site of tuberculosis infection, yet remains a rare clinical entity in North America. We report the case of a 37-year-old man who presented for extracorporeal shock wave lithotripsy for a suspected ureteral stone on imaging. Further workup confirmed a diagnosis of genitourinary tuberculosis. Medical management was undertaken and, ultimately, nephrectomy performed. This case highlights the importance of maintaining a high index of clinical suspicion for genitourinary tuberculosis. PMID:23766841

  9. Factors predicting the spontaneous passage of a ureteric calculus of ⩽10 mm

    PubMed Central

    Ahmed, Abul-fotouh; Gabr, Ahmed H.; Emara, Abdel-Aziz; Ali, Mahmoud; Abdel-Aziz, Al-Sayed; Alshahrani, Saad

    2014-01-01

    Objective To evaluate the outcome of the expectant management of ureteric stones and to determine the factors predictive of the spontaneous passage of stones. Patients and methods We retrospectively reviewed the medical records of patients who had ureteric stones of ⩽10 mm and who were treated conservatively at our institutions during the period 2008–2013. The stone-passage rate and time, and different clinical, laboratory and radiological variables, were analysed. Results In all, 163 patients with ureteric stones were enrolled in the study, of whom 127 (77.9%) passed their stones spontaneously, with a mean (SD) passage time of 24.0 (8.09) days. The cumulative stone-passage rate was 1.6%, 15%, 41.7%, 72.4%, 89.8% and 98.4% at 7, 14, 21, 28, 35 and 42 days from the first presentation, respectively. Patients with a high pain-scale score, stones of ⩽5 mm, a lower ureteric stone, a high white blood cell count and those with absent computed tomography (CT) findings of perinephric fat stranding (PFS) and tissue-rim sign (TRS) had a higher likelihood of spontaneous stone passage. Patients with stones of ⩽5 mm, stones in the lower ureter and those with no PFS had a shorter spontaneous passage time. In a multivariate analysis the absence of PFS and TRS were the only significant predictors for spontaneous stone passage (P < 0.001 and 0.002, respectively). Conclusions The spontaneous ureteric stone-passage rate and time varies with different factors. The absence of CT findings of PFS and TRS are significant predictors for stone passage, and should be considered when choosing the expectant management. PMID:26413326

  10. Modular flexible ureteroscopy and holmium laser lithotripsy for the treatment of renal and proximal ureteral calculi: A single-surgeon experience of 382 cases

    PubMed Central

    YAN, ZEJUN; XIE, GUOHAI; YUAN, HESHENG; CHENG, YUE

    2015-01-01

    To determine the safety and efficacy of modular flexible ureteroscopy and holmium laser lithotripsy for the treatment of renal and proximal ureteral calculi, a retrospective chart review of a single surgeon's 3-year modular flexible ureteroscopy experience was performed. All of the patients were treated with modular flexible ureteroscopy and holmium laser lithotripsy by a single surgeon. Stone-free status was defined as no fragments or a single fragment ≤4 mm in diameter at the 3-month follow-up. The procedure number, operative time, stone-free rates, repeat usage of the multilumen catheter, and perioperative complications were documented. The present study included 215 male patients and 167 female patients, with an average age of 48.5±13.7 years (range, 17–84 years). The mean stone size was 11.5±4.1 mm (range, 4–28 mm), and the mean total stone burden was 17.5±5.7 mm (range 15–46 mm). A total of 305 patients (79.8%) had a stone burden ≤20 mm, and 77 patients (20.2%) had a stone burden >20 mm. The mean number of primary procedures was 1.3±0.2 (range, 1–3). The stone-free rate following the first and the second procedure was 73.4 and 86.9%, respectively. The mean postoperative hospital stay was 3.1±1.2 days (range, 2–6 days). The highest clearance rates were observed for proximal ureteral stones (100%) and renal pelvic stones (88.7%), whereas the lowest clearance rates were observed for lower calyx stones (76.7%) and multiple calyx stones (77.8%). The higher the initial stone burden, the lower the postoperative stone-free rate (≤20 vs. >20 mm; 89.8 vs. 75.3%). The overall complication rate was 8.1%. The results of the present study suggest that modular flexible ureteroscopy with holmium laser lithotripsy may be considered the primary method for the treatment of renal and proximal ureteral calculi in select patients, due to its acceptable efficacy, low morbidity, and relatively low maintenance costs. PMID:26622508

  11. Proteus mirabilis fimbriae- and urease-dependent clusters assemble in an extracellular niche to initiate bladder stone formation.

    PubMed

    Schaffer, Jessica N; Norsworthy, Allison N; Sun, Tung-Tien; Pearson, Melanie M

    2016-04-19

    The catheter-associated uropathogenProteus mirabilisfrequently causes urinary stones, but little has been known about the initial stages of bladder colonization and stone formation. We found thatP. mirabilisrapidly invades the bladder urothelium, but generally fails to establish an intracellular niche. Instead, it forms extracellular clusters in the bladder lumen, which form foci of mineral deposition consistent with development of urinary stones. These clusters elicit a robust neutrophil response, and we present evidence of neutrophil extracellular trap generation during experimental urinary tract infection. We identified two virulence factors required for cluster development: urease, which is required for urolithiasis, and mannose-resistantProteus-like fimbriae. The extracellular cluster formation byP. mirabilisstands in direct contrast to uropathogenicEscherichia coli, which readily formed intracellular bacterial communities but not luminal clusters or urinary stones. We propose that extracellular clusters are a key mechanism ofP. mirabilissurvival and virulence in the bladder. PMID:27044107

  12. Use of drug therapy in the management of symptomatic ureteric stones in hospitalised adults: a multicentre, placebo-controlled, randomised controlled trial and cost-effectiveness analysis of a calcium channel blocker (nifedipine) and an alpha-blocker (tamsulosin) (the SUSPEND trial).

    PubMed Central

    Pickard, Robert; Starr, Kathryn; MacLennan, Graeme; Kilonzo, Mary; Lam, Thomas; Thomas, Ruth; Burr, Jennifer; Norrie, John; McPherson, Gladys; McDonald, Alison; Shearer, Kirsty; Gillies, Katie; Anson, Kenneth; Boachie, Charles; N'Dow, James; Burgess, Neil; Clark, Terry; Cameron, Sarah; McClinton, Samuel

    2015-01-01

    BACKGROUND Ureteric colic, the term used to describe the pain felt when a stone passes down the ureter from the kidney to the bladder, is a frequent reason for people to seek emergency health care. Treatment with the muscle-relaxant drugs tamsulosin hydrochloride (Petyme, TEVA UK Ltd) and nifedipine (Coracten(®), UCB Pharma Ltd) as medical expulsive therapy (MET) is increasingly being used to improve the likelihood of spontaneous stone passage and lessen the need for interventional procedures. However, there remains considerable uncertainty around the effectiveness of these drugs for routine use. OBJECTIVES To determine whether or not treatment with either tamsulosin 400 µg or nifedipine 30 mg for up to 4 weeks increases the rate of spontaneous stone passage for people with ureteric colic compared with placebo, and whether or not it is cost-effective for the UK NHS. DESIGN A pragmatic, randomised controlled trial comparing two active drugs, tamsulosin and nifedipine, against placebo. Participants, clinicians and trial staff were blinded to treatment allocation. A cost-utility analysis was performed using data gathered during trial participation. SETTING Urology departments in 24 UK NHS hospitals. PARTICIPANTS Adults aged between 18 and 65 years admitted as an emergency with a single ureteric stone measuring ≤ 10 mm, localised by computerised tomography, who were able to take trial medications and complete trial procedures. INTERVENTIONS Eligible participants were randomised 1 : 1 : 1 to take tamsulosin 400 µg, nifedipine 30 mg or placebo once daily for up to 4 weeks to make the following comparisons: tamsulosin or nifedipine (MET) versus placebo and tamsulosin versus nifedipine. MAIN OUTCOME MEASURES The primary effectiveness outcome was the proportion of participants who spontaneously passed their stone. This was defined as the lack of need for active intervention for ureteric stones at up to 4 weeks after randomisation. This was determined from 4- and 12-week case-report forms completed by research staff, and from the 4-week participant self-reported questionnaire. The primary economic outcome was the incremental cost per quality-adjusted life-year (QALY) gained over 12 weeks. We estimated costs from NHS sources and calculated QALYs from participant completion of the European Quality of Life-5 Dimensions health status questionnaire 3-level response (EQ-5D-3L™) at baseline, 4 weeks and 12 weeks. RESULTS Primary outcome analysis included 97% of the 1167 participants randomised (378/391 tamsulosin, 379/387 nifedipine and 379/399 placebo participants). The proportion of participants who spontaneously passed their stone did not differ between MET and placebo [odds ratio (OR) 1.04, 95% confidence interval (CI) 0.77 to 1.43; absolute difference 0.8%, 95% CI -4.1% to 5.7%] or between tamsulosin and nifedipine [OR 1.06, 95% CI 0.74 to 1.53; absolute difference 1%, 95% CI -4.6% to 6.6%]. There was no evidence of a difference in QALYs gained or in cost between the trial groups, which means that the use of MET would be very unlikely to be considered cost-effective. These findings were unchanged by extensive sensitivity analyses around predictors of stone passage, including sex, stone size and stone location. CONCLUSIONS Tamsulosin and nifedipine did not increase the likelihood of stone passage over 4 weeks for people with ureteric colic, and use of these drugs is very unlikely to be cost-effective for the NHS. Further work is required to investigate the phenomenon of large, high-quality trials showing smaller effect size than meta-analysis of several small, lower-quality studies. TRIAL REGISTRATION Current Controlled Trials ISRCTN69423238. European Clinical Trials Database (EudraCT) number 2010-019469-26. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 63. See the NIHR Journals Library website for further project information. PMID:26244520

  13. Management of full-length complete ureteral avulsion

    PubMed Central

    Tang, Kaifa; Sun, Fa; Tian, Yuan; Zhao, Yili

    2016-01-01

    ABSTRACT Introduction Complete ureteral avulsion is one of the most serious complications of ureteroscopy. The aim of this report was to look for a good solution to full-length complete ureteral avulsion. Case presentation A 40-year-old man underwent ureteroscopic management. Full-length complete avulsion of ureter occurred during ureteroscopy. Pyeloureterostomy plus greater omentum investment outside the avulsed ureter and ureterovesical anastomosis were performed 6 hours after ureteral avulsion. The patient was followed-up during 34 months. Double-J tube was removed at 3 months after operation. Twenty three months after the first operation, the patient developed hydronephrosis because of a new ureter upside stone, then rigid ureteroscopy and holmium laser lithotripsy were used successfully. Conclusion Pyeloureterostomy plus greater omentum investment outside the avulsed ureter and ureterovesical anastomosis may be a good choice for full-length complete ureteral avulsion. PMID:27136483

  14. Evolving Guidance on Ureteric Calculi Management in the Acute Setting.

    PubMed

    Makanjuola, Jonathan K; Rintoul-Hoad, Sophie; Bultitude, Matthew

    2016-03-01

    Ureteric colic is a common presentation to acute emergency services. The gold standard test for the diagnosis of acute ureteric colic is a non-contrast computer tomography of the kidneys ureters and bladder (CT KUB). Non-steroidal anti-inflammatory drugs (NSAIDs) should be used as first-line analgesia, with studies showing that there is no role for steroid or phosphodiesterase-5 inhibitors. There is emerging evidence that a high body mass index (BMI) is a risk factor. The drugs used to facilitate stone passage are known as medical expulsive therapy (MET). The most evaluated being alpha-blockers. The Spontaneous Urinary Stone Passage Enabled by Drugs (SUSPEND) trial was designed to evaluate the use of MET (tamsulosin and nifedipine). This trial showed that there was no difference with MET and placebo for the spontaneous passage of ureteric stones. There is an emerging role for the use of primary ureteroscopy in the management of non-infective ureteric stones. PMID:26874536

  15. Retrograde flexible ureteroscopy-assisted retroperitoneal laparoscopic ureteroureterostomy for refractory ureteral stricture: A case report

    PubMed Central

    Tsuru, Nobuo; Mugiya, Soichi; Sato, Shigenori

    2016-01-01

    Introduction Laparoscopic ureteroureterostomy (UU) is a preferred and valid minimally invasive procedure for treatment of benign ureteral strictures. In some cases with chronic inflammation or after repeated endoscopic ureteral surgery, it is difficult to identify the location of a ureteral stricture. Presentation of case We report a case of 48-year-old man with an impacted stone after laparoscopic partial nephrectomy. Although transurethral lithotripsy (TUL) was performed, the ureteral stricture did not improve by subsequent endoscopic ureteral Holmium laser incision and balloon dilation. Discussion To simultaneously identify the exact location of the constriction, we performed retroperitoneal laparoscopic ureteroureterostomy with intraoperative observations via super-slim flexible fiberoptic ureteroscopy retrograde. Conclusions Accurate identification of the ureteral stricture via observation by laparoscopy and observation by ureteroscopy was feasible. In contrast to the use of a rigid ureteroscopy, flexible fiberoptic ureteroscopy did not require placing the patient in an unnatural position. PMID:26826930

  16. Serial nominations for the AWH initiative: the paradigm of seven-stone antas and beyond

    NASA Astrophysics Data System (ADS)

    Belmonte, Juan Antonio; César González-García, A.; Hoskin, Michael

    2015-08-01

    Seven-stone antas are a group of megalithic monuments that were built in the southwest of the Iberian Peninsula for a period of some one thousand years in the 4th millennium B.C. They were constructed with a pattern of orientations that certainly situate them among the oldest monuments on Earth with undisputable astronomical orientations. They were built in an extended area of the present day regions of Alentejo, in Portugal and Extremadura, in Spain. The presence of such impressive, extremely old monuments at both sides of the Spanish-Portuguese frontier and their reliability as an extremely important Case Study for the UNESCO Astronomical Heritage initiative makes of this particular set of megalithic tombs a good opportunity as a paradigm for serial nominations. We believe that seven-stone antas as a group, and especially a particularly well-preserved set of them in the area of Valencia de Alcántara (Spain) and central Alentejo (Portugal), deserve recognition within the framework of the astronomical world heritage initiative. This would certainly serve for guarantee the protection of the sites for any possible challenge in the future and for gaining a deserved recognition among society. Interestingly, at the other extreme of the Mediterranean, in the Transjordan plateau there are some of the largest and most attractive groups of dolmens of the Levant, fully comparable to the best western exemplars. The orientations of 180 dolmens were measured, allowing the study of the astronomical aspect of the megalithic phenomena in the region. In this case, EBA populations orientated their tombs according to the sky, providing a 2nd potential case for serial nomination. However, in contrast to Iberia, we should stress that it is especially troubling that specialists in the Levant are now faced with the rapid destruction of Jordan’s megalithic heritage due to the huge quarries that are expanding as a plague. It is indeed necessary to increase the interest through UNESCO promotion on these beautiful and extremely interesting monuments. They may be seriously protected as soon as possible by local authorities before it is too late.

  17. Matched pair analysis of ureteroscopy vs. shock wave lithotripsy for the treatment of upper ureteric calculi.

    PubMed

    Stewart, G D; Bariol, S V; Moussa, S A; Smith, G; Tolley, D A

    2007-05-01

    There is controversy over whether shock wave lithotripsy (SWL) or ureteroscopy (URS) is the best management of ureteric calculi, especially for stones located in the upper ureter. This study compares URS and SWL management of upper ureteric stones directly for the first time using a different analysis tool, the matched pair analysis study design. This method enables meaningful comparisons to be made on a small number of matched patients, using precise like-for-like matching. Adult patients undergoing primary treatment of solitary radiopaque proximal ureteric stones were identified. Patients with stents, nephrostomies or stones at the pelvi-ureteric junction were excluded. Patients had a minimum of 3 months follow-up. Patients treated by primary URS were matched using four parameters (sex, laterality, stone size and location) to patients treated on a Dornier Compact Delta Lithotriptor. A total of 1479 patients had URS or SWL from which 27 upper ureteric stone matched pairs were identified. Three-month stone free rates were 82% for URS and 89% for SWL (McNemar's test, p=0.625). Re-treatment was required in 11% and 26% following URS and SWL respectively (p=0.219). Forty-one per cent of URS patients required an ancillary treatment, such as stent removal, compared with only 22% of SWL patients (p=0.227). Introduction of a holmium:YAG laser for use with URS improved the stone free rate for URS to 100%. Using a robust like-for-like comparison of similar patients with very similar upper ureteric stones the outcomes following SWL and URS were comparable. Choice of treatment should therefore be based on parameters such as availability of equipment, waiting times and patient preference. PMID:17386062

  18. Silent But Giant: Giant ureteric calculus in a 7-year-old boy

    PubMed Central

    Mak, D; Wragg, R; Chandran, H; McCarthy, R; Parashar, K

    2010-01-01

    Giant ureteric calculi are extremely rare in children. We present a case of a child who was originally admitted for observation following non-accidental injury and had an episode of painless haematuria as an inpatient. Ultrasonography demonstrated left hydronephrosis and a 2cm echogenic area in the proximal ureter. A plain abdominal radiograph surprisingly revealed two left ureteric calculi, one 7cm and the other 4cm in length. Stone extraction was achieved using an open left ureterolithotomy and pyelolithotomy. PMID:24946326

  19. Ureteroscopic removal of forgotten ureteral stent.

    PubMed

    Kawahara, Takashi; Ishida, Hiroaki; Kubota, Yoshinobu; Matsuzaki, Junichi

    2012-01-01

    A 69-year-old female had a right ureteral stent placed due to ureteral stricture resulting from cervical cancer in March 2008. The ureteral stent migrated to the ureter and was not exchanged. A new ureteral stent was inserted, and was exchanged every 3 months. The patient was referred to our department to remove the forgotten ureteral stent. In January 2012, her old ureteral stent was removed ureteroscopically, and no ureteral stent encrustation was found. PMID:22707678

  20. Hydronephrosis due to ureteral endometriosis in women of reproductive age

    PubMed Central

    Wang, Ping; Wang, Xue-Ping; Li, Yan-Yuan; Jin, Bai-Ye; Xia, Dan; Wang, Shuo; Pan, Hao

    2015-01-01

    Objective: The aim of the present study was to improve the understanding of ureteral endometriosis, and remind the clinics to be highly suspicious of it in women of reproductive age with hydronephrosis without evidence of stones and malignancy. Methods: A retrospective analysis was performed on a database of 82 patients who underwent surgery for hydronephrosis due to ureteral endometriosis between Jan. 2007 and Apr. 2014. Results: All patients evaluated in this study were divided into three groups: Group A consisted of patients between 20-30 years (n = 12), Group B comprised of patients between 31-40 years (n = 29), Group C consisted of patients between 41-50 years (n = 41). Patients in Group C had a greater prevalence of pelvic pain compared with patients in Group A and Group B (P < 0.05). However there were no differences with respect to the prevalence of other non-specific genitourinary symptoms and the urinary symptoms. Infertility was found to occur more frequently in patients in Group A compared with patients in Group B and Group C (P < 0.05). Because of the lack of specific symptoms, ureteral endometriosis was diagnosed (20.1 ± 10.3) months on average after the patients suffered from mild hydronephrosis or mild loin pain. Preoperative examinations showed different degree of hydronephrosis, but lack of specificity. All patients underwent surgery by laparotomy or laparoscopy, such as ureterectomy with ureteroureterostomy or ureterocystoneostomy. The pathological examination confirmed the diagnosis of ureteral endometriosis. Conclusion: The diagnosis of ureteral endometriosis is elusive and relies heavily on clinical suspicion. Hence, women in the reproductive age, especially with infertility and pelvic pain, who have hydronephrosis without evidence of stones and malignance, should be adequately assessed via imaging techniques or diagnostic laparoscopy or cystoscopy to highly suspect the diagnosis of ureteral endometriosis. PMID:25785093

  1. Calculus-related ureteral intussusception: A case report and literature review

    PubMed Central

    Sewell, James; Blecher, Gideon; Tsai, Ken; Bishop, Conrad

    2015-01-01

    Introduction Ureteral intussusception is a rarely reported condition, primarily as a complication of ureteric tumours. Fewer than 30 case reports have been made. This case represents the first reported case, to our knowledge, of ureteral intussusception caused by a ureteric calculus. Presentation of case We present the case of a 70 year old man with a history of conservatively managed renal calculi, in whom obstructive ureterolithiasis was incidentally detected. Retrograde pyelography and ureteroscopy revealed intussusception of the ureter around a calculus. Extensive biopsies revealed no evidence of tumour, and the intussusception resolved following stone clearance. Discussion Literature review of previously reported cases of ureteral intussusception revealed 26 cases, of which 22 were secondary to tumour and 4 were secondary to surgical procedures. We propose a mechanism by which calculus-related ureteral intussusception may occur, and suggest treatment for this condition. Conclusion Calculus-related ureteral intussusception is a rare condition, of which this represents the only case report. Management of the condition should involve excluding the presence of tumour, and then clearing the stone, avoiding the use of a basket for retrieval of fragments. PMID:26011803

  2. Evaluation of risk factors and treatment options in patients with ureteral stricture disease at a single institution

    PubMed Central

    Tran, Henry; Arsovska, Olga; Paterson, Ryan F.; Chew, Ben H.

    2015-01-01

    Introduction: Ureteral strictures are a significant cause of morbidity and mortality, resulting in potential kidney damage requiring several surgical procedures. Non-malignant causes include radiation, trauma from calculi impaction, pelvic surgery, or ureteroscopy (URS). We identified risk factors in our patients with ureteral strictures and the success of their treatment outcomes. Methods: A retrospective chart review of 25 patients with 29 ureteral strictures was performed to determine the success of their treatment. Results: Twenty-five (25) patients with 29 benign ureteral strictures were identified. Most cases (60%) were caused by impacted stones where the median stone size was 1.15 cm (0.37–1.8 cm). Intervention for stones prior to stricture development included shockwave lithotripsy, URS, and percutaneous nephrolithotomy. Five patients with strictures from impacted stones had ureteric complications during stone treatment including perforation +/− urinoma (n=3), fractured guidewire left in situ (n=1), and ureteric orifice resection (n=1). Other stricture etiologies included radiation (28%) and endometriosis (4%). Treatment modalities used included ureteroureterostomy (n=2), ureteral re-implant (n=3), urinary diversion (n=3), autotrasplant (n=1), laser endoureterotomy +/− balloon dilation (n=8), nephrectomy (n=2), balloon dilation +/− stent (n=3), ureterovesical junction (UVJ) resection + stent (n=1), chronic stent changes (n=4), or surveillance (n=3). Conclusions: Our evaluation highlights important principles. Patients with complicated ureteroscopies or severely impacted calculi warrant close followup with imaging after stone treatment due to possibility of rapid renal deterioration from stricture formation. Radiation-induced strictures are difficult to manage, possibly requiring subsequent urinary diversion. Finally, endoscopic management of benign ureteral strictures via balloon dilation and laser endoureterotomy is an excellent choice in properly selected patients, with opportunity for subsequent salvage treatments if needed. PMID:26788241

  3. Ureteroscopy and holmium:YAG laser lithotripsy: an emerging definitive management strategy for symptomatic ureteral calculi in pregnancy

    NASA Astrophysics Data System (ADS)

    Watterson, James D.; Girvan, Andrew R.; Beiko, Darren T.; Nott, Linda; Wollin, Timothy A.; Razvi, Hassan A.; Denstedt, John D.

    2003-06-01

    Objectives: Symptomatic urolithiasis in pregnancy that does not respond to conservative measures has traditionally been managed with ureteral stent insertion or percutaneous nephrostomy (PCN). Holmium:yttrium-aluminum-garnet (YAG) laser lithotripsy using state-of-the-art ureteroscopes represents an emerging strategy for definitive stone management in pregnancy. The purpose of this study was to review the results of holmium laser lithotripsy in a cohort of patients who presented with symptomatic urolithiasis in pregnancy. Methods: A retrospective analysis was conducted at 2 tertiary stone centers from January 1996 to August 2001 to identify pregnant patients who were treated with ureteroscopic holmium laser lithotripsy for symptomatic urolithiasis or encrusted stents. Eight patients with a total of 10 symptomatic ureteral calculi and 2 encrusted ureteral stents were treated. Mean gestational age at presentation was 22 weeks. Mean stone size was 8.1 mm. Stones were located in the proximal ureter/ureteropelvic junction (UPJ) (3), mid ureter (1), and distal ureter (6). Results: Complete stone fragmentation and/or removal of encrusted ureteral stents were achieved in all patients using the holmium:YAG laser. The overall procedural success rate was 91%. The overall stone-free rate was 89%. No obstetrical or urological complications were encountered. Conclusions: Ureteroscopy and holmium laser lithotripsy can be performed safely in all stages of pregnancy providing definitive management of symptomatic ureteral calculi. The procedure can be done with minimal or no fluoroscopy and avoids the undesirable features of stents or nephrostomy tubes.

  4. Xenx (Xenolith): preliminary considerations of a new "all-in-one" ureteral guidewire and anti-repulsion device.

    PubMed

    Montanari, Emanuele; Longo, Fabrizio; Macchione, Nicola; Traxer, Olivier

    2015-04-01

    A new anti-retropulsion device for the endoscopic treatment of ureteral stones was evaluated for safety and potential efficacy. The Xenx™ (Rocamed, Monaco-Montecarlo) is an anti-retropulsion device that operates as a normal hydrophilic guidewire when "closed" and as a nitinol ureteral mesh when "open". We performed semirigid ureterorenoscopy and Ho:YAG Laser lithotripsy in 15 patients, with a single ureteral stone. For each procedure, the papilla was negotiated with the Xenx™, the radiopaque markers were positioned over the stone via direct visualization and the device was opened under fluoroscopic control. The ureteroscope was then retracted and reinserted beside the Xenx™. At the end of the procedure, the Xenx™ was closed, and a ureteral catheter was coaxially placed and left for 24-48 h post-operation. We evaluated device positioning success with respect to pushability, ease of deployment, full expansion and fitting with the ureteral walls, kink resistance and stone retention capabilities during lithotripsy and device retrieval. Operative time, post-operative complications (Clavien-Dindo scale), ultrasound kidney stone-free rate and the hydronephrosis grade, were also recorded. At 4 weeks post-operation, the stone-free rate was assessed via non-contrast computed tomography with 1-mm slices. All procedures were successfully accomplished without complications according to the Clavien-Dindo scale. In all the cases, Xenx™ was inserted successfully past the stone and opened over it. In 4/15 cases (27%) some difficulties in pushability and kink resistance were recorded. In no case stone fragment basketing was performed. The median operative time was 24 min. At hospital discharge, 14/15 patients (93%) were kidney stone-free. At 4 weeks, the NCCT stone-free rate was 100%. This study demonstrated that the Xenx™ is safe and effective in terms of the stone-free rate, complications and operating time. Moreover, use of the Xenx™ allows the use of a basket or guide wire to be avoided. PMID:25392003

  5. Nephroliths and ureteroliths: a new stone age.

    PubMed

    Adams, L G

    2013-07-01

    Nephroliths may obstruct the renal pelvis or ureter, predispose to pyelonephritis, or result in compressive injury of the renal parenchyma leading to progressive chronic kidney disease. Indications for removal of nephroliths in dogs include obstruction, recurrent infection, progressive nephrolith enlargement, presence of clinical signs (renal pain), and patients with nephroliths in a solitary functional kidney. The most common indication for removal of upper tract uroliths in cats is ureteral obstruction caused by ureteroliths. Nonobstructive nephroliths in cats are not usually treated unless they move into the ureter resulting in ureteral obstruction. The treatment approach to nephroliths and ureteroliths is different for dogs versus cats. Surgical removal of nephroliths or ureteroliths by nephrotomy and ureterotomy respectively is associated with potential for complications in more than 30% of cats treated by ureterotomy; therefore, minimally invasive options should also be considered. Extracorporeal shock wave lithotripsy (ESWL) treatment of nephroliths results in small "passable" stone fragments in most dogs, whereas ESWL does not work effectively in cats. Ureteral stents are effective for relief of ureteral obstruction by ureteroliths in both dogs and cats. Ureteral stents may be left in place long-term to relieve ureteral obstruction by ureteroliths. Post-operative morbidity and mortality are substantially lower for ureteral stent placement compared to open surgical ureterotomy in cats. PMID:23484823

  6. Ureteral wound caused by blunt abdominal trauma.

    PubMed

    Gunnarsson, Ulf; Lewenhaupt, Arvid; Heuman, Rolf

    2003-01-01

    A man fell on icy ground whilst walking to an outdoor toilet. An initial CT scan with intravenous contrast medium was negative. As the man experienced increasing pain a plain abdominal radiograph was performed 2 h later and revealed extravasation of contrast medium emanating from a ureteral injury. This case underlines the possibility that important injuries may not be visible on the initial CT scan that is often used in trauma diagnostics. PMID:12745753

  7. Effects of PDE5 Inhibitors and sGC Stimulators in a Rat Model of Artificial Ureteral Calculosis

    PubMed Central

    Sandner, Peter; Tinel, Hanna; Affaitati, Giannapia; Costantini, Raffaele; Giamberardino, Maria Adele

    2015-01-01

    Urinary colics from calculosis are frequent and intense forms of pain whose current pharmacological treatment remains unsatisfactory. New and more effective drugs are needed to control symptoms and improve stone expulsion. Recent evidence suggested that the Nitric Oxide (NO) / cyclic guanosine monophosphate (cGMP) / phosphodiesterase type 5 (PDE5) system may contribute to ureteral motility influencing stone expulsion. We investigated if PDE5 inhibitors and sGC stimulators influence ureteral contractility, pain behaviour and stone expulsion in a rat model of ureteral calculosis. We investigated: a)the sex-specific PDE5 distribution in the rat ureter; b)the functional in vitro effects of vardenafil and sildenafil (PDE5 inhibitors) and BAY41-2272 (sGC stimulator) on induced ureteral contractility in rats and c)the in vivo effectiveness of vardenafil and BAY41-2272, alone and combined with ketoprofen, vs hyoscine-N-butylbromide alone or combined with ketoprofen, on behavioural pain indicators and stone expulsion in rats with artificial calculosis in one ureter. PDE5 was abundantly expressed in male and female rats’ ureter. In vitro, both vardenafil and BAY41-2272 significantly relaxed pre-contracted ureteral strips. In vivo, all compounds significantly reduced number and global duration of “ureteral crises” and post-stone lumbar muscle hyperalgesia in calculosis rats. The highest level of reduction of the pain behaviour was observed with BAY41-2272 among all spasmolytics administered alone, and with the combination of ketoprofen with BAY41-2272. The percentage of stone expulsion was maximal in the ketoprofen+BAY41-2272 group. The NO/cGMP/PDE5 pathway is involved in the regulation of ureteral contractility and pain behaviour in urinary calculosis. PDE5 inhibitors and sGC stimulators could become a potent new option for treatment of urinary colic pain. PMID:26509272

  8. Initial experiences with laparoscopy and flexible ureteroscopy combination pyeloplasty in management of ectopic pelvic kidney with stone and ureter-pelvic junction obstruction.

    PubMed

    Yin, Zhuo; Wei, Y B; Liang, B L; Zhou, K Q; Gao, Y L; Yan, B; Wang, Z; Yang, J R

    2015-06-01

    To demonstrate the safety and efficacy of combine laparoscopy and flexible ureteroscopy to treat ectopic pelvic kidneys with ureteropelvic junction obstruction (UPJO) and stones. 16 patients of ectopic pelvic kidneys with ureteropelvic junction obstruction and stones were treated with laparoscopy and flexible ureteroscopy (FURS). The operative time, required dose of tramadol, visual analog pain scale (VAPS), postoperative day, stone-free rates (SFRs), perioperative complications, and serum creatinine were evaluated. The SFRs were evaluated with noncontrasted renal computed tomography (CT). Intravenous pyelography (IVP) and CT scan were used to evaluate the UPJO. Stone-free status was defined as absence of stone fragments in kidney or the size of that is less than 3 mm. Operation time from 118 to 225 min, average time (171 ± 28) min; lithotomy time from 16 to 45 min, average time (32 ± 6) min. Average tramadol required at the first day postoperation was (118 ± 49.6) mg; at the second day was (78 ± 24.8) mg. VAPS score at 24 h (5.0 ± 0.7), VAPS score at 48 h (2.5 ± 0.8). Postoperative day (3.9 ± 0.6) days. Stone-free rate was 100%. Average serum creatinine was (88.7 ± 24.3) mol/L before surgery and (92.8 ± 21.6) mol/L after surgery. No major complication. No stone and obstruction recurrence in the follow-up of average 29.3 months. Combined FUR and LC is a good option for patient of ectopic pelvic kidney with renal stone and UPJO. From our initial experience, the SFRs and the effect of pyeloplasty are satisfactory and without major complication, the operative time is acceptable. PMID:25666341

  9. Management of iatrogenic ureteral injury

    PubMed Central

    Burks, Frank N.

    2014-01-01

    Iatrogenic injury to the ureter is a potentially devastating complication of modern surgery. The ureters are most often injured in gynecologic, colorectal, and vascular pelvic surgery. There is also potential for considerable ureteral injury during endoscopic procedures for ureteric pathology such as tumor or lithiasis. While maneuvers such as perioperative stenting have been touted as a means to avoid ureteral injury, these techniques have not been adopted universally, and the available literature does not make a case for their routine use. Distal ureteral injuries are best managed with ureteroneocystostomy with or without a vesico-psoas hitch. Mid-ureteral and proximal ureteral injuries can potentially be managed with ureteroureterostomy. If the distal segment is unsuitable for anastomosis then a number of techniques are available for repair including a Boari tubularized bladder flap, transureteroureterostomy, or renal autotransplantation. In rare cases renal autotransplantation or ureteral substitution with gastrointestinal segments may be warranted to re-establish urinary tract continuity. Laparoscopic and minimally invasive techniques have been employed to remedy iatrogenic ureteral injuries. PMID:24883109

  10. Computed tomography-based novel prediction model for the stone-free rate of ureteroscopic lithotripsy.

    PubMed

    Kim, Jong Wook; Chae, Ji Yun; Kim, Jin Wook; Oh, Mi Mi; Park, Hong Seok; Moon, Du Geon; Yoon, Cheol Yong

    2014-02-01

    The purpose of this study was to evaluate whether computed tomography (CT) parameters can predict the success of ureteroscopic lithotripsy (URSL) and establish a model for predicting the success rates of a single URSL procedure for the treatment of a single ureteral stone. We retrospectively reviewed the records of 237 patients who underwent URSL for ureteral stones diagnosed by CT between January 2009 and June 2012. Stone-free status was defined as the absence of stones or residual stone fragments <2 mm by ureteroscopy and plain abdominal radiography. We analyzed the correlations between the outcome of URSL and the patients' sex, age, height, body weight, body mass index, and history of ureteral stone. Stone factors such as the diameter (D), stone height (H), volumetric stone burden (VSB; D(2) × H × 5 mm × π × 1/6), estimated stone location (ESL; number of axial cut images between the stone and uretero-vesical junction), tissue rim sign (RS; 0-3), perinephric edema (0-3), hydronephrosis (0-3), and Hounsfield unit (HU) were also analyzed. We then developed a model to predict the probability of successful URSL by applying a logistic model to our data. The success rate of URSL was 85.7% (203/237). Univariate analysis found that stone diameter, length, VSB, ESL, HU and RS significantly affected the stone-free rate. Multivariate analysis indicated that stone diameter, ESL and RS independently influenced the stone-free rate. The logistic model indicated that success rates = 1/[1 + exp{-6.146 + 0.071(D) + 0.153(ESL) + 1.534(RS)}] with an area under the receiver operating characteristic curve of 0.825. Stone diameter, ESL, and RS were independent predictors of the outcome of a single URSL for a single ureteral stone. PMID:24162952

  11. Ureteric Suture Urolithiasis Following Open Emergency Ureteric Repair

    PubMed Central

    Sarmah, Piyush B.; Kelly, Brian D.; Devarajan, Raghuram

    2016-01-01

    Suture urolithiasis is an unusual but recognised phenomenon following surgery on the urinary tract. We report a case in a 30-year-old man who sustained a gunshot injury to the left ureter in Burundi and underwent open ureteric repair in a regional hospital. He migrated to the UK and presented one year later with left loin pain. An intravenous urogram revealed two foci of calcification to the left of L3, within a peri-ureteric position. The patient underwent left-sided ureteroscopy where two calculi each formed around a nylon suture were discovered within a ureteric pseudo-diverticulum, and basketed. This is the first reported case of suture urolithiasis occurring following ureteric surgery. PMID:26989371

  12. Ureteric Suture Urolithiasis Following Open Emergency Ureteric Repair.

    PubMed

    Sarmah, Piyush B; Kelly, Brian D; Devarajan, Raghuram

    2016-02-01

    Suture urolithiasis is an unusual but recognised phenomenon following surgery on the urinary tract. We report a case in a 30-year-old man who sustained a gunshot injury to the left ureter in Burundi and underwent open ureteric repair in a regional hospital. He migrated to the UK and presented one year later with left loin pain. An intravenous urogram revealed two foci of calcification to the left of L3, within a peri-ureteric position. The patient underwent left-sided ureteroscopy where two calculi each formed around a nylon suture were discovered within a ureteric pseudo-diverticulum, and basketed. This is the first reported case of suture urolithiasis occurring following ureteric surgery. PMID:26989371

  13. URETERIC ANGIOMYOLIPOMA CAUSING UNILATERAL PELVI-URETERIC JUNCTION OBSTRUCTION.

    PubMed

    Khan, Iftikhar Ali; Shahab, Durre; Rehman, Asad; Jamil, Imran; Akhter, Saeed

    2015-01-01

    A 63-year-old lady, presented to us with nonspecific abdominal pain. Ultrasonography (USG) and CT scan abdomen and pelvis, showed right moderate hydronephrosis, with no evidence of mass at pelvi-ureteric junction (PUJ) obstruction. Per-operatively mass upper ureter was found obstructing PUJ. Mass was excised and pyeloplasty done, with Double J (DJ) Stenting. Stent was removed after a week. Histopathology of specimen showed upper ureteric Angiomyolipoma. PMID:26182785

  14. Epidemiologic insights into pediatric kidney stone disease.

    PubMed

    Matlaga, Brian R; Schaeffer, Anthony J; Novak, Thomas E; Trock, Bruce J

    2010-12-01

    The epidemiology of pediatric kidney stone has not yet been as rigorously defined as that of adult kidney stone disease. Herein, we review our recent epidemiologic works characterizing pediatric stone disease using the Kids' Inpatient Database (KID). Specifically we investigated the age and gender distribution of pediatric kidney stone disease, changes in disease prevalence over time, and medical comorbidities associated with this disorder. We identified patients by International Classification of Disease 9th Edition (ICD-9) codes for renal and ureteral calculi as the primary diagnosis. Medical comorbidities were identified using specific comorbidity software. Statistical comparisons between children with and without stone disease were performed. In the first decade of life, stone disease was more prevalent among males than females; however, in the second decade of life females were more commonly affected. Of note, there was a significant increase in treated stone disease across both genders between 1997 and 2003. We also found that the risk of kidney stone diagnosis in children younger than 6 years of age was significantly associated with hypertension and diabetes mellitus. The gender distribution among pediatric stone formers varies significantly by age, although overall females have a greater prevalence than males. There is also a strong association of stone disease and both diabetes and hypertension, although this was only observed in children less than 6 years of age. Taken all together, these findings suggest that urolithiasis in the young child is a complex systemic disease process. PMID:20967433

  15. [Impacted ureteral stents with cystine encrustation in cystinuric patients : report of two cases].

    PubMed

    Nakanishi, Yukako; Hanasaki, Takeshi; Yo, Toeki; Shiraishi, Yusuke; Togo, Yoshikazu; Taoka, Rikiya; Suzuki, Toru; Higuchi, Yoshihide; Kanematsu, Akihiro; Hashimoto, Takahiko; Doi, Yutaka; Nojima, Michio; Yamamoto, Shingo

    2013-10-01

    A 23-year-old man and a 62-year-old man suffering from cystinuria underwent extracorporeal shock wave lithotripsy (ESWL) for right renal stone and left ureteral stone, respectively. They had double-J stents placed before ESWL, but since attempts to retrieve the stents were unsuccessful due to encrustation, they were referred to our clinic. Multimodal endourologic and open approaches including ESWL, transurethral ureterolithotripsy, and pyelolithotomy were required to render them stent- and stone-free. The guidelines do not recommend routine stenting before ESWL ; therefore, the indication and duration of indwelling stents should be minimized. Multimodal options including not only ESWL and endoscopic surgery but also open surgery, should be attempted for the management of encrusted stents. Close monitoring and follow up are important to the prevent complications of ureteral stents. PMID:24262706

  16. The ureteric bud epithelium: Morphogenesis and roles in metanephric kidney patterning

    PubMed Central

    Nagalakshmi, Vidya K.; Yu, Jing

    2015-01-01

    The mammalian metanephric kidney is composed of two epithelial components –the collecting duct system and the nephron epithelium– that differentiate from two different tissues –the ureteric bud epithelium and the nephron progenitors, respectively– of intermediate mesoderm origin. The collecting duct system is generated through reiterative ureteric bud branching morphogenesis whereas the nephron epithelium is formed in a process termed nephrogenesis, which is initiated with the mesenchymal-epithelial transition of the nephron progenitors. Ureteric bud branching morphogenesis is regulated by nephron progenitors, and in return the ureteric bud epithelium regulates nephrogenesis. The metanephric kidney is also physiologically divided along the cortico-medullary axis into subcompartments that are enriched with specific segments of these two epithelial structures. Here we provide an overview of the major molecular and cellular processes underlying the morphogenesis and patterning of the ureteric bud epithelium and its roles in the cortical-medullary patterning of the metanephric kidney. PMID:25783232

  17. Bladder stones

    MedlinePlus

    Stones - bladder; Urinary tract stones; Bladder calculi ... Benway BM, Bhayani SM. Lower urinary tract calculi. In: Wein AJ, ed. Campbell-Walsh Urology . 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 89. Sharma R, Dill CE, Gelman DY. Urinary ...

  18. Kidney stones

    MedlinePlus

    ... dissolved in the urine can crystallize, forming a kidney stone (renal calculus). Usually the calculus is the size ... painful. Often, people may not know they have kidney stones until they feel the painful symptoms resulting from ...

  19. Ureteric sarcoidosis — a rare entity

    PubMed Central

    Kalia, V; Vishal, K; Gill, J S; Gill, A

    2010-01-01

    Primary ureteric involvement in sarcoidosis is very rare; to our knowledge, only a few cases have been reported in the literature. We present here a rare case of ureteric sarcoidosis presenting with obstructive uropathy. PMID:21088080

  20. Laparoscopic Stone Surgery With the Aid of Flexible Nephroscopy

    PubMed Central

    Jung, Jae Hyun; Cho, Sung Yong; Jeong, Chang Wook; Jeong, Hyeon; Son, Hwancheol; Woo, Seung Hyo; Kim, Dae Kyung; Min, Sun-Ho; Oh, Seung-June; Kim, Hyeon-Hoe

    2014-01-01

    Purpose To report the outcome of laparoscopic pyelo- and ureterolithotomies with the aid of flexible nephroscopy. Materials and Methods A retrospective analysis was performed in 71 patients with complex renal stones or large and impacted proximal ureteral stones. Patients underwent laparoscopic pyelo- or ureterolithotomies with or without the removal of small residual stones by use of flexible nephroscopy between July 2005 and July 2010. Operative success was defined as no residual stones in the intravenous pyelogram at 12 weeks postoperatively. Perioperative results and surgical outcomes were analyzed. Results The patients' mean age was 54.7±13.7 years, and 53 males (74.6%) and 18 females (25.4%) were included. The mean maximal stone size was 19.4±9.4 mm. A total of 47 cases were complex renal stones and 24 cases were impacted ureteral stones. Mean operative time was 139.0±63.7 minutes. Stones were completely removed in 61 cases (85.9%), and no further ancillary treatment was needed for clinically insignificant residual fragments in 7 cases (9.9%). For complex renal stones, the complete stone-free rate and clinically significant stone-free rate were 80.9% and 93.6%, respectively. Multivariate analysis showed that the use of flexible nephroscopy for complex renal stones can reduce the risk of residual stones. A major complication occurred in one case, in which open conversion was performed. Conclusions Laparoscopic stone surgery is a safe and minimally invasive procedure with a high success rate, especially with the aid of flexible nephroscopy, and is not associated with procedure-specific complications. PMID:25045447

  1. 21 CFR 876.4620 - Ureteral stent.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Ureteral stent. 876.4620 Section 876.4620 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4620 Ureteral stent. (a) Identification. A ureteral...

  2. 21 CFR 876.4620 - Ureteral stent.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ureteral stent. 876.4620 Section 876.4620 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4620 Ureteral stent. (a) Identification. A ureteral...

  3. Arterio-Ureteric Fistula Following Iliac Angioplasty

    SciTech Connect

    Aarvold, Alexander; Wales, Lucy Papadakos, Nikolaos; Munneke, Graham; Loftus, Ian; Thompson, Matt

    2008-07-15

    Arterio-ureteric fistulae are rare but can be associated with significant morbidity and mortality. We describe a novel case in which an arterio-ureteric fistula occurred as a complication following external iliac artery angioplasty and stenting, in a patient who had undergone previous pelvic surgery, radiotherapy, ureteric stenting, and urinary diversion surgery. Prompt recognition enabled successful endovascular management using a covered stent.

  4. Spontaneous retrograde migration of ureterovesical junction stone to the kidney; first ever reported case in the English literature in human

    PubMed Central

    Khan, Ziauddin; Yaqoob, Alaeddin A.; Bhatty, Tanweer A.

    2016-01-01

    We present a case of spontaneous retrograde migration of ureterovesical junction stone to the kidney. A 26-year-old Bahraini male, diagnosed with left lower ureteric stone 7 months before this presentation. On his recent presentation, the stone has migrated down but not passed, confirmed on imaging. Operative removal was planned. X-ray kidney ureter bladder (KUB) in the morning of surgery did not reveal stone in the ureter, but the same shadow was seen in the kidney. An urgent computerized tomography-KUB was done, and this confirms the stone has migrated to the kidney. Surgery was canceled, and the stone was dealt with extracorporeal shockwave lithotripsy and was fragmented in the first session. This retrograde migration of lower ureteric stone to the kidney is not reported in the English literature in human before. PMID:27141199

  5. Dimension stone

    USGS Publications Warehouse

    Dolley, T.P.

    2003-01-01

    Dimension stone can be defined as natural rock material quarried to obtain blocks or slabs that meet specifications as to size (width, length and thickness) and shape for architectural or engineering purposes. Color, grain texture and pattern, and surface finish of the stone are also normal requirements. Other important selection criteria are durability (based on mineral composition, hardness and past performance), strength and the ability of the stone to take a polish.

  6. Ureteroscopic Lithotripsy Using Swiss Lithoclast for Treatment of Ureteral Calculi: 12-Years Experience

    PubMed Central

    Park, Dong Soo

    2009-01-01

    Ureteroscopic lithotripsy using Swiss Lithoclast was performed in 411 cases from January 1996 to September 2007 in a single hospital. Medical records of 341 cases, in which Swiss Lithoclast was successfully applied, were available for this retrospective study. We used 9.5Fr and 10Fr Storz rigid ureteroscopes. A success was defined as being free of stone-related symptoms and residual stones larger than 2 mm. Sixty one stones were located in the upper ureter, 49 stones were in the mid ureter, and 231 stones were in the lower ureter. The overall success rate was 93.5%. The success rate of upper ureter stone (80.3%) was significantly lower compared with those of mid (93.8%) and lower (96.9%) ureter stones (P=0.001). The higher the calculi was located within the ureter, the more chance of upward migration there was (P<0.001). The success rate in male patients was lower than in female patients without a statistical significance (P=0.068). The success rate decreased as the size of the stone increased (P<0.001), and as the degree of hydronephrosis increased (P=0.03). Perforation rates were 4.9%, 4.1%, and 2.6% from upper to lower ureter stone group. Ureteroscopic lithotripsy using Swiss Lithoclast is a safe and useful treatment modality for ureteral calculi. PMID:19654954

  7. Ultrasonic Destruction of Kidney Stones

    PubMed Central

    Brannen, George E.; Bush, William H.

    1984-01-01

    Kidney stones may be removed without using a surgical incision by a combination of techniques and skills recently developed in the fields of urology and radiology. Percutaneous access to the kidney is established under fluoroscopic control. A guide wire placed into the renal pelvis allows a nephroscope to be inserted and the collecting system visualized. A long hollow metal probe is advanced through the nephroscope and placed in contact with the stone. This probe conducts the ultrasonic energy. The stone absorbs the energy and breaks into fine granules, which are evacuated by suction. Twenty-three consecutively seen patients presenting with 27 upper urinary tract calculi for which removal was indicated underwent successful percutaneous ultrasonic lithotripsy. Fifteen stones were located in the renal pelvis, eight in a calix, three at the ureteropelvic junction and one in the upper ureter. One infected staghorn calculus was removed. Two complications resulted in extended hospital stays, but in no patients were surgical incisions required. Of the 23 patients, 9 had previously had a surgical lithotomy. The authors believe that most renal and upper ureteral calculi for which removal is indicated may be extracted percutaneously with the aid of the ultrasonic lithotriptor. The patients may expect a rapid convalescence with diminished pain. Images PMID:6730470

  8. Ureteroscopy-assisted retrograde nephrostomy (UARN) without ureteral access sheath (UAS)

    PubMed Central

    Kawahara, Takashi; Ito, Hiroki; Terao, Hideyuki; Uemura, Hiroji; Yao, Masahiro; Matsuzaki, Junichi

    2015-01-01

    Introduction We previously described ureteroscopy assisted retrograde nephrostomy (UARN). In UARN, it is possible to continuously visualize the dilation of the ureter from puncture to insertion of the nephroaccess sheath with minimal complication. But in the course of making nephrostomy, UARN requires ureteral access sheath (UAS). UAS has a potential risk of ureteral stricture. Herein, we report the first case of UARN without the use of UAS. Presentation of case A 53-year-old female was referred to our hospital for treatment of her right renal stone. Because her stone burden was 27mm, we planned to perform percutaneous nephrolithotomy (PCNL) using UARN without UAS. Discussion UAS facilitates a decrease in the intrarenal pressure due to irrigation, and it makes controlling the URS easier. However, in terms of the risk of ureteral stricture, unnecessary insertion of a UAS should be avoided. Conclusion We describe the first case of a renal stone successfully treated by PCNL using the UARN method without the use of a UAS. PMID:25813125

  9. Kidney Stones

    MedlinePlus

    ... when you urinate Your doctor will diagnose a kidney stone with urine, blood, and imaging tests. If you have a stone that won't pass on its own, you may need treatment. It can be done with shock waves; with ...

  10. Stone chewing

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Picking stones up into the mouth and chewing them has been commonly reported in pigs and also in dogs. It has variously been described as play behavior, redirected foraging behavior or a stereotypic behavior. In pigs, stone chewing is often observed in sows housed on paddocks, and most frequently o...

  11. The Efficacy of Medical Expulsive Therapy (MET) in Improving Stone-free Rate and Stone Expulsion Time, After Extracorporeal Shock Wave Lithotripsy (SWL) for Upper Urinary Stones: A Systematic Review and Meta-analysis.

    PubMed

    Skolarikos, Andreas; Grivas, Nikolaos; Kallidonis, Panagiotis; Mourmouris, Panagiotis; Rountos, Thomas; Fiamegos, Alexandros; Stavrou, Sotirios; Venetis, Chris

    2015-12-01

    In this meta-analysis, we included randomized studies on medical expulsive therapy implemented following shock wave lithotripsy for renal and ureteral stones. Pooled results demonstrated the efficacy of α-blockers, nifedipine, Rowatinex, and Uriston in increasing stone clearance. In addition, the time to stone elimination, the intensity of pain, the formation of steinstrasse, and the need for auxiliary procedures were reduced mainly with α-blockers. Expulsion rate was not correlated with the type of α-blocker, the diameter, and the location of stone. Our results show that medical expulsive therapy for residual fragments after shock wave lithotripsy should be implemented in clinical practice. PMID:26383613

  12. Evaluation of Hounsfield Units as a predictive factor for the outcome of extracorporeal shock wave lithotripsy and stone composition.

    PubMed

    Nakasato, Takehiko; Morita, Jun; Ogawa, Yoshio

    2015-02-01

    The objective of this study was to evaluate the utility of the Hounsfield Unit (HU) values as a predictive factor of extracorporeal shock wave lithotripsy outcome for ureteral and renal stones. We also assessed the possibility that HU values could be used to predict stone composition. A retrospective study was performed to measure stone HU values in 260 patients who underwent extracorporeal shock wave lithotripsy (ESWL) for solitary renal and ureteral stones from July 2007 to January 2012. Stone volume, location, skin-to-stone distance, stone HU values, and stone composition were assessed. Success of ESWL was defined as: (1) being stone-free or (2) residual stone fragments <4 mm after 3 months by radiography. Of the 260 assessed patients, 141 (54.2%) were stone-free, 32 (12.3%) had residual stone fragments <4 mm (clinically insignificant stone fragments), and 87 (33.5%) had residual stone fragments ≥4 mm after one round of ESWL. Multivariate analysis revealed that stone location and mean HU were significant predictors of ESWL success. Receiver operating characteristic curves defined cutoff values for predicting treatment outcome. Treatment success rates were significantly higher for stones <815 HU than with stones >815 HU (P < 0.0265). HU of calcium oxalate and calcium phosphate stones were higher than those of uric acid stones, but we could not differentiate between calcium oxalate monohydrate and calcium oxalate dihydrate stones. Evaluation of stone HU values prior to ESWL can predict treatment outcome and aid in the development of treatment strategies. PMID:25139151

  13. Ureteric injuries associated with gynecologic surgery.

    PubMed

    Onwudiegwu, U; Makinde, O O; Badejo, O A; Okonofua, F E; Ogunniyi, S O

    1991-03-01

    We conducted a review of eight ureteric injuries associated with major gynecologic surgery in seven patients over an 11-year period. Our low incidence of 0.36% is comparable with other reports. Diagnosis was made either intra-operatively or postoperatively. Immediate ureteric repair is advocated for all injuries discovered intra-operatively. Attention to preventive measures both before and during gynecological operations will reduce the incidence of ureteric injuries. PMID:1673940

  14. Probabilistic Modeling of the Renal Stone Formation Module

    NASA Technical Reports Server (NTRS)

    Best, Lauren M.; Myers, Jerry G.; Goodenow, Debra A.; McRae, Michael P.; Jackson, Travis C.

    2013-01-01

    The Integrated Medical Model (IMM) is a probabilistic tool, used in mission planning decision making and medical systems risk assessments. The IMM project maintains a database of over 80 medical conditions that could occur during a spaceflight, documenting an incidence rate and end case scenarios for each. In some cases, where observational data are insufficient to adequately define the inflight medical risk, the IMM utilizes external probabilistic modules to model and estimate the event likelihoods. One such medical event of interest is an unpassed renal stone. Due to a high salt diet and high concentrations of calcium in the blood (due to bone depletion caused by unloading in the microgravity environment) astronauts are at a considerable elevated risk for developing renal calculi (nephrolithiasis) while in space. Lack of observed incidences of nephrolithiasis has led HRP to initiate the development of the Renal Stone Formation Module (RSFM) to create a probabilistic simulator capable of estimating the likelihood of symptomatic renal stone presentation in astronauts on exploration missions. The model consists of two major parts. The first is the probabilistic component, which utilizes probability distributions to assess the range of urine electrolyte parameters and a multivariate regression to transform estimated crystal density and size distributions to the likelihood of the presentation of nephrolithiasis symptoms. The second is a deterministic physical and chemical model of renal stone growth in the kidney developed by Kassemi et al. The probabilistic component of the renal stone model couples the input probability distributions describing the urine chemistry, astronaut physiology, and system parameters with the physical and chemical outputs and inputs to the deterministic stone growth model. These two parts of the model are necessary to capture the uncertainty in the likelihood estimate. The model will be driven by Monte Carlo simulations, continuously randomly sampling the probability distributions of the electrolyte concentrations and system parameters that are inputs into the deterministic model. The total urine chemistry concentrations are used to determine the urine chemistry activity using the Joint Expert Speciation System (JESS), a biochemistry model. Information used from JESS is then fed into the deterministic growth model. Outputs from JESS and the deterministic model are passed back to the probabilistic model where a multivariate regression is used to assess the likelihood of a stone forming and the likelihood of a stone requiring clinical intervention. The parameters used to determine to quantify these risks include: relative supersaturation (RS) of calcium oxalate, citrate/calcium ratio, crystal number density, total urine volume, pH, magnesium excretion, maximum stone width, and ureteral location. Methods and Validation: The RSFM is designed to perform a Monte Carlo simulation to generate probability distributions of clinically significant renal stones, as well as provide an associated uncertainty in the estimate. Initially, early versions will be used to test integration of the components and assess component validation and verification (V&V), with later versions used to address questions regarding design reference mission scenarios. Once integrated with the deterministic component, the credibility assessment of the integrated model will follow NASA STD 7009 requirements.

  15. Ureteric obstruction secondary to pelvic actinomycosis.

    PubMed

    Jackson, A E; Parry, J R; Shah, P J

    1988-07-01

    With only 7 other cases reported throughout history, the incidence of ureteric obstruction is a rare complication of actinomycosis. Diagnosis of pelvic actinomycosis is generally difficult and only confirmed after histological examination. In the case of a 45-year-old caucasian woman who had been complaining of night sweats, epigastric and back pain and constipation, histological examination demonstrated the presence of actinomycosis in both the endometrium and the myometrium. Actinomyces israelli is a gram positive anaerobic parasite that alternates in form between a true bacterium and a complex fungus. The disease is often connected with the presence of a foreign body. It has been theorized that the presence of a foreign body combined with heavy anaerobic vaginal flora provides the perfect setting for actinomycotic growth. This growth is possible with all types of IUDs. Antibiotic therapy initially at a high dosage followed by prolonged oral therapy is generally recommended. However, laparotomy is needed for diagnosis and for the debulking procedure. PMID:3044479

  16. Ureteral obstruction by prostate cancer leads to spontaneous ureteric rupture: a case report

    PubMed Central

    Deng, Fei; Liu, Xuemei; Li, Yixiao; Zhou, Yihong; Tang, Jin; Tang, Yuxin; Dai, Yingbo

    2015-01-01

    Spontaneous ureteric rupture (SUR) is an unusual entity associated with perinephric or retroperitoneal extravasation of urine. Patients with SUR are often presented with severe and progressive abdominal or flank pain. It is commonly related to the obstruction of genitourinary system, among which urinary calculi represents the most frequent cause. Prostate cancer with ureteral orifice invasion can lead to ureteral obstruction, which can also be a threat to SUR. Herein, we present a case of a 68-year-old male with SUR after prostate cancer invaded the left ureteral orifice. To our best knowledge, this is the first case of SUR secondary to ureteral obstruction from prostate cancer. PMID:26629231

  17. Ultrasonic propulsion of kidney stones

    PubMed Central

    May, Philip C.; Bailey, Michael R.; Harper, Jonathan D.

    2016-01-01

    Purpose of review Ultrasonic propulsion is a novel technique that uses short bursts of focused ultrasonic pulses to reposition stones transcutaneously within the renal collecting system and ureter. The purpose of this review is to discuss the initial testing of effectiveness and safety, directions for refinement of technique and technology, and opinions on clinical application. Recent findings Preclinical studies with a range of probes, interfaces, and outputs have demonstrated feasibility and consistent safety of ultrasonic propulsion with room for increased outputs and refinement toward specific applications. Ultrasonic propulsion was used painlessly and without adverse events to reposition stones in 14 of 15 human study participants without restrictions on patient size, stone size, or stone location. The initial feasibility study showed applicability in a range of clinically relevant situations, including facilitating passage of residual fragments following ureteroscopy or shock wave lithotripsy, moving a large stone at the UPJ with relief of pain, and differentiating large stones from a collection of small fragments. Summary Ultrasonic propulsion shows promise as an office-based system for transcutaneously repositioning kidney stones. Potential applications include facilitating expulsion of residual fragments following ureteroscopy or shock wave lithotripsy, repositioning stones prior to treatment, and repositioning obstructing UPJ stones into the kidney to alleviate acute renal colic. PMID:26845428

  18. Kidney Stones

    PubMed Central

    Kleeman, Charles R.; Coburn, Jack W.; Brickman, Arnold S.; Lee, David B. N.; Narins, Robert G.; Ehrlich, Richard M.

    1980-01-01

    The prevalence of kidney stones has steadily risen during this century; passage of a calculus and a positive family history increase the probability of recurrence. Findings from recent studies on the cause of renal calculi have stressed crystallization and crystal aggregation of stone minerals from supersaturated urine, rather than excessive organic matrix. Absence of normal urine inhibitors of calcium salts is also stressed. Formation of calcium oxalate stones is the major problem. Therapy with decreased calcium and oxalate intake, thiazides, phosphate salts and allopurinol in various combinations has substantially decreased the prevalence of recurrent stones. The rationale for the use of allopurinol is that uric acid salts enhance the tendency for calcium oxalate to crystallize from supersaturated urine. The hypercalciuria seen in 30 percent to 40 percent of patients with oxalate stones is usually caused by intestinal hyperabsorption of calcium. Although patients with uric acid calculi constitute only a small fraction of those in whom stones form, they represent a group in whom good medical therapy, based on sound physiologic principles, has proved extremely successful. Renal tubular syndromes lead to nephrocalcinosis and lithiasis through hypercalciuria, alkaline urine and hypocitraturia, the latter an inhibitor of calcium salt precipitation. Recent advances in surgical techniques are discussed, including the rationale for removing staghorn calculi. The ileal ureter and coagulum pyelolithotomy deserve special emphasis. ImagesFigure 2.Figure 4.Figure 5.Figure 7. PMID:7385835

  19. Analysis of urinary stone composition in Eastern India by X-ray diffraction crystallography

    PubMed Central

    Jindal, Tarun; Mandal, Soumendra Nath; Sonar, Pankaj; Kamal, Mir Reza; Ghosh, Nabankur; Karmakar, Dilip

    2014-01-01

    Background: Stones in the urinary system are common in our country. This study was done to assess the composition of the urinary stones in eastern part of India. Materials and Methods: A prospective study was done over a period of thirty months. A total of 90 stones were analyzed in this time period by using X-ray diffraction crystallography. Results: Of the 90 stones analyzed, 77 were renal stones, 12 were ureteric stones and one was a bladder stone. Six stones (all renal) did not have properties to be represented by X-ray diffraction crystallography. The overall prevalence of the oxalate containing stones was 85.7% with calcium oxalate monohydrate (COM) being the major constituent. Calcium oxalate dihydrate (COD) was the next most common constituent. Struvite stones constituted 9.5% of the stones analyzed. Pure calcium phosphate stones were found in 4.7% of the cases. Conclusion: Our study reveals that the stone composition in the eastern part of India is different from that in other parts of the country. We have a comparatively lower prevalence of oxalate stones while a higher prevalence of phosphate and struvite stones. PMID:25337533

  20. Ureteric obstruction due to pelvic actinomycosis.

    PubMed

    Brown, R; Bancewicz, J

    1982-03-01

    Since 1973 several reports of pelvic actinomycosis arising in association with modern types of IUDs have appeared. Various presentations occur such as vaginal discharge, tubo-ovarian abscess, or "frozen pelvis." Ureteric obstruction is uncommon and its management unclear. A case is presented of ureteric obstruction due to pelvic actinomycosis associated with an IUD. A 34 year old woman presented with a 6 month history of alternating constipation and diarrhea, weight loss, amenorrhea, and laterally, a vaginal discharge. A Lippes loop had been inserted 2 years earlier. On examination, she was anemic, cachectic, pyrexial and had a frozen pelvis. There was a stricture of the midrectum but the mucosa was intact. The strings of the IUD could be felt and the cervix appeared normal. There was skin redness and induration over the right ischiorectal fossa. Intravenous urogram showed bilateral hydronephrosis with hydroureter. Examination under anesthesia confirmed the midrectal stricture. Biopsies showed mild inflammatory changes only. The IUD was removed and curettings revealed an acute endometritis. At laparotomy, apparently normal small bowel loops were adherent to a friable mass in the pelvis, which displaced the bladder forwards. The colon and uterus appeared normal but bilateral pyosalpinges were present and were resected. Neither ovary could be identified. Despite the tubal infection, pelvic malignancy was suspected and a sigmoid colostomy fashioned in view of impending rectal obstruction. Histology of the mass showed a large amount of fibrous tissue infiltrated by acute and chronic inflammatory cells and containing micro-abscesses. In 2 places only, colonies of actinomycetes surrounded by polymorphs were observed. No sulphur granules were identified. No growth was obtained on aerobic and anaerobic culture of the tissue and the pyosalpinges. Treatment with penicillin V 500 mg q.d.s. produced an allergic reaction and was changed to tetracycline 250 mg q.d.s. which was continued for 2 months at home. 4 months later, the rectal stricture had resolved and the colostomy was closed. 9 months after the initial presentation a urogram showed complete resolution of the left hydronephrosis. There was slight residual right hydronephrosis but no evidence of ureteric obstruction. PMID:7066656

  1. Initial excavation and dating of Ngalue Cave: a Middle Stone Age site along the Niassa Rift, Mozambique.

    PubMed

    Mercader, Julio; Asmerom, Yemane; Bennett, Tim; Raja, Mussa; Skinner, Anne

    2009-07-01

    Direct evidence for a systematic occupation of the African tropics during the early late Pleistocene is lacking. Here, we report a record of human occupation between 105-42ka, based on results from a radiometrically-dated cave section from the Mozambican segment of the Niassa (Malawi/Nyasa) Rift called Ngalue. The sedimentary sequence from bottom to top has five units. We concentrate on the so-called "Middle Beds," which contain a Middle Stone Age industry characterized by the use of the discoidal reduction technique. A significant typological feature is the presence of formal types such as points, scrapers, awls, and microliths. Special objects consist of grinders/core-axes covered by ochre. Ngalue is one of the few directly-dated Pleistocene sites located along the biogeographical corridor for modern human dispersals that links east, central, and southern Africa, and, with further study, may shed new light on hominin cave habitats during the late Pleistocene. PMID:19487015

  2. Obturator Hernia with Ureteral Entrapment

    PubMed Central

    Izzo, Matteo; Regusci, Luca; Fasolini, Fabrizio

    2014-01-01

    Obturator hernia of the ureter is uncommon. Computed tomography of a 77-year-old woman with sudden-onset lower left abdominal pain and urinary symptoms showed an obturator hernia with ureteral entrapment. Obturator hernia is a diagnostic challenge because the hernial mass is very insidious. It should be suspected in emaciated, multiparous, elderly women presenting with unexplained pain in the groin, hip, thigh or knee. High levels of clinical suspicion of high-risk patients and recourse to investigation by computed tomography are important, as delay in diagnosis and treatment is associated with increased morbidity and mortality. PMID:24926229

  3. Use of percutaneous nephrostomy and ureteral stenting in management of ureteral obstruction

    PubMed Central

    Hsu, Linda; Li, Hanhan; Pucheril, Daniel; Hansen, Moritz; Littleton, Raymond; Peabody, James; Sammon, Jesse

    2016-01-01

    The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no consensus on the ideal treatment or treatment pathway for ureteral obstruction owing, in part, to the varied etiologies of obstruction and diversity of institutional practices. Additionally, different clinicians such as internists, urologists, oncologists and radiologists are often involved in the care of patients with ureteral obstruction and may have differing opinions concerning the best management strategy. The purpose of this manuscript was to review available literature that compares percutaneous nephrostomy placement vs ureteral stenting in the management of ureteral obstruction from both benign and malignant etiologies. PMID:26981442

  4. Xanthine urolithiasis causing bilateral ureteral obstruction in a 10-month-old cat.

    PubMed

    Mestrinho, Lisa A; Gonçalves, Tiago; Parreira, Pedro B; Niza, Maria M R E; Hamaide, Annick J

    2013-10-01

    Xanthine urolithiasis was diagnosed in a 10-month-old intact female domestic shorthair cat presented with acute renal failure due to bilateral ureteral obstruction. Ultrasonography revealed the presence of multiple uroliths in both kidneys and ureters that were not detectable on previous survey radiographs. Medical management failed and ureteral obstruction persisted with no evidence of stone migration into the bladder. Bilateral ureterotomy with urolith removal was performed in order to relieve the obstruction. The cat recovered from surgery, and blood urea nitrogen and creatinine values decreased within normal limits 6 days postoperatively. Urolith analysis by infrared spectrometry determined xanthine composition, and a higher blood and urine concentration of hypoxanthine and xanthine was also found. At 1-year follow-up, the cat was free of clinical signs. However, ultrasonography of the abdomen revealed small-size calculi in both kidneys, despite the low protein diet intake. The very young age of the animal suggests a possible congenital xanthinuria. PMID:23413269

  5. Ureteral calculus presenting as generalized abdominal cramps.

    PubMed Central

    Leung, Alexander K. C.; Robson, Wm Lane M.; Ng, Anthony Chi Fai

    2007-01-01

    We describe a 58-year-old man with a left ureteral calculus who presented with normal-looking urine, generalized abdominal cramps and abdominal distension that was thought to be due to acute intestinal obstruction. The diagnosis of ureteral calculus was established with an abdominal radiograph and a nonenhanced helical computed tomography of the abdomen, and the symptoms were promptly relieved by extracorporeal shock wave lithotripsy. Physicians should be vigilant that ureteral calculus may, although very rarely, present with generalized abdominal cramps. Images Figure 1 Figure 2 Figure 3 PMID:17668648

  6. Ovarian Dermoid Cyst Causing Distal Ureteral Obstruction.

    PubMed

    Aiken, W D; Mayhew, R G; Mitchell, S; Stennett, M; Johnson, P

    2015-03-01

    A case of a 45-year old woman with an ovarian dermoid cyst causing ureteric colic secondary to distal ureteral obstruction is reported. The dermoid cyst was observed on computed tomography to be adjacent to and compressing the distal left ureter and this was confirmed at surgical exploration. Following oophorectomy, the patient's symptoms completely resolved and the excised ovarian cyst was confirmed on pathological evaluation to be a dermoid cyst. This appears to be the first reported case of ureteral obstruction caused by an ovarian dermoid cyst in the English medical literature. PMID:26360692

  7. Ovarian Dermoid Cyst Causing Distal Ureteral Obstruction

    PubMed Central

    Aiken, WD; Mayhew, RG; Mitchell, S; Stennett, M; Johnson, P

    2015-01-01

    ABSTRACT A case of a 45-year old woman with an ovarian dermoid cyst causing ureteric colic secondary to distal ureteral obstruction is reported. The dermoid cyst was observed on computed tomography to be adjacent to and compressing the distal left ureter and this was confirmed at surgical exploration. Following oophorectomy, the patient's symptoms completely resolved and the excised ovarian cyst was confirmed on pathological evaluation to be a dermoid cyst. This appears to be the first reported case of ureteral obstruction caused by an ovarian dermoid cyst in the English medical literature. PMID:26360692

  8. Percutaneous Therapy of Ureteral Obstructions and Leak After Renal Transplantation: Long-Term Results

    SciTech Connect

    Aytekin, Cueneyt Boyvat, Fatih; Harman, Ali; Ozyer, Umut; Colak, Turan; Haberal, Mehmet

    2007-11-15

    The purpose of this study was to evaluate the long-term outcome of percutaneous therapy of ureteral complications after renal transplantation. Between January 2000 and June 2006 we percutaneously treated 26 renal transplant patients with ureteral obstruction (n=19) and leak (n=7). Obstructions were classified as early (<2 months after transplantation) or late (>2 months). Patients with leak were treated with nephro-ureteral catheter placement and subsequent double-J stenting. Balloon dilatation, stent placement, and basket extraction were used to treat ureteral obstructions. Patients were followed with ultrasonography. No major procedure-related complication occurred. The mean follow-up time was 34.3 months (range: 6 to 74 months). Initial clinical success was achieved in all 19 patients with obstruction and 6 of 7 patients with leak. Four of 9 early obstructions and 4 of 10 late obstructions recurred during the follow-up. All recurrences were initially managed again with percutaneous methods, including cutting balloon technique and metallic stent placement. Although there was no recurrence in patients with successfully treated leak, stricture was seen at the previous leak site in two patients. These strictures were also successfully managed percutaneously. We conclude that in the treatment of ureteral obstruction and leak following renal transplantation, percutaneous therapy is an effective alternative to surgery. However, further interventions are usually needed to maintain long-term patency.

  9. Dietary Intake of Fiber, Fruit, and Vegetables Decrease the Risk of Incident Kidney Stones in Women: A Women's Health Initiative (WHI) Report

    PubMed Central

    Sorensen, Mathew D.; Hsi, Ryan S.; Chi, Thomas; Shara, Nawar; Wactawski-Wende, Jean; Kahn, Arnold J.; Wang, Hong; Hou, Lifang; Stoller, Marshall L.

    2014-01-01

    Purpose We evaluated the relationship between dietary fiber, fruit, and vegetable intake, and the risk of kidney stone formation. Methods Overall, 83,922 postmenopausal women from the WHI Observational Study were included and followed prospectively. Cox proportional hazards regression analyses evaluated the associations between total dietary fiber, fruits, and vegetable intake, and the risk of incident kidney stone formation adjusting for nephrolithiasis risk factors (age, race/ethnicity, geographic region, diabetes mellitus, calcium supplementation, hormone therapy use, body mass index, calibrated caloric intake, and dietary water, sodium, animal protein, and calcium intake). Women with a prior history of kidney stones (3,471 women) were analyzed separately. Results Mean age was 64±7 years, 85% of women were Caucasian and 2,937 women (3.5%) experienced a kidney stone occurrence in 8 years median follow-up. In women with no history of kidney stones, higher total dietary fiber (6-26% decreased risk, p<0.001), higher fruit intake (12-25% decreased risk, p<0.001), and higher vegetable intake (9-22% decreased risk, p=0.002) were associated with a decreased risk of incident kidney stone formation in separate adjusted models. In women with a history of stones, there were no significant protective effects of fiber, fruits, or vegetable intake on the risk of kidney stone recurrence. Conclusions Greater dietary intake of fiber, fruits and vegetables were each associated with a reduced risk of incident kidney stones in postmenopausal women. The protective effects were independent of other known risk factors for kidney stones. In contrast, there was no reduction in risk in women with a history of stones. PMID:24859445

  10. Ureteral Stents. New Materials and Designs

    NASA Astrophysics Data System (ADS)

    Monga, Manoj

    2008-09-01

    Issues of stent migration and challenges of stent placement can be addressed adequately with current stent designs and materials, and an emphasis on precision in technique. Future changes in ureteral stents will need to maintain the current standard that has been set with existing devices in these regards. In contrast, new advances are sorely needed in encrustation and infection associated with ureteral stents. The main target for future development in ureteral stent materials lies in a biodegradable stent that degrades either on demand or degrades reliably within one-month with predictable degradation patterns that do not predispose to urinary obstruction, discomfort or need for secondary procedures. The main target for future development in ureteral stent design is improved patient comfort.

  11. Ureteral access strategies: pro-access sheath.

    PubMed

    Vanlangendonck, Richard; Landman, Jaime

    2004-02-01

    Routine use of the ureteral access sheath during flexible ureteroscopic procedures provides consistent, reliable, and unencumbered access to the upper tracts. The ureteral access sheath can be reliably and easily deployed if used properly and requires no special training. As such, it can be easily adopted into current urologic practice. Not only does the access sheath facilitate rapid, repeated, and atraumatic access to the upper tracts, but it also avoids back-loading over a superstiff guidewire, which may incur costly damage to the ureteroscope. The access sheath reduces overall costs and decreases operative times. Furthermore, application of a ureteral access sheath reduces the frustration associated with complex and some routine ureteroscopic procedures by optimizing irrigant flow to improve the surgeon's endoscopic vision while minimizing the intrarenal pressures that the kidney must tolerate. There is no evidence that the access sheath results in clinically significant ureteral ischemia, and extensive clinical use of the access sheath for long procedures has not resulted in increased stricture formation. Finally, the ureteral access sheath is useful for other procedures, such as PCNL, by improving visualization and minimizing the requirement for multiple percutaneous access sites. Winston Churchill said it best: "Give us the tools and we will finish the job." Industry has provided urologists with the tools in the form of advanced flexible ureteroscopes, the holmium laser, nitinol baskets, and the ureteral access sheath. Now it is up to urologists to finish the job. PMID:15040403

  12. A Prototype Ultrasound Instrument To Size Stone Fragments During Ureteroscopy

    NASA Astrophysics Data System (ADS)

    Sorensen, Mathew D.; Teichman, Joel M. H.; Bailey, Michael R.

    2008-09-01

    An intraoperative tool to measure the size of kidney stones or stone fragments during ureteroscopy would help urologists assess if a fragment is small enough to be removed through the ureter or ureteral access sheath. The goal of this study was to determine the accuracy and precision of a prototype ultrasound device used to measure in vitro stone fragments compared to caliper measurements. A 10-MHz, 10-french ultrasound transducer probe was used to send an ultrasound pulse and receive ultrasound reflections from the stone using two methods. In Method 1 the instrument was aligned over the stone and the ultrasound pulse traveled through the stone. The time between reflections from the proximal and the distal surface of the stone were used along with the sound speed to calculate the stone size. Although the sound speed varied between stones, it was unlikely to be known during surgery and thus was estimated at 3000 m/s for calculations. In Method 2 the instrument was aligned partially over the stone and the ultrasound pulse traveled through water with a sound speed of 1481 m/s. Time was determined between the reflection from the proximal stone surface and the reflection from the tissue phantom on which the stone rested. Methods 1 and 2 were compared by linear regression to caliper measurements of the size of 19 human stones of 3 different stone types. Accuracy was measured by the difference of the mean ultrasound and mean caliper measurement and precision was measured as the standard deviation in the ultrasound measurements. For Method 1, the correlation between caliper-determined stone size and ultrasound-determined stone size was r2 = 0.71 (p<0.0001). In all but two stones accuracy and precision were less than 1 mm. For Method 2, the correlation was r2 = 0.99 (p<0.0001) and measurements were accurate and precise to within 0.25 mm. We conclude that the prototype device and either method measure stone size with good accuracy.

  13. Stone disease in pregnancy: imaging-guided therapy.

    PubMed

    Masselli, Gabriele; Derme, Martina; Bernieri, Maria Giulia; Polettini, Elisabetta; Casciani, Emanuele; Monti, Riccardo; Laghi, Francesca; Framarino-Dei-Malatesta, Marialuisa; Guida, Marianna; Brunelli, Roberto; Gualdi, Gianfranco

    2014-12-01

    Renal colic is the most frequent nonobstetric cause for abdominal pain and subsequent hospitalization during pregnancy. The physio-anatomical changes in the urinary tract and the presence of the fetus may complicate the clinical presentation and management of nephrolithiasis. Ultrasound (US) is the primary radiological investigation of choice. Magnetic resonance urography (MRU) and low-dose computed tomography (CT) have to be considered as a second- and third-line test, respectively. If a study that uses ionizing radiation has to be performed, the radiation dose to the fetus should be as low as possible. The initial management of symptomatic ureteric stones is conservative during pregnancy. Intervention will be necessary in patients who do not respond to conservative measures. Therefore, it is crucial to obtain a prompt and accurate diagnosis to optimize the management of these patients. Teaching Points • In pregnancy, renal colic is the most frequent nonobstetric cause for abdominal pain and hospitalization. • Magnetic resonance urography should be considered when ultrasound is nondiagnostic. • Low-dose CT should be considered as a last-line test during pregnancy. PMID:25249333

  14. Encrustation of the Ureteral Double J Stent in Patients with a Solitary Functional Kidney – a Case Report

    PubMed Central

    Milicevic, Snjezana; Bijelic, Radojka; Jakovljevic, Branislava

    2015-01-01

    Introduction: The efficacy of ureteric stents in the management of various urological conditions causing the upper urinary tract obstruction has been extensively proven, and their contribution to urology remains enormous. The clinical use of ureteric stents is associated with several complications. “Stent syndrome,” encrustation, migration and urothelial hyperplasia are the most common problems related to long-term ureteral stenting. Case report: This work presents an interesting case from our practice: a complete encrustation of a classical polyurethane double J stent two and a half months after its initial instillation, in a 70 year old man, with a solitary functioning kidney, as well as successful removal of it by using a simultaneous treatment of extracorporeal lithotripsy and ureteroscopy with a contact disintegration of encrustations and with percutaneous nephrostomy, as an auxiliary procedure for providing of additional urine derivation. Conclusion: These problems can be overcome by the introduction of new advanced ureteral stent designs and biomaterials. PMID:26543316

  15. Malignant Ureteral Obstruction: Functional Duration of Metallic versus Polymeric Ureteral Stents

    PubMed Central

    Chow, Po-Ming; Chiang, I-Ni; Chen, Chia-Yen; Huang, Kuo-How; Hsu, Jui-Shan; Wang, Shuo-Meng; Lee, Yuan-Ju; Yu, Hong-Jeng; Pu, Yeong-Shiau; Huang, Chao-Yuan

    2015-01-01

    Background Ureteral obstruction caused by extrinsic compression is often associated with intra-abdominal cancers. Internal drainage with ureteral stents is typically the first-line therapy to relieve such obstructions. Novel designs of ureteral stents made of different materials have been invented to achieve better drainage. In this study, we described the functional outcomes of a Resonance metallic ureteral stent (Cook Medical, Bloomington, Indiana, USA) in patients with malignant ureteral obstruction and compare the functional duration of Resonance stents with regular polymeric stents in the same cohort. Methods Cancer patients who received polymeric stents and subsequent Resonance stents for ureteral obstruction between July 2009 and November 2012 were included in a chart review. Stent failure was detected by clinical symptoms, imaging studies, and renal function tests. The functional durations of each stent were calculated, and possible factors affecting stent patency were investigated. Results A total of 50 stents were successfully inserted into 50 ureteral units in 42 patients with malignant ureteral obstruction. There were 7 antegrade stents and 43 retrograde stents. There were no major complications. Stent-related symptoms were similar in both kinds of stents. After polymeric stents were replaced with Resonance metallic stents, hydronephrosis subsided or remained stable in 90% (45/50) of the ureteral units. Serum creatinine decreased or remained stable in 90% (38/42) of these patients. The Resonance stent exhibited a mean increase in functional duration of 4 months compared with the polymeric stents (p<0.0001), and 50% (25/50) of the Resonance stents exhibited a significant increase in functional duration (more than 3 months). Pre-operative serum creatinine < 2 was associated with a substantial increase in stent duration. Conclusions Resonance stents are effective and safe in relieving malignant ureteral obstructions after polymeric stents failure. Resonance stents can provide a longer functional duration than polymeric stents and should be offered as an option for internal drainage. PMID:26267140

  16. Patient Experiences and Preferences with Ureteral Stent Removal

    PubMed Central

    Low, Roger K.; Monga, Manoj; Nguyen, Mike M.

    2015-01-01

    Abstract Purpose: Ureteral stent removal is a source of patient morbidity. We surveyed 599 patients to evaluate their experiences and identify the preferred method of stent removal. Materials and Methods: Visitors to a kidney stone website were invited to participate. Respondents were asked how their ureteral stent was removed? Pain during and after the procedure, patient experiences, and preferences regarding stent removal were queried. Chi-square and ANOVA tests were used to identify significant differences among removal methods. Results: Five hundred seventy-one respondents were included in the study. The majority of stents (44%) were removed by office cystoscopy while 39% had their stents removed by string. Mean pain during stent removal was 4.8 out of 10 with 57% reporting moderate-to-severe pain levels of 4 or more. Removal by office cystoscopy resulted in the highest experienced pain (5.3). Thirty-two percent reported delayed severe pain after stent removal, including 9% who returned for emergency care. Removal by string resulted in more emergency room visits when compared to cystoscopy. Willingness to undergo the same removal technique was lowest for those who underwent office cystoscopy and highest for operating room cystoscopy. Being informed of why a stent was placed and the removal process was of high priority for respondents. Conclusions: The majority of patients report moderate-to-severe pain with stent removal and a third report delayed significant pain after stent removal. Variations exist in the patient experience with stent removal based on the method used. More research is needed to identify effective ways to prevent or manage stent-removal-related adverse events. PMID:25019375

  17. Fluoroscopy Guided Transurethral Placement of Ureteral Metallic Stents

    PubMed Central

    Myung Gyu, Song; Seo, Tae Seok; Park, Cheol Min; Choi, Jae Woong; Lee, Jong Mee; Park, Yang Shin

    2015-01-01

    Ureteral stent exchange is usually performed under both fluoroscopic and cystoscopic guidance. We experienced two cases with retrograde placement of metallic ureteral stent via urethra under fluoroscopic guidance. When patients with double-J ureteral stent (DJUS)have symptom and want to change DJUS to metallic stent, fluoroscopic guided transurethral placement of ureteral metallic stent is a good option as alternative of cystoscopic procedure or percutaneous procedure through percutaneous nephrostomy tract. PMID:26557281

  18. Laparoscopic Ureterolithotomy for Giant Ureteric Calculus: A Case Report

    PubMed Central

    Magdum, Prasad V.; Nerli, Rajendra B.; Devaraju, Shishir; Hiremath, Murigendra B.

    2015-01-01

    We present a case of a 21 year old male who presented with symptomatic right upper ureteric calculus measuring 5 cm × 1.5 cm fulfilling the criteria to be named as giant ureteric calculus. Laparoscopic right ureterolithotomy was performed and the giant ureteric calculus was retrieved. PMID:26793529

  19. 21 CFR 876.4020 - Fiberoptic light ureteral catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Fiberoptic light ureteral catheter. 876.4020... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4020 Fiberoptic light ureteral catheter. (a) Identification. A fiberoptic light ureteral catheter is a device that consists of...

  20. Laparoscopic Ureterolithotomy for Giant Ureteric Calculus: A Case Report.

    PubMed

    Magdum, Prasad V; Nerli, Rajendra B; Devaraju, Shishir; Hiremath, Murigendra B

    2015-09-01

    We present a case of a 21 year old male who presented with symptomatic right upper ureteric calculus measuring 5 cm × 1.5 cm fulfilling the criteria to be named as giant ureteric calculus. Laparoscopic right ureterolithotomy was performed and the giant ureteric calculus was retrieved. PMID:26793529

  1. Bilateral congenital ureteral strictures in a young cat

    PubMed Central

    Lee, Namsoon; Choi, Mihyun; Keh, Seoyeon; Oh, Yein; Seo, Jimin; Choi, Heeyeon; Kim, Hyunwook; Yoon, Junghee

    2014-01-01

    An 8-month-old cat was presented with bilateral hydronephrosis. Bilateral ureteral obstructions were identified by diagnostic imaging and confirmed by necropsy. Histopathologic findings revealed polypoid transitional epithelial hyperplasia with chronic lymphoplasmacytic inflammation. This report documents congenital ureteral strictures as a cause of ureteral obstruction in a young cat. PMID:25183890

  2. 21 CFR 876.4020 - Fiberoptic light ureteral catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Fiberoptic light ureteral catheter. 876.4020... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4020 Fiberoptic light ureteral catheter. (a) Identification. A fiberoptic light ureteral catheter is a device that consists of...

  3. 21 CFR 876.4020 - Fiberoptic light ureteral catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Fiberoptic light ureteral catheter. 876.4020... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4020 Fiberoptic light ureteral catheter. (a) Identification. A fiberoptic light ureteral catheter is a device that consists of...

  4. 21 CFR 876.4020 - Fiberoptic light ureteral catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Fiberoptic light ureteral catheter. 876.4020... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4020 Fiberoptic light ureteral catheter. (a) Identification. A fiberoptic light ureteral catheter is a device that consists of...

  5. Spontaneous rupture of renal pelvis as a rare complication of ureteral lithiasis.

    PubMed

    Porfyris, Orestis; Apostolidi, Elena; Mpampali, Andromachi; Kalomoiris, Paraskevas

    2016-03-01

    Spontaneous rupture of renal pelvis with urine extravasation is a rare condition and usually associated with obstructing ureteric calculus. It poses diagnostic and therapeutic dilemmas, while a stepwise approach for the confirmation of diagnosis, treatment and follow up is needed. We present a case of a 75-year old male patient who had a renal pelvis rupture with perirenal extravasation of urine due to a 4 mm stone located at the right ureterovesical junction. Diagnosis was confirmed by computed tomography, while the patient was treated successfully with the placement of a percutaneous nephrostomy. A week later a CT- nephrostomography showed the healing of renal pelvis with no extravasation and no evidence of the obstructing stone. PMID:27011880

  6. Spontaneous rupture of renal pelvis as a rare complication of ureteral lithiasis

    PubMed Central

    Porfyris, Orestis; Apostolidi, Elena; Mpampali, Andromachi; Kalomoiris, Paraskevas

    2016-01-01

    Spontaneous rupture of renal pelvis with urine extravasation is a rare condition and usually associated with obstructing ureteric calculus. It poses diagnostic and therapeutic dilemmas, while a stepwise approach for the confirmation of diagnosis, treatment and follow up is needed. We present a case of a 75-year old male patient who had a renal pelvis rupture with perirenal extravasation of urine due to a 4 mm stone located at the right ureterovesical junction. Diagnosis was confirmed by computed tomography, while the patient was treated successfully with the placement of a percutaneous nephrostomy. A week later a CT- nephrostomography showed the healing of renal pelvis with no extravasation and no evidence of the obstructing stone. PMID:27011880

  7. Shock wave lithotripsy outcomes for lower pole and non-lower pole stones from a university teaching hospital: Parallel group comparison during the same time period

    PubMed Central

    Geraghty, Robert; Burr, Jacob; Simmonds, Nick; Somani, Bhaskar K.

    2015-01-01

    Introduction: Shock wave lithotripsy (SWL) is a treatment option for all locations of renal and ureteric stones. We compared the results of SWL for lower pole renal stones with all other non-lower pole renal and ureteric stones during the same time period. Material and Methods: All SWL procedures were carried out as day case procedures by a mobile lithotripter from January 2012 to August 2013. The follow-up imaging was a combination of KUB X-ray or USS. Following SWL treatment, the stone free rate (SFR) was defined as ≤3 mm fragments. Results: A total of 148 patients with a mean age of 62 years underwent 201 procedures. Of the 201 procedures, 93 (46%) were for lower pole stones. The non-lower pole stones included upper pole (n = 36), mid pole (n = 40), renal pelvis (n = 10), PUJ (n = 8), mid ureter (n = 3), upper ureter (n = 5) and a combination of upper, middle and/or lower pole (n = 6). The mean stone size for lower pole stones (7.4 mm; range: 4-16 mm) was slightly smaller than non-lower pole stones (8 mm; range: 4-17 mm). The stone fragmentation was successful in 124 (62%) of patients. However, the SFR was statistically significantly better (P = 0.023) for non-lower pole stones 43 (40%) compared to lower pole stones 23 (25%). There were 9 (4%) minor complications and this was not significantly different in the two groups. Conclusions: Although SWL achieves a moderately high stone fragmentation rate with a low complication rate, the SFR is variable depending on the location of stone and the definition of SFR, with lower pole stones fairing significantly worse than stones in all other locations. PMID:25657543

  8. The history of urinary stones: in parallel with civilization.

    PubMed

    Tefekli, Ahmet; Cezayirli, Fatin

    2013-01-01

    The roots of modern science and history of urinary stone disease go back to the Ancient Egyptians and Mesopotamia. Hippocrates defined the symptoms of bladder stones. The first recorded details of "perineal lithotomy" were those of Cornelius Celsus. Ancient Arabic medicine was based mainly on classical Greco-Roman works. Interestingly, the Fourth Lateran Council in 1215 forbade physicians from performing surgical procedures, as contact with blood or body fluids was viewed as contaminating to men. With Renaissance new procedures could be tried on criminals. The first recorded suprapubic lithotomy was carried out by Pierre Franco in 1561. In 1874, Bigelow developed a lithotrite, which was introduced into the bladder under anaesthesia (called as "litholopaxy"). Young was the first to report ureteroscopy (1929). With advances in intracorporeal lithotripsy techniques, ureteroscopy became the treatment of choice for ureteric stones. In 1976, Fernstrom and Johannson established percutaneous access to remove a renal stone. However, with the introduction of the first extracorporeal shock wave machine in 1980, a dramatic change in stone management was observed. Civilization in parallel with scientific developments has brought us to a point where we try not to "cut" our patients for stone disease, as Hippocrates admonishes, but rather manage them with minimal invasive alternatives. PMID:24348156

  9. The History of Urinary Stones: In Parallel with Civilization

    PubMed Central

    Tefekli, Ahmet; Cezayirli, Fatin

    2013-01-01

    The roots of modern science and history of urinary stone disease go back to the Ancient Egyptians and Mesopotamia. Hippocrates defined the symptoms of bladder stones. The first recorded details of “perineal lithotomy” were those of Cornelius Celsus. Ancient Arabic medicine was based mainly on classical Greco-Roman works. Interestingly, the Fourth Lateran Council in 1215 forbade physicians from performing surgical procedures, as contact with blood or body fluids was viewed as contaminating to men. With Renaissance new procedures could be tried on criminals. The first recorded suprapubic lithotomy was carried out by Pierre Franco in 1561. In 1874, Bigelow developed a lithotrite, which was introduced into the bladder under anaesthesia (called as “litholopaxy”). Young was the first to report ureteroscopy (1929). With advances in intracorporeal lithotripsy techniques, ureteroscopy became the treatment of choice for ureteric stones. In 1976, Fernstrom and Johannson established percutaneous access to remove a renal stone. However, with the introduction of the first extracorporeal shock wave machine in 1980, a dramatic change in stone management was observed. Civilization in parallel with scientific developments has brought us to a point where we try not to “cut” our patients for stone disease, as Hippocrates admonishes, but rather manage them with minimal invasive alternatives. PMID:24348156

  10. The electromechanical impactor: a new device for intracorporeal stone fragmentation.

    PubMed

    Dretler, S P

    1993-06-01

    The Electromechanical Impactor was conceived as a safe and effective device for intracorporeal stone fragmentation. It is a 3 French EHL electrode enclosed within a stainless steel sheath. The interior is irrigated with saline. Discharge of the system causes an EHL spark which vaporizes saline and produces a cavitation bubble and subsequent shock wave. The shock wave propels a conical titanium tip forward for a distance of 2.7 mm with an impact pressure of 900 bar. Bench and animal testing has proven its effectiveness for stone fragmentation and safety for use within the ureter. The mean lifetime of each probe is approximately 700 pulses. It is used under direct vision through the straight operating port of a rigid or semi-rigid 9.5 French ureteroscope. Clinical studies at the Massachusetts General Hospital (reported herein) and the Mayo Clinic demonstrate approximately 90% efficacy. It is especially effective on cystine, calcium oxalate dihydrate, struvite and mixed calcium oxalate monohydrate calculi. Shiny-smooth black calcium oxalate monohydrate calculi will fragment but are more resistant. There has been no evidence of ureteral wall injury. The EMI is currently 5 French and is used both safely and effectively under direct vision of fragment ureteral calculi. Larger sizes are designed for percutaneous use and for bladder stone fragmentation. PMID:8342987

  11. Stone orientation affects the mechanism of failure in artificial kidney stones subject to shock waves

    NASA Astrophysics Data System (ADS)

    van Cauwelaert, Javier; Cleveland, Robin O.

    2003-10-01

    Micro computed tomography (CT) imaging was used to follow the progressive development of cracks in artificial kidney stones. The artificial stones were made from U30 cement with a cylindrical shape (6.5 mm diameter and 8.5 mm long). The stones were held within a polypropylene vial in one of three orientations: vertical, horizontal, and angled at 45 deg. The stones were treated with an electromagnetic lithotripter and the initiation and growth of cracks was observed using microCT. The images show that the orientation of the stones with respect to the shock changes the dominant mechanism for fragmentation. Vertical stones developed a spall-like crack near the distal surface, which propagated from the surface to the interior of the stone. Initiation of a secondary spall-like crack was observed proximal to the first crack. Little surface damage was observed. Horizontal stones presented pitting in the proximal surface and erosion in lateral faces, indicating the action of cavitation. Angled stones presented both spall-like fracture in either the leading or the distal corners and surface damage (pitting) in the proximal surface. Experiments are being performed to follow the development of cracks in human kidney stones. [Work supported by the Whitaker Foundation.

  12. Holmium: YAG laser lithotripsy versus pneumatic lithotripsy for treatment of distal ureteral calculi: a meta-analysis.

    PubMed

    Yin, Xiangrui; Tang, Ziwei; Yu, Bei; Wang, Yarong; Li, Yuehua; Yang, Qi; Tang, Wei

    2013-04-01

    The objective of this study was to estimate the treatment effect of Pneumatic Lithotripsy (PL) versus holmium: YAG laser lithotripsy (LL) in the treatment of distal ureteric calculi. A bibliographic search covering the period from 1990 to April 2012 was conducted using search engines such as MEDLINE, EMBASE, and Cochrane library. Data were extracted and analyzed with RevMan5.1 software. A total of 47 studies were scant, and 4 independent studies were finally recruited. Holmium: YAG LL conveyed significant benefits compared with PL in terms of early stone-free rate [odds ratio (OR)=4.42, 95% confidence interval (CI) (1.14, 17.16), p=0.03], delayed stone-free rate [OR=4.42, 95%CI (1.58, 12.37), p=0.005], mean operative time [WMD=-16.86, 95%CI (-21.33, -12.39), p<0.00001], retaining double-J catheter rate [OR=0.44, 95%CI (0.25, 0.78), p=0.004], and stone migration incidence [OR=0.26, 95%CI (0.11, 0.62), p=0.003], but not yet in the postoperative hematuria rate and the ureteral perforation rate according to this meta-analysis. Precise estimates on larger sample size and trials of high quality may provide more uncovered outcomes in the future. PMID:23016622

  13. Stone heterogeneity index as the standard deviation of Hounsfield units: A novel predictor for shock-wave lithotripsy outcomes in ureter calculi.

    PubMed

    Lee, Joo Yong; Kim, Jae Heon; Kang, Dong Hyuk; Chung, Doo Yong; Lee, Dae Hun; Do Jung, Hae; Kwon, Jong Kyou; Cho, Kang Su

    2016-01-01

    We investigated whether stone heterogeneity index (SHI), which a proxy of such variations, was defined as the standard deviation of a Hounsfield unit (HU) on non-contrast computed tomography (NCCT), can be a novel predictor for shock-wave lithotripsy (SWL) outcomes in patients with ureteral stones. Medical records were obtained from the consecutive database of 1,519 patients who underwent the first session of SWL for urinary stones between 2005 and 2013. Ultimately, 604 patients with radiopaque ureteral stones were eligible for this study. Stone related variables including stone size, mean stone density (MSD), skin-to-stone distance, and SHI were obtained on NCCT. Patients were classified into the low and high SHI groups using mean SHI and compared. One-session success rate in the high SHI group was better than in the low SHI group (74.3% vs. 63.9%, P = 0.008). Multivariate logistic regression analyses revealed that smaller stone size (OR 0.889, 95% CI: 0.841-0.937, P < 0.001), lower MSD (OR 0.995, 95% CI: 0.994-0.996, P < 0.001), and higher SHI (OR 1.011, 95% CI: 1.008-1.014, P < 0.001) were independent predictors of one-session success. The radiologic heterogeneity of urinary stones or SHI was an independent predictor for SWL success in patients with ureteral calculi and a useful clinical parameter for stone fragility. PMID:27035621

  14. Stone heterogeneity index as the standard deviation of Hounsfield units: A novel predictor for shock-wave lithotripsy outcomes in ureter calculi

    PubMed Central

    Lee, Joo Yong; Kim, Jae Heon; Kang, Dong Hyuk; Chung, Doo Yong; Lee, Dae Hun; Do Jung, Hae; Kwon, Jong Kyou; Cho, Kang Su

    2016-01-01

    We investigated whether stone heterogeneity index (SHI), which a proxy of such variations, was defined as the standard deviation of a Hounsfield unit (HU) on non-contrast computed tomography (NCCT), can be a novel predictor for shock-wave lithotripsy (SWL) outcomes in patients with ureteral stones. Medical records were obtained from the consecutive database of 1,519 patients who underwent the first session of SWL for urinary stones between 2005 and 2013. Ultimately, 604 patients with radiopaque ureteral stones were eligible for this study. Stone related variables including stone size, mean stone density (MSD), skin-to-stone distance, and SHI were obtained on NCCT. Patients were classified into the low and high SHI groups using mean SHI and compared. One-session success rate in the high SHI group was better than in the low SHI group (74.3% vs. 63.9%, P = 0.008). Multivariate logistic regression analyses revealed that smaller stone size (OR 0.889, 95% CI: 0.841–0.937, P < 0.001), lower MSD (OR 0.995, 95% CI: 0.994–0.996, P < 0.001), and higher SHI (OR 1.011, 95% CI: 1.008–1.014, P < 0.001) were independent predictors of one-session success. The radiologic heterogeneity of urinary stones or SHI was an independent predictor for SWL success in patients with ureteral calculi and a useful clinical parameter for stone fragility. PMID:27035621

  15. Purbeck Stone - A possible Global Heritage Stone from England

    NASA Astrophysics Data System (ADS)

    Marker, Brian

    2014-05-01

    By definition, a Global Heritage Stone Resource (GHSR) should have international significance. The Purbeck Group of uppermost Jurassic to lowermost Cretaceous age (Tithonian- Berriasian) outcrops mainly in the Purbeck area of Dorset, England. It was deposited in shallow freshwater to brackish lagoons with occasional marine incursions. Limestones, mainly biosparites, occur at 6 main levels. Differences in bed thickness, jointing and hardness make it suitable for a variety of purposes including dimension stone, monumental and ornamental stone, roofing tiles, paving, flooring and rockery stone. Near the top of the sequence is a dark gastropod biosparite, traditionally called Purbeck Marble, easily carved, which has been extensively used for decorative interior work in churches and cathedrals particularly for fonts, tombs, flooring and facings on columns for example in the medieval cathedrals of Salisbury, Exeter, Durham, York and Wells and Worcester and Westminster Abbey. The stone was extracted at least from Roman times (1st century AD) through the medieval period. Quarrying expanded from about 1700 reaching a peak in the late 18th and 19th centuries. Stone was transported first by sea but later by rail for wider use. Used in many local buildings, it gives an important element of local character. Many of the villages are designated conservation areas with a requirement for repair, maintenance and new building using local stone. Initially the stone was taken from quarries but was later mined. The number of operating companies declined from 15 to 5 over the past 40 years, with 10 active small quarries. Outputs are from few hundred tonnes to a few thousand tonnes per annum or about 9 to 12 years of permitted reserves but the Planning Authority intends to make sufficient provision for production at recent levels for their development plan period. The extraction sites are in an Area of Outstanding Natural Beauty and close to Jurassic Coast World Heritage Site. This might be a test case for considering whether a stone with this history is significant enough to be designated as a GHSR or is, rather, of national significance.

  16. Ureteroscopy for treatment of upper urinary tract stones in children: technical considerations.

    PubMed

    Gupta, Natasha; Ko, Joan; Matlaga, Brian R; Wang, Ming-Hsien

    2014-05-01

    The incidence of pediatric urolithiasis is increasing. While many smaller stones may pass spontaneously, surgical therapy is sometimes warranted. Surgical options include shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, and open surgery. Ureteroscopy represents a minimally invasive approach, and it is increasingly being used to treat pediatric upper tract calculi. Ureteroscopy is performed under anesthesia and fluoroscopic guidance, with basket extraction or lithotripsy of the calculi. Technical considerations include active or passive ureteral dilatation, the use of ureteral access sheaths for larger stone burdens, and post-operative stent placement. The current pediatric literature suggests high success rates (equal to or surpassing shock wave lithotripsy) and low complication rates. However, concerns remain regarding feasibility in patients with variant anatomies and risk due to intra-operative radiation exposure. PMID:24658833

  17. Correlation of volume, position of stone, and hydronephrosis with microhematuria in patients with solitary urolithiasis

    PubMed Central

    Inci, Mehmet Fatih; Ozkan, Fuat; Bozkurt, Selim; Sucakli, Mustafa Haki; Altunoluk, Bulent; Okumus, Mehmet

    2013-01-01

    Background The aim of this study was to determine the relationship between hematuria and volume, position of stone, and hydronephrosis in patients with a solitary stone, using unenhanced multidetector computed tomography (MDCT). Material/Methods This retrospective study evaluated the clinical and radiological records of 83 patients undergoing MDCT for the evaluation of acute flank pain and suspected renal colic, who also underwent a microscopic urinalysis at the emergency department of our hospital during a 1-year period. Inclusion criteria of the MDCT study were solitary urolithiasis and cumulative stone diameter under 1 cm. Results A total of 83 patients were included in the study, with a mean age of 42.1±14.4 years; 48 (57.8%) were females and 35 (42.2%) were males. Detection of 5 or more red cells on urinalysis was regarded as microscopic hematuria, and was positive in 46 patients (55.4%). There was a positive correlation between the position of the stone (especially upper two-thirds ureteral stones) and microhematuria rate (r: 0.28, p=0.009). There was a statistically significant difference in presence of hydronephrosis between the microhematuria (36 patients, 78%) and non-microhematuria (12 patients, 32%) groups (p<0.001). The median stone volume between the microhematuria and non-microhematuria groups were not statistically different, 37.5 mm3 (range 5–425) and 28 mm3 (range 4–412), respectively (p=0.39). Conclusions Although stone volume is one of the best indicators of stone burden, it was not correlated with microhematuria. However, in patients with renal colic, microhematuria requires ultrasound examination whether hydronephrosis and ureteral stones are present or not. Further studies with larger sample sizes are warranted. PMID:23612123

  18. A biomechanical simulation of ureteral flow during peristalsis using intraluminal morphometric data.

    PubMed

    Vahidi, Bahman; Fatouraee, Nasser

    2012-04-01

    Reflux nephropathy and vesicoureteral reflux are two of the most important abnormalities in the upper urinary system in which toxins and bacteria from the bladder infect the ureter and the kidney and initiate renal scar formation. A quantitative analysis that characterizes urine flow will further help our understanding of the ureter and also assist in the design of flow aided devices such as valves and stents to correct reflux situations. Here, A numerical simulation with fluid-structure interactions (FSI) using arbitrary Lagrangian-Eulerian (ALE) formulation and adaptive mesh procedure was introduced and solved to perform ureteral flow analysis. Incompressible Navier-Stokes equations were utilized as the governing equations of fluid domain. Ureteral in-vivo morphometric data during peristalsis were used to construct the presented model. A nonlinear material model was used to exhibit ureteral wall mechanical properties. Direct coupling method was used to solve the solid, fluid and interface equations simultaneously. Results showed that recirculation regions formed against the jet flow, neighboring the bolus peak. Through wave propagation, separation occurred behind the moving bolus on the wall and ureteropelvic reflux began from that location and extended upstream to the ureteral inlet. The maximum luminal pressure consistently occurred behind the urine bolus during peristalsis. The measured magnitude of maximum volumetric flow rate resulted from isolated bolus transportation was 0.92 ml/min. In conclusion; due to presence of fluid inertial forces during peristalsis, the function of ureteropelvic junction in prevention of reflux is significant, especially at the beginning of peristaltic wave propagation. Moreover, modeling of ureteral function using imaging data will be valuable and it may help physicians to diagnose and cure the abnormalities. PMID:22214750

  19. Large impacted upper ureteral calculi: A comparative study between retrograde ureterolithotripsy and percutaneous antegrade ureterolithotripsy in the modified lateral position

    PubMed Central

    Moufid, Kamal; Abbaka, Najib; Touiti, Driss; Adermouch, Latifa; Amine, Mohamed; Lezrek, Mohammed

    2013-01-01

    Context: The treatment for patients with large impacted proximal ureteral stone remains controversial, especially at institutions with limited resources. Aim: The aim of this study is to compare and to evaluate the outcome and complications of two main treatment procedures for impacted proximal ureteral calculi, retrograde ureterolithotripsy (URS), and percutaneous antegrade ureterolithotripsy (Perc-URS). Settings and Design: Our inclusion criteria were solitary, radiopaque calculi, >15 mm in size in a functioning renal unit. Only those patients in whom the attempt at passing a guidewire or catheter beyond the calculus failed were included in this study. Patients and Methods: Between January 2007 and July 2011, a total of 52 patients (13 women and 39 men) with large impacted upper-ureteral calculi >15 mm and meeting the inclusion criteria were selected. Of these, Perc-URS was done in 22 patients (group 1) while retrograde ureteroscopy was performed in 30 patients (group 2). We analyzed operative time, incidence of complications during and after surgery, the number of postoperative recovery days, median total costs associated per patient per procedure, and the stone-free rate immediately after 5 days and after 1 month. Statistical Analysis Used: Bivariate analysis used the Student t-test and the Mann-Whitney test to compare two means and Chi-square and Fisher's exact tests to compare two percentages. The significance level was set at 0.05. Results: The mean age was 42.3 years (range 22-69). The mean stone sizes (mm) were 34 ± 1.2 and 29.3 ± 1.8 mm in group 1 and 2, respectively. In the Perc-URS group, 21 patients (95.45%) had complete calculus clearance through a single tract in one session of percutaneous surgery, whereas in the URS group, only 20 patients (66.7%) had complete stone clearance (P = 0.007). The mean operative time was higher in the Perc-URS group compared to group 2 (66.5 ± 21.7 vs. 52.13 ± 17.3 min, respectively; P = 0.013). Complications encountered in group 1 included transient postoperative fever (2 pts) and simple urine outflow (2 pts). Ten patients (33%) of group 2 experienced failure: Migration to the kidney (3 pts), ureteral perforation (2 pts), tortuosity of the ureter (2 pts), and epithelial polyps (2 patients). Group 1 patients had an average visual analog (VAS) pain score of 47 mm compared with 31 mm in group 2 patients. The mean hospital stay (days) in group 1 was higher than the group 2 (2.27 ± 0.8 vs. 1.67 ± 0.6, respectively; P = 0.01). The mean analgesia requirement for group 1 (paracetamol chlorhydrate + codeine 12 ± 3 g) was significantly more compared with group B (6.8 ± 2 g) (P < 0.01). The difference in average blood loss between the two groups was not statistically significant. Total costs was slightly higher in group 1 but the difference was not statistically significant between the two groups (15000 vs. 13400 MDH respectively; P > 0.05). After 1 month, the stone free-rate remained higher in group 1 (95.5% vs. 66.7%, respectively; P = 0.012). Conclusions: In our series, Perc-URS is a safe and efficient treatment option for proximal ureteral stone, especially when the stone size is superior to 15 mm with the presence of moderate or severe hydronephrosis. PMID:24049373

  20. Intrarenal Doppler Indices in Acute Ureteric Obstruction

    PubMed Central

    2014-01-01

    Context: Urolithiasis remains a major health problem despite advances in therapy. Obstruction results in an increase in pressure within the urinary tract, causing structural and physiologic changes. This study aimed to calculate the intra renal Resistivity Index (RI) of acutely obstructed kidney, to determine the significance of Resistivity Index Ratio (RIR) and difference in Resistivity Index of obstructed and contralateral non obstructed kidney. Materials and Methods: Prospective study with renal Doppler for patients presenting with acute unilateral ureteric obstruction. Seventy two patients between the age group 20-45 y presenting to the Department of Radiodiagnosis, between January – December 2006 with acute unilateral ureteric obstruction were included in the study. Gray scale and Doppler evaluation of the kidneys done; with assessment of the ureteric calculus. Renal Doppler indices calculated and follow up of the same done after relief of obstruction. Statistical Analysis: Statistical analysis was done using SPSS Software V13 and p-value <0.05 was considered as statistically significant. Results: Forty two patients (58.33%) had mild, 28 (38.89%) moderate and 2 (2.78%) severe hydronephrosis. The mean RI of the obstructed kidney was 0.66±0.88 and that of contralateral non obstructed kidney was 0.569±0.05. Delta RI between the obstructed and contralateral non obstructed kidney was 0.08±0.03. The mean RIR between the obstructed and non obstructed kidney was 1.12±0.04 and the same after relief of obstruction was 1.03±0.06. Conclusion: The intrarenal Resistivity indices are less sensitive indicators in predicting the diagnosis of acute ureteric obstruction, although Resistivity Index Ratio appears to be a better parameter. The indices within the normal range do not rule out the absence of obstruction. Hence these parameters should not be interpreted in isolation. PMID:25654006

  1. Outcomes of ureteral surgery and ureteral stenting in cats: 117 cases (2006-2014).

    PubMed

    Wormser, Chloe; Clarke, Dana L; Aronson, Lillian R

    2016-03-01

    OBJECTIVE To evaluate and compare outcomes in cats following ureteral surgery or ureteral stent placement. DESIGN Retrospective case series. ANIMALS 117 cats. PROCEDURES Data regarding signalment, history, concurrent disease, clinical signs, clinicopathologic tests, surgical procedures, and perioperative complications (including death) were recorded. Follow-up data, including presence of signs of chronic lower urinary tract disease, chronic urinary tract infection, reobstruction, and death, if applicable, were obtained by records review or telephone contact with owners. Variables of interest were compared statistically between cats treated with and without stent placement. Kaplan-Meier analysis and Cox regression were performed to assess differences in survival time between cats with and without ureteral stents. RESULTS Perioperative complications referable to the urinary tract were identified in 6 of 43 (14%) cats that had ≥ 1 ureteral stent placed and 2 of 74 (3%) cats that underwent ureteral surgery without stenting. Perioperative mortality rates were similar between cats with (4/43 [9%]) and without (6/74 [8%]) stents. After surgery, signs of chronic lower urinary tract disease and chronic urinary tract infection were significantly more common among cats with than cats without stents. Nineteen of 87 (22%) cats with follow-up information available had recurrent obstruction; incidence of reobstruction did not differ between cats with and without stents. Median survival time did not differ between the 2 groups. CONCLUSIONS AND CLINICAL RELEVANCE The potential for signs of chronic lower urinary tract disease and chronic infection, particularly among cats that receive ureteral stents, warrants appropriate client counseling. Judicious long-term follow-up for detection of reobstruction is recommended. PMID:26885594

  2. Ureteroscopy with conscious sedation for distal ureteric calculi: 10-year experience

    PubMed Central

    Kroczak, Tadeusz J.; Kaler, Kamaljot Singh; Patel, Premal; Al-Essawi, Turki

    2016-01-01

    Introduction: Distal ureteroscopy for stone extraction is a common procedure that is generally performed with spinal or general anesthesia. We retrospectively reviewed all distal ureteroscopy performed for ureteric stone extraction with conscious sedation at our institution over a 10-year period to determine its efficacy and safety. Methods: A retrospective chart review was performed of all distal ureteroscopy performed for calculus removal from 2004 to 2014. Patient characteristics, analgesic requirement, tolerability, procedure time, stone size and composition, method of stone extraction, success rate, and complications were collected. Results: Between 2004 and 2014, 314 procedures were performed. Mean age was 53.74 years, with 160 males and 154 females. A success rate of 97% and 10 (3.2%) complications were reported. Mean analgesic requirement was 189 μg of fentanyl (range: 50–400) and 2.79 mg of midazolam (range: 0–8). A total of 263 patients (83.7%) tolerated the procedure well, with only seven (2.2%) having poor tolerability. When comparing females to males, females were found to require less fentanyl (p=0.0001) and midazolam (p=0.0001). When calculi >5 mm were compared to those <5 mm, there was no statistically significant difference in success rate, procedure time, analgesic requirement, tolerability, or complications. Conclusion: Distal ureteroscopy with conscious sedation is safe and efficacious. To our knowledge, this is the first report demonstrating stones >5 mm can be safely and effectively treated with conscious sedation during this procedure. The context of our findings must be understood within the limitations of our retrospective analysis. PMID:26858781

  3. Treatment of the Infected Stone.

    PubMed

    Marien, Tracy; Miller, Nicole L

    2015-11-01

    Infected kidney stones refer to stones that form because of urinary tract infections with urease-producing bacteria, secondarily infected stones of any composition, or stones obstructing the urinary tract leading to pyelonephritis. The mainstay of treatment of infection stones is complete stone removal. Kidney stones that obstruct the urinary tract and cause obstructive pyelonephritis are also frequently referred to as infected stones. Obstructive pyelonephritis is a urologic emergency as it can result in sepsis and even death. Infection stones and obstructive stones causing pyelonephritis are different disease processes, and their workup and management are described separately. PMID:26475943

  4. The Paving Stones: initial feed-back on an attempt to apply the AGILE principles for the development of a CubeSat space mission to Mars

    NASA Astrophysics Data System (ADS)

    Segret, Boris; Semery, Alain; Vannitsen, Jordan; Mosser, Benot.; Miau, Jiun-Jih; Juang, Jyh-Ching; Deleflie, Florent

    2014-08-01

    The AGILE principles in the software industry seems well adapted to the paradigm of CubeSat missions that involve students for the development of space missions. Some of well-known engineering and program processes are revisited on the example of an interplanetary CubeSat mission profile that has been developed by several teams of students in various countries and at various educational levels since 02/2013. The lessons learned at adapting traditional space mission methods are emphasized and they produce a metaphoric image of paving stones.

  5. Acute kidney injury due to bilateral ureteral obstruction in children

    PubMed Central

    Bianchi, Daniele; Vespasiani, Giuseppe; Bove, Pierluigi

    2014-01-01

    Bilateral ureteral obstruction in children is a rare condition arising from several medical or surgical pictures. It needs to be promptly suspected in order to attempt a quick renal function recovery. In this paper we concentrated on uncommon causes of obstruction, with the aim of giving a summary of such multiple, rare and heterogeneous conditions joint together by the common denominator of sudden bilateral ureteral obstruction, difficult to be suspected at times. Conversely, typical and well-known diseases have been just run over. We considered pediatric cases of ureteral obstruction presenting as bilateral, along with some cases which truly appeared as single-sided, because of their potential bilateral presentation. We performed a review of the literature by a search on PubMed, CrossRef Metadata Search, internet and reference lists of single articles updated to May 2014, with no time limits in the past. Given that we deal with rare conditions, we decided to include also papers in non-English languages, published with an English abstract. For the sake of clearness, we divided our research results into 8 categories: (1) urolithiasis; (2) congenital urinary tract malformations; (3) immuno-rheumatologic causes of ureteral obstruction; (4) ureteral localization of infections; (5) other systemic infective causes of ureteral obstructions; (6) neoplastic intrinsic ureteral obstructions; (7) extrinsic ureteral obstructions; and (8) iatrogenic trigonal obstruction or inflammation. Of course, different pathogenic mechanisms underlay those clinical pictures, partly well-known and partly not completely understood. PMID:25374811

  6. Microscopic hematuria and calculus-related ureteral obstruction.

    PubMed

    Stewart, D P; Kowalski, R; Wong, P; Krome, R

    1990-01-01

    The evaluation of patients with ureteral calculi in the emergency department has historically included urinalysis (UA) and intravenous pyelograms (IVP). This retrospective study was done to determine if a statistically significant relationship existed between the degree of calculus-related ureteral obstruction, proven by IVP, and the presence or absence of microscopic hematuria. Urine red blood cells were recorded as less than 3 rbc/hpf (negative) or greater than or equal to 3 rbc/hpf (positive). IVPs were recorded as nonsevere or severe. IVP criteria were based on the presence or absence of extravasation, greater than 2-hour ureteral filling times, and a numerical scoring system of 1 to 4 for ureteral or calyceal dilatation and nephrogenic effect. Eighty-nine men (72%) had non-severe obstructions and 34 (28%) had severe obstructions. Twenty-five women (68%) had nonsevere obstructions and 12 (32%) had severe obstructions. Of the 28 patients with normal UAs, 11 had severe ureteral obstructions and 17 had nonsevere ureteral obstructions. There were no statistically significant differences between the presence or absence of significant microscopic hematuria and the presence or absence of severe ureteral obstruction. Microscopic hematuria is neither sensitive nor specific in determining the degree of calculus-related ureteral obstruction. PMID:2096163

  7. Application of Skin Electrical Conductance of Acupuncture Meridians for Ureteral Calculus: A Case Report

    PubMed Central

    Lin, Wu-Chou; Chen, Yung-Hsiang; Xu, Jian-Ming; Chen, Der-Cherng; Chen, Wen-Chi; Lee, Chao-Te

    2011-01-01

    Renal colic is a common condition seen in the emergency department (ED). Our recent study showed that measures of electrical conductance may be used as supplementary diagnostic methods for patients with acute renal colic. Here, we describe the case of a 30-year-old male subject with a left ureteral calculus who presented with frequency and normal-looking urine. He had already visited the outpatient department, but in vain. Normal urinalysis and nonobstructive urogram were reported at that time. Two days later, he was admitted to the ED because of abdominal pain in the left lower quadrant. The urinalysis did not detect red blood cells. Ultrasonography did not indicate hydronephrosis. The meridian electrical conductance and index of sympathovagal balance were found to be abnormal. High level of electrical conductance on the left bladder meridian was found. An unenhanced helical computed tomography was scheduled to reveal a left ureterovesical stone. Ureteroscopic intervention was later uneventfully performed, and the patient's pain was relieved. The follow-up measurements showed that the meridian parameters had returned to normal one month after treatment. This case suggests that bladder meridian electrical conductance might be used as a supplemental method for ureteral calculus diagnosis. PMID:24533191

  8. Extracorporeal Ureteric Stenting for Pediatric Laparoscopic Pyeloplasty.

    PubMed

    Kocherov, Stanislav; Lev, Genady; Chertin, Leonid; Chertin, Boris

    2016-04-01

    Introduction We aimed to evaluate a novel technique for ureteric stent insertion during dismembered pediatric laparoscopic pyeloplasty. Patients and Methods Following identification and dissection of the ureteropelvic junction (UPJ) with the proximal part of ureter, the ureter is dismembered just proximal to the UPJ at the level of the renal pelvis, allowing use of the excess pelvic tissue for further manipulation of the ureter. Then the abdomen is desufflated and the ureter delivered to the skin level. The externalized ureter is then spatulated and the stent inserted in an antegrade fashion to the bladder. The first stitch for further laparoscopic anastomosis is applied to the lower part of the spatulated ureteric end and then following insufflations the ureter is returned to the abdomen. The laparoscopic anastomosis is completed in a routine fashion. Results Over the past 4 years, we have used this technique in 26 children (17 boys and 9 girls) with median age of 4 years (range, 2-18 years). Left pyeloplasty was performed in 16 and right pyeloplasty in the remaining 10 patients. The mean (range) time of insertion was 6 minutes (range, 4-7 minutes). All stents were correctly placed. In one patient, the stent dislodged to distal part of the ureter. No other intraoperative or postoperative complications related to our technique of stent insertion were observed. Conclusion Our data show that extracorporeal antegrade ureteric stent insertion is an easy-to-learn and a safe and reliable technique for pediatric dismembered pyeloplasty. It obviates the problem of having the stent in the pelvis during dissection and the need for patient repositioning. PMID:25774958

  9. Endoluminal release of ureteral ligature after hysterectomy.

    PubMed

    Wang, Chih-Jen; Lin, Victor Chia-Hsiang; Huang, Ching-Yu

    2016-01-01

    Iatrogenic ureteral injury is a well-recognized complication of abdominal total hysterectomy. We report a case of a 57-year-old female who underwent abdominal total hysterectomy for a uterine myoma and experienced severe right flank pain postoperatively. The imaging study displayed an obstruction of the right distal ureter. Under ureteroscopy, an extraluminal ligature was released with a holmium:yttrium-aluminum-garnet laser. The stenotic segment was immediately relieved. Two months later, the intravenous urogram illustrated patency of the distal ureter with regression of right hydronephrosis. There was no recurrent hydronephrosis during 1 year of follow-up. PMID:25241286

  10. A novel ureter dilatation method for replacing hydromantic perfusion pump during ureteroscopic lithotripsy in patients with ureteral calculi and ibroepithelial polyps.

    PubMed

    Li, Tengcheng; Fang, Youqiang; Wu, Jieying; Zhou, Xiangfu

    2014-01-01

    This study aimed to evaluate the clinical value of a novel ureter dilatation method during ureteroscopic pneumatic lithotripsy in patients with ureteral calculi and polyps. Clinical information of 86 patients with ureter calculi and polyps who underwent ureteroscopic pneumatic lithotripsy was reviewed. A cavity-distention machine was used in 44 cases to inject normal saline for keeping clear operation view (cavity-distention machine-assisted group). A high handled water bag with artificial water injection (traditional pneumatic lithotripsy group) was used in 42 cases. The total operation time, time of stone removal, stone clearance rate and surgery complications were compared between two groups. All operations were successful with no patients transferred to open surgery. No ureter breakage or avulsion occurred in two groups. Two patients in traditional pneumatic lithotripsy group suffered from ureter perforation. In cavity-distention machine-assisted group and traditional pneumatic lithotripsy group, the total operation time was 30.1±4.8 min and 36.2±6.0 min, respectively (t=-5.22, P<0.01); the time of stone removal was 6.4±1.3 min and 9.3±1.5 min, respectively (t=-9.59, P<0.01); the stone clearance rate was 100% (44/44) and 95.2% (40/42; upper ureter stone immigrated to the renal pelvis in 2, and extraorgan shock wave lithotripsy was performed), respectively. Thus, intraoperative infusion of saline with a cavity-distention machine may replace the hydromantic perfusion pump to maintain a clear operation view and favor the stone removal in lesser time. This method has important clinical value in the treatment of ureteral calculi and polyps. PMID:24753755

  11. Diet for Kidney Stone Prevention

    MedlinePlus

    ... specific type of kidney stone include the following: Calcium Oxalate Stones reducing sodium reducing animal protein, such as ... with increased daily sodium consumption. People who form calcium oxalate or calcium phosphate stones should limit their intake ...

  12. Prone split-leg position to manage encrusted ureteral stents in a single-stage procedure in women: Step-by-step surgical technique

    PubMed Central

    Marchini, Giovanni Scala; Torricelli, Fábio César Miranda; Mazzucchi, Eduardo; Srougi, Miguel; Monga, Manoj

    2015-01-01

    The management of encrusted ureteral stents is costly, time consuming and may be risky for the patient and challenging for the urologist. Treatment modalities for encrusted stents include extracorporeal shock wave lithotripsy, cystolithopaxy, rigid or flexible ureteroscopy with intracorporeal lithotripsy, percutaneous nephrolithotomy, open surgery, and a combination of those methods. In this study we describe the management of severe forgotten encrusted ureteral stents in 3 female patients using a prone split-leg position. This position allows us to effectively treat any site and degree of stent encrustation in a single-session approach with the patient in the same position during the whole procedure. All patients were rendered stent and stone free. No complications occurred. PMID:26279723

  13. Should flexible ureteroscope be added to our armamentarium to treat stone disease?

    PubMed

    Dharaskar, Anand; Mandhani, Anil

    2008-10-01

    The field of Urology in Medicine has witnessed tremendous advancement in technology and in accordance with it. Endourology has taken a leap ahead in terms of stone management. Most of the stones could be treated with semi-rigid ureteroscopy, percutaneous nephrolithotomy (PNL) and ESWL and some would need Flexible ureteroscopy. Flexible ureteroscopy has been primarily indicated to treat ESWL resistant renal stones but with changes in the technology of incorporating secondary active deflection and availability of laser fibres, its horizon for indications to treat stones is being widened. Though Flexible ureteroscopy is being used to treat stones of various sizes and locations, its cost effectiveness is debatable. Should it be used ubiquitously to treat stones amenable to PNL or ESWL is a big question we need to answer. As of now true indications of Flexible ureteroscopy are limited and there is an urgent need for a randomized trial to compare its efficacy with ESWL and PNL for renal and upper ureteric stones. PMID:19468509

  14. SOURCE ASSESSMENT: CRUSHED STONE

    EPA Science Inventory

    This report describes a study of air emissions from crushed stone production. The potential environmental effect of the source is evaluated. Crushed stone production in 1972 was 1.07 x 10 to the 8th power metric tons (1.18 x 10 to the 8th power tons), 68% of which was traprock. C...

  15. Chimpanzee accumulative stone throwing.

    PubMed

    Kühl, Hjalmar S; Kalan, Ammie K; Arandjelovic, Mimi; Aubert, Floris; D'Auvergne, Lucy; Goedmakers, Annemarie; Jones, Sorrel; Kehoe, Laura; Regnaut, Sebastien; Tickle, Alexander; Ton, Els; van Schijndel, Joost; Abwe, Ekwoge E; Angedakin, Samuel; Agbor, Anthony; Ayimisin, Emmanuel Ayuk; Bailey, Emma; Bessone, Mattia; Bonnet, Matthieu; Brazolla, Gregory; Buh, Valentine Ebua; Chancellor, Rebecca; Cipoletta, Chloe; Cohen, Heather; Corogenes, Katherine; Coupland, Charlotte; Curran, Bryan; Deschner, Tobias; Dierks, Karsten; Dieguez, Paula; Dilambaka, Emmanuel; Diotoh, Orume; Dowd, Dervla; Dunn, Andrew; Eshuis, Henk; Fernandez, Rumen; Ginath, Yisa; Hart, John; Hedwig, Daniela; Ter Heegde, Martijn; Hicks, Thurston Cleveland; Imong, Inaoyom; Jeffery, Kathryn J; Junker, Jessica; Kadam, Parag; Kambi, Mohamed; Kienast, Ivonne; Kujirakwinja, Deo; Langergraber, Kevin; Lapeyre, Vincent; Lapuente, Juan; Lee, Kevin; Leinert, Vera; Meier, Amelia; Maretti, Giovanna; Marrocoli, Sergio; Mbi, Tanyi Julius; Mihindou, Vianet; Moebius, Yasmin; Morgan, David; Morgan, Bethan; Mulindahabi, Felix; Murai, Mizuki; Niyigabae, Protais; Normand, Emma; Ntare, Nicolas; Ormsby, Lucy Jayne; Piel, Alex; Pruetz, Jill; Rundus, Aaron; Sanz, Crickette; Sommer, Volker; Stewart, Fiona; Tagg, Nikki; Vanleeuwe, Hilde; Vergnes, Virginie; Willie, Jacob; Wittig, Roman M; Zuberbuehler, Klaus; Boesch, Christophe

    2016-01-01

    The study of the archaeological remains of fossil hominins must rely on reconstructions to elucidate the behaviour that may have resulted in particular stone tools and their accumulation. Comparatively, stone tool use among living primates has illuminated behaviours that are also amenable to archaeological examination, permitting direct observations of the behaviour leading to artefacts and their assemblages to be incorporated. Here, we describe newly discovered stone tool-use behaviour and stone accumulation sites in wild chimpanzees reminiscent of human cairns. In addition to data from 17 mid- to long-term chimpanzee research sites, we sampled a further 34 Pan troglodytes communities. We found four populations in West Africa where chimpanzees habitually bang and throw rocks against trees, or toss them into tree cavities, resulting in conspicuous stone accumulations at these sites. This represents the first record of repeated observations of individual chimpanzees exhibiting stone tool use for a purpose other than extractive foraging at what appear to be targeted trees. The ritualized behavioural display and collection of artefacts at particular locations observed in chimpanzee accumulative stone throwing may have implications for the inferences that can be drawn from archaeological stone assemblages and the origins of ritual sites. PMID:26923684

  16. Chimpanzee accumulative stone throwing

    PubMed Central

    Kühl, Hjalmar S.; Kalan, Ammie K.; Arandjelovic, Mimi; Aubert, Floris; D’Auvergne, Lucy; Goedmakers, Annemarie; Jones, Sorrel; Kehoe, Laura; Regnaut, Sebastien; Tickle, Alexander; Ton, Els; van Schijndel, Joost; Abwe, Ekwoge E.; Angedakin, Samuel; Agbor, Anthony; Ayimisin, Emmanuel Ayuk; Bailey, Emma; Bessone, Mattia; Bonnet, Matthieu; Brazolla, Gregory; Buh, Valentine Ebua; Chancellor, Rebecca; Cipoletta, Chloe; Cohen, Heather; Corogenes, Katherine; Coupland, Charlotte; Curran, Bryan; Deschner, Tobias; Dierks, Karsten; Dieguez, Paula; Dilambaka, Emmanuel; Diotoh, Orume; Dowd, Dervla; Dunn, Andrew; Eshuis, Henk; Fernandez, Rumen; Ginath, Yisa; Hart, John; Hedwig, Daniela; Ter Heegde, Martijn; Hicks, Thurston Cleveland; Imong, Inaoyom; Jeffery, Kathryn J.; Junker, Jessica; Kadam, Parag; Kambi, Mohamed; Kienast, Ivonne; Kujirakwinja, Deo; Langergraber, Kevin; Lapeyre, Vincent; Lapuente, Juan; Lee, Kevin; Leinert, Vera; Meier, Amelia; Maretti, Giovanna; Marrocoli, Sergio; Mbi, Tanyi Julius; Mihindou, Vianet; Moebius, Yasmin; Morgan, David; Morgan, Bethan; Mulindahabi, Felix; Murai, Mizuki; Niyigabae, Protais; Normand, Emma; Ntare, Nicolas; Ormsby, Lucy Jayne; Piel, Alex; Pruetz, Jill; Rundus, Aaron; Sanz, Crickette; Sommer, Volker; Stewart, Fiona; Tagg, Nikki; Vanleeuwe, Hilde; Vergnes, Virginie; Willie, Jacob; Wittig, Roman M.; Zuberbuehler, Klaus; Boesch, Christophe

    2016-01-01

    The study of the archaeological remains of fossil hominins must rely on reconstructions to elucidate the behaviour that may have resulted in particular stone tools and their accumulation. Comparatively, stone tool use among living primates has illuminated behaviours that are also amenable to archaeological examination, permitting direct observations of the behaviour leading to artefacts and their assemblages to be incorporated. Here, we describe newly discovered stone tool-use behaviour and stone accumulation sites in wild chimpanzees reminiscent of human cairns. In addition to data from 17 mid- to long-term chimpanzee research sites, we sampled a further 34 Pan troglodytes communities. We found four populations in West Africa where chimpanzees habitually bang and throw rocks against trees, or toss them into tree cavities, resulting in conspicuous stone accumulations at these sites. This represents the first record of repeated observations of individual chimpanzees exhibiting stone tool use for a purpose other than extractive foraging at what appear to be targeted trees. The ritualized behavioural display and collection of artefacts at particular locations observed in chimpanzee accumulative stone throwing may have implications for the inferences that can be drawn from archaeological stone assemblages and the origins of ritual sites. PMID:26923684

  17. Kidney Stones in Adults

    MedlinePlus

    ... specific type of kidney stone include the following: Calcium Oxalate Stones reducing sodium reducing animal protein, such as ... fish getting enough calcium from food or taking calcium supplements with food avoiding foods high in oxalate, such as spinach, rhubarb, nuts, and wheat bran ...

  18. Old Stone Field Marker

    This is a stone field marker that marked boundaries for land ownership. In the early days of Land Office Recordings, this is one type of monument used. Trees, Posts, Iron Pipes and as shown stones were used to mark off land during the Land Rush days. Later, when mapping was being done, Brass Caps wi...

  19. Percutaneous ureteral stent placement for the treatment of a benign ureteral obstruction in a Sumatran tiger (Panthera tigris sumatrae).

    PubMed

    Delk, Katie W; Wack, Raymund F; Burgdorf-Moisuk, Anne; Palm, Carrie A; Zwingenberger, Allison; Glaiberman, Craig B; Ferguson, Kenneth H; Culp, William T N

    2015-01-01

    A 15-year-old, 113 kg intact male Sumatran tiger (Panthera tigris sumatrae) was evaluated for weight loss, polydipsia, and intermittent hematuria. The tiger was immobilized for diagnostic testing including blood work, urinalysis, and abdominal ultrasound. Laboratory testing demonstrated macro- and microhematuria, azotemia, and an increased urine protein:creatinine ratio. Abdominal ultrasound revealed bilateral ureterolithiasis as well as hydronephrosis and ureteral dilation. Ultrasonography performed 5 months later revealed worsening of the right-sided hydronephrosis and hydroureter and a decrease in the severity of dilation on the left side presumably from passage of the left-sided ureteral calculi. Nephroureteral decompression via the placement of a stent was elected. A pigtail ureteral catheter (8.2 French diameter) was placed in the right ureter via an antegrade percutaneous approach utilizing ultrasound and fluoroscopic-guidance. Following stent placement, macrohematuria resolved although microhematuria was noted in opportunistic urine samples. Five months after stent placement, the azotemia had mildly progressed, the urine protein:creatinine ratio was improved, the right hydronephrosis and hydroureter had completely resolved, and the ureteral stent remained in the appropriate position. The tiger had clinically improved with a substantial increase in appetite, weight, and activity level. Ureteral stenting allowed for nephroureteral decompression in the captive large felid of this report, and no complications were encountered. Ureteral stenting provided a minimally invasive method of managing ureteral obstruction in this patient and could be considered in future cases due to the clinical improvement and low morbidity. PMID:25653150

  20. Tissue Engineering of Ureteral Grafts: Preparation of Biocompatible Crosslinked Ureteral Scaffolds of Porcine Origin

    PubMed Central

    Koch, Holger; Hammer, Niels; Ossmann, Susann; Schierle, Katrin; Sack, Ulrich; Hofmann, Jörg; Wecks, Mike; Boldt, Andreas

    2015-01-01

    The surgical reconstruction of ureteric defects is often associated with post-operative complications and requires additional medical care. Decellularized ureters originating from porcine donors could represent an alternative therapy. Our aim was to investigate the possibility of manufacturing decellularized ureters, the characteristics of the extracellular matrix (ECM) and the biocompatibility of these grafts in vitro/in vivo after treatment with different crosslinking agents. To achieve these goals, native ureters were obtained from pigs and were decellularized. The success of decellularization and the ECM composition were characterized by (immuno)histological staining methods and a DNA-assay. In vitro: scaffolds were crosslinked either with carbodiimide (CDI), genipin (GP), glutaraldehyde, left chemically untreated or were lyophilized. Scaffolds in each group were reseeded with Caco2, LS48, 3T3 cells, or native rat smooth muscle cells (SMC). After 2 weeks, the number of ingrown cells was quantified. In vivo: crosslinked scaffolds were implanted subcutaneously into rats and the type of infiltrating cells were determined after 1, 9, and 30 days. After decellularization, scaffold morphology and composition of ECM were maintained, all cellular components were removed, DNA destroyed and strongly reduced. In vitro: GP and CDI scaffolds revealed a higher number of ingrown 3T3 and SMC cells as compared to untreated scaffolds. In vivo: at day 30, implants were predominantly infiltrated by fibroblasts and M2 anti-inflammatory macrophages. A maximum of MMP3 was observed in the CDI group at day 30. TIMP1 was below the detection limit. In this study, we demonstrated the potential of decellularization to create biocompatible porcine ureteric grafts, whereas a CDI-crosslink may facilitate the remodeling process. The use of decellularized ureteric grafts may represent a novel therapeutic method in reconstruction of ureteric defects. PMID:26157796

  1. Silent Loss of Kidney Seconary to Ureteral Endometriosis

    PubMed Central

    Paka, Chandhana; Gomaa, Mona; Schipper, Erica

    2012-01-01

    Background: Ureteral endometriosis is a serious localization of disease burden that can lead to urinary tract obstruction, with subsequent hydroureter, hydronephrosis, and potential kidney loss. Diagnosis is elusive and relies heavily on clinical suspicion as ureteral endometriosis can occur with both minimal and extensive disease. Surgical technique to treatment varies, but the goal is to salvage renal function and decrease disease burden. Case Descriptions: We describe 3 cases in which there was documentation of renal atrophy and function loss with subsequent workup and surgical intervention. Results: The cases illustrate varying surgical approaches tailored to localization of ureteral endometriosis. All cases were carried out laparoscopically. Conclusion: Ureteral endometriosis, albeit rare, can be complicated by potential loss of renal function. Clinical suspicion and preoperative assessment may help with diagnosis and allows for a multidisciplinary preconsultation. Laparoscopic surgical approach is based on extent of disease and localization and can be carried out successfully in the hands of a highly experienced laparoscopic surgeon. PMID:23318072

  2. [Endoscopic modified technique of ureteral resection during nephroureterectomy].

    PubMed

    Aguirre Benites, F; Blanco Carballo, O; Pamplona Casamayor, M; Díaz González, R; Leiva Galvis, O

    2007-01-01

    We show a technical modification of the ureteral endoscopic resection with which we try to avoid comunication between urine and surgical bed in order to prevent tumor local spread of upper urotelial tumor. PMID:17902476

  3. Spontaneous ureteral rupture in a patient with systemic lupus erythematosus

    SciTech Connect

    Benson, C.H.; Pennebaker, J.B.; Harisdangkul, V.; Songcharoen, S.

    1983-08-01

    A patient with known systemic lupus erythematosus had fever and symptoms of a lower urinary tract infection. Bone scintigraphy showed left ureteral perforation and necrosis with no demonstrable nephrolithiasis. It is speculated that this episode was due to lupus vasculitis.

  4. 12. FLOOR 2; STONE CRANE IN PLACE FOR ROCK STONES; ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    12. FLOOR 2; STONE CRANE IN PLACE FOR ROCK STONES; STONE CRANE HAS OAK SPAR, JIB AND BRACE, METAL SCREW, IRON YOKE AND DOGS; IRON PINS FIT THROUGH HOLES IN DOGS INTO HOLES DRILLED IN RUNNER STONE - Hook Windmill, North Main Street at Pantigo Road, East Hampton, Suffolk County, NY

  5. [Vesico-ureteral reflux in pediatrics].

    PubMed

    Fanos, V; Khoory, B J; Vecchini, S; Pedrolli, A; Pizzini, C; Benini, D

    1998-01-01

    Vesico-ureteral reflux (VUR) is the most frequent uropathy involving 1-2% of children. Genetics, familiarity, race gender and age intervene in the pathogenesis of VUR. In particular, neonatal VUR seems to represent a specific entity. Different factors determine a renal damage due to RVU: direct action of VUR (back pression), urinary tract infection (UTI), inflammatory mechanisms and renal dysplasia. Micturing cystourethrography and nuclear cystography are currently performed for the diagnosis of VUR, being ultrasound examination aspecific. Functional parameters are now investigated in association with new morphologic studies. The strict relationship of VUR and UTI is discussed. The treatment (medical, surgical) of VUR is not well established, although some guidelines can be suggested. Finally an adequate support must be given to the family for an optimal management. PMID:9973804

  6. Laparoscopic Nephroureterectomy: The Distal Ureteral Dilemma

    PubMed Central

    Srirangam, Shalom J.; van Cleynenbreugel, Ben; van Poppel, Hein

    2009-01-01

    Transitional cell carcinoma affecting the upper urinary tract, though uncommon, constitutes a serious urologic disease. Radical nephroureterectomy remains the treatment of choice but has undergone numerous modifications over the years. Although the standard technique has not been defined, the laparoscopic approach has gained in popularity in the last two decades. The most appropriate oncological management of the distal ureteral and bladder cuff has been a subject of much debate. The aim of the nephroureterectomy procedure is to remove the entire ipsilateral upper tract in continuity while avoiding extravesical transfer of tumor-containing urine during bladder surgery. A myriad of technical modifications have been described. In this article, we review the literature and present an overview of the options for dealing with the lower ureter during radical nephroureterectomy. PMID:19020654

  7. Ureteral Metastasis as the Presenting Manifestation of Pancreatic Carcinoma

    PubMed Central

    Arvind, Nand Kishore; Singh, Onkar; Gupta, Shilpi; Ali, Qutub

    2013-01-01

    We recently cared for a patient with adenocarcinoma of the pancreas who presented with ureteral metastasis followed by hydroureteronephrosis long before the appearance of any symptoms related to the primary lesion. The entity is extremely rare; only seven similar cases are on record in the scientific literature. No recent review exists on this topic. This encouraged us to present our case along with the previous cases of adenocarcinoma of the pancreas with ureteral metastasis that have been reported. PMID:24223025

  8. Danazol in the management of ureteral obstruction secondary to endometriosis

    SciTech Connect

    Rivlin, M.E.; Krueger, R.P.; Wiser, W.L.

    1985-08-01

    A case is reported in which a woman was diagnosed with ureteral obstruction secondary to endometriosis after cystourethrogram, retrograde pyelogram and a renal scan. After unsuccessful treatment with danazol, a retroperitoneal ureteroneocystotomy was performed. The ureter was found to be obstructed by dense fibrous tissue that contained endometrial glands. It was concluded that danazol is unlikely to relieve endometriotic ureteric obstruction once dense fibrosis has occurred. 8 references, 2 figures.

  9. Iatrogenic ureteric injuries: approaches to etiology and management

    PubMed Central

    Watterson, James D.; Mahoney, John E.; Futter, Norman G.; Gaffield, Johanna

    1998-01-01

    Injury to the ureter is a risk of any pelvic or abdominal surgery, including laparoscopy and ureteroscopy. The morbidity associated with such injury may be serious, resulting in increased hospital stay, compromise of the original surgical outcome, secondary invasive interventions, reoperation, potential loss of renal function and deterioration of the patient’s quality of life. Management of ureteric injuries, in conjunction with frank and open dialogue with the patient, can lead to an optimal outcome. For ureteral ligation, removal of the suture and assessment of ureteral viability are recommended, with surgical correction if necessary. For partial transection primary closure is suggested over stent placement. For uncomplicated upper- and middle-third ureteral injury ureteroureterostomy is the procedure of choice. For injuries above the pelvic brim several procedures are available: ureteroureterostomy, ureteroileal interposition and nephrectomy. For injuries below the pelvic brim ureteroneocystostomy is recommended with a psoas hitch or Boari bladder flap. To decrease the incidence of iatrogenic ureteral injury, a sound knowledge of abdominal and pelvic anatomy is the best prevention. If the proposed operation is likely to be close to the ureter, the ureter should be identified at the pelvic brim. If the dissection is likely to be difficult, preoperative intravenous pyelography and placement of a ureteral catheter may help in identifying and protecting the ureter. PMID:9793505

  10. Skimming and Skipping Stones

    ERIC Educational Resources Information Center

    Humble, Steve

    2007-01-01

    This article presents an example of skimming and skipping stone motion in mathematical terms available to students studying A-level mathematics. The theory developed in the article postulates a possible mathematical model that is verified by experimental results.

  11. Outcomes of ureteroscopy for patients with stones in a solitary kidney: evidence from a systematic review

    PubMed Central

    Rai, Bhavan Prasad; Somani, Bhaskar K.

    2016-01-01

    Introduction Management of urolithiasis in a solitary functioning kidney can be clinically challenging. The aim of this article was to review the outcomes of URS for patients with stone disease in a solitary kidney and critically appraise the existing evidence and outcome reporting standards. Material and methods We conducted a systematic review in line with PRISMA checklist and Cochrane guidelines between January 1980 and February 2015. Our inclusion criteria were all English language articles reporting on a minimum of 10 patients with a solitary kidney undergoing ureteroscopy for stone disease. Results A total of 116 patients (mean age 50 years) underwent URS for stones in solitary kidney. For a mean stone size of 16.8 mm (range: 5–60 mm) and 1.23 procedures/patient, the mean stone free rate was 87%. No significant change in renal function was recorded in any of the studies although a transient elevation in creatinine was reported in 10 (8.6%) patients. A total of 33 (28%) complications were recorded a majority (n = 21) of which were Clavien grade I. The Clavien grade II/III complications as reported by authors were urosepsis, steinstrasse and renal colic. None of the procedures required conversion to open surgery with no cases of renal haematoma or ureteric perforation. Conclusions This contemporary review highlights URS as a viable treatment option for stone disease in patients with a solitary kidney. It is associated with superior clearance rates to SWL and fewer high-risk complications compared to PCNL. PMID:27123332

  12. Evidence for Ureterorenoscopy and Laser Fragmentation (URSL) for Large Renal Stones in the Modern Era.

    PubMed

    Geraghty, Robert; Abourmarzouk, Omar; Rai, Bhavan; Biyani, Chandra Shakhar; Rukin, Nicholas J; Somani, Bhaskar K

    2015-08-01

    Large renal stones (>2 cm) are managed with percutaneous nephrolithotomy (PCNL), which has a good stone-free rate (SFR) but a relatively high incidence of complications graded Clavien ≥ 3. We wanted to review the literature for the use of ureterorenoscopy and laser fragmentation (URSL) for the management of these stones. A systematic review was done from 1990 to April 2014 for all English language articles reporting on a minimum of 10 patients for stones >2 cm in size (done by 2 reviewers independently) in accordance with the PRISMA and Cochrane review guidelines. A total of 379 articles were identified and after screening for the titles (54) and abstracts (29), 12 papers (651 patients) were included. The male to female ratio was 356:232 with a mean age of 54 years (range 16-86 years). With a mean stone size of 2.7 cm (2-3.15 cm) and the mean operating time of 96 min (28-238 min); the SFR was 91 % (1.45 procedures/patient). The overall number of complications was 58 (8.6 %) of which 26 (4.5 %) were complications classed Clavien ≥ 3 (haematuria with subcapsular haematoma/clot retention-7; ureteral perforation-7; steinstrasse-5; sepsis/pyelonephritis-5; prostatitis-1; cerebrovascular accident-1). Ureterorenoscopy for large renal stones in the modern era has good SFR with a small risk of major complications. PMID:26077357

  13. Urolithiasis in Tunisian children: a study of 120 cases based on stone composition.

    PubMed

    Kamoun, A; Daudon, M; Abdelmoula, J; Hamzaoui, M; Chaouachi, B; Houissa, T; Zghal, A; Ben Ammar, S; Belkahia, C; Lakhoua, R

    1999-11-01

    The composition of urinary stones in children depends on socioeconomic conditions and hygiene, geographical area, and dietary habits. We analyzed urinary stones from 120 consecutive Tunisian children (81 males, 39 females) aged 5 months to 15 years. The stone was located in the upper urinary tract in 91 cases (76%). Stone analysis included both a morphological examination and an infrared analysis of the nucleus and the inner and peripheral layers. The main components of bladder calculi were whewellite (69%) and struvite (22%), whereas the main component of upper urinary tract calculi was whewellite (67%). The nucleus of bladder stones was composed of ammonium urate (45%), struvite (28%), cystine (10%), and carbapatite (7%). The nucleus of kidney and ureteral calculi was mainly composed of ammonium urate (38%), whewellite (24%), carbapatite (13%), or struvite (11%). Based on stone composition, urinary tract infection was involved in the nucleation or growth of a third of calculi. Endemic urolithiasis involving simultaneous nutritional, metabolic, and infectious factors, and defined by its nucleus composed of ammonium urate without struvite, represented 40% of cases. Exclusive metabolic factors - including genetic diseases such as primary hyperoxaluria, cystinuria, and hypercalciuria - were responsible for less than 25% of cases. PMID:10603149

  14. Imaging of stone disease in pregnancy.

    PubMed

    Masselli, Gabriele; Derme, Martina; Laghi, Francesca; Polettini, Elisabetta; Brunelli, Roberto; Framarino, Maria Luisa; Gualdi, Gianfranco

    2013-12-01

    Renal colic is the most frequent non-obstetric cause for abdominal pain and subsequent hospitalization during pregnancy. Intervention is necessary in patients who do not respond to conservative treatment. Ultrasound (US) is widely used as the first-line diagnostic test in pregnant women with nephrolithiasis, despite it is highly nonspecific and may be unable to differentiate between ureteral obstruction secondary to calculi and physiologic hydronephrosis. Magnetic resonance imaging (MRI) should be considered as a second-line test, when US fails to establish a diagnosis and there are continued symptoms despite conservative management. Moreover, MRI is able to differentiate physiologic from pathologic dilatation. In fact in the cases of obstruction secondary to calculi, there is renal enlargement and perinephric edema, not seen with physiological dilatation. In the latter, there is smooth tapering of the middle third of the ureter because of the mass effect between the uterus and adjacent retroperitoneal musculature. When the stone is lodged in the lower ureter, a standing column of dilated ureter is seen below this physiological constriction. MRI is also helpful in demonstrating complications such as pyelonephritis. In the unresolved cases, Computed tomography remains a reliable technique for depicting obstructing urinary tract calculi in pregnant women, but it involves ionizing radiation. Nephrolithiasis during pregnancy requires a collaboration between urologists, obstetricians, and radiologists. PMID:23771120

  15. Monitoring for Renal Stone Recurrence in Astronauts With History of Stone

    NASA Technical Reports Server (NTRS)

    Reyes, David P.; Sargsyan, Ashot; Locke, James; Davis, Jeffrey

    2014-01-01

    After an initial stone episode persons are at increased risk for future stone formation. A systematic approach is required to monitor the efficacy of treatment and preventive measures, and to assess the risk of developing new stones. This is important for persons working in critical jobs or austere environments, such as astronauts. A literature review of the current standards of care for renal stone monitoring and imaging was done. Military and civil aviation standards were also reviewed, as well as the medical precedents from the space program. Additionally, a new, more effective, renal stone ultrasound protocol has been developed. Using this work, a monitoring algorithm was proposed that takes into consideration the unique mission and operational environment of spaceflight. The approach to imaging persons with history of renal stones varies widely in the literature. Imaging is often done yearly or biannually, which may be too long for mission critical personnel. In the proposed algorithm astronauts with a history of renal stone, who may be under consideration for assignment, are imaged by a detailed, physiciandriven, ultrasound protocol. Unassigned personnel are monitored by yearly ultrasound and urine studies. Any positive ultrasound study is then followed by low-dose renal computed tomography scan. Other criteria are also established. The proposed algorithm provides a balanced approach between efficacy and reduced radiation exposure for the monitoring of astronauts with a renal stone history. This may eventually allow a transition from a risk-averse, to a risk-modifying approach that can enable continued service of individuals with history of renal stone that have adequately controlled risk factors.

  16. Novel application of an established technique for removing a knotted ureteric stent.

    PubMed

    Tempest, Heidi; Turney, Ben; Kumar, Sunil

    2011-01-01

    This report describes a case whereby a ureteric stent became knotted during removal and lodged within the upper ureter. The authors describe a novel minimally invasive technique to remove the knotted ureteric stent using the holmium laser. PMID:22701009

  17. Crossing Ureteric Strictures: Microcatheters to the Rescue When Conventional Methods Fail

    SciTech Connect

    Keeling, A. N.; Lee, M. J.

    2007-11-15

    Tight distal ureteric strictures can be most challenging to traverse both from above, by interventional radiologists, and below, by urologists. Despite the advent of numerous guidewires, manufactured from different materials, often ureteric strictures are too tight to allow conventional guidewires to pass through. We describe an alternative approach to cross tight ureteric strictures, using a microguidewire and microcatheter combination.

  18. [An unusual cause of ureteral obstruction in kidney transplant].

    PubMed

    Vigo, Valentina; Rossi, Luigi; Lisi, Piero; Antonelli, Maurizio; Lomonte, Carlo; Basile, Carlo

    2016-01-01

    Inguinal herniation of the ureter in a kidney transplantation is a rare cause of late distal ureteral obstruction. Herniation is usually secondary to the implant of a long redundant ureter and to its course on the spermatic cord. This clinical condition can worsen graft function in the presence of ipsilateral hydroureteronephrosis. In this review, we describe the case of an asymptomatic 51-year-old man with a history of right iliac renal allotransplantation 12 years before. Kidney ultrasound showed moderate hydroureteronephrosis and ureteral kneeling at the upper third of the inguinal canal. The patient presented a mild increase in serum creatinine; physical examination revealed an ipsilateral inguinal hernia. A CT scan of the abdomen with no contrast medium confirmed middle-distal ureteral kneeling engaging in the sac of the right inguinal hernia. The patient underwent surgical hernia repair with no complications and his renal function recovered completely. PMID:26913744

  19. Meckel's stone ileus.

    PubMed

    Rudge, F W

    1992-02-01

    Meckel's diverticulum is the most common congenital abnormality of the small bowel; it occurs in approximately 2% of the population. Complications of Meckel's diverticulum include hemorrhage, usually associated with heterotopic tissue within the diverticulum, intussusception, development of benign or malignant neoplasms, and inflammation. Formation of one or more enteroliths within a diverticulum is rare. An extremely rare complication is mechanical small bowel obstruction secondary to extrusion of an enterolith from a Meckel's diverticulum (Meckel's stone ileus). A case of Meckel's stone ileus is described herein, with a review of the literature of this extremely rare complication. PMID:1603394

  20. Kidney Stone Treatment with Lithotripsy

    MedlinePlus Videos and Cool Tools

    Kidney Stone Treatment with Lithotripsy Broward Health Medical Center Fort Lauderdale, FL November 11, 2011 I'm ... got at least three stones in his left kidney. He's been having pain and blood in his ...

  1. Radionuclide renal function study in various surgical treatments of upper urinary stones.

    PubMed

    Chen, K K; Chen, M T; Yeh, S H; Chang, L S

    1992-05-01

    We conducted a radionuclide renal function study using 131I-hippuran in 188 patients with upper urinary stones before and every 3 months to the maximum of 12 months after various surgical treatments. Of 28 patients with renal staghorn stone, 24 underwent anatrophic nephrolithotomy and 4 percutaneous nephrolithotomy (PCNL). Of 36 patients with renal pelvic stone, 15 received open pyelolithotomy, 16 received PCNL and 5 received extracorporeal shock wave lithotripsy (ESWL). Of 71 patients with renal calyceal stone, 48 underwent PCNL and 23 ESWL. Of 53 patients with ureteral stone, 41 received ureterolithotomy, 8 PCNL and 4 ureteroscopic extraction. The renal function study determined individual and total renal function in terms of effective renal plasma flow (ERPF) at unilateral and bilateral kidneys. The mean total ERPF decreased 3-6 months after anatrophic nephrolithotomy (377.4 +/- 121.8 vs. 308.8 +/- 105.4 ml/min) or PCNL (447.4 +/- 152.3 vs. 386.8 +/- 140.8 ml/min) for staghorn stone. The mean ERPF of the kidney on the operative side decreased significantly to an extent of 29.4% up to 6 months after anatrophic nephrolithotomy. The mean ERPF on operative side increased significantly to an extent of 18.3% up to 6 months after ureterolithotomy. In conclusion, among the upper urinary stones, the unilateral (operative side) and total bilateral renal function decreased 1, 3, and 6 months, respectively, after anatrophic nephrolithotomy. On the contrary, the renal function increased significantly on the operative side up to 6 months after open ureterolithotomy. There was no significant change of mean ERPF at the kidney on operative or non-operative side in other kinds of upper urinary stones and surgical treatment. PMID:1320991

  2. Pancreatitis leading to retroperitoneal fibrosis and ureteric obstruction.

    PubMed

    Tan, H M; Khoo, J; Pang, K P

    2003-06-01

    Two patients who had acute pancreatitis subsequently developed characteristic appearance on urography of smooth extrinsic narrowing and medial deviation of the right ureter suggestive of retroperitoneal fibrosis (RPF) resulting in ureteric obstruction. Both these patients had clinical, biochemical and sonographic evidence of acute pancreatitis. CT scan of the abdomen performed on the second patient also documented acute pancreatitis. Intravenous urograms were consistent with ureteric obstruction due to retroperitoneal fibrosis. Both cases were treated conservatively. They were well after an average of 20 months. These 2 cases illustrate the uncommon association between pancreatitis and RPF. PMID:14569752

  3. Stones and urinary tract infections.

    PubMed

    Miano, Roberto; Germani, Stefano; Vespasiani, Giuseppe

    2007-01-01

    The term infection stones refers to calculi that occur following urinary tract infections (UTIs) caused by urease-producing gram-negative organisms. They consist of magnesium ammonium phosphate, carbonate apatite and monoammonium urate. Alkaline urine is most favorable to their formation. Urinary tract obstruction, neurogenic bladder, voiding dysfunction, temporary or indwelling urinary catheters, distal renal tubular acidosis and medullary sponge kidney are considered the main risk factors for developing infection stones. Urinalysis and urine culture are essential for diagnosis. A typical finding on imaging is a moderately radiopaque, staghorn or branched stone. Curative treatment is possible only by eliminating all of the stone fragments and by eradicating UTI. A variety of operative and pharmaceutical approaches is available. Metaphylactic treatment is mandatory to prevent recurrences. The relationship between urinary stones and UTIs is well known and shows two different clinical pictures: (1) stones that develop following UTIs (infection stones) which play a key role in stone pathogenesis, and (2) stones complicated by UTIs (stones with infection) which are metabolic stones that passively trap bacteria from coexistent UTIs and may consist of calcium or non-calcium. This article presents an overview of infection stones, analyzing the epidemiology, composition, pathogenesis, diagnosis, treatment and prevention of this type of calculi. PMID:17726350

  4. Bioresorbable ureteral stents from natural origin polymers.

    PubMed

    Barros, Alexandre A; Rita, Ana; Duarte, C; Pires, Ricardo A; Sampaio-Marques, Belém; Ludovico, Paula; Lima, Estevão; Mano, João F; Reis, Rui L

    2015-04-01

    In this work, stents were produced from natural origin polysaccharides. Alginate, gellan gum, and a blend of these with gelatin were used to produce hollow tube (stents) following a combination of templated gelation and critical point carbon dioxide drying. Morphological analysis of the surface of the stents was carried out by scanning electron microscopy. Indwelling time, encrustation, and stability of the stents in artificial urine solution was carried out up to 60 days of immersion. In vitro studies carried out with simulated urine demonstrated that the tubes present a high fluid uptake ability, about 1000%. Despite this, the materials are able to maintain their shape and do not present an extensive swelling behavior. The bioresorption profile was observed to be highly dependent on the composition of the stent and it can be tuned. Complete dissolution of the materials may occur between 14 and 60 days. Additionally, no encrustation was observed within the tested timeframe. The ability to resist bacterial adherence was evaluated with Gram-positive Staphylococcus aureus and two Gram-negatives Escherichia coli DH5 alpha and Klebsiella oxytoca. For K. oxytoca, no differences were observed in comparison with a commercial stent (Biosoft(®) duo, Porges), although, for S. aureus all tested compositions had a higher inhibition of bacterial adhesion compared to the commercial stents. In case of E. coli, the addition of gelatin to the formulations reduced the bacterial adhesion in a highly significant manner compared to the commercial stents. The stents produced by the developed technology fulfill the requirements for ureteral stents and will contribute in the development of biocompatible and bioresorbable urinary stents. PMID:24965000

  5. Verification of relationships between anthropometric variables among ureteral stents recipients and ureteric lengths: a challenge for Vitruvian-da Vinci theory

    PubMed Central

    Acelam, Philip A

    2015-01-01

    Objective To determine and verify how anthropometric variables correlate to ureteric lengths and how well statistical models approximate the actual ureteric lengths. Materials and methods In this work, 129 charts of endourological patients (71 females and 58 males) were studied retrospectively. Data were gathered from various research centers from North and South America. Continuous data were studied using descriptive statistics. Anthropometric variables (age, body surface area, body weight, obesity, and stature) were utilized as predictors of ureteric lengths. Linear regressions and correlations were used for studying relationships between the predictors and the outcome variables (ureteric lengths); P-value was set at 0.05. To assess how well statistical models were capable of predicting the actual ureteric lengths, percentages (or ratios of matched to mismatched results) were employed. Results The results of the study show that anthropometric variables do not correlate well to ureteric lengths. Statistical models can partially estimate ureteric lengths. Out of the five anthropometric variables studied, three of them: body frame, stature, and weight, each with a P<0.0001, were significant. Two of the variables: age (R2=0.01; P=0.20) and obesity (R2=0.03; P=0.06), were found to be poor estimators of ureteric lengths. None of the predictors reached the expected (match:above:below) ratio of 1:0:0 to qualify as reliable predictors of ureteric lengths. Conclusion There is not sufficient evidence to conclude that anthropometric variables can reliably predict ureteric lengths. These variables appear to lack adequate specificity as they failed to reach the expected (match:above:below) ratio of 1:0:0. Consequently, selections of ureteral stents continue to remain a challenge. However, height (R2=0.68) with the (match:above:below) ratio of 3:3:4 appears suited for use as estimator, but on the basis of decision rule. Additional research is recommended for stent improvements and ureteric length determinations. PMID:26317082

  6. When Stones Teach.

    ERIC Educational Resources Information Center

    Lucier, Todd

    2001-01-01

    Creating towers of balanced stones is a versatile outdoor learning activity that can be experienced in the classroom, school yard, forest, or parking lot. Students discover hidden talents, learn to work and communicate clearly with others, and reconnect with the natural world. Several variations on the exercise are given, along with principles of…

  7. Kidney stones - lithotripsy - discharge

    MedlinePlus

    ... days after this procedure. Drink a lot of water in the weeks after treatment. This helps pass any pieces of stone that still remain. Your health care provider may give you a medicine ... take and drink a lot of water if you have pain. You may need to ...

  8. Kidney Stones (For Parents)

    MedlinePlus

    ... as urine (pee). Urine contains substances — such as calcium, oxalate, phosphate, carbonate, cystine, and uric acid — that in ... high in sodium can increase the risk of calcium stones. Obesity can ... lead to concentrated levels of oxalate (a substance made in the body and found ...

  9. Retrograde upper-pole calyceal access for percutaneous nephrolithotripsy of stones in the lower-pole calyx

    PubMed Central

    Al-Otaibi, Khalid M.

    2012-01-01

    Objective To present the results of upper calyceal access during percutaneous nephrolithotripsy (PCNL) for stones in the lower calyx, as PCNL is considered the most effective minimally invasive surgery for managing lower calyceal stones, with percutaneous access either directly to the lower calyx or through an upper or middle calyx. Patients and methods The study included 76 patients with single (51) and multiple (25) stones in the lower calyx, and stones in the lower calyx plus renal pelvis (six) and associated pelvi-ureteric junction obstruction (PUJO, five). They were managed by PCNL using retrograde access through the upper-pole calyx in addition to laser endopyelotomy for the PUJO. Results The mean duration required for establishing the retrograde nephrostomy tract was 14.4 min, and for completing the procedure was 40 min. The mean fluoroscopy exposure time was 3.2 min. Access from the upper calyx allowed easy and rapid advancement of the nephroscope to the lower calyx. The stones varied in size, at 10–25 mm. Stones were cleared completely in 70 of the 76 patients (92%); the stone-free rate was 100%. The residual stone fragments (2–4 mm) in the remaining six patients (8%) were considered insignificant. Complications were minor in four patients (5%), and included pleural effusion in two, bleeding in one and an arteriovenous fistula in one. Conclusions Upper-pole calyceal access for PCNL provides easy and effective clearance of stones in the lower calyx. This access should be considered for PCNL of single or multiple stones in the lower calyx. PMID:26558049

  10. Acute ureteral obstruction and glomerulotubular function in rats.

    PubMed

    Dias, E P; Garcia, W E; Gontijo, J R; Homsi, E; Figueiredo, J F

    1997-03-01

    Urinary tract obstruction is a common cause of acute renal failure (ARF). During unilateral ureteral obstruction (UUO) arteriolar vasoconstriction, increase in tubular pressure, and ultrafiltrate retrodiffusion occur. We studied renal function of rats with surgical UUO for 24 hr. After this period of UUO, the contralateral kidney was removed and the right ureter was deobstructed. The control uninephrectomized group consisted of normal rats submitted to left uninephrectomy (UNx). Functional studies were performed 12 and 24 hr, and 7 days after deobstruction and UNx. We measured creatinine clearance, and fractional excretion of sodium and lithium. Using conventional formulas we calculated fractional proximal and distal sodium reabsorption. Initially we observed a reduction in glomerular filtration rate (GFR) after deobstruction (12 and 24 hr). However, after 7 days, the GFR was significantly higher in deobstructed rats than in controls (340.3 +/- 18.3 vs. 286.4 +/- 9.3 microL/min/100 g, p < 0.01). The dry kidney weight was also increased in these rats. The fractional sodium excretion was increased in deobstructed rats, mainly in early studies (12 and 24 hr). Whereas fractional proximal reabsorption was reduced in both groups, the fractional distal reabsorption was significantly decreased in the deobstructed group compared to UNX controls (93.9 +/- 0.9 vs. 98.9 +/- 0.1% after 24 hr, p < 0.01). Our data showed that UUO influenced both glomerular and tubular functions. A salient finding was the overcorrection of GFR 7 days after deobstruction. The renal release of hormones and growth factors could mediate these alterations in renal function through their vascular, tubular, and proliferative actions. PMID:9101612

  11. Ureteral Stent Coatings: What's Here and What's Coming

    NASA Astrophysics Data System (ADS)

    Razvi, Hassan

    2008-09-01

    Ureteral stents have become an indispensable tool to the urologist in the management of various disorders afflicting the urinary tract. While the ideal stent remains elusive, novel technical advances in stent coating technology offer the potential of enhancing stent biocompatibility and clinical application. Currently available stent coatings as well as new and emerging devices will be reviewed.

  12. An H-shaped complete ureteric duplication: embryology or erosion.

    PubMed

    Jayasekera, Ashan; Tempest, Heidi; Kumar, Sunil

    2011-01-01

    The authors report the case of a duplex urinary collecting system that forms a single chamber about 2 cm proximal to the bladder with distal bifurcation and drainage into the bladder via distinct ureteric orifices. This anatomical variant has not been described before. PMID:22691584

  13. AN IN VITRO MODEL FOR MURINE URETERIC EPITHELIAL CELLS

    EPA Science Inventory

    This report presents a model developed to study growth and differentiation of primary cultures of ureteric epithelial cells from embryonic C57BL/6N mouse urinary tracts. Single cells were resuspended in medium and plated onto transwells coated with collagen IV and laminin. Basa...

  14. Congenital Bilateral Mid Ureteral Stenosis: A Rare Finding

    PubMed Central

    Avinash Vijay, Joshi; Vinayak Gorakhnath, Wagaskar; Manoj Vilas, Bachhav; Sudarshan Omprakash, Daga

    2015-01-01

    Bilateral congenital mid ureteric stenosis is a very rare entity causing hydroureteronephrosis. The pathophysiology and aetiology of this condition is uncertain. Congenital functional obstruction of the mid ureter has only 17 reported cases, that too of unilateral pathology. We report a case of an 11-year-old male child who was presented with left sided lump in abdomen since one year. On bilateral retrograde ureteropyelography (RGP), bilateral mid ureteric stenosis was documented at the level of pelvic brim. Tc99m Diethylene Triamine Pentacaetic Acid (DTPA) scan showed non functioning left kidney and decreased function and retention on right side. We did a left nephroureterectomy and uretero-ureterostomy without tapering over a Double-J stent (DJ), with excision of stenosed segment on right side. Pathological review of the ureteric segments of both sides revealed proximal dilatation with non-specific thickening of the muscular wall of the stenosed segments of ureter. The differential diagnosis must additionally include ureteral valves and fibro epithelial polyps. Important role of intravenous pyelography in such cases must be emphasized to localize the pathology site. In addition, retrograde ureteropyelography is essential in management of this anomaly to delineate the stenosed segment of the ureter preoperatively, so that the surgeon can be well prepared with final plan of management. PMID:26155518

  15. Large bifid ureteric calculus in a patient with an ileal conduit

    PubMed Central

    Rajaian, Shanmugasundaram; Kekre, Nitin S.

    2012-01-01

    Urinary diversion after extirpative surgery of the bladder is done by various methods. Conduit urinary diversion is the most commonly practiced method of urinary diversion. It is relatively easy to perform and has a lower complication rate than other forms of diversion, e.g., orthotopic neobladder and continent cutaneous urinary diversion. Urolithiasis is a known and common complication of urinary diversion. Upper tract calculi in these cases often manifest symptomatically as occurs in the general population. Stones in the conduit can have a variable clinical presentation. Asymptomatic presentation is also noted in a few cases. We report a case of a large silent bifid ureteric calculus within an ileal conduit in a woman who had undergone urinary diversion 32 years earlier. Plain X-ray of the abdomen is the only investigation necessary to rule out urinary lithiasis in those who have had urinary diversion for a long time. This simple tool can diagnose the condition well in advance and aid in planning the management of this condition. PMID:23248527

  16. Wanted: suitable replacement stones for the Lede stone (Belgium)

    NASA Astrophysics Data System (ADS)

    De Kock, T.; Dewanckele, J.; Boone, M. A.; De Boever, W.; De Schutter, G.; Jacobs, P.; Cnudde, V.

    2012-04-01

    The Lede stone is an arenaceous limestone with a Lutetian age, occurring as discrete (most of the times three) stone banks in the marine sandy sediments of the Lede Formation (Belgium). It has a quartz content of approximate 40%. This increases abrasion strength and together with the cementation results in an average compressive strength of about 80-85 MPa. The cement is a microsparitic calcite cement. Other carbonate particles are both microfossils (mainly foraminifers) and macrofossils (bivalves, serpulids, echinoderms, …). This great diversity gives the stone a heterogeneous, animated appearance. The intra- and interparticle porosity is in total 5-10 % in average and the apparent density is 2400-2550 kg/m3. Another important constituent is glauconite, present in a few percent. In fresh state, the stone has a greenish-grey colour, but when it is exposed to atmospheric conditions for a couple of years, the stone acquires a yellowish to rust-coloured patina due to the weathering of glauconite. Sulphatation causes severe damage to the stone, and black gypsum crusts are common in urban environments on stones protected from runoff. This stone was excavated in both open air and underground quarries in the areas of Brussels and Ghent. The proximity of main rivers such as the Scheldt and Zenne provided transport routes for export towards the north (e.g. Antwerp and The Netherlands). Its first known use dates back to Roman times but the stone flourished in Gothic architecture due to its easy workability and its 'divine' light coloured patina. This results nowadays in a dominant occurrence in the cultural heritage of northwestern Belgium and the south of The Netherlands. Socio-economical reasons caused several declines and revivals of Lede stone in use. In the beginning of the 20th century, only a few excavation sites remained, with as main quarry the one located at Bambrugge (Belgium). By the end of the first half of the 20th century, however, no quarry sites remained. In the sixties, a sand quarry located in Balegem (Belgium) started with the extraction of Lede stone combined with its other activities. Until now, only this site supplies blocks of fresh Lede stones and it doesn't seem there will rise an opportunity of a new site in the near future. Therefore, during the huge amount of renovation works in the past century, the Lede stone was often replaced by imported (mostly French) limestones such as Massangis stone, Savonnières stone and Euville stone. The commercial value seems to have had a large impact and too little attention was paid on the optical appearance, ageing and technical compatibility of the stones. The use of especially Massangis stone was taken for granted. In the 21st century, there is a growing awareness of the impact of such consequent replacement for the historical value of our cultural heritage and several alternative stones are suggested and even used. These include stones from France, Spain and Portugal, but also from other regions in Belgium. For the moment, there is no consensus on the most appropriate replacement stone and further research should be done in order to evaluate compatibility of the different stone types with Lede stone. In this context, it is also very important to actively search for better alternatives, which resemble the Lede stone in both a mechanical and aesthetical point of view. Therefore, this abstract is an open question to its readers. Any commercial natural stone suggestions with affiliation to the aforementioned properties are welcome by e-mailing the corresponding author.

  17. Complicated bile duct stones

    PubMed Central

    Roy, Ashwin; Martin, Derrick

    2013-01-01

    Common bile duct stones (CBDSs) are solid deposits that can either form within the gallbladder or migrate to the common bile duct (CBD), or form de novo in the biliary tree. In the USA around 15% of the population have gallstones and of these, 3% present with symptoms annually. Because of this, there have been major advancements in the management of gallstones and related conditions. Management is based on the patient's risk profile; young and healthy patients are likely to be recommended for surgery and elderly patients with comorbidities are usually recommended for endoscopic procedures. Imaging of gallstones has advanced in the last 30 years with endoscopic retrograde cholangiopancreatography evolving from a diagnostic to a therapeutic procedure in removing CBDSs. We present a complicated case of a patient with a CBDS and periampullary diverticulum and discuss the techniques used to diagnose and remove the stone from the biliary system. PMID:23946532

  18. Complicated bile duct stones.

    PubMed

    Roy, Ashwin; Martin, Derrick

    2013-01-01

    Common bile duct stones (CBDSs) are solid deposits that can either form within the gallbladder or migrate to the common bile duct (CBD), or form de novo in the biliary tree. In the USA around 15% of the population have gallstones and of these, 3% present with symptoms annually. Because of this, there have been major advancements in the management of gallstones and related conditions. Management is based on the patient's risk profile; young and healthy patients are likely to be recommended for surgery and elderly patients with comorbidities are usually recommended for endoscopic procedures. Imaging of gallstones has advanced in the last 30 years with endoscopic retrograde cholangiopancreatography evolving from a diagnostic to a therapeutic procedure in removing CBDSs. We present a complicated case of a patient with a CBDS and periampullary diverticulum and discuss the techniques used to diagnose and remove the stone from the biliary system. PMID:23946532

  19. National rates and risk factors for stent failure after successful insertion in patients with obstructed, infected upper tract stones

    PubMed Central

    Varda, Briony; Sood, Akshay; Krishna, Nandita; Gandaglia, Giorgio; Sammon, Jesse D.; Zade, John; Schmid, Marianne; Zorn, Kevin C.; Trinh, Quoc-Dien; Bhojani, Naeem

    2015-01-01

    Introduction: We report the incidence of stent failure, defined as the need for salvage percutaneous nephrostomy (PCN) placement following the placement of a ureteral stent, in patients with infection of an obstructed urinary tract secondary to urolithiasis. We also sought to identify risk factors associated with ureteral stent failure. Methods: Using the Nationwide Inpatient Sample, we used time trend analysis to examine the incidence of ureteral stent failure for infected urolithiasis, as well as the estimated annual percent change (EAPC) from 1998 to 2010. Logistic regression was performed to estimate the odds of stent failure based on patient and hospital characteristics. Results: A total of 164 546 stents were placed during the study period. Of these, 97.8% resulted in successful decompression. The rates of successful stent decompression and stent failure increased over time (EAPC 14.05%, p < 0.001; EAPC 11.61%, p < 0.001). Middle-aged males with renal stones and acute kidney failure had higher odds of stent failure (p < 0.05). Salvage percutaneous nephrostomies were performed most frequently in urban teaching institutions (odds ratio [OR] 1.98, p = 0.001; OR 1.83, p < 0.001). Conclusions: Ureteral stent decompression for an infected obstructed urinary tract secondary to urolithiasis is almost always effective. For a small proportion of patients, stent failure will occur and will require the placement of a nephrostomy tube. Stent failure is associated with male gender, stone location, and renal failure. Salvage percutaneous nephrostomies for these patients occur most frequently in urban teaching hospitals. Of note, this study was limited by the presumption that coding for a PCN after stent placement indicated stent failure, which could not be verified because of the inherent limitations of the dataset. PMID:26085874

  20. Perfusion Index Derived from a Pulse Oximeter Can Detect Changes in Peripheral Microcirculation during Uretero-Renal-Scopy Stone Manipulation (URS-SM)

    PubMed Central

    Huang, Ho-Shiang; Chu, Chun-Lin; Tsai, Chia-Ti; Wu, Cho-Kai; Lai, Ling-Ping; Yeh, Huei-Ming

    2014-01-01

    Background The objective of this study was to test the effect of removal of a ureteral obstruction (renal calculus) from anesthetized patients on the perfusion index (PI), as measured by a pulse oximeter, and on the estimated glomerular filtration rate (eGFR). Patients and Methods This prospective study enrolled 113 patients with unilateral ureteral obstructions (kidney stones) who were scheduled for ureteroscopy (URS) laser lithotripsy. One urologist graded patient hydronephrosis before surgery. A pulse oximeter was affixed to each patient's index finger ipsilateral to the intravenous catheter, and a non-invasive blood pressure cuff was placed on the contralateral side. Ipsilateral double J stents and Foley catheters were inserted and left indwelling for 24 h. PI and mean arterial pressure (MAP) were determined at baseline, 5 min after anesthesia, and 10 min after surgery; eGFR was determined at admission, 1 day after surgery, and 14 days after surgery. Results Patients with different grades of hydronephrosis had similar age, eGFR, PI, mean arterial pressure (MAP), and heart rate (HR). PI increased significantly in each hydronephrosis group after ureteral stone disintegration. None of the groups had significant post-URS changes in eGFR, although eGFR increased in the grade I hydronephrosis group after 14 days. The percent change of PI correlates significantly with the percent change of MAP, but not with that of eGFR. Conclusion Our results demonstrate that release of a ureteral obstruction leads to a concurrent increase of PI during anesthesia. Measurement of PI may be a valuable tool to monitor the successful release of ureteral obstructions and changes of microcirculation during surgery. There were also increases in eGFR after 14 days, but not immediately after surgery. PMID:25542000

  1. Percutaneous Balloon Dilatation for the Treatment of Early and Late Ureteral Strictures After Renal Transplantation: Long-Term Follow-Up

    SciTech Connect

    Bachar, Gil N. Mor, E.; Bartal, G.; Atar, Eli; Goldberg, N.; Belenky, A.

    2004-08-15

    We report our experience with percutaneous balloon dilatation (PBD) for the treatment of ureteral strictures in patients with renal allografts. Of the 422 consecutive patients after renal transplantation in our center 10 patients had ureteral strictures. An additional 11 patients were referred from other centers. The 21 patients included 15 men and 6 women aged 16 to 67 years. Strictures were confirmed by sonography and scintigraphy in all cases. Patients underwent 2 to 4 PBDs at 7-10-day intervals. Clinical success was defined as resolution of the stenosis and hydronephrosis on sequential ultrasound and normalization of creatinine levels. Patients were divided into two groups: those who underwent transplantation more than 3 months previously and those who underwent transplantation less than 3 months previously. PBD was successful in 13 of the 21 patients (62%). There was no statistically significant difference in success rate between the patients with early (n 12) and those with late (n = 9) obstruction: 58.4% and 66%, respectively. No major complications were documented. PBD is a safe and simple tool for treating ureteral strictures and procedure-related morbidity is low. It can serve as an initial treatment in patients with early or late ureteral strictures after renal transplantation.

  2. Medical management of renal stones.

    PubMed

    Morgan, Monica S C; Pearle, Margaret S

    2016-01-01

    The prevalence of kidney stones is increasing in industrialized nations, resulting in a corresponding rise in economic burden. Nephrolithiasis is now recognized as both a chronic and systemic condition, which further underscores the impact of the disease. Diet and environment play an important role in stone disease, presumably by modulating urine composition. Dietary modification as a preventive treatment to decrease lithogenic risk factors and prevent stone recurrence has gained interest because of its potential to be safer and more economical than drug treatment. However, not all abnormalities are likely to be amenable to dietary therapy, and in some cases drugs are necessary to reduce the risk of stone formation. Unfortunately, no new drugs have been developed for stone prevention since the 1980s when potassium citrate was introduced, perhaps because the long observation period needed to demonstrate efficacy discourages investigators from embarking on clinical trials. Nonetheless, effective established treatment regimens are currently available for stone prevention. PMID:26977089

  3. Design of the dual stone locating system on an extracorporeal shock wave lithotriptor.

    PubMed

    Pu, Yong-Ren; Manousakas, Ioannis; Liang, Shen-Min; Chang, Chien-Chen

    2013-01-01

    Extracorporeal Shock Wave Lithotriptors are very popular for the treatment of urinary stones all over the world. They depend basically upon either X-ray fluoroscopy or ultrasound scans to detect the stones before therapy begins. To increase the effectiveness of treatment this study took advantage of both X-ray and ultrasound to develop a dual stone locating system with image processing modules. Its functions include the initial stone locating mode with stone detection by fluorescent images and the follow-up automatic stone tracking mode made by constant ultrasound scanning. The authors have integrated both apparatus and present the operating principles for both modes. The system used two in vitro experiments to justify its abilities of stone location in all procedures. PMID:23337335

  4. Stone Morphology: Implication for Pathogenesis

    NASA Astrophysics Data System (ADS)

    Daudon, Michel; Jungers, Paul; Bazin, Dominique

    2008-09-01

    Urinary stones of similar crystalline composition as identified by X-ray diffraction or Fourier transform infrared spectroscopy (FT-IR) may exhibit distinct structures, which are reflected in distinctive stone morphology. Among factors involved in stone morphology—some reflecting lithogenic activity, others depending on the crystal shape, or on the propensity of crystalline phases to form large aggregates, finally the environment where the stone is growing—all of these factors influence the inner structure of the stone and its superficial characteristics. We present here examples of the clinical interest of refined morphologic examination of stones, in addition to X-ray diffraction or FT-IR identification of its components. Such combination of methods allows the identification of specific etiologies among calcium oxalate stones, especially a morphological type pathognomonic of primary hyperoxaluria and other types related to distinct conditions of stone formation. Among phosphatic stones—in addition to stone composition, which must be considered not only on the basis of the main component, but also taking into account the minor crystalline phases, which often are clinically relevant—morphological types also contribute to diagnosis of the underlying etiology, especially for stones related to distal tubular acidosis. Finally, common purine stones also exhibit different morphologies related to stone composition and etiology: two main structures for uric acid and two for ammonium urate help to distinguish risk factors and lithogenic conditions involved in the formation of these calculi. Morphologic examination is a simple, rapid and cheap method that points to specific diseases or lithogenic factors. Better awareness of its clinical relevance should lead to wider utilization.

  5. [MICROBIAL COMMUNITIES ON KIDNEY STONES].

    PubMed

    Romanova, Yu M; Mulabaev, N S; Tolordava, E R; Seregin, A V; Seregin, I V; Alexeeva, N V; Stepanova, T V; Levina, G A; Barhatova, O I; Gamova, N A; Goncharova, S A; Didenko, L V; Rakovskaya, I V

    2015-01-01

    The clinical material obtained surgically in patients with kidney stone disease (KSD) was tested for content of the stone microflora using PCR and standard microbiological methods. It was demonstrated that about 50% of stones in patients with KSD were infected with various infection agents as observed using standard microbiological and molecular genetic methods. The percentage of detection of the Mycoplasma hominis using cultural method is lower than the percentage detected using PCR, which is due to difficult isolation and cultivation, as well as DNA fragments of mycoplasma observed after antibiotic therapy. Studies based on modern microscopy methods showed that microorganisms on the surface of the kidney stone formed multispecies biofilms. PMID:26182663

  6. Villamayor stone (Golden Stone) as a Global Heritage Stone Resource from Salamanca (NW of Spain)

    NASA Astrophysics Data System (ADS)

    Garcia-Talegon, Jacinta; Iñigo, Adolfo; Vicente-Tavera, Santiago

    2013-04-01

    Villamayor stone is an arkosic stone of Middle Eocene age and belongs to the Cabrerizos Sandstone Formation that comprising braided fluvial systems and paleosoils at the top of each stratigraphic sequence. The sandstone is known by several names: i) the Villamayor Stone because the quarries are located in Villamayor de Armuña village that are situated at 7 km to the North from Salamanca city; ii) the Golden Stone due to its patina that produced a ochreous/golden color on the façades of monuments of Salamanca (World Heritage City,1988) built in this Natural stone (one of the silicated rocks utilised). We present in this work, the Villamayor Stone to be candidate as Global Heritage Stone Resource. The Villamayor Stone were quarrying for the construction and ornamentation of Romanesque religious monuments as the Old Cathedral and San Julian church; Gothic (Spanish plateresc style) as the New Cathedral, San Esteban church and the sculpted façade of the Salamanca University, one of the oldest University in Europe (it had established in 1250); and this stone was one of the type of one of the most sumptuous Baroque monuments is the Main Square of the its galleries and arcades (1729). Also, this stone was used in building palaces, walls and reconstruction of Roman bridge. Currently, Villamayor Stone is being quarried by small and family companies, without a modernized processing, for cladding of the façades of the new buildings until that the construction sector was burst (in 2008 the international economic crisis). However, Villamayor Stone is the main stone material used in the city of Salamanca for the restoration of monuments and, even in small quantities when compared with just before the economic crisis, it would be of great importance for future generations protect their quarries and the craft of masonry. Villamayor Stone has several varieties from channels facies to floodplains facies, in this work the selected varieties are: i) the fine-grained stone, microporous, is partially cemented by dolomite, 27% (bulk porosity), ii) the ochre and fine-grained stone, microporous, with smectite, 30% (bulk porosity), iii) the medium-grained stone, 38% (bulk porosity). Main components for all three varieties: Quartz (up to 60%), feldspars, 2:1 layered silicates (smectites), palygorskite-type fibrous silicates, and small amounts of micaceous minerals (illite/mica).

  7. Delayed migration of embolized coil with large renal stone formation: a rare presentation.

    PubMed

    Kumar, Santosh; Jayant, Kumar; Singh, Shrawan K; Parmar, Kalpesh M; Devana, Sudheer K; Choudhari, Gautam R; Mittal, Ankur

    2014-01-01

    Delayed bleeding following percutaneous nephrolithotomy (PCNL) usually occurs due to development of the pseudoaneurysm which can be successfully managed with coil embolization. However very few cases of such complications have been reported in the literature. Here we are reporting a case of delayed post-PCNL bleeding that occurred in a 53-year-old diabetic patient operated on for renal stone. Computed tomography scan revealed a presence of the pseudoaneurysm in the segmental branch of right renal artery, which was successfully managed with coiling. Patient remained asymptomatic for the next 9 years after which he again presented with similar complaints. X-ray KUB was done which revealed a 2.7 cms renal pelvic calculus with the migrated coil in its center and a left upper ureteric calculus. His routine haemogram, coagulogram, serum electrolytes, and liver function tests, renal function tests, vitamin D3, and PTH (parathyroid hormone) were within normal limits. He underwent left laparoscopic ureterolithotomy and right percutaneous nephrolithotomy (PCNL). Intraoperatively the migrated stainless steel embolization coil was seen engulfed all around by the multiple stones in the right renal pelvis. Postoperative period was uneventful. Later he was followed in the outpatient department and was doing well. To conclude, this is the only case report of development of a large calculus around a migrated embolization coil which was successfully managed with PCNL. PCNL offers better stone clearance in cases of stones being formed over foreign bodies like fragmented double J stents, fragmented nephrostomies, or migrated embolization coil. PMID:25610700

  8. Intracardiac migration of ureteral double-J stent: A case report and review

    PubMed Central

    Farshi, Ali Reza; Roshandel, M. Reza

    2015-01-01

    Ureteral double-J (DJ) stenting is a common urologic procedure in several ureteral surgeries and has been used to manage ureteral obstructions during pregnancy. It may result in early and late complications. We review a rare case of migration of the DJ stent into the cardiovascular system in a pregnant female. We also review the literature. The endoscopic procedure to remove this displacement has been done postnatally with no adverse effects. PMID:26425236

  9. Our Modern Stone Age

    NASA Astrophysics Data System (ADS)

    Lowry, W. D.

    Unlike most books dealing with industrial minerals and rocks, Our Modern Stone Age is a pleasure to read. Within a matter of several hours, one can get an excellent introduction to nonmetallic mineral resources and industries exclusive o f the mineral fuels. The book is very well written and well illustrated with photographs and drawings; although pitched for the intelligent layman, it is in no way dull reading for even a well-versed economic geologist. Nearly every geologist, mining engineer, mineral economist, planner, and politician will find points of interest in this book.

  10. Our experience in the application of the biocompatible indwelling ureteral stents.

    PubMed

    Minkov, N; Gotsev, G; Naumov, N

    1986-01-01

    The need of indwelling ureteral stents for long-term use is established. The authors describe the indications for the indwelling ureteral stents and report their experience with the application of two types of endoprostheses: Gibbons stent and Double J ureteral catheters. The technique of the insertion of the stents is described and the complications are listed. It is concluded that the modern ureteral stents for long-term use have the place in the daily practice and are a real step forward in the fight against hospitalism and nosocomial infections. PMID:3818216

  11. Different Management Options for Transplant Ureteral Obstructions within an Inguinal Hernia

    PubMed Central

    Cheung, Felix; Debartolo, Merrit Marion; Copertino, Leonard Michael; Szafran, April Adams; Estrada, Chelsea Caron; Lynch, Patrick Gerard; Darras, Frank Sam

    2016-01-01

    Ureteral obstruction secondary to an inguinal hernia with transplant ureteral component is an extremely rare entity with only several case reports found in literature. In all previously reported cases, management of the obstruction involved temporary drainage with ureteral stenting or nephrostomy tube placements followed by delayed definitive repair. We present two case reports, here one being the first one managed by immediate definitive repair via ureteral reimplant and herniorrhaphy and a second case by delayed definitive repair after percutaneous nephrostomy tube placement. Both patients continued to do well postoperatively with normalization of renal function on follow-up. PMID:27144049

  12. Ureteral Dilatation with No Apparent Cause on Intravenous Urography: Normal or Abnormal? A Pilot Study

    PubMed Central

    Rathi, Vinita; Agrawal, Sachin; Bhatt, Shuchi; Sharma, Naveen

    2015-01-01

    A pilot study was done in 18 adults to assess the significance of ureteral dilatation having no apparent cause seen on Intravenous Urography (IVU). A clinicoradiological evaluation was undertaken to evaluate the cause of ureteral dilatation, including laboratory investigations and sonography of the genitourinary tract. This was followed, if required, by CT Urography (using a modified technique). In 9 out of 18 cases, the cause of ureteral dilatation on laboratory investigations was urinary tract infection (6) and tuberculosis (3). In the remaining 9 cases, CTU identified the cause as extrinsic compression by a vessel (3), extrinsic vascular compression of the ureter along with ureteritis (2), extrinsic vascular impression on the right ureter and ureteritis in the left ureter (1), ureteral stricture (2), and ureteral calculus (1). Extrinsic vascular compression and strictures did not appear to be clinically significant in our study. Hence, ureteral dilatation without any apparent cause on intravenous urogram was found to be clinically significant in 12 out of 18 (66.6%) cases. We conclude that ureteral dilatation with no apparent cause on IVU may indicate urinary tract tuberculosis, urinary tract infection (E. coli), or a missed calculus. Thus, cases with a dilated ureter on IVU, having no obvious cause, should undergo a detailed clinicoradiological evaluation and CTU should be used judiciously. PMID:26576150

  13. Progression of crack formation in artificial kidney stones subject to shock waves

    NASA Astrophysics Data System (ADS)

    Van Cauwelaert, Javier; Cleveland, Robin

    2002-11-01

    We used micro computed tomography (CT) imaging to follow the progressive development of cracks in artificial kidney stones. The artificial stones were made from U30 cement with a cylindrical shape (6.5 mm diameter and 7.5 mm long). The stones were held within a polypropylene vial in one of three different orientations: vertical, horizontal, and angled at 45 deg. The stones were treated with an electromagnetic lithotripter using between 50 and 150 shock waves. The initiation and growth of cracks was observed using microCT. We found that crack formation in the U30 stones was influenced by the orientation of the stone with respect to the shock wave (SW) propagation direction. Vertical stones developed a spall-like crack near the distal surface; horizontal stones had little internal damage for the number of shock waves applied; and angled stones were damaged primarily in the vicinity of the leading corner. The position of the cracks were in qualitative agreement with the numerical solutions of the pressure field inside the stones. The elastic properties of the U30 stones are being measured which will alow a quantitative analysis of crack growth to be performed and compared to the experimental data. [Work supported by the Whitaker Foundation.

  14. Kidney Stones in Children and Teens

    MedlinePlus

    ... Issues Listen Español Text Size Email Print Share Kidney Stones in Children and Teens Page Content Article Body ​ ... teen girls having the highest incidence. Types of Kidney Stones There are many different types of kidney stones ...

  15. Papain immobilized polyurethane as an ureteral stent material.

    PubMed

    Maria Manohar, Cynthya; Doble, Mukesh

    2016-05-01

    Long term use of polyurethane-based ureteral stent is hampered by the development of infection due to the formation of bacterial biofilm and salt deposition. Here papain, is covalently immobilized to polyurethane using glutarldehyde and is investigated as a possible anti-infective ureteral stent material. Fourier transform infrared spectrum confirmed its immobilization. Immobilized enzyme retained 85% of the activity of the free enzyme and about 12% loss of enzyme was observed from the polymer surface in one month. The modified polyurethane showed 8 log reduction in Staphylococcus aureus and 7 log reduction in Escherichia coli live colonies and 3-4 times decrease in the protein and carbohydrate in the biofilms than bare polymer. The amount of calcium and magnesium salts deposited on the polymer surface reduced by 40% after enzyme immobilization. 80% of L6 myoblast cells were viable on this material which indicated that it was noncytotoxic. A linear regression equation with hydrophilicity of the polymer surface and the cell surface hydrophobicity as the two independent variables was able to predict the number of live cells attached on the modified PU. This study indicated the possibility of using such an approach to overcome the problems of ureteral stent associated biofilm and salt encrustation. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 723-731, 2016. PMID:26853541

  16. Sonographic diagnosis of a presumed ureteral tear in a horse.

    PubMed

    Diaz, Olga Seco; Zarucco, Laura; Dolente, Brett; Reef, Virginia B

    2004-01-01

    A 14-year-old thoroughbred gelding was presented for the evaluation of acute abdominal pain. Rectally, there was a soft fluctuant painful swelling dorsal to the bladder and to the right of the midline. The creatinine concentration of the peritoneal fluid was 15 mg/dl. Transrectal ultrasonographic examination of the urinary tract revealed a large collection of fluid dissecting from the pelvic portion of the right ureter ventrally through the right side of the bladder wall and into the retroperitoneal space, and a thickened right ureter and bladder wall at the level of the trigone. Cystoscopically there was moderate hemorrhage within the wall of the bladder. Ultrasonography revealed air within the retroperitoneal fluid collection after ureteral catheterization, confirming the preliminary diagnosis of a tear in the right ureter. The gelding was treated medically. After 48 h of hospitalization, nuclear scintigraphy revealed normal clearance from both kidneys and no apparent leakage from the right ureter. The ureteral tear and urinoma were monitored using transrectal ultrasound until resolution. The horse was successfully returned to racing. This case establishes the value of diagngstic ultrasound in the diagnosis and monitoring of a traumatic ureteral tear in a horse. PMID:15005365

  17. Hyaluronan and Stone Disease

    NASA Astrophysics Data System (ADS)

    Asselman, Marino

    2008-09-01

    Kidney stones cannot be formed as long as crystals are passed in the urine. However, when crystals are retained it becomes possible for them to aggregate and form a stone. Crystals are expected to be formed not earlier than the distal tubules and collecting ducts. Studies both in vitro and in vivo demonstrate that calcium oxalate monohydrate crystals do not adhere to intact distal epithelium, but only when the epithelium is proliferating or regenerating, so that it possesses dedifferentiated cells expressing hyaluronan, osteopontin (OPN) and their mutual receptor CD44 at the apical cell membrane. The polysaccharide hyaluronan is an excellent crystal binding molecule because of its negative ionic charge. We hypothesized that the risk for crystal retention in the human kidney would be increased when tubular cells express hyaluronan at their apical cell membrane. Two different patient categories in which nephrocalcinosis frequently occurs were studied to test this hypothesis (preterm neonates and kidney transplant patients). Hyaluronan (and OPN) expression at the luminal membrane of tubular cells indeed was observed, which preceded subsequent retention of crystals in the distal tubules. Tubular nephrocalcinosis has been reported to be associated with decline of renal function and thus further studies to extend our knowledge of the mechanisms of retention and accumulation of crystals in the kidney are warranted. Ultimately, this may allow the design of new strategies for the prevention and treatment of both nephrocalcinosis and nephrolithiasis in patients.

  18. Scottish Short Stone Rows

    NASA Astrophysics Data System (ADS)

    Ruggles, Clive L. N.

    Short stone rows received a good deal of attention during the 1980s and 1990s, at a time when archaeoastronomy in prehistoric Britain and Ireland was moving beyond reassessments of Alexander Thom's "megalithic observatories" by identifying coherent groups of similar monuments with clear orientation trends. Many such rows are found in western Scotland, with the main concentration in Argyll and the island of Mull. Systematic analyses of their orientations produced credible evidence of an awareness of the 18.6-year lunar node cycle, within a "primary-secondary" pattern whereby isolated rows were oriented close to moonrise or moonset at the southern major standstill limit, while others oriented in this way were accompanied by a second row oriented in a declination range that could be interpreted either as lunar or solar. A detailed investigation of the landscape situation of the sites in northern Mull, accompanied by excavations at two of the sites, suggested that they were deliberately placed in locations where critical moonsets would be seen against prominent distant landscape features, but where the distant horizon in most or all other directions was hidden from view. A lack of independent archaeological evidence may help to explain why archaeoastronomical investigations at short stone rows have never progressed beyond "data-driven" studies of orientations and landscape situation. Nonetheless, the work that was done at these sites raised important general methodological issues, and pioneered techniques, that remain relevant across archaeoastronomy today.

  19. Recumbent Stone Circles

    NASA Astrophysics Data System (ADS)

    Ruggles, Clive L. N.

    During the 1970s and early 1980s, British archaeoastronomers were striving to bridge the interpretative gulf between the "megalithic observatories" of Alexander Thom and an archaeological mainstream that, generally speaking, was hostile to any mention of astronomy in relation to the megalithic monuments of Neolithic and Early Bronze Age Britain. The Scottish recumbent stone circles (RSCs) came to represent an example where sounder methodology could overcome many of the data selection issues that had beset earlier studies and, with due restraint, produce credible interpretations. Systematic studies of their orientations consistently concluded that the RSCs had a strong lunar connection, and it was widely envisaged that they were the setting for ceremonies associated with the appearance of the moon over the recumbent stone. Other evidence such as the presence of white quartz and the spatial distribution of cupmarks appeared to back up this conclusion. New archaeological investigations since 1999 have challenged and modified these conclusions, confirming in particular that the circles were built to enclose cairns rather than to demarcate open spaces. Yet the restricted pattern of orientations of these structures could only have been achieved by reference to the basic diurnal motions of the skies, and orientation in relation to simple observations of the midsummer moon remains the most likely reading of the alignment evidence taken as a whole. On the other hand, a consideration of the broader context, which includes the nearby Clava cairns, highlights instead the symbolic importance of the sun.

  20. The exposome for kidney stones.

    PubMed

    Goldfarb, David S

    2016-02-01

    The exposome is the assembly and measure of all the exposures of an individual in a lifetime. An individual's exposures begin before birth and include insults from environmental and occupational sources. The associated field is called exposomics, which relies on the application of internal and external exposure assessment methods. Exposomics has not yet been thoroughly applied to the study of kidney stones although much is known about how diet and fluid intake affect nephrolithiasis. Some other novel exposures that may contribute to kidney stones are discussed including use of antibiotics, urbanization and migration to urban heat islands, and occupation. People whose school and jobs limit their access to fluids and adequate bathroom facilities may have higher prevalence of stones. Examples include athletes, teachers, heathcare workers, and cab drivers. Occupational kidney stones have received scant attention and may represent a neglected, and preventable, type of stone. An exposomic-oriented history would include a careful delineation of occupation and activities. PMID:26615595

  1. Identification of factors associated with postoperative febrile urinary tract infection after ureteroscopy for urinary stones.

    PubMed

    Mitsuzuka, Koji; Nakano, Osamu; Takahashi, Norio; Satoh, Makoto

    2016-06-01

    The aim of this study was to elucidate risk factors associated with postoperative febrile UTI after URS for urinary stones. Data from 153 patients undergoing URS for renal and/or ureteral stones between 2011 and 2013 at a single center were reviewed to detect factors predicting postoperative febrile UTI. URS for residual stones was excluded. Postoperative febrile UTI was defined as body temperature >38 °C and was graded according to the Clavien grading system. The definition of pyuria was 10 or more white blood cells per high power field. Median age of the patients was 57 (range 17-89) years. Of the 153 patients, 98 (64.1 %) were male, 10 (6.5 %) had Eastern Cooperative Oncology Group performance status 2 or greater, 14 (9.2 %) had Charlson comorbidity index 3 or greater. Before URS, 69 (45.1 %) had pyuria, 27 (17.6 %) had acute pyelonephritis, 42 (27.5 %) had ureteral stent, and 50 (32.7 %) were treated with antibiotics. After URS, 28 (18.3 %) developed febrile UTI (Clavien grade I, n = 16; grade II, n = 10; grade III, n = 1; grade IV, n = 1). Preoperative pyuria and acute pyelonephritis were significant factors for postoperative febrile UTI (pyuria: odds ratio 3.62, 95 % CI 1.26-8.11, P value 0.017; pyelonephritis: odds ratio 4.43, 95 % CI 1.06-11.16, P value 0.044). Degree of pyuria was likely to be associated with severity of postoperative febrile UTI, and two cases (1.3 %) with severe pyuria developed sepsis. Careful management is needed for patients with preoperative pyelonephritis or pyuria; risk factors for postoperative febrile UTI to avoid sepsis. PMID:26321205

  2. Direct Primary or Secondary Percutaneous Ureteral Stenting: What Is the Most Compliant Option in Patients with Malignant Ureteral Obstructions?

    SciTech Connect

    Carrafiello, Gianpaolo Lagana, Domenico; Lumia, Domenico; Giorgianni, Andrea; Mangini, Monica; Santoro, Domenico; Cuffari, Salvatore; Marconi, Alberto; Novario, Raffaele; Fugazzola, Carlo

    2007-09-15

    The objective of this study was to analyze three ureteral stenting techniques in patients with malignant ureteral obstructions, considering the indications, techniques, procedural costs, and complications. In the period between June 2003 and June 2006, 45 patients with bilateral malignant ureteral obstructions were evaluated (24 males, 21 females; average age, 68.3; range, 42-87). All of the patients were treated with ureteral stenting: 30 (mild strictures) with direct stenting (insertion of the stent without predilation), 30 (moderate/severe strictures) with primary stenting (insertion of the stent after predilation in a one-stage procedure), and 30 (mild/moderate/severe strictures with infection) with secondary stenting (insertion of the stent after predilation and 2-3 days after nephrostomy). The incidence of complications and procedural costs were compared by a statistical analysis. The primary technical success rate was 98.89%. We did not observe any major complications. The minor complication rate was 11.1%. The incidence of complications for the various techniques was not statistically significantly. The statistical analysis of costs demonstrated that the average cost of secondary stenting ( Euro 637; SD, Euro 115) was significantly higher than that of procedures which involved direct or primary stenting ( Euro 560; SD, Euro 108). We conclude that one-step stenting (direct or primary) is a valid option to secondary stenting in correctly selected patients, owing to the fact that when the procedure is performed by expert interventional radiologists there are high technical success rates, low complication rates, and a reduction in costs.

  3. Bath Stone - a Possible Global Heritage Stone from England

    NASA Astrophysics Data System (ADS)

    Marker, Brian

    2014-05-01

    The Middle Jurassic strata of England have several horizons of oolitic and bioclastic limestones that provide high quality dimension stone. One of the most important is found in and near the City of Bath. The Great Oolite Group (Upper Bathonian) contains the Combe Down and Bath Oolites, consisting of current bedded oolites and shelly oolites, that have been used extensively as freestones for construction nearby, for prestigious buildings through much of southern England and more widely. The stone has been used to some extent since Roman times when the city, then known as Aquae Sulis, was an important hot spa. The stone was used to a limited extent through medieval times but from the early 18th century onwards was exploited on a large scale through surface quarrying and underground mining. The City was extensively redeveloped in the 18th to early 19th century, mostly using Bath Stone, when the spas made it a fashionable resort. Buildings from that period include architectural "gems" such as the Royal Crescent and Pulteney Bridge, as well as the renovated Roman Baths. Many buildings were designed by some of the foremost British architects of the time. The consistent use of this stone gives the City an architectural integrity throughout. These features led to the designation of the City as a World Heritage Site. It is a requirement in current City planning policy documents that Bath Stone should be used for new building to preserve the appearance of the City. More widely the stone was used in major houses (e.g. Buckingham Palace and Apsley House in London; King's Pavilion in Brighton); civic buildings (e.g. Bristol Guildhall; Dartmouth Naval College in Devon); churches and cathedrals (e.g. Truro Cathedral in Cornwall); and engineered structures (e.g. the large Dundas Aqueduct on the Kennet and Avon Canal). More widely, Bath Stone has been used in Union Station in Washington DC; Toronto Bible College and the Town Hall at Cape Town, South Africa. Extraction declined in the late 20th century but several quarries and underground mines remain operational providing stone for the local market, repair and maintenance of historic buildings and for special international projects. Reserves permitted for extraction are substantial and resources are fairly extensive so the stone will be accessible in the long term. Taking such points into account, it is suggested that Bath Stone should be recognised as a Global Heritage Stone Resource.

  4. The bioreceptivity of building stone

    NASA Astrophysics Data System (ADS)

    Mauko Pranjić, Alenka; Mulec, Janez; Muck, Tadeja; Hladnik, Aleš; Mladenovič, Ana

    2015-04-01

    Bioreceptivity is an intrinsic property of stone, and is defined as the ability of a material to be colonized by living organisms. The fouling and staining of building stone material due to the activity of microorganisms presents a serious problem in modern as well as historical buildings, not only due to the aesthetic impact but also due to the deterioration of the material. Biological colonisation on stone materials is influenced by a number of factors, e.g. the intrinsic properties of the stone (porosity, roughness, permeability, mineral composition), environmental parameters (e.g. solar radiation, temperature, water regime, climate, etc.), and specific microclimatic parameters (e.g. orientation, exposure to shadow, permanent capillary humidity, etc.). In order to assess the bioreceptivity of building stones, use is often made of artificial colonisation experiments compromising the inoculation of stones with a single species or a few isolated strains under laboratory conditions. In the present work the authors present the development of a method for the determination of bioreceptivity, as well as a study of the bioreceptivity of selected natural stone versus the latter's intrinsic properties. Field examples of biodeterioration are also presented. The study was supported by the Slovenian Research Agency (L1-5453).

  5. Surgical Management of Ureteral Strictures Arising From Radiotherapy for Prostate Cancer

    PubMed Central

    Orchard, J.; Tward, Jonathan D.; Lenherr, Sara; Hotaling, James M.; Brant, William O.; Myers, Jeremy B.

    2016-01-01

    Ureteral strictures arising from radiotherapy for the treatment of prostate cancer are rare. We describe four cases of these ureteral strictures emphasizing pre-operative factors that may have contributed to development of the strictures, their ultimate surgical management, and the patients' short-term outcomes. PMID:27175344

  6. Liver Resection for Intrahepatic Stones

    PubMed Central

    Tranberg, Karl-Göran; Beng-Mark, Stig

    1990-01-01

    Intrahepatic stones are difficult to manage, especially when they are associated with bile duct stricture, cholangitis and destruction of liver parenchyma. Suggested modes of treatment include surgical bile duct exploration, endoscopic procedures, transhepatic cholangiolithotomy and liver resection. This paper reports 2 patients in whom liver resection was performed because of intrahepatic ductal stones, bile duct strictures and repeated episodes of cholangitis. Liver resection was uncomplicated and long-term results were satisfactory. Our results support the view that liver resection is indicated in rare instances of intrahepatic bile duct stones associated with bile duct strictures. PMID:2278909

  7. Intrarenal pressure and irrigation flow with commonly used ureteric access sheaths and instruments

    PubMed Central

    Wright, Anna; Williams, Kevin; Somani, Bhaskar

    2015-01-01

    Introduction Flexible ureterorenoscopy is becoming a first-line treatment for many intrarenal stones. Ureteric access sheaths are commonly used to aid access, stone removal and reduce intrarenal pressure. We evaluated the effects of two commonly used access sheaths on irrigation flow and intrarenal pressure during flexible ureterorenoscopy. We measured the effect of scope instrumentation on flow and pressure. Material and methods We utilized a 10/12F and 12/14F, 35 cm Re-Trace™ access sheath with a FlexX2 scope in a cadaveric porcine kidney. We evaluated the effect of four Nitinol baskets (1.3F, 1.5F, 1.9F, 2.2F), three different 200 µm laser fibres and a hand-held pump. Measurements of irrigation flow and intrarenal pressure were recorded and compared between the different sized access sheaths. Results Flow rates varied widely between access sheaths. Without instrumentation, mean flow was 17 mls/min (10/12F access sheath), versus 33 mls/min (12/14F sheath) (p <0.0001). Increasing basket size produced a gradual reduction in flow and pressure in both access sheaths. Reassuringly, pressures were low overall (<40 cm H2O). Pressures were significantly reduced when using the larger 12/14F sheath, with and without all instrumentations (p <0.0001). Hand-held pump devices have a marked effect on flow and pressure in both sheaths; with pressures rising up to 121 cm H2O with a 10/12F sheath, versus 29 cm H2O (12/14F) (p <0.0001). Conclusions A 12/14F access sheath offered significantly improved irrigation whilst maintaining significantly lower intrarenal pressure, when compared to a 10/12F access sheath in a cadaveric porcine model. Scope instrumentation affects irrigation flow and pressure in both sized sheaths. Furthermore, there should be caution with hand-held pump devices, especially with smaller sized sheaths, as intrarenal pressure can be very high. PMID:26855796

  8. Prevention of iatrogenic ureteral injuries during robotic gynecologic surgery: a review.

    PubMed

    Lee, Ziho; Kaplan, Joshua; Giusto, Laura; Eun, Daniel

    2016-05-01

    Iatrogenic ureteral injuries, more than half of which occur during gynecologic surgery, may have devastating consequences for both patients and physicians. Gynecologists have employed various techniques such as cystoscopy, ureteral stents, and lighted ureteral stents to prevent ureteral injuries. The emergence and increasing prevalence of robotic surgery necessitates that we not only reevaluate the utility of these techniques, but also develop new ones specific for the robotic modality. In the robotic setting, the surgeon lacks tactile feedback and must rely primarily on visual cues. The use of intraureteral indocyanine green and subsequent visualization under near-infrared fluorescence appears to be a promising technique to primarily and secondarily prevent ureteral injuries during robotic gynecologic surgery. PMID:26519785

  9. Mechanisms of human kidney stone formation.

    PubMed

    Evan, Andrew P; Worcester, Elaine M; Coe, Fredric L; Williams, James; Lingeman, James E

    2015-01-01

    The precise mechanisms of kidney stone formation and growth are not completely known, even though human stone disease appears to be one of the oldest diseases known to medicine. With the advent of the new digital endoscope and detailed renal physiological studies performed on well phenotyped stone formers, substantial advances have been made in our knowledge of the pathogenesis of the most common type of stone former, the idiopathic calcium oxalate stone former as well as nine other stone forming groups. The observations from our group on human stone formers and those of others on model systems have suggested four entirely different pathways for kidney stone formation. Calcium oxalate stone growth over sites of Randall's plaque appear to be the primary mode of stone formation for those patients with hypercalciuria. Overgrowths off the ends of Bellini duct plugs have been noted in most stone phenotypes, do they result in a clinical stone? Micro-lith formation does occur within the lumens of dilated inner medullary collecting ducts of cystinuric stone formers and appear to be confined to this space. Lastly, cystinuric stone formers also have numerous small, oval, smooth yellow appearing calyceal stones suggestive of formation in free solution. The scientific basis for each of these four modes of stone formation are reviewed and used to explore novel research opportunities. PMID:25108546

  10. Nutritional Management of Kidney Stones (Nephrolithiasis)

    PubMed Central

    Segal, Adam M.; Seifter, Julian L.; Dwyer, Johanna T.

    2015-01-01

    The incidence of kidney stones is common in the United States and treatments for them are very costly. This review article provides information about epidemiology, mechanism, diagnosis, and pathophysiology of kidney stone formation, and methods for the evaluation of stone risks for new and follow-up patients. Adequate evaluation and management can prevent recurrence of stones. Kidney stone prevention should be individualized in both its medical and dietary management, keeping in mind the specific risks involved for each type of stones. Recognition of these risk factors and development of long-term management strategies for dealing with them are the most effective ways to prevent recurrence of kidney stones. PMID:26251832

  11. Contemporary Series of Robotic-Assisted Distal Ureteral Reconstruction Utilizing Side Docking Position

    PubMed Central

    Slater, Rick C.; Farber, Nicholas J.; Riley, Julie M.; Shilo, Yaniv; Ost, Michael C.

    2015-01-01

    ABSTRACT Purpose: The robot-assisted approach to distal ureteral reconstruction is increasingly utilized. Traditionally, the robot is docked between the legs in lithotomy position resulting in limited bladder access for stent placement. We examined the use of side docking of the daVinci robot® to perform distal ureteral reconstruction. Materials and Methods: A retrospective review of distal ureteral reconstruction (ureteral reimplantation and uretero-ureterostomy) executed robotically was performed at a single institution by a single surgeon. The daVinci robotic® Si surgical platform was positioned at the right side of the patient facing towards the head of the patient, i.e. side docking. Results: A total of 14 cases were identified from 2011–2013. Nine patients underwent ureteral reimplantation for ureteral injury, two for vesicoureteral reflux, one for ureteral stricture, and one for megaureter. One patient had an uretero-ureterostomy for a distal stricture. Three patients required a Boari flap due to extensive ureteral injury. Mean operative time was 286 minutes (189–364), mean estimated blood loss was 40cc (10–200), and mean length of stay was 2.3 days (1–4). Follow-up renal ultrasound was available for review in 10/14 patients and revealed no long-term complications in any patient. Mean follow-up was 20.7 months (0.1–59.3). Conclusion: Robot-assisted laparoscopic distal ureteral reconstruction is safe and effective. Side docking of the robot allows ready access to the perineum and acceptable placement of the robot to successfully complete ureteral repair. PMID:26742974

  12. Sall1-dependent signals affect Wnt signaling and ureter tip fate to initiate kidney development

    PubMed Central

    Kiefer, Susan M.; Robbins, Lynn; Stumpff, Kelly M.; Lin, Congxing; Ma, Liang; Rauchman, Michael

    2010-01-01

    Development of the metanephric kidney depends on precise control of branching of the ureteric bud. Branching events represent terminal bifurcations that are thought to depend on unique patterns of gene expression in the tip compared with the stalk and are influenced by mesenchymal signals. The metanephric mesenchyme-derived signals that control gene expression at the ureteric bud tip are not well understood. In mouse Sall1 mutants, the ureteric bud grows out and invades the metanephric mesenchyme, but it fails to initiate branching despite tip-specific expression of Ret and Wnt11. The stalk-specific marker Wnt9b and the ?-catenin downstream target Axin2 are ectopically expressed in the mutant ureteric bud tips, suggesting that upregulated canonical Wnt signaling disrupts ureter branching in this mutant. In support of this hypothesis, ureter arrest is rescued by lowering ?-catenin levels in the Sall1 mutant and is phenocopied by ectopic expression of a stabilized ?-catenin in the ureteric bud. Furthermore, transgenic overexpression of Wnt9b in the ureteric bud causes reduced branching in multiple founder lines. These studies indicate that Sall1-dependent signals from the metanephric mesenchyme are required to modulate ureteric bud tip Wnt patterning in order to initiate branching. PMID:20702564

  13. Kidney stones - self-care

    MedlinePlus

    ... stones: Eat less salt. Chinese and Mexican food, tomato juice, regular canned foods, and processed foods are ... beets, leeks, summer squash, sweet potatoes, spinach, and tomato soup Drinks: tea and instant coffee Other foods: ...

  14. Stone weathering in Southeast England

    NASA Astrophysics Data System (ADS)

    Jaynes, Suzanne M.; Cooke, R. U.

    A 2-year exposure programme of Portland stone and Monk's Park stone at 25 sites in SE England revealed significant differences in weight losses, changes in surface roughness and chemistry at each location that can be attributed to the activity of air pollutants and salts. In particular it was shown that weight loss of exposed samples can be attributed to both solution and sulphation (the latter probably contributing an average of at least 39% for Portland stone, 44% of Monk's Park stone); that salt attack of sheltered samples is evident at Bletchley (brickmaking) and coastal locations; and surface roughness changes, measured by Ra values on a Surfcom plotter, appear to be particularly sensitive to processes of surface disruption, such as salt weathering. Analysis of SO 2 data at the sites showed significantly higher concentrations at London sites. The corresponding gradient in weight loss was gentler, probably as the result of the influence of other atmospheric variables.

  15. Renographic Demonstration of Desmoid Tumor-Ureteral Fistula.

    PubMed

    Kim, David U; McQuinn, Garland; Lin, Eugene; Lee, Marie

    2016-01-01

    A 20-year-old woman with Gardner syndrome and intra-abdominal desmoid tumors presented with increasing abdominal pain. CT demonstrated a new area of central hypodensity in a presumed desmoid tumor, compressing the left ureter. Findings were suspicious for abscess or fistula to the ureter. Subsequent Tc-MAG3 renogram demonstrated persistent extraureteral radiotracer activity in the region of the tumor, confirming a desmoid tumor-ureteral fistula. Desmoid tumors are benign but locally aggressive fibrous neoplasms that can be sporadic or associated with familial adenomatous polyposis syndromes, specifically Gardner syndrome. Fistula formation to the ureter has been reported infrequently. PMID:26284772

  16. Retrograde ejaculation following open ureteric reimplantation: a case report

    PubMed Central

    2009-01-01

    Introduction Retrograde ejaculation is not a recognized complication of ureteric reimplantation surgery. We describe this unusual complication in a 25-year-old man, with no other cause for his ejaculatory dysfunction. Case presentation A 25-year-old Caucasian man presented with left hydronephrosis ascribed to a megaureter. Following open reimplantation of the ureter, the patient developed retrograde ejaculation that did not respond to medical therapy. Conclusion The key result reported here is that retrograde ejaculation is a possible complication of open pelvic surgery, for which patients should receive counselling. This is relevant for both urologists and general physicians who consult relatively young men with ejaculatory difficulties. PMID:19918274

  17. Differentiation of murine embryonic stem cells toward renal lineages by conditioned medium from ureteric bud cells in vitro.

    PubMed

    Ren, Xiaohui; Zhang, Jingya; Gong, Xiaowen; Niu, Xin; Zhang, Xuejin; Chen, Peng; Zhang, Xuejun

    2010-07-01

    The kidney is formed from two tissue populations derived from the intermediate mesoderm, the ureteric bud, and the metanephric mesenchyme. Metanephric mesenchyme is a pluripotent renal stem population, and conversion of renal mesenchyme into epithelia depends on the ureteric bud in vivo and in vitro. Embryonic stem (ES) cells have been induced to differentiate into a broad spectrum of specialized cell types in vitro, including hematopoietic, pancreatic, and neuronal cells. Such ES-derived cells can provide a valuable source of progenitor cells. However, whether ES cells can be stimulated by factors secreted from the fetal renal cells to differentiate into renal precursor cells in vitro has not been reported. In this study, we showed that murine ES cells can give rise to embryoid bodies in the absence of leukemia inhibitory factor. Culture conditions were optimized [6 days, 10 ng/ml activin and 10(-7) M retinoic acid (RA)] to generate maximal mesoderm populations specifically expressing Pax2 and brachyury. Results showed that 72% of the cells were brachyury positive by fluorescent activated cell sorter on Day 6 of EB cell differentiation. Conditioned medium collected from cultures of ureteric bud cells from renal cells of a 13-day-old fetus was added to the culture medium. Mesoderm cells were cultured for up to 10 days before showing expression of renal markers, initiation of nephrogenesis (WT-1 and Pax2), and terminally differentiated renal cell types (POD-1 and E-cadherin). This study suggests that ES cells pre-treated by RA and activin can interact with secreted molecules of the fetal renal cells to specifically differentiate into renal precursor cells. Our results provide an experimental basis for the development of in vitro assays to steer differentiation of ES cells toward renal lineages. PMID:20705585

  18. Histopathology Predicts the Mechanism of Stone Formation

    NASA Astrophysics Data System (ADS)

    Evan, Andrew P.

    2007-04-01

    About 5% of American women and 12% of men will develop a kidney stone at some time in their life and these numbers appear to be on the rise. Despite years of scientific research into the mechanisms of stone formation and growth, limited advances have been made until recently. Randall's original observations and thoughts on the mechanisms for kidney stone formation have been validated for idiopathic calcium oxalate stone formers (ICSF) but not for most other stone forming groups. Our current studies on selected groups of human stone formers using intraoperative papillary biopsies has shown overwhelming evidence for the presence of Randall's plaque in ICSF and that stone formation and growth are exclusively linked to its availability to urinary ions and proteins. Intense investigation of the plaque-stone junction is needed if we are to understand the factors leading to the overgrowth process on exposed regions of plaque. Such information should allow the development of treatment strategies to block stone formation in ICSF patients. Patients who form brushite stones, or who form apatite stones because of distal renal tubular acidosis (dRTA), or patients with calcium oxalate stones due to obesity bypass procedures, or patients with cystinuria, get plugged inner medullary collecting ducts (IMCD) which leads to total destruction of the lining cells and focal sites of interstitial fibrosis. These stone formers have plaque but at levels equal to or below non-stone formers, which would suggest that they form stones by a different mechanism than do ICSF patients.

  19. The Stepping Stone Approach

    NASA Astrophysics Data System (ADS)

    Brumfitt, A.

    Education is a profession in its own right. It has its own parameters, passions and language. Having the responsibility both of educare and educere, education has a focus of delivering specific factual knowledge whilst drawing out the creative mind. Space Science is a special vehicle having the properties of both educare and educere. It has a magic and wonder that touches the very essence of an individual and his place in time and space; it offers the "wow" factor that all teachers strive for. Space Science is the wrapping paper for other elements in the curriculum, e.g. cross-curricula and skill-based activities, such as language development, creativity, etc. as well as the pure sciences which comprise of engineering, physics and other natural sciences from astronomy to chemistry to biology. Each of these spheres of influence are relevant from kindergarten to undergraduate studies and complement, and in addition support informal education in museums, science centers and the world of e-learning. ESA Science Education has devised the "Stepping Stone Approach" to maximize the greatest outreach to all education stakeholders in Europe. In this paper we illustrate how to best reach these target groups with very specific activities to trigger and sustain enthusiasm whilst supporting the pedagogical, subject content and skill-based needs of a prescribed curriculum.

  20. Lunar stone saw

    NASA Technical Reports Server (NTRS)

    Clark, Tom; Croker, Todd; Hines, Ken; Knight, Mike; Walton, Todd

    1988-01-01

    This project addresses the problem of cutting lunar stones into blocks to be used to construct shelters to protect personnel and equipment from harmful solar radiation. This plant will manufacture 6 in x 1 ft x 2 ft blocks and will be located near the south pole to allow it to be in the shade at all times. This design uses a computer controlled robot, a boulder handler that uses hydraulics for movement, a computer system that used 3-D vision to determine the size of boulders, a polycrystalline diamond tipped saw blade that utilizes radiation for cooling, and a solar tower to collect solar energy. Only two electric motors are used in this plant because of the heavy weight of electric motors and the problem of cooling them. These two motors will be cooled by thermoelectric cooling. All other motors and actuators are to be hydraulic. The architectural design for the building as well as the conceptual design of the machines for cutting the blocks are described.

  1. TROP2 Expressed in the Trunk of the Ureteric Duct Regulates Branching Morphogenesis during Kidney Development

    PubMed Central

    Tsukahara, Yuko; Tanaka, Minoru; Miyajima, Atsushi

    2011-01-01

    TROP2, a cell surface protein structurally related to EpCAM, is expressed in various carcinomas, though its function remains largely unknown. We examined the expression of TROP2 and EpCAM in fetal mouse tissues, and found distinct patterns in the ureteric bud of the fetal kidney, which forms a tree-like structure. The tip cells in the ureteric bud proliferate to form branches, whereas the trunk cells differentiate to form a polarized ductal structure. EpCAM was expressed throughout the ureteric bud, whereas TROP2 expression was strongest at the trunk but diminished towards the tips, indicating the distinct cell populations in the ureteric bud. The cells highly expressing TROP2 (TROP2high) were negative for Ki67, a proliferating cell marker, and TROP2 and collagen-I were co-localized to the basal membrane of the trunk cells. TROP2high cells isolated from the fetal kidney failed to attach and spread on collagen-coated plates. Using MDCK cells, a well-established model for studying the branching morphogenesis of the ureteric bud, TROP2 was shown to inhibit cell spreading and motility on collagen-coated plates, and also branching in collagen-gel cultures, which mimic the ureteric bud's microenvironment. These results together suggest that TROP2 modulates the interaction between the cells and matrix and regulates the formation of the ureteric duct by suppressing branching from the trunk during kidney development. PMID:22194864

  2. Transcriptional Dysregulation in the Ureteric Bud Causes Multicystic Dysplastic Kidney by Branching Morphogenesis Defect

    PubMed Central

    Guo, Qiusha; Tripathi, Piyush; Manson, Scott R.; Austin, Paul F.; Chen, Feng

    2015-01-01

    Purpose The calcineurin-NFAT signaling pathway regulates the transcription of genes important for development. It is impacted by various genetic and environmental factors. We investigated the potential role of NFAT induced transcriptional dysregulation in the pathogenesis of congenital abnormalities of the kidneys and urinary tract. Materials and Methods A murine model of conditional NFATc1 activation in the ureteric bud was generated and examined for histopathological changes. Metanephroi were also cultured in vitro to analyze branching morphogenesis in real time. Results NFATc1 activation led to defects resembling multicystic dysplastic kidney. These mutants showed severe disorganization of branching morphogenesis characterized by decreased ureteric bud branching and the disconnection of ureteric bud derivatives from the main collecting system. The orphan ureteric bud derivatives may have continued to induce nephrogenesis and likely contributed to the subsequent formation of blunt ended filtration units and cysts. The ureter also showed irregularities consistent with impaired epithelial-mesenchymal interaction. Conclusions This study reveals the profound effects of NFAT signaling dysregulation on the ureteric bud and provides insight into the pathogenesis of multicystic dysplastic kidney. Our results suggest that the obstruction hypothesis and the bud theory may not be mutually exclusive to explain the pathogenesis of multicystic dysplastic kidney. Ureteric bud dysfunction such as that induced by NFAT activation can disrupt ureteric bud-metanephric mesenchyma interaction, causing primary defects in branching morphogenesis, subsequent dysplasia and cyst formation. Obstruction of the main collecting system can further enhance these defects, producing the pathological changes associated with multicystic dysplastic kidney. PMID:25301096

  3. Letter Report: LAW Simulant Development for Cast Stone Screening Test

    SciTech Connect

    Russell, Renee L.; Westsik, Joseph H.; Swanberg, David J.; Eibling, Russell E.; Cozzi, Alex; Lindberg, Michael J.; Josephson, Gary B.; Rinehart, Donald E.

    2013-03-27

    More than 56 million gallons of radioactive and hazardous waste are stored in 177 underground storage tanks at the U.S. Department of Energy’s (DOE’s) Hanford Site in southeastern Washington State. The Hanford Tank Waste Treatment and Immobilization Plant (WTP) is being constructed to treat the wastes and immobilize them in a glass waste form. The WTP includes a pretreatment facility to separate the wastes into a small volume of high-level waste (HLW) containing most of the radioactivity and a larger volume of low-activity waste (LAW) containing most of the nonradioactive chemicals. The HLW will be converted to glass in the HLW vitrification facility for ultimate disposal at an offsite federal repository. At least a portion (~35%) of the LAW will be converted to glass in the LAW vitrification facility and will be disposed of onsite at the Integrated Disposal Facility (IDF). The pretreatment and HLW vitrification facilities will have the capacity to treat and immobilize the wastes destined for each facility. However, a second facility will be needed for the expected volume of additional LAW requiring immobilization. A cementitious waste form known as Cast Stone is being considered to provide the required additional LAW immobilization capacity. The Cast Stone waste form must be acceptable for disposal in the IDF. The Cast Stone waste form and immobilization process must be tested to demonstrate that the final Cast Stone waste form can comply with waste acceptance criteria for the IDF disposal facility and that the immobilization processes can be controlled to consistently provide an acceptable waste form product. Further, the waste form must be tested to provide the technical basis for understanding the long term performance of the waste form in the IDF disposal environment. These waste form performance data are needed to support risk assessment and performance assessment (PA) analyses of the long-term environmental impact of the waste disposal in the IDF. A testing program was developed in fiscal year (FY) 2012 describing in some detail the work needed to develop and qualify Cast Stone as a waste form for the solidification of Hanford LAW (Westsik et al. 2012). Included within Westsik et al. (2012) is a section on the near-term needs to address Tri-Party Agreement Milestone M-062-40ZZ. The objectives of the testing program to be conducted in FY 2013 and FY 2014 are to: • Determine an acceptable formulation for the LAW Cast Stone waste form. • Evaluate sources of dry materials for preparing the LAW Cast Stone. • Demonstrate the robustness of the Cast Stone waste form for a range of LAW compositions. • Demonstrate the robustness of the formulation for variability in the Cast Stone process. • Provide Cast Stone contaminant release data for PA and risk assessment evaluations. The first step in determining an acceptable formulation for the LAW Cast Stone waste form is to conduct screening tests to examine expected ranges in pretreated LAW composition, waste stream concentrations, dry-materials sources, and mix ratios of waste feed to dry blend. A statistically designed test matrix will be used to evaluate the effects of these key parameters on the properties of the Cast Stone as it is initially prepared and after curing. The second phase of testing will focus on selection of a baseline Cast Stone formulation for LAW and demonstrating that Cast Stone can meet expected waste form requirements for disposal in the IDF. It is expected that this testing will use the results of the screening tests to define a smaller suite of tests to refine the composition of the baseline Cast Stone formulation (e.g. waste concentration, water to dry mix ratio, waste loading).

  4. Intraoperative electron-beam radiotherapy and ureteral obstruction

    SciTech Connect

    Miller, Robert C.; Haddock, Michael G.; Petersen, Ivy A.; Gunderson, Leonard L.; Furth, Alfred F.

    2006-03-01

    Purpose: To quantify the risk of ureteral obstruction (UO) after intraoperative electron-beam radiotherapy (IOERT). Methods and Materials: One hundred forty-six patients received IOERT of 7.5 to 30 Gy to 168 ureters; 132 patients received external radiotherapy. Results: Follow-up ranged from 0.01 to 19.1 years (median, 2.1 years). The rates of clinically apparent type 1 UO (UO from any cause) after IOERT at 2, 5, and 10 years were 47%, 63%, and 79%, respectively. The rates of clinically apparent type 2 UO (UO occurring at least 1 month after IOERT, excluding UO caused by tumor or abscess and patients with stents) at 2, 5, and 10 years were 27%, 47%, and 70%, respectively. Multivariate analysis revealed that the presence of UO before IOERT (p < 0.001) was associated with an increased risk of clinically apparent type 1 UO. Increasing IOERT dose (p < 0.04) was associated with an increased risk of clinically apparent type 2 UO. UO rates in ureters not receiving IOERT at 2, 5, and 10 years were 19%, 19%, and 51%, respectively. Conclusions: Risk of UO after IOERT increases with dose. However, UO risk for ureters not receiving IOERT was also high, which suggests an underlying risk of ureteral injury from other causes.

  5. Urinary stones in Eastern Saudi Arabia

    PubMed Central

    Alkhunaizi, Ahmed Mansour

    2016-01-01

    Introduction: Nephrolithiasis is a common problem worldwide especially in areas of the hot climate like Saudi Arabia. The aim of this analysis was to study the characteristics of urinary stones in Eastern Saudi Arabia and to report the following: Composition of urinary stones, age and gender distribution, seasonal variation of stone development, comorbid conditions associated with stone development and the incidence of urinary stones. Methods: All urinary stones that were submitted to the Johns Hopkins Aramco Healthcare, previously Saudi Aramco Medical Services Organization for analysis from January 2011 through January 2013 were analyzed. Results: A total of 384 urinary stones were collected and submitted for analysis from 347 patients. There was a male predominance with a male: female ratio of 3.9:1. The average age was 48.5 ± 12.8 years. Weight abnormality was predominant in both genders, and especially females. Calcium-based stones constituted the great majority (84.6%) followed by uric acid stones (12.8%). The other forms of stones were rare. More stones were recovered during the hot season, May to September. The calculated annual incidence of urolithiasis was 111/100,000 individuals. Conclusion: Calcium based stones are the most common urinary stones observed in Eastern Saudi Arabia. There is a clear association between the diagnosis of urinary stones and the hot season PMID:26834393

  6. Stone Polygons: Self-Organization Assisted by Noise

    NASA Astrophysics Data System (ADS)

    Fang, M.; Hager, B. H.

    2002-12-01

    Polygonal patterns formed by sorted gravel are commonly found on flat surfaces where water drainage is poor because of underlying permafrost. The similarity in pattern of these stone polygons with Rayleigh-Benard thermal convection cells is intriguing. There is even a suggestion that stone polygons are formed by Rayleigh-Benard convection of water through the underlying porous soil (Kranz et al, 1983). Recent developments in understanding the microphysical mechanisms of frost heaving (e.g. Wettlaufer, 1999; Zhu et al 2000) reinforce the conventional view that the freeze-thawing cycle of ice is the primary natural agent for this pattern formation. Mathematically, a large body of solutions to problems in pattern formation can be attributed to the reaction-diffusion system. There is a subtle difference, however, between systems like Rayleigh-Benard convection cells and stone polygons: The latter are formed in a noisy natural environment, the former in a highly controlled laboratory environment. In other words, the effects of large sources of noise must be accounted for explicitly in understanding the pattern formation of stone polygons. A distribution of stone polygons formed cooperatively results from sorting among water, soil, and stones controlled by weather changes. We propose a nonlinear reaction-diffusion type of model for this coupled process. We consider the incremental population density of stones (positive or negative relative to the initial uniform distribution). The positive feedback between freeze-thaw cycles and the local stone accumulation (positive or negative) is modeled by a linear production term, while the gravitational reconfiguration gives rise to a cubic nonlinear saturation term. Noise due to fluctuations of the environment is represented by the diffusion term. Similar systems have emerged in wide ranges of physical and chemical problems, yet most of the investigations in the other fields are on stability fields associated with varying control parameters. Our interest here is on pattern formation, especially the role played by the nonlinear effects. We use the difference equation to represent inaccuracy in the physical model and the discreteness of the stones. Preliminary calculations at steady state demonstrate that the cubic nonlinear term has a strong influence, and mostly favors the formation of hexagonal patterns. Formation of stone stripes can be accounted for by adding a gradient term along the downhill direction.

  7. Evaluation of stone-free rate using Guy's Stone Score and assessment of complications using modified Clavien grading system for percutaneous nephro-lithotomy.

    PubMed

    Sinha, Rajan Kumar; Mukherjee, Subhabrata; Jindal, Tarun; Sharma, Pramod Kumar; Saha, Barun; Mitra, Nilanjan; Kumar, Jay; Mukhopadhyay, Chandranath; Ghosh, Nabankur; Kamal, Mir Reza; Mandal, Soumendra Nath; Karmakar, Dilip

    2015-08-01

    To prospectively evaluate the ability of Guy's Stone Score (GSS) in predicting stone clearance rate and complication rate (by modified Clavien grade) for renal stones treated by percutaneous nephrolithotomy (PNL). From January 2013 to June 2014, a total of 142 patients undergoing PNL were evaluated prospectively. Patients with co-morbidities like hypertension, diabetes, renal failure were excluded from the study. All patients were classified according to GSS based on the findings of pre-operative intravenous urography (IVU) and per-operative retrograde pyelography (RGP). All PNL procedures were done by standard technique in prone position and success was defined as no residual stone visible on X-ray KUB done on the third postoperative day. Complications were classified according to modified Clavien grading system. The initial stone clearance rate was 71.1% and overall final stone clearance rate was 90.14%. The complication rate according to Clavien grading system was 40.1%. The final stone clearance rates were 93.9, 85.71, 90.47, and 77.77% in GSS I, II, III, and IV, respectively (p<0.001, <0.05, <0.05 and >0.05, respectively). The Clavien complication rates were 23, 61, 52, and 77.7% in GSS I, II, III, and IV, respectively (p<0.001). The GSS is a simple and easily reproducible system to preoperatively predict stone-free rate and perioperative complication rate. It helps in better patient counseling preoperatively. PMID:25850962

  8. Renal Transplant Ureteral Stenosis: Treatment by Self-Expanding Metallic Stent

    SciTech Connect

    Cantasdemir, Murat; Kantarci, Fatih; Numan, Furuzan; Mihmanli, Ismail; Kalender, Betul

    2003-02-15

    We report the use of a metallic stent in a transplant ureteral stenosis. A 28-year-old man with chronic renal failure due to chronic pyelonephritis, who received a living-donor renal transplant, presented with transplant ureteral stenosis. The stenosis was unresponsive to balloon dilation and was treated by antegrade placement of a self-expanding Memotherm stent. The stentedureter stayed patent for 3 years. It may be reasonable to treat post-transplant ureteral stenosis resistant to balloon dilation with self-expanding metallic stents. However, long-term follow-up is required to evaluate the efficacy of this treatment.

  9. β-catenin is necessary to keep cells of ureteric bud/Wolffian duct epithelium in a precursor state

    PubMed Central

    Marose, Thomas D.; Merkel, Calli E.; McMahon, Andrew P.; Carroll, Thomas J.

    2009-01-01

    Differentiation is the process by which tissues/organs take on their final, physiologically functional form. This process is mediated in part by the silencing of embryonic genes and the activation of terminal, differentiation gene products. Mammalian kidney development is initiated when the Wolffian duct branches and invades the overlying metanephric mesenchyme. The newly formed epithelial bud, known as the ureteric bud, will continue to branch ultimately differentiating into the collecting duct system and ureter. Here, we show that Hoxb7-Cre mediated removal of β-catenin from the mouse Wolffian duct epithelium leads to the premature expression of gene products normally associated with the differentiated kidney collecting duct system including the water channel protein, Aquaporin-3 and the tight junction protein isoform, ZO-1α+. Mutant cells fail to maintain expression of some genes associated with embryonic development, including several mediators of branching morphogenesis, which subsequently leads to kidney aplasia or hypoplasia. Reciprocally, expression of a stabilized form of β-catenin appears to block differentiation of the collecting ducts. All of these defects occur in the absence of any effects on the adherens junctions. These data indicate a role for β-catenin in maintaining cells of the Wolffian ducts and the duct derived ureteric bud/collecting duct system in an undifferentiated or precursor state. PMID:18177851

  10. Calcium oxalate crystal growth in human urinary stones

    SciTech Connect

    Kim, K.M.; Johnson, F.B.

    1981-01-01

    Calcium oxalate stones are very common and increasing. Crystal growth is no less important than the crystal nucleation in the pathogenesis of stone formation. The crystal growth was studied in human calcium oxalate stones by a combined electron microscopy and x-ray diffraction. The main mode of weddellite growth was interpenetration twinning of tetrahedral bipyramids. Bipyramids may form as initial crystal seeds, develop from anhedral crystals (crystals which lack flat symmetric faces) of spherular or mulberry shape, develop on the surface of preformed bipyramids by spiral dislocation mechanisms, or develop on whewellite crystal by heterogeneous nucleation and epitaxy. Heterogeneous nucleations of whewellite on weddellite, and calcium apatite on whewellite were also observed. Whewellite grew mainly by parallel twinning. Interpenetration twinning was exceptional. Transformation of anhedral to euhedral (completely bounded by flat faces that are set ar fixed angles to one another) whewellite occurred by parallel fissurations followed by brick wall like stacking of the crystals, while euhedral transformation of weddellite occurred by protrusion of bipyramids frm anhedral crystal surface. Occasionally, an evidence of crystal dissolution was noted. Although an aggregation of crystals is believed to play a pivotal role in stone nidus formation, growth in size of the formed crystals, and twinning and epitactic crystal intergrowth apparently play a significant role in the obstructive urinary stone formation.

  11. What I Need to Know about Kidney Stones

    MedlinePlus

    ... Alternate Language URL Español What I need to know about Kidney Stones Page Content On this page: ... stones? To prevent kidney stones, you need to know what caused your kidney stone. Your doctor may ...

  12. Bioreceptivity of building stones: a review.

    PubMed

    Miller, A Z; Sanmartín, P; Pereira-Pardo, L; Dionísio, A; Saiz-Jimenez, C; Macedo, M F; Prieto, B

    2012-06-01

    In 1995, Guillitte defined bioreceptivity, a new term in ecology, as the ability of a material to be colonized by living organisms. Information about the bioreceptivity of stone is of great importance since it will help us to understand the material properties which influence the development of biological colonization in the built environment, and will also provide useful information as regards selecting stones for the conservation of heritage monuments and construction of new buildings. Studies of the bioreceptivity of stone materials are reviewed here with the aim of providing a clear set of conclusions on the topic. Definitions of bioreceptivity are given, stone bioreceptivity experiments are described, and finally the stone properties related to bioreceptivity are discussed. We suggest that a standardized laboratory protocol for evaluating stone bioreceptivity and definition of a stone bioreceptivity index are required to enable creation of a database on the primary bioreceptivity of stone materials. PMID:22534363

  13. Gender Distribution of Pediatric Stone Formers

    NASA Astrophysics Data System (ADS)

    Novak, Thomas E.; Trock, Bruce J.; Lakshmanan, Yegappan; Gearhart, John P.; Matlaga, Brian R.

    2008-09-01

    Recent epidemiologic evidence suggests that the gender prevalence among adult stone-formers is changing, with an increasing incidence of stone disease among women. No similar data have ever been reported for the pediatric stone-forming population. We performed a study to define the gender distribution among pediatric stone-formers using a large-scale national pediatric database. Our findings suggest that gender distribution among stone formers varies by age with male predominance in the first decade of life shifting to female predominance in the second decade. In contrast to adults, females in the pediatric population are more commonly affected by stones than are males. The incidence of pediatric stone disease appears to be increasing at a great rate in both sexes. Further studies should build on this hypothesis-generating work and define the effects of metabolic and environmental risk factors that may influence stone risk in the pediatric patient population

  14. "Stone Age" Fun: Releasing the Animal Within.

    ERIC Educational Resources Information Center

    Geist, Janet Marie

    2000-01-01

    Discusses a fifth-grade sculpture project that uses a subtractive, rather than additive, technique. Students carve an animal sculpture from a block of simulated stone compound. Explains the process and how to make the simulated stone compound. (CMK)

  15. Uretero-Uterine Fistula: Delayed Presentation After Ureteral Reimplantation for Vesicoureteral Reflux.

    PubMed

    Richter, Lee A; Coviello, Elizabeth; Loftus, Kelly; Gutman, Robert E

    2015-01-01

    Primary cyclic hematuria occurring with the onset of menstruation can be a presenting symptom of a fistula between the Mullerian structures (uterus/cervix/upper vagina) and the urinary tract. When occurring, these fistulas are most often vesicovaginal connections caused by congenital Mullerian anomalies. We present a case of a fistula occurring between a bicornuate uterus and the ureteral stump that had been ligated at the time of ureteral reimplantation during childhood. The presenting symptom was cyclic hematuria beginning at the age of 14 years with the onset of menarche. Cystoscopy and retrograde pyelogram showed a fistula connecting the ureteral stump (which had been ligated at the time of ureteral reimplantation) to the small horn of the bicornuate uterus. Computed tomographic scan showed bilateral single orthotopic kidneys and collecting systems. The patient underwent successful transvaginal and transvesical surgical repair of the fistula, with complete resolution of her cyclic hematuria. We review genitourinary embryology in discussion of this unusual case. PMID:25730434

  16. Distal ureteral atresia with ureteropelvic junction obstruction in a female child: a rare case

    PubMed Central

    Wu, Shuiqing; Xu, Ran; Zhu, Xuan; Zhao, Xiaokun

    2015-01-01

    This case report describes a distal ureteral atresia along with ureteropelvic junction obstruction which occurred in a 19-month-old female child. It is easily to be misdiagnosed as mere ureteropelvic junction obstruction and omitted the combined diagnosis of distal ureteral atresia. Dismembered pyeloplasty was done in local hospital after admission, however with the result of recurrent fever when clamp the left nephrostomy tube and Antegrade urography demonstrated distal ureteral atresia. After two months, boari flap reconstruction was performed for the patient in the Second Xiangya Hospital of Central South University, and the child had good rehabilitation in the end. To our knowledge, this is the first case report on distal ureteral atresia associated with ureteropelvic junction obstruction. PMID:25785157

  17. Quantification of asymptomatic kidney stone burden by computed tomography for predicting future symptomatic stone events

    PubMed Central

    Selby, Michael G.; Vrtiska, Terri J.; Krambeck, Amy E.; McCollough, Cynthia H.; Elsherbiny, Hisham; Bergstralh, Eric J.; Lieske, John C.; Rule, Andrew D.

    2014-01-01

    Objective To find the optimal characterization of asymptomatic radiographic stone burden on computed tomographic (CT) scans. Methods A survey was sent to stone formers who underwent a CT scan while asymptomatic during a stone clinic evaluation. Symptomatic stone passage events after CT scan were detected by survey and medical record review. Radiographic stone burden was quantified by number of stones, largest stone diameter, automated total stone volume (TSV), and bilateral stones and then compared as predictors of stone events. Results There were 550 stone formers; 43% had a stone event a median 4.7 years after the CT scan. Stone burden by quartiles was 0–1, 2–3, 4–6, ≥7 for number of stones; 0–2, 3–4, 5–7, ≥8 mm for largest stone diameter; and 0–8, 9–78, 79–280, and ≥ 281 mm3 for TSV; 48% had bilateral stones. The hazard ratios (HRs) for symptomatic event was 1.30 (p<0.001) for the number of stones per quartile, 1.26 (p<0.001) for largest stone diameter per quartile, 1.38 (p<0.001) for TSV per quartile, and 1.80 (p<0.001) for bilateral stones. On multivariable analysis, only TSV was an independent predictor of symptomatic events (HR=1.35 per quartile, p=0.01). This risk of events with TSV was also independent of demographics, urine chemistries, and stone composition. Among the 53 patients with interim events between CT scans, a rapid increase in TSV between CT scans (>570 mm3/year) predicted subsequent events (HR=2.8, p=0.05). Conclusions Automated TSV is more predictive of symptomatic events than manual methods for quantifying stone burden on CT scan. PMID:25440821

  18. Luserna Stone: A nomination for "Global Heritage Stone Resource"

    NASA Astrophysics Data System (ADS)

    Primavori, Piero

    2015-04-01

    Luserna Stone (Pietra di Luserna) is the commercial name of a grey-greenish leucogranitic orthogneiss, probably from the Lower Permian Age, that outcrops in the Luserna-Infernotto basin (Cottian Alps, Piedmont, NW Italy) on the border between the Turin and Cuneo provinces. Geologically speaking, it pertains to the Dora-Maira Massif that represents a part of the ancient European margin annexed to the Cottian Alps during the Alpine orogenesis; from a petrographic point of view, it is the metamorphic result of a late-Ercinian leucogranitic rock transformation. Lithological features and building applications allow the recognition of two main varieties: 1) a micro-augen gneiss with very regular schistosity planes with centimetric spacing and easy split workability, known as Splittable facies; 2) a micro-Augen gneiss characterized by lower schistosity and poor split, suitable for blocks cutting machines (diamond wires, gang-saws, traditional saws), known as Massive facies. A third, rare, white variety also exists, called "Bianchetta". Luserna stone extends over an area of approximately 50 km2, where more than fifty quarries are in operation, together with a relevant number of processing plants and artisanal laboratories. The stone is quarried and processed since almost the Middle Age, and currently represents one of the three most important siliceous production cluster in Italy (together with the Ossola and Sardegna Island granites). Some characteristics of this stone - such as the relevant physical-mechanical properties, an intrinsic versatility and its peculiar splittability - have made it one of the most widely used stone materials in Italy and in the countries surrounding the North Western border of Italy. Apart from its intrinsic geological, petrographic, commercial and technical properties, several issues related to the Luserna Stone are considered to be of relevant importance for its designation as a Global Heritage Stone Resource, such as the distinctive mark on the architecture and urban landscape of many areas in NW Italy, some quite peculiar applications (for ex.: the "so-called "loze" or "lose", for the traditional roofing in alpine buildings) and the related constructive culture, the presence of an Eco-Museum, the occurrence of a local Fair (Pietra & Meccanizzazione), and many other important aspects.

  19. 77 FR 27245 - Big Stone National Wildlife Refuge, Big Stone and Lac Qui Parle Counties, MN

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-09

    ... Fish and Wildlife Service Big Stone National Wildlife Refuge, Big Stone and Lac Qui Parle Counties, MN... comprehensive conservation plan (CCP) and environmental assessment (EA) for Big Stone National Wildlife Refuge...: r3planning@fws.gov . Include ``Big Stone Draft CCP/ EA'' in the subject line of the message. Fax:...

  20. Comparison of totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for kidney stones: a randomized, clinical trial

    PubMed Central

    Moosanejad, N.; Firouzian, A.; Hashemi, S.A.; Bahari, M.; Fazli, M.

    2016-01-01

    This study aimed to compare the totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy techniques regarding their rates of success and complications in patients with kidney stones. Patients were randomly assigned to two groups. Forty-four patients (24 men; mean age: 50.40±2.02 years) received totally tubeless percutaneous nephrolithotomy (PCNL; no nephrostomy catheter or ureteral catheter after PCNL) and 40 patients (18 men; mean age: 49.95±13.38 years) underwent standard PCNL (a nephrostomy catheter and ureteral catheter were used after PCNL). All surgeries were performed by one surgeon. Postoperative changes in hemoglobin, the blood transfusion rate, changes in creatinine levels, operation time, analgesic need, hospitalization time, and complication rate were compared between the groups. No significant differences were observed in age, gender, stone size, and surgery side between the groups (P<0.05). The operation time was significantly lower in the totally tubeless PCNL group than in the standard PCNL group (P=0.005). Pethidine requirements were significantly higher in the standard PCNL group than the totally tubeless PCNL group (P=0.007). Hospitalization time was significantly higher in the standard PCNL group than in the totally tubeless PCNL group (P<0.0001). The complication rate was 15% in the standard PCNL group and 9.1% in the totally tubeless PCNL group (P=0.73). The totally tubeless PCNL technique is safe and effective, even for patients with staghorn stones. This technique is associated with decreased pain, analgesic needs, and operative and hospitalization time. We believe that a normal peristaltic ureter is the best drainage tube. PMID:27007650

  1. Laser-welded ureteral anastomoses: experimental studies with three techniques.

    PubMed

    Gürpinar, T; Gürer, S; Kattan, M W; Wang, L; Griffith, D P

    1996-01-01

    Tissue welding with laser energy is a new technique for reconstructive surgery. The potential advantages of laser welding are (a) lack of foreign body reaction, (b) decreased operative time, (c) less tissue manipulation, and (d) effective union of tissues equivalent to sutured anastomoses. We have performed ureteral anastomoses in adult mongrel dogs using a KTP 532 nm laser at an intensity of 1.4 W. Multiple "spot welds" of 1-s duration were utilized in a single layer anastomosis. Laser-welded anastomoses were performed with and without protein solder (33% and 50% human albumin) and were compared to sutured anastomoses. The laser-welded anastomoses required less operative time and provided bursting pressure levels similar to those of traditional sutured anastomoses. There was no advantage or disadvantage to the addition of human albumin as a solder in these experimental studies. PMID:9118408

  2. A sign on CT that predicts a hazardous ureteral anomaly

    PubMed Central

    Allam, E.S.; Johnson, D.Y.; Grewal, S.G.; Johnson, F.E.

    2016-01-01

    Introduction An aberrant course of the distal ureter can pose a risk of ureteral injury during surgery for inguinal hernia repair and other groin operations. In a recent case series of inguinoscrotal hernation of the ureter, we found that each affected ureter was markedly anterior to the psoas muscle at its mid-point on abdominal CT. We hypothesized that this abnormality in the abdominal course of the ureter would predict the potentially hazardous aberrant course of the distal ureter. Presentation of cases We reviewed all evaluable CT urograms performed at St. Louis University Hospital from June 2012 to July 2013 and measured the ureteral course at several anatomically fixed points. Discussion 93% (50/54) of ureters deviated by less than 1 cm from the psoas muscle in their mid-course (at the level of the L4 vertebra). Reasons for anterior deviation of the ureter in this study included morbid obesity with prominent retroperitoneal fat, congenital renal abnormality, and post-traumatic renal/retroperitoneal hematoma. We determined that the optimal level on abdominal CT to detect the displaced ureter was the mid-body of the L4 vertebra. Conclusion Anterior deviation of the ureter in its mid-course appears to predict inguinoscrotal herniation of the ureter. This finding is a sensitive predictor and should raise concern for this anomaly in the appropriate clinical setting. It is not entirely specific as morbid obesity and congenital anomalies may result in a similar imaging appearance. We believe that this association has not been reported previously. Awareness of this anomaly can have significant operative implications. PMID:27046105

  3. A resorbable bicomponent braided ureteral stent with improved mechanical performance.

    PubMed

    Zou, Ting; Wang, Lu; Li, Wenchao; Wang, Wenzu; Chen, Fang; King, Martin W

    2014-10-01

    Bioresorbable ureteral stents have the advantage of eliminating the need for a second removal surgery and hence avoiding certain complications. However the inadequate mechanical performance and lack of control over the rate of resorption limit the use of current prototype designs. This paper focuses on a series of resorbable millimeter-sized stents which were fabricated by a unique combination of braiding and thermal treatment processes. Their mechanical properties where optimized by varying the braided structure and different resorbable components. Five different bicomponent structures were fabricated for the stent with different areas and distributions of poly (glycolic acid) (PGA) and poly (lactic-co-glycolic acid) (PLGA) resorbable yarns. Subsequent thermal treatment then converted the PLGA yarns into areas of continuous PLGA polymer film. The morphology, applied compression resistance and recovery and tensile strength tests were conducted on these prototype stents so as to investigate the relationship between their structures and mechanical properties. By selecting the appropriate resorbable biomaterials and altering the design of the braided structure it was possible to generate different sized areas and distributions of 100% braided yarn and 100% polymer film within the same bicomponent tubular structure. The relative total area of braided yarn to polymer film coverage was different for the five different prototype stents as well as between the external and internal surfaces of the bicomponent stents. This relative coverage of the braided yarn to polymer film played an important role in determining the mechanical performance of the stents, including the compression and recovery behavior as well as the tensile properties and failure morphology. The design of Stent C appeared to have the optimal structure for a resorbable ureteral stent with superior applied compression and tensile properties. PMID:24997428

  4. Keep Your Kidneys Clear: Kicking Kidney Stones

    MedlinePlus

    ... Your Kidneys Clear Keep Your Kidneys Clear Kicking Kidney Stones Some say that passing a kidney stone is like delivering a baby made of razor ... is that, although they can be excruciatingly painful, kidney stones rarely cause permanent damage, and you may be ...

  5. Developing disease resistant stone fruits

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Stone fruit (Prunus spp.) (peach, nectarine, plum, apricot, cherry) and almonds are susceptible to a number of pathogens. These pathogens can cause extensive losses in the field, during transport and storage, and in the market. Breeding for disease resistance requires an extensive knowledge of the...

  6. Is shock wave lithotripsy efficient for the elderly stone formers? Results of a matched-pair analysis.

    PubMed

    Philippou, Prodromos; Lamrani, Djelali; Moraitis, Konstantinos; Bach, Christian; Masood, Junaid; Buchholz, Noor

    2012-08-01

    The aim of the study was to evaluate the impact of age on the efficacy of extracorporeal shock wave lithotripsy (SWL), in a comparative study based on the principles of matched-pair analysis. Over a period of 4 years, 2,311 patients were treated with SWL in a tertiary referral center. Patient and stone data were recorded in a prospective electronic database. Among these patients, 115 (4.97%) were older than 70 years of age and fulfilled the criteria for inclusion in the study (Group A). For the purposes of the comparative analysis, Group A patients were matched for gender and stone parameters (side, location of stone, and diameter ±2 mm) with a control group of patients under the age of 70 (Group B). Following matching, the patients' electronic medical records were reviewed, to identify SWL success rates at 3 months and McNemar's test was used to compare the efficacy of SWL between the two groups. Matching was possible in all cases. The results indicate that there were no statistically significant differences in the mean number of SWL sessions or in the mean number of impulses per session between the two groups. The overall stone clearance rate achieved by SWL alone was 71.3% for Group A and 73.9% for group B. Discordant pairs were found in 37 cases (in 17 pairs only patients in Group A became stone-free, while in 20 pairs only patients in Group B became stone-free). By using McNemar's test, the difference in stone clearance rates between the two groups was not found to be statistically significant (p = 0.742). A total of 22 patients (19.1%) in Group A and 17 patients (14.7%) in Group B underwent an adjuvant procedure to achieve stone clearance. McNemar's test also revealed the absence of any statistically significant difference in SWL success rates between older and younger patients in the subgroups of patients presenting with either ureteric or renal stones (p = 0.727 and p = 0.571, respectively). In conclusion, SWL is still considered one of the first-line tools for geriatric patients suffering from urolithiasis, as increased age alone does not seem to adversely affect the efficacy of SWL. PMID:21901557

  7. A Drosophila model identifies a critical role for zinc in mineralization for kidney stone disease.

    PubMed

    Chi, Thomas; Kim, Man Su; Lang, Sven; Bose, Neelanjan; Kahn, Arnold; Flechner, Lawrence; Blaschko, Sarah D; Zee, Tiffany; Muteliefu, Gulinuer; Bond, Nichole; Kolipinski, Marysia; Fakra, Sirine C; Mandel, Neil; Miller, Joe; Ramanathan, Arvind; Killilea, David W; Brückner, Katja; Kapahi, Pankaj; Stoller, Marshall L

    2015-01-01

    Ectopic calcification is a driving force for a variety of diseases, including kidney stones and atherosclerosis, but initiating factors remain largely unknown. Given its importance in seemingly divergent disease processes, identifying fundamental principal actors for ectopic calcification may have broad translational significance. Here we establish a Drosophila melanogaster model for ectopic calcification by inhibiting xanthine dehydrogenase whose deficiency leads to kidney stones in humans and dogs. Micro X-ray absorption near edge spectroscopy (μXANES) synchrotron analyses revealed high enrichment of zinc in the Drosophila equivalent of kidney stones, which was also observed in human kidney stones and Randall's plaques (early calcifications seen in human kidneys thought to be the precursor for renal stones). To further test the role of zinc in driving mineralization, we inhibited zinc transporter genes in the ZnT family and observed suppression of Drosophila stone formation. Taken together, genetic, dietary, and pharmacologic interventions to lower zinc confirm a critical role for zinc in driving the process of heterogeneous nucleation that eventually leads to stone formation. Our findings open a novel perspective on the etiology of urinary stones and related diseases, which may lead to the identification of new preventive and therapeutic approaches. PMID:25970330

  8. A Drosophila Model Identifies a Critical Role for Zinc in Mineralization for Kidney Stone Disease

    PubMed Central

    Lang, Sven; Bose, Neelanjan; Kahn, Arnold; Flechner, Lawrence; Blaschko, Sarah D.; Zee, Tiffany; Muteliefu, Gulinuer; Bond, Nichole; Kolipinski, Marysia; Fakra, Sirine C.; Mandel, Neil; Miller, Joe; Ramanathan, Arvind; Killilea, David W.; Brückner, Katja; Kapahi, Pankaj; Stoller, Marshall L.

    2015-01-01

    Ectopic calcification is a driving force for a variety of diseases, including kidney stones and atherosclerosis, but initiating factors remain largely unknown. Given its importance in seemingly divergent disease processes, identifying fundamental principal actors for ectopic calcification may have broad translational significance. Here we establish a Drosophila melanogaster model for ectopic calcification by inhibiting xanthine dehydrogenase whose deficiency leads to kidney stones in humans and dogs. Micro X-ray absorption near edge spectroscopy (μXANES) synchrotron analyses revealed high enrichment of zinc in the Drosophila equivalent of kidney stones, which was also observed in human kidney stones and Randall’s plaques (early calcifications seen in human kidneys thought to be the precursor for renal stones). To further test the role of zinc in driving mineralization, we inhibited zinc transporter genes in the ZnT family and observed suppression of Drosophila stone formation. Taken together, genetic, dietary, and pharmacologic interventions to lower zinc confirm a critical role for zinc in driving the process of heterogeneous nucleation that eventually leads to stone formation. Our findings open a novel perspective on the etiology of urinary stones and related diseases, which may lead to the identification of new preventive and therapeutic approaches. PMID:25970330

  9. Late ureteral obstruction in an adult who had STING/Teflon in childhood: Should we expect an epidemic?

    PubMed Central

    Rosenberg, Shilo; Lorber, Amitay; Landau, Ezekiel H.; Pode, Dov; Gofrit, Ofer N.; Hidas, Guy; Duvdevani, Mordechai; Sfoungaristos, Stavros

    2015-01-01

    We present a case of left renal colic in a 25-year-old female patient. She had subureteral injection of Teflon (STING) at the age of 10 due to vesico-ureteral reflux (VUR) disease and recurrent urinary tract infections. Renal colic was the result of late ureteral obstruction due to Teflon-induced periureteral foreign body reaction. To our knowledge, this is the longest interval between STING and ureteral obstruction reported and the first case of delayed ureteral obstruction caused by Teflon. Monitoring the upper tracts of patients after STING should go beyond childhood. PMID:26664516

  10. Primary carcinoma of the ureteral stump following radical nephrectomy for renal cell carcinoma: A case report and literature review

    PubMed Central

    JIN, SHIHUA; WANG, GANG; YU, CHENGFAN; LI, NINGCHEN

    2016-01-01

    The occurrence of primary carcinoma of the ureteral stump following radical nephrectomy for renal cell carcinoma is extremely rare; 7 patients with the disease have been reported previously. All these patients were males with transitional cell carcinoma. The current study reports the case of a 61-year-old woman, who presented with gross hematuria following a radical nephrectomy for local clear cell renal carcinoma. A computed tomography scan revealed the presence of a mass on the ureteral stump. The patient underwent a left ureteral stump and bladder cuff excision. The histological diagnosis was high-grade transitional cell carcinoma of the ureteral stump, with focal interstitial cancer cell infiltrates. There was no evidence of recurrence during a follow-up period of 35 months. In addition, the present study reviewed the literature for previous patients with ureteral stump carcinoma following a radical nephrectomy for renal cell carcinoma; 7 previous patients with the disease were identified. The present study suggests that, if patients who have previously undergone a radical nephrectomy for renal cell carcinoma present with hematuria, the possibility of ureteral stump carcinoma should be considered, particularly in East Asian countries. The existence or a history of bladder carcinoma should be considered as a high-risk factor for developing ureteral stump carcinoma. A ureteral stump and bladder cuff excision should be performed once ureteral stump carcinoma is diagnosed. PMID:27123110

  11. Single ectopic ureteral orifice with bilateral duplicated renal collecting systems in an adult girl: Diagnosis by magnetic resonance urography

    PubMed Central

    Tang, Min; Wang, Quanrongzi; Liu, Bianjiang; Li, Jie; Lu, Qiang; Song, Ninghong; Wang, Zengjun; Zhang, Wei

    2015-01-01

    Renal duplication accompanied by ureteral ectopia is an uncommon urinary congenital abnormality. We report the case of a 21-year-old girl who suffered from lifelong continuous urinary leakage. She was finally diagnosed with bilateral duplicated collecting systems complicated with right ectopic ureteral orifice – an extremely rare case. The patient underwent ureteric re-implantation for the ectopic side, and her urinary incontinence ceased soon thereafter. In this case, traditional imaging failed to show the exact insertion of an ectopic ureter. However, magnetic resonance urography combined with retrograde intubation radiography successfully depicted the point of ureteric insertion, which may make the diagnostic process accurate and efficient. PMID:26609333

  12. Treatment Outcomes of Retrograde Intrarenal Surgery for Renal Stones and Predictive Factors of Stone-Free

    PubMed Central

    Lim, Soo Hyun; Jeong, Byong Chang; Seo, Seong Il; Jeon, Seong Soo

    2010-01-01

    Purpose The aim of this study was to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) for the treatment of renal stones and to analyze the predictive factors for stone-free. Materials and Methods We retrospectively reviewed the records of patients who underwent RIRS for renal stones from January 2000 to July 2009. We identified 66 RIRSs (63 patients with 3 bilateral renal stones) and collected data. Stone-free and success were respectively defined as no visible stones and clinically insignificant residual stones less than 3 mm on postoperative imaging; predictive factors for stone-free were evaluated. Results Of the 66 renal stones, 18 stones (27.3%) were located in the upper pole or midpole or renal pelvis and 48 (72.7%) in the lower pole with or without others, respectively. The mean cumulative stone burden was 168.9±392.5 mm2. The immediate postoperative stone-free rate was 69.7%, and it increased to 72.7% at 1 month after surgery. The success rate was 80.3% both immediately after the operation and 1 month later. In the multivariate analysis, stone location except at the lower pole (p=0.049) and small cumulative stone burden (p=0.002) were significantly favorable predictive factors for the immediate postoperative stone-free rate. The overall complication rate was 6%. Conclusions RIRS is a safe and effective treatment for renal stones. The stone-free rate of RIRS was particularly high for renal stones with a small burden, except for those located in the lower pole. RIRS could be considered in selective patients with renal stones. PMID:21165199

  13. Primary vesico-ureteric reflux: The need for individualised risk stratification

    PubMed Central

    Hidas, Guy; Nam, Alexander; Soltani, Tandis; Pribish, Maryellen; Watts, Blake; Khoury, Antoine E.

    2013-01-01

    The management of paediatric primary vesico-ureteric reflux (VUR) has undergone serial changes over the last decade. As this disorder is extremely heterogeneous, and high-quality prospective data are limited, the treatment strategies vary among centres. Current treatment options include observation only, continuous antibiotic prophylaxis, and surgery. Surgical intervention is indicated if a child has a breakthrough urinary tract infection (UTI) while on continuous antibiotic prophylaxis or if there are renal scars present. After excluding a secondary cause of VUR the physician should consider the risk factors affecting the severity of VUR and manage the child accordingly. Those factors include demographic factors (age at presentation, gender, ethnicity) and clinical factors (VUR grade, unilateral vs. bilateral, presence of renal scars, initial presentation, the number of UTIs, and presence of any voiding or bowel dysfunction). In this review we summarise the major controversial issues in current reports on VUR and highlight the importance of individualised patient management according to their risk stratification. PMID:26579238

  14. Ketoprofen-eluting biodegradable ureteral stents by CO2 impregnation: In vitro study.

    PubMed

    Barros, Alexandre A; Oliveira, Carlos; Reis, Rui L; Lima, Estevão; Duarte, Ana Rita C

    2015-11-30

    Ureteral stents are indispensable tools in urologic practice. The main complications associated with ureteral stents are dislocation, infection, pain and encrustation. Biodegradable ureteral stents are one of the most attractive designs with the potential to eliminate several complications associated with the stenting procedure. In this work we hypothesize the impregnation of ketoprofen, by CO2-impregnation in a patented biodegradable ureteral stent previously developed in our group. The biodegradable ureteral stents with each formulation: alginate-based, gellan gum-based were impregnated with ketoprofen and the impregnation conditions tested were 100 bar, 2 h and three different temperatures (35 °C, 40 °C and 50 °C). The impregnation was confirmed by FTIR and DSC demonstrated the amorphization of the drug upon impregnation. The in vitro elution profile in artificial urine solution (AUS) during degradation of a biodegradable ureteral stent loaded with ketoprofen was evaluated. According to the kinetics results these systems have shown to be very promising for the release ketoprofen in the first 72 h, which is the necessary time for anti-inflammatory delivery after the surgical procedure. The in vitro release studied revealed an influence of the temperature on the impregnation yield, with a higher impregnation yield at 40 °C. Higher yields were also obtained for gellan gum-based stents. The non-cytotoxicity characteristic of the developed ketoprofen-eluting biodegradable ureteral stents was evaluated in L929 cell line by MTS assay which demonstrated the feasibility of this product as a medical device. PMID:26392243

  15. Treatment of ureteral calculus obstruction with laser lithotripsy in an Atlantic bottlenose dolphin (Tursiops truncatus).

    PubMed

    Schmitt, Todd L; Sur, Roger L

    2012-03-01

    An adult female bottlenose dolphin (Tursiops truncatus) presented with acute anorexia secondary to progressive azotemia (blood urea nitrogen = 213 mg/dl, creatinine [Cr] = 9.5 mg/dl) and electrolyte abnormalities (K = 7.4 mEq/L). It was later diagnosed with postrenal obstruction secondary to bilaterally obstructing ureteral calculi seen on ultrasound. Treatment of the obstruction required two endoscopic procedures, cystoscopy for ureteral stent placement and ureteroscopy to perform intracorporeal lithotripsy on the obstructing calculi. Before the first procedure, the dolphin's azotemia was stabilized with aggressive fluid therapy, peritoneal dialysis, and treatment for acidosis. Diuresis subsequent to the fluid therapy enabled passage of the right obstructing urolith. For both endoscopic procedures, the dolphin was placed in left lateral recumbency due to the peritoneal dialysis catheter in the right retroperitoneal region. For the first procedure, a 12-French (Fr) flexible cystoscope was inserted retrograde into the bladder via the urethra, whereupon a calculus was seen obstructing the left ureteral orifice. A 4.8-Fr, 26-cm double-pigtail ureteral stent was placed up the left ureter to relieve the postrenal obstruction. Inadvertent proximal migration of the left ureteral stent occurred during the procedure. However, renal parameters (serum Cr = 5.8, K = 5.4) improved significantly by the next day. For the second procedure, 28 hr later, ureteroscopy was performed to treat the calculus and replace the existing stent with a longer stent. The left ureteral calculus was pulverized into tiny fragments by using a holmium:yttrium-aluminum-garnet laser inserted through a 6.9-Fr semirigid ureteroscope. The migrated stent was visualized in the distal left ureter and replaced with a 90-cm single-pigtail ureteral stent that was sutured exterior to the urogenital slit and removed 3 days later. Renal function normalized over the next several days, and the dolphin recovered over the next 2 mo. PMID:22448516

  16. Is the Routine Check Nephrostogram Following Percutaneous Antegrade Ureteric Stent Placement Necessary?

    SciTech Connect

    Soh, Keng Chuan; Tay, Kiang Hiong Tan, Bien Soo; MM Htoo, Austin; HG Lo, Richard; Lin, Shueh En

    2008-05-15

    Our aim was to review our experience with percutaneous antegrade ureteric stent (PAUS) placement and to determine if the routinely conducted check nephrostogram on the day following ureteric stent placement was necessary. Retrospective review of patients who had undergone PAUS placement between January 2004 and December 2005 was performed. There were 83 subjects (36 males, 47 females), with a mean age of 59.9 years (range, 22-94 years). Average follow-up duration was 7.1 months (range, 1-24 months). The most common indications for PAUS placement were ureteric obstruction due to metastatic disease (n = 56) and urinary calculi (n = 34). Technical success was 93.2% (96/103 attempts), with no major immediate procedure-related complications or mortalities. The Bard 7Fr Urosoft DJ Stent was used in more than 95% of the cases. Eighty-one of 89 (91.0%) check nephrostograms demonstrated a patent ureteric stent with resultant safety catheter removal. Three check nephrostograms revealed distal stent migration requiring repositioning by a goose-snare, while five others showed stent occlusion necessitating permanent external drainage by nephrostomy drainage catheter reinsertion. Following PAUS placement, the serum creatinine level improved or stabilized in 82% of patients. The serum creatinine outcome difference between the groups with benign and malignant indications for PAUS placement was not statistically significant (p = 0.145) but resolution of hydronephrosis was significantly better (p = 0.008) in patients with benign indications. Percutaneous antegrade ureteric stent placement is a safe and effective means of relief for ureteric obstruction. The check nephrostogram following ureteric stent placement was unnecessary in the majority of patients.

  17. Bariatric Surgery and Stone Disease

    NASA Astrophysics Data System (ADS)

    Lieske, John C.; Kumar, Rajiv

    2008-09-01

    Bariatric surgery is an effective treatment strategy for patients with morbid obesity that can result in effective weight loss, resolution of diabetes mellitus and other weight related complications, and even improved mortality. However, it also appears that hyperoxaluria is common after modern bariatric surgery, perhaps occurring in up to 50% of patients after Rouxen-Y gastric bypass. Although increasing numbers of patients are being seen with calcium oxalate kidney stones after bariatric surgery, and even a few with oxalosis and renal failure, the true risk of these outcomes remains unknown. The mechanisms that contribute to this enteric hyperoxaluria are also incompletely defined, although fat malabsorption may be an important component. Since increasing numbers of these procedures are likely to be performed in the coming years, further study regarding the prevalence and mechanisms of hyperoxaluria and kidney stones after bariatric surgery is needed to devise effective methods of treatment in order to prevent such complications.

  18. The Matariki Stone of Rapanui

    NASA Astrophysics Data System (ADS)

    Hockey, T. A.

    2005-12-01

    Anthropological studies of Rapanui (Easter Island) are valuable insofar as the island's remoteness allowed its culture to develop independently until western contact. Of special importance to cultural astronomers is the indigenous inhabitants' expressed interest in the sky, through lore, monumental architecture, and rock art. 1 The Matariki Stone is a unique basaltic boulder found on Rapanui; my analysis of it is the result of in situ investigation (2000). The boulder is 1 m x 1.5 m x 2 m in approximate size and weighs in excess of 10,000 kg. According to local informants, at least six cupules, averaging 6 cm in diameter and 5 cm in depth, were placed in it prior to western contact with the island and prior to transport to the boulder's present location. Information about the Matariki Stone's original setting, orientation, and context is lost. "Matariki" means "Pleiades" (or, more generally, a group of stars). However, the pattern of the Matariki Stone cupules strongly resembles another familiar asterism of third-magnitude stars. 2 These zodiac stars were placed significantly in the Rapanui sky of 1500 CE. Yet no local ethnographic evidence mentions these stars, nor is association with these stars and other regional cultures (e. g., Australian aboriginal and Mayan) compelling. 3 Moreover, there is no Polynesian tradition of constellation depiction in rock art at all, whereas the Pleiades figure prominently in that culture's oral tradition. 4 Thus, the Matariki Stone remains a conundrum. 1 Liller, William. The Ancient Solar Observatories of Rapanui: The Archaeoastronomy of Easter Island. (1993) 2 Hockey, Thomas and Hoffman, Alice. "An Archaeoastronomical Investigation: Does A Constellation Pattern Appear in Rapanui Rock Art?" Rapa Nui Journal. 14, no. 3. (2000) 3 For example, Kelly, David H. and Milone, Eugene F. Exploring Ancient Skies: An Encyclopedic Survey of Archaeoastronomy. (2005) 4 For example, Makemson, Maude. The Morning Star Rises. (1941)

  19. Greco-Roman Stone Disease

    NASA Astrophysics Data System (ADS)

    Moran, Michael E.; Ruzhansky, Katherine

    2008-09-01

    Greek and Roman thought had a profound influence upon Western medical practice. From the fall of the Greek civilization to the fall of the Roman, remarkable progress of our understanding of human anatomy and physiology occurred. Here we review the attempts of Greek and Roman thinkers to develop the first understanding of the pathophysiology of urolithiasis, its epidemiology, differential diagnosis of renal versus bladder stones, medications for both colic and prevention, the role of familial syndromes, and dietary management.

  20. Silicosis among Stone- Cutter Workers: A Cross-Sectional Study

    PubMed Central

    Naserbakht, Ali; Naserbakht, Morteza; Attari, Ghavamedin

    2012-01-01

    Background Production process of most factory-made products is harmful to our health and environment. Silica is the most important stone used in stone cutting factories. Numerous researches have reported respiratory diseases due to the inhalation of these particles in various occupations. Silicosis is a disease with typical radiographic pattern caused as the result of inhalation of silica particles. According to the intensity of exposures and onset of initiation of clinical symptoms silicosis is classified into three groups of acute, chronic and accelerated forms. The present study evaluated silicosis among stone cutter workers. Materials and Methods This cross sectional study was performed on stone cutter workers in Malayer city (Azandarian) between 2008 and 2009. Respiratory data of our study participants were collected with a respiratory questionnaire and performing spirometry tests and chest radiography. Results Among our participants, 16 silicosis cases were diagnosed by radiographic changes. Among them, 10 workers had exposure for more than three years and 6 workers were smokers. Eleven workers had an abnormal radiographic pattern on their chest x-rays. Seven workers had obstructive and 4 workers had restrictive spirometric patterns. Conclusion Prevalence of silicosis was high among our understudy workers and preventive strategies are required to control it. PMID:25191413

  1. Monitoring Artificial Tracer Stones at the Danube East of Vienna

    NASA Astrophysics Data System (ADS)

    Liedermann, Marcel; Gerstl, Margit; Trithart, Michael; Habersack, Helmut

    2010-05-01

    The Integrated River Engineering Project on the Danube to the East of Vienna aims to implement innovative measures to stop riverbed incision on one of the last free flowing sections of the Austrian Danube River. In order to reduce erosion processes, it is planned to add larger gravel sizes within the natural grain size spectrum (granulometric bed improvement). It is planned to superimpose a layer of 25 cm thickness to reduce sediment discharge to a minimum of 10 to 15% of the current amount, but not to stop it entirely. Additionally seven huge sidearm systems will be reconnected, about 30% of the bank protection will be removed and low flow regulation structures will be improved in order to enhance the ecological situation. Within the scope of this Project a comprehensive sediment monitoring program is implemented. Besides bedload transport measurements using a basket sampler and sediment transport modelling applying a newly designed numerical model, artificial stones were added and monitored in order to observe transport velocities and initiation of motion. For the monitoring performed at the three kilometer long test reach near Hainburg, 40 artificial stones of three different sizes (intermediate b-axis: 23 mm, 40 mm, 70 mm) were produced and a coded radio acoustic transmitter was attached to each gravel. The stones were lowered to the river bed at six different locations at the beginning of the test reach, at a gravel bar and in a groyne field within the stretch. The positions of the stones have been observed about once a week, depending on hydrology, over a whole year including a HQ15 flood event. The positions of the stones have been determined by radio tracking from a boat. Hence transport paths and velocities as well as the initiation of bedload transport could be monitored. The paper gives an overview on the methodology and presents results of the monitoring program. The observed stones showed a size selective behaviour in transport. At all discharges, small stones were transported more frequently, faster and further than medium and large stones. Independent of gravel size, the tracers generally covered short travel distances, long travel distances were observed less frequently. With increasing discharge, a higher quantity of stones was transported and travel distances increased. A relationship was found between river morphology and the positions of tracers where no transport occurred. Areas of no transport were more likely to have deeper water levels, less flow velocity and lower shear stress values than areas where tracerstones were moved. More than half of all stones passed the three kilometer long reach with a mean travel velocity of about 10 m per day and a mean transport length of about 200 m. The initiation of motion of the large gravel was detected at lower discharges than predicted by uniform bedload transport formulae.

  2. Ureteral Extension In Wilms Tumor: A Report from the National Wilms Tumor Study Group (NWTSG)

    PubMed Central

    Ritchey, Michael; Daley, Shane; Shamberger, Robert C.; Ehrlich, Peter; Hamilton, Thomas; Haase, Gerald; Sawin, Robert

    2010-01-01

    Background Extension of Wilms tumor into the ureter is a rare event. We reviewed the National Wilms Tumor Study Group (NWTSG) database to define the clinical presentation, associated pathologic features and clinical outcome of these patients. Methods Records of children identified to have ureteral extension of Wilms tumor enrolled in NWTS-3, -4, and -5 were reviewed. Presenting symptoms, diagnostic studies, histopathology, operation performed, and outcome were recorded. The NWTS-5 data was prospectively collected. Results 45 children were identified with ureteral extension. For NWTS-5, the incidence of ureteral extension was 2%. Clinical presentations were gross hematuria in 22 patients, two had passage of tissue per urethra and one child had a urethral mass. The remainder had nonspecific presentations. Ureteral extension was seen on preoperative imaging in 14 patients, intraoperatively in 22, and on pathologic examination in nine patients. Hydronephrosis was noted in 12 patients and there was non function of the kidney in another 8. Laterality of the tumor was right side in 26 and left in 19. Cystoscopy was performed in 12 children. Findings included tumor seen at the ureteral orifice in six patients and bleeding from the orifice in one child. All patients had radical nephrectomy including partial ureterectomy. The ureteral margin was positive in three patients, including two of the seven with separate removal of the ureteral extension. The clinical stage was: stage I – 10, stage II – 18, stage III – 14, and stage IV - 3. The tumor extended into the proximal ureter in 23 patients, distal ureter in 13, seven had extension into the bladder, and one had urethral involvement. The level of ureteral extension was not clearly noted in the 45th child. The median follow-up was 96 months. Overall, 41 of 45 patients were alive at last contact. There were three deaths due to tumor in patients with unfavorable histology tumors, and one due to treatment toxicity in a child with favorable histology. Conclusions Ureteral extension occurs in approximately 2% of patients with Wilms tumor. The diagnosis should be suspected in patients with gross hematuria, hydronephrosis or nonfunctioning kidney. Cystoscopy with retrograde ureterogram may aid in preoperative diagnosis in these patients. Preoperative diagnosis is important since complete resection of the involved portion of ureter at the time of nephrectomy can avoid residual disease and the need for second surgery or radiation therapy. PMID:18778996

  3. Diet and renal stone formation.

    PubMed

    Trinchieri, A

    2013-02-01

    The relationship between diet and the formation of renal stones is demonstrated, but restrictive diets do not take into account the complexity of metabolism and the complex mechanisms that regulate the saturation and crystallization processes in the urine. The restriction of dietary calcium can reduce the urinary excretion of calcium but severe dietary restriction of calcium causes hyperoxaluria and a progressive loss of bone mineral component. Furthermore urinary calcium excretion is influenced by other nutrients than calcium as sodium, potassium, protein and refined carbohydrates. Up to 40% of the daily excretion of oxalate in the urine is from dietary source, but oxalate absorption in the intestine depends linearly on the concomitant dietary intake of calcium and is influenced by the bacterial degradation by several bacterial species of intestinal flora. A more rational approach should be based on the cumulative effects of foods and different dietary patterns on urinary saturation rather than on the effect of single nutrients. A diet based on a adequate intake of calcium (1000-1200 mg per day) and containment of animal protein and salt can decrease significantly urinary supersaturation for calcium oxalate and reduce the relative risk of stone recurrence in hypercalciuric renal stone formers. The DASH-style diet that is high in fruits and vegetables, moderate in low-fat dairy products and low in animal proteins and salt is associated with a lower relative supersaturation for calcium oxalate and a marked decrease in risk of incident stone formation. All the diets above mentioned have as a common characteristic the reduction of the potential acid load of the diet that can be correlated with a higher risk of recurrent nephrolithiasis, because the acid load of diet is inversely related to urinary citrate excretion. The restriction of protein and salt with an adequate calcium intake seem to be advisable but should be implemented with the advice to increase the intake of vegetables that can carry a plentiful supply of alkali that counteract the acid load coming from animal protein. New prospective studies to evaluate the effectiveness of the diet for the prevention of renal stones should be oriented to simple dietary advices that should be focused on a few specific goals easily controlled by means of self-evaluation tools, such as the LAKE food screener. PMID:23392537

  4. Benefits and Complications of Removing Ureteral Stent Based on the Elapsed Time After Renal Transplantation Surgery

    PubMed Central

    Dadkhah, Farid; Yari, Hassan; Ali Asgari, Majid; Fallahnezhad, Mohammad Hossein; Tavoosian, Ali; Ghadian, Alireza

    2016-01-01

    Background The most important surgical complications of renal transplantation are stenosis and obstruction of anastomosis of the ureter to the bladder. Although the routine use of the ureteral stents to prevent such complications seems rational, the optimal time to keep the ureteral stent is still controversial. Objectives This study presents the benefits and complications of removing the ureteral stent based on the elapsed time after the surgery. Patients and Methods All patients who underwent kidney transplantation between May 2011 and August 2014 in Modarres hospital, Tehran, Iran, were enrolled in the study. The patients were classified into three groups. The ureteral stent was removed 10, 20, and 30 days after the transplantation in these groups. Results A total of 529 patients underwent kidney transplant surgery in our center. Urologic complications among the three groups consisting of hydronephrosis, urinoma and collection did not have statistically significant differences. Conclusions Ureteral stent can be picked up with no increased risk of urologic complications at shorter intervals after the kidney transplantation surgery. PMID:27231685

  5. Optimal management of distal ureteric strictures following renal transplantation: a systematic review.

    PubMed

    Kwong, Justin; Schiefer, Danielle; Aboalsamh, Ghaleb; Archambault, Jason; Luke, Patrick P; Sener, Alp

    2016-05-01

    Our objective was to define optimal management of distal ureteric strictures following renal transplantation. A systematic review on PubMed identified 34 articles (385 patients). Primary endpoints were success rates and complications of specific primary and secondary treatments (following failure of primary treatment). Among primary treatments (n = 303), the open approach had 85.4% success (95% CI 72.5-93.1) and the endourological approach had 64.3% success (95% CI 58.3-69.9). Among secondary treatments (n = 82), the open approach had 93.1% success (95% CI 77.0-99.2) and the endourological approach had 75.5% success (95% CI 62.3-85.2). The most common primary open treatment was ureteric reimplantation (n = 33, 81.8% success, 95% CI 65.2-91.8). The most common primary endourological treatment was dilation (n = 133, 58.6% success, 95% CI 50.1-66.7). Fourteen complications, including death (4 weeks post-op) and graft loss (12 days post-op), followed endourological treatment. One complication followed open treatment. This is the first systematic review to examine the success rates and complications of specific treatments for distal ureteric strictures following renal transplantation. Our review indicates that open management has higher success rates and fewer complications than endourological management as a primary and secondary treatment for post-transplant distal ureteric strictures. We also outline a post-transplant ureteric stricture evaluation and treatment algorithm. PMID:26895782

  6. TREM-1 regulates macrophage polarization in ureteral obstruction.

    PubMed

    Lo, Tzu-Han; Tseng, Kai-Yu; Tsao, Wen-Shan; Yang, Chih-Ya; Hsieh, Shie-Liang; Chiu, Allen Wen-Hsiang; Takai, Toshiyuki; Mak, Tak W; Tarng, Der-Cherng; Chen, Nien-Jung

    2014-12-01

    Chronic kidney disease (CKD) is an emerging worldwide public health problem. Inflammatory cell infiltration and activation during the early stages in injured kidneys is a common pathologic feature of CKD. Here, we determined whether an important inflammatory regulator, triggering receptor expressed on myeloid cells (TREM)-1, is upregulated in renal tissues collected from mouse ureteral obstruction-induced nephritis. TREM-1 is crucial for modulating macrophage polarization, and has a pivotal role in mediating tubular injury and interstitial collagen deposition in obstructive nephritis. Lysates from nephritic kidneys triggered a TREM-1-dependent M1 polarization ex vivo, consistent with the observation that granulocyte-macrophage colony-stimulating factor (GM-CSF)-derived M1 macrophages express higher levels of TREM-1 in comparison with M-CSF-derived cells. Moreover, agonistic TREM-1 cross-link significantly strengthens the inductions of iNOS and GM-CSF in M1 cells. These observations are validated by a strong clinical correlation between infiltrating TREM-1-expressing/iNOS-positive macrophages and renal injury in human obstructive nephropathy. Thus, TREM-1 may be a potential diagnostic and therapeutic target in human kidney disease. PMID:24918157

  7. Ultrasound-guided percutaneous antegrade hydropropulsion to relieve ureteral obstruction in a pet guinea pig (Cavia porcellus)

    PubMed Central

    Eshar, David; Lee-Chow, Bridget; Chalmers, Heather J.

    2013-01-01

    Severe hydroureter and hydronephrosis secondary to ureteral obstruction by calculus were present in a guinea pig. A palliative ultrasound-guided percutaneous antegrade hydropropulsion was performed under general anesthesia to relieve the ureteral obstruction and the associated clinical signs. We describe the technique and the considerations for its potential application in similar cases. PMID:24293674

  8. Ultrasound-guided percutaneous antegrade hydropropulsion to relieve ureteral obstruction in a pet guinea pig (Cavia porcellus).

    PubMed

    Eshar, David; Lee-Chow, Bridget; Chalmers, Heather J

    2013-12-01

    Severe hydroureter and hydronephrosis secondary to ureteral obstruction by calculus were present in a guinea pig. A palliative ultrasound-guided percutaneous antegrade hydropropulsion was performed under general anesthesia to relieve the ureteral obstruction and the associated clinical signs. We describe the technique and the considerations for its potential application in similar cases. PMID:24293674

  9. Investigations of stone consolidants by neutron imaging

    NASA Astrophysics Data System (ADS)

    Hameed, F.; Schillinger, B.; Rohatsch, A.; Zawisky, M.; Rauch, H.

    2009-06-01

    The chemical preservation and structural reintegration of natural stones applied in historical buildings is carried out by the use of different stone strengtheners. As these agents contain hydrogen, they offer good properties for neutron imaging. The main interest in the restoration process is the development of a suitable stone consolidant. In cooperation with the St. Stephans Cathedral and the geologists at Vienna University of Technology, we are investigating the penetration depth and distribution of different stone consolidants. These studies are being carried out with different stone samples, mostly porous natural building stones, limestones and sandstones. The two strengtheners used in this study are ethyl silicate ester (Wacker OH100) and dissolved polymethylmetacrylate (PMMA, Paraloid B72). Neutron radiography and neutron tomography can be used successfully to visualize the distribution of consolidants both in two and three dimensions.

  10. Bioremediation of weathered-building stone surfaces.

    PubMed

    Webster, Alison; May, Eric

    2006-06-01

    Atmospheric pollution and weathering of stone surfaces in urban historic buildings frequently results in disfigurement or damage by salt crust formation (often gypsum), presenting opportunities for bioremediation using microorganisms. Conventional techniques for the removal of these salt crusts from stone have several disadvantages: they can cause colour changes; adversely affect the movement of salts within the stone structure; or remove excessive amounts of the original surface. Although microorganisms are commonly associated with detrimental effects to the integrity of stone structures, there is growing evidence that they can be used to treat this type of stone deterioration in objects of historical and cultural significance. In particular, the ability and potential of different microorganisms to either remove sulfate crusts or form sacrificial layers of calcite that consolidate mineral surfaces have been demonstrated. Current research suggests that bioremediation has the potential to offer an additional technology to conservators working to restore stone surfaces in heritage buildings. PMID:16647149

  11. Modern management of common bile duct stones.

    PubMed

    Buxbaum, James

    2013-04-01

    It is imperative for gastroenterologists to understand the different formations of bile duct stones and the various medical treatments available. To minimize the complications of endoscopic retrograde cholangiopancreatography (ERCP), it is critical to appropriately assess the risk of bile duct stones before intervention. Biliary endoscopists should be comfortable with the basic techniques of stone removal, including sphincterotomy, mechanical lithotripsy, and stent placement. It is important to be aware of advanced options, including laser and electrohydraulic stone fragmentation, and papillary dilatation for problematic cases. The timing and need for ERCP in those who require a cholecystectomy is also a consideration. PMID:23540960

  12. Computational stoning method for surface defect detection

    NASA Astrophysics Data System (ADS)

    Ma, Ninshu; Zhu, Xinhai

    2013-12-01

    Surface defects on outer panels of automotive bodies must be controlled in order to improve the surface quality. The detection and quantitative evaluation of surface defects are quite difficult because the deflection of surface defects is very small. One of detecting methods for surface defects used in factories is a stoning method in which a stone block is moved on the surface of a stamped panel. The computational stoning method was developed to detect surface low defect by authors based on a geometry contact algorithm between a stone block and a stamped panel. If the surface is convex, the stone block always contacts with the convex surface of a stamped panel and the contact gap between them is zero. If there is a surface low, the stone block does not contact to the surface and the contact gap can be computed based on contact algorithm. The convex surface defect can also be detected by applying computational stoning method to the back surface of a stamped panel. By performing two way stoning computations from both the normal surface and the back surface, not only the depth of surface low defect but also the height of convex surface defect can be detected. The surface low defect and convex surface defect can also be detected through multi-directions. Surface defects on the handle emboss of outer panels were accurately detected using the computational stoning method and compared with the real shape. A very good accuracy was obtained.

  13. The full metallic double-pigtail ureteral stent: Review of the clinical outcome and current status

    PubMed Central

    Kallidonis, Panagiotis S.; Georgiopoulos, Ioannis S.; Kyriazis, Iason D.; Kontogiannis, Stavros; Al-Aown, Abdulrahman M.; Liatsikos, Evangelos N.

    2015-01-01

    The full metallic double-J ureteral stent (MS) was introduced as a method for providing long-term drainage in malignant ureteral obstruction. Experimental evaluation of the MS revealed that its mechanical features allow efficient drainage in difficult cases, which could not be managed by the insertion of a standard polymeric double-J stent. Clinical experience with the MS showed controversial results. Careful patient selection results in efficient long-term management of malignant ureteral obstruction. The use of the MS should also be considered in selected benign cases. Major complications are uncommon and the minor complications should not hinder its use. Experience in pediatric patients is limited and warrants additional study. The cost-effectiveness of the MS seems to be appropriate for long-term treatment. Further investigation with comparative clinical trials would document the outcome more extensively and establish the indications as well as the selection criteria for the MS. PMID:25624569

  14. Antegrade placement of a ureteric stent by a pull-through technique.

    PubMed

    Asch, M R; Jaffer, N M

    1995-12-01

    Internal double-J ureteric stents are valuable in the treatment of ureteric obstruction, obviating the need for an external drainage catheter. Retrograde placement of these stents is often performed by the urologist, or, if such placement fails, antegrade placement is performed by the interventional radiology service. In cases of high-grade obstruction it may be possible to pass a guide wire through the stricture but impossible to do so with a catheter. The authors describe a pull-through technique, which was used to place a ureteric stent in a 65-year-old man with bilateral hydronephrosis. The method consists of gaining control of the distal end of the guide wire by retrieving it through the penile urethra to allow the stenosis to be crossed with a catheter. PMID:7583729

  15. Ureteral Injury with Delayed Massive Hematuria after Transvaginal Ultrasound-Guided Oocyte Retrieval

    PubMed Central

    Burnik Papler, Tanja; Vrtačnik Bokal, Eda; Šalamun, Vesna; Galič, Dejan; Smrkolj, Tomaž; Jančar, Nina

    2015-01-01

    We report a case of ureteral injury with delayed hematuria after transvaginal oocyte retrieval. A 28-year-old infertile patient with a history of previous laparoscopic resection of endometriotic nodes of both sacrouterine ligaments presented with abdominal pain one day after oocyte retrieval. Four days after oocyte retrieval, she presented with massive hematuria that reappeared 6 days after oocyte retrieval. Monopolar coagulation with wire electrode and insertion of a double-J-stent was performed during operative cystoscopy. The patient recovered completely after transfusion and had no signs of renal impairment after ureteric stent removal. This is the first report of ureteral injury after oocyte retrieval presenting itself with delayed massive hematuria and no signs of renal dysfunction or urinary leakage into retroperitoneal space. PMID:26146577

  16. Ureteral rupture after blunt abdominal trauma in a child with unknown horseshoe kidney.

    PubMed

    Mariotto, Arianna; Zampieri, Nicola; Cecchetto, Mariangela; Camoglio, Francesco Saverio

    2015-01-01

    More than 90% of renal injuries in children result from blunt abdominal trauma. A 10-year-old female had a blunt abdominal trauma with macro-hematuria. The computed tomography scan revealed the presence of a horseshoe kidney and a 3rd grade renal lesion and contrast leakage from the right ureter. The ureteral rupture was confirmed by cystoscopy and ascendant pyelography and than a double J-stent was implanted. The stent was removed one month later. Non-surgical management has become the standard of care for both ureteral and renal lesions in children. Non-surgical treatment is a safe procedure for renal trauma with ureteral rupture in children. PMID:26429120

  17. A Secreted BMP Antagonist, Cer1, Fine Tunes the Spatial Organization of the Ureteric Bud Tree during Mouse Kidney Development

    PubMed Central

    Chi, Lijun; Saarela, Ulla; Railo, Antti; Prunskaite-Hyyryläinen, Renata; Skovorodkin, Ilya; Anthony, Shelagh; Katsu, Kenjiro; Liu, Yu; Shan, Jingdong; Salgueiro, Ana Marisa; Belo, José António; Davies, Jamie; Yokouchi, Yuji; Vainio, Seppo J.

    2011-01-01

    The epithelial ureteric bud is critical for mammalian kidney development as it generates the ureter and the collecting duct system that induces nephrogenesis in dicrete locations in the kidney mesenchyme during its emergence. We show that a secreted Bmp antagonist Cerberus homologue (Cer1) fine tunes the organization of the ureteric tree during organogenesis in the mouse embryo. Both enhanced ureteric expression of Cer1 and Cer1 knock out enlarge kidney size, and these changes are associated with an altered three-dimensional structure of the ureteric tree as revealed by optical projection tomography. Enhanced Cer1 expression changes the ureteric bud branching programme so that more trifid and lateral branches rather than bifid ones develop, as seen in time-lapse organ culture. These changes may be the reasons for the modified spatial arrangement of the ureteric tree in the kidneys of Cer1+ embryos. Cer1 gain of function is associated with moderately elevated expression of Gdnf and Wnt11, which is also induced in the case of Cer1 deficiency, where Bmp4 expression is reduced, indicating the dependence of Bmp expression on Cer1. Cer1 binds at least Bmp2/4 and antagonizes Bmp signalling in cell culture. In line with this, supplementation of Bmp4 restored the ureteric bud tip number, which was reduced by Cer1+ to bring it closer to the normal, consistent with models suggesting that Bmp signalling inhibits ureteric bud development. Genetic reduction of Wnt11 inhibited the Cer1-stimulated kidney development, but Cer1 did not influence Wnt11 signalling in cell culture, although it did inhibit the Wnt3a-induced canonical Top Flash reporter to some extent. We conclude that Cer1 fine tunes the spatial organization of the ureteric tree by coordinating the activities of the growth-promoting ureteric bud signals Gndf and Wnt11 via Bmp-mediated antagonism and to some degree via the canonical Wnt signalling involved in branching. PMID:22114682

  18. The 'buoy' stent: evaluation of a prototype indwelling ureteric stent in a porcine model.

    PubMed

    Krebs, Alfred; Deane, Leslie A; Borin, James F; Edwards, Robert A; Sala, Leandro G; Khan, Farhan; Abdelshehid, Corollos; McDougall, Elspeth M; Clayman, Ralph V

    2009-07-01

    OBJECTIVE To assess a prototype ureteric 'buoy' stent with a 10 F upper body tapering to a 3F tail, developed to potentially reduce stent-related irritative symptoms while providing an adequate mould for healing after endopyelotomy. MATERIALS AND METHODS Eighteen Yucatan minipigs had the stent placed either into the intact ureter (phase I) or after Acucise proximal endoureterotomy (phase II). Buoy stents were compared to 10/7 F endopyelotomy stents and to standard 7 F stents in phases I and II, respectively. The pigs were assessed for vesico-ureteric reflux, hydronephrosis and infection, before stent insertion and at harvest. Stents were weighed before and after placement and the removal force was measured. Pressure/flow studies, antegrade nephrostograms and specimens for histopathology from the renal pelvis, ureter and vesico-ureteric junction (VUJ) were obtained at harvest. RESULTS Thirteen minipigs survived the entire study. Ureteric flow with the stents in situ was better for buoy stents than for 10/7 F stents (P < 0.005). Ureteric flow after endoureterotomy and subsequent stent removal was similar for buoy stents and standard 7 F stents. None of the stents refluxed. There was no difference between stents in removal force, weight change or incidence of hydronephrosis. At 1 and 12 weeks, buoy stents tended to produce lower histopathological alteration scores than control stents, especially at the VUJ (phase I, 2.0 vs 3.9, P = 0.092; phase II, 0.6 vs 1.7, P = 0.18). CONCLUSIONS The novel buoy stents are easily placed and removed via the urethra. They can cause less VUJ inflammation than standard stents while allowing for adequate ureteric flow and healing after proximal endoureterotomy. PMID:19154469

  19. Global stone heritage: larvikite, Norway

    NASA Astrophysics Data System (ADS)

    Heldal, Tom; Dahl, Rolv

    2013-04-01

    Larvikite has for more than hundred years been appreciated as one of the world's most attractive dimension-stones, and at present time its production and use is more extensive than ever. The main reason for the continuous success of the larvikite on the world market is the blue iridescence displayed on polished surfaces, which is caused by optical interference in microscopic lamellae within the ternary feldspars. The larvikite complex consists of different intrusions defining several ring-shaped structures, emplaced during a period of approximately five million years. Following this pattern, several commercial subtypes of larvikite, characterised by their colour and iridescence, have been identified. The name "larvikite" was first applied by Waldemar Brøgger, in his descriptions of the monzonitic rocks within the southern part of the Carboniferous-Permian Oslo Igneous Province. The name has its origin in the small coastal town of Larvik, situated almost right in the centre of the main plutonic complex of larvikite. From a geologist's point of view, the larvikites are important for understanding the igneous mechanisms behind the formation of the Oslo rift, representing a series of semi-circular intrusions, varying from quartz-bearing monzonites in the east (earliest phases) towards nepheline-bearing monzonites and nepheline syenite in the west (latest phases). However, most other people see larvikite as a particularly beautiful rock. Production started already in the 1880s, and at present time the export value of rough blocks of dimension-stone from the Larvik Region is close to 100 million euro, distributed on approximately 20 individual quarries. Different types of larvikite have different market value, and the customers can choose between a range of types and qualities under trade names such as "Blue Pearl", "Emerald Pearl" and "Marina Pearl". Globally, larvikite has put a significant mark on architecture around the world, and should be included in the global stone heritage.

  20. A Lion of a Stone

    NASA Technical Reports Server (NTRS)

    2004-01-01

    This approximate true-color image of the rock called 'Lion Stone' was acquired by the Mars Exploration Rover Opportunity's panoramic camera on sol 104 (May 9, 2004). The rock stands about 10 centimeters tall (about 4 inches) and is about 30 centimeters long (12 inches). Plans for the coming sols include investigating the rock with the spectrometers on the rover's instrument arm.

    This image was generated using the camera's L2 (750-nanometer), L5 (530-nanometer) and L6 (480-nanometer) filters.

  1. Persistent Ureteric Dilatation due to Pelvic Actinomycosis Presenting as Pelvic Inflammatory Disease

    PubMed Central

    Khafagy, Richard; Jundi, Omar; Rogawski, Karol; Namasiviyam, Siva

    2011-01-01

    Actinomyces is a Gram-positive, filamentous bacterium that normally colonizes mucosal areas. Pelvic actinomycosis is a chronic granulomatous disease caused by Actinomyces israelii that frequently mimics ovarian tumors during presentation. It is diagnosed after surgery in most of the cases. Intravenous penicillin is the most preferred therapeutic agent, and it requires hospitalization up to one month. Pelvic actinomycosis is a rare cause of ureteric obstruction and renal failure. The final diagnosis is usually difficult and often apparent only after histological examination of an operative specimen. The present case led us to consider the etiology and clinical findings and to review the management of reported cases involving ureteric obstruction. PMID:24523972

  2. A rare cause of anuria: Bilateral synchronous isolated mid-ureteric tubercular lesions

    PubMed Central

    Dangi, Anuj D.; Kodiatte, Thomas Alex; Kumar, Santosh; Kekre, Nitin S.

    2015-01-01

    A young female presenting with right flank pain, fever, raised creatinine and bilateral hydronephrosis was treated with antibiotics elsewhere, with presumptive diagnosis of bilateral pyelonephritis. She had partial relief in symptoms and her creatinine level showed an improvement. Three months later during evaluation at our center she had anuria, hypertensive crisis and pulmonary edema which were managed with emergency bilateral percutaneous nephrostomies. Cross-sectional imaging and ureteroscopy suggested bilateral synchronous intramural mid-ureteric lesions as underlying pathology. Histopathology of the ureteric segments during laparotomy revealed caseating granulomas suggestive of tuberculosis. This clinical presentation has not been previously described in urinary tuberculosis. PMID:26604451

  3. Persistent Ureteric Dilatation due to Pelvic Actinomycosis Presenting as Pelvic Inflammatory Disease.

    PubMed

    Khafagy, Richard; Jundi, Omar; Rogawski, Karol; Namasiviyam, Siva

    2011-01-01

    Actinomyces is a Gram-positive, filamentous bacterium that normally colonizes mucosal areas. Pelvic actinomycosis is a chronic granulomatous disease caused by Actinomyces israelii that frequently mimics ovarian tumors during presentation. It is diagnosed after surgery in most of the cases. Intravenous penicillin is the most preferred therapeutic agent, and it requires hospitalization up to one month. Pelvic actinomycosis is a rare cause of ureteric obstruction and renal failure. The final diagnosis is usually difficult and often apparent only after histological examination of an operative specimen. The present case led us to consider the etiology and clinical findings and to review the management of reported cases involving ureteric obstruction. PMID:24523972

  4. Chemical dissolution of common bile duct stones.

    PubMed

    Leuschner, U; Baumgärtel, H

    1984-01-01

    Dissolution of bile duct calculi is complicated by the facts that about 30-40% of them are pigment stones and the stone cannot be unambiguously identified by radiography before the start of therapy. Thus it does not appear logical only to infuse irrigation media that dissolve cholesterol (cholate, Capmul) but to use solutions that also dissolve calcium bilirubinate. Calcium bilirubinate is the most important compound in primary pigment stones in the bile duct. Thin sections of calcium bilirubinate stones can be dissolved in EDTA 4Na. The rate is determined by the temperature, the pH, and the surface tension of the solution. In vitro experiments showed that cholesterol stones and composition stones can be dissolved more rapidly by alternating therapy with an EDTA solution and a Capmul preparation than by monotherapy with glycerol octanoate, and that bovine pigment stones can also be disaggregated. Since calcium bilirubinate stones consist up to 20-60% of an organic matrix, a mixture of glycerol octanoate and EDTA was prepared containing SH-activated papain. It was possible, by using this mixture, to disaggregate human calcium bilirubinate stones. The process of dissolution is complex and is not yet understood in detail. It is supposed that the important steps are the extraction of calcium, the chemical solution and molecular dispersion of bilirubin and cholesterol, and the disaggregation of the structure of the stone by surface-active substances. The irrigation media have but little effect on black pigment stones. Toxicity studies have shown that cholate, glycerol octanoate, and glycerol octanoate preparations are locally toxic and can lead to cholangitis and cholecystitis in animals. EDTA solutions bring about lesser changes. In humans, it has not been possible to distinguish these inflammatory changes unambiguously from those found in untreated gallstone patients. PMID:6433355

  5. Uterine Artery Embolization for Ureteric Obstruction Secondary to Fibroids

    SciTech Connect

    Mirsadraee, Saeed; Tuite, David; Nicholson, Anthony

    2008-11-15

    This case series examines the safety and efficacy of uterine artery embolization (UAE) in the treatment of obstructive nephropathy caused by large fibroids. Between 2004 and 2007, 10 patients referred with symptomatic uterine fibroids that were found to be causing either unilateral (7 patients) or bilateral (3 patients) hydronephrosis were treated by UAE. Presenting complaints included menorrhagia, dysmenorrhea, bulk symptoms, loin pain, postobstructive atrophy, and mild renal impairment. All had posterior intramural dominant fibroids >11 cm in maximum sagittal diameter and uterine volumes between 3776 and 15,625 ml. Outcome measures at between 12 and 36 months included procedural success, repeat intervention, relief of symptoms, resolution of hydronephrosis, stable renal function and size, and avoidance of hysterectomy. In all cases the cause of renal obstruction was confirmed to be a giant fibroid compressing the ureter at the pelvic brim. In all cases UAE was technically successful, though two patients required a repeat procedure. In eight patients hydronephrosis resolved and the obstruction was relieved, though two still had some bulk symptoms not requiring further treatment. Renal function improved or was stable in all cases. Renal size was stable in all cases. Where menorrhagia was part of the symptom complex it was relieved in all cases. Two patients diagnosed as having postobstructive atrophy of one kidney underwent retrograde ureteric stenting on the nonatrophied side prior to UAE. This was unsuccessful in one of the cases due to the distortion caused by the fibroid. Despite improvement in hydronephrosis this patient underwent hysterectomy at 7 months after a renogram demonstrated persistent obstruction at the pelvic brim. In the second patient a double pigtail stent was inserted with difficulty and eventually removed at 8 months. This patient has had stable renal function and size for 3 years post-UAE. We conclude that UAE is safe and effective in treating patients with obstructive hydronephrosis caused by large fibroids.

  6. Cost-effectiveness v patient preference in the choice of treatment for distal ureteral calculi: a literature-based decision analysis.

    PubMed

    Wolf, J S; Carroll, P R; Stoller, M L

    1995-06-01

    Ureteroscopy (URS) and extracorporeal shockwave lithotripsy (SWL) battle for supremacy in the management distal ureteral calculi. In order to clarify issues surrounding this controversy, we created a decision tree modeling URS or SWL with literature-based probabilities and used as endpoints both cost and patient preferences. Ureteroscopy was more successful than single-session or multiple-session SWL, 92.1% v 74.3% or 84.5%, and had a lower retreatment/complication rate. Although initial SWL was only slightly more expensive than URS, $4,420 v $4,337, the difference increased when the additional costs of complications and retreatment were calculated, $6,745 v $5,555. Using values for an "average" patient, SWL was preferred to URS in terms of patient satisfaction. The most important factors distinguishing between URS and SWL were the success of treatment, the cost of initial therapy, and patient attitudes toward unplanned ancillary procedures and retreatment. Although no alteration of success rates and cost figures within reasonable ranges made URS less cost-effective than SWL, individual differences in patients' aversion for complications allowed URS to be preferred to SWL in some situations. Therefore, SWL is less cost-effective than URS and is not necessarily preferred by patients. The physician should be aware of the principal determinants of the choice between URS and SWL treatment of distal ureteral calculi. PMID:7550267

  7. Nutrition and renal stone disease in space

    NASA Technical Reports Server (NTRS)

    Zerwekh, Joseph E.

    2002-01-01

    There is a growing body of evidence from the National Aeronautics and Space Administration and the Russian space program showing that humans exposed to the microgravity environment of space have a greater risk for developing renal stones. Increased bone resorption and the attendant hypercalciuria and hyperphosphaturia contribute significantly to raising the urinary state of saturation with respect to the calcium salts, namely calcium oxalate and calcium phosphate. In addition, other environmental and dietary factors may adversely affect urine composition and increase stone formation risk during space flight. For example, reductions in urinary volume, pH, and citrate contribute to raising stone formation risk. In addition to raising the risk for calcium stone formation, this metabolic profile is conducive to the formation of uric acid stones. Although observations to date have suggested that there may actually be a reduced food intake during the early phase of flight, crew members on longer-duration flights may increase food intake and be at increased risk for stone formation. Taken together, these findings support the use of nutritional recommendations for crew members that would serve to reduce the stone-forming propensity of the urinary environment. Pharmacologic intervention should be directed at raising urinary volumes, diminishing bone losses, and preventing reductions in urinary pH and citrate. Success in reducing the risk for stone formation in astronauts would also be of potential major benefit to the estimated 20 million Americans with nephrolithiasis.

  8. Armenian Khatchkar (Stone Cross) Carved in 1308.

    ERIC Educational Resources Information Center

    Hacobian, Mossik

    This booklet introduces students to a unique form of stone sculpture made by Armenian artists for over twelve centuries, the khatchkar, or stone cross. The document is part of a series of seven instructional materials dealing with the history and culture of Armenian Americans. It contains a reading on khatchkars as symbols of faith for eternity, a…

  9. The Stone Center: A Visitor's Perspective.

    ERIC Educational Resources Information Center

    Liddle, Shirley M.

    1991-01-01

    Author describes her perspective on the Stone Center for Developmental Services and Studies, integral part of Wellesley College established in 1981 and dedicated to prevention of emotional problems, primarily among women. Describes Education, Research, and Counseling divisions of the Stone Center and the basic tenets that drive the center's…

  10. Ventricular candidiasis in stone curlews (Burhinus oedicnemus).

    PubMed

    Caliendo, Valentina; Bull, Andrew

    2011-09-01

    Ventricular candidiasis is consistently one of the most prominent pathologic conditions diagnosed in stone curlews (Burhinus oedicnemus) in the United Arab Emirates, predominately affecting the captive population. Predisposing factors are a humid environment, stress, immunosuppression, inadequate nutrition, and an extended use of oral antibiotics. In this report, we describe the clinical signs, diagnosis, and pathologic result in stone curlews with ventricular candidiasis. PMID:22017057

  11. Elemental Content of Calcium Oxalate Stones from a Canine Model of Urinary Stone Disease

    PubMed Central

    Killilea, David W.; Westropp, Jodi L.; Shiraki, Ryoji; Mellema, Matthew; Larsen, Jennifer; Kahn, Arnold J.; Kapahi, Pankaj; Chi, Thomas; Stoller, Marshall L.

    2015-01-01

    One of the most common types of urinary stones formed in humans and some other mammals is composed of calcium oxalate in ordered hydrated crystals. Many studies have reported a range of metals other than calcium in human stones, but few have looked at stones from animal models such as the dog. Therefore, we determined the elemental profile of canine calcium oxalate urinary stones and compared it to reported values from human stones. The content of 19 elements spanning 7-orders of magnitude was quantified in calcium oxalate stones from 53 dogs. The elemental profile of the canine stones was highly overlapping with human stones, indicating similar inorganic composition. Correlation and cluster analysis was then performed on the elemental profile from canine stones to evaluate associations between the elements and test for potential subgrouping based on elemental content. No correlations were observed with the most abundant metal calcium. However, magnesium and sulfur content correlated with the mineral hydration form, while phosphorous and zinc content correlated with the neuter status of the dog. Inter-elemental correlation analysis indicated strong associations between barium, phosphorous, and zinc content. Additionally, cluster analysis revealed subgroups within the stones that were also based primarily on barium, phosphorous, and zinc. These data support the use of the dog as a model to study the effects of trace metal homeostasis in urinary stone disease. PMID:26066810

  12. Kidney stone risk following modern bariatric surgery.

    PubMed

    Gonzalez, Ricardo D; Canales, Benjamin K

    2014-05-01

    Over the past 10 years, a variety of reports have linked bariatric surgery to metabolic changes that alter kidney stone risk. Most of these studies were retrospective, lacked appropriate controls, or involved bariatric patients with a variety of inclusion criteria. Despite these limitations, recent clinical and experimental research has contributed to our understanding of the pathophysiology of stone disease in this high-risk population. This review summarizes the urinary chemistry profiles that may be responsible for the increased kidney stone incidence seen in contemporary epidemiological bariatric studies, outlines the mechanisms of hyperoxaluria and potential therapies through a newly described experimental bariatric animal model, and provides a focused appraisal of recommendations for reducing stone risk in bariatric stone formers. PMID:24658828

  13. [Asymptomatic kidney stones: active surveillance vs. treatment].

    PubMed

    Neisius, A; Thomas, C; Roos, F C; Hampel, C; Fritsche, H-M; Bach, T; Thüroff, J W; Knoll, T

    2015-09-01

    The prevalence of kidney stones is increasing worldwide. Asymptomatic non-obstructing kidney stones are increasingly detected as an incidental finding on radiologic imaging, which has been performed more frequently over the last decades. Beside the current interventional treatment modalities such as extracorporeal shockwave lithotripsy (ESWL), ureterorenoscopy (URS) and percutaneous nephrolithotomy (PNL), active surveillance of asymptomatic kidney stones has been a focus of discussion lately, not only for attending physicians, but even more so for patients. The current German and European guidelines recommend active surveillance for patients with asymptomatic kidney stones if no interventional therapy is mandatory because of pain or medical factors. Herein we review the current literature on risks and benefits of active surveillance of asymptomatic non-obstructing kidney stones. PMID:26378390

  14. Protecting Space Travelers from Kidney Stones: Renal Stone Risk During Space Flight

    NASA Technical Reports Server (NTRS)

    Whitson, Peggy; Bloomberg, Jacob; Lee, Angie (Technical Monitor)

    2002-01-01

    Renal stones, popularly known as kidney or bladder stones, are small rock-like objects formed in the kidneys or urinary tract by deposits of calcium and other minerals. The problem arises when the stones block the drainage of the kidney, resulting in urinary obstruction and pain. Passing these stones can be one of the most painful experiences a person will endure so doctors often prescribe pain relievers to ease the experience. Drinking plenty of fluids, which help flush waste out of the body, and eating a well-balanced diet are the first steps to preventing stones. For individuals at risk, this may not be enough, and a doctor may recommend a special diet and medications. Unfortunately, approximately 60 percent of people who have had a renal stone will experience a recurrence. This is particularly true of men, who are four to five times more likely to develop stones than women. Renal stones do not discriminate based on age; even children are at risk. Astronauts are particularly at risk of developing renal stones because they lose bone and muscle mass; calcium, other minerals, and protein normally used for bone and muscle end up in the bloodstream and then in the kidneys. Without plenty of fluid to wash them away, crystals can form and then grow into stones. This factor compounds the risk for astronauts, since they also perceive that they are less thirsty in space and will drink less than normal during the mission. To minimize all of these factors, doctors must instead treat the stone-forming compounds with medication. This study will use potassium citrate to reduce the risk of stone formation. Renal stones are never convenient, but they are a particular concern for astronauts who have limited access to treatment during flight. Researchers are examining how earthbound preventions for renal stone formation work in flight, ensuring missions are not ended prematurely due to this medical condition. During STS-107, earthbound preventions and treatments become astronauts' gain.

  15. Economics of stone disease/treatment

    PubMed Central

    Strohmaier, Walter Ludwig

    2012-01-01

    Objectives Urolithiasis is a considerable economic burden for health systems, especially in industrialised countries where the incidence of stone disease has increased during the last few decades, and probably will further increase for several reasons. Methods The survey was based on investigations in collaboration with a German health insurance company and on a literature search (PubMed, and the author’s collection of proceedings of urolithiasis conferences: The keywords included economics, cost, urolithiasis, nephrolithiasis, renal stone disease, metaphylaxis, recurrence) during 1999–2011. In all, 1221 articles were found but only those cited here were sufficient for the purpose of the study. Due to the nature of the subject it is not possible to give levels of evidence, as economic data on stone treatment cannot be obtained with randomised studies. Results The costs for the treatment and diagnosis of stones vary tremendously among different healthcare systems. Several calculation models showed that metaphylaxis is medically and economically effective when used rationally. Rational metaphylaxis is restricted to patients with a high risk of recurrence (brushite, uric acid, cystine and infected stones, patients with residual fragments after stone treatment and recurrent calcium oxalate stone formers). Conclusions For the groups identified, metaphylaxis is cost-effective in almost all healthcare systems, but the cost saved differs. The savings increase even more when adding the economic loss avoided from days off work due to treatment of recurrent stones. In most countries, stone frequency must exceed one stone per patient per year before medical therapy is more cost-effective than dietary measures. PMID:26558036

  16. Impact of stone content on soil moisture measurement with capacitive sensors 10HS (Decagon)

    NASA Astrophysics Data System (ADS)

    Deraedt, Deborah; Bernard, Julien; Bietlot, Louise; Clerbois, Laura; Rosière, Clément; Starren, Amandine; Colinet, Gilles; Mercatoris, Benoit; Degré, Aurore

    2015-04-01

    Lot of soil survey focused on agricultural soils. For practical reasons, those soils have a low stone content. So, most of the soil water content sensors are placed on low stone content soils and the calibration equations are developed for them. Yet some researches take an interest in forest soils that are often much different from the previous ones. The differences lie in their stone content and their slope. Lots of studies have proved the importance of making soil specific calibration of the soil water content sensor. As our lab use regularly the 10HS sensors (Decagon Devices, United States) in forested soil, we decided to evaluate the importance of the stone content in the soil moisture measurement. The soil used for this experimentation comes from Gembloux (50°33'54.9''N, 4°42'11.3''E). It is silt that has been sieved at 2 mm to remove the gravel. The stones used to form the samples come from an experimental site located in the Belgian Ardennes (50°1'52.6''N, 4°53'22.5''E). They are mainly composed of schist with some quartz and sandstone elements. Initially, only five samples were constructed with three replications each. The size and the proportion of stones were the variables. Stones were classified in two groups, the first contains gravels whose size is less than 1,5 cm and a the second contains gravels whose size is comprised between 2 and 3 cm. The proportions of stone selected for the experiment are 0, 20 and 40%. In order to generate validation data, two more samples were constructed with intermediate proportion of stone content (30%). The samples were built in PVC container which dimensions are slightly bigger than the sensor volume of influence (1.1-1.3l). The soil samples were saturated and then dried on a thermal chamber set at about 32°C. During at least 14 days, the samples soil water content was determined by the sensor measurement with the Procheck read-out system (Decagon Devices, United State) and by weighting the samples thrice a day. The evolution of the soil sample height was monitored as well. As first result, the stone content is a parameter that seems to influence soil water content. The stone size is no important. Because soil moisture deserves to be measured accurately in every soil and to confirm the first results the experiment is going on with more samples, different stone proportions, other sensor positioning and a natural air drying.

  17. Ureteral triplication with a contralateral duplication and ureterocele: a case report

    PubMed Central

    Alhajri, Fayza; Al-Mutawa, Sara

    2009-01-01

    We report a 10-year-old boy who presented with nocturnal enuresis. Radiological workup revealed a left ureteral triplication (Smith type 2) with a contralateral duplication and ureterocele. This presentation and its association are extremely rare. The clinical and radiological features are presented here as early diagnosis is important to avoid complications and future renal damage. PMID:19829983

  18. Validation of screening examinations of the ureteral orifices in dogs: Comparison of ultrasonography with dissection.

    PubMed

    Balogh, O; Degrandi, F; Hässig, M; Reichler, I M

    2015-08-01

    In dogs, ultrasonography is performed to locate the ureteral orifices in the urinary bladder, but reference values for their normal location using this technique are missing. In this study, the ureterovesical-vesicourethral and inter-ureterovesical distances were determined in 20 freshly euthanized medium size dogs by detecting artificially produced ureteral jets in color-flow Doppler ultrasonography at two different bladder volumes, and comparing them to manual measurements in the dissected bladder. All distances determined by ultrasonography were in agreement with values found by dissection (P ≥ 0.100). With increasing bladder volume only the left ureterovesical-vesicourethral distance changed (P = 0.041). The right ureteral opening was more cranial than the left in 16 dogs. The inter-ureterovesical distances differed by gender (P = 0.016), but spay/neuter status had no influence (P ≥ 0.847). In conclusion, ultrasonography is a reliable modality for screening ureteral orifices in medium size dogs and agrees with anatomical findings. PMID:26027729

  19. Ballistics and the management of ureteral injuries from high velocity missiles.

    PubMed

    Stutzman, R E

    1977-12-01

    The management of 21 patients with 22 ureteral injuries from high velocity missiles is described and 6 cases are reported in detail. Ballistics should be considered in all wounds of violence. Débridement, internal stents, proximal diversion and thorough drainage are advocated. PMID:926271

  20. Ureteric obstruction secondary to retroperitoneal fibrosis leading to acute kidney injury

    PubMed Central

    Bjorndalen, Harald; Hastings, Robert A

    2013-01-01

    A 65-year-old man presenting with apparent acute coronary syndrome was found to have an acute kidney injury. A CT scan of the abdomen revealed bilateral hydronephrosis secondary to retroperitoneal fibrosis, and an unruptured infrarenal abdominal aortic aneurysm Medical management with corticosteroids relieved the ureteric obstruction and renal function started to normalise within 72 h. PMID:23389719

  1. The antenatally detected pelvi-ureteric junction stenosis: advances in renography and strategy of management.

    PubMed

    Ismaili, Khalid; Piepsz, Amy

    2013-04-01

    This review includes an analysis of new developments in the field of renography, the predictive factors suggesting the need for pyeloplasty in cases of pelvi-utereric stenosis detected antenatally and integration of the pelvi-ureteric junction stenosis within the framework of antenatally detected hydronephrosis. PMID:23525768

  2. Apparatus for disintegrating kidney stones

    NASA Technical Reports Server (NTRS)

    Angulo, E. D. (Inventor)

    1984-01-01

    The useful life of the wire probe in an ultrasonic kidney stone disintegration instrument is enhanced and prolonged by attaching the wire of the wire probe to the tip of an ultrasonic transducer by means of a clamping arrangement. Additionally, damping material is applied to the wire probe in the form of a damper tube through which the wire probe passes in the region adjacent the transducer tip. The damper tube extends outwardly from the transducer tip a predetermined distance, terminating in a resilient soft rubber joint. Also, the damper tube is supported intermediate its length by a support member. The damper system thus acts to inhibit lateral vibrations of the wire in the region of the transducer tip while providing little or no damping to the linear vibrations imparted to the wire by the transducer.

  3. Cosmogenic radionuclides in stone meteorites

    NASA Technical Reports Server (NTRS)

    Cressy, P. J., Jr.

    1976-01-01

    This document presents the techniques and compilation of results of cosmogenic Al-26 measurements at Goddard Space Flight Center on 91 samples of 76 stone meteorites. Short-lived radionuclides, including Na-22, Sc-46, Mn-54, and Co-60, were measured in 13 of these meteorites. About one-third of these data has not previously been published. The results are discussed briefly in terms of (1) depletion of Al-26 and natural potassium due to weathering, (2) possible exposure of several chondrites to an unusually high cosmic-ray flux, (3) comparison of Al-26, Na-22, Sc-46, and Mn5-54 in chondrites with the spallation Ne-22/Ne-21 ratio as a shielding indicator, and (4) comparison of (Al-26)-(Ne-22)/Ne-21 data for achondrite classes with the chondrite trend.

  4. Fluoroscopically guided laser lithotripsy versus extracorporeal shock wave lithotripsy for retained bile duct stones: a prospective randomised study.

    PubMed Central

    Jakobs, R; Adamek, H E; Maier, M; Krömer, M; Benz, C; Martin, W R; Riemann, J F

    1997-01-01

    BACKGROUND AND AIMS: To compare extracorporeal shock wave lithotripsy (ESWL) and laser induced shock wave lithotripsy (LISL) of retained bile duct stones to stone free rate, number of therapeutic sessions, and costs. PATIENTS: Thirty four patients were randomly assigned to either ESWL or LISL therapy. The main reasons for failure of standard endoscopy were due to stone impaction (n = 12), biliary stricture (n = 8), or large stone diameter (n = 14). METHODS: An extracorporeal piezoelectic lithotripter with ultrasonic guidance and a rhodamine 6G laser with an integrated stone tissue detection system were used. LISL was performed exclusively under radiological control. RESULTS: Using the initial methods complete stone fragmentation was achieved in nine of 17 patients (52.4%) of the ESWL group and in 14 of 17 patients (82.4%) in the LISL group, or combined with additional fragmentation techniques 31 of the 34 patients (91.2%) were stone free at the end of treatment. In comparison LISL tended to be more efficient in clearing the bile ducts (p = 0.07, NS). Significantly less fragmentation sessions (1.29 v 2.82; p = 0.0001) and less additional endoscopic sessions (0.65 v 1.6; p = 0.002) were necessary in the LISL group. There were no major complications in either procedure. CONCLUSIONS: Compared with ESWL, fluoroscopically guided LISL achieves stone disintegration more rapidly and with significantly less treatment sessions, which leads to a significant reduction in cost. PMID:9203950

  5. Characterization of Technetium Speciation in Cast Stone

    SciTech Connect

    Um, Wooyong; Jung, Hun Bok; Wang, Guohui; Westsik, Joseph H.; Peterson, Reid A.

    2013-11-11

    This report describes the results from laboratory tests performed at Pacific Northwest National Laboratory (PNNL) for the U.S. Department of Energy (DOE) EM-31 Support Program (EMSP) subtask, “Production and Long-Term Performance of Low Temperature Waste Forms” to provide additional information on technetium (Tc) speciation characterization in the Cast Stone waste form. To support the use of Cast Stone as an alternative to vitrification for solidifying low-activity waste (LAW) and as the current baseline waste form for secondary waste streams at the Hanford Site, additional understanding of Tc speciation in Cast Stone is needed to predict the long-term Tc leachability from Cast Stone and to meet the regulatory disposal-facility performance requirements for the Integrated Disposal Facility (IDF). Characterizations of the Tc speciation within the Cast Stone after leaching under various conditions provide insights into how the Tc is retained and released. The data generated by the laboratory tests described in this report provide both empirical and more scientific information to increase our understanding of Tc speciation in Cast Stone and its release mechanism under relevant leaching processes for the purpose of filling data gaps and to support the long-term risk and performance assessments of Cast Stone in the IDF at the Hanford Site.

  6. Type 2 diabetes mellitus and renal stones

    PubMed Central

    Nerli, Rajendra; Jali, Mallikarjuna; Guntaka, Ajay Kumar; Patne, Pravin; Patil, Shivagouda; Hiremath, Murigendra Basayya

    2015-01-01

    Background: The incidence of urinary stone disease has shown a steep rise in recent decades along with marked modifications in dietary habits and life- style. There has been an increased prevalence of urinary stone disease in patients with diabetes. We took up this study to determine the association of diabetes mellitus with kidney stones in patients undergoing surgical treatment. Materials and Methods: Patients presenting with renal stones for surgical management formed the study group. Body mass index (BMI) was calculated by noting the weight and height of the patient. The extracted stone/stone fragments were analyzed to determine the chemical composition. Urinary pH was similarly noted in all. Results: The mean BMI among the diabetics was 26.35 ± 5.20 (range 17.75-35.60), whereas the mean BMI among the non-diabetics was 23.41 ± 2.85 (range 17.71-31.62) (P < 0.0004). The incidence of uric acid calculi in the diabetics was significantly high (P < 0.03). The mean urinary pH among the diabetics was 5.61 ± 0.36 and among the non-diabetics was 6.87 ± 0.32, which was significantly lower (P < 0.000044). Conclusions: There is a strong association between type 2 diabetes and uric acid stone formation. There is also a strong association between diabetes mellitus, BMI, and also with lower urinary pH. PMID:26605219

  7. Factors governing urinary tract stone disease.

    PubMed

    Watts, R W

    1989-07-01

    Urinary stone formation depends on the degree of saturation of the urine with respect to potential stone-forming substances. Urine contains a range of electrolytes which ionise to different and variable degrees and which interact with one another in ways which influence their solubilities. These ionisations are themselves influenced by the pH of the urine which is another variable factor. Urinary organic molecules, which may or may not ionise and which may bear surface charges, also influence the solubility of the low molecular weight stone-constituents. Some other substances in the urine, such as glycosaminoglycans, can modify the ability of inorganic micro-crystals to aggregate and form stones. Environmental factors, other urinary tract pathology and genetic influences all predispose to urolithiasis, but many cases lack either an identifiable specific cause or the presence of recognisable risk factors. In the risk factor model of calcium stone formation there are pre-renal risk factors which lead to urinary risk factors and hence to the chemical risk factors of supersaturation and decreased ability to inhibit crystallisation. There are, in addition to these general factors which may act synergistically to produce urinary stones, several specific single enzyme defects which alter the urinary composition in such a way as to produce stones of a highly characteristic composition. PMID:2702116

  8. How Should Biliary Stones be Managed?

    PubMed Central

    2010-01-01

    Minimally invasive therapy is currently invaluable for the treatment of biliary stones. Clinicians should be familiar with the various endoscopic modalities that have been evolving. I reviewed the treatment of biliary stones from the common practice to pioneering procedures, and here I also briefly summarize the results of many related studies. Lithotripsy involves procedures that fragment large stones, and they can be roughly classified into two groups: intracorporeal modalities and extracorporeal shock-wave lithotripsy (ESWL). Intracorporeal modalities are further divided into mechanical lithotripsy (ML), electrohydraulic lithotripsy, and laser lithotripsy. ESWL can break stones by focusing high-pressure shock-wave energy at a designated target point. Balloon dilation after minimal endoscopic sphincterotomy (EST) is effective for retrieving large biliary stones without the use of ML. Peroral cholangioscopy provides direct visualization of the bile duct and permits diagnostic procedures or therapeutic interventions. Biliary stenting below an impacted stone is sometimes worth considering as an alternative treatment in elderly patients. This article focuses on specialized issues such as lithotripsy rather than simple EST with stone removal in order to provide important information on state-of-the-art procedures. PMID:20559517

  9. Ureteral Stent Insertion in the Management of Renal Colic during Pregnancy

    PubMed Central

    Choi, Chang Il; Yu, Young Dong

    2016-01-01

    To determine an optimal invasive intervention for renal colic patients during pregnancy after conservative treatments have been found to be unhelpful. Among the available invasive interventions, we investigated the reliability of a ureteral stent insertion, which is considered the least invasive intervention during pregnancy. Between June 2006 and February 2015, a total of 826 pregnant patients came to the emergency room or urology outpatient department, and 39 of these patients had renal colic. The mean patient age was 30.49 years. In this retrospective cohort study, the charts of the patients were reviewed to collect data that included age, symptoms, the lateralities and locations of urolithiasis, trimester, pain following treatment and pregnancy complications. Based on ultrasonography diagnoses, 13 patients had urolithiasis, and 13 patients had hydronephrosis without definite echogenicity of the ureteral calculi. Conservative treatments were successful in 25 patients. Among these treatments, antibiotics were used in 15 patients, and the remaining patients received only hydration and analgesics without antibiotics. Several urological interventions were required in 14 patients. The most common intervention was ureteral stent insertion, which was performed in 13 patients to treat hydronephrosis or urolithiasis. The patients' pain was relieved following these interventions. Only one patient received percutaneous nephrostomy due to pyonephrosis. No pregnancy complications were noted. Ureteral stent insertion is regarded as a reliable and stable first-line urological intervention for pregnant patients with renal colic following conservative treatments. Ureteral stent insertion has been found to be equally effective and safe as percutaneous nephrostomy, which is associated with complications that include bleeding and dislocation, and the inconvenience of using external drainage system. PMID:27231677

  10. Focused ultrasound guided relocation of kidney stones

    PubMed Central

    Abrol, Nitin; Kekre, Nitin S.

    2015-01-01

    Purpose: Complete removal of all fragments is the goal of any intervention for urinary stones. This is more important in lower pole stones where gravity and spatial orientation of lower pole infundibulum may hinder spontaneous passage of fragments. Various adjuvant therapies (inversion, diuresis, percussion, oral citrate, etc.) are described to enhance stone-free rate but are not widely accepted. Focused ultrasound-guided relocation of fragments is a recently described technique aimed at improving results of intervention for stone disease. Purpose of this review is to discuss development of this technology and its potential clinical applications. Materials and Methods: Pubmed search was made using key words “Focused ultrasound” and “kidney stone”. All English language articles were reviewed by title. Relevant studies describing development and application of focused ultrasound in renal stones were selected for review. Results: Focused ultrasound has proven its efficacy in successfully relocating up to 8 mm stone fragments in vitro and in pigs. Relocation is independent of stone composition. The latest model allows imaging and therapy with a single handheld probe facilitating its use by single operator. The acoustic energy delivered by the new prototype is even less than that used for extracorporeal shock wave lithotripsy. Therapeutic exposure has not caused thermal injury in pig kidneys. Conclusion: Focused ultrasound-guided relocation of stones is feasible. Though it is safe in application in pigs, technology is awaiting approval for clinical testing in human beings. This technology has many potential clinical applications in the management of stone disease. PMID:25624572

  11. Surgical Management of Stone Disease in Patient with Primary Hyperoxaluria

    PubMed Central

    Carrasco, Alonso; Granberg, Candace F.; Gettman, Matthew T.; Milliner, Dawn S.; Krambeck, Amy E.

    2015-01-01

    Objectives To present our experience with surgical management of nephrolithiasis in patients with primary hyperoxaluria (PH). Methods A retrospective chart review from 1994–2012 was perform to identify patients with diagnosis of PH. Results A total of 14 patients with PH were identified with median follow-up of 18.6 years (range: 0.9–51). Median age at initial symptom and subsequent diagnosis were 6.7 years (range: 1.1–35.5) and 0.42 years (range: 0–33.25), respectively. Patients underwent a total of 54 procedures at our institution including: ureteroscopy 27 (50%), percutaneous nephrolithotomy 15 (28%), shock wave lithotripsy 8 (15%), and combined procedures 4 (7%). Overall non-intraparenchymal stone free rate after first, second, and third procedure(s) were 59%, 76%, and 78%, respectively. On average 1.6 procedures (range: 1–4) were required to rid patients of symptomatic stones, which subsequently afforded them a mean of 3.62 years (range: 0.25–21.5) without the need of additional intervention. There were 6 Clavien grade ≥ III complications in 4 patients, including immediate postoperative ESRD in 3. Conclusions Despite optimal medical and surgical management, patients experience recurrent acute stone events requiring multiple urologic interventions. Significant complications such as ESRD can occur secondary to surgical intervention. PMID:25733260

  12. Absorption of impinging water droplet in porous stones.

    PubMed

    Lee, J B; Radu, A I; Vontobel, P; Derome, D; Carmeliet, J

    2016-06-01

    This paper presents an experimental investigation and numerical analysis of the absorption of water droplets impacting porous stones. The absorption process of an impinging droplet is here fully characterized from spreading to evaporation in terms of absorbed mass during droplet depletion and moisture content distribution in a time-resolved manner for three different natural stones. High-speed imaging and neutron radiography are used to quantify moisture absorption in porous stones of varying moisture properties from deposition until depletion. During impact and spreading, the droplet exhibits a dynamic non-wetting behavior. At maximum spreading, the droplet undergoes pinning, resulting into the contact radius remaining constant until droplet depletion. Absorption undergoes two phases: initially, absorption is hindered due a contact resistance attributed to entrapped air; afterwards, a more perfect capillary contact occurs and absorption goes on until depletion, concurrently with evaporation and further redistribution. A finite-element numerical model for isothermal unsaturated moisture transport in porous media captures the phases of mass absorption in good agreement with the experimental data. Droplet spreading and absorption are highly determined by the impact velocity of the droplet, while moisture content redistribution after depletion is much less dependent on impact conditions. PMID:26975034

  13. An in vitro ultrastructural study of infectious kidney stone genesis.

    PubMed

    McLean, R J; Nickel, J C; Noakes, V C; Costerton, J W

    1985-09-01

    A ureolytic strain of Proteus mirabilis, isolated from a patient with infectious kidney stones, produced struvite (MgNH4PO4 X 6 H2O) and apatite [Ca10(PO4)6CO3] crystals in vitro when grown in artificial urine. Surface-attached crystals were encased in a slime-like layer. Scanning electron microscopy revealed that surfaces submerged in the artificial urine were colonized by P. mirabilis. Bacteria-associated crystals appeared soon after colonization and eventually became coated with an amorphous substance. Energy-dispersive X-ray analysis of these crystals revealed the presence of Mg, Ca, and P which are major components of struvite and apatite. Transmission electron microscopy of surface scrapings revealed that the glycocalyx of P. mirabilis contained a large number of crystals. Based on these observations and previous work, a theory for infectious renal calculogenesis is proposed. The kidney is initially colonized by invading ureolytic pathogens. These pathogens secrete copious amounts of glycocalyx which facilitates adhesion of the organisms to the kidney, provides protection for these bacteria, and serves to bind struvite and apatite crystals that result from bacterial urease activity. Growth of these calcified microcolonies into mature stones is characterized by continued bacterial growth, incorporation of urinary mucoproteins into the matrix along with bacterial glycocalyx, and a continued deposition of struvite and apatite crystals due to the high pH. The mature stone, in effect, represents an enlarged "fossilized" bacterial microcolony. PMID:3897064

  14. Famous building stones of our Nation's capital

    USGS Publications Warehouse

    U.S. Geological Survey

    2012-01-01

    The buildings of our Nation's Capital are constructed with rocks from quarries located throughout the United States and many distant lands. The earliest Government buildings, however, were constructed with stones from nearby sources because it was too difficult and expensive to move heavy materials such as stone any great distance without the aid of modern transportation methods, including large cargo ships, trains, and trucks. This fact sheet describes the source and appearance of three frequently used local stones employed in building Washington, D.C., and the geologic environment in which they were formed.

  15. Pattern of ocular injuries in stone pelters in Kashmir valley☆

    PubMed Central

    Khan, Shabana; Maqbool, Akifa; Abdullah, Nowsheen; Keng, Manzoor Q.

    2012-01-01

    Purpose To describe the pattern and types of ocular injuries in stone pelters in Kashmir valley during recent turmoil. Design Cross sectional study. Methods Sixty patients with different types of eye injuries were assessed between June–September 2010 and initial visual acuity was recorded. The injuries were classified according to Systems for Classifying Ocular Injuries (OTCS) and Ocular Trauma Score (OTS) was calculated in order to estimate the probability of follow-up visual acuity range. Results Most of the victims (75%) were young boys between 16–26 years with a mean age of 20.95, 95% of cases were males. The main cause of injury was stones (48.3%) and pellets (30%) besides rubber bullets, sling shots and tear gas shells. Most of the open-globe injuries due to stones were of Type B and A, Grade E, Zone II and III with Afferent Pupillary Defect (APD) in 30% of the cases. Closed-globe injuries were mostly of Type A, Grade C and D and Zone II and III. Most of the open-globe injuries due to pellets were of Type D, Grade D, Zone II and APD in 33.3%. Pellets Intra Ocular Foreign Body (IOFB) was in 41.6%. Most of the closed-globe injuries were of Type A, Grade D and E and of Zone III. Overall OTS of 1 was calculated in 16.6% and 3 in 53.3% of the cases. Conclusion In stone pelting demonstrations eye injuries can result in visually significant trauma. Injuries due to pellets are mostly perforating and pellet IOFB, and both tend to have a very poor prognosis. OTS can be used to estimate visual prognosis. PMID:23961014

  16. INACCURATE REPORTING OF MINERAL COMPOSITION BY COMMERCIAL STONE ANALYSIS LABORATORIES: IMPLICATIONS FOR INFECTION AND METABOLIC STONES

    PubMed Central

    Krambeck, Amy E.; Khan, Naseem F.; Jackson, Molly E.; Lingeman, James E.; McAteer, James A; Williams, James C.

    2011-01-01

    INTRODUCTION The goal of this study was to determine the accuracy of stone composition analysis by commercial laboratories. METHODS 25 human renal stones with infrared spectroscopy (IR) determined compositions were fragmented into aliquots and studied with micro-computed tomography (CT) to ensure fragment similarity. Representative fragments of each stone were submitted to 5 commercial stone laboratories for blinded analysis. RESULTS All laboratories agreed on composition for 6 pure stones. Of 4 stones known to contain struvite, only 2(50%) were identified as struvite by all laboratories. Struvite was reported as a component by some laboratories for 4 stones previously determined not to contain struvite. Overall, there was disagreement regarding struvite in 6(24%) stones. For 9 calcium oxalate (CaOx) stones, all laboratories reported some mixture of CaOx, but the quantities of subtypes differed significantly among laboratories. In 6 apatite containing stones, apatite was missed by the laboratories in 20% of the samples. None of the laboratories identified atazanavir in a stone containing that antiviral drug. One laboratory reported protein in every sample, while all others reported it in only 1 sample. Nomenclature for apatite differed among laboratories, with one reporting apatite as carbonate apatite (CA) and never hydroxyapatite (HA), another never reporting CA and always reporting HA, and a third reporting CA as apatite with calcium carbonate. CONCLUSIONS Commercial laboratories reliably recognize pure calculi; however, variability in reporting of mixed calculi suggests a problem with accuracy of stone analysis results. Furthermore, there is a lack of standard nomenclature used by laboratories. PMID:20728108

  17. A Case of Recurrent Renal Aluminum Hydroxide Stone

    PubMed Central

    Cakıroglu, Basri; Dogan, Akif Nuri; Tas, Tuncay; Gozukucuk, Ramazan; Uyanik, Bekir Sami

    2014-01-01

    Renal stone disease is characterized by the differences depending on the age, gender, and the geographic location of the patients. Seventy-five percent of the renal stone components is the calcium (Ca). The most common type of the stones is the Ca oxalate stones, while Ca phosphate, uric acid, struvite, and sistine stones are more rarely reported. Other than these types, triamterene, adenosine, silica, indinavir, and ephedrine stones are also reported in the literature as case reports. However, to the best of our knowledge, aluminum hydroxide stones was not reported reported before. Herein we will report a 38-years-old woman with the history of recurrent renal colic disease whose renal stone was determined as aluminum hydroxide stone in type. Aluminum mineral may be considered in the formation of kidney stones as it is widely used in the field of healthcare and cosmetics. PMID:25013740

  18. Portugues Marbles as Stone Heritage

    NASA Astrophysics Data System (ADS)

    Lopes, Luis; Martins, Ruben

    2013-04-01

    The main objective of this paper is to present and justify the reasons for the worldwide recognition of Portuguese Marbles as Stone Heritage. These marbles are also known as "Estremoz Marble" since was the first county were exploited. In the Estremoz Anticline marbles occupy an intermediate stratigraphic position being part of a volcano-sedimentary sequence of Cambrian age. The anticlinal structure has a Precambrian core and the younger rocks aged Devonian Period. This sequence has deformed by the Variscan Orogeny, which performed twice with different intensities both in ductile and brittle tension fields. The early Alpine Cycle also acts in the region and cause more fracturing of the marble. Practically in all the quarries is possible to perceive the spatial-temporal continuity of the deformation where one can describe a complete Wilson Cycle. Together all these geological features imprint the marbles beautiful aesthetic patterns that can be highlighted when used as dimension stone. Nowadays most of the quarries are placed in the counties of Borba and mainly in Vila Viçosa. This last city claims for itself the "Capital of the Marble" title and named the marble as "White Gold". In fact, according to the historical record, the marbles were quarried in Portuguese Alentejo's Province since the fourth century BC. Locally these geological materials are available easily accessible. Exhibit physical properties that allow the fabrication of structural and decorative elements and so were used since humans settled in the region and developed a structured Society. In the Roman period, the pieces of art made with Estremoz Marbles were exported abroad and today are represented in Museums and Archaeological Sites throughout Europe and North Africa countries. The Portuguese Marbles and Limestones, transformed into altars, stairways, columns, statues and pieces of wall cladding, were carried as ballast in the holds of ships. At the destination the Portuguese People had built numerous churches which today can be found in Brazil but also along the South American and African coasts. Currently the global market of Modern Dimension Stones Industry allows Portuguese Marbles to be present in buildings, architectural pieces and works of arts all over the World. Despite almost continuous mining activity in the region it's notice that there was no depletion of raw material, in fact almost every varieties of marble have enough reserves to sustain the mining activity is several hundreds of years. The Alentejo whitewashed houses are a hallmark of the unique landscape that can only have been developed by the availability of marbles to produce quicklime. In cities and villages, the built heritage based on the marble is very rich and is always present, meanwhile the surrounding countryside is marked by intense mining activity living side by side with rural industries, namely wheatfields, groves, orchards and vineyards; therefore the region has unique characteristics allowing the development of integrated industrial tourism routes. The Portuguese Marbles are a key factor for local sustainable development and it's leading the region to new opportunities of industrial, scientific and technological culture, pointing to a successful future.

  19. The nutrition consult for recurrent stone formers.

    PubMed

    Penniston, Kristina L

    2015-07-01

    Diet is implicated in stone formation and growth. Whether alone or in concert with pharmacologics, dietary changes may be useful in reducing recurrence but only when they correct dietary stone-forming risks. Patients benefit from recommendations individualized to their food preferences as well as to lifestyle, age, food knowledge and access, preparation skills, and cultural and ethnic identities. Urologists can provide general dietary recommendations but often lack the time to provide the full complement of individualized nutrition care offered by a registered dietitian nutritionist (RDN). Urologists can partner with and refer patients to a RDN for any component of the nutrition care process: assessment of diet, diagnosis of dietary factors that contribute to stone risk factors, intervention formulation and implementation, and monitoring the effectiveness of the intervention and modifying it as needed to maintain suitably low dietary risk for stone recurrence. PMID:26025494

  20. [A case of ammonium urate urinary stone].

    PubMed

    Hara, Noboru; Koike, Hiroshi

    2004-05-01

    An 18-year-old female, who had undergone antireflux surgery for bilateral vesicoureteral reflux 5 years ago, was admitted to our department with complaints of fever and left-sided back pain. Bilateral renal stones and pyelonephritis were diagnosed after roentgenography, ultrasonography and urinalysis. Pyelonephritis was successfully treated with antibiotics and the left renal stone was completely disintegrated with extracorporeal shock wave lithotripsy. Spectrophotometric analysis revealed that the stone was composed of pure ammonium urate (AU). The patient had not experienced any episodes of urinary tract infection from the antireflux surgery until the present event, but had lost 20 kg in body weight during the last year due to a low-caloric diet and laxative abuse. AU urinary stones have been infrequently reported in Japan, and they are supposed to be associated with a low-caloric diet, laxative abuse, and anorexia nervosa. PMID:15237492

  1. Flexible Ureterorenoscopy versus Extracorporeal Shock Wave Lithotripsy for the treatment of upper/middle calyx kidney stones of 10-20 mm: a retrospective analysis of 174 patients.

    PubMed

    Cecen, Kursat; Karadag, Mert Ali; Demir, Aslan; Bagcioglu, Murat; Kocaaslan, Ramazan; Sofikerim, Mustafa

    2014-01-01

    To compare the outcomes of flexible ureterorenoscopy (F-URS) with extracorporeal shock wave lithotripsy (ESWL) for the treatment of upper or mid calyx kidney stones of 10 to 20 mm. A total of 174 patients with radioopaque solitary upper or mid calyx stones who underwent ESWL or F-URS with holmium:YAG laser were enrolled in this study. Each group treated with ESWL and F-URS for upper or mid calyx kidney stones were retrospectively compared in terms of retreatment and stone free rates, and complications. 87% (n = 94) of patients who underwent ESWL therapy was stone free at the end of 3rd month. This rate was 92% (n = 61) for patients of F-URS group (p = 0.270 p > 0.05). Retreatment was required in 12.9% of patients (n = 14) who underwent ESWL and these patients were referred to F-URS procedure after 3rd month radiologic investigations. The retreatment rate of cases who were operated with F-URS was 7.5% (n = 5) (p = 0.270 p > 0.05). Ureteral perforation (Clavien grade 3B) was occured in 3 patients (4.5%) who underwent F-URS. Fever (Clavien grade 1) was noted in 7 and 5 patients from ESWL and F-URS group, respectively (6.4% vs 7.5%) (p = 0.78 p > 0.05). F-URS and ESWL have similar outcomes for the treatment of upper or mid calyx renal stones of 10-20 mm. ESWL has the superiority of minimal invasiveness and avoiding of general anethesia. F-URS should be kept as the second teratment alternative for patients with upper or mid caliceal stones of 10-20 mm and reserved for cases with failure in ESWL. PMID:25332859

  2. Investigation on laser induced salivary stone fragmentation

    NASA Astrophysics Data System (ADS)

    Sroka, Ronald; Pongratz, Thomas; Eder, Matthias; Domes, Mona; Vogeser, Michael; Johnson, Thorsten; Siedeck, Vanessa; Schroetzlmair, Florian; Zengel, Pamela

    2014-03-01

    Objective: It was the objective of this in-vitro study to investigate photon-based techniques for identifying the composition and fragmentation of salivary stones using a Ho:YAG laser. Materials and Method: Salivary stones (n=47) extracted from patients with clinical symptoms of sialolithiasis were examined in-vitro. After extraction, the stones were kept in Ringers solution until size and volume measurements could be performed. Thereafter, dual-energy CT scans (DECT) were performed to classify the composition of the stones. Subsequently, fluorescence measurements were performed by taking images under blue light excitation as well as by fluorescence spectroscopy, measuring excitation-emission-matrixes (EEM). Further investigation to identify the exact composition of the stone was performed by Raman spectroscopy and FTIR spectroscopy of stone fragments and debris. Fragmentation was performed in an aquarium set-up equipped with a mesh (hole: 1.5mm) using a Ho:YAG-laser to deliver laser pulses of 0.5, 1.0 and 1.5J/pulse at a frequency of 3Hz through a 200?m-fibre to the stone surface. The collected data were analyzed and fragmentation rates were calculated. Finally, correlation between stone composition and fragmentation was performed. Results: Blue light fluorescence excitation resulted in either fluorescence in the green spectral region or in a combination of green and red fluorescence emission. EEM-measurement showed the corresponding spectra. Raman spectroscopy showed a mixture of carbonate apatite and keratin. DECT results in evidence of calcium containing components. FTIR-spectroscopy results showed that carbonate apatite is the main component. Fragmentation experiment showed a dependency on the energy per pulse applied if the evaluation implies the ratio of fragmented weight to pulse, while the ratio fragmented weight to energy remains about constant for the three laser parameter used. Conclusion: The composition of salivary stones could be determined using different photonic techniques. Attempts to correlate salivary stone composition to fragmentation rates resulted in no correlation. Thus it could be concluded that each salivary stone could be easily destroyed using Ho:YAG-laser light by means of a 200?m bare fibre at lowest energy per pulse.

  3. Stone Composition as a Function of Age and Sex

    PubMed Central

    Rule, Andrew D.; Krambeck, Amy E.; Williams, James C.; Bergstralh, Eric J.; Mehta, Ramila A.; Moyer, Thomas P.

    2014-01-01

    Background and objectives Kidney stones are heterogeneous but often grouped together. The potential effects of patient demographics and calendar month (season) on stone composition are not widely appreciated. Design, setting, participants, & measurements The first stone submitted by patients for analysis to the Mayo Clinic Metals Laboratory during 2010 was studied (n=43,545). Stones were classified in the following order: any struvite, any cystine, any uric acid, any brushite, majority (?50%) calcium oxalate, or majority (?50%) hydroxyapatite. Results Calcium oxalate (67%) was the most common followed by hydroxyapatite (16%), uric acid (8%), struvite (3%), brushite (0.9%), and cystine (0.35%). Men accounted for more stone submissions (58%) than women. However, women submitted more stones than men between the ages of 1019 (63%) and 2029 (62%) years. Women submitted the majority of hydroxyapatite (65%) and struvite (65%) stones, whereas men submitted the majority of calcium oxalate (64%) and uric acid (72%) stones (P<0.001). Although calcium oxalate stones were the most common type of stone overall, hydroxyapatite stones were the second most common before age 55 years, whereas uric acid stones were the second most common after age 55 years. More calcium oxalate and uric acid stones were submitted in the summer months (July and August; P<0.001), whereas the season did not influence other stone types. Conclusions It is well known that calcium oxalate stones are the most common stone type. However, age and sex have a marked influence on the type of stone formed. The higher number of stones submitted by women compared with men between the ages of 10 and 29 years old and the change in composition among the elderly favoring uric acid have not been widely appreciated. These data also suggest increases in stone risk during the summer, although this is restricted to calcium oxalate and uric acid stones. PMID:25278549

  4. Meridian Stones: for Form or for Function?

    NASA Astrophysics Data System (ADS)

    Amory, L.; Boyce, P.; diCurcio, R.; Strelnitski, V.

    2002-12-01

    The goal of this investigation was to reveal the original intent and purpose of the creator of the ``Nantucket Meridian Stones'' - self taught astronomer and surveyor William Mitchell (the father of the first American female astronomer, Maria Mitchell). Throughout time, these two enigmatic stone obelisks in downtown Nantucket have been cloaked in controversial legends. We did not find any mention of these stones in the original diaries and journals of William Mitchell, or in the town's public documents (except for the written decision of the 1840 town meeting to allot money for the stones' erection). However, amongst several controversial articles on the stones in the local newspaper published during the 20th century, we found one (dated 1921) which gives the most plausible explanation: the meridian line defined by the stones was used by the local surveyors to keep track of the variation in the magnetic declination, the angle between the directions to the magnetic North and the true (geographical) North. This hypothesis will be compared with the existing information on the purpose and use of other historical meridian markers, both in America and Europe. This project was supported by Vassar College and the Nantucket Maria Mitchell Association.

  5. Stone formation and management after bariatric surgery.

    PubMed

    Tarplin, Sarah; Ganesan, Vishnu; Monga, Manoj

    2015-05-01

    Obesity is a significant health concern and is associated with an increased risk of nephrolithiasis, particularly in women. The underlying pathophysiology of stone formation in obese patients is thought to be related to insulin resistance, dietary factors, and a lithogenic urinary profile. Uric acid stones and calcium oxalate stones are common in these patients. Use of surgical procedures for obesity (bariatric surgery) has risen over the past two decades. Although such procedures effectively manage obesity-dependent comorbidities, several large, controlled studies have revealed that modern bariatric surgeries increase the risk of nephrolithiasis by approximately twofold. In patients who have undergone bariatric surgery, fat malabsorption leads to hyperabsorption of oxalate, which is exacerbated by an increased permeability of the gut to oxalate. Patients who have undergone bariatric surgery show characteristic 24 h urine parameters including low urine volume, low urinary pH, hypocitraturia, hyperoxaluria and hyperuricosuria. Prevention of stones with dietary limitation of oxalate and sodium and a high intake of fluids is critical, and calcium supplementation with calcium citrate is typically required. Potassium citrate is valuable for treating the common metabolic derangements as it raises urinary pH, enhances the activity of stone inhibitors, reduces the supersaturation of calcium oxalate, and corrects hypokalaemia. Both pyridoxine and probiotics have been shown in small studies to reduce hyperoxaluria, but further study is necessary to clarify their effects on stone morbidity in the bariatric surgery population. PMID:25850790

  6. Kidney stones are common after bariatric surgery

    PubMed Central

    Lieske, John C.; Mehta, Ramila A.; Milliner, Dawn S.; Rule, Andrew D; Bergstralh, Eric J.; Sarr, Michael G.

    2014-01-01

    Obesity, a risk factor for kidney stones and chronic kidney disease (CKD), is effectively treated with bariatric surgery. However, it is unclear if surgery alters stone or CKD risk. To determine this we studied 762 Olmsted County, Minnesota residents who underwent bariatric surgery and matched them with equally obese control individuals who did not undergo surgery. The majority of bariatric patients underwent standard Roux-en-Y gastric bypass (RYGB) (78%), with the remainder having more malabsorptive procedures (very long limb RYGB or biliopancreatic diversion/duodenal switch; 14%), or restrictive procedures (laparoscopic banding or sleeve gastrectomy; 7%). Mean age was 45 years with 80% female. The mean preoperative BMI was 46.7 kg/m2 for both cohorts. Rates of kidney stones were similar between surgery patients and controls at baseline, but new stone formation significantly increased in surgery patients (11.0%) compared to controls (4.3%) during 6.0 years of follow up. After malabsorptive and standard surgery, the comorbidity-adjusted hazard ratio of incident stones was significantly increased to 4.15 and 2.13, respectively but not significantly changed for restrictive surgery. The risk of CKD significantly increased after the malabsorptive procedures (adjusted hazard ratio of 1.96). Thus, while RYGB and malabsorptive procedures are more effective for weight loss, both are associated with increased risk of stones, while malabsorptive procedures also increase CKD risk. PMID:25354237

  7. Famous Stone Patients and Their Disease

    NASA Astrophysics Data System (ADS)

    Moran, Michael E.

    2007-04-01

    The fact that stone patients have endured much throughout the ages and that prior to our current era, when the ultimate horror, "being cut for the stone" was the only alternative to the repeated episodes of colic, should be recalled from time to time. Urolithiasis has affected humanity throughout the ages and has been indiscriminate to those lives it touched. A full accounting of those who have suffered and recorded their agonies is beyond the scope of this investigation; however, even a partial accounting is valuable for present day physicians who care for those with stone disease. For the present work, the historical accounts of stone disease literature were scrutinized for individual sufferers who could be cross-referenced from other sources as legitimately afflicted by stones. Only those patients that could be documented and were (or are) well known were included, because the internet is now a verdant repository of thousands of "not so well knowns." Reliable historical data was found for a variety of persons from the pre-Christian era to the present, including those remembered as philosophers and scientists, physicians, clergy, leaders and rulers, entertainers, athletes and fictitious/Hollywood-type individuals. Verified accounts of famous stone formers were chosen for this paper, and are presented in chronological order. The list of urolithiasis sufferers presented here is undoubtedly incomplete, but it is not through lack of trying that they are missing. Most often, the suffering do so silently, and that is always allowed.

  8. Cox-2 gene overexpression in ureteral stump urothelial carcinoma following nephrectomy for renal cell carcinoma: a case report

    PubMed Central

    2012-01-01

    Introduction A primary ureteral stump tumor after a nephrectomy is rare; urothelial carcinoma of the ureteral stump after a nephrectomy for renal cell carcinoma is even rarer. A thorough review of the literature indicated that only seven cases have previously been reported. In this study, we report the first Taiwanese case of urothelial carcinoma of the ureteral stump after a nephrectomy. It is also the first female case in the literature. The relationship between inflammatory genes, medication history and ureteral stump carcinoma after a nephrectomy for renal cell carcinoma has not been reported. Case presentation A 72-year-old Asian Taiwanese women with chronic hepatitis C, liver cirrhosis and chronic kidney disease underwent a hand-assisted laparoscopic radical nephrectomy in 2001 due to renal cell carcinoma. Nine years later, she was diagnosed with ureteral stump urothelial carcinoma. Genetic and medication surveys were performed. Importantly, our patient had taken Chinese herbal drugs for more than 10 years and the inflammatory gene, Cox-2, was highly expressed in this patient. This is the first report to study the relationship between the Cox-2 gene and ureteral stump carcinoma after a nephrectomy for renal cell carcinoma. Conclusion Long-term multiple use of Chinese herbal drugs could be one of the important risk factors for developing urothelial cancer. Close functional coupling between Chinese herbal drugs, Cox-2 gene activation and urothelial cancer should be further investigated. PMID:22289336

  9. Vascular Calcification and Stone Disease: A New Look towards the Mechanism

    PubMed Central

    Yiu, Allen J.; Callaghan, Daniel; Sultana, Razia; Bandyopadhyay, Bidhan C.

    2015-01-01

    Calcium phosphate (CaP) crystals are formed in pathological calcification as well as during stone formation. Although there are several theories as to how these crystals can develop through the combined interactions of biochemical and biophysical factors, the exact mechanism of such mineralization is largely unknown. Based on the published scientific literature, we found that common factors can link the initial stages of stone formation and calcification in anatomically distal tissues and organs. For example, changes to the spatiotemporal conditions of the fluid flow in tubular structures may provide initial condition(s) for CaP crystal generation needed for stone formation. Additionally, recent evidence has provided a meaningful association between the active participation of proteins and transcription factors found in the bone forming (ossification) mechanism that are also involved in the early stages of kidney stone formation and arterial calcification. Our review will focus on three topics of discussion (physiological influences—calcium and phosphate concentration—and similarities to ossification, or bone formation) that may elucidate some commonality in the mechanisms of stone formation and calcification, and pave the way towards opening new avenues for further research. PMID:26185749

  10. Percutaneous nephrolithotomy for isolated calyceal stones: How important is the stone location?

    PubMed Central

    Özgör, Faruk; Küçüktopcu, Onur; Şimşek, Abdulmuttalip; Sarılar, Ömer; Binbay, Murat; Gürbüz, Gökhan

    2015-01-01

    Objective To evaluate the effect of percutaneous access site on the success and complication rates of isolated calyceal stones. Material and methods We retrospectively evaluated 2700 patients who underwent percutaneous nephrolithotomy (PNL) in our clinic between October 2002 and August 2014. We selected only the patients with isolated lower, middle or upper calyceal stones and we grouped the patients according to the location of their stones. Successful operation was defined as complete stone clearence or retention of stone fragments smaller than 4 mm which do not lead to infection, obstruction or pain requiring treatment. Intraoperative and postoperative complications were also recorded. Results Totally 360 patients underwent PNL for their isolated upper, middle and lower calyceal stones. Access sites for those patients were selected based on stone location. The stones were localized in the lower (n=304), middle (n=14), and upper (n=42) calices. There was no statistically significant difference between the groups with respect to operation and scopy times. Hemoglobin drop was seen more frequently in the upper calyceal access group, without any significant intergroup difference. Thoracic complications including hemothorax, pneumothorax and pleural effusion were more common in the upper calyceal access group (11.9%; p<0.001). Complete stone clerance was accomplished in 81.9%, 92.9% and 78.6% of the patients with lower, middle and upper calyceal stones respectively without any significant intergroup difference (p=0.537). Conclusion PNL is an effective and safe treatment modality for isolated calyceal kidney stones and upper calyceal access causes thoracic complications more than other access sites. PMID:26623144

  11. Introductory Overview of Stone Heritages in Japan

    NASA Astrophysics Data System (ADS)

    Kato, Hirokazu; Oikawa, Teruki; Fujita, Masayo; Yokoyama, Shunji

    2013-04-01

    As one contribution to 'Global Heritage Stone Resources' (GHSR), some stone heritages in Japan, which are nominated in the interim list, are briefly introduced. The geology of Japanese Islands where are the one of the most active areas in the history of the Earth, is very complicated. Therefore Japanese Islands consist of various kinds of minerals and rocks. Some of them were used to make stone implements and accessories. Japanese people also used to the best possible advantage to built tombstone, gate, pavement ,and the basement and wall of the large building such as temples, shrines, castles and modern buildings. 1. Stone Heritages of Pre-historical age: In the late Pleistocene and the early Holocene, ancient Japanese used obsidian cooled rapidly from rhyolitic magma.to make small implements and accessories. For example, Shirataki, Hokkaido (north island) is the largest place producing obsidian in Japan where Paleolithic people made arrowhead, knives and so on. Another example, Jade yielded in Itoigawa City, Japan Sea coast of central Japan, was made in the metamorphic rock about five hundred million years ago. Itoigawa area is only one place where jade is abundantly produced in Japan. Ancient people had been already collected and processed to ornaments although it is very hard and traded in wide area more than several thousand years ago. 2. Stone Heritages of Historical age: 2.1 Archaeological remains: In the Kofun (old mound) period (250 to 538 AD), stone burial chambers were used for old mounds to preserve against the putrefaction and to protect from the theft. For example, Ishibutai Kofun ("ishi" means "stone" and "butai" means "stage") in Nara old capital city, southwest Japan, is the largest known megalithic structure made of granite in Japan. 2.2 Stone walls of some typical castles Stones used is because of not only the rich reserves of rocks but also restriction of transportation. Osaka (second biggest city) castle, are composed of Cretaceous granite exceeding over 500,000 in number and the largest block is 108 ton in weight. Stoens of Hikone Castle came from Paleogene Koto Rhyolite. Edo (old Tokyo, biggest city, central Japan) castle ,Imperial Palace at present, Stones are late Quaternary andesite of Hakone Volcanic Products whose quarrying places are more than 100km far from Edo.They were transported by ships and manpower on land .

  12. Renal Stone Risk During Space Flight

    NASA Technical Reports Server (NTRS)

    Whitson, Peggy A.; Pietrzyk, Robert A.; Sams, Clarence F.; Pak, Charles Y. C.; Jones, Jeffrey A.

    1999-01-01

    Space flight produces a number of metabolic and physiological changes in the crewmembers exposed to microgravity. Following launch, body fluid volumes, electrolyte levels, and bone and muscle undergo changes as the human body adapts to the weightless environment. Changes in the urinary chemical composition may lead to the potentially serious consequences of renal stone formation. Previous data collected immediately after space flight indicate changes in the urine chemistry favoring an increased risk of calcium oxalate and uric acid stone formation (n = 323). During short term Shuttle space flights, the changes observed include increased urinary calcium and decreased urine volume, pH and citrate resulting in a greater risk for calcium oxalate and brushite stone formation (n = 6). Results from long duration Shuttle/Mir missions (n = 9) followed a similar trend and demonstrated decreased fluid intake and urine volume and increased urinary calcium resulting in a urinary environment saturated with the calcium stone-forming salts. The increased risk occurs rapidly upon exposure to microgravity, continues throughout the space flight and following landing. Dietary factors, especially fluid intake, or pharmacologic intervention can significantly influence the urinary chemical composition. Increasing fluid intake to produce a daily urine output of 2 liters/day may allow the excess salts in the urine to remain in solution, crystals formation will not occur and a renal stone will not develop. Results from long duration crewmembers (n = 2) who had urine volumes greater than 2.5 L/day minimized their risk of renal stone formation. Also, comparisons of stone-forming risk in short duration crewmembers clearly identified greater risk in those who produced less than 2 liters of urine/day. However, hydration and increased urine output does not correct the underlying calcium excretion due to bone loss and only treats the symptoms and not the cause of the increased urinary salts. Dietary modification and promising pharmacologic treatments may also be used to reduce the potential risk for renal stone formation. Potassium citrate is being used clinically to increase the urinary inhibitor levels to minimize the development of crystals and the growth of renal stones. Bisphosphonates are a class of drugs recently shown to help in patients with osteoporosis by inhibiting the loss of bones in elderly patients. This drug could potentially prevent the bone loss observed in astronauts and thereby minimize the increase in urinary calcium and reduce the risk for renal stone development. Results of NASA's renal stone risk assessment program clearly indicate that exposure to microgravity changes the urinary chemical environment such that there is an increased risk for supersaturation of stone-forming salts, including calcium oxalaie and brushite. These studies have indicated specific avenues for development of countermeasures for the increased renal stone risk observed during and following space flight. Increased hydration and implementation of pharmacologic countermeasures should largely mitigate the in-flight risk of renal stones.

  13. Kidney stone erosion by micro scale hydrodynamic cavitation and consequent kidney stone treatment.

    PubMed

    Perk, Osman Yavuz; Şeşen, Muhsincan; Gozuacik, Devrim; Koşar, Ali

    2012-09-01

    The objective of this study is to reveal the potential of micro scale hydrodynamic bubbly cavitation for the use of kidney stone treatment. Hydrodynamically generated cavitating bubbles were targeted to the surfaces of 18 kidney stone samples made of calcium oxalate, and their destructive effects were exploited in order to remove kidney stones in in vitro experiments. Phosphate buffered saline (PBS) solution was used as the working fluid under bubbly cavitating conditions in a 0.75 cm long micro probe of 147 μm inner diameter at 9790 kPa pressure. The surface of calcium oxalate type kidney stones were exposed to bubbly cavitation at room temperature for 5 to 30 min. The eroded kidney stones were visually analyzed with a high speed CCD camera and using SEM (scanning electron microscopy) techniques. The experiments showed that at a cavitation number of 0.017, hydrodynamic bubbly cavitation device could successfully erode stones with an erosion rate of 0.31 mg/min. It was also observed that the targeted application of the erosion with micro scale hydrodynamic cavitation may even cause the fracture of the kidney stones within a short time of 30 min. The proposed treatment method has proven to be an efficient instrument for destroying kidney stones. PMID:22476893

  14. Inferior vena cava filter penetration following Whipple surgical procedure causing ureteral injury

    PubMed Central

    Abdel-Aal, Ahmed Kamel; Ezzeldin, Islam B.; Moustafa, Amr Soliman; Ertel, Nathan; Oser, Rachel

    2015-01-01

    We report a case of an indwelling inferior vena cava filter that penetrated the IVC wall after Whipple’s pancreatico-duodenectomy procedure performed in a patient with ampullary carcinoma, resulting in right ureteral injury and obstruction with subsequent hydroureter and hydronephrosis. This was incidentally discovered on a computed tomography scan performed as routine follow up to evaluate the results of the surgery. We retrieved the inferior vena cava filter and placed a nephrostomy catheter to relieve the ureteral obstruction. Our case highlights the importance of careful inferior vena cava manipulation during abdominal surgery in the presence of an inferior vena cava filter, and the option of temporary removal of the filter to be placed again after surgery in order to avoid this complication, unless protection is required against clot migration during the surgical procedure. PMID:27200175

  15. Head-mounted display for a personal integrated image monitoring system: ureteral stent placement.

    PubMed

    Yoshida, Soichiro; Kihara, Kazunori; Takeshita, Hideki; Nakanishi, Yasukazu; Kijima, Toshiki; Ishioka, Junichiro; Matsuoka, Yoh; Numao, Noboru; Saito, Kazutaka; Fujii, Yasuhisa

    2015-01-01

    The personal head-mounted display (HMD) has emerged as a novel image monitoring system. We present here the application of a high-definition organic electroluminescent binocular HMD in ureteral stent placement. Our HMD system displayed multiple forms of information such as integrated, sharp, high-contrast images using a four-split screen or a picture-in-picture technique both seamlessly and synchronously. When both the operator and the assistant wore an HMD, they could continuously and simultaneously monitor the cystoscopic and fluoroscopic images in an ergonomically natural position. Furthermore, each participant was able to modulate the displayed images depending on the procedure. In all five cases, both the operator and the assistant successfully used this system with no unfavorable event. No participants experienced any HMD wear-related adverse effects. We therefore believe this HMD system might be potentially beneficial during ureteral stent placement procedures. Furthermore, it is compact, easily introduced and affordable. PMID:25139526

  16. Management of Ureteral Strictures in Renal Transplants by Antegrade Balloon Dilatation and Temporary Internal Stenting

    SciTech Connect

    Yong, Audrey Alice; Ball, Simon Thomas; Pelling, Marc X.; Gedroyc, Wladyslaw Michal Witold; Morgan, Robert Anthony

    1999-09-15

    Purpose: To evaluate the efficacy of percutaneous balloon dilatation and temporary internal stenting in the treatment of transplant ureteral strictures. Methods: Nine patients presenting with obstructed renal transplants were treated by antegrade nephrostomy insertion, ureteroplasty, and temporary internal stenting. Following stent removal, patients were divided into two groups for analysis according to whether the obstruction occurred less than (group A) or more than (group B) 3 months following transplantation. Results: All procedures were technically successful. In group A (n= 6), all patients were successfully treated by one or two dilatations with stenting. In group B (n= 3), two patients were successfully treated by one dilatation with stenting. Overall, eight patients (89%) have had their primary or secondary stent removed successfully at a mean interval of 97.5 days after insertion, and remain well at a mean follow-up interval of 22 months. Conclusion: Balloon dilatation and temporary internal stenting is a useful method for treating transplant ureteral strictures.

  17. Management of 1-2 cm renal stones

    PubMed Central

    Srivastava, Aneesh; Chipde, Saurabh S

    2013-01-01

    Introduction: The preferred treatment of >1cm stone is shockwave lithotripsy (SWL), while that of stone <2 cm is percutaneous nephrolithotomy (PCNL), but treatment of 1-2 cm renal stones is a controversial issue. We searched the literature to present a comprehensive review on this group. Material and Methods: Pubmed search of literature was done using the appropriate key words. We separately discussed the literature in lower polar and non lower polar stone groups. Results: For non lower polar renal stones of 1-2 cm, SWL is preferred approach, while for the lower polar stones; literature favors the use of PCNL. Retrograde intrarenal surgery (RIRS) is emerging as a promising technique for these calculi. Conclusions: Treatment of renal stone disease depends on stone and patient related, as well as on renal anatomical factors. Treatment should be individualized according to site of stone and available expertise. PMID:24082440

  18. Urinary stone composition in Oman: with high incidence of cystinuria.

    PubMed

    Al-Marhoon, Mohammed S; Bayoumi, Riad; Al-Farsi, Yahya; Al-Hinai, Abdullhakeem; Al-Maskary, Sultan; Venkiteswaran, Krishna; Al-Busaidi, Qassim; Mathew, Josephkunju; Rhman, Khalid; Sharif, Omar; Aquil, Shahid; Al-Hashmi, Intisar

    2015-06-01

    Urinary stones are a common problem in Oman and their composition is unknown. The aim of this study is to analyze the components of urinary stones of Omani patients and use the obtained data for future studies of etiology, treatment, and prevention. Urinary stones of 255 consecutive patients were collected at the Sultan Qaboos University Hospital. Stones were analyzed by Fourier transform infrared spectrophotometer. The biochemical, metabolic, and radiological data relating to the patients and stones were collected. The mean age was 41 years, with M:F ratio of 3.7:1. The common comorbidities associated with stone formation were hypertension; diabetes, benign prostate hyperplasia; urinary tract infection; obesity; and atrophic kidney. The common presentation was renal colic and flank pain (96%). Stones were surgically retrieved in 70% of patients. Mean stone size was 9 ± 0.5 mm (range 1.3-80). Stone formers had a BMI ≥ 25 in 56% (P = 0.006) and positive family history of stones in 3.8%. The most common stones in Oman were as follows: Calcium Oxalates 45% (114/255); Mixed calcium phosphates & calcium oxalates 22% (55/255); Uric Acid 16% (40/255); and Cystine 4% (10/255). The most common urinary stones in Oman are Calcium Oxalates. Overweight is an important risk factor associated with stone formation. The hereditary Cystine stones are three times more common in Oman than what is reported in the literature that needs further genetic studies. PMID:25805105

  19. [Use of pyelo-cystic anastomosis in ureteral obliteration after kidney transplantation].

    PubMed

    Perlin, D V; Darenkov, S P; Petrova, M V; Anashkin, V A; Okhobotov, D A; Aleksandrov, I V

    2003-01-01

    Reconstruction of the urinary tract because of ureteral stricture after kidney transplantation is a serious problem. In development of obliteration of the recipient's ureter near anastomosis and in the absence of own ureters reconstruction is made by pyelocystoanastomosis. A case is reported of a successful use of this method in reconstruction of the urinary tract. Preoperative preparation includes transcutaneous nephrostomy. Sometimes Boary flap is used. The arising reflux had insignificant effect on the transplant's function. PMID:12621966

  20. Bleeding ureter: endometriosis mascarading as a ureteral malignancy - a case report.

    PubMed

    Babu, S M L Prakash; Sandeep, Puvvada; Pathade, Amey; Nagaraj, H K

    2014-10-01

    Ureteral endometriosis is a serious localization of disease burden that can lead to urinary tract obstruction, with subsequent hydroureter, hydronephrosis, and potential kidney loss. As the diagnosis is elusive, a heavy clinical suspicion is necessary. Surgical technique to treatment varies, but the goal is to salvage renal function and decrease disease burden. Here, we are presenting a rare case of bleeding ureter in a young lady who had endometriosis of the ureter. PMID:25478397

  1. Bleeding Ureter: Endometriosis Mascarading as a Ureteral Malignancy - A Case Report

    PubMed Central

    Sandeep, Puvvada; Pathade, Amey; Nagaraj, H K

    2014-01-01

    Ureteral endometriosis is a serious localization of disease burden that can lead to urinary tract obstruction, with subsequent hydroureter, hydronephrosis, and potential kidney loss. As the diagnosis is elusive, a heavy clinical suspicion is necessary. Surgical technique to treatment varies, but the goal is to salvage renal function and decrease disease burden. Here, we are presenting a rare case of bleeding ureter in a young lady who had endometriosis of the ureter. PMID:25478397

  2. Ureteritis Cystica: Important Consideration in the Differential Diagnosis of Acute Renal Colic

    PubMed Central

    Padilla-Fernández, B.; Díaz-Alférez, FJ.; Herrero-Polo, M.; Martín-Izquierdo, M.; Silva-Abuín, JM.; Lorenzo-Gómez, MF.

    2012-01-01

    Ureteritis cystica is an uncommon cause of acute renal pain. The aetiology remains unclear and the diagnosis may be difficult to establish. We report the case of a 29 year old woman with a history of repeated urinary tract infections presenting with acute renal colic in the absence of lithiasis. We review the diagnostic tools available to make the diagnosis and the recent pertinent literature. PMID:22474406

  3. Bilateral ureteric obstruction: an unusual complication of male-to-female gender reassignment surgery

    PubMed Central

    Rezwan, Nivin; Basit, Anas Abdel; Andrews, Henry

    2014-01-01

    Gender reassignment surgery is a form of treatment for gender dysphoria. It can be male-to-female or female-to-male. We present a patient who underwent male to female reassignment and had a vaginal reconstruction. She presented almost a year later with acute kidney injury and bilateral ureteric obstruction, subsequently ending up with nephrectomy for a non-functioning kidney. PMID:24813202

  4. Bilateral ureteric obstruction: an unusual complication of male-to-female gender reassignment surgery.

    PubMed

    Rezwan, Nivin; Abdel Basit, Anas; Andrews, Henry

    2014-01-01

    Gender reassignment surgery is a form of treatment for gender dysphoria. It can be male-to-female or female-to-male. We present a patient who underwent male to female reassignment and had a vaginal reconstruction. She presented almost a year later with acute kidney injury and bilateral ureteric obstruction, subsequently ending up with nephrectomy for a non-functioning kidney. PMID:24813202

  5. Modified laparoscopic intravesical nonrefluxing ureteral reimplantation with psoas hitch using a submucosal tunneling.

    PubMed

    Kim, Chang-Hee; Ro, Joo Hwan; Jung, Han

    2014-12-01

    We aimed to study the safety and efficacy of the cystoscopy-assisted nonrefluxing ureteral reimplantation technique using submucosal tunneling during laparoscopic ureteroneocystostomy (UNC) with a psoas hitch in patients with distal ureter stricture after gynecologic surgery. We reviewed six female patients who underwent gynecological surgeries. All patients showed persistent postoperative distal ureter stricture or obstruction. These patients underwent laparoscopic nonrefluxing UNC with a psoas hitch using a submucosal tunneling technique combined with cystoscopy at our institute. They had corrective surgery at an average of 13.3 weeks after ureteral injury. The short-term success was confirmed either by voiding cystourethrography (VCU) or by diuretic isotope renal scan (MAG-3) conducted 3 months after the operation. None of the patients showed evidence of postoperative stricture at the reimplanted site and reflux on either MAG-3 renal scan or VCU. None of the patients showed major or minor complications during follow-up. It is safe and feasible to perform the laparoscopic nonrefluxing UNC with a psoas hitch using a submucosal tunneling technique combined with cystoscopy for ureteral stricture. PMID:25610823

  6. Directed differentiation of human pluripotent cells to ureteric bud kidney progenitor-like cells.

    PubMed

    Xia, Yun; Nivet, Emmanuel; Sancho-Martinez, Ignacio; Gallegos, Thomas; Suzuki, Keiichiro; Okamura, Daiji; Wu, Min-Zu; Dubova, Ilir; Esteban, Concepcion Rodriguez; Montserrat, Nuria; Campistol, Josep M; Izpisua Belmonte, Juan Carlos

    2013-12-01

    Diseases affecting the kidney constitute a major health issue worldwide. Their incidence and poor prognosis affirm the urgent need for the development of new therapeutic strategies. Recently, differentiation of pluripotent cells to somatic lineages has emerged as a promising approach for disease modelling and cell transplantation. Unfortunately, differentiation of pluripotent cells into renal lineages has demonstrated limited success. Here we report on the differentiation of human pluripotent cells into ureteric-bud-committed renal progenitor-like cells. The generated cells demonstrated rapid and specific expression of renal progenitor markers on 4-day exposure to defined media conditions. Further maturation into ureteric bud structures was accomplished on establishment of a three-dimensional culture system in which differentiated human cells assembled and integrated alongside murine cells for the formation of chimeric ureteric buds. Altogether, our results provide a new platform for the study of kidney diseases and lineage commitment, and open new avenues for the future application of regenerative strategies in the clinic. PMID:24240476

  7. Clinical observation of different minimally invasive surgeries for the treatment of impacted upper ureteral calculi

    PubMed Central

    Liu, Yuanhua; Zhou, Zhangyan; Xia, An; Dai, Haitao; Guo, Linjie; Zheng, Jiang

    2013-01-01

    Objective: To compare the clinical effects of three minimally invasive surgeries on the treatment of impacted upper ureteral calculi. Methods: 135 patients with impacted upper ureteral calculi were selected and randomly divided into three groups (Group A-C) (n=45), which were treated with transurethral ureteroscopic lithotripsy, minimally invasive percutaneous nephrolithotomy, and retroperitoneal laparoscopic ureterolithotomy respectively. Relevant results of the three groups were compared. Results: The surgery time of Group C was significantly longer than those of Group A and Group B (P < 0.05). The postoperative hospitalization time of Group B was significantly longer than those of Group A and Group C (P < 0.05). 37.78% (17/45) of Group A patients required extracorporeal shock wave lithotripsy, being significantly more than those in Group B (6.67%, 3/45) and Group C (0, 0/45) (P < 0.05). The postoperative calculus clearance rate of Group A (51.11%, 82.22%) was significantly lower than those of Group B (91.11%, 97.78%) and Group C (93.33%, 100%) (P < 0.05). The incidence rates of postoperative complications in Group A-C were 11.11% (5/45), 8.89% (4/45) and 6.67% (3/45) respectively without significant differences (P > 0.05). Conclusion: The three surgical methods for impacted upper ureteral calculi should be selected according to practical conditions to improve therapeutic effects and to ensure safe surgery. PMID:24550953

  8. Modulation of ureteric Ca signaling and contractility in humans and rats by uropathogenic E. coli.

    PubMed

    Floyd, Rachel V; Winstanley, Craig; Bakran, Ali; Wray, Susan; Burdyga, Theodor V

    2010-04-01

    Ascending urinary tract infections, a significant cause of kidney damage, are predominantly caused by uropathogenic Escherichia coli (UPEC). However, the role and mechanism of changes in ureteric function during infection are poorly understood. We therefore investigated the effects of UPEC on Ca signaling and contractions in rat (n = 17) and human (n = 6) ureters. Ca transients and force were measured and effects of UPEC on the urothelium were monitored in live tissues. In both species, luminal exposure of ureters to UPEC strains J96 and 536 caused significant time-dependent decreases in phasic and high K depolarization-induced contractility, associated with decreases in the amplitude and duration of the Ca transients. These changes were significant after 3-5 h and irreversible over the next 5 h. The infection causes increased activity of K channels, causing inhibition of voltage-gated Ca entry, and K channel blockers could reverse the effects of UPEC on ureteric function. A smaller direct effect on Ca entry also occurs. Nonpathogenic E. coli (TG2) or abluminal application of UPEC did not produce changes in Ca signaling or contractility. UPEC exposure also caused significant impairment of urothelial barrier function; luminal application of the Ca channel blocker nifedipine caused a reduction in contractions as it entered the tissue, an effect not observed in untreated ureters. Thus, UPEC impairs ureteric contractility in a Ca-dependent manner, largely caused by stimulation of potassium channels and this mechanism is dependent on host-urothelium interaction. PMID:20130119

  9. Treatment of Ureteroarterial Fistulae with Covered Vascular Endoprostheses and Ureteral Occlusion

    SciTech Connect

    Bilbao, Jose I. Cosin, Octavio; Bastarrika, Gorka; Rosell, David; Zudaire, Javier; Martinez-Cuesta, Antonio

    2005-04-15

    Background. Ureteroarterial fistulae (UAFs) are a rare entity, often difficult to identify, and associated with a high mortality rate. This fact has been attributed to a delay in diagnosis and treatment. Five conditions that can predispose to the development of this uncommon entity have been described: prior pelvic surgery, prolonged ureteral stenting, radiation therapy, previous vascular surgery and vascular pathology. Methods. We present 4 patients with UAFs and at least three of the above-mentioned conditions. Ureteral ischemia and subsequent necrosis promote the formation of these fistulae. The constant pulsation of the iliac artery is transmitted to an already compromised ureter containing a stiff intraluminal foreign body, resulting in pressure necrosis, most likely where the ureter crosses the iliac artery. Results and Conclusion. Cases were managed percutaneously with a combination of the deployment of a covered prosthesis and, when needed, with mechanical occlusion of the ureter. Hematuria stopped in all the patients with no evidence of immediate rebleeding. One patient presented a new episode of vaginal bleeding 13 months after endograft placement and ureteral embolization. Arteriography showed the presence of a hypogastric artery pseudoaneurysm that was occluded using coils. No new bleeding has occurred in this patient 12 months after the second embolization. At present all 4 patients are alive with follow-up periods of 5, 9, 11 and 25 months since the first procedure.

  10. A Tissue-Specific Scaffold for Tissue Engineering-Based Ureteral Reconstruction

    PubMed Central

    Xu, Yongde; Fu, Weijun; Wang, Zhongxin; Li, Gang; Zhang, Xu

    2015-01-01

    Terminally differentiated somatic cells can rapidly change phenotypes when they are isolated from their native tissue and cultured in vitro. This problem may become a barrier to tissue engineering-based organ reconstruction, which utilizes somatic cells. The present study was designed to validate the feasibility of maintaining the urothelial cell phenotype in a tissue-specific ureteral scaffold. The tissue-specific scaffold was fabricated by blending poly (L-lactic acid) (PLLA) and ureteral extracellular matrix (UECM) using electrostatic spinning technology. PLLA was used to enhance the mechanical properties, and UECM was used to mimic the natural components of the ureter. Primary urothelial cells (UCs), derived from ureteral mucosa, were seeded onto the tissue-specific scaffold to assess cell adhesion, proliferation and phenotypes at designated time points. The results showed that UCs in the tissue-specific scaffold exhibited better proliferation compared to cells in pure PLLA or a PLLA-small intestinal submucosa (PLLA-SIS) scaffold (p<0.05). At different time points, the expression of a UC-specific marker (UroplakinⅢ) in the tissue-specific scaffold was significantly higher than its expression in pure PLLA or a PLLA-SIS scaffold (p<0.05). Therefore, the tissue-specific scaffold appears to be an ideal substrate for promoting UC survival and phenotype maintenance. PMID:25775033

  11. Physical properties and compatibility with dental stones of current alginate impression materials.

    PubMed

    Murata, H; Kawamura, M; Hamada, T; Chimori, H; Nikawa, H

    2004-11-01

    This study examined physical properties and compatibility with dental stones of two types of alginate impression materials. Five powder-type alginate impression materials (Alginoplast EM, Aroma Fine, Algiace Z, Coe Alginate, Jeltrate Plus) and a paste-type alginate impression material (Tokuso AP-1) were used. The dynamic viscosity immediately after mixing was measured by means of a controlled-stress rheometer. The gelation times were determined according to Japanese Industrial Standards (JIS) T6505, and recovery from deformation, strain in compression and compressive strength were determined according to the International Organization for Standardization (ISO) specification 1563. Detail reproduction and surface roughness of type III dental stones (New Plastone, New Sunstone) and a type IV dental stone (Die Stone) were evaluated using a ruled test block as specified in the ISO specification 1563 and a profilometer, respectively. The alginate impression materials evaluated in this study were all in compliance with the ISO specification 1563 and JIS T6505. The alginate impression materials had similar mechanical properties after gelation, whilst a wide range of dynamic viscosity immediately after being mixed, gelation times and compatibility with dental stones were found among the materials. The paste-type material had a higher dynamic viscosity and a shorter gelation time than the powder-type materials. The best surface quality was obtained with the paste-type material/type III dental stone cast combinations. The materials should be selected in consideration of initial flow, setting characteristics and compatibility with dental stones. The results suggested that a paste-type material would better meet the requirements of an alginate impression material. PMID:15525391

  12. "Sydney sandstone": Heritage Stone from Australia

    NASA Astrophysics Data System (ADS)

    Cooper, Barry; Kramar, Sabina

    2014-05-01

    Sydney is Australia's oldest city being founded in 1788. The city was fortunate to be established on an extensive and a relatively undeformed layer of lithified quartz sandstone of Triassic age that has proved to be an ideal building stone. The stone has been long identified by geologists as the Hawkesbury Sandstone. On the other hand the term "Sydney sandstone" has also been widely used over a long period, even to the extent of being utilised as the title of published books, so its formal designation as a heritage stone will immediately formalise this term. The oldest international usage is believed to be its use in the construction of the Stone Store at Kerikeri, New Zealand (1832-1836). In the late 19th century, public buildings such as hospitals, court houses as well as the prominent Sydney Town Hall, Sydney General Post Office, Art Gallery of New South Wales, State Library of New South Wales as well as numerous schools, churches, office building buildings, University, hotels, houses, retaining walls were all constructed using Sydney sandstone. Innumerable sculptures utilising the gold-coloured stone also embellished the city ranging from decorative friezes and capitals on building to significant monuments. Also in the late 19th and early 20th century, Sydney sandstone was used for major construction in most other major Australian cities especially Melbourne, Adelaide and Brisbane to the extent that complaints were expressed that suitable local stone materials were being neglected. Quarrying of Sydney sandstone continues today. In 2000 it was recorded noted that there were 33 significant operating Sydney sandstone quarries including aggregate and dimension stone operations. In addition sandstone continues to be sourced today from construction sites across the city area. Today major dimension stone producers (eg Gosford Quarries) sell Sydney sandstone not only into the Sydney market but also on national and international markets as cladding and paving products as well as block. Recent international projects by Gosford Quarries include Mishima Golf Club in Japan, Al Awadi Tower in Kuwait, New World Resort in China and a Hard Rock Café in Florida, USA. Arguably Sydney sandstone is Australia's most prominent potential Global Heritage Stone Resource and details are readily available in existing publications to make the nomination.

  13. Medical and dietary therapy for kidney stone prevention.

    PubMed

    Gul, Zeynep; Monga, Manoj

    2014-12-01

    The prevalence of kidney stone disease is increasing, and newer research is finding that stones are associated with several serious morbidities. These facts suggest that emphasis needs to be placed not only on stone treatment but also stone prevention. However, there is a relative dearth of information on dietary and medical therapies to treat and avoid nephrolithiasis. In addition, studies have shown that there are many misconceptions among both the general community and physicians about how stones should be managed. This article is meant to serve as a review of the current literature on dietary and drug therapies for stone prevention. PMID:25512810

  14. Medical and Dietary Therapy for Kidney Stone Prevention

    PubMed Central

    Gul, Zeynep

    2014-01-01

    The prevalence of kidney stone disease is increasing, and newer research is finding that stones are associated with several serious morbidities. These facts suggest that emphasis needs to be placed not only on stone treatment but also stone prevention. However, there is a relative dearth of information on dietary and medical therapies to treat and avoid nephrolithiasis. In addition, studies have shown that there are many misconceptions among both the general community and physicians about how stones should be managed. This article is meant to serve as a review of the current literature on dietary and drug therapies for stone prevention. PMID:25512810

  15. Search for fullerenes in stone meteorites

    NASA Astrophysics Data System (ADS)

    Oester, M. Y.; Kuechl, D.; Sipiera, P. P.; Welch, C. J.

    1994-07-01

    The possibility of identifying fullerenes in stony meteorites became apparent from a paper given by Radicati de Brozolo. In this paper it was reported that fullerenes were present in the debris resulting from a collision between a micrometeoroid and an orbiting satellite. This fact generated sufficient curiosity to initiate a search for the presence of fullerenes in various stone meteorites. In the present study seven ordinary chondrites (al-Ghanim L6 (find), Dimmitt H4 (find), Lazbuddie LL5 (find), New Concord H5 (fall), Silverton H4 (find), Springlake L6 (find), and Umbarger L3/6 (find)). Four carbonaceous chondrites (ALH 83100 C2 (find), ALH 83108 C30 (find), Allende CV3 (fall), and Murchison CM2 (fall), and one achondrite (Monticello How (find)) were analyzed for the presence of fullerenes. The analytical procedure employed was as follows: 100 mg of meteorite was ground up with a mortar and pestle; 10 mL of toluene was then added and the mixture was refluxed for 90 min; this mixture was then filtered through a short column of silica; a 50 microliter sample was then analyzed by high pressure liquid chromatography (HPLC) using a Buckyclutcher I column with a mobile phase consisting of equal volumes of toluene and hexane at a flow rate of 1.00 mg per minute, with detection at 330 and 600 nm. Three of the meteorites, Allende, Murchison, and al-Ghanim, gave HPLC traces containing peaks with similar retention times to the HPLC trace of an authentic fullerene C60. However, further analysis using an HPLC instrument equipped with a diode-array detector failed to confirm any of the substances detected in the three meteorites as C60. Additional analyses will be conducted to identify what the HPLC traces actually represent.

  16. Mid-Infrared Study of Samples from Several Stones from the Sutter's Mill Meteorite

    NASA Technical Reports Server (NTRS)

    Sandford, Scott; Nuevo, Michel; Flynn, George J.; Wirick, Sue

    2013-01-01

    On April 22, 2012, a fireball was observed over California and Nevada, and the falling fragments of the meteorite were detected by weather radar near small townships in the El Dorado County, California. Some of these stones were collected at Sutter s Mill, in the historic site where the California gold rush was initiated, giving the name to this meteorite. Thus far, 77 pieces of the meteorite have been collected, for a total mass of 943 g, with the biggest stone weighing 205 g [1].

  17. Aggregation of Calcium Phosphate and Oxalate Phases in the Formation of Renal Stones

    PubMed Central

    2015-01-01

    The majority of human kidney stones are comprised of multiple calcium oxalate monohydrate (COM) crystals encasing a calcium phosphate nucleus. The physiochemical mechanism of nephrolithiasis has not been well determined on the molecular level; this is crucial to the control and prevention of renal stone formation. This work investigates the role of phosphate ions on the formation of calcium oxalate stones; recent work has identified amorphous calcium phosphate (ACP) as a rapidly forming initial precursor to the formation of calcium phosphate minerals in vivo. The effect of phosphate on the nucleation of COM has been investigated using the constant composition (CC) method in combination with scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Our findings indicate COM nucleation is strongly promoted by the presence of phosphate; this occurs at relatively low phosphate concentrations, undersaturated with respect to brushite (dicalcium phosphate dehydrate, DCPD) formation. The results show that ACP plays a crucial role in the nucleation of calcium oxalate stones by promoting the aggregation of amorphous calcium oxalate (ACO) precursors at early induction times. The coaggregations of ACP and ACO precursors induce the multiple-point nucleation of COM. These novel findings expand our knowledge of urinary stone development, providing potential targets for treating the condition at the molecular level. PMID:25598742

  18. Laparoscopic drainage of abdominal wall abscess from spilled stones post-cholecystectomy

    PubMed Central

    Chong, Vincent; Ram, Rishi

    2015-01-01

    We present a case on abdominal wall abscess from spilled stones post-cholecystectomy and describe laparoscopic drainage as our choice of management. Mr M is a 75-year-old male who presented on multiple occasions to the hospital with right upper quadrant pain and fever post-laparoscopic cholecystectomy. He also required multiple courses of antibiotics. Subsequent computed tomography and magnetic resonance imaging scan confirmed a number of retained stone with signs of chronic inflammation. Hence, 6 months after his initial laparoscopic cholecystectomy, he proceeded to an exploratory laparoscopy. We found an abscess cavity measuring 3 × 4 cm over the anterior abdominal wall. The cavity was de-roofed, drained and washed out. The tissue culture grew Klebsiella pneumoniae. Laparoscopic approach is optimal as the abscess cavity can be clearly identified, stones visualized and removed under direct vision. Patient does not require a laparotomy. PMID:26183574

  19. Laser ablation of gall bladder stones.

    PubMed

    Marafi, M; Makdisi, Y; Bhatia, K S; Abdulah, A H; Kokaj, Y; Mathew, K; Quinn, F; Qabazard, A

    1999-06-01

    Study of laser interaction with calculi is presented. A system of Nd-Yag and Ho-Yag pulsed lasers were used to produce fluorescence and plasma signals at the stone surface surrounded by saline and bile fluids. Fourth harmonic from Nd-Yag laser was transmitted to the samples by graded UV optical fibres. Gall bladder stones of various compositions were subjected to the high power Ho-Yag laser. Temporal transients and spectral evolution of plasma and fluorescence signals were monitored by a streak camera. A profile of acoustic pressures generated by shock waves was recorded with sensitive hydrophones placed in the surrounding fluids. Ablation threshold, cavitation process and fluorescence dependence on the laser parameters were studied in detail. Potential of stone identification by fluorescence and possible hydrodynamic model for ablation of biological samples is discussed. PMID:10384733

  20. Urinary Stone Disease: Progress, Status, and Needs.

    PubMed

    Kirkali, Ziya; Rasooly, Rebekah; Star, Robert A; Rodgers, Griffin P

    2015-10-01

    Urinary stone disease (USD) is an important healthcare problem in the US affecting both adults and children, and costs $10 billion to the nation. Prevalence of USD has nearly doubled during the last 15 years in parallel to the obesity and type 2 diabetes epidemic. Despite the advances in the management of an acute episode, one of three stone formers experience recurrence. A better understanding of stone formation is necessary to develop secondary prevention strategies. There are many unanswered research questions that require a multidisciplinary approach. National Institute of Diabetes and Digestive and Kidney Diseases recently held a workshop on USD, and is committed to continue conducting and supporting research in this field. PMID:26190090

  1. Terahertz lens made out of natural stone.

    PubMed

    Han, Daehoon; Lee, Kanghee; Lim, Jongseok; Hong, Sei Sun; Kim, Young Kie; Ahn, Jaewook

    2013-12-20

    Terahertz (THz) time-domain spectroscopy probes the optical properties of naturally occurring solid aggregates of minerals, or stones, in the THz frequency range. Refractive index and extinction coefficient measurement reveals that most natural stones, including mudstone, sandstone, granite, tuff, gneiss, diorite, slate, marble, and dolomite, are fairly transparent for THz frequency waves. Dolomite in particular exhibits a nearly uniform refractive index of 2.7 over the broad frequency range from 0.1 to 1 THz. The high index of refraction allows flexibility in lens designing with a shorter accessible focal length or a thinner lens with a given focal length. Good agreement between the experiment and calculation for the THz beam profile confirms that dolomite has high homogeneity as a lens material, suggesting the possibility of using natural stones for THz optical elements. PMID:24513932

  2. Technetium Getters to Improve Cast Stone Performance

    SciTech Connect

    Neeway, James J.; Lawter, Amanda R.; Serne, R. Jeffrey; Asmussen, Robert M.; Qafoku, Nikolla

    2015-10-15

    The cementitious material known as Cast Stone has been selected as the preferred waste form for solidification of aqueous secondary liquid effluents from the Hanford Tank Waste Treatment and Immobilization Plant (WTP) process condensates and low-activity waste (LAW) melter off-gas caustic scrubber effluents. Cast Stone is also being evaluated as a supplemental immobilization technology to provide the necessary LAW treatment capacity to complete the Hanford tank waste cleanup mission in a timely and cost effective manner. Two radionuclides of particular concern in these waste streams are technetium-99 (99Tc) and iodine-129 (129I). These radioactive tank waste components contribute the most to the environmental impacts associated with the cleanup of the Hanford site. A recent environmental assessment of Cast Stone performance, which assumes a diffusion controlled release of contaminants from the waste form, calculates groundwater in excess of the allowable maximum permissible concentrations for both contaminants. There is, therefore, a need and an opportunity to improve the retention of both 99Tc and 129I in Cast Stone. One method to improve the performance of Cast Stone is through the addition of “getters” that selectively sequester Tc and I, therefore reducing their diffusion out of Cast Stone. In this paper, we present results of Tc and I removal from solution with various getters with batch sorption experiments conducted in deionized water (DIW) and a highly caustic 7.8 M Na Ave LAW simulant. In general, the data show that the selected getters are effective in DIW but their performance is comprised when experiments are performed with the 7.8 M Na Ave LAW simulant. Reasons for the mitigated performance in the LAW simulant may be due to competition with Cr present in the 7.8 M Na Ave LAW simulant and to a pH effect.

  3. Management of Asymptomatic Renal Stones in Astronauts

    NASA Technical Reports Server (NTRS)

    Reyes, David; Locke, James

    2016-01-01

    Introduction: Management guidelines were created to screen and manage asymptomatic renal stones in U.S. astronauts. The risks for renal stone formation in astronauts due to bone loss and hypercalcuria are unknown. Astronauts have a stone risk which is about the same as commercial aviation pilots, which is about half that of the general population. However, proper management of this condition is still crucial to mitigate health and mission risks in the spaceflight environment. Methods: An extensive review of the literature and current aeromedical standards for the monitoring and management of renal stones was done. The NASA Flight Medicine Clinic's electronic medical record and Longitudinal Survey of Astronaut Health were also reviewed. Using this work, a screening and management algorithm was created that takes into consideration the unique operational environment of spaceflight. Results: Renal stone screening and management guidelines for astronauts were created based on accepted standards of care, with consideration to the environment of spaceflight. In the proposed algorithm, all astronauts will receive a yearly screening ultrasound for renal calcifications, or mineralized renal material (MRM). Any areas of MRM, 3 millimeters or larger, are considered a positive finding. Three millimeters approaches the detection limit of standard ultrasound, and several studies have shown that any stone that is 3 millimeters or less has an approximately 95 percent chance of spontaneous passage. For mission-assigned astronauts, any positive ultrasound study is followed by low-dose renal computed tomography (CT) scan, and flexible ureteroscopy if CT is positive. Other specific guidelines were also created. Discussion: The term "MRM" is used to account for small areas of calcification that may be outside the renal collecting system, and allows objectivity without otherwise constraining the diagnostic and treatment process for potentially very small calcifications of uncertain significance. However, a small asymptomatic MRM or stone within the renal collecting system may become symptomatic, and so affect launch and flight schedules, cause incapacitation during flight, and ultimately require medical evacuation. For exploration class missions, evacuation is unlikely. The new screening and management algorithm allows better management of mission risks, and will define the true incidence of renal stones in U.S. astronauts. This information will be used to refine future screening, countermeasures and treatment methods; and will also inform the needed capabilities to be flown on exploration-class missions.

  4. Building stones of our Nation's Capital

    USGS Publications Warehouse

    Withington, Charles F.

    1975-01-01

    The buildings of our Nation's Capital serve as an unusual geologic display, for the city has been constructed with rocks from quarries throughout the United States and many distant lands. Each building is a unique museum that not only displays the important features of various stones and the geologic environment in which they were formed, but also serves as an historic witness to the city's growth and to the development of its architecture. This booklet describes the source and appearance of the stones used in Washington, D.C.; it includes a map and a walking guide to assist the visitor in examining them.

  5. 2. VIEW OF STONE CABIN I FROM SOUTHEAST CORNER. CAMERA ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    2. VIEW OF STONE CABIN I FROM SOUTHEAST CORNER. CAMERA POINTED WEST. - Florida Mountain Mining Sites, Stone Cabin I, West slope Florida Mountain, Northeast Empire Mine below summit, Silver City, Owyhee County, ID

  6. 1. STONE CABIN II FROM ABOVE NORTHEAST CORNER. CAMERA POINTED ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. STONE CABIN II FROM ABOVE NORTHEAST CORNER. CAMERA POINTED WEST. - Florida Mountain Mining Sites, Stone Cabin II, West slope Florida Mountain, East of Empire State Mine below summit, Silver City, Owyhee County, ID

  7. 3. STONE CABIN II FROM ABOVE SOUTHEAST CORNER. CAMERA POINTED ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. STONE CABIN II FROM ABOVE SOUTHEAST CORNER. CAMERA POINTED NORTH. - Florida Mountain Mining Sites, Stone Cabin II, West slope Florida Mountain, East of Empire State Mine below summit, Silver City, Owyhee County, ID

  8. 3. VIEW OF STONE CABIN I. CAMERA POINTED EASTNORTHEAST. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. VIEW OF STONE CABIN I. CAMERA POINTED EAST-NORTHEAST. - Florida Mountain Mining Sites, Stone Cabin I, West slope Florida Mountain, Northeast Empire Mine below summit, Silver City, Owyhee County, ID

  9. 2. STONE CABIN II FROM MIDNORTHERN WALL. CAMERA POINTED SOUTH. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    2. STONE CABIN II FROM MID-NORTHERN WALL. CAMERA POINTED SOUTH. - Florida Mountain Mining Sites, Stone Cabin II, West slope Florida Mountain, East of Empire State Mine below summit, Silver City, Owyhee County, ID

  10. 4. CLOSEUP VIEW OF CHIMNEY STONE CABIN I. CAMERA POINTED ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. CLOSEUP VIEW OF CHIMNEY STONE CABIN I. CAMERA POINTED EAST-NORTHEAST. - Florida Mountain Mining Sites, Stone Cabin I, West slope Florida Mountain, Northeast Empire Mine below summit, Silver City, Owyhee County, ID

  11. 1. VIEW OF STONE CABIN I AND LANDSCAPE TO THE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. VIEW OF STONE CABIN I AND LANDSCAPE TO THE NORTH. CAMERA POINTED NORTH. - Florida Mountain Mining Sites, Stone Cabin I, West slope Florida Mountain, Northeast Empire Mine below summit, Silver City, Owyhee County, ID

  12. 22. August, 1970 STONE ALLEY, VIEW TO ORANGE STREET FROM ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    22. August, 1970 STONE ALLEY, VIEW TO ORANGE STREET FROM GARDNER HOUSES - Orange & Union Streets Neighborhood Study, 8-31 Orange Street, 9-21 Union Street & Stone Alley, Nantucket, Nantucket County, MA

  13. 24. August, 1970 STONE ALLEY, LOOKING TOWARD ORANGE STREET FROM ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    24. August, 1970 STONE ALLEY, LOOKING TOWARD ORANGE STREET FROM HALF-WAY POINT - Orange & Union Streets Neighborhood Study, 8-31 Orange Street, 9-21 Union Street & Stone Alley, Nantucket, Nantucket County, MA

  14. View east, stone sluice, beginning of lower standing section, showing ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View east, stone sluice, beginning of lower standing section, showing third drop, stone pier in center, cement piers to right - Glens Falls Feeder, Sluice, Along south side of Glens Falls Feeder between locks 10 & 20, Hudson Falls, Washington County, NY

  15. 54. View looking north on meal floor level showing stone ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    54. View looking north on meal floor level showing stone floor, mill stone vat and hurst frame. HAER PR, 6-MAGU, 1D-6 - Hacienda Buena Vista, PR Route 10 (Ponce to Arecibo), Magueyes, Ponce Municipio, PR

  16. 3. VIEW OF WEST HEADWALL AND CARVED STONE UNIT IDENTIFYING ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. VIEW OF WEST HEADWALL AND CARVED STONE UNIT IDENTIFYING THE BUILDER AND YEAR OF CONSTRUCTION, FACING NORTHEAST. - Cut Stone Bridge, Southern Pacific Railroad line spanning runoff channel at South Spruce Avenue, South San Francisco, San Mateo County, CA

  17. 8. FLOOR 1: TENTERING GEAR FOR SOUTH STONES, CENTRIFUGAL GOVERNOR ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    8. FLOOR 1: TENTERING GEAR FOR SOUTH STONES, CENTRIFUGAL GOVERNOR MOUNTED ON STONE SPINDLE, VERY SHORT STEELYARD - Windmill at Water Mill, Montauk Highway & Halsey Lane, Water Mill, Suffolk County, NY

  18. The ROKS Nomogram for Predicting a Second Symptomatic Stone Episode

    PubMed Central

    Lieske, John C.; Li, Xujian; Melton, L. Joseph; Krambeck, Amy E.; Bergstralh, Eric J.

    2014-01-01

    Most patients with first-time kidney stones undergo limited evaluations, and few receive preventive therapy. A prediction tool for the risk of a second kidney stone episode is needed to optimize treatment strategies. We identified adult first-time symptomatic stone formers residing in Olmsted County, Minnesota, from 1984 to 2003 and manually reviewed their linked comprehensive medical records through the Rochester Epidemiology Project. Clinical characteristics in the medical record before or up to 90 days after the first stone episode were evaluated as predictors for symptomatic recurrence. A nomogram was developed from a multivariable model based on these characteristics. There were 2239 first-time adult kidney stone formers with evidence of a passed, obstructing, or infected stone causing pain or gross hematuria. Symptomatic recurrence occurred in 707 of these stone formers through 2012 (recurrence rates at 2, 5, 10, and 15 years were 11%, 20%, 31%, and 39%, respectively). A parsimonious model had the following risk factors for recurrence: younger age, male sex, white race, family history of stones, prior asymptomatic stone on imaging, prior suspected stone episode, gross hematuria, nonobstructing (asymptomatic) stone on imaging, symptomatic renal pelvic or lower-pole stone on imaging, no ureterovesicular junction stone on imaging, and uric acid stone composition. Ten-year recurrence rates varied from 12% to 56% between the first and fifth quintiles of nomogram score. The Recurrence of Kidney Stone nomogram identifies kidney stone formers at greatest risk for a second symptomatic episode. Such individuals may benefit from medical intervention and be good candidates for prevention trials. PMID:25104803

  19. The ROKS nomogram for predicting a second symptomatic stone episode.

    PubMed

    Rule, Andrew D; Lieske, John C; Li, Xujian; Melton, L Joseph; Krambeck, Amy E; Bergstralh, Eric J

    2014-12-01

    Most patients with first-time kidney stones undergo limited evaluations, and few receive preventive therapy. A prediction tool for the risk of a second kidney stone episode is needed to optimize treatment strategies. We identified adult first-time symptomatic stone formers residing in Olmsted County, Minnesota, from 1984 to 2003 and manually reviewed their linked comprehensive medical records through the Rochester Epidemiology Project. Clinical characteristics in the medical record before or up to 90 days after the first stone episode were evaluated as predictors for symptomatic recurrence. A nomogram was developed from a multivariable model based on these characteristics. There were 2239 first-time adult kidney stone formers with evidence of a passed, obstructing, or infected stone causing pain or gross hematuria. Symptomatic recurrence occurred in 707 of these stone formers through 2012 (recurrence rates at 2, 5, 10, and 15 years were 11%, 20%, 31%, and 39%, respectively). A parsimonious model had the following risk factors for recurrence: younger age, male sex, white race, family history of stones, prior asymptomatic stone on imaging, prior suspected stone episode, gross hematuria, nonobstructing (asymptomatic) stone on imaging, symptomatic renal pelvic or lower-pole stone on imaging, no ureterovesicular junction stone on imaging, and uric acid stone composition. Ten-year recurrence rates varied from 12% to 56% between the first and fifth quintiles of nomogram score. The Recurrence of Kidney Stone nomogram identifies kidney stone formers at greatest risk for a second symptomatic episode. Such individuals may benefit from medical intervention and be good candidates for prevention trials. PMID:25104803

  20. Prediction of calcium oxalate monohydrate stone composition during ureteroscopy

    NASA Astrophysics Data System (ADS)

    Hamidizedah, Reza; Melnyk, Megan; Teichman, Joel M. H.

    2012-02-01

    Introduction: Prior research shows that Ho:YAG lithotripsy produces tiny dust fragments at low pulse energy (0.2J). However, calcium oxalate monohydrate (COM) stones may not fragment at this low pulse energy setting. Stone composition is rarely known until after surgery and historically, attempts to predict stone composition on the basis of endoscopic stone appearance were unsuccessful. Current endoscopic technology permits visual details that previously were not evident. As COM appears black under ambient light, we attempt to predict COM stone composition at the time of ureteroscopy based on its endoscopic appearance. Methods: Consecutive subjects undergoing ureteroscopy for stone disease were studied. Any portion of the stone that appeared black under endoscopic vision was considered clinical evidence of COM. Predicted stone composition was correlated with post-operative calculus analysis. Results: 46 consecutive ureteroscopic stone cases were analyzed prospectively. 25 of 28 subjects (89%) with black stones had stones later proven to be COM by composition analysis, versus one of 18 patients (6%) with non-black stones that were COM (p<0.0001). A black endoscopic stone appearance had a positive predictive value for COM of 89% and a non-black endoscopic stone appearance had a negative predictive value for COM of 94% (sensitivity 96%, specificity 83%). Conclusions: COM may reasonably be predicted intra-operatively by its black endoscopic appearance. The clinical utility would be to use higher laser pulse energy settings than for non-COM compositions. This data raises the possibility that more sophisticated optical characterization of endoscopic stone appearance may prove to be a useful tool to predict stone composition.

  1. A Radiographic Correlation between Renal and Pulp Stones

    PubMed Central

    Ertas, E Tarim; Inci, M; Demirtas, A; Ertas, H; Yengil, E; Sisman, Y; Gokce, C

    2014-01-01

    ABSTRACT Aim: The purpose of this study was to determine the correlation between pulp stones and renal stones. This study also aimed to report associations between the presence of pulp stone and gender, age, tooth type, dental arches and sides. Patients and Methods: Data were collected through examination of bitewing radiographs of 116 kidney stone patients and a similar number of age-matched controls, referred to the Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University. Two oral radiologists examined the radiographs to identify pulp stones. The Chi-squared and Mann Whitney U tests were used to investigate the correlations between the presence of pulp chamber calcification and age, gender, dental status and kidney stone. Results: Pulp chamber opacities were detected in 199 (19.3%) out of the 1031 examined teeth, and in 84 (72.4%) out of the 116 kidney stone patients. There was no statistically significant difference between the study and control group (p = 0.882). The occurrence of pulp stones was significantly higher in molars than premolars and similar prevalences were found between dental arches and sides. Conclusion: In this study, no correlation was found between the presence of pulp stones and kidney stones in the investigated group. Therefore, the presence of pulp stones does not seem to be correlated with that of kidney stones. PMID:25803378

  2. Stone Soup: The Teacher Leader's Contribution

    ERIC Educational Resources Information Center

    Bambrick-Santoyo, Paul

    2013-01-01

    In the tale of "Stone Soup," a stranger vows to make soup for everyone in a village using only a stone--and convinces everyone in town to throw an ingredient into the stewpot. Schools that need to improve teacher practice quickly can also make stone soup, the author says, by harnessing the power of well-prepared teacher leaders to

  3. 21 CFR 862.1780 - Urinary calculi (stones) test system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Urinary calculi (stones) test system. 862.1780... Systems § 862.1780 Urinary calculi (stones) test system. (a) Identification. A urinary calculi (stones) test system is a device intended for the analysis of urinary calculi. Analysis of urinary calculi...

  4. 21 CFR 862.1780 - Urinary calculi (stones) test system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Urinary calculi (stones) test system. 862.1780... Systems § 862.1780 Urinary calculi (stones) test system. (a) Identification. A urinary calculi (stones) test system is a device intended for the analysis of urinary calculi. Analysis of urinary calculi...

  5. 21 CFR 862.1780 - Urinary calculi (stones) test system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Urinary calculi (stones) test system. 862.1780... Systems § 862.1780 Urinary calculi (stones) test system. (a) Identification. A urinary calculi (stones) test system is a device intended for the analysis of urinary calculi. Analysis of urinary calculi...

  6. 21 CFR 862.1780 - Urinary calculi (stones) test system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Urinary calculi (stones) test system. 862.1780... Systems § 862.1780 Urinary calculi (stones) test system. (a) Identification. A urinary calculi (stones) test system is a device intended for the analysis of urinary calculi. Analysis of urinary calculi...

  7. 21 CFR 862.1780 - Urinary calculi (stones) test system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Urinary calculi (stones) test system. 862.1780... Systems § 862.1780 Urinary calculi (stones) test system. (a) Identification. A urinary calculi (stones) test system is a device intended for the analysis of urinary calculi. Analysis of urinary calculi...

  8. Detail, squared cut stone masonry center pier, from northwest, showing ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Detail, squared cut stone masonry center pier, from northwest, showing original cut stone masonry, concrete-encased nose on upstream end, portion of squared cut stone masonry south abutment, and portion of truss superstructure - Castle Garden Bridge, Township Route 343 over Bennetts Branch of Sinnemahoning Creek, Driftwood, Cameron County, PA

  9. 8. TENTERING GEAR OF EAST BURR STONES; CENTRIFUGAL GOVERNOR MOUNTED ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    8. TENTERING GEAR OF EAST BURR STONES; CENTRIFUGAL GOVERNOR MOUNTED ON STONE SPINDLE; ALSO SEEN IS THE CHUTE FROM THE TUN OF THE BURR STONES; HANGING IN THE BACKGROUND ARE THE MILL SAILS. - Hayground Windmill, Windmill Lane, East Hampton, Suffolk County, NY

  10. Minimally invasive percutaneous nephrolithotomy: an effective treatment for kidney stones in infants under 1year of age. A single-center experience.

    PubMed

    Da?glli, Mansur; Sancaktutar, Ahmet Ali; Dede, Onur; Utan?a, Mehmet Mazhar; Bodaki, Mehmet Nuri; Penbegl, Necmettin; Hatipo?lu, Nam?k Kemal; akmak?, Sleyman

    2015-11-01

    We aimed to present the outcomes of PNL surgery performed in infantile patients with small renal stones who were younger than 1 year of age. A single-center prospective trial was initiated and during the period between Jan 2013 and Jan 2015, PNL was applied to 20 renal units of 16 infants (6 girls and 10 boys), including 4 patients with bilateral kidney stones. PNL was performed in patients with renal stones larger than 2 cm, as well as stones resistant to SWL or renal stones that were undetectable during SWL. The mean age of the patients was 9.55 (5-12) months. Of the 20 renal units, 1 had complete staghorn stones, 3 had partial staghorn stones, 13 had renal pelvic stones, and 3 had lower pole stones. The mean stone size was 18.5 mm (range 12-36 mm). Mean operative time for PNL was 88 (25-135 min). Mean fluoroscopy time was estimated as 3.4 min. Mean hemoglobin loss was 0.72 g/L (0.2-3). The mean hospital stay was 4.1 days (2-8 days). On postoperative day 1, a complete stone-free state was achieved in 70% of renal units (14 of 20). At the end of the first postoperative week, the remaining two patients had insignificant residual fragments of 3 mm and were followed conservatively without any specific intervention. Thus, the total SFR was 80% (16 of 20) at discharge. In infants aged less than 1 year, minimal access tract dilation during PNL, the use of smaller caliber pediatric instruments, and the realization of this procedure by surgeons with adequate experience in adults carry utmost importance. In addition, special care should be taken to avoid hypothermia and radiation exposure during PNL. PMID:26002160

  11. Effect of the stone content on the quality of plum and cherry spirits produced from mash fermentations with commercial and laboratory yeast strains.

    PubMed

    Schehl, Beatus; Lachenmeier, Dirk; Senn, Thomas; Heinisch, Jürgen J

    2005-10-19

    To evaluate the influence of stone content on spirit quality from stone fruit, cherry and plum mashes were prepared and fermented with a commercial and a diploid laboratory yeast strain. Fermentation parameters such as sugar content and ethanol production were followed. Despite an initial lag phase in cherry spirits, both yeast strains performed similarly, as substantiated by the determination of specific flavor compounds, ethyl carbamate, and methanol in the mashes and after distillation. The spirits produced were subjected to sensory analyses by trained panels of at least 25 judges. Although mashes retaining the stones could be clearly distinguished from those where the stones had been removed, no significant preference could be attributed to either spirit, indicating that qualities added by the presence of stones during fermentation are largely a matter of personal taste. Interestingly, the yeast strain used for fermentation seemed to have little influence on the spirit quality. PMID:16218669

  12. Environmental management of the stone cutting industry.

    PubMed

    Nasserdine, Khaled; Mimi, Ziad; Bevan, Blair; Elian, Belal

    2009-01-01

    Environmental Management of the stone cutting industry in Hebron is required to reduce the industry's adverse impact on the downstream agricultural land and the adverse impact on the drinking water aquifers. This situation requires the implementation of an industrial wastewater management strategic approach and technology, within the available technical and financial resources. Ten pilot projects at different locations were built at Hebron to reduce or eliminate the incompatible discharge of the liquid and solid waste to the environment and improve the stone cutting industry's effluent quality. A review of existing practices and jar test experiments were used to optimize the water recycling and treatment facilities. The factors reviewed included influent pumping rates and cycles, selection of the optimal coagulant type and addition methods, control of the sludge recycling process, control over flow rates, control locations of influent and effluent, and sludge depth. Based on the optimized doses and Turbidity results, it was determined that the use of Fokland polymer with an optimal dose of 1.5mg/L could achieve the target turbidity levels. The completion of the pilot projects resulted in the elimination of stone cutting waste discharges and an improvement in the recycled effluent quality of 44-99%. This in turn reduced the long term operating costs for each participating firm. A full-scale project that includes all the stone cutting firms in Hebron industrial area is required. PMID:18248874

  13. Kidney Stones - Multiple Languages: MedlinePlus

    MedlinePlus

    ... List of All Topics All Kidney Stones - Multiple Languages To use the sharing features on this page, please enable JavaScript. Chinese - Simplified (简体中文) French (français) Hindi (हिन्दी) Japanese (日本語) Korean (한국어) ...

  14. [Reproduction of interocclusal relationship on stone casts].

    PubMed

    Arai, Y

    2000-12-01

    We fabricate a prosthesis by the indirect method. To fabricate a prosthesis functionally harmonized with the stomatognathic system, the interocclusal relationship must be reproduced on stone casts as accurately as possible. In this study, two subjects (one male, age 28; one female, age 31) were selected, and the occlusal contacts of complete arch stone casts made by three different impression methods were observed and compared with the true occlusal contacts in the intercuspal position in the mouth. To take the interocclusal records, we used a silicone bite checker. The following results were obtained. The occlusal contact points reproduced on the stone casts made by a conventional custom tray and a stock tray were rather low; that is, the number of occlusal contact points was less, and the size of the occlusal contact area was smaller, than in vivo. The states of the occlusal contact on the casts made by the same method differed from each other. On the bite-impression technique, the reproduction of occlusal contact was superior to that of the others. The shape, area, and number of contact regions under 60 micrometers were similar to contact regions under 30 micrometers in the mouth. There was no significant difference in reproduction between the custom tray and the stock tray. It is likely that the results were due to the distortion of the jaws and periodontal tissue during clenching at the intercuspal position, which could not be reproduced on the stone casts made by both the conventional custom and stock trays. PMID:11201196

  15. Deep 'Stone Soup' Trenching by Phoenix

    NASA Technical Reports Server (NTRS)

    2008-01-01

    Digging by NASA's Phoenix Mars Lander on Aug. 23, 2008, during the 88th sol (Martian day) since landing, reached a depth about three times greater than in any trench Phoenix has excavated. The deep trench, informally called 'Stone Soup' is at the borderline between two of the polygon-shaped hummocks that characterize the arctic plain where Phoenix landed.

    The lander's Surface Stereo Imager took this picture of Stone Soup trench on Sol 88 after the day's digging. The trench is about 25 centimeters (10 inches) wide and about 18 centimeters (7 inches) deep.

    When digging trenches near polygon centers, Phoenix has hit a layer of icy soil, as hard as concrete, about 5 centimeters or 2 inches beneath the ground surface. In the Stone Soup trench at a polygon margin, the digging has not yet hit an icy layer like that.

    Stone Soup is toward the left, or west, end of the robotic arm's work area on the north side of the lander.

    The Phoenix Mission is led by the University of Arizona, Tucson, on behalf of NASA. Project management of the mission is by NASA's Jet Propulsion Laboratory, Pasadena, Calif. Spacecraft development is by Lockheed Martin Space Systems, Denver.

  16. Barton Warren Stone: An American Religious Movement.

    ERIC Educational Resources Information Center

    Ulrey, Evan

    This biographical sketch of Barton Warren Stone, an early American advocate of the Restoration Movement, describes and interprets some of the innate and environmental factors that must have been to a large measure responsible for his leadership of what has been called the largest indigenous American religious movement. It details some of the…

  17. Profilometry of medieval Irish stone monuments

    NASA Astrophysics Data System (ADS)

    Daubos, Thierry; Redfern, Michael; O Croinin, Daibh

    2005-06-01

    National monuments are at ever-increasing risk of severe and permanent damage. The 3D laser scanning of stone monuments brings a new dimension in the field of cultural heritage by providing means of preserving, visualizing, accessing and analysing some of its most invaluable artefacts. In this article, we present the results obtained with our project "Profilometry of Medieval Irish Stone Monuments" hosted at the Centre for the Study of Human Settlement and Historical Change, NUI Galway. This project aims to create a virtual archive of selected incised stones from 3D scans taken in the field. The raw scans are processed into watertight 3D models and new processing techniques have been developed to enhance the surface features of the stones. Also, textured 3D models of the artefacts have been made available online for the benefit of both the historian community and the broader public. This article focuses on the analysis we performed on the shaft of the east cross at Toureen Peacaun, Co Tipperary, which shows the longest inscription in Ireland with geometrical capitals.

  18. Deep 'Stone Soup' Trenching by Phoenix (Stereo)

    NASA Technical Reports Server (NTRS)

    2008-01-01

    Digging by NASA's Phoenix Mars Lander on Aug. 23, 2008, during the 88th sol (Martian day) since landing, reached a depth about three times greater than in any trench Phoenix has excavated. The deep trench, informally called 'Stone Soup' is at the borderline between two of the polygon-shaped hummocks that characterize the arctic plain where Phoenix landed.

    Stone Soup is in the center foreground of this stereo view, which appears three dimensional when seen through red-blue glasses. The view combines left-eye and right-eye images taken by the lander's Surface Stereo Imager on Sol 88 after the day's digging. The trench is about 25 centimeters (10 inches) wide and about 18 centimeters (7 inches) deep.

    When digging trenches near polygon centers, Phoenix has hit a layer of icy soil, as hard as concrete, about 5 centimeters or 2 inches beneath the ground surface. In the Stone Soup trench at a polygon margin, the digging has not yet hit an icy layer like that.

    Stone Soup is toward the left, or west, end of the robotic arm's work area on the north side of the lander.

    The Phoenix Mission is led by the University of Arizona, Tucson, on behalf of NASA. Project management of the mission is by NASA's Jet Propulsion Laboratory, Pasadena, Calif. Spacecraft development is by Lockheed Martin Space Systems, Denver.

  19. Honors Education and Stone-Campbell Heritage

    ERIC Educational Resources Information Center

    Willerton, Chris

    2010-01-01

    In this article, the author explores the Stone-Campbell tradition, which produced the North American Disciples of Christ and Churches of Christ. In this tradition he finds the distinctive combination of three emphases to promote civic virtues in an honors context: (1) the individual pursuit of truth; (2) reliance on Scripture; and (3) the drive

  20. Drop impact on natural porous stones.

    PubMed

    Lee, J B; Derome, D; Carmeliet, J

    2016-05-01

    Drop impact and spreading on three natural porous stones are experimentally determined using high-speed imaging and compared with spreading over an impermeable steel surface. The dynamic non-wetting behavior during spreading and the hydrophobic contact angle >90° is attributed to the presence of an air layer between the droplet and the porous substrate. As the contact line pins at maximum spreading on the porous stone, the maximum spreading determines the liquid contact area on such substrate. The droplet gets pinned when the air layer is broken at the contact line and capillary forces develop in fines pores at the droplet edge, pinning the droplet. Maximum spreading on porous stones increases with impact velocity but does not scale with Weber number at low impact velocity. It is demonstrated that dynamic wetting plays an important role in the spreading at low velocity and that the dynamic wetting as characterized by the dynamic contact angle θD has to be taken into account for predicting the maximum spreading. Correcting the maximum spreading ratio with the dynamic wetting behavior, all data for porous stones and non-porous substrate collapse onto a single curve. PMID:26874980

  1. Transducer Joint for Kidney-Stone Ultrasonics

    NASA Technical Reports Server (NTRS)

    Angulo, E. D.

    1983-01-01

    Ultrasonic therapy for kidney stones improved by new way of connecting wire-probe ultrasonic waveguide to transducer. Improved mounting allows joint to last long enough for effective treatment. Sheath and rubber dampers constrain lateral vibration of wire waveguide. Combination of V-shaped mounting groove, sheath, and rubber dampers increases life expectancy of wire 15 times or more.

  2. Automated visual inspection for polished stone manufacture

    NASA Astrophysics Data System (ADS)

    Smith, Melvyn L.; Smith, Lyndon N.

    2003-05-01

    Increased globalisation of the ornamental stone market has lead to increased competition and more rigorous product quality requirements. As such, there are strong motivators to introduce new, more effective, inspection technologies that will help enable stone processors to reduce costs, improve quality and improve productivity. Natural stone surfaces may contain a mixture of complex two-dimensional (2D) patterns and three-dimensional (3D) features. The challenge in terms of automated inspection is to develop systems able to reliably identify 3D topographic defects, either naturally occurring or resulting from polishing, in the presence of concomitant complex 2D stochastic colour patterns. The resulting real-time analysis of the defects may be used in adaptive process control, in order to avoid the wasteful production of defective product. An innovative approach, using structured light and based upon an adaptation of the photometric stereo method, has been pioneered and developed at UWE to isolate and characterize mixed 2D and 3D surface features. The method is able to undertake tasks considered beyond the capabilities of existing surface inspection techniques. The approach has been successfully applied to real stone samples, and a selection of experimental results is presented.

  3. Kidney Stones: What You Need to Know

    MedlinePlus

    ... Kidney stones are caused by high levels of calcium, oxalate, and phosphorus in the urine. Some foods may ... consume of the following: • liquids • sodium • animal protein • calcium • oxalate Drinking enough liquids each day is the best ...

  4. Sarsen Stones of Stonehenge: How and by what route were the stones transported? What is the significance of their markings?

    PubMed

    Hill, P A

    1961-04-21

    A route via Lockeridge and the Avon Valley, involving a slide down the chalk escarpment, is postulated for the sarsen stones of Stonehenge. The transportation problem would have been greatly simplified if the stones had been relayed from point to point over snow or slush during successive winters. Markings on the stones hitherto undescribed are interpreted. PMID:17830710

  5. Risk Factors for Stone Recurrence after Percutaneous Nephrolithotomy

    NASA Astrophysics Data System (ADS)

    Krambeck, Amy E.; Rangel, Laureano J.; LeRoy, Andrew J.; Patterson, David E.; Gettman, Matthew T.

    2008-09-01

    Recent studies have demonstrated more than 30% of percutaneous nephrolithotomy (PCNL) patients will experience a stone recurrence over a 20 year period. The goal of our study was to identify risk factors for stone recurrence after PCNL. Chart review identified 754 patients treated with PCNL for urolithiasis from March of 1983 to July 1984 at our institution. Of this cohort, 87 patients continued to receive medical care at our clinic and had been evaluated within the last 5 years. Of the 87 patients, 80 had recent radiographic imaging. Average follow-up was 19.2 years and 32 (40.0%) experienced at least 1 stone recurrence. There was no difference in preoperative BMI (p = 0.453) or change in BMI (p = 0.964) between patients that did and did not have a stone recurrence. Renal stone location (p = 0.605) and stone size (p = 0.238) were not predictive of recurrence. Patients with calcium oxalate monohydrate stones were less likely to recur (38.7% vs. 41.6%, p = 0.004) and those with calcium oxalate dihydrate (COD) were more likely to recur (31.1% vs. 19.6%, p = 0.006) compared to other compositions. Diabetes mellitus was not associated with recurrent stones (p = 0.810). Those patients with residual stones or fragments <3 mm were more likely to recur and to recur earlier than patients rendered entirely stone free at time of PCNL (p = 0.015). Stone recurrences were associated with the late development of renal insufficiency (25% vs. 2.1%, p = 0.002). In conclusion, stone composition, as well as the presence of residual fragments was associated with recurrent symptomatic stone events after PCNL. Recurrent stone events were significantly associated with the risk of developing renal insufficiency, further stressing the need for complete stone clearance at time of PCNL.

  6. Percutaneous papillary large balloon dilation during percutaneous cholangioscopic lithotripsy for the treatment of large bile-duct stones: a feasibility study.

    PubMed

    Han, Jee Young; Jeong, Seok; Lee, Don Haeng

    2015-03-01

    When access to a major duodenal papilla or endoscopic retrograde cholangiopancreatography has failed, percutaneous transhepatic cholangioscopic lithotripsy (PTCS-L) may be useful for removing common bile duct (CBD) stones. However, the feasibility and usefulness of percutaneous transhepatic papillary large-balloon dilation (PPLBD) during PTCS-L for the removal of large CBD stones has not been established. We aimed to determine the safety and efficacy of PPLBD for the treatment of large CBD stones. Eleven patients with large CBD stones in whom the access to the major papilla or bile duct had failed were enrolled prospectively. Papillary dilation was performed using a large (12-20 mm) dilation balloon catheter via the percutaneous transhepatic route. Post-procedure adverse events and efficacy of the stone retrieval were measured. The initial success rate of PPLBD was 100%. No patient required a basket to remove a stone after PPLBD. Electrohydraulic lithotripsy was required in 2 (18.2%) patients. The median time to complete stone removal after PPLBD was 17.8 min and no adverse events occurred after PPLBD. Asymptomatic hyperamylasemia was not encountered in any patients. This study indicates that PPLBD is safe and effective for removal of large CBD stones. PMID:25729250

  7. Compatibility study and adaption of stone repair mortars for the Lede stone (Belgium)

    NASA Astrophysics Data System (ADS)

    De Kock, T.; Vandevoorde, D.; Boone, M. A.; Dewanckele, J.; De Boever, W.; Lanzón, M.; De Schutter, G.; Van Hoorebeke, L.; Jacobs, P.; Cnudde, V.

    2012-04-01

    One of the main historic building materials in northern Belgium is the Lede stone. This arenaceous limestone from Lutetian age was excavated in the region of Ghent and Brussels and was transported northwards by main rivers such as the Scheldt and Zenne. Thanks to this natural transport route, the stone in also found in many cities which lie abroad the excavation area, such as Antwerp (Belgium) and various cities in the Netherlands (Breda, Zierikzee, …). Due to its dominant occurrence in our cultural heritage, it is frequently subjected to restoration and renovation works. Depending on the degree of decay, most frequent stone operations are cleaning, healing with mortar or replacing it by (often exotic) fresh blocks. Originally, this limestone has a greenish-gray colour, but when being exposed to atmospheric conditions it acquires a yellowish to rusty coloured patina. The origin of the latter is most likely the oxidation of glauconite minerals which are present in a few percent in the stone. In addition, the stone often demonstrates black crust formation due to sulphation. Cleaning of the stone often results in an excess removal of this black gypsum crusts and patina, thus exposing deeper parts of the stone which appear more greenish-gray again. When the stone is subsequently healed by adding repair mortar to damaged parts, the question rises which mortar colour is more appropriate. The choice of repair mortar is greatly depending on commercial aspects. When handling entire facades on monuments, a mineral mortar based on ZnCl is most often applied in Belgium. The big advantage of this mortar is its fast curing. Three colour types have been developed for the Lede stone in specific. However, the hardness of this mortar is sometimes in conflict with reversibility. For the handling of individual sculptures some conservators choose for the application of (hydraulic) lime mortars. The advantage of using such mortars is their high compatibility and reversibility. The disadvantage, besides being more labour intensive than mineral mortars based on ZnCl, is that no specific recipes are yet developed for Lede stone and the result is thus dependent on the knowledge of the restorer. Both of the repair mortars have the problem that Lede stone changes its colour due to ageing while the mortar itself remains colour stable. This means that if the mortar colour was adapted for a resemblance at the moment of application, the colour difference between stone and mortar will increase in time. In this study, the compatibility of the different stone repair mortars with the Lede stone are tested. Further, a study was made whether the mortar recipes can be adapted for a better compatibility. In addition, the effect of glauconite addition in the mortar is studied to resolve the possibility of ageing of the mortar similar to the stone.

  8. Bile duct stone formation around a Prolene suture after cholangioenterostomy

    PubMed Central

    Li, Qiang; Tao, Liang; Wu, Xingyu; Mou, Lingjun; Sun, Xitai; Zhou, Jianxin

    2016-01-01

    The iatrogenic cause of bile duct stone formation is mainly due to suture materials, especially silk sutures. In recent years, Prolene and Vicryl sutures have been widely used in biliary surgery, and bile duct stone formation related to sutures are seemingly becoming rare, as there has only been one report of bile duct stone formation caused by Prolene sutures in the literature. In the last few years we have had two cases of Prolene suture-related bile duct stone formation within our unit. We therefore suggest that Vicryl sutures should be used as the first choice in biliary surgery, in order to prevent the formation of iatrogenic bile duct stones. PMID:27022388

  9. Ureteroscopy and stones: Current status and future expectations

    PubMed Central

    Wright, Anna E; Rukin, Nicholas J; Somani, Bhaskar K

    2014-01-01

    Urolithaisis is becoming an ever increasing urological, nephrological and primary care problem. With a lifetime prevalence approaching 10% and increasing morbidity due to stone disease, the role of ureteroscopy and stone removal is becoming more important. We discuss the current status of stone disease and review the ever increasing role that ureteroscopy has to play in its management. We discuss technological advances that have been made in stone management and give you an overview of when, how and why ureteroscopy is the most common treatment option for stone management. We touch on the role of robotic ureteroscopy and the future of ureteroscopy in the next 10 years. PMID:25374818

  10. Bile duct stone formation around a Prolene suture after cholangioenterostomy.

    PubMed

    Li, Qiang; Tao, Liang; Wu, Xingyu; Mou, Lingjun; Sun, Xitai; Zhou, Jianxin

    2016-01-01

    The iatrogenic cause of bile duct stone formation is mainly due to suture materials, especially silk sutures. In recent years, Prolene and Vicryl sutures have been widely used in biliary surgery, and bile duct stone formation related to sutures are seemingly becoming rare, as there has only been one report of bile duct stone formation caused by Prolene sutures in the literature. In the last few years we have had two cases of Prolene suture-related bile duct stone formation within our unit. We therefore suggest that Vicryl sutures should be used as the first choice in biliary surgery, in order to prevent the formation of iatrogenic bile duct stones. PMID:27022388

  11. Impact of Nutritional Factors on Incident Kidney Stone Formation: A Report From the WHI OS

    PubMed Central

    Sorensen, Mathew D.; Kahn, Arnold J.; Reiner, Alex P.; Tseng, Timothy Y.; Shikany, James M.; Wallace, Robert B.; Chi, Thomas; Wactawski-Wende, Jean; Jackson, Rebecca D.; O’Sullivan, Mary Jo; Sadetsky, Natalia; Stoller, Marshall L.

    2014-01-01

    Purpose Increased fluid intake, and decreased dietary sodium and animal protein intake are thought to reduce the risk of kidney stones but the role of calcium intake is controversial. We evaluated the relationship between dietary factors and incident kidney stone formation. Materials and Methods Secondary analysis was done of 78,293 women from the prospective WHI OS (Women’s Health Initiative Observational Study) with no history of nephrolithiasis who completed the validated food frequency questionnaire. Multivariate logistic regression was used to determine demographic and dietary factors, and supplement use independently associated with incident kidney stones. Results Overall 1,952 women (2.5%) reported an incident kidney stone in 573,575 person-years of followup. The risk of incident kidney stones was decreased by 5% to 28% (p = 0.01) with higher dietary calcium intake and by 13% to 31% (p = 0.002) with higher water intake after adjusting for nephrolithiasis risk factors. Conversely higher dietary sodium intake increased the risk of nephrolithiasis by 11% to 61% (p <0.001) after adjustment with the most pronounced effect in women with the highest intake. Higher body mass index independently increased the risk of incident nephrolithiasis (adjusted OR 1.19–2.01, p <0.001). Animal protein intake was not associated with nephrolithiasis on multivariate analysis. Conclusions This study adds to the growing evidence underscoring the importance of maintaining adequate fluid and dietary calcium intake. Greater dietary calcium intake significantly decreased the risk of incident kidney stones. In contrast, excess sodium intake increased the risk of incident nephrolithiasis, especially in women with the highest intake. Animal protein intake was not independently associated with nephrolithiasis. PMID:22425103

  12. Aliskiren restores renal AQP2 expression during unilateral ureteral obstruction by inhibiting the inflammasome.

    PubMed

    Wang, Weidong; Luo, Renfei; Lin, Yu; Wang, Feifei; Zheng, Peili; Levi, Moshe; Yang, Tianxin; Li, Chunling

    2015-04-15

    Ureteral obstruction is associated with reduced expression of renal aquaporins (AQPs), urinary concentrating defects, and an enhanced inflammatory response, in which the renin-angiotensin system (RAS) may play an important role. We evaluated whether RAS blockade by a direct renin inhibitor, aliskiren, would prevent the decreased renal protein expression of AQPs in a unilateral ureteral obstruction (UUO) model and what potential mechanisms may be involved. UUO was performed for 3 days (3UUO) and 7 days (7UUO) in C57BL/6 mice with or without aliskiren injection. In 3UUO and 7UUO mice, aliskiren abolished the reduction of AQP2 protein expression but not AQP1, AQP3, and AQP4. mRNA levels of renal AQP2 and vasopressin type 2 receptor were decreased in obstructed kidneys of 7UUO mice, which were prevented by aliskiren treatment. Aliskiren treatment was also associated with a reduced inflammatory response in obstructed kidneys of UUO mice. Aliskiren significantly decreased mRNA levels of several proinflammatory factors, such as transforming growth factor-β and tumor necrosis factor-α, seen in obstructed kidneys of UUO mice. Interestingly, mRNA and protein levels of the NOD-like receptor family, pyrin domain-containing 3 (NLRP3) inflammasome components apoptosis-associated speck-like protein containing a caspase recruitment domain, caspase-1, and IL-1β were dramatically increased in obstructed kidneys of 7UUO mice, which were significantly suppressed by aliskiren. In primary cultured inner medullary collecting duct cells, IL-1β significantly decreased AQP2 expression. In conclusions, RAS blockade with the direct renin inhibitor aliskiren increased water channel AQP2 expression in obstructed kidneys of UUO mice, at least partially by preventing NLRP3 inflammasome activation in association with ureteral obstruction. PMID:25694485

  13. Robotic-assisted partial nephrectomy without using ureteral stent: a single center experience

    PubMed Central

    Özkan, Burak; Coşkuner, Enis Rauf; Yalçın, Veli

    2016-01-01

    Objective To share our results of robotic assisted partial nephrectomy (RAPN) we performed without using ureteral stent in a single center from Turkey. Material and methods Medical records of consecutive 45 patients (34 men and 11 women) who underwent RAPN for kidney lesions between March 2011 and December 2014 were retrieved, and evaluated. All the procedures were performed by a transperitoneal approach without using ureteral stent prior to surgery. Renal artery clamping was used in all cases and intraoperative ultrasonography was used in 2 cases. Results Patients undergoing RAPN had a mean tumor size of 4.42 cm (2–8) and a mean renal nephrometry score of 5.82 (4–11). The mean estimated blood loss was 250 mL (150–450 ml) and the mean operative time was 195 minutes (150–300). There was no statistical difference between the preoperative and postoperative serum creatinine levels at the first follow-up visit (0.9 vs. 0.95, p=0.087). Surgical margin positivity was not detected in any patient, and the mean surgical margin distance was calculated as 0.4 mm (0.2–10). In only 1 patient disease recurrence was detected at the 21st month of the the follow-up period, and no distant metastases was reported in our patients at a mean follow-up of 10 months (3–36 mos). Our complication rate was 11.1% and according to the Clavien system complications were as; grade 2 (3 patients), grade 3a (1 patient) and grade 3b (1 patient). Conclusion With appropriately selected patients and adequate surgical experience, RAPN performed without using ureteral stent is a safe and feasible method for localized renal tumors. PMID:27011873

  14. Laparoscopic reconstruction of ureteral strictures involving solitary renal units-1 year and 5 year outcomes

    PubMed Central

    Abraham, George P.; Das, Krishanu; Siddiaiah, Avinash T.; Ramaswami, Krishnamohan; George, P. Datson; Abraham, Jisha J.

    2015-01-01

    CONTEXT: Long-term outcome following a laparoscopic reconstruction of ureteral strictures (US) involving solitary renal units (SRU) are scarcely reported. AIMS: The aim was to report short-term (1 year) and long-term (5 years) outcomes following a laparoscopic reconstruction of US in a solitary kidney. SETTINGS AND DESIGN: Retrospective. MATERIALS AND METHODS: Records of patients operated for similar scenarios between January 2004 and January 2014 were evaluated. Clinical, biochemical and radiological profile were noted. Operative and post-operative profile were recorded. Follow-ups were scheduled at regular intervals (3 months post-procedure, 6 monthly for 2 years and yearly thereafter. Imaging was repeated at yearly intervals). Outcome was assessed by comparing pre-operative and post-operative clinical, biochemical, and radiological parameters. STATISTICAL ANALYSIS USED: SAS software 9.2 version. A P < 0.05 was inferred as statistically significant. RESULTS: Seven patients underwent a laparoscopic reconstruction. Stricture location was upper ureter (n = 1), mid ureter (n = 2), lower ureter (n = 4). Surgeries performed were ureteroureterostomy, Boari flap ureteroneocystostomy and ureteroneocystostomy with psoas hitch. Four patients reported prior contralateral nephrectomy. Three patients underwent prior endoscopic correction. Four patients presented with elevated serum creatinine (>1.4 mg/dl). Till last follow-up, improvement in symptomatology and improvement or stabilisation of serum creatinine was perceived in all. Ureteral patency with resolution of hydronephrosis was observed in five patients at 1 year follow-up. Two patients revealed ureteral patency with persistence of hydronephrosis. Clinical, biochemical and radiological outcomes were maintained till long-term follow-up. CONCLUSION: Laparoscopic reconstruction of US in SRU offers impressive short- and long-term outcome. PMID:26622112

  15. Immediate and late management of iatrogenic ureteric injuries: 28 years of experience

    PubMed Central

    El Abd, Ahmed S.; El-Abd, Shawky A.; El-Enen, Mohamed Abo; Tawfik, Ahmed M.; Soliman, Mohamed G.; Abo-Farha, Mohamed; Gamasy, Abd-El Naser El; El-Sharaby, Mahmoud; El-Gamal, Samir

    2015-01-01

    Objective To evaluate the long-term results after managing intraoperative and late-diagnosed cases of iatrogenic ureteric injury (IUI), treated endoscopically or by open surgery. Patients and methods Patients immediately diagnosed with IUI were managed under the same anaesthetic, while those referred late had a radiological assessment of the site of injury, and endoscopic management. Open surgical procedures were used only for the failed cases with previous diversion. Results In all, 98 patients who were followed had IUI after gynaecological, abdominopelvic and ureteroscopic procedures in 60.2%, 14.3% and 25.5%, respectively. The 27 patients diagnosed during surgery were managed immediately, while in the late-referred 71 patients ureteroscopic ureteric realignment with stenting was successful in 26 (36.6%). Complex open reconstruction with re-implantation or ureteric substitution, using bladder-tube or intestinal-loop procedures, was used in 27 (60%), 16 (35.5%) and two (4.5%) patients of the late group, respectively. A long-term radiological follow-up with a mean (range) of 46.6 (24.5–144) months showed recurrent obstruction in 16 (16.3%) patients managed endoscopically and reflux in six (8.3%) patients. Three renal units only (3%) were lost in the late-presenting patients. Conclusion Patients managed immediately had better long-term results. More than a third of the late-diagnosed patients were successfully managed endoscopically with minimal morbidity. Open reconstruction by an experienced urologist who can perform a complex substitutional procedure was mandatory to preserve renal units in the long-term. PMID:26609443

  16. Double-J Versus External Ureteral Stents in Kidney Transplantation: A Retrospective Analysis

    PubMed Central

    Vogel, Thomas; Utech, Markus; Schmidt, Fabian; Holscher Keplin, Wiebke; Diller, Ricarda; Brockmann, Jens; Wolters, Heiner

    2015-01-01

    Background: Kidney transplantation has long been recognized as the best available therapy for end stage kidney disease. Objectives: This study aimed to compare outcomes of double-J versus percutaneous ureteral stent placement in renal transplantation. Patients and Methods: A retrospective analysis was performed on data of renal transplantations performed at our institution in a 12-month period. In this period, external and double-J stents were used in parallel. Length of hospital stay and stent-associated complications were evaluated. Results: In 76 kidney transplants, 43 external (group 1) and 33 double-J (group 2) urinary stents were used. No significant difference was observed in the number of urinary tract infections, ureteric stenosis or necrosis. The mean overall length of hospital stay was comparable in both groups (20.7 days in group 1 vs 19.3 days in group 2, P = 0.533). For patients without immunological complications, the hospital stay was significantly reduced using double-J stents (12.9 days in group 1, 10.8 days in group 2, P = 0.018). Leakage of the ureteroneocystostomy occurred in 6 out of 43 patients in group 1 (13.9%). No case of anastomotic insufficiency was observed in group 2 (P = 0.035). Macrohematuria was detected in 13 out of the 43 patients in group 1 (30.2%), compared to 3 out of 33 patients in group 2 (9.1%; P = 0.045). Conclusions: This nonrandomized comparison of stent types in kidney transplantation supports the use of prophylactic double-J stents in terms of decreased ureteric complications and reduced length of hospital stay. PMID:26539415

  17. Ureteral Stents and Foley Catheters-Associated Urinary Tract Infections: The Role of Coatings and Materials in Infection Prevention

    PubMed Central

    Lo, Joey; Lange, Dirk; Chew, Ben H.

    2014-01-01

    Urinary tract infections affect many patients, especially those who are admitted to hospital and receive a bladder catheter for drainage. Catheter associated urinary tract infections are some of the most common hospital infections and cost the health care system billions of dollars. Early removal is one of the mainstays of prevention as 100% of catheters become colonized. Patients with ureteral stents are also affected by infection and antibiotic therapy alone may not be the answer. We will review the current evidence on how to prevent infections of urinary biomaterials by using different coatings, new materials, and drug eluting technologies to decrease infection rates of ureteral stents and catheters. PMID:27025736

  18. Minimal invasive treatment of benign anastomotic uretero-ileal stricture in Hautmann neobladder with thermoexpandable ureteral metal stent

    PubMed Central

    Efthimiou, Ioannis P.; Porfyris, Orestis T.; Kalomoiris, Paraskevas I.

    2015-01-01

    Technical challenges and increased morbidity of open reconstruction for uretero-ileal strictures have led to a search for minimal invasive treatments as an alternative solution. The insertion of a thermo-expandable ureteral Memokath 051® metal stent across benign uretero-ileal anastomotic stricture in orthotopic neobladder has not been described in the English literature. Herein, we describe a case of a woman with a Hautmann neobladder and a 3.5 cm benign stricture of the right uretero-ileal anastomosis that was treated with insertion of a thermo-expandable ureteral Memokath 051® metal stent. PMID:25878417

  19. Minimal invasive treatment of benign anastomotic uretero-ileal stricture in Hautmann neobladder with thermoexpandable ureteral metal stent.

    PubMed

    Efthimiou, Ioannis P; Porfyris, Orestis T; Kalomoiris, Paraskevas I

    2015-01-01

    Technical challenges and increased morbidity of open reconstruction for uretero-ileal strictures have led to a search for minimal invasive treatments as an alternative solution. The insertion of a thermo-expandable ureteral Memokath 051(®) metal stent across benign uretero-ileal anastomotic stricture in orthotopic neobladder has not been described in the English literature. Herein, we describe a case of a woman with a Hautmann neobladder and a 3.5 cm benign stricture of the right uretero-ileal anastomosis that was treated with insertion of a thermo-expandable ureteral Memokath 051(®) metal stent. PMID:25878417

  20. A mathematical simulation of the ureter: effects of the model parameters on ureteral pressure/flow relations.

    PubMed

    Vahidi, Bahman; Fatouraee, Nasser; Imanparast, Ali; Moghadam, Abbas Nasiraei

    2011-03-01

    Ureteral peristaltic mechanism facilitates urine transport from the kidney to the bladder. Numerical analysis of the peristaltic flow in the ureter aims to further our understanding of the reflux phenomenon and other ureteral abnormalities. Fluid-structure interaction (FSI) plays an important role in accuracy of this approach and the arbitrary Lagrangian-Eulerian (ALE) formulation is a strong method to analyze the coupled fluid-structure interaction between the compliant wall and the surrounding fluid. This formulation, however, was not used in previous studies of peristalsis in living organisms. In the present investigation, a numerical simulation is introduced and solved through ALE formulation to perform the ureteral flow and stress analysis. The incompressible Navier-Stokes equations are used as the governing equations for the fluid, and a linear elastic model is utilized for the compliant wall. The wall stimulation is modeled by nonlinear contact analysis using a rigid contact surface since an appropriate model for simulation of ureteral peristalsis needs to contain cell-to-cell wall stimulation. In contrast to previous studies, the wall displacements are not predetermined in the presented model of this finite-length compliant tube, neither the peristalsis needs to be periodic. Moreover, the temporal changes of ureteral wall intraluminal shear stress during peristalsis are included in our study. Iterative computing of two-way coupling is used to solve the governing equations. Two phases of nonperistaltic and peristaltic transport of urine in the ureter are discussed. Results are obtained following an analysis of the effects of the ureteral wall compliance, the pressure difference between the ureteral inlet and outlet, the maximum height of the contraction wave, the contraction wave velocity, and the number of contraction waves on the ureteral outlet flow. The results indicate that the proximal part of the ureter is prone to a higher shear stress during peristalsis compared with its middle and distal parts. It is also shown that the peristalsis is more efficient as the maximum height of the contraction wave increases. Finally, it is concluded that improper function of ureteropelvic junction results in the passage of part of urine back flow even in the case of slow start-up of the peristaltic contraction wave. PMID:21303180

  1. Asymptomatic ureteral rupture secondary to chronic urinary retention from massive prostatic enlargement

    PubMed Central

    Sarmah, Piyush B.; Noah, Anthony; Kelly, Brian D.; Ryan, Peter G.

    2015-01-01

    Non-traumatic ureteral rupture has been reported more frequently, resulting from increased intraluminal pressures from distal urinary tract obstruction. We report the case of a 77-year-old man presenting with chronic urinary retention secondary to massive prostatic enlargement through acute kidney injury. Ultrasound scan detected a shallow left perinephric fluid collection with a possible bladder mass, demonstrated on flexible cystoscopy to be a massive median lobe of prostate. Computed tomography confirmed extravasation of urine from the left proximal ureter. In the absence of specific symptoms, the patient had successful conservative management with antibiotics and urinary catheterization for his acute episode, although declined further surgical intervention. PMID:26521159

  2. Environmental factors of urinary stones mineralogy, Khouzestan Province, Iran

    NASA Astrophysics Data System (ADS)

    Zarasvandi, Alireza; Carranza, E. J. M.; Heidari, Majid; Mousapour, Esmaeil

    2014-09-01

    Urinary stone diseases in the Khouzestan province (southwest Iran) are growing in number and it required extensive studies on various factors of the urinary stones formation in this province. In this research, in addition to distribution of urinary stones in different areas of province, the role of bioenvironmental (race), climate (temperature) and geology (water hardness) factors in urinary stones diversity has been studied. Mineralogical studied using X-ray diffraction showed that uricite and whewellite are the most frequency mineral phases. Struvite, Cystine, hydroxyapatite, weddellite, and Niahite can be observed as urinary stones, too. These data show that the urinary stone in the Khouzestan province can divide into 7 groups: calcium oxalate, phosphate, calcium oxalate/ phosphate, Urate, Urate/calcium, Urate/calcium oxalate/phosphate, Cystine/calcium oxalate. Also the results which attained from temperature effect investigation on the mineralogy of urinary stones, confirms that from Mediterranean sub-humid climates (northeastern area) to warm and dry climates (south and southwest area), calcium oxalate stones and urate stones concentration decreases and increases respectively. Comparison of data related to the drinking water hardness and mineralogy of urinary stones in different areas of Khouzestan province show that the combination of drinking water (especially water hardness) affects mineralogy of urinary stones in some areas (such az Ramhormoz and Hendijan). Finally, the data suggest that frequency of calcium oxalate in women is more than that of men. Moreover, there is direct relationship between the age (>45 years) and the increase in frequency of Urate minerals.

  3. Kidney Stones in Primary Hyperoxaluria: New Lessons Learnt

    PubMed Central

    Jacob, Dorrit E.; Grohe, Bernd; Gener, Michaela; Beck, Bodo B.; Hoppe, Bernd

    2013-01-01

    To investigate potential differences in stone composition with regard to the type of Primary Hyperoxaluria (PH), and in relation to the patients medical therapy (treatment nave patients versus those on preventive medication) we examined twelve kidney stones from ten PH I and six stones from four PH III patients. Unfortunately, no PH II stones were available for analysis. The study on this set of stones indicates a more diverse composition of PH stones than previously reported and a potential dynamic response of morphology and composition of calculi to treatment with crystallization inhibitors (citrate, magnesium) in PH I. Stones formed by PH I patients under treatment are more compact and consist predominantly of calcium-oxalate monohydrate (COM, whewellite), while calcium-oxalate dihydrate (COD, weddellite) is only rarely present. In contrast, the single stone available from a treatment nave PH I patient as well as stones from PH III patients prior to and under treatment with alkali citrate contained a wide size range of aggregated COD crystals. No significant effects of the treatment were noted in PH III stones. In disagreement with findings from previous studies, stones from patients with primary hyperoxaluria did not exclusively consist of COM. Progressive replacement of COD by small COM crystals could be caused by prolonged stone growth and residence times in the urinary tract, eventually resulting in complete replacement of calcium-oxalate dihydrate by the monohydrate form. The noted difference to the nave PH I stone may reflect a reduced growth rate in response to treatment. This pilot study highlights the importance of detailed stone diagnostics and could be of therapeutic relevance in calcium-oxalates urolithiasis, provided that the effects of treatment can be reproduced in subsequent larger studies. PMID:23940605

  4. Stone toolmaking and the evolution of human culture and cognition

    PubMed Central

    Stout, Dietrich

    2011-01-01

    Although many species display behavioural traditions, human culture is unique in the complexity of its technological, symbolic and social contents. Is this extraordinary complexity a product of cognitive evolution, cultural evolution or some interaction of the two? Answering this question will require a much better understanding of patterns of increasing cultural diversity, complexity and rates of change in human evolution. Palaeolithic stone tools provide a relatively abundant and continuous record of such change, but a systematic method for describing the complexity and diversity of these early technologies has yet to be developed. Here, an initial attempt at such a system is presented. Results suggest that rates of Palaeolithic culture change may have been underestimated and that there is a direct relationship between increasing technological complexity and diversity. Cognitive evolution and the greater latitude for cultural variation afforded by increasingly complex technologies may play complementary roles in explaining this pattern. PMID:21357227

  5. Functional and morphological evaluation of radiation nephropathy and ureteral injury in the dog

    SciTech Connect

    Cloran, J.A.

    1986-01-01

    Intraoperative radiotherapy (IORT) may provide a therapeutic advantage in the treatment of certain intraabdominal malignancies. However, before the therapeutic potential of innovative modalities can be assessed adequately, the in vivo radiobiological effects and responses of normal tissues to clinical doses of irradiation must be determined. In this study, the reactions of normal canine kidneys, ureters, and major vessels wee assessed following IORT, fractionated x-irradiation, or a combination of these modalities. Radiographically derived morphological endpoints, including kidney size and cortical width, were monitored for one year following irradiation. The renal parenchymal atrophy, vascular alterations and functional impairment that developed was directly related to the IORT dose, whether delivered alone or in combination with fractionated x-irradiation. The incidence of ureteral injury and secondary hydronephrosis increased with both the IORT dose and post-irradiation time. No ureteral changes were detected in dogs that received only fractionated x-irradiation (60-80 Gy). No significant arteriographic abnormalities could be detected in the caudal aorta during the one year follow-up period.

  6. Early management and long-term outcomes in primary vesico-ureteric reflux.

    PubMed

    Coleman, Robert

    2011-11-01

    What's known on the subject? and What does the study add? Despite evolving understanding of pathogenesis and natural history, controversy exists regarding management of childhood vesicoureteric reflux. Surgical correction of the reflux itself may reduce risk of upper tract complications in some but may not in itself constitute appropriate management of lower tract morbidity in many. This review examines the evidence for early management and long term outcomes in primary vesicoureteric reflux. Primary vesico-ureteric reflux is a common condition in childhood associated with bladder dysfunction and an increased risk of urinary tract infection. Recent evidence indicates a lower tract functional abnormality in its pathogenesis. Whilst spontaneous resolution will occur in many, some patients will go on to develop complications in adulthood including reflux nephropathy, hypertension, urinary tract infection, bladder dysfunction and complications of pregnancy. An evolving understanding of the natural history has seen radical changes in management. Evidence for management of the child with primary vesico-ureteric reflux is reviewed with a focus on the implications on long-term outcomes in adulthood. PMID:22085118

  7. A mathematical model for the induction of the mammalian ureteric bud.

    PubMed

    Lawson, Brodie A J; Flegg, Mark B

    2016-04-01

    Congenital abnormalities of the kidney and urinary tract collectively form the most common type of prenatally diagnosed malformations. Whilst many of the crucial genes that direct the kidney developmental program are known, the mechanisms by which kidney organogenesis is achieved is still largely unclear. In this paper, we propose a mathematical model for the localisation of the ureteric bud, the precursor to the ureter and collecting duct system of the kidney. The mathematical model presented fundamentally implicates Schnakenberg-like ligand-receptor Turing patterning as the mechanism by which the ureteric bud is localised on the Wolfian duct as proposed by Menshykaul and Iber (2013). This model explores the specific roles of regulatory proteins GREM1 and BMP as well as the domain properties of GDNF production. Our model demonstrates that this proposed pattern formation mechanism is capable of naturally predicting the phenotypical outcomes of many genetic experiments from the literature. Furthermore, we conclude that whilst BMP inhibits GDNF away from the budding site and GREM1 permits GDNF to signal, GREM1 also stabilises the effect of BMP on GDNF signalling from fluctuations in BMP sensitivity but not signal strength. PMID:26801874

  8. Complications of Percutaneous Nephrostomy, Percutaneous Insertion of Ureteral Endoprosthesis, and Replacement Procedures

    SciTech Connect

    Kaskarelis, Ioannis S.; Papadaki, Marina G.; Malliaraki, Niki E.; Robotis, Epaminondas D.; Malagari, Katerina S.; Piperopoulos, Ploutarchos N.

    2001-07-15

    Purpose: The aim of the present study was to record and identify the frequency of complications following percutaneous nephrostomy, replacement of nephrostomy drains and percutaneous insertion of ureteral endoprostheses.Methods: During a 10-year period 341 patients were referred to our department with indications for percutaneous nephrostomy and/or percutaneous insertion of a ureteral endoprosthesis, and a total of 1036 interventional procedures were performed (nephrostomy, catheter change, stenting).Results: There were three major complications (0.29%): two patients died during the first 30 days after the procedure, due to aggravation of their condition caused by the procedure, and one patient had retroperitoneal bleeding requiring surgery. There were 76 complications of intermediate severity (7.33%): catheter or stent displacement (n = 37, 3.57%) catheter occlusion (n = 18, 1.73%), hematuria (n = 12, 1.16%), and urinary tract infection (n = 9, 0.87%). The 55 minor complications (5.3%) comprised inflammation of the skin at the site of insertion of the percutaneous catheter.Conclusion: The small number of complications observed during acts of interventional uroradiology prove transcutaneous manipulations to be safe medical procedures.

  9. Escherichia coli–Mediated Impairment of Ureteric Contractility Is Uropathogenic E. coli Specific

    PubMed Central

    Floyd, Rachel V.; Upton, Mathew; Hultgren, Scott J.; Wray, Susan; Burdyga, Theodor V.; Winstanley, Craig

    2012-01-01

    Background. Ureters are fundamental for keeping kidneys free from uropathogenic Escherichia coli (UPEC), but we have shown that 2 strains (J96 and 536) can subvert this role and reduce ureteric contractility. To determine whether this is (1) a widespread feature of UPEC, (2) exhibited only by UPEC, and (3) dependent upon type 1 fimbriae, we analyzed strains representing epidemiologically important multilocus sequence types ST131, ST73, and ST95 and non-UPEC E. coli. Methods. Contractility and calcium transients in intact rat ureters were compared between strains. Mannose and fim mutants were used to investigate the role of type 1 fimbriae. Results. Non-UPEC had no significant effect on contractility, with a mean decrease after 8 hours of 8.8%, compared with 8.8% in controls. UPEC effects on contractility were strain specific, with decreases from 9.47% to 96.7%. Mannose inhibited the effects of the most potent strains (CFT073 and UTI89) but had variable effects among other UPEC strains. Mutation and complementation studies showed that the effects of the UTI89 cystitis isolate were fimH dependent. Conclusions. We find that (1) non-UPEC do not affect ureteric contractility, (2) impairment of contractility is a common feature of UPEC, and (3) the mechanism varies between strains, but for the most potent UPEC type 1 fimbriae are involved. PMID:23002447

  10. Designing of dynamic polyethyleneimine (PEI) brushes on polyurethane (PU) ureteral stents to prevent infections.

    PubMed

    Gultekinoglu, Merve; Tunc Sarisozen, Yeliz; Erdogdu, Ceren; Sagiroglu, Meral; Aksoy, Eda Ayse; Oh, Yoo Jin; Hinterdorfer, Peter; Ulubayram, Kezban

    2015-07-01

    Permanent antibacterial coatings have been developed by brush-like polyethyleneimine (PEI) on polyurethane (PU) ureteral stents since bacterial adhesion and biofilm formation with the following encrustation on stent surface limit their long term usage. In order to control or prevent bacterial infections; PEI chains with two different molecular weights (Mn: 1800 or 60,000 Da) were covalently attached on the polyurethane (PU) surface by "grafting to" approach to obtain a brush-like structure. Then, PEI brushes were alkylated with bromohexane to enhance the disruption of bacterial membranes with increasing polycationic character. X-ray Photoelectron and Infrared Spectroscopy investigations confirmed that PEI grafting and alkylation steps were performed successfully. Surface roughness in dry state increased dramatically from 65.8 nm to 277.7 nm and 145.2 nm for short chain PEI and long chain PEI grafted samples, respectively. Both low and high molecular weight PEI grafts exhibited a brush-like structure and potent antibacterial activity by lowering the adherence of Klebsiella pneumonia, Escherichia coli and Proteus mirabilis species up to two orders of magnitude without any cytotoxic effect on L929 and G/G cells. Thus, permanent bactericidal activity was achieved by the contact-active strategy of dynamic PEI brush-like structures on polyurethane ureteral stent. PMID:25848724

  11. Comparative efficacy of tamsulosin versus nifedipine for distal ureteral calculi: a meta-analysis

    PubMed Central

    Wang, Hai; Man, Li Bo; Huang, Guang Lin; Li, Gui Zhong; Wang, Jian Wei

    2016-01-01

    Objective The aim of this study was to systematically compare the therapeutic effect and safety of tamsulosin with nifedipine in medical expulsive therapy for distal ureteral calculi. Methods Databases, including PubMed, EMBASE, the Cochrane Library, and Clinical Trial Register Centers, were comprehensively searched. Relevant randomized controlled trials (RCTs) were selected, and quality assessment was performed according to the Cochrane Handbook. RevMan software was used to analyze the outcome measures, which consisted of expulsion rate, expulsion time, and complications. Results Twelve RCTs consisting of 4,961 patients were included (tamsulosin group, 2,489 cases; nifedipine group, 2,472 cases). Compared with nifedipine, tamsulosin significantly increased the expulsion rate (risk ratio =1.29, 95% CI [1.25, 1.33], P<0.0001) and reduced the expulsion time (standard mean difference =−0.39, 95% CI [−0.72, −0.05], P=0.02). Regarding safety, tamsulosin was associated with fewer complications than nifedipine (risk ratio =0.45, 95% CI [0.28, 0.72], P=0.0008), and further subgroup analysis showed that tamsulosin was associated with a lower risk of both mild and moderate-to-severe complications. Conclusion On the bias of current evidence, tamsulosin showed an overall superiority to nifedipine for distal ureteral calculi <10 mm in aspects of expulsion rate, expulsion time, and safety. Tamsulosin was supposed to be the first drug to be recommended to patients willing to receive medical expulsive therapy. PMID:27099471

  12. Preparation, degradation and in vitro release of ciprofloxacin-eluting ureteral stents for potential antibacterial application.

    PubMed

    Ma, Xiaofei; Xiao, Yan; Xu, Heng; Lei, Kun; Lang, Meidong

    2016-09-01

    Drug-eluting stents with biodegradable polymers as reservoirs have shown great potential in the application of interventional therapy due to their capability of local drug delivery. Herein, poly(l-lactide-co-ε-caprolactone) (PLCL) with three different compositions as carriers for ciprofloxacin lactate (CIP) was coated on ureteral stents by the dipping method. To simulate a body environment, degradation behavior of PLCL as both the bulk film and the stent coating was evaluated in artificial urine (AU, pH6.20) respectively at 37°C for 120days by tracing their weight/Mn loss, water absorption and surface morphologies. Furthermore, the release profile of the eluting drug CIP on each stent exhibited a three-stage pattern, which was greatly affected by the degradation behavior of PLCL except for the burst stage. Interestingly, the degradation results on both macroscopic and molecular level indicated that the release mechanism at stage I was mainly controlled by chain scission instead of the weight loss or morphological changes of the coatings. While for stage II, the release profile was dominated by erosion resulting from the hydrolysis reaction autocatalyzed by acidic degradation residues. In addition, ciprofloxacin-loaded coatings displayed a significant bacterial resistance against E. coli and S. aureus without obvious cytotoxicity to Human foreskin fibroblasts (HFFs). Our results suggested that PLCL copolymers with tunable degradation rate as carriers for ciprofloxacin lactate could be used as a promising long-term antibacterial coating for ureteral stents. PMID:27207042

  13. Anti-fibrotic effect of natural toxin bee venom on animal model of unilateral ureteral obstruction.

    PubMed

    An, Hyun Jin; Kim, Kyung Hyun; Lee, Woo Ram; Kim, Jung Yeon; Lee, Sun Jae; Pak, Sok Cheon; Han, Sang Mi; Park, Kwan Kyu

    2015-06-01

    Progressive renal fibrosis is the final common pathway for all kidney diseases leading to chronic renal failure. Bee venom (BV) has been widely used as a traditional medicine for various diseases. However, the precise mechanism of BV in ameliorating the renal fibrosis is not fully understood. To investigate the therapeutic effects of BV against unilateral ureteral obstruction (UUO)-induced renal fibrosis, BV was given intraperitoneally after ureteral ligation. At seven days after UUO surgery, the kidney tissues were collected for protein analysis and histologic examination. Histological observation revealed that UUO induced a considerable increase in the number of infiltrated inflammatory cells. However, BV treatment markedly reduced these reactions compared with untreated UUO mice. The expression levels of TNF-α and IL-1β were significantly reduced in BV treated mice compared with UUO mice. In addition, treatment with BV significantly inhibited TGF-β1 and fibronectin expression in UUO mice. Moreover, the expression of α-SMA was markedly withdrawn after treatment with BV. These findings suggest that BV attenuates renal fibrosis and reduces inflammatory responses by suppression of multiple growth factor-mediated pro-fibrotic genes. In conclusion, BV may be a useful therapeutic agent for the prevention of fibrosis that characterizes progression of chronic kidney disease. PMID:26035488

  14. Mechanism by which shock wave lithotripsy can promote formation of human calcium phosphate stones

    PubMed Central

    Evan, Andrew P.; Coe, Fredric L.; Connors, Bret A.; Handa, Rajash K.; Lingeman, James E.

    2015-01-01

    Human stone calcium phosphate (CaP) content correlates with higher urine CaP supersaturation (SS) and urine pH as well as with the number of shock wave lithotripsy (SWL) treatments. SWL does damage medullary collecting ducts and vasa recta, sites for urine pH regulation. We tested the hypothesis that SWL raises urine pH and therefore Cap SS, resulting in CaP nucleation and tubular plugging. The left kidney (T) of nine farm pigs was treated with SWL, and metabolic studies were performed using bilateral ureteral catheters for up to 70 days post-SWL. Some animals were given an NH4Cl load to sort out effects on urine pH of CD injury vs. increased HCO3− delivery. Histopathological studies were performed at the end of the functional studies. The mean pH of the T kidneys exceeded that of the control (C) kidneys by 0.18 units in 14 experiments on 9 pigs. Increased HCO3− delivery to CD is at least partly responsible for the pH difference because NH4Cl acidosis abolished it. The T kidneys excreted more Na, K, HCO3−, water, Ca, Mg, and Cl than C kidneys. A single nephron site that could produce losses of all of these is the thick ascending limb. Extensive injury was noted in medullary thick ascending limbs and collecting ducts. Linear bands showing nephron loss and fibrosis were found in the cortex and extended into the medulla. Thus SWL produces tubule cell injury easily observed histopathologically that leads to functional disturbances across a wide range of electrolyte metabolism including higher than control urine pH. PMID:25656372

  15. Minority shareholder claims foul at Stone & Webster

    SciTech Connect

    Krizan, W.G.

    1994-05-09

    An activist minority shareholder is trying to shake up the management of one of the industry`s oldest firms, New York City-based engineering-constructor Stone & Webster Inc., The shareholder has filed a lawsuit against the 105-year-old firm, claiming that it is understanding losses from construction activities and is using the voting rights of employee-owned stock to perpetuate current management to the detriment of all shareholders.

  16. Surface analysis of stone and bone tools

    NASA Astrophysics Data System (ADS)

    Stemp, W. James; Watson, Adam S.; Evans, Adrian A.

    2016-03-01

    Microwear (use-wear) analysis is a powerful method for identifying tool use that archaeologists and anthropologists employ to determine the activities undertaken by both humans and their hominin ancestors. Knowledge of tool use allows for more accurate and detailed reconstructions of past behavior, particularly in relation to subsistence practices, economic activities, conflict and ritual. It can also be used to document changes in these activities over time, in different locations, and by different members of society, in terms of gender and status, for example. Both stone and bone tools have been analyzed using a variety of techniques that focus on the observation, documentation and interpretation of wear traces. Traditionally, microwear analysis relied on the qualitative assessment of wear features using microscopes and often included comparisons between replicated tools used experimentally and the recovered artifacts, as well as functional analogies dependent upon modern implements and those used by indigenous peoples from various places around the world. Determination of tool use has also relied on the recovery and analysis of both organic and inorganic residues of past worked materials that survived in and on artifact surfaces. To determine tool use and better understand the mechanics of wear formation, particularly on stone and bone, archaeologists and anthropologists have increasingly turned to surface metrology and tribology to assist them in their research. This paper provides a history of the development of traditional microwear analysis in archaeology and anthropology and also explores the introduction and adoption of more modern methods and technologies for documenting and identifying wear on stone and bone tools, specifically those developed for the engineering sciences to study surface structures on micro- and nanoscales. The current state of microwear analysis is discussed as are the future directions in the study of microwear on stone and bone tools.

  17. Minimally invasive surgical treatment for kidney stone disease.

    PubMed

    Rodríguez, Dayron; Sacco, Dianne E

    2015-07-01

    Minimally invasive interventions for stone disease in the United States are mainly founded on 3 surgical procedures: extracorporeal shock wave lithotripsy, ureteroscopic lithotripsy, and percutaneous nephrolithotomy. With the advancement of technology, treatment has shifted toward less invasive strategies and away from open or laparoscopic surgery. The treatment chosen for a patient with stones is based on the stone and patient characteristics. Each of the minimally invasive techniques uses an imaging source, either fluoroscopy or ultrasound, to localize the stone and an energy source to fragment the stone. Extracorporeal shock wave lithotripsy uses a shock wave energy source generated outside the body to fragment the stone. In contrast, with ureteroscopy, laser energy is placed directly on the stone using a ureteroscope that visualizes the stone. Percutaneous nephrolithotomy requires dilation of a tract through the back into the renal pelvis so that instruments can be inserted directly onto the stone to fragment or pulverize it. The success of the surgical intervention relies on performing the least invasive technique with the highest success of stone removal. PMID:26088070

  18. Welsh Slate: A Candidate for Global Heritage Stone Status

    NASA Astrophysics Data System (ADS)

    Horak, Jana; Hughes, Terry; Lott, Graham

    2013-04-01

    Slate is the iconic stone of Wales, and has a temporal and geographic record of usage such that it is considered worthy of consideration for Global Heritage Stone status. The reputation of Welsh slate is built on the quality and durability of the stone, enabling it to be used in a wide range of contexts from industrial roofing, through domestic housing to higher prestige buildings. Although metamorphic slates are present in several across Wales, the highest quality roofing material was extracted from just two areas in north-west Wales; the Cambrian Slate Belt, around Bethesda to Nantlle, working purple and green slates of the Llanberis Slate Formation and a second area to the south around Blaenau Ffestiniog - the Ordovician Slate Belt - which works grey slates of the Nant Francon Supergroup. These two areas are considered to form the core of the Welsh Slate Province. Welsh slate has been extracted for at least 2000 years, as evidenced by their presence as roofing slates in Roman forts in North Wales dating from 77AD. Slates from medieval churches and castles in north Wales indicate extraction continued throughout this period. In the 16th century exportation of Welsh slate commenced, initially limited to Ireland and those parts of England where it could be transported by boat. The second half of 18th century saw the first major expansion of the industry, facilitated by improved road transportation and some mechanisation, and subsequently in the 1830s by repeal of punitive boat taxes: production increased substantially through the late 19th century supported by the introduction of steam railways, and both production and exports peaked around 1900. The industry is still active today, although on a much reduced scale, with an estimate of around 20% of output being exported. Considerable reserves of this high quality slate resource remain in North Wales and it is important to ensure that they are protected to maintain continuity of supply to the heritage sector and are also available for use in new build The basis for the proposal of Welsh Slate as a candidate for Global Heritage Stone status is founded on its World-wide use in prestigious buildings. The most significant export of slate occurred in the 19th century where it was the roofing material of choice for many buildings of note across Europe. Examples from the many documented uses include the Town Hall in Copenhagen, the Kunsthistorisches Museum in Vienna, Hotel de Ville, Paris, Turin University and Peace Palace Den Haag, and Waraw Cathedral. Welsh slate was also used for the extensive rebuilding of Hanover in 1842 after devastation by fire. Outside of Europe Welsh slate was used extensively in key buildings in Sydney, Melbourne and Perth and other centres of the then British Empire in New Zealand, Nigeria, South Africa and the West Indies. Use of Welsh slate in more recent times includes the Exxon HQ in Texas, Boston Airport and the Wales Millenium Centre, Cardiff. The significance and global importance of Welsh slate is indicated by the proposal for part of the Welsh Slate Province to be designated a UNESCO World Heritage Site, Global Heritage Stone status would support and corroborate this designation.

  19. Comparison of Two Types of Double-J Ureteral Stents that Differ in Diameter and the Existence of Multiple Side Holes along the Straight Portion in Malignant Ureteral Strictures

    SciTech Connect

    Song, Myung Gyu Seo, Tae-Seok Lee, Chang Hee Kim, Kyeong Ah; Kim, Jun Suk Oh, Sang Cheul; Lee, Jae-Kwan

    2015-06-15

    PurposeThis study was decided to evaluate the impact of diameter and the existences of multiple side holes along the straight portion of double-J ureteral stents (DJUS) on early dysfunction of stents placed for malignant ureteral strictures.MethodsBetween April 2007 and December 2011, 141 DJUSs were placed via a percutaneous nephrostomy (PCN) tract in 110 consecutive patients with malignant ureteral strictures. 7F DJUSs with multiple side holes in the straight portion were placed in 58 ureters of 43 patients (Group 1). 8F DJUSs with three side holes in the proximal 2-cm of the straight portion were placed in 83 ureters of 67 patients (Group 2). The incidence of early DJUS dysfunction was compared between the two groups, and nephrostographic findings were evaluated in the cases of early dysfunction.ResultsEarly dysfunction of the DJUS was noted in 14 of 58 patients (24.1 %) in Group 1, which was significantly higher (p = 0.001) than in Group 2 in which only 1 of 83 patients (1.2 %) had early dysfunction of the DJUS. Nephrostographic findings of early dysfunction included dilatation of the pelvicalyceal system, filling defects in the ureteral stent, and no passage of contrast media into the urinary bladder.ConclusionsIn malignant ureteral strictures, multiple side holes in the straight portion of the 7-F DJUS seem to cause early dysfunction. The 8F DJUSs with three side holes in the proximal 2-cm of the straight portion may be superior at preventing early dysfunction.

  20. Is There Hope for Renal Growth on Imaging Studies Following Ureteral Reimplant for Boys With Fetal Hydronephrosis and Urinary Reflux?

    PubMed Central

    Wang, Ming-Hsien

    2015-01-01

    Reflux nephropathy is thought to be the etiology for renal maldevelopment. We present two boys with fetal hydronephrosis and sterile vesicoureteral reflux (VUR). There was lack of renal growth of the refluxing renal units on surveillance renal ultrasound. Parents elected to undergo open ureteral reimplants. Post-surgical ultrasounds demonstrated improved renal growth. PMID:26793522

  1. Fat4/Dchs1 signaling between stromal and cap mesenchyme cells influences nephrogenesis and ureteric bud branching

    PubMed Central

    Mao, Yaopan; Francis-West, Philippa; Irvine, Kenneth D.

    2015-01-01

    Formation of the kidney requires reciprocal signaling among the ureteric tubules, cap mesenchyme and surrounding stromal mesenchyme to orchestrate complex morphogenetic events. The protocadherin Fat4 influences signaling from stromal to cap mesenchyme cells to regulate their differentiation into nephrons. Here, we characterize the role of a putative binding partner of Fat4, the protocadherin Dchs1. Mutation of Dchs1 in mice leads to increased numbers of cap mesenchyme cells, which are abnormally arranged around the ureteric bud tips, and impairment of nephron morphogenesis. Mutation of Dchs1 also reduces branching of the ureteric bud and impairs differentiation of ureteric bud tip cells into trunk cells. Genetically, Dchs1 is required specifically within cap mesenchyme cells. The similarity of Dchs1 phenotypes to stromal-less kidneys and to those of Fat4 mutants implicates Dchs1 in Fat4-dependent stroma-to-cap mesenchyme signaling. Antibody staining of genetic mosaics reveals that Dchs1 protein localization is polarized within cap mesenchyme cells, where it accumulates at the interface with stromal cells, implying that it interacts directly with a stromal protein. Our observations identify a role for Fat4 and Dchs1 in signaling between cell layers, implicate Dchs1 as a Fat4 receptor for stromal signaling that is essential for kidney development, and establish that vertebrate Dchs1 can be molecularly polarized in vivo. PMID:26116666

  2. Performance of distributed bagged stone dust barrier in combating coal-dust explosions

    SciTech Connect

    Plessis, J.J.L. du; Vassard, P.S.

    1999-07-01

    The Kloppersbos Research Facility of the CSIR's Division of Mining Technology has developed a new method of building stone dust barriers. The new barrier makes use of a previous concept of containing stone dust in a bag, but incorporates a new method of rupturing the bag. This was achieved by adapting the closing mechanism and by balancing the stone dust content with the void in the bag. The bagged barrier was extensively tested in the 200-m test gallery. During these tests, it became evident that these bags could be made to rupture and spread stone dust when subjected to smaller forces than those required for the most commonly used passive barrier, the Polish light barrier. To validate this, as well as to gain international acceptance of this new barrier, tests were conducted in the German experimental mine, DMT Tremonia, Dortmund. The barrier was evaluated against numerous methane-initiated coal-dust explosions. The paper describes the successful inhibition of coal-dust explosions at Kloppersbos and DMT tremonia. The barrier has been proven successfully for static pressures of 44 to 82 kpa, dynamic pressures of 12 to 36 kpa and for flame speeds as low as 23 m/s. This barrier is now accepted by the South African government and has been implemented in numerous South African collieries.

  3. Laser profilometry and length-scale analysis of stone tools: second series experiment results.

    PubMed

    James Stemp, W; Childs, Ben E; Vionnet, Samuel

    2010-01-01

    Based on the need to develop a method to reliably and objectively document and discriminate the use-wear on archaeological stone tools, Stemp et al. (2009) tested whether the surface roughness measured on experimentally worn stone tools used on different contact materials could be discriminated. Results of these initial experiments indicated that discrimination was possible and also determined the scales over which this discrimination occurred. In this article, we report the results of additional experiments using the same method on a second set of tools to test its reliability and reproducibility. In these experiments, four flint flakes were intensively used for 20 min on either conch shell or dry deer antler. The surface roughness or texture of the stone tools was measured by generating 2D profiles using a UBM laser profilometer. Relative lengths (RLs) calculated from the profiles were used directly as characterization parameters and subsequently compared statistically at each scale using the F-test to establish a level of confidence for the differentiation at each scale represented in the measured profiles. The mean square ratios of measurement data were used to determine whether the variation in roughness was statistically significant and to what level of confidence. The scales at which there was a high level of confidence were the ones at which the tools were differentiable. The results of these experiments confirm our previous findings that RLs, over certain scale ranges, can discriminate the stone tool surface wear profiles produced by the different contact materials. PMID:20853403

  4. Removal of tetracycline from wastewater using pumice stone: equilibrium, kinetic and thermodynamic studies

    PubMed Central

    2014-01-01

    In this study, pumice stone was used for the removal of tetracyline (TC) from aqueous solutions. It was characterized by XRD, FT-IR, SEM and BET analyses. Cation exchange capacity of pumice stone was found to be 9.9 meq/100 g. Effect of various parameters such as solution pH (2–11), adsorbent dosage (0.5-10 g/L), contact time (2.5-120 min), initial TC concentration (5–300 mg/L) and temperature (20–50°C) on TC adsorption onto pumice was investigated. Also the adsorption of TC on pumice stone was studied as a function of Na+ and Cu2+ cations changing pH from 2 to 11 using batch experiments. The best removal efficiency performance was exhibited at adsorbent dosage 10 g/L, pH 3, contact time 120 min. Langmuir, Freundlich and Dubinin-Radushkevich (D-R) isotherm models were applied to the equilibrium data. The result has shown that the adsorption was favorable, physicochemical in nature and agrees well with Langmuir and Freundlich models. The maximum Langmuir adsorption capacity was found to be 20.02 mg/g. The adsorption behavior of TC on pumices stone was fitted well in the pseudo-second order kinetics model. Thermodynamic parameters calculated from the adsorption data at different temperature showed that the adsorption reaction was feasible, spontaneous and exothermic. PMID:24936305

  5. Removal of tetracycline from wastewater using pumice stone: equilibrium, kinetic and thermodynamic studies.

    PubMed

    Guler, Ulker Asli; Sarioglu, Meltem

    2014-01-01

    In this study, pumice stone was used for the removal of tetracyline (TC) from aqueous solutions. It was characterized by XRD, FT-IR, SEM and BET analyses. Cation exchange capacity of pumice stone was found to be 9.9 meq/100 g. Effect of various parameters such as solution pH (2-11), adsorbent dosage (0.5-10 g/L), contact time (2.5-120 min), initial TC concentration (5-300 mg/L) and temperature (20-50°C) on TC adsorption onto pumice was investigated. Also the adsorption of TC on pumice stone was studied as a function of Na(+) and Cu(2+) cations changing pH from 2 to 11 using batch experiments. The best removal efficiency performance was exhibited at adsorbent dosage 10 g/L, pH 3, contact time 120 min. Langmuir, Freundlich and Dubinin-Radushkevich (D-R) isotherm models were applied to the equilibrium data. The result has shown that the adsorption was favorable, physicochemical in nature and agrees well with Langmuir and Freundlich models. The maximum Langmuir adsorption capacity was found to be 20.02 mg/g. The adsorption behavior of TC on pumices stone was fitted well in the pseudo-second order kinetics model. Thermodynamic parameters calculated from the adsorption data at different temperature showed that the adsorption reaction was feasible, spontaneous and exothermic. PMID:24936305

  6. Right sided double inferior vena cava with obstructed retrocaval ureter: Managed with single incision multiple port laparoscopic technique using "Santosh Postgraduate Institute tacking ureteric fixation technique"

    PubMed Central

    Singh, Shivanshu; Garg, Nitin

    2015-01-01

    Right double inferior vena cava with obstructed retrocaval ureter is an extremely rare anomaly with only a few reported cases in the literature. To the best of our knowledge, this is the first case report describing ureteric repair by use of a single-incision laparoscopic technique. In addition, this report addresses the underlying surgical challenges of this repair and provides a brief review of the embryology of this anomaly. The "Santosh Postgraduate Institute ureteric tacking fixation technique" provides ease of end-to-end uretero-ureteric anastomosis in a single-incision laparoscopic surgery. PMID:25874048

  7. Mineralogy and chemistry of urinary stones: patients from North Jordan.

    PubMed

    Abboud, Iyad Ahmed

    2008-10-01

    Urinary stone diseases are increasing in the Middle East. The majority of urinary stone cases are found in the northern part of the country. Stone samples taken from patients living in the Irbid area were collected from Princess Basma Hospital. The present study concentrates on the mineralogical and chemical composition of the urinary stones and on the effective environmental factors that assist in developing the different types of urinary stones. Using X-ray diffraction techniques, the mineralogical composition of the urinary stones was found to be as follows: oxalate, cholesten, and uric acid, with cystine stones occuring more frequently than the others. Cholesten and calcium oxalate stones are the most dominant types of stones. Calcium oxalate is the most common type of oxalate stone. Calcium oxalate is represented in: whewellite, wheddellite, and calcium carbonate oxalate hydrate minerals, in addition to other minerals such as brushite, ammonium phosphate, vaterite, valleriite, and bobierrite from other types of stones. Bobierrite (phosphate group) is a new mineral reported in urinary stones, and this has not been determined in any previous study worldwide. Apatite (calcium phosphate) is deduced using scanning electron microscope (SEM) images. The SEM technique determined crystal forms and systems, shapes, morphological features, and the names of the minerals forming urine stones, while optical properties are studied by polarizing microscope. X-ray fluorescence technique determined the concentrations of major and some trace elements. It revealed that Ca is the main constituent of the urinary stones, especially those composed of calcium oxalate and calcium phosphate. The concentration of trace elements was Ba = 1.57, P = 3.61, Fe = 1.78, S = 2.08, Zr = 4.63, Mo = 3.92, Cu = 1.89, Co = 1.56, and F = 4.2% and was higher in the urinary stones of Jordanian patients than in foreigners in the country. Questionnaires completed by patients suggest that the most significant factors directly effecting the formation of stones are water, climate conditions, food rich in protein and rich in different chemicals. Moreover, some drugs and diseases might also help in developing other stones. PMID:18064405

  8. Application research of CO2 laser cutting natural stone plates

    NASA Astrophysics Data System (ADS)

    Ma, Lixiu; Song, Jijiang

    2009-08-01

    Now, the processing of natural stone plates is the high performance sawing machine primarily,many researchers deeply studied the processing characters in the sawing process and the strength characters during the processing. In order to realize the profiled-processing and pattern- carving of the natural stone, It lays a solid foundation for the laser cutting and the pattern-carving technology of natural stone plate. The working principle, type and characteristics of laser cutting are briefly described. The paper selects 6 kinds stone plates of natural taken as experimental sample,the experimental sample was China Shanxi Black, Old Spain Golden Yellow, New Spain Golden Yellow, Jazz White, Maple Leaf Red, Cream White respectively. Use high power CO2 laser cutting system,the stone plates cutting experiment of 6 kinds different hardness, the best working speed are obtained,The experimental results indicate that: The laser cutting speed has no correlation with the ingredient content of stone plate.

  9. Introduction: Kidney Stone Research, Lessons From Human Studies

    NASA Astrophysics Data System (ADS)

    Coe, Fredric L.

    2007-04-01

    About 5% of American women and 12% of men will develop a kidney stone at some time in their life, the prevalence has been rising in both sexes. Approximately 80% of stones are composed of calcium oxalate, and calcium phosphate; 10% of struvite; 9% of uric acid; and the remaining 1% are composed of cystine or ammonium acid urate or are diagnosed as drug-related stone. Stones ultimately arise because of an unwanted phase change of these substances from liquid to solid state. In this introduction, I have outlined our current thinking of the possible mechanisms involved in stone formation based on our biopsy data collected from a series of human kidney stone formers. In addition, I have presented a set of questions as a means of focusing future research in this field.

  10. Development of latent fingermarks from rocks and stones.

    PubMed

    Hefetz, Ido; Cohen, Amit; Cohen, Yaron; Chaikovsky, Alan

    2014-09-01

    Since the beginning of recorded history, stones have been used in the commission of crimes due to their widespread availability. Stones can be used as a lethal weapon that sometimes might be the only evidence in a serious case. The common perception, even in professional fingermark circles, is that stones do not yield identifiable latent fingermarks. The authors of this research paper examined the feasibility of developing fingermarks from seven types of stones using three latent fingermark techniques: magnetic powder, cyanoacrylate fuming, and ninhydrin. The paper will demonstrate that by classifying stones and rocks according to their natural properties (porosity, permeability, and the nature of surface area), even application of the simplest development techniques can produce good results. In conclusion, chert and limestone yielded the most qualitative and quantitative results using magnetic powder. The time factor is also important in recovering latent fingermarks on stones and rocks. PMID:24502220

  11. Epidemiologic Insights into Stone Disease as a Systemic Disorder

    NASA Astrophysics Data System (ADS)

    Curhan, Gary C.

    2007-04-01

    Examining the epidemiology of stone disease can provide insight into etiology. There is a growing body of evidence that stone disease is not simply a disorder of the kidney. In fact, nephrolithiasis is clearly a systemic disorder. Conditions associated with stone disease include the classic ones such as inflammatory bowel disease and primary hyperparathyroidism. More recent studies have demonstrated strong associations with obesity, gout, diabetes and hypertension. Future studies will help uncover the underlying common pathophysiologic abnormalities.

  12. Milk of calcium stones: radiological signs and management outcome.

    PubMed

    El-Shazly, M

    2015-06-01

    Milk of calcium (MOC) is a rare type of stone that was first described in 1940 by Ludin and Howald who reported MOC in renal cysts. Milk of calcium is a viscous colloidal suspension of calcium salts. Stasis, obstruction and infection are important predisposing factors. Due to a layering effect, characteristic radiological signs especially in CT can help in diagnosis to avoid unsuccessful shock wave lithotripsy. This is the largest reported case series, in which radiological signs by CT scan to predict renal MOC stones, clinical picture and management outcome are described in detail. Cases with suspected renal milk of calcium stones were studied over 7 years (2008-2015). All cases were diagnosed preoperatively by non-contrast CT. Urine cultures were performed in all patients preoperatively. Intra-operative and postoperative findings were reported. Stones retrieved were sent for chemical analysis using an infrared method. Seven cases of milk of calcium renal stones were included in this study. These stones were faint radio-opaque in two cases and radiolucent in five cases. All cases were diagnosed preoperatively with non-contrast CT. Their Hounsfield units (HU) ranged from 114 to 612. All stones were located in a dependent position (gravitational effect) in the posterior aspect of dilated calyces. Five cases exhibited the typical fluid level and two cases demonstrated semilunar (half moon) pattern in the anterior surface of the stones. All cases underwent PCNL with suction and retrieval of soft stones without the need for disintegration. When stones demonstrate a low Hounsfield unit, are arranged in dependent positions within dilated calyces and exhibit fluid level or semilunar pattern on non-contrast CT, milk of calcium stones should be considered. PCNL is an effective modality for management of renal milk of calcium stones. PMID:25820293

  13. Natural stones of historic and future importance in Sweden

    NASA Astrophysics Data System (ADS)

    Schouenborg, Björn; Andersson, Jenny; Göransson, Mattias

    2013-04-01

    Several activities and responsibilities of the Geological Survey of Sweden (SGU) are related to the work of the newly formed international Heritage Stone Task Group (HSTG) for designating historically important stones. SGU is among other things a referral organization, frequently dealing with the preparation of statements in connection with the quarrying permit applications of stone producers. When preparing these statements, SGU takes into account a number of parameters, e.g. the importance for local and regional business development, historic importance, area of occurrence, quality of the geological documentation of the stone type, peculiarities of the stone types and technical properties relevant for the intended use. Traditionally, SGU has not worked with bedrock mapping looking at the potential of natural stones production but more commonly looking at the potential production of aggregates, industrial minerals and metals. The competence is, therefore, presently being built up with new databases over important natural stone types and definition of criteria for their selection etc. In this respect the criteria defined by the HSTG provide important help. This work goes hand in hand with the task of proposing stone-deposits and quarries of "national interest". The criteria for selection of a stone type, quarry etc as one of national interest are currently being revised. SGU plays an important role in this work. However, the final decision and appointment lies in the hands of the Swedish Board of Housing, Building and Planning (Boverket), an authority dealing with sustainable land use and regional development, town and country planning. Boverket supervises how the planning legislation is handled by the municipal authorities and the county administrative boards. The two latter organizations are those in charge of giving extraction permits for stone quarrying. The "Hallandia gneiss", of SW Sweden, is described as a case story and presented in this paper. Keywords: Hallandia gneiss, natural stones, historic stones, urban planning and building

  14. PERSPECTIVE, FROM NORTHWEST. NOTE HOW ARCH SPRINGS FROM STONE SKEWBACKS ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    PERSPECTIVE, FROM NORTHWEST. NOTE HOW ARCH SPRINGS FROM STONE SKEWBACKS ON FACEWALL OF ABUTMENTS. - Barrackville Covered Bridge, Spanning Buffalo Creek on Pike Street , Barrackville, Marion County, WV

  15. Do Kidney Stone Formers Have A Kidney Disease?

    PubMed Central

    Zisman, Anna L.; Evan, Andrew P.; Coe, Fredric L.; Worcester, Elaine M.

    2015-01-01

    Nephrolithiasis is a highly prevalent disorder affecting approximately one in eleven people and is associated with multiple complications including hypertension, cardiovascular disease, and chronic kidney disease. Significant epidemiologic associations with chronic kidney disease and ESRD have been noted and are reviewed herein, but debate persists in the literature as to whether kidney stone formation is a pathogenic process contributing to kidney disease. Corroborating evidence supporting the presence of kidney disease in stone formers includes the variability of renal function by stone type, the positive association of stone size with renal dysfunction, the presence of markers of renal injury in the urine of even asymptomatic stone formers, and direct evidence of renal tissue injury on histopathology. Proposed pathogenic mechanisms include recurrent obstruction and comorbid conditions such as recurrent urinary tract infections and structural abnormalities. Recent work evaluating the renal histopathology of different groups of stone formers adds further granularity, suggesting variability in mechanisms of renal injury by stone type and confirming the pathogenic effects of crystal formation. Genetic abnormalities leading to stone formation including cystinuria and primary hyperoxaluria, among others, contribute to the burden of disease in the stone-forming population. PMID:26376133

  16. Renal stone risk assessment during Space Shuttle flights

    NASA Technical Reports Server (NTRS)

    Whitson, P. A.; Pietrzyk, R. A.; Pak, C. Y.

    1997-01-01

    PURPOSE: The metabolic and environmental factors influencing renal stone formation before, during, and after Space Shuttle flights were assessed. We established the contributing roles of dietary factors in relationship to the urinary risk factors associated with renal stone formation. MATERIALS AND METHODS: 24-hr. urine samples were collected prior to, during space flight, and following landing. Urinary and dietary factors associated with renal stone formation were analyzed and the relative urinary supersaturation of calcium oxalate, calcium phosphate (brushite), sodium urate, struvite and uric acid were calculated. RESULTS: Urinary composition changed during flight to favor the crystallization of calcium-forming salts. Factors that contributed to increased potential for stone formation during space flight were significant reductions in urinary pH and increases in urinary calcium. Urinary output and citrate, a potent inhibitor of calcium-containing stones, were slightly reduced during space flight. Dietary intakes were significantly reduced for a number of variables, including fluid, energy, protein, potassium, phosphorus and magnesium. CONCLUSIONS: This is the first in-flight characterization of the renal stone forming potential in astronauts. With the examination of urinary components and nutritional factors, it was possible to determine the factors that contributed to increased risk or protected from risk. In spite of the protective components, the negative contributions to renal stone risk predominated and resulted in a urinary environment that favored the supersaturation of stone-forming salts. Dietary and pharmacologic therapies need to be assessed to minimize the potential for renal stone formation in astronauts during/after space flight.

  17. Trap door and underside of cap stone of pyramid ion ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Trap door and underside of cap stone of pyramid ion - Washington Monument, High ground West of Fifteenth Street, Northwest, between Independence & Constitution Avenues, Washington, District of Columbia, DC

  18. 7. STONE PIER OF ORIGINAL WATERWHEEL INSTALLATION DOWNSTREAM FROM MILL ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    7. STONE PIER OF ORIGINAL WATERWHEEL INSTALLATION DOWNSTREAM FROM MILL William E. Barrett, photographer, 1973 (copy negative) - Thomas Shepherd's Grist Mill, High Street Vicinity, Shepherdstown, Jefferson County, WV

  19. "Azul Platino": another Spanish natural stone to be considered as Global Heritage Stone Resource.

    NASA Astrophysics Data System (ADS)

    José Tejado, Juan; Mota, M. Isabel; Pereira, Dolores

    2014-05-01

    Several granites are quarried in Extremadura, Spain, with very good aesthetic and physic and mechanical characteristics. "Azul Platino" has a striking bluish colour and its properties make this granite a perfect option for most applications as ornamental rocks. This granite has been used for centuries, first in the architectonic heritage of the extraction surrounding area, but afterwards in many important projects in Spain, Europe and all around the world: La Guardia Airport (NYC, USA), Yokohama Bridge (Tokyo, Japan), European Parliament (Brussels, Belgium), Planetarium (Valencia, Spain), Tenerife Auditorium (Tenerife, Spain), Suntec City (Singapore), MTR Kowlonn Station (Hong Kong), O'Connel Street (Dublin, Ireland), .... One important characteristic of this natural stone is the low radon exhalation that all the varieties, including the more weathered ones, show. For being a granite, this is an important characteristic for its use, both in interior and exterior use. But "Azul Platino" accomplishes all requirements to be considered as a nominee for Global Heritage Stone Resource consideration. Together with other local natural stones, it could be part as well of a Global Heritage Stone Province nomination.

  20. Pollution-fueled `biodeterioration` threatens historic stone

    SciTech Connect

    Young, P.

    1996-05-01

    Microorganisms appear to pose as great a threat to historic buildings, monuments, and statues as does acid precipitation, according to recent research findings. Air pollution from urban and industrial growth may be fueling these microbes and speeding the deterioration of venerated artworks and cultural treasures in many parts of the world - the Taj Mahal in India; the Acropolis and the Delos Sanctuary in Greece; stone Buddhas in Japan; cathedrals in Europe; and ancient temples in Cambodia, Vietnam, and Central America. This paper reports research being done in this field. 8 refs.