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Sample records for ureteral stones initial

  1. Transumbilical Laparoendoscopic Single-Site Ureterolithotomy for Large Impacted Ureteral Stones: Initial Experiences

    PubMed Central

    Kim, Tae Heon; Jeong, Byong Chang; Seo, Seong Il; Jeon, Seong Soo

    2010-01-01

    Purpose We presented our initial clinical experiences with transumbilical laparoendoscopic single-site (LESS) ureterolithotomy for large, impacted ureteral stones. Materials and Methods Between March 2009 and November 2009, seven LESS ureterolithotomies were performed at our institute. During the operation, we made a single 2 cm incision at the umbilicus and a homemade port by using a small wound retractor (Alexis®, Applied Medical, Rancho Santa Margarita, USA), a surgical glove, and conventional trocars. The operation was performed in the same manner as conventional laparoscopic surgery. The mean maximal stone diameter was 21.9 mm (range, 16.0-27.0 mm). There were six cases of upper ureteral stones and one case of a mid-ureteral stone. Perioperative and postoperative parameters were evaluated. Results The mean operative time was 197.1 min (range, 150-270 min). No transfusions were required. The mean postoperative hospital stay was 3.3 days (range, 2-6 days). The mean pain intensity on a visual analogue scale (VAS) on postoperative day 2 was 26 mm (range, 0-80 mm), and the mean cosmetic VAS at 6 weeks after the operation was 0 mm. The mean time for patients to return to their baseline activities was 4.0 days (range, 3-7 days). In six cases, all stones were completely removed on the basis of postoperative radiologic evaluation. There were no cases of major complications, including internal organ injury, urinary leakage, or urinary tract infection. Conclusions Transumbilical LESS ureterolithotomy can be considered as an alternative treatment option with minimal invasiveness and good effectiveness for large, impacted ureteral stones. PMID:20577607

  2. Emergency management of ureteral stones: Recent advances

    PubMed Central

    Osorio, Luis; Lima, Estêvão; Autorino, Riccardo; Marcelo, Filinto

    2008-01-01

    Most ureteral stones can be observed with reasonable expectation of uneventful stone passage. When an active ureteral stone treatment is warranted, the best procedure to choose is dependent on several factors, besides stone size and location, including operators’ experience, patients’ preference, available equipment and related costs. Placement of double-J stent or nephrostomy tube represents the classical procedures performed in a renal colic due to acute ureteral obstruction when the conservative drug therapy does not resolve the symptoms. These maneuvers are usually followed by ureteroscopy or extracorporeal shockwave lithotripsy, which currently represent the mainstay of treatment for ureteral stones. In this review paper a literature search was performed to identify reports dealing with emergency management of renal colic due to ureteral stones. The main aspects related to this debated issue are analyzed and the advantages and disadvantages of each treatment option are carefully discussed. PMID:19468497

  3. Laparoscopic transperitoneal ureterolithotomy for large ureteric stones

    PubMed Central

    Al-Sayyad, Ahmed

    2012-01-01

    Objectives: To evaluate the efficacy and safety of laparoscopic transperitoneal ureterolithotomy for management of large proximal ureteric stones. Materials and Methods: Medical records of patients who underwent laparoscopic transperitoneal ureterolithotomy for proximal ureteral stones ≥2 cm were reviewed retrospectively. Patients’ characteristics, stone characteristics, perioperative and follow-up data were studied. Patients with stones <2 cm in size, previous transperitoneal surgical procedure, or follow-up duration <6 months were excluded from the study. Results: Twelve patients (mean age = 52.9 ± 12 years) with large upper ureteric stones (mean stone largest diameter = 39 ± 13 mm) were included. Nine patients had single stone, 2 patients had two stones, and 1 patient had large impacted stone with 2 small stones floating above. Mean operative time was 107 ± 49.5 min with mean blood loss of 60.5 ± 19.2 cc. Mean total pain score was 38.4 ± 5.5 (100 point scale) and mean time till resuming oral intake was 3.6 ± 0.5 h. Mean duration of hospital stay was 2.6 ± 1.4 days and mean duration of stenting was 7.3 ± 2 weeks. Throughout a mean duration of follow-up of 14.8 ± 7.6 months, 100% stone clearance rate was achieved with no recurrence. One patient developed a ureteric stricture treated by laser endoureterotomy and stenting for 6 weeks and responded without re-stricture formation. Conclusion: Laparoscopic transperitoneal ureterolithotomy is a safe and effective approach for selected patients with large proximal ureteric stones with reduced postoperative pain and short hospital stay, and should be considered as a treatment option for such stones. PMID:22346099

  4. 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

  5. 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

  6. 21 CFR 876.4680 - Ureteral stone dislodger.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ureteral stone dislodger. 876.4680 Section 876.4680 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4680 Ureteral stone dislodger....

  7. 21 CFR 876.4680 - Ureteral stone dislodger.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Ureteral stone dislodger. 876.4680 Section 876.4680 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4680 Ureteral stone dislodger....

  8. 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

  9. Pneumatic v electrokinetic lithotripsy in treatment of ureteral stones.

    PubMed

    Vorreuther, R; Klotz, T; Heidenreich, A; Nayal, W; Engelmann, U

    1998-06-01

    Recently, a new device (Combilith) for electrokinetic lithotripsy (EKL) has become available which is very similar to the well-known device for pneumatic (ballistic) lithotripsy (Swiss Lithoclast). The Lithoclast uses air pressure to push a projectile within the handpiece against the end of a metal probe, which is thereby accelerated and thrown like a jackhammer against the stone. In principle, the same stroking movement of a small metal probe is provided by EKL; the difference is that instead of a projectile, a magnetic core within the handpiece is accelerated by the electromagnetic principle. This paper compares the clinical efficacy and the features of the two devices. Testing the devices on a stone model, taking into account stone propulsion, the systems turned out to equally effective regarding stone disintegration. However, stone displacement was more pronounced with the Lithoclast applied on easily breaking stones. In a second experiment, an optoelectronic movement-measuring apparatus (Zimmer camera) was employed to measure the range and velocity of the movement of the probe tip without any contact. The linear acceleration velocity ranged from 5 to a maximum of 12.5 m/sec with both systems, but the maximum height of the stroke was 2.5 mm with the Lithoclast and 1 mm with EKL. After the initial break-up of soft stones, further impact of the probe tip against the stone resulted merely in propulsion; thus, the greater probe stroke height is the cause of the stone displacement. In a clinical trial, 22 ureteral stones were treated with the Lithoclast and 35 with the EKL. The two devices were equally effective in terms of stone disintegration and safety margin. Fixation using a Dormia basket was necessary in 12 cases (8 Lithoclast, 4 EKL). Although a difference in probe stroke height was noted when comparing pneumatic and electrokinetic lithotripsy, there were no clinically significant differences in the efficacy of stone fragmentation or stone-free rates. At the

  10. [Medical therapy for ureteral stones: high versus low fluid intake].

    PubMed

    Hauser, Johannes; Caviezel, Alessandro; Iselin, Christophe

    2010-12-01

    The mainstays of renal colic medical treatment are first to provide efficient pain relief, and second to facilitate migration of the ureteral stone or dissolve it. In the ambulatory setting, non steroidal anti-inflammatory drugs are the treatment of choice of pain relief. To facilitate stone migration, the debate between hydric restriction and hyperhydration remains somewhat open. Besides that, alpha-blockers and anti-calcic agents appear to speed up stone explusion, whereas stone chemolysis acts on a longer time scale. PMID:21290866

  11. Flexible ureteroscopic renal stone extraction during laparoscopic ureterolithotomy in patients with large upper ureteral stone and small renal stones

    PubMed Central

    You, Jae Hyung; Kim, Young Gon; Kim, Myung Ki

    2014-01-01

    Introduction: We describe laparoscopic ureterolithotomy with renal stone extraction using a stone basket under flexible ureteroscopy. We describe its efficacy through a laparoscopic port and a ureterotomy site in patients with large upper ureteral stone and small renal stones. Methods: Between January 2009 and February 2012, we performed laparoscopic ureterolithotomy with renal stone extraction using a stone basket under flexible ureteroscopy in 11 patients who had upper ureteral and renal stones. The retroperitoneal approaches were used in all patients using 3–4 trocars. Results: All procedures were performed successfully without significant complications. Mean operative time was 78.5 minutes (range: 52–114 minutes). The mean size of ureteral stone was 19.91 mm (range: 15–25 mm). In addition, 25 renal stones (mean size 7.48 mm, range: 2–12 mm) were removed from 11 patients. The mean length of hospital stay was 3.5 days (range: 2–6 days). Conclusions: Laparoscopic ureterolithotomy with renal stone extraction using a stone basket under flexible ureteroscopy can be considered one of treatment modalities for patients with large upper ureteral stones accompanied by renal stones who are indicated in laparoscopic ureterolithotomy. PMID:25295127

  12. 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

  13. Unilateral ureteric stone associated with gross hydronephrosis and kidney shrinkage: a cadaveric report

    PubMed Central

    Tay, Ern-Wei; Bay, Boon-Huat

    2014-01-01

    Ureteric stones are a common cause of obstruction of the urinary tract, usually presenting with characteristic signs and symptoms, such as acute ureteric colic and hematuria. Occasionally, stones may present with non-specific symptoms such as low back pain and remain unidentified, leading to stone growth, chronic ureteric obstruction and complications such as hydronephrosis and renal damage. Here, we report a large ureteric stone in a cadaver with complete obstruction at the left ureterovesical junction, resulting in severe dilatation of the left ureter and renal pelvis. PMID:25548725

  14. Can stone density on plain radiography predict the outcome of extracorporeal shockwave lithotripsy for ureteral stones?

    PubMed Central

    Lim, Ki Hong; Jung, Jin-Hee; Kwon, Jae Hyun; Lee, Yong Seok; Bae, Jungbum; Cho, Min Chul; Lee, Kwang Soo

    2015-01-01

    Purpose The objective was to determine whether stone density on plain radiography (kidney-ureter-bladder, KUB) could predict the outcome of extracorporeal shockwave lithotripsy (ESWL) for ureteral stones. Materials and Methods A total of 223 patients treated by ESWL for radio-opaque ureteral stones of 5 to 20 mm were included in this retrospective study. All patients underwent routine blood and urine analyses, plain radiography (KUB), and noncontrast computed tomography (NCCT) before ESWL. Demographic, stone, and radiological characteristics on KUB and NCCT were analyzed. The patients were categorized into two groups: lower-density (LD) group (radiodensity less than or equal to that of the 12th rib, n=163) and higher-density (HD) group (radiodensity greater than that of the 12th rib, n=60). Stone-free status was assessed by KUB every week after ESWL. A successful outcome was defined as stone free within 1 month after ESWL. Results Mean stone size in the LD group was significantly smaller than that in the HD group (7.5±1.4 mm compared with 9.9±2.9 mm, p=0.002). The overall success rates in the LD and HD groups were 82.1% and 60.0%, respectively (p=0.007). The mean duration of stone-free status and average number of SWL sessions required for success in the two groups were 21.7 compared with 39.2 days and 1.8 compared with 2.3, respectively (p<0.05). On multivariate logistic analysis, stone size and time to ESWL since colic and radiodensity of the stone on KUB were independent predictors of successful ESWL. Conclusions Our data suggest that larger stone size, longer time to ESWL, and ureteral stones with a radiodensity greater than that of the 12th rib may be at a relatively higher risk of ESWL failure 1 month after the procedure. PMID:25598937

  15. Noncontrast helical CT for ureteral stones.

    PubMed

    Boridy, I C; Nikolaidis, P; Kawashima, A; Sandler, C M; Goldman, S M

    1998-01-01

    Noncontrast helical computed tomography (CT) has recently been found to be superior to excretory urography (IVU) in the evaluation of patients with suspected ureterolithiasis. Noncontrast helical CT does not require the use of intravenous contrast material with its associated cost and risk of adverse reactions and can be completed within 5 min, in most cases. Noncontrast CT often detects extraurinary pathology responsible for the patient's symptoms. CT is also more sensitive than IVU in detecting the calculus, regardless of its size, location, and chemical composition. However, confidently differentiating ureteral calculi from phleboliths along the course of the ureter may, at times, be difficult. The "tissue-rim" sign, a rim of soft tissue attenuation around the suspicious calcification, is helpful in making this distinction. Noncontrast CT does not provide physiological information about renal function and the degree of obstruction. A pilot study has suggested a proportional relationship between the extent of perinephric edema and the degree of obstruction. The cost of the examination and the radiation dose delivered to the patient may be higher with CT. Despite these limitations, noncontrast helical CT has quickly become the imaging study of choice in evaluating patients with acute flank pain. PMID:9542010

  16. 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

  17. [Extracorporeal shockwave lithotripsy in the treatment of distal ureteral stones larger than 10 mm in diameter].

    PubMed

    Ishii, Nobuyuki; Yoshinaga, Atsushi; Ohno, Rena; Chiba, Koji; Hayashi, Tetsuo; Kamata, Shigeyoshi; Watanabe, Toru; Yamada, Takumi

    2004-06-01

    Optimal treatment for distal ureteral stones remains controversial. During a period of 10 years, from December 1992 to December 2002, 103 distal ureteral stones larger than 10 mm in diameter were treated at our institution with extracorporeal shock wave lithotripsy (ESWL) using the Siemens Lithostar. Only 2 patients had a ureteral stent in place at the time of treatment. The overall stone-free rate was 98% with 1-12 session and 3-month stone-free rate was 95.1%. These data reveal that a high success rate was achieved in multisession ESWL. Therefore, ESWL is considered to be acceptable as first-line therapy for fragmentation of distal ureteral stones larger than 10 mm in diameter. PMID:15293734

  18. Giant ureteral stone in a patient with a single functioning kidney: a case report.

    PubMed

    Jeong, Y B; Park, J K; Kim, H J; Kim, Y G; Kim, M K

    2011-06-01

    A 43-year-old man presented with long-standing left flank pain. A plain abdominal radiograph and intravenous urography (IVU) revealed a giant ureteral stone measuring 6.2 × 2.2 cm causing ureteral obstruction. A non-enhanced computerized tomography (CT) scan showed a significantly atrophied right kidney and left hydronephroureterosis with a giant stone. A left transperitoneal laparoscopic ureterolithotomy was performed with excellent results. PMID:21612759

  19. Safety and efficacy of using the stone cone and an entrapment and extraction device in ureteroscopic lithotripsy for ureteric stones

    PubMed Central

    Shabana, Waleed; Teleb, Mohamed; Dawod, Tamer

    2015-01-01

    Objective To assess the safety and efficacy of using a stone cone and an entrapment and extraction device (N-Trap®, Cook Urological, Bloomington, IN, USA) to avoid stone retropulsion during ureteroscopic lithotripsy for ureteric stones. Patients and methods This retrospective comparative study included 436 patients treated with ureteroscopic lithotripsy for a single ureteric stone from February 2011 to January 2014. The diagnosis of a stone was confirmed by plain spiral computed tomography in all cases. Patients were divided according to the ureteric occlusion device applied to avoid stone retropulsion during pneumatic lithotripsy into three groups; group 1 (156) had no instruments used, group 2 (140) in whom the stone cone was applied, and group 3 (140) in whom the N-Trap was used. Patient demographics, stone criteria, operative duration and complications, and success rates (complete stone disintegration with no upward migration) were reported and analysed statistically. Results The stone was in the lower ureter in >55% of patients in all groups. The mean (SD) of maximum stone length was 9.8 (2.5), 10.4 (2.8) and 9.7 (2.9) in groups 1–3, respectively. The use of the stone cone or N-Trap did not significantly increase the operative duration (P = 0.13) or complication rates (P = 0.67). There was a statistically significant difference (P < 0.001) favouring groups 2 and 3 for retropulsion and success rates, being 83.3% in group 1, 97.1% in group 2 and 95.7% in group 3. Conclusion The stone cone and N-Trap gave high success rates in preventing stone retropulsion during ureteric pneumatic lithotripsy. Both devices caused no increase in operative duration or complications when used cautiously. PMID:26413324

  20. Minimally invasive surgical treatment for large impacted upper ureteral stones: Ureteroscopic lithotripsy or percutaneous nephrolithotomy?

    PubMed Central

    Bozkurt, Ibrahim Halil; Yonguc, Tarik; Arslan, Burak; Degirmenci, Tansu; Gunlusoy, Bulent; Aydogdu, Ozgu; Koras, Omer

    2015-01-01

    Introduction: The management of patients with large impacted upper ureteral stones is difficult; there is no standard treatment. We compared the outcomes of percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (UL) to treat large (≥1.5 cm), impacted, upper ureteral stones. Methods: In total, 86 patients with large impacted upper ureteral stones were included in this study. Of these patients 41 underwent UL and 45 underwent PCNL. The inclusion criteria were: longest diameter of stone ≥1.5 cm, the localization of stone between the lower border of L4 spine and ureteropelvic junction and impacted stone. Results: In the UL group, we were unable to reach the stone in 3 patients because of ureteral stricture and edema despite balloon dilation. Of these 3 patients, we were unable to optimally visualize the stone in 2 patients due to bleeding and mucosal injury following balloon dilation. The stricture was too firm and could not be passed in the third patient. Also in the UL group, 15 patients had stones or big fragments which migrated into the renal collecting system. In the PCNL group, 21 patients had concurrent renal stones <1 cm and stones were successfully removed in all patients. No statistically significant difference was found between groups in terms of operation time. Mean hospital stay was significantly shorter in the UL group. Success rates were 82.3% in the UL group and 97.6% in the PCNL group (p = 0.001). Conclusion: The recent study confirms that PCNL is a safe and effective minimally invasive procedure with acceptable complication rates in the treatment of patients with large, impacted upper ureteral stones. PMID:25844097

  1. Anuria Secondary to Bilateral Obstructing Ureteral Stones in the Absence of Renal Colic

    PubMed Central

    Lang, Christopher; Altamar, Hernan O.

    2016-01-01

    Abstract Background: Obstructing ureteral stones are a rare cause of anuria, which is typically from prerenal or renal etiologies. Classically, obstructive stones cause moderate to severe renal colic. Urolithiasis is rarely considered during evaluation of painless anuria. Case Presentation: We present an unusual case of a 73-year-old Caucasian female who presented with anuria and was found to have large bilateral obstructing ureteral stones in the absence of renal colic. Conclusion: Given that patients with obstructive anuria can be asymptomatic, urolithiasis should be considered in all patients presenting with anuria. PMID:27579429

  2. [Operative fiberoptic nephroureteroscope--removal of renal and upper ureteral stones].

    PubMed

    Aso, Y; Otawara, Y; Fukuta, K; Sudoko, H; Nakano, M; Ushiyama, T; Ota, N; Suzuki, K; Tajima, A

    1987-06-01

    Two types of operative fiberoptic nephroureteroscopes were developed with the cooperation of the Olympus Optical Company mainly to remove the upper urinary tract calculi. Removal of the renal and upper ureteral stones was attempted in nine cases. The ureter was dilated with olive tip, balloon and Teflon dilators alone or in combination. The combination of balloon and Teflon dilators seemed the most promising. As a result of ureteral dilation, operative fiberoptic nephroureteroscopes, 4.5 mm and 3.5 mm in diameter, could be passed into the ureter in all the cases and the stones could be visualized clearly. Four of the 7 upper ureteral stones and 1 of the 2 pelvic stones could be removed. The success ratio was 56%. The method of stone removal still requires improvement. At present, application of the operative fiberoptic nephroureteroscope is indicated for upper ureteral and renal stones less than 1.0 cm in diameter. With the improved techniques of stone removal using this fiberscope, the indications of extracorporeal shock-wave lithotripsy or percutaneous nephrolithotripsy will probably be greatly reduced in the near future. PMID:3673834

  3. 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

  4. 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

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

    PubMed

    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

  6. Combined Endoscopic and Percutaneous Retrieval of a Retained 4-Wire Ureteral Stone Basket

    PubMed Central

    Kaplan, Adam G.; Preminger, Glenn M.

    2015-01-01

    Abstract Complex endourologic procedures may require the use of a combined ureteroscopic and percutaneous approach. Endoscopic removal of a retained 4-wire ureteral stone basket is particularly complex, as broken tines can potentially injure the ureter if the basket is removed in a retrograde manner. The patient in this case presented with a ureteral stone basket embedded within the urothelium of the upper pole of the kidney. Holmium laser incision of the overlying urothelium allowed retrieval of the basket, although the tines were broken. Endoscopically guided percutaneous access to the kidney was obtained to allow for direct passage of the retained basket out of a nephrostomy sheath, thereby protecting the kidney.

  7. The Role of Ureteral Relaxation in the Promotion of Stone Passage

    NASA Astrophysics Data System (ADS)

    Davenport, Kim; Timoney, Anthony G.; Keeley, Francis X.

    2007-04-01

    In order to promote stone passage in renal colic, we must first understand normal ureteral activity and how this is affected by the presence of a stone. Measuring normal ureteral activity in humans is difficult without the use of invasive methods or techniques which in themselves may affect peristalsis. Monitoring the activity during confirmed renal colic is even more difficult and virtually impossible. Both animal and human studies have therefore been used in an attempt to understand the physiology of the ureter and how this is affected by the presence of a stone. Using this knowledge, drugs can be used to alter the behavior of the ureter in an attempt to promote stone passage. Peristalsis has always been thought to be essential to allow stone passage and therefore it has been necessary to determine whether stone passage occurs by promotion of ureteral activity or by smooth muscle relaxation. Research indicates that drugs which allow continued peristalsis whilst preventing the increased uncoordinated activity seen in renal colic would be the most advantageous. The alpha-1A-adrenoceptor antagonists are the most effective drugs to date.

  8. 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

  9. Tamsulosin versus tadalafil as a medical expulsive therapy for distal ureteral stones: A prospective randomized study

    PubMed Central

    Shrestha, Anil; Acharya, Ganesh Bhakta; Basnet, Robin Bahadur; Shah, Arvind Kumar; Shrestha, Parash Mani

    2016-01-01

    Purpose This study aimed to compare the safety and efficacy of tamsulosin and tadalafil as medical expulsive therapy for distal ureteral stones. Materials and Methods This prospective randomized study was conducted at the Department of Urology of Bir Hospital over a period of 12 months in patients with distal ureteral stones sized 5 to 10 mm. Patients were randomly divided into 2 groups: group A received tamsulosin 0.4 mg and group B received tadalafil 10 mg at bedtime for 2 weeks. Stone expulsion rate, number of ureteric colic episodes and pain score, analgesic requirements, and adverse drug effects were noted in both groups. Statistical analyses were performed by using Student t-test and chi-square test. Results Altogether 85 patients, 41 in group A and 44 in group B, were enrolled in the study. The patients' average age was 31.72±12.63 years, and the male-to-female ratio was 1.5:1. Demographic profiles, stone size, and baseline investigations were comparable between the 2 groups. The stone expulsion rate was significantly higher in the tadalafil group than in the tamsulosin group (84.1% vs. 61.0%, p=0.017). Although the occurrence of side effects was higher with tadalafil, this difference was not significant (p=0.099). There were no serious adverse effects. Conclusions Tadalafil has a significantly higher stone expulsion rate than tamsulosin when used as a medical expulsive therapy for distal ureteral stones sized 5–10 mm. Both drugs are safe, effective, and well tolerated with minor side effects. PMID:27617317

  10. The comparison of laparoscopy, shock wave lithotripsy and retrograde intrarenal surgery for large proximal ureteral stones

    PubMed Central

    Ozturk, M.D. Ufuk; Şener, Nevzat Can; Goktug, H.N. Goksel; Gucuk, Adnan; Nalbant, Ismail; İmamoglu, M. Abdurrahim

    2013-01-01

    Introduction In this study we compare the success rates and complication rates of shock wave lithotripsy (SWL), laparoscopic, and ureteroscopic approaches for large (between 1 and 2 cm) proximal ureteral stones. Methods: In total, 151 patients with ureteral stones between 1 and 2 cm in diameter were randomized into 3 groups (52 SWL, 51 laparoscopy and 48 retrograde intrarenal surgery [RIRS]). The groups were compared for stone size, success rates, and complication rates using the modified Clavien grading system. Results: Stone burden of the groups were similar (p = 0.36). The success rates were 96%, 81% and 79%, respectively in the laparoscopy, SWL, and ureteroscopy groups. The success rate in laparoscopy group was significantly higher (p < 0.05). When these groups were compared for complication rates, RIRS seemed to be the group with the lowest complication rates (4.11%) (p < 0.05). SWL and laparoscopy seem to have similar rates of complication (7.06% and 7.86%, respectively, p = 0.12). Interpretation: To our knowledge, this is the first study to compare the results of laparoscopy, SWL and RIRS in ureteral stones. Our results showed that in management of patients with upper ureteral stones between 1 and 2 cm, laparoscopy is the most successful method based on its stone-free rates and acceptable complication rates. However, the limitations of our study are lack of hospital stay and cost-effectiveness data. Also, studies conducted on larger populations should support our findings. When a less invasive method is the only choice, SWL and flexible ureterorenoscopy methods have similar success rates. RIRS, however, has a lower complication rate than the other approaches. PMID:24282455

  11. Antegrade Flexible Ureteroscopy for Bilateral Ureteral Stones in a Patient with Severe Hip Joint Ankylosis

    PubMed Central

    Kim, Bum Soo; Lee, Jun Nyung; Choi, Jae Young; Park, Yoon Kyu

    2010-01-01

    In the past several decades there has been a remarkable development of small-caliber, flexible ureteroscopes and various ancillary instruments for stone manipulation and retrieval. Percutaneous antegrade ureteroscopy can be substituted in select cases for retrograde ureteroscopy. We report a case of a 60-year-old man with severe ankylosis in both hip joints who was diagnosed with bilateral ureteral stones. The patient underwent antegrade flexible ureteroscopy and laser lithotripsy. This case illustrates the role of antegrade flexible ureteroscopy combined with the holmium:YAG laser as a minimally invasive, safe, and effective technique for the management of stones in a patient who cannot undergo a retrograde approach. PMID:21165203

  12. A Prospective, Multi-Institutional Study of Flexible Ureteroscopy for Proximal Ureteral Stones Smaller than 2 cm

    PubMed Central

    Hyams, Elias S.; Monga, Manoj; Pearle, Margaret S.; Antonelli, Jodi A.; Semins, Michelle J.; Assimos, Dean G.; Lingeman, James E.; Pais, Vernon M.; Preminger, Glenn M.; Lipkin, Michael E.; Eisner, Brian H.; Shah, Ojas; Sur, Roger L; Mufarrij, Patrick W.; Matlagak, Brian R.

    2015-01-01

    Purpose Flexible ureteroscopy is rapidly becoming a first line therapy for many patients with renal and ureteral stones. However, current understanding of treatment outcomes in patients with isolated proximal ureteral stones is limited. Therefore, we performed a prospective, multi-institutional study of ureteroscopic management of proximal ureteral stones smaller than 2 cm to better define clinical outcomes associated with this approach. Materials and Methods Adult patients with proximal ureteral calculi smaller than 2 cm were prospectively identified. Patients with concomitant ipsilateral renal calculi or prior ureteral stenting were excluded from study. Flexible ureteroscopy, holmium laser lithotripsy and ureteral stent placement was performed. Ureteral access sheath use, laser settings and other details of perioperative and postoperative management were based on individual surgeon preference. Stone clearance was determined by the results of renal ultrasound and plain x-ray of the kidneys, ureters and bladder 4 to 6 weeks postoperatively. Results Of 71 patients 44 (62%) were male and 27 (38%) were female. Mean age was 48.2 years. ASA® score was 1 in 12 cases (16%), 2 in 41 (58%), 3 in 16 (23%) and 4 in 2 (3%). Mean body mass index was 31.8 kg/m2, mean stone size was 7.4 mm (range 5 to 15) and mean operative time was 60.3 minutes (range 15 to 148). Intraoperative complications occurred in 2 patients (2.8%), including mild ureteral trauma. Postoperative complications developed in 6 patients (8.7%), including urinary tract infection in 3, urinary retention in 2 and flash pulmonary edema in 1. The stone-free rate was 95% and for stones smaller than 1 cm it was 100%. Conclusions Flexible ureteroscopy is associated with excellent clinical outcomes and acceptable morbidity when applied to patients with proximal ureteral stones smaller than 2 cm. PMID:25014576

  13. Efficacy of nifedipine and alfuzosin in the management of distal ureteric stones: A randomized, controlled study

    PubMed Central

    Sameer; Lal, Shyam; Charak, K. S.; Chakravarti, Sumit; Kohli, Supreeti; Ahmad, Shamshad

    2014-01-01

    Introduction: Stone disease is a significant and world-wide health problem. Recently, certain drugs have been used as a supplement to observation alone in an effort to improve spontaneous stone expulsion. We evaluated the efficacy of nifedipine and alfuzosin in the medical treatment of symptomatic, uncomplicated distal ureteral stones. Materials and Methods: This was a randomized controlled prospective study to determine the efficacy of alfuzosin and nifedipine as an adjunctive medical therapy, to increases the stone-expulsion rates in distal ureteric calculus of size ≤10 mm. Investigators and patients were blinded to the randomization scheme. Patients were randomly divided into three equal groups of 35 patients each. Patients in Group I received tablet nifedipine 30 mg/day, Group II received alfuzosin 10 mg/day and Group III was the control group received tablet diclofenac sodium. The patient blood pressure, stone position on imaging, number of pain attacks, time of stone-expulsion, hospital re-admission and any adverse events were assessed. Patients were followed-up weekly and continued until the patient was rendered stone free or up to 28 days. Statistical analysis was performed and P < 0.05 was considered to be significant. Results: Stone-expulsion was observed in 60%, 85.7% and 20% patients in Group I, II and III respectively. A statistically significant difference was noted in between Groups I versus III, Groups II versus III and Groups I versus II (P < 0.0001, P < 0.0001, and P < 0.0315 respectively). The mean number of pain attacks was 2.91 ± 1.01 for Group I, 1.8 ± 0.83 for Group II, and 2.82 ± 1.12 for Group III, which is statistical significant in Groups II versus III, and Groups I versus II (P < 0.001 and P < 0.001). Hospital re-admission rate was less in treatment groups when compare to control group (P < 0.0001). Conclusion: The use of alfuzosin and nifedipine as a medical expulsive therapy for distal ureteric stones proved to be safe and

  14. Tamsulosin versus Alfuzosin in the Treatment of Patients with Distal Ureteral Stones: Prospective, Randomized, Comparative Study

    PubMed Central

    Al-sayed, Abul-yazid Saad

    2010-01-01

    Purpose We evaluated and compared the efficacy of tamsulosin and alfuzosin in the medical treatment of symptomatic, uncomplicated distal ureteral stones. Materials and Methods A total of 87 patients with distal ureteral stones of ≤10 mm were randomly divided into 3 groups. Group I patients (n=29) received 0.4 mg tamsulosin daily, group II patients (n=30) received 10 mg alfuzosin daily, and group III patients (n=28) were not given tamsulosin or alfuzosin. Patients in all groups received Diclofenac sodium regularly for 1 week and then on demand. Follow-up was done on a weekly basis for 30 days. Results The mean stone size was comparable in the 3 groups (4.97±2.24, 5.47±2.13, and 5.39±1.81 mm, respectively). The stone expulsion rate was 86.2%, 76.6%, and 50% in groups I, II, and III, respectively. The difference in groups I and II with respect to group III was significant (p=0.0028 and 0.035). The mean expulsion time for groups I to III was 7.52±7.06, 8.26±7.34, and 13.90±6.99 days, respectively. The expulsion time was significantly shorter in groups I and II than in group III (p=0.0097 and 0.026). Patients taking tamsulosin and alfuzosin had fewer pain attacks than did group III patients (1.24±0.57 vs. 1.43±0.67 vs. 1.75±1.17). Only 3 cases of drug side effects, 2 in group I and 1 in group II, were recorded. Conclusions The use of tamsulosin or alfuzosin for the medical treatment of lower ureteric stones proved to be safe and effective. Moreover, tamsulosin did not have any significant benefits over alfuzosin. PMID:20414396

  15. 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

  16. 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

  17. Comparative efficacy of tadalafil versus tamsulosin as the medical expulsive therapy in lower ureteric stone: a prospective randomized trial

    PubMed Central

    Mylarappa, Prasad; Aggarwal, Kuldeep; Patil, Avinash; Joshi, Prarthan; Desigowda, Ramesh

    2016-01-01

    Introduction In recent years, medical expulsive therapy has been used in the management of distal ureteric stones as a supplement to conservative treatment. Therefore, we conducted a prospective randomized study to evaluate the possible role of tadalafil individually in comparison with proven tamsulosin therapy in ureteric stone expulsion. The aim of this study is to compare the safety and efficacy of a phosphodiesterase-5 inhibitor (tadalafil) and an α-1 blocker (tamsulosin) as medical expulsive therapy for distal ureteric calculi. Material and methods Between August 2014 and October 2015, 207 patients who presented with distal ureteric stones of size 5–10 mm were randomly divided into two groups: tadalafil (Group A) and tamsulosin (Group B). Therapy was given for a maximum of 4 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow-up, endoscopic treatment and adverse effects of drugs were noted. Both groups were compared for normally distributed data by percentage, analysis of variance, and T-test. All the classified and categorical data were analyzed for both groups using the chi-square test. Results A statistically significant expulsion rate of 84.0% in Group A compared with 68.0% in Group B (P value = 0.0130), and shorter stone expulsion time in Group A (14.7±3.8) in comparison to Group B (16.8 ±4.5) was observed. Statistically significant differences were noted in renal colic episodes and analgesic requirement in Group A than Group B. No serious adverse effects were noted. Conclusions Tadalafil is safe, efficacious, and well tolerated as medical expulsive therapy for distal ureteric stones. This study showed that tadalafil increases ureteric stone expulsion quite significantly along with better control of pain and significantly lower analgesic requirement. PMID:27551555

  18. 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

  19. A Comparison of Antegrade Percutaneous and Laparoscopic Approaches in the Treatment of Proximal Ureteral Stones

    PubMed Central

    Sari, Sercan; Ozok, Hakki Ugur; Sagnak, Levent; Ersoy, Hamit

    2014-01-01

    Purpose. To compare the effectiveness and safety of retroperitoneal laparoscopic ureterolithotomy (RLU) and percutaneous antegrade ureteroscopy (PAU) in which we use semirigid ureteroscopy in the treatment of proximal ureteral stones. Methods. Fifty-eight patients with large, impacted stones who had a history of failed shock wave lithotripsy (SWL) and, retrograde ureterorenoscopy (URS) were included in the study between April 2007 and April 2014. Thirty-seven PAU and twenty-one RLU procedures were applied. Stone-free rates, operation times, duration of hospital stay, and follow-up duration were analyzed. Results. Overall stone-free rate was 100% for both groups. There was no significant difference between both groups with respect to postoperative duration of hospital stay and urinary leakage of more than 2 days. PAU group had a greater amount of blood loss (mean hemoglobin drops for PAU group and RLU group were 1.6 ± 1.1 g/dL versus 0.5 ± 0.3 g/dL, resp.; P = 0.022). RLU group had longer operation time (for PAU group and RLU group 80.1 ± 44.6 min versus 102.1 ± 45.5 min, resp.; P = 0.039). Conclusions. Both PAU and RLU appear to be comparable in the treatment of proximal ureteral stones when the history is notable for a failed retrograde approach or SWL. The decision should be based on surgical expertise and availability of surgical equipment. PMID:25295266

  20. 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

  1. Laparoscopic management of distal ureteric stones in a bilharzial ureter: Results of a single-centre prospective study

    PubMed Central

    Nour, Hani H.; Elgobashy, Samir E.; Elkholy, Amr; Kamal, Ahmad M.; Roshdy, Mamdouh A.; Elbaz, Ahmad G.; Riad, Essam

    2015-01-01

    Objective To determine the efficacy and safety of the laparoscopic management of an impacted distal ureteric stone in a bilharzial ureter, as bilharzial ureters are complicated by distal stricture caused by the precipitation of bilharzial ova in the distal ureter. These cases are associated with poorly functioning and grossly hydronephrotic kidneys that hinder the endoscopic manipulation of the coexistent distal high burden of, and long-standing, impacted stones. Patients and methods We used laparoscopic ureterolithotomy, with four trocars, to manage 51 bilharzial patients (33 men and 18 women; mean age 40.13 years) with distal ureteric stones. The ureter was opened directly over the stone and the stone was extracted. A JJ stent was inserted into the ureter, which was then closed with a 4–0 polyglactin running suture. Results The mean stone size was 2.73 cm. Conversion to open surgery was required in only one patient. The mean operative duration was 92 min, the postoperative pain score was 20–60, the mean (range) number of analgesic requests after surgery was 1.72 (1–3), comprising once in 21 patients, twice in 23 and thrice in seven. The mean hospital stay was 2.74 days, and the total duration of follow-up was 7–12 months. The stone recurred in four patients and a ureteric stricture was reported in two. All patients were rendered stone-free. Conclusion Laparoscopy is a safe and effective minimally invasive procedure for distal ureteric stones in a bilharzial ureter with hydronephrosis. PMID:26413344

  2. A novel approach for accurate prediction of spontaneous passage of ureteral stones: support vector machines.

    PubMed

    Dal Moro, F; Abate, A; Lanckriet, G R G; Arandjelovic, G; Gasparella, P; Bassi, P; Mancini, M; Pagano, F

    2006-01-01

    The objective of this study was to optimally predict the spontaneous passage of ureteral stones in patients with renal colic by applying for the first time support vector machines (SVM), an instance of kernel methods, for classification. After reviewing the results found in the literature, we compared the performances obtained with logistic regression (LR) and accurately trained artificial neural networks (ANN) to those obtained with SVM, that is, the standard SVM, and the linear programming SVM (LP-SVM); the latter techniques show an improved performance. Moreover, we rank the prediction factors according to their importance using Fisher scores and the LP-SVM feature weights. A data set of 1163 patients affected by renal colic has been analyzed and restricted to single out a statistically coherent subset of 402 patients. Nine clinical factors are used as inputs for the classification algorithms, to predict one binary output. The algorithms are cross-validated by training and testing on randomly selected train- and test-set partitions of the data and reporting the average performance on the test sets. The SVM-based approaches obtained a sensitivity of 84.5% and a specificity of 86.9%. The feature ranking based on LP-SVM gives the highest importance to stone size, stone position and symptom duration before check-up. We propose a statistically correct way of employing LR, ANN and SVM for the prediction of spontaneous passage of ureteral stones in patients with renal colic. SVM outperformed ANN, as well as LR. This study will soon be translated into a practical software toolbox for actual clinical usage. PMID:16374437

  3. 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

  4. 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

  5. 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

  6. Study of the ureterovesical jet flow by means of dupplex Doppler ultrasonography in patients with residual ureteral stone after extracorporeal shock wave lithotripsy.

    PubMed

    Ciftci, Halil; Cece, Hasan; Dusak, Abdurrahim; Savas, Murat; Verit, Ayhan; Yeni, Ercan

    2010-02-01

    The aims of our study are to evaluate ureterovesical jet flow Doppler ultrasound (US) in patients with residual ureteral stone after extracorporeal shock wave lithotripsy (ESWL) and to compare with unobstructed contralateral ureter. Patients who have residual ureteral stone in intravenous pyelography (IVP) and/or computed tomography (CT) after ESWL and unobstructed contralateral ureter in 20 patients were prospectively evaluated with Doppler US. The mean peak velocity of the Doppler waveforms was obtained on the residual ureteral stone and contralateral non-obstructed ureter (17.10 +/- 20), (56.0 +/- 32), respectively (P < 0.05). In conclusion, due to the absence of contraindications and side-effects, Doppler US is sensitive and highly specific that can contribute significantly to the diagnosis of residual ureteral stone after ESWL. It can replace IVP and/or CT, in condition where IVP is undesirable and in addition Doppler US can supply a functional investigation of the obstructed ureter. PMID:19940988

  7. 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

  8. 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

  9. 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

  10. Management of Large Proximal Ureteral Stones: A Comparative Clinical Trial Between Transureteral Lithotripsy (TUL) and Shock Wave Lithotripsy (SWL)

    PubMed Central

    Rabani, Seyed Mohammadreza; Moosavizadeh, Ali

    2012-01-01

    Background A review of the related medical journals indicates that there is no definite evidence-based option for managing large proximal ureteral stones, although many procedures such as transureteral lithotripsy (TUL), shock wave lithotripsy (SWL), percutaneous nephrolithotripsy, laparoscopic ureterolithotomy, and open ureterolithotomy are currently used to treat this urological problem. Objectives In this study, we tried to determine the most appropriate treatment plan for proximal ureteral stones larger than 12 mm by comparing the two most commonly used procedures. Patients and Methods Between February 2005 and April 2011, 62 patients including 40 males and 22 females (mean age 39.5 years, range 19 to 64) with proximal ureteral stones larger than 12 mm (12–26 mm) with a mean size of 17.64 mm were prospectively divided into two groups consisting of 32 patients who underwent TUL (group A) and 30 who underwent SWL (group B). In unsuccessful cases, repeat SWL or TUL was planned. Patients who could not tolerate the lithotomy position, younger than 18 years, had undergone coagulopathy, had concurrent renal and ureteral stones, were pregnant, or had sepsis were excluded from this study. Results Stone access was successful in 28 patients and the treatment was efficient in 18 patients (56.25%) in group A. For the patients with successful stone access but unsuccessful TUL, a DJ was inserted and a second ureteroscopic intervention was performed. The second intervention was successful in 7 patients (21.87). SWL was successful in 14 patients (46.66%) in the first attempt and in 7 additional patients in the second intervention (23.33%). Conclusions In this study, we showed different success rates for SWL and TUL because of the larger size of the stones. We achieved a success rate of 56.25% in the first attempt in the TUL group, and the overall success rate (after the second TUL) was 78.12%. In comparison, the SWL group had a success rate of 46.66% in the first attempt, and

  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. Retroperitoneoscopic versus open mini-incision ureterolithotomy for upper- and mid-ureteric stones: a prospective randomized study.

    PubMed

    Prakash, Jai; Singh, Vishwajeet; Kumar, Manoj; Kumar, Manoj; Sinha, Rahul Janak; Sankhwar, Satyanarayan

    2014-04-01

    To compare the retroperitoneoscopic ureterolithotomy (RPLU) versus open mini-incision ureterolithotomy (MIOU) for large and impacted proximal or mid-ureteric stones in prospective randomized manner and to assess the outcome results. In a prospective randomized study between January 2009 and December 2012, 35 RPLU and 35 MIOU were included in the study. The indications for ureterolithotomy were as primary treatment of large and impacted stones more than 1.5 cm in the proximal and mid-ureter and as salvage treatment of failed ureteroscopy (URS)/extracorporeal shock wave lithotripsy (SWL). The two groups were compared for visual pain score on the first and second postoperative day, analgesic requirement, stone removal in one attempt, operative time, blood loss, postoperative complications, hospital stays and the period of convalescence. The difference in the visual pain score and the tramadol requirement was significantly higher in MIOU group. The hospital stay (RPLU 2.86 ± 0.43, MIOU 5.71 ± 0.67, P ≤ 0.001) and period of convalescence (RPLU 12.29 ± 4.06, MIOU 24.11 ± 5.55, P ≤ 0.001) were also significantly higher in MIOU group. The complications were 11.4 % (P ≤ 0.02) in RPLU versus 17.4 % in MIOU group. However, the stone removal in one attempt was similar in both groups. In condition of failed URS/SWL, unavailability of the full endoscopic armamentarium and limitation of costs, RPLU and MIOU both are safe and effective treatment options for large impacted upper- and mid-ureteric stones and RPLU has better tolerability, lesser hospital time and equal stone clearance rate. PMID:24272062

  15. A 52-Year-Old Male with Bilaterally Duplicated Collecting Systems with Obstructing Ureteral Stones: A Case Report

    PubMed Central

    Scantling, Dane; Ross, Curtis; Altman, Howard

    2013-01-01

    Collecting system duplication is marked by a variety of clinical syndromes. Bilateral and obstructed duplicated systems, particularly with asymmetric levels of duplication, are rare and typically due to ureteric bud development anomalies. The infrequency with which this condition exists makes it a formidable challenge for physicians and patients. To our knowledge, we present the first case report of bilateral obstruction of bilaterally duplicated collecting systems. In our case, a 52-year-old male complaining of low back pain, constipation, urinary urgency and hematuria was found to have bilateral obstructing stones as well as asymmetrical bilateral collecting system duplication. We discuss the natural history of this condition, its consequences and identification. PMID:24917767

  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. A giant ureteric calculus.

    PubMed

    Rathod, Rajiv; Bansal, Prashant; Gutta, Srinivas

    2013-07-01

    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

  18. A rare case of obstructive azoospermia due to compression of the seminal vesicle and ejaculatory duct by a large lower ureteric stone.

    PubMed

    Ranjan, Priyadarshi; Yadav, Abhishek; Kapoor, Rohit; Singh, Ranjana

    2013-03-01

    Male infertility due to obstructive azoospermia is a well-known entity. It is characterised by obstruction to the outflow of sperms either in the epididymis, vas, seminal vesicles or the ejaculatory ducts. We describe a rare case of obstructive azoospermia due to compression of the ejaculatory duct and seminal vesicle by a large lower ureteric stone in a 30-year-old man who had infertility for the past ten years. The patient's azoospermia resolved after removal of the stone. PMID:23546036

  19. The effect of ureteroscope size in the treatment of ureteral stone: 15-year experience of an endoscopist

    PubMed Central

    Kılınç, Muhammet Fatih; Doluoğlu, Ömer Gökhan; Karakan, Tolga; Dalkılıç, Ayhan; Sönmez, Nurettin Cem; Yücetürk, Cem Nedim; Reşorlu, Berkan

    2016-01-01

    Objective We aimed to investigate the ureter stone treatment results performed by using different- caliber semirigid ureteroscopes (URS). Material and methods Adult patients who were treated for ureteral stones by a single endoscopist between January 2000 and March 2015 were analyzed. The patients were divided into 3 groups in accordance with the caliber of the ureteroscope used: 10/10.5 F Storz (Karl Storz, Tuttlingen, Germany) (January 2002–January 2005) URS was used in group 1, 8.9/9.8 F Storz (February 2005–December 2011) URS was used in group 2, and 6/7.5 FWolf (Richard Wolf, Knittlingen, Germany) (January 2012–March 2015) URS was used in group 3. Patients’ age and gender, size and site of stones, stone-free rates (SFR), intra- and perioperative complication rates, and durations of surgery were compared among the groups. Intraoperative complications were classified according to modified Satava, and perioperative complications were classified according to modified Clavien classification systems. Results A total of 2461 patients treated for ureteral stones were analyzed. There were 583 patients in group 1 (10/10.5 F Storz), 1302 patients in group 2 (8.9/9.8 F Storz), and 576 patients in group 3 (6/7.5 F Wolf). SFR were 83.7%, 87.4%, and 92.2% in groups 1, 2, and 3, respectively (p=0.01). Duration of surgery was 30.34±10.36 min in group 1, 31.61±10.10 min in group 2, and 42.40±7.35 min in group 3 (p=0.01). The overall complication rates classified according to modified Satava classification were 10.8%, 7.6%, and 6.9% (p=0.01) while grade 3 modified Satava complication rates were 1.9%, 1.5%and 0.5% in groups 1, 2, and 3, respectively (p=0.01). Conclusion In this study, we found that more frequent use of a small- caliber URS resulted in a longer duration of surgery and an increased rate for JJ stent insertion, however it facilitated a safer and more successful ureteroscopy procedure. PMID:27274889

  20. 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

  1. Randomized Controlled Trial to Compare the Safety and Efficacy of Naftopidil and Tamsulosin as Medical Expulsive Therapy in Combination With Prednisolone for Distal Ureteral Stones

    PubMed Central

    Kurdia, Kailash Chand; Ganesamoni, Raguram; Singh, Shrawan Kumar; Nanjappa, Bhuvanesh

    2013-01-01

    Purpose To compare the safety and efficacy of naftopidil and tamsulosin with prednisolone as medical expulsive therapy for distal ureteric stones. Materials and Methods Between July 2010 and March 2012, 120 adult patients presenting with distal ureteric stones of size 5 to 10 mm were randomized equally to tamsulosin (group A), naftopidil (group B) or watchful waiting (group C). Tamsulosin or naftopidil was given for a maximum of four weeks. In addition patients in group A and B were given 5 mg prednisolone once daily (maximum one week). Stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow-up and endoscopic treatment and adverse effects of drugs were noted. Statistical analyses were done using chi-square test, Mann-Whitney test and analysis of variance. Results There was a statistically higher expulsion rate in groups A (70%) and B (87.5%) as compared to group C (32.5%) (p<0.001). The expulsion rates were not statistically different between groups A and B (p=0.056). The mean time to expulsion was comparable between groups A and B but longer in group C. Analgesic use was significantly lower in groups A and B. Average number of hospital visits for pain, follow-up and endoscopic treatment was similar in all groups. There was no serious adverse event. Conclusions Medical expulsive therapy for the distal ureteric stones using either naftopidil or tamsulosin in combination with prednisolone is safe and efficacious. PMID:23700496

  2. 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

  3. 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.

  4. Ureteral fibroepithelial polyp causing urinary obstruction

    PubMed Central

    Shive, Melissa L.; Baskin, Laurence S.; Harris, Catherine R.; Bonham, Michael; MacKenzie, John D.

    2012-01-01

    Ureteral polyps are rare causes of ureteropelvic junction (UPJ) obstruction, particularly in children. We report a nine year-old boy with UPJ obstruction initially suggestive of an obstructive urinary stone. CT showed intraureteral calcification at the UPJ and hydronephrosis. A retrograde pyelogram showed narrowing at the UPJ and partial obstruction that was found to be a ureteral polyp. This case illustrates a rare cause of UPJ obstruction that should be considered when the imaging findings and presentation are atypical for more common etiologies of ureteral obstruction. PMID:23365709

  5. 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

  6. 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

  7. Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta – analysis of randomized controlled trials

    PubMed Central

    Torricelli, Fabio C. M.; Monga, Manoj; Marchini, Giovanni S.; Srougi, Miguel; Nahas, William C.; Mazzucchi, Eduardo

    2016-01-01

    ABSTRACT Introduction: To provide a systematic review and meta-analysis of randomized controlled trials (RCT) comparing semi-rigid ureteroscopic lithotripsy (URS) with laparoscopic ureterolithotomy (LU) for the treatment of the large proximal ureteral stone. Materials and methods: A systematic literature review was performed in June 2015 using the PubMed, Scopus, and Web of Science databases to identify relevant studies. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria. Results: Six RCT including 646 patients were analyzed, 325 URS cases (50.3%) and 321 LU cases (49.7%). URS provided a significantly shorter operative time (weighted mean difference [WMD] = −31.26 min; 95%CI −46.88 to −15.64; p<0.0001) and length of hospital stay (WMD = −1.48 days; 95%CI −2.78 to −0.18; p=0.03) than LU. There were no significant differences in terms of overall complications (OR = 0.78; 95%CI 0.21-2.92; p=0.71) and major complications – Clavien ≥3 – (OR = 1.79; 95%CI 0.59-5.42; p=0.30). LU led to a significantly higher initial stone-free rate (OR = 8.65; 95%CI 4.18-17.91; p<0.00001) and final stone-free rate (OR = 6.41; 95%CI 2.24-18.32; p=0.0005) than URS. There was a significantly higher need for auxiliary procedures in URS cases (OR = 6.58; 95%CI 3.42-12.68; p<0.00001). Conclusions: Outcomes with LU for larger proximal ureteral calculi are favorable compared to semi-rigid URS and should be considered as a first-line alternative if flexible ureteroscopy is not available. Utilization of flexible ureteroscopy in conjunction with semi-rigid ureteroscopy may impact these outcomes, and deserves further systematic evaluation. PMID:27564273

  8. Diagnosis and initial management of kidney stones.

    PubMed

    Portis, A J; Sundaram, C P

    2001-04-01

    The diagnosis and initial management of urolithiasis have undergone considerable evolution in recent years. The application of noncontrast helical computed tomography (CT) in patients with suspected renal colic is one major advance. The superior sensitivity and specificity of helical CT allow urolithiasis to be diagnosed or excluded definitively and expeditiously without the potential harmful effects of contrast media. Initial management is based on three key concepts: (1) the recognition of urgent and emergency requirements for urologic consultation, (2) the provision of effective pain control using a combination of narcotics and nonsteroidal anti-inflammatory drugs in appropriate patients and (3) an understanding of the impact of stone location and size on natural history and definitive urologic management. These concepts are discussed with reference to contemporary literature, with the goal of providing tools that family physicians can use in the emergency department or clinic. PMID:11310648

  9. Procalcitonin is a strong predictor of urine culture results in patients with obstructing ureteral stones: A prospective, pilot study

    PubMed Central

    Papagiannopoulos, Dimitri; Whelan, Patrick; Ahmad, Waseem; Rybak, James; Hota, Bala; Deane, Leslie; Nehra, Ajay

    2016-01-01

    Purpose: The appropriate management of infected obstructing ureteral calculi is prompt genitourinary decompression. Urine cultures are the gold standard for confirming infection but often take 24–48 h to result. Although white blood cell (WBC) count is an important diagnostic laboratory test, it is a nonspecific inflammatory marker. Similarly, urinalysis (UA) can be misleading in the setting of a contaminated sample, bladder colonization, or in cases of a completely obstructed the upper urinary tract. Procalcitonin (PCT) has shown promise in predicting the presence and degree of bacterial infections. In this proof-of-concept study, we explore whether PCT is effective at predicting concomitant infections in the setting of obstructing ureteral stones. Materials and Methods: This is a prospective, single-institution observational pilot study examining adult patients who presented to the emergency room with acute obstructing ureterolithiasis. In total, 22 patients were enrolled. At the time of presentation, data obtained were vital signs, WBC count, PCT, UA, urine, and blood cultures. Fisher-exact two-tailed t-tests and receiver operating characteristic statistics with area under the curve (AUC) calculations were used to determine the correlation between urine culture results and PCT, WBC count, nitrite-positive UA, heart rate, and fever. Results: In total, 5/22 patients had bacteria-positive urine cultures. PCT (P = 0.020) and nitrite-positive UA (0.024) were the only statistically significant predictors of urine culture results. In comparing the AUC, PCT (0.812) was strongly correlated with eventual urine culture results. Conclusions: This proof-of-concept pilot study gives encouraging results, in that PCT was a good predictor of positive cultures (P = 0.02, AUC 0.812). Given, the small sample size, one cannot directly compare PCT to other markers of infection. However, PCT shows promise in this arena and warrants future investigation. PMID:27453647

  10. Perinephric Hematoma and Hemorrhagic Shock as a Rare Presentation for an Acutely Obstructive Ureteral Stone with Forniceal Rupture: A Case Report

    PubMed Central

    Zynger, Debra L.; Box, Geoffrey N.; Shah, Ketul K.

    2016-01-01

    Abstract Background: Spontaneous perinephric hematoma (SPH) secondary to a forniceal rupture as the first presenting sign for an obstructive ureteral stone in a patient without history of urolithiasis has not been described previously. Case presentation: We report a 70-year-old Caucasian male patient who presented to our emergency room with fever, altered mental status, and left flank pain. He had a temperature of 103.3°F, tachycardia, but stable blood pressure. He had left flank tenderness. A computed tomography scan of the abdomen/pelvis with intravenous contrast revealed an intracapsular hematoma (13.3 × 10.0 × 6.4 cm) with an active bleeding and a 1.1 cm left proximal ureteral stone. The patient became quickly hemodynamically unstable and was taken for emergent exploratory laparotomy and left nephrectomy. An active bleeding was encountered secondary to a (2.4 × 2.0 cm) lateral capsular defect in the kidney. Conclusion: Hemorrhagic/septic shock as a presenting sign for an obstructive ureteral stone may require an emergent nephrectomy in a hemodynamically unstable patient.

  11. Management of impacted proximal ureteral stone: Extracorporeal shock wave lithotripsy versus ureteroscopy with holmium: YAG laser lithotripsy

    PubMed Central

    Khalil, Mostafa

    2013-01-01

    Objective: Prospective evaluation of the efficacy and safety of the extracorporeal shock wave lithotripsy (SWL) and ureteroscopy with Holmium: YAG laser lithotripsy (URSL) as a primary treatment for impacted stone in the proximal ureter. Patients and Methods: A total of 82 patients with a single impacted stone in the proximal ureter were included in the study. Patients were allocated into two groups according to patient preference for either procedure. The first group included 37 patients who were treated by SWL and the second group included 45 patients treated by URSL. The preoperative data and treatment outcomes of both procedures were compared and analyzed. Results: There was no difference as regards to patient and stone characters between the two groups. There was significantly higher mean session number and re-treatment rate in the SWL group in comparison to URSL group (1.5 ± 0.8 vs. 1.02 ± 0.15 session, and 43.2% vs. 2.2%, respectively). At one month, the stone-free rate of the URSL group was statistically significantly higher than that of the SWL group (80% vs. 67.6%, respectively). The stone-free rate at three months was still higher in the URSL group, but without statistically significant difference (80.2% vs. 78.4%, respectively). There was no statistically significant difference in the rate of complications between the SWL and URSL (24.3% vs. 15.6%, respectively). Conclusion: Both procedures can be used effectively and safely as a primary treatment for impacted stone in the proximal ureter; however, the URSL has a significantly higher initial stone-free rate and lower re-treatment rate. PMID:23798864

  12. 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

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

    PubMed

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

    2016-03-01

    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

  14. 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

  15. 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

  16. 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

  17. Percutaneous antegrade fiberoptic ureterorenoscopic treatment of ureteral calculi.

    PubMed

    Berkhoff, W B; Meijer, F

    1990-09-01

    Treatment of upper ureteral calculi can be accomplished by various endourological techniques and/or extracorporeal shock wave lithotripsy. Percutaneous fiberoptic treatment of upper ureteral stones provides an alternative especially suited as second line treatment in cases when extracorporeal shock wave lithotripsy failed. Usually, these patients will present with impacted ureteral stones. Our first experiences with 8 stones in 7 patients to date proved this technique to be safe and reliable, with no complications encountered on excretory urography 3 months postoperatively. PMID:2388317

  18. Urinary Tract Stones and Osteoporosis: Findings From the Women's Health Initiative.

    PubMed

    Carbone, Laura D; Hovey, Kathleen M; Andrews, Christopher A; Thomas, Fridtjof; Sorensen, Mathew D; Crandall, Carolyn J; Watts, Nelson B; Bethel, Monique; Johnson, Karen C

    2015-11-01

    Kidney and bladder stones (urinary tract stones) and osteoporosis are prevalent, serious conditions for postmenopausal women. Men with kidney stones are at increased risk of osteoporosis; however, the relationship of urinary tract stones to osteoporosis in postmenopausal women has not been established. The purpose of this study was to determine whether urinary tract stones are an independent risk factor for changes in bone mineral density (BMD) and incident fractures in women in the Women's Health Initiative (WHI). Data were obtained from 150,689 women in the Observational Study and Clinical Trials of the WHI with information on urinary tract stones status: 9856 of these women reported urinary tract stones at baseline and/or incident urinary tract stones during follow-up. Cox regression models were used to determine the association of urinary tract stones with incident fractures and linear mixed models were used to investigate the relationship of urinary tract stones with changes in BMD that occurred during WHI. Follow-up was over an average of 8 years. Models were adjusted for demographic and clinical factors, medication use, and dietary histories. In unadjusted models there was a significant association of urinary tract stones with incident total fractures (HR 1.10; 95% CI, 1.04 to 1.17). However, in covariate adjusted analyses, urinary tract stones were not significantly related to changes in BMD at any skeletal site or to incident fractures. In conclusion, urinary tract stones in postmenopausal women are not an independent risk factor for osteoporosis. PMID:25990099

  19. Use of drug therapy in the management of symptomatic ureteric stones in hospitalized adults (SUSPEND), a multicentre, placebo-controlled, randomized trial of a calcium-channel blocker (nifedipine) and an α-blocker (tamsulosin): study protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Urinary stone disease is common, with an estimated prevalence among the general population of 2% to 3%. Ureteric stones can cause severe pain and have a significant impact on quality of life, accounting for over 15,000 hospital admissions in England annually. Uncomplicated cases of smaller stones in the lower ureter are traditionally treated expectantly. Those who fail standard care or develop complications undergo active treatment, such as extracorporeal shock wave lithotripsy or ureteroscopy with stone retrieval. Such interventions are expensive, require urological expertise and carry a risk of complications. Growing understanding of ureteric function and pathophysiology has led to the hypothesis that drugs causing relaxation of ureteric smooth muscle, such as the selective α-blocker tamsulosin and the calcium-channel blocker nifedipine, can enhance the spontaneous passage of ureteric stones. The use of drugs in augmenting stone passage, reducing the morbidity and costs associated with ureteric stone disease, is promising. However, the majority of clinical trials conducted to date have been small, poor to moderate quality and lacking in comprehensive economic evaluation. This trial aims to determine the clinical and cost-effectiveness of tamsulosin and nifedipine in the management of symptomatic urinary stones. Methods/design The SUSPEND (Spontaneous Urinary Stone Passage ENabled by Drugs) trial is a multicentre, double-blind, randomized controlled trial evaluating two medical expulsive therapy strategies (nifedipine or tamsulosin) versus placebo. Patients aged 18 to 65 with a ureteric stone confirmed by non-contrast computed tomography of the kidney, ureter and bladder will be randomized to receive nifedipine, tamsulosin or placebo (400 participants per arm) for a maximum of 28 days. The primary clinical outcome is spontaneous passage of ureteric stones at 4 weeks (defined as no further intervention required to facilitate stone passage). The

  20. Intrinsic ureteral endometriosis as a cause of unilateral obstructive uropathy

    PubMed Central

    Mason, Ross J.; Alamri, Abdulaziz; Gusenbauer, Kaela; Kapoor, Anil

    2016-01-01

    Endometriosis is a common gynecological condition, but involvement of the urinary tract is rare. Ureteral endometriosis can present in a nonspecific fashion, and may mimic ureteral malignancy. This case report describes a 44-year-old woman who initially presented with chronic flank pain and was found to have left-sided renal dysfunction and a distal left ureteric mass. She was eventually diagnosed with ureteral endometriosis after undergoing nephroureterectomy for what was thought to be either a ureteral fibroepithelial polyp or transitional cell carcinoma. Ureteral endometriosis should be considered in the differential diagnosis for a woman presenting with obstructive uropathy in the presence of a ureteric mass. PMID:27330580

  1. 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.

  2. An Everting Ureteral Access Sheath: Concepts and In Vitro Testing

    NASA Astrophysics Data System (ADS)

    Lee, Keith L.; Stoller, Marshall L.

    2007-04-01

    Ureteral access sheaths have been a recent innovation in facilitating ureteral stone surgery. Once properly placed, access sheaths allow the movement of ureteroscopes and other instruments through the ureter with minimal injury to the urothelium. However, there are shortcomings of the current device designs. Initial sheath placement requires significant force, and shear stress can injure the ureter. In addition, inadvertent advancement of the outer sheath without the inner introducer stylet can tear and avulse the ureter. A novel eversion design incorporating a lubricous film provides marked improvement over current access sheaths. In bench top and animal models, the eversion shealths require less force during advancement, cause less injury to the urothelial tissue, and have a lower potential of introducing extraneous materials (e.g., microbes) into a simulated urinary tract. While, the everting design provides important advantages over traditional non-everting designs, further preclinical and clinical trials are required.

  3. Ureteral stricture formation after ureteroscope treatment of impacted calculi: A prospective study

    PubMed Central

    Singam, Praveen; Ho, Christopher Chee Kong; Sridharan, Radhika; Hod, Rozita; Bahadzor, Badrulhisham; Goh, Eng Hong; Tan, Guan Hee; Zainuddin, Zulkifli

    2015-01-01

    Purpose Urinary calculi is a familiar disease. A well-known complication of endourological treatment for impacted ureteral stones is the formation of ureteral strictures, which has been reported to occur in 14.2% to 24% of cases. Materials and Methods This was a prospective study. Ureterotripsy treatment was used on patients with impacted ureteral stones. Then, after 3 months and 6 months, the condition of these patients was assessed by means of a kidney-ureter-bladder (KUB) ultrasound. If the KUB ultrasound indicated moderate to serious hydronephrosis, the patient was further assessed by means of a computed tomography intravenous urogram or retrograde pyelogram to confirm the occurrence of ureteral strictures. Results Of the 77 patients who participated in the study, 5 developed ureteral strictures. Thus, the stricture rate was 7.8%. An analysis of the intraoperative risk factors including perforation of the ureter, damage to the mucous membrane, and residual stone impacted within the ureter mucosa revealed that none of these factors contributed significantly to the formation of the ureteric strictures. The stone-related risk factors that were taken into consideration were stone size, stone impaction site, and duration of impaction. These stone factors also did not contribute significantly to the formation of the ureteral strictures. Conclusions This prospective study failed to identify any predictable factors for ureteral stricture formation. It is proposed that all patients undergo a simple postoperative KUB ultrasound screening 3 months after undergoing endoscopic treatment for impacted ureteral stones. PMID:25598938

  4. 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

  5. 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.

  6. An Indwelling Ureteral Stent Forgotten for Over 12 Years.

    PubMed

    Bidnur, Samir; Huynh, Melissa; Hoag, Nathan; Chew, Ben

    2016-01-01

    Ureteral stents are one of the most commonly used urologic devices with the purpose of establishing and maintaining ureteral patency. They are also associated with a number of complications including infection, migration, stent-related symptoms, and encrustation, leading to lithiasis. Prolonged stent dwell time is associated with a greater degree of these complications. We present the case of a 36-year-old man who presented with a severely encrusted ureteral stent that had been placed 12.5 years prior for an obstructive left-sided ureteral stone and was lost to follow-up. The patient underwent a combination of percutaneous nephrolithomy, cystolitholapaxy, and ureteroscopy to remove the stent and associated 1.7 cm renal pelvic stone and 4.1 cm bladder stone, necessitating two operative sittings to render him stone free. PMID:27579442

  7. An Indwelling Ureteral Stent Forgotten for Over 12 Years

    PubMed Central

    Bidnur, Samir; Huynh, Melissa; Hoag, Nathan

    2016-01-01

    Abstract Ureteral stents are one of the most commonly used urologic devices with the purpose of establishing and maintaining ureteral patency. They are also associated with a number of complications including infection, migration, stent-related symptoms, and encrustation, leading to lithiasis. Prolonged stent dwell time is associated with a greater degree of these complications. We present the case of a 36-year-old man who presented with a severely encrusted ureteral stent that had been placed 12.5 years prior for an obstructive left-sided ureteral stone and was lost to follow-up. The patient underwent a combination of percutaneous nephrolithomy, cystolitholapaxy, and ureteroscopy to remove the stent and associated 1.7 cm renal pelvic stone and 4.1 cm bladder stone, necessitating two operative sittings to render him stone free. PMID:27579442

  8. Flexible ultrasonic lithotriptor and fiberoptic ureterorenoscope: a new approach to ureteral calculi.

    PubMed

    Higashihara, E; Aso, Y

    1989-07-01

    A newly developed flexible ultrasonic lithotriptor has been used with a fiberoptic ureterorenoscope for removal of upper ureteral and kidney stones. There was an 87.5 per cent success rate in 16 patients. This technique can be used safely and effectively to remove mid and upper ureteral stones not amenable to extracorporeal shock wave lithotripsy or the rigid ureterorenoscope. PMID:2733106

  9. Kidney stones

    PubMed Central

    2011-01-01

    Introduction The age of peak incidence for stone disease is 20 to 40 years, although stones are seen in all age groups. There is a male to female ratio of 3:2. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions for stone removal in people with asymptomatic kidney stones? What are the effects of interventions for the removal of symptomatic renal stones? What are the effects of interventions to remove symptomatic ureteric stones? What are the effects of interventions for the management of acute renal colic? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 21 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: antispasmodic drugs, extracorporeal shockwave lithotripsy, intravenous fluids, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, oral fluids, percutaneous nephrolithotomy, and ureteroscopy. PMID:22075544

  10. Glucagon, ureteral colic and ureteral peristalsis.

    PubMed

    Boyarsky, S; Labay, P C

    1978-01-01

    Experimentally, glucagon is an effective ureteral relaxant that induces a moderate diuresis. Our data suggest that in specified cases of ureteral colic, before the development of a ureteral bar, flaccid dilatation of the pelvis and renal shutdown, glucagon may facilitate the expulsion of small ureteral calculi. When the ureteral pain is due to hyperperistalsis the drug has promise in the alleviation of pain. The complexities of the pathophysiology of ureteral colic in an experimental model support the treatment of ureteral edema in colic with anti-inflammatory drugs but suggest certain precautions in the design of any investigation of drug therapy for colic, lest a good drug be found ineffective for the wrong reason-that it was used in an impossible situation. PMID:753018

  11. 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.

  12. Optimizing Stone-free Rates With Ureteroscopy

    PubMed Central

    Reddy, Thanmaya G; Assimos, Dean G

    2015-01-01

    Ureteroscopy is being increasingly utilized in the treatment and management of patients with renal and ureteral stones. Improving stone-free rates with ureteroscopy decreases the need for ancillary procedures and improves patient outcomes and satisfaction. This article reviews contemporary literature regarding the efficacy of a wide range of currently available techniques for improving stone-free rates with this procedure. PMID:26543430

  13. Ureteral retrograde brush biopsy

    MedlinePlus

    Biopsy - brush - urinary tract; Retrograde ureteral brush biopsy cytology; Cytology - ureteral retrograde brush biopsy ... to be biopsied is rubbed with the brush. Biopsy forceps may be used instead to collect a ...

  14. 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.

  15. [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

  16. The Gachon University Ureteral Narrowing score: A comprehensive standardized system for predicting necessity of ureteral dilatation to treat proximal ureteral calculi

    PubMed Central

    Lee, Seung Kyu; Kim, Tae Beom; Ko, Kwang-Pil; Kim, Chang Hee; Kim, Kwang Taek; Chung, Kyung Jin; Kim, Khae Hawn; Jung, Han; Yoon, Sang Jin

    2016-01-01

    Purpose For treating proximal ureteral calculi, treatment decision has been known still difficult to choose ureteroscopic lithotripsy (URS) or shockwave lithotripsy. The aims of our study are to identify the possible predictors for necessity of URS and to propose the Gachon University Ureteral Narrowing scoring system (GUUN score) as a helpful predictor. Materials and Methods We evaluated 83 consecutive patients who underwent semirigid URS due to proximal ureteral calculi between April 2011 and February 2014 by a single surgeon. We reviewed patient characteristics and pre- and postoperative parameters and surgical records. We divided the patients into 2 groups (group 1, nondilation group; group 2, dilation group) according to whether or not balloon dilation was performed. A stepwise logistic regression was performed to identify the factors that predict dilatation. Receiver operating characteristic (ROC) curves were plotted and areas under the ROC curve (AUC) were calculated to GUUN score. Results Mean patients' age and their stone size were 48.53±12.90 years and 7.79±2.57 cm, respectively. Significantly smaller stone size (p=0.009), lower stone density (p=0.005), and lower ureteral density differences between ureteral narrowing level and far distal ureter (UD) (p<0.001) were observed in group 1 (n=34) than in group 2 (n=49). GUUN score consists of age, stone size and UD (AUC, 0.938). Overall stone-free clearance rate was 85.5%. Conclusions We suggest that the GUUN score is an excellent scoring system to predict the necessity of ureteral dilatation for decision making whether or not to perform surgical manipulation. PMID:27437538

  17. 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

  18. 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

  19. 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

  20. 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

  1. 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

  2. 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

  3. Kidney stones.

    PubMed

    Khan, Saeed R; Pearle, Margaret S; Robertson, William G; Gambaro, Giovanni; Canales, Benjamin K; Doizi, Steeve; Traxer, Olivier; Tiselius, Hans-Göran

    2016-01-01

    Kidney stones are mineral deposits in the renal calyces and pelvis that are found free or attached to the renal papillae. They contain crystalline and organic components and are formed when the urine becomes supersaturated with respect to a mineral. Calcium oxalate is the main constituent of most stones, many of which form on a foundation of calcium phosphate called Randall's plaques, which are present on the renal papillary surface. Stone formation is highly prevalent, with rates of up to 14.8% and increasing, and a recurrence rate of up to 50% within the first 5 years of the initial stone episode. Obesity, diabetes, hypertension and metabolic syndrome are considered risk factors for stone formation, which, in turn, can lead to hypertension, chronic kidney disease and end-stage renal disease. Management of symptomatic kidney stones has evolved from open surgical lithotomy to minimally invasive endourological treatments leading to a reduction in patient morbidity, improved stone-free rates and better quality of life. Prevention of recurrence requires behavioural and nutritional interventions, as well as pharmacological treatments that are specific for the type of stone. There is a great need for recurrence prevention that requires a better understanding of the mechanisms involved in stone formation to facilitate the development of more-effective drugs. PMID:27188687

  4. Percutaneous ureteral interventions.

    PubMed

    Adamo, Robert; Saad, Wael E A; Brown, Daniel B

    2009-09-01

    Urinary strictures are commonly managed by interventional radiologists and can result from both benign and malignant etiologies. Many patients end up with lifelong catheters. Although stricture dilation is commonly unsuccessful, some patients can eventually become catheter free. This review describes current outcomes with a variety of dilation and stenting techniques. Management of complex ureteral and urinary complications is also reviewed, including ureteral/arterial fistulas and ureteral embolization for permanent diversion. PMID:19945661

  5. Emergency ureteroscopic lithotripsy in acute renal colic caused by ureteral calculi: a retrospective study.

    PubMed

    Al-Ghazo, Mohammed A; Ghalayini, Ibrahim Fathi; Al-Azab, Rami S; Bani Hani, Osamah; Bani-Hani, Ibrahim; Abuharfil, Mohammad; Haddad, Yazan

    2011-12-01

    This work was conducted to evaluate the safety and efficacy of emergency ureteroscopic lithotripsy in patients with ureteral stones. From May 2003 to December 2010, 244 patients (184 men and 60 women, mean age 45.6 ± 12.7 years (range 22-73 years) were treated with emergency ureteroscopic lithotripsy for ureteral calculi. All patients were divided into three groups according to the stone location in the ureter. Intracorporeal lithotripsy when necessary was performed with the Swiss lithoclast. The overall stone-free status was defined as the complete absence of stone fragments at 4 weeks, postoperatively. A double J stent was inserted in selected patients if there was significant ureteral wall trauma, edema at the stone impaction site, suspected or proved ureteral perforation, and if the stone migrated to the kidney. The overall success rate was 90.6%. The success rates were different according to the stone site. The success rate of groups A, B and C was 69.4, 94.8 and 96.6%, respectively. The overall rate of ureteral stent insertion at the end of the procedure was 177/244 (72.5%). The rate of stent insertion was 41/49 (83.7%), 32/46 (69.6%) and 104/149 (69.8%) in groups A, B and C, respectively. The overall complication, failure, and stricture rate was 32/244 (13.1%), 23/244 (9.4%) and 0.8%, respectively. With the recent advances in ureteroscopic technology, intracorporeal probes and stone extraction devices, emergency ureteroscopy is found to be a safe and effective procedure with immediate relief from ureteral colic and ureteral stone fragmentation. PMID:21499919

  6. Economic impact of urinary stones

    PubMed Central

    Hyams, Elias S.

    2014-01-01

    Kidney stones have been rising in prevalence in the United States and worldwide, and represent a significant cost burden. Cost effectiveness research in this area may enable improvements in treatment efficiency that can benefit patients, providers and the healthcare system. There has been limited research in the cost effectiveness of surgical interventions for stone disease, despite the diverse treatment approaches that are available. Medical expulsive therapy (MET) has been shown to improve rates of stone passage for ureteral stones, and there is evidence that this practice should be liberalized from the standpoint of both clinical and cost effectiveness. While conservative treatment following a primary stone event appears to be cost effective, the economic impact of medical therapy for recurrent stone formers requires clarification despite its clinical efficacy. Future study regarding the cost effectiveness of prevention and interventions for stone disease are likely to improve both the quality and efficiency of care. PMID:26816777

  7. Acute bilateral ureteral obstruction secondary to guaifenesin toxicity.

    PubMed

    Cockerill, Patrick A; de Cógáin, Mitra R; Krambeck, Amy E

    2013-10-01

    Several medications or their metabolites have been associated with urolithiasis, although overall they remain an infrequent cause of urolithiasis. Guaifenesin stones were originally reported as complexed with ephedrine, and subsequent reports have demonstrated pure guaifenesin stones, occurring after long term abuse. We report a case of a 23-year-old male who ingested a large, one time dose of guaifenesin, resulting in acute bilateral ureteral obstruction, which, to our knowledge, is the first such reported case in the literature. PMID:24128843

  8. 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

  9. 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

  10. 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

  11. 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

  12. Adjunctive Therapy to Promote Stone Passage

    PubMed Central

    Nuss, Geoffrey R; Rackley, Judson D; Assimos, Dean G

    2005-01-01

    The majority of individuals with nephrolithiasis have small ureteral stones that pass spontaneously. However, patients may experience severe pain during this process, which significantly alters their quality of life and may limit their vocational responsibilities. Therefore, measures to facilitate stone passage are uniformly embraced. We discuss methods to enhance spontaneous stone passage as well as the elimination of fragments generated with extracorporeal shock-wave lithotripsy. PMID:16985812

  13. Definitive ureteroscopy and intracorporeal lithotripsy in treatment of ureteral calculi during pregnancy

    PubMed Central

    Teleb, Mohamed; Ragab, Ahmed; Dawod, Tamer; Elgalaly, Hazem; Elsayed, Ehab; Sakr, Ahmed; Abdelhameed, Ahmed; Maarouf, Arif; Khalil, Salem

    2014-01-01

    Objective To evaluate the outcome of using semi-rigid ureteroscopy with or without intracorporeal pneumatic lithotripsy vs. temporary ureteric JJ stenting in the management of obstructing ureteric calculi in pregnant women. Patients and methods This prospective comparative study comprised 43 pregnant women with obstructing ureteric calculi. The diagnosis was based on the acute flank pain as the main symptom, microscopic haematuria, and unilateral hydronephrosis on abdominal ultrasonography (US). The patients were randomly divided into two groups; those in group 1 (22 patients) were treated by temporary ureteric JJ stenting until after delivery, and those in group 2 (21) were treated definitively by ureteroscopic stone extraction with intracorporeal pneumatic lithotripsy. Postoperative complications and the degree of patient satisfaction were reported. Results An obstructing ureteric stone was identified by US in 68% and 76% of groups 1 and 2, respectively. In group 1, nine patients had mid-ureteric stones and 13 had stones in the lower ureter. In group 2, seven patients had mid-ureteric stones, whilst the stones were in the distal ureter in 14. No perioperative foetal complications were detected in any group and all patients completed the full term of pregnancy. In group 1, four patients had a postoperative urinary tract infection (UTI), and the JJ stent was exchanged in seven. Two patients in group 2 had a postoperative UTI. Conclusions Definitive ureteroscopy, even with intracorporeal pneumatic lithotripsy, is an effective and safe treatment for pregnant women with obstructing ureteric calculi. It has a better outcome and is more satisfactory for the patients than a temporary JJ stent. PMID:26019966

  14. Combined endoscopic surgery in the prone-split leg position for successful single-session removal of an encrusted ureteral stent: a case report

    PubMed Central

    2014-01-01

    Introduction Although encrusted stents may lead to some unwanted complications including urinary tract obstruction, urinary sepsis, and potential loss of kidney function, there is currently no consensus on the most efficient method for managing stents that are intentionally left in situ. This is the first report describing the management of an encrusted stent using combined endoscopic surgery in the prone split-leg position in a single session. Case presentation A 47-year-old Asian man presented with left flank pain and macrohematuria. The patient had undergone left ureteral stenting three years previously for the treatment of left ureteral stones and hydronephrosis; however, he was lost to follow-up before the treatment for the ureter stones was completed. Therefore, the ureteral stent and stones were not removed. An abdominal radiograph and a noncontrast computed tomography scan showed encrustation along the retained stent with stone burdens in the kidney and ureter. The ureteral stent could not be removed by cystoscopy after shock wave lithotripsy of the left ureteral stones. Therefore, endoscopic lithotripsy combined with flexible ureteroscopy and miniature nephroscopy was performed with the patient in the prone split-leg position. All the stones and the encrusted ureteral stent were successfully removed in a single session. Conclusions In this case, percutaneous nephrolithomy in addition to flexible ureteroscopy was preferred because severe encrustation of the proximal stent and ureteral stones complicated the therapeutic strategy. Combined endoscopic techniques in the prone split-leg position can achieve successful and safe management of encrusted stents. PMID:24742133

  15. Retroperitoneal Laparoscopic Ureterolithotomy for Proximal Ureteral Calculi in Selected Patients

    PubMed Central

    Hu, Qingfeng; Ding, Weihong; Gou, Yuancheng; Ho, Yatfaat; Xu, Ke; Gu, Bin; Sun, Chuanyu; Xia, Guowei; Ding, Qiang

    2014-01-01

    Objectives. To summarize our experience of retroperitoneal laparoscopic ureterolithotomy for ureteral calculi and evaluate the safety and efficiency of this procedure. Methods. We conducted a retrospective analysis of 197 patients with proximal ureteral calculi who accepted retroperitoneal laparoscopic ureterolithotomy from June 2005 to June 2014. Results. All procedures were performed successfully and the mean operating time and estimated blood loss were 87 min and 64 mL. The clearance rate was 98.5% and the rates of urine leak and ureteral stricture were 2.5% and 1.0%. Conclusions. Retroperitoneal laparoscopic ureterolithotomy is a safe and effective procedure for patients with complex stones or anatomic abnormalities, and, with experience of high volume series, it is also a reasonable choice as the primary treatment for such selected patients. PMID:25548791

  16. Effect of smooth muscle relaxant drugs on proximal human ureteric activity in vivo: a pilot study.

    PubMed

    Davenport, Kim; Timoney, Anthony G; Keeley, Francis X

    2007-08-01

    Drugs are increasingly being used to promote stone passage in renal colic. Diclofenac, nifedipine and tamsulosin cause ureteric smooth muscle relaxation in vitro; however, in clinical trials nifedipine and tamsulosin promote stone passage whereas diclofenac has no apparent benefit. We adapted a ureteric pressure transducer catheter in an attempt to compare the human ureteric response to these drugs in vivo. The catheter was inserted into the contralateral ureter following ureteroscopy for stone disease. Contraction frequency, pressure and velocity measurements were recorded at 24 h. Each patient was randomly allocated to receive oral diclofenac, nifedipine or tamsulosin. Measurements were taken following drug administration. Eighteen patients (mean age 50 years) were recruited. Two patients were excluded intraoperatively and three required early removal of the catheter. Prior to drug administration, the mean number of contractions recorded was 0-4.1/min and the peak contraction pressure ranged from 11 to 35 mmHg. Conduction velocity ranged from 1.5 to 2.6 cm/s. Ureteric peristalsis persisted in all patients despite these drugs. Diclofenac and nifedipine produced inconsistent ureteric pressure responses but had little effect on contraction frequency. Tamsulosin significantly reduced ureteric pressure but had no effect on contraction frequency. There are many limitations associated with the use of ureteric catheters, however, they may provide some useful information when used to record the response to an intervention in the same patient. These preliminary results suggest a reduction in pressure generation may be the essential factor in the promotion of stone passage. More work is required but these drugs may work by preventing the increased, uncoordinated muscular activity seen in renal colic whilst maintaining peristalsis, thereby promoting stone passage. PMID:17530238

  17. 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

  18. Unenhanced CT for the evaluation of acute ureteric colic: the essential pictorial guide.

    PubMed

    Kennish, Steven J; Wah, Tze M; Irving, Henry C

    2010-07-01

    Acute ureteric colic is a common emergency, often dealt with by the emergency physician or general practitioner and referred on to the urologist. Unenhanced CT of the kidneys, ureters and bladder (CTKUB) is the 'gold standard' imaging investigation for establishing a diagnosis and guiding management. An appreciation of the CTKUB signs, which support or refute a diagnosis of ureteric colic, is highly valuable to the clinician when making a urological referral, and to the urologist, who must make appropriate management plans. All salient diagnostic and supportive features of ureteric colic are carefully illustrated, as are important radiological mimics, with the objectives of educating and informing the non-radiologist. Ready access to the picture archive and communication system (PACS) allows all specialists involved to interpret the radiological report with the benefit of images. A stone within the ureter may not always be readily apparent. Soft tissue rim sign around a calcific focus is an important indicator of a ureteric stone, whereas a comet tail sign suggests a phlebolith (a calcified venous thrombosis), a radiological mimic of a ureteric stone. Numerous secondary signs of ureteric obstruction may be present including hydronephrosis and perinephric stranding, and can help to confirm the diagnosis. The relative diagnostic weighting of signs is discussed, and a checklist is provided to assist with interpretation. Unexpected alternative radiological diagnoses are also illustrated, which may have significant management consequences necessitating specialist referral. PMID:20634253

  19. Activity, energy intake, obesity, and the risk of incident kidney stones in postmenopausal women: a report from the Women's Health Initiative.

    PubMed

    Sorensen, Mathew D; Chi, Thomas; Shara, Nawar M; Wang, Hong; Hsi, Ryan S; Orchard, Tonya; Kahn, Arnold J; Jackson, Rebecca D; Miller, Joe; Reiner, Alex P; Stoller, Marshall L

    2014-02-01

    Obesity is a strong risk factor for nephrolithiasis, but the role of physical activity and caloric intake remains poorly understood. We evaluated this relationship in 84,225 women with no history of stones as part of the Women's Health Initiative Observational Study, a longitudinal, prospective cohort of postmenopausal women enrolled from 1993 to 1998 with 8 years' median follow-up. The independent association of physical activity (metabolic equivalents [METs]/wk), calibrated dietary energy intake, and body mass index (BMI) with incident kidney stone development was evaluated after adjustment for nephrolithiasis risk factors. Activity intensity was evaluated in stratified analyses. Compared with the risk in inactive women, the risk of incident stones decreased by 16% in women with the lowest physical activity level (adjusted hazard ratio [aHR], 0.84; 95% confidence interval [95% CI], 0.74 to 0.97). As activity increased, the risk of incident stones continued to decline until plateauing at a decrease of approximately 31% for activity levels ≥10 METs/wk (aHR, 0.69; 95% CI, 0.60 to 0.79). Intensity of activity was not associated with stone formation. As dietary energy intake increased, the risk of incident stones increased by up to 42% (aHR, 1.42; 95% CI, 1.02 to 1.98). However, intake <1800 kcal/d did not protect against stone formation. Higher BMI category was associated with increased risk of incident stones. In summary, physical activity may reduce the risk of incident kidney stones in postmenopausal women independent of caloric intake and BMI, primarily because of the amount of activity rather than exercise intensity. Higher caloric intake further increases the risk of incident stones. PMID:24335976

  20. 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

  1. Procalcitonin determined at emergency department as an early indicator of progression to septic shock in patient with sepsis associated with ureteral calculi

    PubMed Central

    Ko, Young Hwii; Ji, Yoon Seob; Park, Sin-Youl; Kim, Su Jin; Song, Phil Hyun

    2016-01-01

    ABSTRACT Introduction: To investigate the role of initial procalcitonin (PCT) level as an early predictor of septic shock for the patient with sepsis induced by acute pyelonephritis (APN) secondary to ureteral calculi. Materials and Methods: The data from 49 consecutive patients who met criteria of sepsis due to APN following ureteral stone were collected and divided into two groups: with (n=15) or without (n=34) septic shock. The clinical variables including PCT level for this outcome were retrospectively compared by univariate analysis, followed by multivariable logistic regression model. Results: All subjects had hydronephrosis, and were hospitalized with the mean of 11.8 days (3–42 days). The mean size of the ureteral stones was 7.5mm (3–30mm), and 57% were located in upper ureter. At univariate analysis, patients with septic shock were significantly older, a higher proportion had hypertension, lower platelet count and serum albumin level, higher CRP and PCT level, and higher positive blood culture rate. Multivariate models indicated that lower platelet count and higher PCT level are independent risk factors (p=0.043 and 0.046, respectively). In ROC curve, the AUC was significantly wider in PCT (0.929), compared with the platelet count (0.822, p=0.004). At the cut-off of 0.52ng/mL, the sensitivity and specificity were 86.7% and 85.3%. Conclusion: Our study demonstrated elevated initial PCT levels as an early independent predictor to progress into septic shock in patients with sepsis associated with ureteral calculi. PMID:27256181

  2. 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.

  3. [Subcutaneous ureteral bypass devices as a treatment option for bilateral ureteral obstruction in a cat with ureterolithiasis].

    PubMed

    Heilmann, Romy M; Pashmakova, Medora; Lamb, Jodie H; Spaulding, Kathy A; Cook, Audrey K

    2016-06-16

    A 6-year-old female spayed Domestic Shorthair cat was presented with acute lethargy, dehydration, marked azotemia, metabolic acidosis, left-sided renomegaly, and bilateral hydronephrosis. Ureterolithiasis and ureteral obstruction were suspected based on further diagnostics including abdominal sonography. Medical treatment was not successful. Fluoroscopically guided antegrade pyelography confirmed the diagnosis of bilateral ureteral obstruction due to ureterolithiasis. Subcutaneous ureteral bypass (SUB) devices were placed bilaterally, followed by close patient monitoring. Frequent reassessment of patient parameters and blood work served to adjust the fluid needs of the patient and to ensure proper hydration, correction of azotemia at an appropriate rate, and cardiovascular stability. After significant improvement of all patient parameters within 5 days, the patient was discharged from the hospital. Treatment included a dietary change to reduce the risk of stone formation as well as a phosphorus binder. Clinical and clinicopathologic parameters were unchanged at the 1- and 4- and 7-month rechecks (consistent with IRIS CKD stage II-NP-AP0), and both SUB devices continued to provide unobstructed urine flow. Bilateral placement of subcutaneous ureteral bypass devices may be a safe and potentially effective treatment option for acute bilateral ureteral obstruction in cats with ureterolithiasis. Strict patient monitoring and patient-centered postoperative treatment decisions are crucial to successful treatment outcomes. PMID:26898228

  4. An Initial Attack of Urinary Stone Disease Is Associated with an Increased Risk of Developing New-Onset Irritable Bowel Syndrome: Nationwide Population-Based Study

    PubMed Central

    Lei, Wei-Yuan; Chang, Chih-Yu; Wu, Jr-Hau; Lin, Fei-Hung; Hsu Chen, Cheng; Chang, Chin-Fu

    2016-01-01

    Background The neurotransmitter pathways in irritable bowel syndrome (IBS) and urinary stone attacks are both related to serotonin, and each disease may be influenced by viscero-visceral hyperalgesia. However, the relationship between urinary tract stone disease and IBS has never been addressed. We aimed to investigate the risk of suffering new-onset IBS after an initial urinary stone attack using a nationwide database. Methods A study group enrolled a total of 13,254 patients who were diagnosed with an initial urinary stone attack; a comparison group recruited 39,762 matched non-urinary stone participants during 2003 and 2007. We followed each patient for 3 years to determine new-onset IBS. We also used Cox proportional hazards models to analyze the risk of IBS between the study and comparison groups after modified by demographics, residence, patient characteristics and personal histories. Results The occurrence rates of IBS were 3.3% (n = 440) and 2.6% (n = 1,034) respectively in the study and comparison groups. A covariate-adjusted hazard ratio (HR) of IBS in the study group that was 1.28 times greater (HR = 1.29, 95% CI, 1.15–1.44) than that in the comparison group was showed in the stratified Cox proportional analysis. The adjusted HRs of IBS did not decrease after considering demographics and past histories. The majority of IBS (30.5%) occurred within the first 6 months after the stone attack. Conclusion Patients with an initial urinary stone attack are at increased risk of developing new-onset IBS. The HRs of IBS did not decrease even after adjusting for patient demographics and past histories. Most importantly, 30.5% of IBS occurred within the first 6 months after the urinary stone attack. PMID:27337114

  5. The development of ureteric strictures after ureteroscopic treatment for ureteric calculi: A long-term study at two academic centres

    PubMed Central

    El-Abd, Ahmed S.; Suliman, Mohammed G.; Abo Farha, Mohamed O.; Ramadan, Ahmed R.; El-Tatawy, Hassan H.; El-Gamal, Osama M.; El-Gamal, Samir A.; Figenshau, Robert; El Abd, Shawky A.

    2013-01-01

    Objective To determine the incidence of symptomatic and ‘silent’ obstruction after ureteroscopic procedures. Patients and methods In all, 1980 patients underwent ureteroscopy for ureteric calculi in two large centres. The methods of disintegration, auxiliary procedures used and type of stenting were considered. Intraoperative complications, in addition to the size and site of the stone, were assessed in relation to postoperative obstruction. The mean (range) follow-up was 42 (12–68) months, with patients assessed after 3–6 months and yearly thereafter. The postoperative evaluation included an assessment of pain, renal ultrasonography, a plain abdominal film, intravenous urography, and a diuretic renal scan in some cases to confirm obstruction. Results The success rate of stone removal was 98.5%. The failures were related to the size of the stone (>2 cm; P < 0.001). In eight patients there was a ureteric perforation, and six of these developed a ureteric stricture. A stricture also occurred in 12 patients (0.6%) during the follow-up; these included nine of 204 with stones of >2 cm (4.4%), compared to three (0.17%) of 1746 patients with stones of <2 cm (P < 0.001). Fourteen patients presented with pain (0.7%), and five had no obstruction, while in nine (0.46%) the pain was associated with obstruction. There was silent obstruction in three cases (0.15%). The negative and positive predictive values for pain were 99.8% and 64.3%, respectively. Conclusions Radiographic surveillance for stricture formation and obstruction is mandatory in patients who are symptomatic after ureteroscopy, and for up to 18 months in patients with intraoperative complications or with a stone of >2 cm in the proximal ureter. PMID:26019943

  6. [The EDAP LT and the M.P.L. 9000. Results of the treatment of reno-ureteral lithiasis].

    PubMed

    De Cobelli, O; Larcher, P; Carmignani, L; Meroni, T; Franchini, V; Panizzuti, M; Rocco, F

    1989-12-01

    The advantages and disadvantages of piezoelectric lithotripsy are discussed with specific analysis of the EDAP LT 01. A description of the EDAP LT 01 is included. Installation, accommodation, and maintenance features are discussed. The Dornier M.P.L. 9000 represents a third-generation lithotripter for both kidney and gallbladder stones with an ultrasound localization system tubules shock-wave coupling. The use of TH M.P.L. 9000 was limited by ultrasound-guided localization of kidney stones, upper ureteral calculi causing obstruction, and intramural lower ureteral stones. PMID:2532403

  7. Diffuse Large B-Cell Lymphoma in an Adolescent Male Presenting as Ureteral Stricture

    PubMed Central

    Jaeger, Christopher D.; McAlvany, Kelly L.; Zingula, Shannon N.; Kramer, Stephen A.; Granberg, Candace F.

    2014-01-01

    Lymphoma may affect the ureter in cases of retroperitoneal involvement. We present a case of an adolescent male found to have non-Hodgkin lymphoma initially presenting as ureteral stricture evident on imaging. He was treated and responded to multiagent chemotherapy with resolution of both the lymphoma and the ureteral stricture. Although rare, non-Hodgkin lymphoma should be included in the differential diagnosis of pediatric patients with noncalculous, idiopathic ureteral strictures. PMID:25093138

  8. 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

  9. Ureteral fibropapilloma in a dog.

    PubMed

    Hattel, A L; Diters, R W; Snavely, D A

    1986-04-15

    A fibropapilloma was found to involve the left ureter in a 7-year-old castrated male Doberman Pinscher dog. Severe unilateral hydronephrosis and hydroureter were associated with the ureteral mass. Treatment consisted of unilateral nephrectomy and ureterectomy. This case represents an additional type of primary ureteral neoplasm found in the dog. PMID:3710881

  10. Should We Place Ureteral Stents in Retroperitoneal Laparoscopic Ureterolithotomy?: Consideration of Surgical Techniques and Complications

    PubMed Central

    You, Jae Hyung; Kim, Young Gon

    2014-01-01

    Purpose There is some debate over the necessity of ureteral stenting after laparoscopic ureterolithotomy. We evaluated the need for ureteral stenting after retroperitoneal laparoscopic ureterolithotomy (RLU). Materials and Methods Between January 2009 and January 2013, 41 patients underwent RLU to remove upper ureteral stones. The retroperitoneal approach was used in all patients by a single surgeon. A double J (D-J) stent was placed in the first 17 patients after the procedure but not in any of the next 24 patients. Results The mean patient age, serum creatinine levels, and stone size were not significantly different between the two groups. The stone-free rate was 100%. The mean operative time was significantly shorter in the stentless group than in the stent group (59.48 minutes vs. 77.88 minutes, p<0.001). Parenteral analgesic use and anticholinergic medication use were observed in the stent group only. The blood loss, drain removal day, and hospital stay were not significantly different between the two groups. No other significant complications occurred during or after the operation in any patients. Conclusions RLU is a safe and effective treatment modality for large impacted ureteral stones. In this study, D-J stent placement was not necessary after RLU. In the future, large-scale studies of RLU without D-J stenting, especially on the frequency of the development of complications according to the surgical technique, may be needed. PMID:25132944

  11. Ureteral peristalsis in pediatric urology

    SciTech Connect

    Schauenburg, W.M.; Anger, K.; Feine, U.; Flach, A.; Reifferscheid, P.; Hofmann, U.

    1984-01-01

    The review is based upon more than 300 pediatric studies from 6 years. Ureteral motility has been assessed in routine renography with I-123-hippuran and Tc-99m-DTPA. Normal ureters were studied with Tc-99m-MDP as by-product to bone scans. In a few cases the radioisotope was injected or infused into the renal pelvis via a Sober loop or a catheter. Ureteral motility information is compressed, similar to the M-mode in sonograhy, by a space time matrix approach, which was introduced in 1978. The clinical applications focussed upon vesico-ureteral reflux, megureter motility, and ureteral stenosis. Concerning vesico-ureteral reflux, the method revealed the clinical and diagnostic interference of retroperistalsis and reflux: (I) Retroperistalsis supports the backflow mechanism. (II) Retroperistalsis may be a symptom of a refluxive ureter, even if there is no actual reflux documented. (III) Discrepancies between direct and indirect tests for reflux are explained partly by the occurrence of retroperistaltic transport of prevesical urine during indirect testing, simulating vesico-ureteral valve dysfunction. Concerning megaureters, the preoperative motility is known to be of prognostic value. Early ureteral stenosis may be judged from peristalitic frequency, either in the basic study or after frusemide. The method became reliable, when the absence of motility could be distinguished from the absence of information on motility, due to a low isotope input into the ureter. In conclusion, the method is now available as routine tool.

  12. 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

  13. 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

  14. 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

  15. Impact of ureteric stent on outcome of extracorporeal shockwave lithotripsy: A propensity score analysis

    PubMed Central

    Gołąb, Adam; Słojewski, Marcin

    2016-01-01

    Introduction Extracorporeal shockwave lithotripsy (SWL) is one of the most frequently performed procedures in patients with urolithiasis. For ureter-localized stones, SWL is often preceded by a double J stent insertion. However, fear of serious complications, including sepsis associated with stents, is often expressed. The following study assessed the impact of stent insertions on the results of SWL in patients with ureteric stones. Material and methods The study group consisted of 411 ureteric stone patients who were treated with SWL from January 2010 to December 2014. In 60 cases, treatment was preceded by ureteric stent insertion. A propensity scoring system was used to pair non-stented patients with the stented group. Success rates were assessed and compared using the chi-squared test. Multivariate logistic regression analysis was used to evaluate the influence of particular variables on the stone-free rate. Results The overall success rate was 82.2%. After matching, the success rate of the stented group was not significantly different from the control group (85.0% vs. 83.3% respectively, p = 0.80). The mean number of sessions was higher in the stented group (1.88 per patient). Stones located in the lower part of the ureter have the greatest chance of being successfully treated. Conclusions The double J stent has no influence on the outcome of SWL treatment. In view of the greater likelihood of having additional sessions, this approach should be reserved for selected cases. PMID:27551556

  16. The treatment of the reno-ureteral calculi by extracorporeal shockwave lithotripsy (ESWL)

    PubMed Central

    Ceban, E

    2012-01-01

    Urolithiasis has an important role in the structure of urological pathology, due to its high incidence, frequency of recurrence and complications it might cause. There are many methods of treatment for kidney stones described in the scientific literature as conservative, surgical, laparoscopic, endoscopic, and ESWL. In this study, we have analyzed the ESWL method of treatment of reno-ureteral stones. There are still many controversies about the effectiveness of different models of lithotripters but the lithotripter type Modulith SLK Storz Medical (Germany) used in our clinic has proved to be very effective. ESWL is currently the first-line treatment for the majority of kidney and ureteral stones, which are up to 20 mm in diameter. PMID:22802877

  17. Holmium laser lithotripsy for ureteral calculi: an outpatient procedure.

    PubMed

    Yip, K H; Lee, C W; Tam, P C

    1998-06-01

    A retrospective review was conducted to evaluate the efficacy of ureteroscopic lithotripsy using the holmium laser with a semirigid endoscope in a newly established day surgery center. In 1996, 69 consecutive patients (40 male and 29 female) with a mean age of 46.7 (range 21-73) years and ASA status I or II underwent ureteroscopic lithotripsy for their ureteral calculi using the holmium laser (365-micron fiber; power setting 0.5-1.4 J/5 Hz) and 8.5F semirigid ureteroscope in a day surgery setting. Stone features, postoperative pain scores, readmissions, and complications were evaluated. Eighteen upper, 17 middle, and 34 lower ureteral stones were treated, with a mean size measuring 12.1 (5-45) mm. The mean operative time was 61 minutes including the anesthetic time (range 15-150 minutes), and the success rate was 91% (63/69). The complication rate was 10% (7/69) including four unscheduled readmissions (6%). Telephone follow-up on postoperative Day 1 and Day 3 revealed mean pain scores of 2 and 1, respectively (on a 0-10 scale) and an analgesic requirement of 1 tablet of Dologesic (containing 32.5 mg of dextropropoxyphene + 320 mg of paracetamol) four times a day on both days. Ureteroscopic lithotripsy using the holmium laser and a semirigid endoscope is highly successful and well tolerated and carries a low complication rate. It is indicated as an ambulatory and minimally invasive treatment modality in low-risk patients with ureteral stones. PMID:9658294

  18. An Extremely Rare Complication of Ureteral Pigtail Stent Placement: A Case Report.

    PubMed

    Arab, Davood; Ardestani Zadeh, Arash; Eskandarian, Rahimeh; Asaadi, Mehrshad; Ghods, Kamran

    2016-05-01

    Double-J (DJ) stents are the main tools used in urological practice for prevention and treatment of obstruction. Stenting is also mandatory after complicated ureteroscopy or TUL (Transureteral Lithotripsy). Known complications are upper migration of DJ stents into the kidney and lower migration to the bladder. In a man with an impacted right lower ureteral stone, a DJ stent was placed because the ureteroscope was not passed from an intramural ureter. We reported a very rare complication of DJ ureteral stent placement with intravascular migration to the pulmonary arteries, which was removed percutaneously through the right femoral vein under fluoroscopic guidance. PMID:27570754

  19. Kidney stones

    MedlinePlus

    ... kidney or ureter. It uses sound or shock waves to break up stones. Then, the stone fragments ... the urine. It is also called extracorporeal shock-wave lithotripsy or ESWL. Procedures performed by passing a ...

  20. 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 ...

  1. 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

  2. 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

  3. Changes in stone composition over two decades: evaluation of over 10,000 stone analyses.

    PubMed

    Moses, Rachel; Pais, Vernon M; Ursiny, Michal; Prien, Edwin L; Miller, Nicole; Eisner, Brian H

    2015-04-01

    To examine the changes in stone composition from 1990 to 2010. A retrospective review was performed of all renal and ureteral stones submitted from the state of Massachusetts to a single laboratory (Laboratory for Stone Research, Newton, MA) for the years 1990 and 2010. Stone composition was determined by infrared spectroscopy and/or polarizing microscopy. A total of 11,099 stones were evaluated (56.7% from 1990, 43.3% from 2010). From 1990 to 2010, the percentage of stones from females (i.e., female/male ratio) increased significantly (29.8% in 1990 to 39.1% in 2010, p < 0.001). Among women, from 1990 to 2010, there was a significant increase in stones which were >50% uric acid (7.6-10.2%, p < 0.005) and a significant decrease in struvite stones (7.8-3.0%, p < 0.001). Among women with calcium stones, the % apatite per stone decreased significantly (20.0 vs. 11.7%, p < 0.001). Among men, there were no changes in stones which were majority uric acid (11.7-10.8%, p = 0.2). Among men with calcium stones, the % apatite per stone increased significantly (9.8 vs. 12.5%, p < 0.001). Males also demonstrated a significant increase in both cystine (0.1-0.6%, p < 0.001) and struvite stones (2.8-3.7%, p = 0.02). The epidemiology of stone disease continues to evolve and appears to vary according to gender. While some of these findings may be related to population changes in body mass index and obesity, the etiology of others remains unclear. PMID:25689875

  4. Salpingo-ureteric fistula—A rare complication following laparoscopic surgery for colorectal cancer: A case report and literature review☆

    PubMed Central

    Nkwam, N.; During, V.; Chen, T.

    2014-01-01

    INTRODUCTION We report the management and outcome of the case of a 57-year old woman with adenocarcinoma of the rectum. Following neo-adjuvant chemo-radiotherapy and laparoscopic-assisted anterior resection of her tumour she developed a right salpingo-ureteric fistula. PRESENTATION OF CASE Three weeks following laparoscopic anterior resection of the tumour she presented with urinary frequency and incontinence. A ureteric stent was inserted and left in-situ for five months but the fistula did not heal. The patient underwent exploration and open repair of the salpingo-ureteric fistula which resolved her symptoms. DISCUSSION There have not been many reported cases in the literature of salpingo-ureteric fistulae but after initial trial of management with ureteric stents all eventually required open exploration and repair. CONCLUSION we advocate open repair of salpingo-ureteric fistulae as the definitive management following intra-operative injury. PMID:24636981

  5. 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.

  6. 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...

  7. 21 CFR 876.4620 - Ureteral stent.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 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...

  8. 21 CFR 876.4620 - Ureteral stent.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 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...

  9. 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...

  10. 21 CFR 876.4620 - Ureteral stent.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 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...

  11. Seasonal variations in the incidence of ureteric colic.

    PubMed

    Al-Dabbagh, T Q; Fahadi, K

    1977-08-01

    A retrospective study of 1097 male in-patients with ureteric colic was conducted to try and define the aetiological effect of climate on the disease. The overall monthly incidence for the study period of 10 years was found, on statistical analysis to correlate with ambient temperature thus: (1) directly with the mean temperature of the preceding month, (2) directly with the difference between mean maximum and mean minimum temperatures of the same month, and (3) inversely with the mean maximum temperature of the same month. The correlation was interpreted on the basis that hot ambient temperatures promoted stone generation whereas cold ones promoted stone descent through cold-induced diuresis. This trend, among its other implications, could pinpoint the reason for the increase in nephrolithiasis with industralisation. PMID:912251

  12. [TRANSURETHRAL URETEROLITHOTRIPSY FOR UPPER URINARY TRACT STONE IN SMALL CHILDREN WEIGHNING AROUND 10KG].

    PubMed

    Nishimura, Yoko; Moriya, Kimihiko; Mitsui, Takahiko; Kitta, Takeya; Kanno, Yukiko; Kon, Masafumi; Shinohara, Nobuo

    2015-10-01

    Management strategy for upper urinary tract calculi in small children is still a matter controversial. We report successful management of ureteral stone with transurethral ureterolithotripsy (TUL) in 2 boys weighing around 10 kg. Case 1: A 2-year-old boy (78 cm in height, 9.6 kg in weight), who received hydrocortisone and fludrocortisone for the treatment of 21-hydroxylase deficiency, was referred to our hospital with a right 9-mm lower ureteral stone. For TUL, a 7.5 Fr rigid cystoscope was introduced into the ureter directly after dilation of the ureteral orifice. By using Holmium:YAG laser for lithotripsy, complete stone evacuation was achieved. Stone analysis showed the composition of calcium phosphate and calcium oxalate. Case 2: A 1-year-old boy (80 cm in height, 10.5 kg in weight) with neurofibromatosis type 1 was referred to our hospital with a left 7.5-mm ureteral stone at the ureteropelvic junction. TUL was performed using a 4.5 F rigid ureteroscope and Holmium:YAG laser. No residual stone was identified. Stone analysis showed the composition of calcium oxalate. TUL is a safe and feasible option for small children, even in boys weighing approximately 10 kg. PMID:26717789

  13. Ultramicronized palmitoylethanolamide reduces viscerovisceral hyperalgesia in a rat model of endometriosis plus ureteral calculosis: role of mast cells.

    PubMed

    Iuvone, Teresa; Affaitati, Giannapia; De Filippis, Daniele; Lopopolo, Mariangela; Grassia, Gianluca; Lapenna, Domenico; Negro, Luana; Costantini, Raffaele; Vaia, Massimo; Cipollone, Francesco; Ialenti, Armando; Giamberardino, Maria Adele

    2016-01-01

    The effects of ultramicronized palmitoylethanolamide were evaluated on pain behaviours and markers of mast cell (MC) activity in a rat model of endometriosis plus ureteral calculosis (ENDO+STONE)-induced viscerovisceral hyperalgesia (VVH). Female Sprague-Dawley rats that underwent surgical induction of endometriosis were randomly assigned to receive active (ultramicronized palmitoylethanolamide 10 mg·kg(-1)·d(-1), orally) or placebo treatment for 25 days. At day 21, they underwent ureteral stone formation and were video-recorded till day 25 to evaluate ureteral and uterine pain behaviours. At autopsy (day 25), ureteral condition and number and diameter of endometrial cysts were evaluated. The following were then measured: number and percentage of degranulating MCs, number of vessels, chymase, nerve growth factor (NGF), vascular endothelial growth factor (VEGF), and Flk-1 (VEGF receptor) in cysts, and NGF in dorsal root ganglia (DRG). Ultramicronized palmitoylethanolamide-treated vs placebo-treated rats showed significantly lower number, duration and complexity of ureteral crises, shorter duration of uterine pain, and smaller cyst diameter (0.0001 < P < 0.004); a significantly higher percentage of expelled stones (P < 0.0001); significantly lower MC number (P < 0.01), vessel number (P < 0.01), chymase (P < 0.05), NGF (P < 0.05), VEGF (P < 0.01), and Flk-1 (P < 0.01) expression in cysts and NGF expression in DRG (P < 0.01). In all animals, the global duration of ureteral crises correlated linearly and directly with cyst diameter, MC number and chymase in cysts, and NGF in cysts and DRG (0.02 < P < 0.0002). Ultramicronized palmitoylethanolamide significantly reduces VVH from ENDO+STONE, probably by modulating MC expression/activity in cysts, thus reducing central sensitization due to noxious signals from endometriotic lesions. The results suggest potential utility of the compound for VVH in clinics. PMID:25974242

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

    PubMed

    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

  15. 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

  16. Ultrasonic destruction of kidney stones.

    PubMed

    Brannen, G E; Bush, W H

    1984-02-01

    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. PMID:6730470

  17. Differences in Urinary Stone Composition according to Body Habitus

    PubMed Central

    Jeong, Ji Yun; Doo, Seung Whan; Lee, Kwang Woo; Kim, Jun Mo

    2011-01-01

    Purpose We analyzed differences in urinary stone composition according to body mass index (BMI). Materials and Methods Between January 2007 and December 2010, 505 ureteral or renal stones were collected from 505 patients who underwent surgical intervention. Data on patient age, gender, BMI, urinary pH, and stone composition were collected. Results The patients' mean age was 49.2 years (range, 20 to 83 years). Of the 505 patients, 196 (38.7%) had calcium oxalate (CO) stones, 172 (33.9%) had mixed calcium oxalate and calcium phosphate (COP) stones, 72 (14.2%) had calcium phosphate (CP) stones, 50 (9.8%) had uric acid (UA) stones, and 15 (2.9%) had struvite stones. We excluded struvite stones in the statistical analysis because of the small number of patients; a total of 490 patients were included in this study. In the multinomial logistic regression analysis, obesity was found to be associated with UA stones compared with COP stones (odds ratio [OR] 3.488; 95% confidence interval [CI] 1.732-7.025; p<0.001) and CP stones (OR 2.765; 95% CI 1.222-6.259; p=0.015). Similar results were observed for CO stones compared with COP stones (OR 2.682; 95% CI 1.727-4.164; p<0.001) and CP stones (OR 2.126; 95% CI 1.176-3.843; p<0.013). Conclusions Obesity was associated with UA and CO stones compared with the occurrence of COP and CP stones. PMID:22025958

  18. Kidney Stones

    MedlinePlus

    ... be signs of kidney stones that need a doctor's help: Extreme pain in your back or side that will not go away Blood in your urine Fever and chills Vomiting Urine that smells bad or looks cloudy A burning feeling when you urinate Your doctor will diagnose a kidney stone with urine, blood, ...

  19. 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...

  20. Ureteral stones due to systemic mastocytosis: diagnostic and therapeutic characteristics.

    PubMed

    Molderings, Gerhard J; Solleder, Gerold; Kolck, Ulrich W; Homann, Jürgen; Schröder, Detlev; von Kügelgen, Ivar; Vorreuther, Roland

    2009-08-01

    Urolithiasis is expected to cause a considerable complication in patients with systemic mastocytosis. The aim of the present report is to demonstrate that due to pathological activation and irritability of mast cells, special features in the diagnostic investigation and therapy of urolithiasis have to be considered in patients with systemic mastocytosis. The clinical presentation, diagnostic investigation and therapeutic procedure of urolithiasis in a patient with systemic mastocytosis are described. Urolithiasis may be a significant complication of systemic mastocytosis. Non-contrast CT is the main tool for diagnosing urolithiasis after a detailed history and clinical exam. Patients with systemic mastocytosis should receive a premedication composed of a glucocorticoid and H(1)- and H(2)-histamine receptor antagonists. An increased vulnerability of mucosal tissues is expected in patients with systemic mastocytosis that may limit the options of operative and postoperative therapy. Opioids should be used cautiously for analgesia in patients with systemic mastocytosis. PMID:19513706

  1. Stone Mountain

    NASA Technical Reports Server (NTRS)

    2004-01-01

    This color image taken by the panoramic camera onboard the Mars Exploration Rover Opportunity shows the part of the rock outcrop dubbed Stone Mountain at Meridiani Planum, Mars. Scientists are examining Stone Mountain with the instruments on the rover's instrument deployment device, or 'arm,' in search of clues about the composition of the rock outcrop. [figure removed for brevity, see original site] A Patch of Stone (Figure credit: NASA/JPL/Cornell/USGS)

    The colorless square in this color image of the martian rock formation called Stone Mountain is one portion of the rock being analyzed with tools on the Mars Exploration Rover Opportunity's instrument deployment device, or 'arm.' The square area is approximately 3 centimeters (1.2 inches) across. Stone Mountain is located within the rock outcrop on Meridiani Planum, Mars. The image was taken by the rover's panoramic camera.

  2. 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

  3. 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

    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.

  4. 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

  5. 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

  6. Bladder stones

    MedlinePlus

    ... such as: Bladder diverticulum Enlarged prostate Neurogenic bladder Urinary tract infection Almost all bladder stones occur in men. Bladder ... stream Pain, discomfort in the penis Signs of urinary tract infection (such as fever, pain when urinating, and need ...

  7. Kidney stones

    MedlinePlus Videos and Cool Tools

    ... cortex to the inner medulla. The renal pelvis is the funnel through which urine exits the kidney ... a kidney stone (renal calculus). Usually the calculus is the size of a small pebble. But ureters ...

  8. Kidney stones

    MedlinePlus Videos and Cool Tools

    ... urine exits the kidney and enters the ureter. As urine can become very concentrated as it passes through the kidneys. When the urine ... chemicals dissolved in the urine can crystallize, forming a kidney stone (renal calculus). Usually the calculus is ...

  9. 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

  10. Double-J ureteric stenting in pregnancy: A single-centre experience from Iraq

    PubMed Central

    Ngai, Ho-Yin; Salih, Hawre Qadir; Albeer, Ayad; Aghaways, Ismaeel; Buchholz, Noor

    2013-01-01

    Objectives To evaluate the safety and effectiveness of ureteric stenting with a JJ stent in pregnant women, to relieve renal obstruction and intractable flank pain. Patients and methods All pregnant patients presenting with intractable flank pain, with or without complications, to a tertiary national teaching hospital in Kurdistan/Iraq, and necessitating ureteric stenting with a JJ stent, were prospectively assessed for this study between March 2008 and March 2010. Results In all, 30 pregnant patients presented with intractable flank pain necessitating JJ ureteric stenting during the 25 months. Intractable flank pain (23 patients, 77%) was the most common indication for ureteric stenting, followed by flank pain with clinical sepsis (six, 20%). All pregnant women had hydronephrosis on ultrasonography (US), and 12 (40%) had evidence of coexisting renal stones on US. All ureteric stents were inserted successfully. The mean (range) indwelling time was 47.4 (3–224) days. Radiologically, 14 (47%) and 15 (50%) had complete resolution of the hydronephrosis on follow-up US in late pregnancy and in the early postnatal period, respectively. Two-thirds of patients had a clinical improvement immediately (15, 50%) and soon after (five, 17%) surgery. Stent encrustation (three, 10%), stent migration (three, 10%) and stent irritation (five, 17%) were reported as complications. The post-natal evaluation confirmed that half the patients had urinary calculus disease. Conclusion Ureteric stenting during pregnancy can be safe, with no intraoperative imaging and even under local anaesthesia. It provides good symptom relief and has a low complication rate. We therefore advocate it as a first-line treatment in pregnant women with therapy-resistant flank pain. PMID:26558073

  11. Ureteric obstruction due to pelvic actinomycosis.

    PubMed

    Brown, R; Bancewicz, J

    1982-03-01

    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

  12. Outcome of bilateral ureteroscopic retrieval of stones in a single session

    PubMed Central

    Mushtaque, Majid; Gupta, C. L.; Shah, Imtiyaz; Khanday, M. Ashraf; Khanday, Samina Ali

    2012-01-01

    Aim: Evaluation of bilateral ureteroscopic retrieval of stones as a single-stage procedure in terms of clearance of the stones, complications of the procedure and duration of hospital stay. A successful outcome was considered when both ureters were free of stones without any major complications. Materials and Methods: A total of 60 patients with bilateral ureteric stones were treated ureteroscopically from March 2006 to September 2009 in the department of Surgery (Urology unit). Majority of the patients were in their third and fourth decade of life with 38 males and 22 females. A single session bilateral ureteroscopic retrieval of stones was done using a 7.8 Fr semirigid ureteroscope. A 0.038-inch guide wire was used and advanced under direct vision, and monitored by C-arm X-ray image intensifier. Balloon dilatation of the intramural ureters was required in 82 renal units. The stones were either extracted directly or disintegrated into small pieces by lithotripsy (pneumatic) before extraction. Ureteric stenting was required in 39 patients. Patients were followed for a period of 3-12 months. Results: A total of 60 patients (120 renal units) with bilateral ureteric stones were treated ureteroscopically. The stone size in the treated patients was in the range 6-20 mm. The stones were radio-opaque in 47 patients and radiolucent in 13 patients. Single stone was present in all except two patients. Operative time ranged between 40 and 120 minutes. Stones were completely removed in 51 (85%) patients following single-session procedure of which 39 (76.4%) were stonefree intraoperatively and another 12 (23.5%) were cleared of the stones in 4 weeks follow-up. Six patients were stonefree unilaterally. Failed procedures were managed with repeated ureteroscopy, DJ stenting and ESWL or open ureterolithotomy. Intraoperatively false passage or minor ureteric perforations were seen in six patients. Postoperative complications included abdominal pain in 10, persistent fever in 4 and

  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. 21 CFR 876.5470 - Ureteral dilator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ureteral dilator. 876.5470 Section 876.5470 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5470 Ureteral dilator....

  15. 21 CFR 876.5470 - Ureteral dilator.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Ureteral dilator. 876.5470 Section 876.5470 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5470 Ureteral dilator....

  16. Kidney Stones (For Parents)

    MedlinePlus

    ... Story" 5 Things to Know About Zika & Pregnancy Kidney Stones KidsHealth > For Parents > Kidney Stones Print A ... remove the stones from their urinary tracts. How Kidney Stones Form It's the kidneys' job to remove ...

  17. Efficacy of Alfuzosin After Shock Wave Lithotripsy for the Treatment of Ureteral Calculi

    PubMed Central

    Cho, Hee Ju; Shin, Soon Cheol; Seo, Do Young; Min, Dong Suk; Cho, Jeong Man; Kang, Jung Yoon

    2013-01-01

    Purpose We evaluated the efficacy of alfuzosin for the treatment of ureteral calculi less than 10 mm in diameter after extracorporeal shock wave lithotripsy (ESWL). Materials and Methods A randomized, single-blind clinical trial was performed prospectively by one physician between June 2010 and August 2011. A total of 84 patients with ureteral calculi 5 to 10 mm in diameter were divided into two groups. Alfuzosin 10 mg (once daily) and loxoprofen sodium 68.1 mg (as needed) were prescribed to group 1 (n=41), and loxoprofen sodium 68.1 mg (as needed) only was prescribed to group 2 (n=44). The drug administration began immediately after ESWL and continued until stone expulsion was confirmed up to a maximum of 42 days after the procedure. Results Thirty-nine of 41 (95.1%) patients in group 1 and 40 of 43 (93.0%) patients in group 2 ultimately passed stones (p=0.96). The number of ESWL sessions was 1.34±0.65 and 1.41±0.85 in groups 1 and 2, respectively (p=0.33). The patients who required analgesics after ESWL were 8 (19.5%) in group 1 and 13 (30.2%) in group 2 (p=0.31). Visual analogue scale pain severity scores were 5.33±1.22 and 6.43±1.36 in groups 1 and 2, respectively (p=0.056). The time to stone expulsion in groups 1 and 2 was 9.5±4.8 days and 14.7±9.8 days, respectively (p=0.005). No significant adverse effects occurred. Conclusions The use of alfuzosin in combination with ESWL seems to facilitate stone passage and to reduce the time of stone expulsion but does not affect the stone-free rate. PMID:23550174

  18. 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

  19. Pain killers and antibacterial therapy for kidney colic and stones.

    PubMed

    Porena, Massimo; Guiggi, Paolo; Balestra, Antonio; Micheli, Carla

    2004-01-01

    In 85% of patients, renal colic is caused by renal-ureteral stones with extrinsic obstructions such as pelvic, retroperitoneal or intestinal abnormalities, and intrinsic reno-ureteral obstructions, e.g. junction pathologies and malformation, accounting for only 10 and 5%, respectively. The objectives of therapy for renal colic therapy are to eliminate pain, preserve renal function and eliminate the obstruction by the excretory pathway. Many drugs can be used to relieve pain: non-steroid anti-inflammatory agents (NSAIDs), opioid analgesics, antidiuretic hormone (ADH), loco-regional anesthesia and acupuncture. Opiates are the first-choice therapy during pregnancy as no other drug is indicated because of tetragenic potential. Paracetamol (N-acetyl-p-aminophenol) is the only NSAID that is registered for pediatric use because it has none of the adverse side effects that are associated with NSAIDs. Tamsulosin, an alpha-lithic drug, has very recently been included among the drugs that are used for stone expulsion. The rationale underlying its use is that a high concentration of alpha-1D adrenergic receptors has been recently detected in the terminal ureter, especially in the intramural tract. Inhibition of alpha-1D receptor stimulation should relax smooth muscle in the intramural ureteral tract, making stone expulsion easier. PMID:15133331

  20. 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

  1. 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

  2. Image-guided ureteral reconstruction using rendezvous technique for complex ureteric transection after gunshot injuries.

    PubMed

    Arabi, Mohammad; Mat'hami, Abdulaziz; Said, Mohammad T; Bulbul, Muhammad; Haddad, Maurice; Al-Kutoubi, Aghiad

    2016-01-01

    Management of complex ureteric transection poses a significant clinical challenge, particularly after gunshot injuries due to marked distortion of anatomy and associated tissue loss. We report two cases of total ureteric transection due to gunshot injury successfully repaired using fluoroscopy-guided rendezvous procedure and double J stent placement. This minimally invasive approach may offer a safe and effective technique to repair complete ureteral transection and obviate the need for complex surgical procedures. PMID:26955601

  3. Image-guided ureteral reconstruction using rendezvous technique for complex ureteric transection after gunshot injuries

    PubMed Central

    Arabi, Mohammad; Mat’hami, Abdulaziz; Said, Mohammad T.; Bulbul, Muhammad; Haddad, Maurice; Al-Kutoubi, Aghiad

    2016-01-01

    Management of complex ureteric transection poses a significant clinical challenge, particularly after gunshot injuries due to marked distortion of anatomy and associated tissue loss. We report two cases of total ureteric transection due to gunshot injury successfully repaired using fluoroscopy-guided rendezvous procedure and double J stent placement. This minimally invasive approach may offer a safe and effective technique to repair complete ureteral transection and obviate the need for complex surgical procedures. PMID:26955601

  4. Comparison and Efficacy of Low-Dose and Standard-Dose Tamsulosin and Alfuzosin in Medical Expulsive Therapy for Lower Ureteral Calculi: Prospective, Randomized, Comparative Study

    PubMed Central

    Cha, Woo Heon; Choi, Jae Duck; Seo, Young Jin; Lee, Kyungseop

    2012-01-01

    Purpose Typically in Korea, for a standard dose (0.4 mg) of tamsulosin, two low doses (0.2 mg) are administered. The aim of this study was to evaluate and compare the efficacy of tamsulosin (0.2 mg and 0.4 mg) and alfuzosin (10 mg) in the treatment of lower ureteral stones. Materials and Methods A total of 141 patients presenting with a single 4- to 10-mm sized lower ureteral stone were randomly assigned to 4 groups. Patients in group 1 (n=41) and group 2 (n=30) received an oral dose of 0.2 mg tamsulosin once and twice daily, respectively, and patients in group 3 (n=36) received a daily oral dose of 10 mg alfuzosin. Patients in group 4 (n=34) received trospium chloride only. The spontaneous passage of stones, the stone expulsion time, and adverse effects were evaluated. Results There were no significant differences in patient background, including age, sex, BMI, stone size, stone side, and symptom duration. The spontaneous stone passage rate through the ureter was higher and the stone expulsion time was faster in groups 1, 2, and 3 than in group 4. There were no statistically different changes in groups 1, 2, and 3. The adverse effects observed in all groups were comparable and were mild. Conclusions Tamsulosin at 0.2 mg and 0.4 mg and alfuzosin (10 mg) proved to be safe and effective. A first cycle of medical expulsive therapy with tamsulosin 0.2 mg could be considered as an option in the management of single lower ureteral stone. PMID:22670195

  5. Intracellular and extracellular regulation of ureteric bud morphogenesis

    PubMed Central

    DAVIES, JAMIE

    2001-01-01

    The urinary collecting duct system of the permanent kidney develops by growth and branching of an initially unbranched epithelial tubule, the ureteric bud. Formation of the ureteric bud as an outgrowth of the wolffian duct is induced by signalling molecules (such as GDNF) that emanate from the adjacent metanephrogenic mesenchyme. Once it has invaded the mesenchyme, growth and branching of the bud is controlled by a variety of molecules, such as the growth factors GDNF, HGF, TGFβ, activin, BMP-2, BMP-7, and matrix molecules such as heparan sulphate proteoglycans and laminins. These various influences are integrated by signal transduction systems inside ureteric bud cells, with the MAP kinase, protein kinase A and protein kinase C pathways appearing to play major roles. The mechanisms of morphogenetic change that produce branching remain largely obscure, but matrix metalloproteinases are known to be necessary for the process, and there is preliminary evidence for the involvement of the actin/myosin contractile cytoskeleton in creating branch points. PMID:11322719

  6. 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.

  7. 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.

  8. 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.

  9. 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

  10. 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

  11. Diagnosis and management of postpercutaneous nephrolithotomy residual stone fragments.

    PubMed

    Skolarikos, Andreas; Papatsoris, Athanasios G

    2009-10-01

    Residual stone fragments can occur in up to 8% of patients who are treated with percutaneous nephrolithotomy (PCNL). When left untreated, approximately half of these patients will experience a stone-related event, for which more than half will need a secondary surgical intervention. Predictors of adverse events are a residual fragment larger than 2 mm that is located in the pelvis or ureter. Preventive measures for the creation of residual fragments include a carefully selected access giving exposure to the bulk of the stone, the creation of multiple tracts, the use of single pulse pneumatic lithotripsy, the prevention of stone migration with ureteral balloons or stone cones, and careful flushing of the stones from the collecting system. Plain radiography of the kidneys, ureters, and bladder, linear tomography, and ultrasonography have all been used to judge the result of PCNL and to detect the presence of residual fragments. Thin-slice, unenhanced helical CT, however, is more sensitive and should be performed at 1 month after surgery. While medical therapy and shockwave lithotripsy possess a minor role, second-look flexible nephroscopy and/or flexible ureterorenoscopy seem to be the treatments of choice for residual stone fragments after PCNL. PMID:19747041

  12. 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

  13. 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

  14. 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...

  15. 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...

  16. 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...

  17. 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...

  18. 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

  19. 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

  20. Diet and calcium stones.

    PubMed Central

    Hughes, J; Norman, R W

    1992-01-01

    OBJECTIVE: To review the current literature on the dietary modification of urinary risk factors as a means of reducing the likelihood of recurrent stone formation and to develop practical dietary recommendations that might be useful to this end. DATA SOURCES: MEDLINE was searched for English-language articles published from 1983 to 1990. Additional references were selected from the bibliographies of identified articles. STUDY SELECTION: Nonrandomized trials and retrospective reviews were included because of a paucity of randomized controlled trials. DATA SYNTHESIS: Information on the dietary intake of calcium, oxalate, protein, sodium and fibre and on alcohol and fluid intake was used to develop practical guidelines on dietary modification. CONCLUSION: Dietary modification plays an important role in the reduction of urinary risk factors in patients with calcium stone disease of the urinary tract. As an initial form of prevention attention should be directed toward moderating the intake of calcium, oxalate, protein, sodium and alcohol and increasing the intake of fibre and water. Future research should include an assessment of the long-term reduction of dietary and urinary risk factors and the rates of recurrence of calcium stones. PMID:1310430

  1. [Flank pain in renal and ureteral calculus].

    PubMed

    Pedersen, Katja Venborg; Drewes, Asbjørn Mohr; Osther, Palle Jørn Sloth

    2011-02-14

    Flank pain is common and often associated with stone colics. Similar pain characteristics can, however, be observed in other diseases. Stone colics have all the characteristics of visceral pain. The pain is diffuse, often referred to the body wall and accompanied by autonomic reflexes. In patients with recurrent stones, the colics may be more intense due to sensitisation of the nervous system. Furthermore, painful diseases in the reproductive organs can enhance stone colics. Non-steroidal anti-inflammatory drugs are the first choice for stone colics because they act by reducing the renal pelvic pressure. PMID:21320415

  2. 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

  3. 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

  4. [Pseudocystic ureteritis. Apropos of a case].

    PubMed

    Joual, A; Sarf, I; Aboutaieb, R; el Mrini, M; Benjelloun, S

    1995-01-01

    The authors report one case of ureteritis cystica in a young adult. The diagnosis was made by intravenous urography and confirmed by histologic examination. The patient was treated surgically (nephro-ureterectomy). The etiopathogenic, clinical and therapeutic aspects are discussed with a review of literature. PMID:8638909

  5. 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

  6. 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

  7. 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

  8. Ureteral Metastasis Secondary to Prostate Cancer: A Case Report.

    PubMed

    Morales, I; Bassa, C; Pavlovic, A; Morales, C

    2016-03-01

    Prostate cancer is very frequent, but secondary ureteral metastasis are extremely rare. We present a 55 year old man with a 2 month history of right flank pain and lower urinary tract symptoms. Prostatic specific antigen of 11.3 ng/mL. Computed tomography showed right hydroureteronephrosis, a developing urinoma and right iliac adenopathies. He underwent right ureteronephrectomy, iliac lymphadenectomy and prostate biopsy. Pathology revealed prostatic carcinoma infiltrating the ureteral muscularis propria, without mucosal involvement. There are 46 reported cases of prostate cancer with ureteral metastases. Ureteral metastasis are a rare cause of renal colic and need of a high index of suspicion. PMID:26793587

  9. Ureteral Metastasis Secondary to Prostate Cancer: A Case Report

    PubMed Central

    Morales, I.; Bassa, C.; Pavlovic, A.; Morales, C.

    2015-01-01

    Prostate cancer is very frequent, but secondary ureteral metastasis are extremely rare. We present a 55 year old man with a 2 month history of right flank pain and lower urinary tract symptoms. Prostatic specific antigen of 11.3 ng/mL. Computed tomography showed right hydroureteronephrosis, a developing urinoma and right iliac adenopathies. He underwent right ureteronephrectomy, iliac lymphadenectomy and prostate biopsy. Pathology revealed prostatic carcinoma infiltrating the ureteral muscularis propria, without mucosal involvement. There are 46 reported cases of prostate cancer with ureteral metastases. Ureteral metastasis are a rare cause of renal colic and need of a high index of suspicion. PMID:26793587

  10. 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

  11. [SURGICAL TREATMENT OF PATIENTS WITH URETERAL RUPTURES].

    PubMed

    Komjakov, B K; Guliev, B G

    2015-01-01

    The aim of the study was to analyze the causes of ureteral ruptures and the types surgical procedures used for their management. Over the period from 2006 to 2014, 7 patients with ureteral ruptures underwent surgical treatment in the Mechnikov N-WSMU clinic. All of them were males aged 50 to 71 years. In all cases, the ureter was injured during ureteroscopy and contact lithotripsy. In two patients the right ureter was cut off at the border of the upper and middle third, in four--at 3-4 cm below pyeloureteral segment, one patient diagnosed with a complete separation of the ureter from the kidney pelvis. Patients, who have suffered a detachment of the ureter in other hospitals, previously underwent surgical exploration of the retroperitoneal space, drainage of the kidney by pyelonephrostomy (5) and ureterocutaneostomy (1). In a case of a patient with an injury that occurred in our clinic, laparoscopic nephrectomy with autologous renal transplantation was carried out. Five patients with extended ureter defects underwent ileo-ureteroplasty. The patient with left ureterocutaneostomy underwent nephrovesical bypass. Patency of the upper urinary tract and kidney function were restored in all patients, all of them were relieved from external drains. The duration of the intestinal plastic averaged 160 minutes, laparoscopic nephrectomy with autologous transplantation--210 min and nephrovesical bypass--110 min. Blood transfusion was required only in autologous graft patient. The ureteral rupture is a serious complication of ureteral endourological procedures in upper urinary tract. It requires such complicated reconstructive operations as autologous transplantation of the kidney or intestinal ureteroplasty. PMID:26390553

  12. Management of nephrostomy drains and ureteral stents.

    PubMed

    Adamo, Robert; Saad, Wael E A; Brown, Daniel B

    2009-09-01

    Nephroureteral and double J stents are routinely placed by interventional radiologists but quality literature on placement and management of these devices is limited. The purpose of this review is to detail indications for ureteral stent placement, review the types of antegrade and retrograde devices that are placed including technical tips, and discuss management of common complications that occur in this patient population. An algorithm for placement and management is included. PMID:19945660

  13. 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

  14. 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

  15. Discolored Ureteral Stents: Findings in Urinalysis and Urine Culture

    PubMed Central

    Kawahara, Takashi; Miyamoto, Hiroshi; Ito, Hiroki; Terao, Hideyuki; Uemura, Hiroji; Kubota, Yoshinobu; Matsuzaki, Junichi

    2015-01-01

    Objective Discolored ureteral stents are sometimes encountered in daily clinical practice; however, the mechanism(s) underlying the development of discolored ureteral stents remain unknown. In this study, we retrospectively analyzed the characteristics of discolored ureteral stents based on the results of a urinalysis and urine culture. Materials & Methods We identified a total of 26 patients with discolored ureteral stents and compared the findings in the urinalyses and urine culture in 21 discolored versus 45 non-colored ureteral stents. Results The median and mean (±SD) duration of stenting time was 78.0 and 81.3 (± 21.3) days for the discolored ureteral stents and 69.0 and 74.9 (± 19.8) days for the non-colored ureteral stents, respectively (P = 0.25). The discolored ureteral stents were associated with a higher mean urine pH than the non-colored ureteral stents (mean: 6.4 vs 6.0, P< 0.05). There were no significant differences between the two groups in the RBC (P = 0.51) and WBC (P = 0.35) counts in the urinalyses. In addition, the rate of a positive culture in the patients with discolored stents [20 of 21 (95.2%)] was significantly (P <0.01) higher than that observed in the patients with non-colored ureteral stents [33 of 45 (73.3%)]. Conclusions In this study, the subjects with discolored ureteral stents showed a significantly higher likelihood of having a positive urine culture and also demonstrated higher pH values in the urinalyses. However, no clear cut-off point to predict discoloration was indicated. PMID:25849790

  16. Comparison between Double J (DJ) Ureteral Stenting and Percutaneous Nephrostomy (PCN) in Obstructive Uropathy

    PubMed Central

    Ahmad, Iftikhar; Saeed Pansota, Mudassar; Tariq, Muhammad; Shahzad Saleem, Muhammad; Ali Tabassum, Shafqat; Hussain, Akbar

    2013-01-01

    Objective: To compare the complications rate of percutaneous nephrostomy and double J ureteral stenting in the management of obstructive uropathy. Methodology: Total number of 300 patients of age 20-80 years who underwent JJ stenting or percutaneous nephrostomy for obstructive uropathy were included in this study. Patients were divided in two groups i.e. A & B. In group A, 100 patients who underwent double J ureteral stenting while in group B, 200 patients who underwent percutaneous nephrostomy tube insertion were included. The stent was inserted retrograde by using cystoscope, under mild sedation or local anesthesia. While the percutaneous nephrostomy was done under ultrasound guidance by using local anesthetic agent. Complications were noted in immediate post-operative period and on follow up. Results: Majority of the patients were between 36 to 50 years of age with male to female ratio was 2.6:1. The most common cause of obstructive uropathy was stone disease i.e. renal, ureteric or both. Post DJ stent, complications like painful trigon irritation, septicemia, haematuria and stent encrustation were seen in 12.0%, 7.0%, 10.0% and 5.0% patients respectively. On the other hand, post-PCN septicemia, bleeding and tube dislodgment or blockage was seen in 3.5%, 4.5% and 4.5% respectively. In this study, overall success rate for double J stenting was up to 83.0% and for percutaneous nephrostomy (PCN) was 92.0% (p<0.0001). Conclusion: Percutaneous nephrostomy is a safe and better method of temporary urinary diversion than double J stenting for management of obstructive uropathy with lower incidence of complications. PMID:24353616

  17. Effects of Tamsulosin, Solifenacin, and Combination Therapy for the Treatment of Ureteral Stent Related Discomforts

    PubMed Central

    Lim, Kyoung Taek; Kim, Yong Tae; Lee, Tchun Yong

    2011-01-01

    Purpose To evaluate the effect of tamsulosin, solifenacin, and combination therapy of two agents in improving the lower urinary tract symptoms of patients with indwelling double-J ureteral stents. Materials and Methods A total of 168 patients underwent placement of a double-J ureteral stent after retrograde ureteroscopy for urinary stone disease. All patients received polyurethane double-J ureteral stents (6 Fr, 24 or 26 cm), which were removed a mean of 14 days postoperatively. A total of 48 patients were given no medication (Group 1), 43 patients were given tamsulosin 0.2 mg once daily (Group 2), 45 patients were given solifenacin 5 mg once daily (Group 3), and 32 patients were given a combination of two agents postoperatively (Group 4). International Prostate Symptom Score/quality of life (IPSS/QoL) and visual analogue pain scale (VAPS) questionnaires were completed by each patient at 1 day postoperatively and on the day of stent removal. Results In the total group of patients, the mean age was 50.24±12.90 years. There was a significant difference in the IPSS total score between group 1 and groups 3 and 4. Group 4 also differed significantly from group 1 in the irritative subscore. The obstructive subscore differed between groups 2 and 4 and group 1. There was a statistically significant difference between group 1 and group 4 in the QoL score. There were no significant differences in the VAPS. Conclusions Combination therapy with tamsulosin and solifenacin improved both irritative and obstructive symptoms more than in the other groups. Combination therapy should be strongly considered for patients who complain of stent-related symptoms. PMID:21860770

  18. Effectiveness of medical treatment in overcoming the ureteral double-J stent related symptoms

    PubMed Central

    Kuyumcuoglu, Ugur; Eryildirim, Bilal; Tuncer, Murat; Faydaci, Gokhan; Tarhan, Fatih; Ozgül, Aydin

    2012-01-01

    Background: We investigated whether the frequency of lower urinary tract symptoms (LUTS) increased in patients in whom double-J stents were applied. We also evaluated several medical therapy protocols to treat symptoms related with ureteral stents. Materials and Methods: A total of 108 patients, in whom unilateral double-j stent was applied during ureteral stone treatment, were included. Before the double-J stent was applied, all patients completed storage components of the “International Prostate Symptom Score” (IPSSs), quality of life components of the IPSS (IPSS-QOL) and “Overactive Bladder Questionnaire” (OABq) forms and scores were calculated. After the procedure, cases were randomized into 5 groups, an antiinflammatory was given to Group 1, spasmolytic to Group 2, anticholinergic to Group 3 and α-blocker to Group 4. No additional drug was given to Group 5 as this control group. During the fourth week of the procedure, IPSSs, IPSS-QOL and OABq forms were again completed and scores were compared with the previous ones. Results: When all the cases were evaluated, the IPSSs, IPSS-QOL and OABq scores of patients in whom the double-J stent was applied were statistically significantly higher the procedure. Compared to the control group, the cases where the double-J stent was applied showed a higher IPSSs, IPSS-QOL and OABq scores and none of the medical therapies could prevent this increase. Interpretation: The frequency of LUTS increased in cases where the ureteral stent was applied and discomfort continued as long as the stent stayed in the body. PMID:21914427

  19. 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

  20. Herniorrhaphy: an unusual cause of ureteral injury in Nigeria

    PubMed Central

    Eziyi, Amogu K; Etonyeaku, Amarachukwu C; Olajide, Abimbola O; Adejumobi, Musibau O

    2014-01-01

    Key Clinical Message Herniorrhaphy is a common surgery worldwide. Common complications include hemorrhage, infection, chronic pain, and recurrence. Ureteric injury from herniorrhaphy is unusual. We present a case of ureteric injury complicating an inguinal herniorrhaphy for a huge right inguino-scrotal hernia. Patient had primary uretero-neocystostomy but died from septicemia in the postoperative period. PMID:25548623

  1. 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

  2. A review of ureteral injuries after external trauma

    PubMed Central

    2010-01-01

    Introduction Ureteral trauma is rare, accounting for less than 1% of all urologic traumas. However, a missed ureteral injury can result in significant morbidity and mortality. The purpose of this article is to review the literature since 1961 with the primary objective to present the largest medical literature review, to date, regarding ureteral trauma. Several anatomic and physiologic considerations are paramount regarding ureteral injuries management. Literature review Eighty-one articles pertaining to traumatic ureteral injuries were reviewed. Data from these studies were compiled and analyzed. The majority of the study population was young males. The proximal ureter was the most frequently injured portion. Associated injuries were present in 90.4% of patients. Admission urinalysis demonstrated hematuria in only 44.4% patients. Intravenous ureterogram (IVU) failed to diagnose ureteral injuries either upon admission or in the operating room in 42.8% of cases. Ureteroureterostomy, with or without indwelling stent, was the surgical procedure of choice for both trauma surgeons and urologists (59%). Complications occurred in 36.2% of cases. The mortality rate was 17%. Conclusion The mechanism for ureteral injuries in adults is more commonly penetrating than blunt. The upper third of the ureter is more often injured than the middle and lower thirds. Associated injuries are frequently present. CT scan and retrograde pyelography accurately identify ureteral injuries when performed together. Ureteroureterostomy, with or without indwelling stent, is the surgical procedure of choice of both trauma surgeons and urologists alike. Delay in diagnosis is correlated with a poor prognosis. PMID:20128905

  3. Damage of Stone Baskets by Endourologic Lithotripters: A Laboratory Study of 5 Lithotripters and 4 Basket Types

    PubMed Central

    Brinkmann, Ralf; Jocham, Dieter

    2013-01-01

    Background. In some cases, the ureteral stone is simultaneously stabilized by a stone basket when endourologic lithotripsy is performed. This stabilization can be either on purpose or by accident. By accident means that an impaction in the ureter occurs by an extraction of a stone with a basket. A stabilization on purpose means to avoid a retropulsion of the stone into the kidney during lithotripsy. At this part of the operation, stone baskets have been frequently damaged. This severing of wires can lead to ureteral trauma because of hook formation. Material and Methods. In a laboratory setting, the time and the pulse numbers were measured until breaking the wires from four different nitinol stone baskets by using five different lithotripsy devices. The endpoint was gross visibledamage to the wire and loss of electric conduction. Results. The Ho:YAG laser and the ultrasonic device were able to destroy almost all the wires. The ballistic devices and the electrohydraulic device were able to destroy thin wires. Conclusion. The operating surgeon should know the risk of damagefor every lithotripter. The Ho:YAG-laser and the ultrasonic device should be classified as dangerous for the basket wire with all adverse effects to the patient. PMID:24288527

  4. 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

  5. Outcome of ureteroscopy for stone disease in patients with horseshoe kidney: Review of world literature

    PubMed Central

    Ishii, Hiro; Rai, Bhavan; Traxer, Olivier; Kata, Slawomir G.; Somani, Bhaskar K.

    2015-01-01

    Introduction and Objectives: The management of urolithiasis in patients with horseshoe kidney (HSK) is difficult. Stone formation occurred in 1:5 patients with HSK due to impaired urinary drainage and infections. Percutaneous nephrolithotomy and shock wave lithotripsy can be technically challenging due to altered anatomy. Materials and Methods: We conducted a systematic review of the literature to look at the role of ureteroscopy for stone management in these patients. We searched MEDLINE, PubMed and the Cochrane Library from January 1990 to April 2013 for results of ureteroscopy and stone treatment in HSK patients. Inclusion criteria were all English language articles reporting on ureteroscopy in patients with HSK. Data were extracted on the outcomes and complications. Results: A total of 3 studies was identified during this period. Forty-one patients with HSK underwent flexible ureteroscopy and stone treatment. The mean age was 42 with a male:female ratio nearly 3:1. The mean stone size was 16 mm (range: 3-35 mm). The mean operating time was 86 min with multiple stones seen in 15 patients. All 41 patients had a ureteral access sheath used and flexible ureteroscopy and holmium laser fragmentation done. Thirty-two (78%) patients were stone-free with a mean hospital stay of 1-day. Minor complications (Clavien I or II) were seen in 13 (32%) of which 6 had stent discomfort, 3 needed intravenous antibiotics for <24 h, 3 had hematuria of which 2 needed blood transfusion and one had pyelonephritis needing re-admission and antibiotics. There were no major complications found in the review. Conclusions: Retrograde stone treatment using ureteroscopy and lasertripsy in HSK patients can be performed with good stone clearance rate, but with a slightly higher complication rate. This procedure should, therefore, be done in high volume stone center with an experienced stone surgeon/team. PMID:26692667

  6. Comparison of the clinical efficacy and safety of retroperitoneal laparoscopic ureterolithotomy and ureteroscopic holmium laser lithotripsy in the treatment of obstructive upper ureteral calculi with concurrent urinary tract infections.

    PubMed

    Jiang, Jun-Tao; Li, Wei-Guo; Zhu, Yi-Ping; Sun, Wen-Lan; Zhao, Wei; Ruan, Yuan; Zhong, Chen; Wood, Kristofer; Wei, Hai-Bin; Xia, Shu-Jie; Sun, Xiao-Wen

    2016-07-01

    The aim of this study is to compare the clinical efficacy and safety of retroperitoneal laparoscopic ureterolithotomy (RPLU) and ureteroscopic holmium laser lithotripsy (UHLL) as two minimally invasive procedures in managing obstructive upper ureteral calculi with concurrent urinary tract infections (UTI). The retrospective study included 189 patients who underwent unilateral obstructive upper ureteral stones with concurrent UTI from January 2007 to November 2014 at our institution. Patients received RPLU (81 cases) or UHLL (108 cases). All patients received preoperative anti-infection treatment (indwelling ureteral stent and/or preoperative antibiotics). Collected data, including sex, age, stone size, success rate, operation duration, post-operation hospitalization time, and post-operation complications, were compared. All patients were followed up for more than 6 months after surgeries, and no ureterostenosis occurred. The study included 189 patients, 41 (21.7 %) females and 148 (78.3 %) males with a medium age of 52 years (range 22-81 years). All surgeries were successfully performed without conversion to open surgery. Stone size in the RPLU group was larger than that of the UHLL group (16.1 ± 1.4 vs. 10.4 ± 1.6 mm, P = 0.012). Operative duration (P = 0.009) and hospitalization time (P < 0.001) in the UHLL group were significantly shorter than those in the RPLU group, whereas stone clearance rate was significantly higher in the RPLU group (100 vs. 88.9 %, P = 0.002). Of note, postoperative fever was more common in patients treated with UHLL (15 cases) versus RPLU (4 cases) (13.9 vs. 4.9 %, P = 0.043). Moreover, in the UHLL group, three patients without a preoperative indwelling ureteral stent were complicated with sepsis, which was not seen in RPLU group. In our study, the safety and stone clearance rate of RPLU are better than those of UHLL in the treatment of unilateral upper ureteric calculi with concurrent UTI

  7. 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

  8. 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

  9. 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...

  10. Cutting laser systems for ureteral strictures

    NASA Astrophysics Data System (ADS)

    Durek, C.; Knipper, Ansgar; Brinkmann, Ralf; Miller, Ado; Gromoll, Bernd; Jocham, Dieter

    1994-02-01

    Acquired ureteral strictures are still treated either with a stent, balloon dilatation, by open surgery or by endoscopic therapy with a `cold knife' or high current density as intubated ureterotomy. The success rates described in the literature range between 50% and 90%. Using the experimental CTH:YAG laser (wavelength 2120 nm) and CT:YAG laser (wavelength 1950 nm), the reduction of invasiveness and of morbidity was evaluated. First, the CTH:YAG laser was investigated on 540 fresh porcine ureters varying the parameters. With a computerized morphometry system, defect depth, defect width, coagulation depth and coagulation width were measured. Then 21 female pigs underwent 7.5 F - 12 F ureteroscopy with CTH:YAG laser, CT:YAG laser, high current density and `cold knife' ureterotomy. An IVP and sacrification with explanation of the whole urinary tract was done on day 6 and around day 60. In practice, laser application via the endoscope was easy to handle and exact cutting was always seen. The CT:YAG laser seems to have the best success results with low ureteral stricture recurrence rates. However, its clinical use remains to be proven.

  11. 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

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

    PubMed

    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. Kidney stone disease

    PubMed Central

    Coe, Fredric L.; Evan, Andrew; Worcester, Elaine

    2005-01-01

    About 5% of American women and 12% of men will develop a kidney stone at some time in their life, and prevalence has been rising in both sexes. Approximately 80% of stones are composed of calcium oxalate (CaOx) and calcium phosphate (CaP); 10% of struvite (magnesium ammonium phosphate produced during infection with bacteria that possess the enzyme urease), 9% of uric acid (UA); and the remaining 1% are composed of cystine or ammonium acid urate or are diagnosed as drug-related stones. Stones ultimately arise because of an unwanted phase change of these substances from liquid to solid state. Here we focus on the mechanisms of pathogenesis involved in CaOx, CaP, UA, and cystine stone formation, including recent developments in our understanding of related changes in human kidney tissue and of underlying genetic causes, in addition to current therapeutics. PMID:16200192

  14. Lithotripsy with the alexandrite laser: our initial 100 clinical cases.

    PubMed

    Pertusa, C; Albisu, A; Acha, M; Blasco, M; Llarena, R; Arregui, P

    1991-01-01

    The alexandrite laser system has proven to be an effective and safe method of treating ureteral stones. When the electromagnetic energy of a laser light pulse is selectively absorbed by the stone, a plasma forms at the surface. This plasma, which is composed of ions and electrons, continues to absorb laser energy, reaching very high pressure and generating a shock wave that fragments the stone. The degree of stone fragmentation is directly related to the composition and crystal lattice structure of the calculus. 112 calculi have been treated, and laser lithotripsy was successful in 87.5%. 6% of the stones were inadvertently flushed back into the kidney. No patient required an open ureterolithotomy. Guidance of the laser fiber onto the stone was performed by rigid ureteroscopy. There were no troublesome complications, and in a 3-month follow-up, no sequelae were reported. PMID:1687678

  15. 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

  16. 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

  17. 1. GENERAL VIEW. NOTE THE FOLLOWING: STONE BUTTRESS ON STONE ...

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

    1. GENERAL VIEW. NOTE THE FOLLOWING: STONE BUTTRESS ON STONE END, STONE COLUMNS ON FOREBAY. DATE STONE REMOVED IN 1914, BUT BARN MAY HAVE BEEN CONSTRUCTED IN THE 1830s - Barn, Beidler Road, Upper Merion Township, King of Prussia, Montgomery County, PA

  18. Urinary tract stones in pregnancy.

    PubMed

    Swanson, S K; Heilman, R L; Eversman, W G

    1995-02-01

    The presence of stones during an otherwise uneventful pregnancy is a dramatic and potentially serious issue for the mother, the fetus, and the treating physicians alike. The incidence and predisposing factors are generally the same as in nonpregnant, sexually active, childbearing women. Unique metabolic effects in pregnancy such as hyperuricuria and hypercalciuria, changes in inhibitors of lithiasis formation, stasis, relative dehydration, and the presence of infection all have an impact on stone formation. The anatomic changes and physiologic hydronephrosis of pregnancy make the diagnosis and treatment more challenging. Presenting signs and symptoms include colic, flank pain, hematuria, urinary tract infection, irritative voiding, fever, premature onset or cessation of labor, and pre-eclampsia. The initial evaluation and treatment are again similar to those used for the nonpregnant population. The most appropriate first-line test is renal ultrasonography, which may, by itself, allow the diagnosis to be made and provide enough information for treatment. Radiographic studies, including an appropriately performed excretory urogram, give specific information as to size and location of the stones, location of the kidneys, and differential renal function and can be used safely, but the ionizing radiation risks should be considered. All forms of treatment with the exception of extracorporeal shock wave lithotripsy and some medical procedures are appropriate in the pregnant patient. Close coordination by the urologist, the obstetrician, the pediatrician, the anesthesiologist, and the radiologist is required for the appropriate care of these patients. PMID:7855714

  19. 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.

  20. [TRANSURETHRAL CONTACT URETERAL LITHOTRIPSY IN A GASEOUS (CO2) MEDIUM].

    PubMed

    Glybochko, P V; Aljaev, Ju G; Rapoport, L M; Carichenko, D G; Arzumanjan, E G

    2015-01-01

    The paper describes for the first time the method of contact ureteral lithotripsy in gaseous (CO2) medium. It presents the results of a comparative study of urolithiasis patients treated with this treatment modality (study group, n=30) and with traditional contact ureteral lithotripsy in liquid medium (control group, n=30). The incidence of retrograde migration of calculus in the kidney in the study group was 0%, while it was 16.6% in the control group. Acute or exacerbation of chronic pyelonephritis was diagnosed in only 3 (10%) patients in the control group. The suggested method of contact ureteral lithotripsy is safe and provides several advantages over traditional contact ureteral lithotripsy in a fluid medium, such as: physiologic validity, absence of calculus hypermobility (increased mobility), improved visualization during surgery and high cost effectiveness. PMID:26237808

  1. [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

  2. Ureteral reimplantation in children with neurogenic bladder.

    PubMed

    Belloli, G P; Musi, L; Campobasso, P; Cattaneo, A

    1979-04-01

    The treatment of urologic complications from myelomeningocele and especially of vesico-renal reflux is a controversial problem. A series of 26 reimplanted ureters in 17 children, with good results in more than 85%, is reported. Ureteroneocystostomy, carried out with a few technical innovation, may represent a useful method for the treatment of vesico-renal reflux and obstruction of the uretero-vesical junction in neurogenic bladder associated with myelomeningocele. This surgical approach leads to the disappearance of the reflux, decrease of dilatation of the upper urinary tract and preservation of renal function in most cases; moreover, infection can be more easily controlled. Ureteral reimplantation should be preceded by periodic urethral dilatation, external transurethral sphincterotomy, and pharmacologic regulation in order to attempt to decrease urethral resistance. After successful surgery, it is possible to try to reeducate the bladder. Reimplantation should be preferred to permanent urinary diversion even if there is gross reflux. PMID:458534

  3. [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

  4. 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

  5. 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.

  6. 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

  7. Robotic-assisted ureteral reimplantation with Boari flap and psoas hitch: a single-institution experience.

    PubMed

    Yang, Christopher; Jones, Loren; Rivera, Marcelino E; Verlee, Graham T; Deane, Leslie A

    2011-11-01

    Robotic-assisted ureteral reimplantations were performed on 3 patients at a single institution, 2 with Boari flap and psoas hitch and 1 with psoas hitch alone. These were for urothelial carcinoma of the distal ureter, ureteral obstruction caused by distal ureteral endometriosis, and ureteral transaction during gynecologic surgery. We used intraoperative ureteroscopy to confirm tumor margins as well as a simple technique for retrograde placement of transvesicle wire prior to ureteral anastomosis. Surgery and recovery were uneventful. This illustrates that robotic-assisted ureteral reimplantation with Boari flap and psoas hitch is a safe and viable approach for ureterovesicle reconstruction. PMID:21859340

  8. Salivary duct stones

    MedlinePlus

    ... glands. Salivary duct stones are a type of salivary gland disorder. ... 83. Jackson NM, Mitchell JL, Walvekar RR. Inflammatory disorders of the salivary glands. In: Flint PW, Haughey BH, Lund LJ, et ...

  9. 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.

  10. Kidney Stones in Children

    MedlinePlus

    ... Nephrology American Kidney Fund National Kidney Foundation MedlinePlus Kidney and Urologic Disease Organizations Many organizations provide support ... Disease Organizations​​ . (PDF, 345 KB) Alternate Language URL Kidney Stones in Children Page Content On this page: ...

  11. Diet and Kidney Stones

    MedlinePlus

    ... drink at least three quarts (12 cups) of water a day to help reduce the risk for stone formation. Making these healthy lifestyle changes can also help reduce ... NY Register Now 2016 Orangeburg Kidney Walk Thu, ...

  12. Kidney Stones in Children

    MedlinePlus

    ... through the child’s body to break the kidney stone into smaller particles to pass more readily through the urinary tract. Children younger than age 12 may receive general anesthesia during the procedure. ...

  13. Renal stones in pregnancy

    PubMed Central

    Gibbons, Norma; DasGupta, Ranan

    2014-01-01

    Diagnosis and treatment of renal stones during pregnancy is a complex problem. Risks to the fetus from ionising radiation and interventional procedures need to be balanced with optimising clinical care for the mother. Management of such patients requires a clear understanding of available options, with a multidisciplinary team approach. In this review, we discuss the role of different diagnostic tests including ultrasound, magnetic resonance urography, and computerized tomography. We also provide an update on recent developments in the treatment of renal stones during pregnancy. Expectant management remains first-line treatment. Where definitive treatment of the stone is required, new evidence suggests that ureteroscopic stone removal may be equally safe, and possibly better than traditional temporising procedures.

  14. Kidney Stones in Adults

    MedlinePlus

    ... had a kidney stone. 2 2 Scales CD, Smith AC, Hanley JM, Saigal CS. Prevalence of kidney ... table or, less commonly, in a tub of water above the lithotripter. The lithotripter generates shock waves ...

  15. [NEW OPTIONS OF ENDOSCOPIC TREATMENT FOR KIDNEY AND URETER STONES IN OBESE PATIENTS].

    PubMed

    Martov, A G; Dutov, S V; Andronov, A S; Kil'chukov, Z I; Tahaev, R A

    2015-01-01

    Effective urolithiasis treatment, especially in overweight patients has a considerable medical and social implication. Extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotripsy (PCNL) in prone position of the patient are standard treatment options for kidney and ureter stones. These interventions are not always effective in patients with concomitant obesity and are associated with technical difficulties and an increased risk of complications. The study included 175 patients with obesity. The first group consisted of 96 (54.8%) patients treated with transurethral contact lithotripsy. The 2nd group consisted of 54 (30.9%) patients who underwent PCNL in the supine position. The third group comprised 25 (14.3%) patients with multiple stones of kidney and ureter, who underwent combined transurethral and percutaneous intervention in the supine position. The 1st and 3rd group had a higher prevalence of patients with II degree of obesity, in the 2nd group--with I degree of obesity. The mean duration of surgery in 1st group was 43.4 min, in the 2nd--70.3 min and in the third--84.6 min. Method of kidney drainage depended mainly on the presence, location and size of residual stone fragments. The average duration of the kidney drainage stent in patients of the 1st group was 39 days (ureteral catheter--1.3 days). In all patients of the 2nd and 3rd groups, at the final stage of the operation a nephrostomy tube was placed for an average of 2.7 days. The average postoperative hospital stay was 2.9 days in the 1st group, 4.1 days in the 2nd group and 4.5 days in the third group. In the 1st group, the stone-free status was achieved in 81 (84.4%) patients. Another 10 (10.4%) patients later needed ESWL for the complete disposal of the stones. In the 2nd group, the complete clearance of kidney stones was achieved in 49 (90.7%) patients. Another 3 (5.6%) patients required added ESWL to achieve the stone-free status. In the third group of patients stone free status

  16. 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

  17. 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

  18. 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.

  19. Analysis of early nephron patterning reveals a role for distal RV proliferation in fusion to the ureteric tip via a cap mesenchyme-derived connecting segment.

    PubMed

    Georgas, Kylie; Rumballe, Bree; Valerius, M Todd; Chiu, Han Sheng; Thiagarajan, Rathi D; Lesieur, Emmanuelle; Aronow, Bruce J; Brunskill, Eric W; Combes, Alexander N; Tang, Dave; Taylor, Darrin; Grimmond, Sean M; Potter, S Steven; McMahon, Andrew P; Little, Melissa H

    2009-08-15

    While nephron formation is known to be initiated by a mesenchyme-to-epithelial transition of the cap mesenchyme to form a renal vesicle (RV), the subsequent patterning of the nephron and fusion with the ureteric component of the kidney to form a patent contiguous uriniferous tubule has not been fully characterized. Using dual section in situ hybridization (SISH)/immunohistochemistry (IHC) we have revealed distinct distal/proximal patterning of Notch, BMP and Wnt pathway components within the RV stage nephron. Quantitation of mitoses and Cyclin D1 expression indicated that cell proliferation was higher in the distal RV, reflecting the differential developmental programs of the proximal and distal populations. A small number of RV genes were also expressed in the early connecting segment of the nephron. Dual ISH/IHC combined with serial section immunofluorescence and 3D reconstruction revealed that fusion occurs between the late RV and adjacent ureteric tip via a process that involves loss of the intervening ureteric epithelial basement membrane and insertion of cells expressing RV markers into the ureteric tip. Using Six2-eGFPCre x R26R-lacZ mice, we demonstrate that these cells are derived from the cap mesenchyme and not the ureteric epithelium. Hence, both nephron patterning and patency are evident at the late renal vesicle stage. PMID:19501082

  20. 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

  1. Lunar Phases and Emergency Department Visits for Renal Colic Due to Ureteral Calculus

    PubMed Central

    Yang, Andy W.; Johnson, Justin D.; Fronczak, Carolyn M.; LaGrange, Chad A.

    2016-01-01

    Background Urolithiasis affects an estimated 5% of the population and the lifetime risk of passing a stone in the urinary tract is estimated to be 8–10%. Urinary calculus formation is highly variable and while certain risk factors such as age, gender, seasonality, anatomic abnormality, and metabolic diseases have been identified, not much is known regarding the association of environmental factors such as lunar phases on renal colic. We conducted a retrospective study to test the hypothesis that full moon phase is an environmental factor associated for increased emergency department (ED) visits for renal colic due to ureteral calculus. Methods We analyzed 559 renal colic diagnoses by the ED at the University of Nebraska Medical Center in a 24-month period and compared them with corresponding lunar phases as well as supermoon events. The lunar phases were defined as full moon ± two days, new moon ± two days, and the days in-between as normal days according to the lunar calendar. Supermoon event dates were obtained from NASA. Results 90 cases (16.1%) were diagnosed during full moon phase, 89 cases (15.9%) were diagnosed during new moon phase, and 380 cases (68.0%) were diagnosed during normal days. The incidence of renal colic showed no statistically significant association with lunar phases or supermoon events. Conclusion In this retrospective longitudinal study with adequate power, neither full moon phase nor supermoon event exhibited an association with increased renal colic diagnoses due to ureteral calculus by the ED at the University of Nebraska Medical Center. PMID:27299307

  2. 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

  3. Robotic Proximal Ureteropyelostomy After Unsuccessful Endourologic Management of Complicated Proximal Ureteral Stone Disease

    PubMed Central

    Olvera-Posada, Daniel; Dion, Marie; Alenezi, Husain; Razvi, Hassan

    2015-01-01

    Abstract We present a clinical case of a 66-year-old female with a left ureteropelvic junction impacted renal calculi associated with a tortuous ureter. After a failed combined retrograde and antegrade endoscopic procedure, a robot-assisted laparoscopic ureteropyelostomy was successful.

  4. Renal intratubular crystals and hyaluronan staining occur in stone formers with bypass surgery but not with idiopathic calcium oxalate stones.

    PubMed

    Evan, Andrew P; Coe, Fredric L; Gillen, Daniel; Lingeman, James E; Bledsoe, Sharon; Worcester, Elaine M

    2008-03-01

    Whether idiopathic calcium oxalate (CaOx) stone formers form inner medullary collecting duct (IMCD) crystal deposits bears on pathogenetic mechanisms of stone formation. In prior work, using light and transmission electron microscopy, we have found no IMCD crystal deposits. Here, we searched serial sections of papillary biopsies from a prior study of 15 idiopathic calcium oxalate stone formers, 4 intestinal bypass patients with CaOx stones, and 4 non-stone-forming subjects, and biopsies from an additional hitherto unreported 15 idiopathic calcium oxalate stone formers and 1 bypass patient using polarized light oil immersion optics, for deposits overlooked in our original study. We found no IMCD deposits in any of 1,500 serial sections from the 30 idiopathic calcium oxalate stone formers, nor in 87 additional sections from a frozen idiopathic calcium oxalate stone former biopsy sample processed without exposure to aqueous solutions. Among 4 of the 5 bypass patients but in none of the 30 idiopathic calcium oxalate stone formers or 4 normal stone formers, we found tiny birefringent thin crystalline overlays on scattered IMCD cell membranes. We also found IMCD lumen deposits in two bypass patients that contained mixed birefringent and nonbirefringent crystals, presumably CaOx and apatite. In the bypass patients, we observed focal apical IMCD cell hyaluronan staining, which was absent in idiopathic calcium oxalate stone formers. The absence of any IMCD deposits in 1,500 serial sections of biopsies from 30 idiopathic calcium oxalate stone formers allows us to place the upper limit on the probability of their occurrence at approximately 0.002 and place the lower limit of their size at the resolution of the optics (<0.2 mu). The tiny deposits in bypass patients may be the initial crystal lesion. PMID:18286613

  5. 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.

  6. Pyelo-ureteral necrosis after renal transplantation.

    PubMed

    Spasovski, Goce B; Masin-Spasovska, Jelka; Stavridis, Sotir; Saiti, Skender; Lekovski, Ljupco

    2008-01-01

    Because of the limited chance of receiving a kidney transplant (for several well-known reasons), a lot of desperate dialysis patients procure an unrelated donor kidney transplant against all medical advice. This type of renal paid transplantation is associated with many surgical complications and invasive opportunistic infections that increase the morbidity and mortality in this group of transplant recipients. In this report, we describe a case of a 22-year-old girl with a segmental infarction of the graft lower pole and a complete pyelo-ureteral necrosis as a consequence of some vascular damage, complicated by a pathohistological finding of an invasive candidiasis. Despite the successful surgical pyelovesical anastomosis and the good recovery of the patient and the kidney, long-term prognosis remains poor. The lack of information from the transplanting center regarding both donor and recipient and the associated, unacceptable risks on the graft and patient survival in unrelated, paid transplant recipients reinforce the standpoint that this practice should be abandoned. PMID:18204913

  7. Stone Comminution Correlates with the Average Peak Pressure Incident on a Stone during Shock Wave Lithotripsy

    PubMed Central

    Smith, N.; Zhong, P.

    2012-01-01

    To investigate the roles of lithotripter shock wave (LSW) parameters and cavitation in stone comminution, a series of in vitro fragmentation experiments have been conducted in water and 1,3-butanediol (a cavitation-suppressive fluid) at a variety of acoustic field positions of an electromagnetic shock wave lithotripter. Using field mapping data and integrated parameters averaged over a circular stone holder area (Rh = 7 mm), close logarithmic correlations between the average peak pressure (P+(avg)) incident on the stone (D = 10 mm BegoStone) and comminution efficiency after 500 and 1,000 shocks have been identified. Moreover, the correlations have demonstrated distinctive thresholds in P+(avg) (5.3 MPa and 7.6 MPa for soft and hard stones, respectively), that are required to initiate stone fragmentation independent of surrounding fluid medium and LSW dose. These observations, should they be confirmed using other shock wave lithotripters, may provide an important field parameter (i.e., P+(avg)) to guide appropriate application of SWL in clinics, and facilitate device comparison and design improvements in future lithotripters. PMID:22935690

  8. Diet for Kidney Stone Prevention

    MedlinePlus

    ... may also help prevent kidney stones, such as citrus drinks. Recommendations based on the specific type of ... do to prevent kidney stones. Some studies suggest citrus drinks like lemonade and orange juice protect against ...

  9. Kidney stones - self-care

    MedlinePlus

    Renal calculi - self-care; Nephrolithiasis - self-care; Stones - kidney - self-care ... You visited your health care provider or the hospital because you have a kidney stone. You will need to take self-care steps. Which steps ...

  10. 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 ...

  11. Flexible ureteroscopy versus laparoscopy for the treatment of patients who initially presented with obstructive pyelonephritis

    PubMed Central

    Sahin, Selcuk; Resorlu, Berkan; Eksi, Mithat; Aras, Bekir; Atar, Arda; Tugcu, Volkan

    2016-01-01

    Objective: To compare the safety and effectiveness of flexible ureteroscopy (F-URS) with transperitoneal laparoscopic ureterolithotomy (TPLU) in cases of obstructive pyelonephritis secondary to large proximal ureteral stones. Methods: A series of 42 patients presenting with obstructive pyelonephritis due to proximal ureteral stones larger than 1.5 cm were included from April 2006 to February 2015 in this comparative study. After drainage of pyonephrosis and resolution of sepsis, 22 patients treated with TPLU (Group I), and 20 patients were treated with F-URS (Group II). Preoperative patient and stone characteristics, procedure-related parameters and clinical outcomes were assessed for each group. Results: It was seen that both methods were effective in the treatment of large proximal ureteral stones. However TPLU provided a higher stone- free rate (100% vs 80%. p=0.043) and lower retreatment rate. There was no difference between the groups for the operative time and complication rate. On the other hand, patients treated with F-URS had less postoperative pain (p=0.008), a shorter hospital stay (p<0.001) and a faster return to daily activities (p<0.001). Conclusions: The results of our study show that both F-URS and TPLU are safe and effective surgical procedures for treatment of large proximal ureteral stones after controlling obstructive pyelonephritis. However, TPLU has a higher stone-free rate with comparable operating time and complication rate as compared to F-URS. On the other hand F-URS has the advantages of less postoperative pain, shorter hospital stay and faster return to daily activities. PMID:27375691

  12. 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…

  13. Challenging Case: Stones.

    PubMed

    Soloway, Mark S; Ziemba, Justin B; Matlaga, Brian R; Monga, Manoj

    2016-10-01

    A 40-year-old woman presents to the emergency department after a motor vehicle accident, and a CT scan revealed no injuries but incidentally notes three non-obstructing stones in the left kidney of 3, 4, and 5 mm in size. She is completely asymptomatic and has no history of urolithiasis. PMID:27566646

  14. 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 ...

  15. Preclinical assessment of the new 1440-nm-wavelength Nd:YAG laser for fragmenting ureteral calculi in an ex-vivo pig model

    NASA Astrophysics Data System (ADS)

    Wollin, Timothy A.; Moore, Ronald B.; Tulip, John; Mourad, Walid A.; McPhee, Malcolm S.

    1996-05-01

    The dual wavelength Nd:YAG (multi-YAG) laser has excellent stone ablating properties. To investigate the safety of this laser for fragmenting ureteral calculi, an ex vivo animal study was undertaken to study acute tissue interactions associated with multi-YAG laser lithotripsy. Human ureteral calculi were implanted in ureters harvested from swine (n equals 42). Direct vision ureteroscopic laser lithotripsy was performed while varying pulse energy (0.3 to 1.5 Joules) and pulse frequency (5 to 15 Hz). All ureters were then examined histologically, graded for tissue injury, and compared to controls. Photofragmentation was associated with mucosal denudation and/or focal mucosal necrosis (grade 0 and 1) in 37/42 cases. Four treatments caused necrosis involving up to two thirds of the ureteral wall (grade 2) and 1/42 had grade 3 changes (transmural necrosis). Ureteroscopic examination alone produced grade 0 to 1 injuries. Logistic regression analysis revealed that pulse energy (p equals 0.47), total energy used for fragmentation (p equals 0.82), and stone weight (p equals 0.64) were not significant predictors of higher grade tissue injury. Pulse frequency (p equals 0.14) began to approach significance. Of the five ureters with grade 2 or greater injury, four were associated with a pulse frequency of 15 Hz. Our findings show that multi-YAG laser lithotripsy is associated with acute tissue changes ranging from mucosal denudation to different levels of coagulative necrosis. Low grade injury is most common and would have minimal potential for strictures. Although higher grade tissue injury is possible, all grade 2 and 3 injuries were microscopically focal in nature. Therefore, multi-YAG laser lithotripsy can be performed with acceptable levels of acute tissue injury at pulse energies up to 1.5 Joules and at pulse frequencies less than 15 Hz.

  16. 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

  17. 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

  18. 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

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

    PubMed

    Rajaian, Shanmugasundaram; Kekre, Nitin S

    2012-09-01

    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

  20. 21 CFR 876.4020 - Fiberoptic light ureteral catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Fiberoptic light ureteral catheter. 876.4020 Section 876.4020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4020 Fiberoptic...

  1. 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.

  2. 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...

  3. 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

  4. 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

  5. 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

  6. Pyrophosphate Transport and Stones

    NASA Astrophysics Data System (ADS)

    Sayer, John A.; Carr, Georgina; Moochhala, Shabbir H.; Simmons, Nicholas L.

    2008-09-01

    Since the 1960's, inorganic pyrophosphate (PPi) has been known to inhibit apatite precipitation. Recent findings suggest that PPi plays a central role in the control of normal bone mineralization. Knockout mice have established the functional importance of PPi transmembrane transport, via the pyrophosphate transporter ANKH. The molecular nature and transport function of ANKH are reviewed. PPi is present in urine and ANKH is expressed in the cortical collecting duct where PPi transport to both the tubular lumen and renal interstitium may occur. Arginine vasopressin stimulation of cortical collecting duct cells grown on semi-permeable supports appears to upregulate apical ANKH expression, which we postulate may be a mechanism of stone inhibition during urinary concentration and supersaturation of calcium salts. Hypopyrophosphaturia may be a forgotten metabolic risk factor for stone formation and polymorphisms of the ANKH gene may underlie this defect. The physiological importance and clinical significance of PPi generation and transport in preventing idiopathic renal stone disease and nephrocalcinosis now needs to be established.

  7. 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

  8. 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

  9. Diet: from food to stone.

    PubMed

    Friedlander, Justin I; Antonelli, Jodi A; Pearle, Margaret S

    2015-02-01

    Dietary factors have been shown to influence urine composition and modulate the risk of kidney stone disease. With the rising prevalence of stone disease in many industrialized nations, dietary modification as therapy to improve lithogenic risk factors and prevent stone recurrence has gained appeal, as it is both relatively inexpensive and safe. While some dietary measures, such as a high fluid intake, have been shown in long-term randomized clinical trials to have durable effectiveness, other dietary factors have been subjected to only short-term clinical or metabolic studies and their efficacy has been inferred. Herein, we review the current literature regarding the role of diet in stone formation, focusing on both the effect on urinary stone risk factors and the effect on stone recurrence. PMID:24938177

  10. 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.

  11. 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.

  12. A mechanistic analysis of stone fracture in lithotripsy.

    PubMed

    Sapozhnikov, Oleg A; Maxwell, Adam D; MacConaghy, Brian; Bailey, Michael R

    2007-02-01

    In vitro experiments and an elastic wave model were used to analyze how stress is induced in kidney stones by lithotripsy and to test the roles of individual mechanisms-spallation, squeezing, and cavitation. Cylindrical U30 cement stones were treated in an HM-3-style lithotripter. Baffles were used to block specific waves responsible for spallation or squeezing. Stones with and without surface cracks added to simulate cavitation damage were tested in glycerol (a cavitation suppressive medium). Each case was simulated using the elasticity equations for an isotropic medium. The calculated location of maximum stress compared well with the experimental observations of where stones fractured in two pieces. Higher calculated maximum tensile stress correlated with fewer shock waves required for fracture. The highest calculated tensile stresses resulted from shear waves initiated at the proximal corners and strengthened along the side surfaces of the stone by the liquid-borne lithotripter shock wave. Peak tensile stress was in the distal end of the stone where fracture occurred. Reflection of the longitudinal wave from the distal face of the stone--spallation-produced lower stresses. Surface cracks accelerated fragmentation when created near the location where the maximum stress was predicted. PMID:17348540

  13. [Infection-induced urinary stones].

    PubMed

    Bichler, K-H; Eipper, E; Naber, K

    2003-01-01

    Infection stones make up approximately 15% of urinary stone diseases and are thus an important group. These stones are composed of struvite and/or carbonate apatite. The basic precondition for the formation of infection stones is a urease-positive urinary tract infection. Urease is necessary to split urea into ammonia and CO(2). As a result, ammonia ions can form and at the same time alkaline urine develops, both being preconditions for the formation of struvite and carbonate apatite crystals. When these crystals are deposited infection stones form. Pathogenetically, various risk factors play a role: urinary obstruction, neurogenic bladder, dRTA, and MSK. If these infections are not treated and the stones are not removed, the kidney will be damaged. Modern methods are available for stone removal, e.g., ESWL and/or instrumental urinary stone removal. Here, especially less invasive methods are preferable. Any treatment must be adjusted to the patient individually. Patients should be examined frequently for recurrent urinary tract infections and stone recurrences, and new infections must be resolutely treated. Good therapy and prophylaxis are possible with present-day treatment modalities. PMID:12574884

  14. [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

  15. 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

  16. 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

  17. Delayed Migration of Embolized Coil with Large Renal Stone Formation: A Rare Presentation

    PubMed Central

    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

  18. 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.

  19. Simultaneous percutaneous nephrolithotomy and early endoscopic ureteric realignment for iatrogenic ureteropelvic junction avulsion during ureteroscopy

    PubMed Central

    Tayeb, Marawan El; Mellon, Matthew J.; Lingeman, James E.

    2015-01-01

    We present a case report of successful management of ureteropelvice junction avulsion during ureteroscopy successfully managed with simultaneous percutaneous nephrolithotomy and early endoscopic ureteral realignment. PMID:26834898

  20. 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

  1. 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.

  2. 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.

  3. 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.

  4. Ureteritis cystica: an interesting case with diagnostic dilemma.

    PubMed

    Zamri, Z; Harunarashid; Das, S; Ramzisham, A R M

    2010-01-01

    Ureteritis cystica is a rare, benign, proliferative condition. We report the case of a 51-year-old female who complained of dysuria and frequency for the last 10 years. The symptoms, however, increased in severity and frequency over the past one year. Urine culture and sensitivity showed presence of Escherichia Coli which was sensitive to augmentin and ciproflaxocin. The urinary tract ultrasonography and intravenous urography revealed bladder diverticula with multiple small, smooth well defects with sharp borders that protruded into the lumen along the proximal and mid left ureter. This finding was later confirmed by retrograde pyelogram. She was treated and currently is on long term antibiotic therapy. The diagnostic features and management of ureteritis cystic is being discussed in detail. PMID:20964103

  5. Inspection of Ureteral Orifices: The Pearl of Flexible Cystoscopy

    PubMed Central

    Matthews, Charmaine; Bushra, Hamid; Das, Sanjay; Pettersson, Bo

    2015-01-01

    Abstract Cystoscopy is most common diagnostic investigation. The examination technique and the findings, both normal and pathological, were well described described a hundred years ago. With technological advances, there has been over-emphasis on imaging modalities for diagnostic purposes. A basic maneuver of examining the ureteral orifices is sometimes rushed through when in fact careful examination can clinch the diagnosis. The importance is exemplified by two cases, one of which is a rare case of Xanthoma of the ureter.

  6. 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

  7. 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. PMID:26853541

  8. 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

  9. 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.

  10. 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

  11. Stenting for malignant ureteral obstruction: Tandem, metal or metal-mesh stents.

    PubMed

    Elsamra, Sammy E; Leavitt, David A; Motato, Hector A; Friedlander, Justin I; Siev, Michael; Keheila, Mohamed; Hoenig, David M; Smith, Arthur D; Okeke, Zeph

    2015-07-01

    Extrinsic malignant compression of the ureter is not uncommon, often refractory to decompression with conventional polymeric ureteral stents, and frequently associated with limited survival. Alternative options for decompression include tandem ureteral stents, metallic stents and metal-mesh stents, though the preferred method remains controversial. We reviewed and updated our outcomes with tandem ureteral stents for malignant ureteral obstruction, and carried out a PubMed search using the terms "malignant ureteral obstruction," "tandem ureteral stents," "ipsilateral ureteral stents," "metal ureteral stent," "resonance stent," "silhouette stent" and "metal mesh stent." A comprehensive review of the literature and summary of outcomes is provided. The majority of studies encountered were retrospective with small sample sizes. The evidence is most robust for metal stents, whereas only limited data exists for tandem or metal-mesh stents. Metal and metal-mesh stents are considerably more expensive than tandem stenting, but the potential for less frequent stent exchanges makes them possibly cost-effective over time. Urinary tract infections have been associated with all stent types. A wide range of failure rates has been published for all types of stents, limiting direct comparison. Metal and metal-mesh stents show a high incidence of stent colic, migration and encrustation, whereas tandem stents appear to produce symptoms equivalent to single stents. Comparison is difficult given the limited evidence and heterogeneity of patients with malignant ureteral obstruction. It is clear that prospective, randomized studies are necessary to effectively scrutinize conventional, tandem, metallic ureteral and metal-mesh stents for their use in malignant ureteral obstruction. PMID:25950837

  12. Sticks and stones.

    PubMed

    Abrahams, S

    1999-01-01

    SUMMARY "Sticks and Stones" is an exploration of life-in-the-ghetto; twenty five years of sex and politics, and wrestling with sexual correctness. It is concerned with the changing paradigms of lesbian 'vice and virtue': the butch-femme bar girl; the feminist woman-identified-woman; the sex radical warrior; the chic babe who's Queer and Here. How's a lesbian supposed to find an identity in all that? And remain true to her erotic preferences and sexual practices, frequently in the face of severe opposition? Joan Nestle, Gayle Rubin, Emma Healey and Sue O'Sullivan act as critical guides through this retrospective view of my collisions with erotic orthodoxy; they add discursive weight to the recollected experiences of negotiating historical shifts and re-alignments in ideology and practice of (Western) lesbian sexuality. Is the only way to spot a 'real' lesbian to watch what she does in bed? PMID:24786275

  13. A novel type of ureteral stents in the treatment of a bilateral iatrogenic transaction of the ureters.

    PubMed

    Mazza, Ernesto; Mondaini, Francesco; Abdulcadir, Dalmar; Raspanti, Claudio; Citone, Michele; Lapini, Alberto

    2013-01-01

    This report illustrates the case of a patient who suffered an iatrogenic complete injury of both ureters after a complex surgical procedure to remove a large sacral chordoma. Ureteral recanalization was achieved with two removable, autoexpandable, and polytetrafluoroethylene covered nitinol stents. To our knowledge, we describe the first application of this type of stents to treat a bilateral ureteral transection. Despite the bad general conditions of the patient, the ureteral stents successfully restored and maintained the bilateral ureteral continuity. PMID:23984172

  14. 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).

  15. Second harmonic generation using nonlinear Rayleigh surface waves in stone

    NASA Astrophysics Data System (ADS)

    Smith, Margaret; Kim, Gun; Kim, Jin-Yeon; Kurtis, Kimberly; Jacobs, Laurence

    2015-03-01

    This research tests the potential application of the Second Harmonic Generation (SHG) method using nonlinear Rayleigh surface waves to nondestructively quantify surface microstructural changes in thin stone. The acoustic nonlinearity parameter (β) has been assessed as a meaningful indicator for characterizing the nonlinearity of civil engineering materials; additionally, Rayleigh waves offer the opportunity to isolate a material's near surface microstructural status. Sandstone was selected for testing due to its relative uniformity and small grain size compared to other stone types; the sample thickness was 2 inches to reflect the minimum panel thickness recommended by the Indiana Limestone Institute. For this research, initially fully non-contact generation and detection techniques are evaluated before a 100kHz wedge transmitter and a 200kHz air-coupled receiver are employed for generation and detection of nonlinear Rayleigh waves. Non-contact transmitters and receivers have advantages such as removing the irregularities associated with coupling as well as not leaving residues, which in stone applications can be considered aesthetically damaging. The experimental results show that the nonlinear parameter, β, can be effectively isolated using the wedge transmitter and non-contact set up and that too much of the signal strength is lost in the fully non-contact method to extract meaningful results for this stone and stones with slow wave speeds. This indicates that the proposed SHG technique is effective for evaluating the nonlinearity parameter, β, and can next be applied to characterize near surface microstructural changes in thin applications of dimensioned stone.

  16. A heuristic model of stone comminution in shock wave lithotripsy

    PubMed Central

    Smith, Nathan B.; Zhong, Pei

    2013-01-01

    A heuristic model is presented to describe the overall progression of stone comminution in shock wave lithotripsy (SWL), accounting for the effects of shock wave dose and the average peak pressure, P+(avg), incident on the stone during the treatment. The model is developed through adaptation of the Weibull theory for brittle fracture, incorporating threshold values in dose and P+(avg) that are required to initiate fragmentation. The model is validated against experimental data of stone comminution from two stone types (hard and soft BegoStone) obtained at various positions in lithotripter fields produced by two shock wave sources of different beam width and pulse profile both in water and in 1,3-butanediol (which suppresses cavitation). Subsequently, the model is used to assess the performance of a newly developed acoustic lens for electromagnetic lithotripters in comparison with its original counterpart both under static and simulated respiratory motion. The results have demonstrated the predictive value of this heuristic model in elucidating the physical basis for improved performance of the new lens. The model also provides a rationale for the selection of SWL treatment protocols to achieve effective stone comminution without elevating the risk of tissue injury. PMID:23927195

  17. Gypsum accumulation on carbonate stone

    USGS Publications Warehouse

    McGee, E.S.; Mossotti, V.G.

    1992-01-01

    The accumulation of gypsum on carbonate stone has been investigated through exposure of fresh samples of limestone and marble at monitored sites, through examination of alteration crusts from old buildings and through laboratory experiments. Several factors contribute to gypsum accumulation on carbonate stone. Marble or limestone that is sheltered from direct washing by rain in an urban environment with elevated pollution levels is likely to accumulate a gypsum crust. Crust development may be enhanced if the stone is porous or has an irregular surface area. Gypsum crusts are a surficial alteration feature; gypsum crystals form at the pore opening-air interface, where evaporation is greatest.

  18. 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

  19. 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

  20. 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

  1. Toradol, an NSAID used for renal colic, decreases renal perfusion and ureteral pressure in a canine model of unilateral ureteral obstruction.

    PubMed

    Perlmutter, A; Miller, L; Trimble, L A; Marion, D N; Vaughan, E D; Felsen, D

    1993-04-01

    Toradol is a new parenteral, nonsteroidal anti-inflammatory drug which is efficacious in treating renal coli. In the present experiments, Toradol was administered to both control dogs and dogs with unilateral ureteral obstruction. In control dogs, Toradol had no effect on RBF or GFR, despite inhibition of renal prostaglandin synthesis (measured as urinary prostaglandin release). In contrast, RBF fell acutely by 35% (p < 0.001) within 15 minutes of Toradol administration in the setting of ureteral obstruction; contralateral RBF was unaffected. Ipsilateral ureteral pressure also fell. Changes in RBF and ureteral pressure, together with the known effects of NSAIDs on pain pathways, may contribute to the pain relief observed clinically with Toradol. However, the abrupt changes in renal hemodynamics brought on by Toradol to the obstructed kidney may compromise renal reserve, and Toradol should be used cautiously in treating renal colic. PMID:8455277

  2. 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

  3. Diet for Kidney Stone Prevention

    MedlinePlus

    ... diet plan should a person follow to prevent future kidney stones? A dietitian can help a person ... Training & Career Development Research at NIDDK Research Resources Technology Advancement & Transfer Meetings & Events Health Information Health Topics ...

  4. 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

  5. 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.

  6. Molecular Pathology of Murine Ureteritis Causing Obstructive Uropathy with Hydronephrosis

    PubMed Central

    Ichii, Osamu; Otsuka, Saori; Namiki, Yuka; Hashimoto, Yoshiharu; Kon, Yasuhiro

    2011-01-01

    Primary causes of urinary tract obstruction that induces urine retention and results in hydronephrosis include uroliths, inflammation, and tumors. In this study, we analyzed the molecular pathology of ureteritis causing hydronephrosis in laboratory rodents. F2 progenies of C57BL/6 and DBA/2 mice were studied histopathologically and by comprehensive gene expression analysis of their ureters. Incidence of hydronephrosis was approximately 5% in F2 progenies. Histopathologically, this hydronephrosis was caused by stenosis of the proximal ureter, which showed fibrosis and papillary malformations of the proliferative epithelium with infiltrations of B-cell-dominated lymphocytes. Additionally, CD16-positive large granular leukocytes and eosinophils infiltrated from the ureteral mucosa to the muscular layer. Eosinophilic crystals were characteristically observed in the lumen of the ureter and the cytoplasm of large granular leukocytes, eosinophils, and transitional epithelial cells. Comprehensive gene profiling revealed remarkably elevated expression of genes associated with hyperimmune responses through activation of B cells in diseased ureters. Furthermore, diseased ureters showed dramatically higher gene expression of chitinase 3-like 3, known as Ym1, which is associated with formation both of adenomas in the transitional epithelium and of eosinophilic crystals in inflammatory conditions. The Ym1 protein was mainly localized to the cytoplasm of the transitional epithelium, infiltrated cells, and eosinophilic crystals in diseased ureters. We determined that the primary cause of hydronephrosis in F2 mice was ureteritis mediated by the local hyperimmune response with malformation of the transitional epithelium. Our data provide a novel molecular pathogenesis for elucidating causes of aseptic inflammation in human upper urinary tracts. PMID:22114694

  7. Eya-Six are necessary for survival of nephrogenic cord progenitors and inducing nephric duct development prior to ureteric bud formation

    PubMed Central

    Xu, Jinshu; Xu, Pin-Xian

    2015-01-01

    Background Specification of the metanephric mesenchyme is a central step of kidney development as this mesenchyme promotes nephric duct induction to form a ureteric bud near its caudal end. Prior to ureteric bud formation, the caudal nephric duct swells to form a pseudostratified epithelial domain that later emerges as the tip of the bud. However, the signals that promote the formation of the transient epithelial domain remain unclear. Here we investigated the early roles of the mesenchymal factor Six family and its cofactor Eya on the initial induction of nephric duct development. Results The nephrogenic progenitor population is initially present but significantly reduced in mice lacking both Six1 and Six4 and undertakes an abnormal cell death pathway to be completely eliminated by ~E10.5-11.0, similar to that observed in Eya1−/− embryos. Consequently, the nephric duct fails to be induced to undergo normal proliferation to pseudostratify and form the ureteric bud in Six1−/−;Six4−/− or Eya1−/− embryos. Conclusion Our data support a model where Eya-Six may form a complex to regulate nephron progenitor cell development before metanephric specification and are critical mesenchymal factors for inducing nephric duct development. PMID:25903664

  8. 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.

  9. 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.

  10. Minimally invasive surgery for the treatment of ureteral stump syndrome

    PubMed Central

    Alenezi, Husain; Eltiraifi, Abdelmoniem E.; Alomar, Mohammad

    2015-01-01

    Objective: The aim was to highlight the advantages and the feasibility of treating ureteral stump syndrome (USS) by different minimally invasive procedures. Materials and Methods: Four patients with USS who were treated by different minimally invasive surgery approaches depending on their presentation and findings on radiologic investigations. Results: Three patients had complete resolution of their symptoms, whereas the fourth patient had persistence of urinary tract infection. Conclusion: Minimally invasive surgery is a valid treatment option for patients with USS with possible less morbidity than conventional open surgical excision. PMID:26692664

  11. 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 99mTc-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

  12. Renal aspergilloma presenting with pelvi-ureteric junction Obstruction (PUJO).

    PubMed

    Ullah, Syed Rabi; Jamshaid, Anila; Zaidi, Syed Zafar

    2016-07-01

    Primary renal aspergillosis, though a rare entity, is still seen in immune compromised individuals. Renal aspergillosis may lead to formation of focal abscesses, fungal bezoars and may cause ureteric obstruction. Treatment involves stabilization of patient and removal of fungal bezoars along with administration of anti-fungal agents. This report describes the case of localized primary renal aspergillosis with fungal bezoars formation in a 55 years old female, diabetic, hypertensive, who presented with upper urinary tract obstruction and was successfully managed by endoscopic removal of fungal bezoars and intravenous amphotericin followed by oral itraconazole. PMID:27427147

  13. 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

    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).

  14. 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

  15. [Adjustable electrohydraulic lithotripsy for minimally invasive ureteroscopic stone treatment].

    PubMed

    Vorreuther, R; Engelking, R

    1992-03-01

    We report on 82 ureteroscopies and electrohydraulic lithotripsies performed with small semirigid ureteroscopes with a minimum outer diameter of 6.5 F and probes of 2.4 F and 3.3 F. Prototypes of new lithotripters were employed, which incorporate infinitely variable energy within a range of 265-1382 mJ per pulse. Increased energy was provided by a rise in voltage, thus modifying the peak pressure and the initial slope of the shock wave. One third of the stones were situated in the upper ureter, 15% in the middle and 46% in the lower ureter. In 54% of these cases previous ESWL (Dornier MFL 5000) had been performed without success. Over 85% of the manipulations were performed under local anesthesia and i.v. sedation. Stone contact was achieved in 99%. Lithotripsy was fully successful in over 90%. The average energy per pulse was 450 mJ. In 7% partial disintegration was achieved and the residual stone was flushed back into the renal pelvis followed by further effective ESWL treatment. One stone had to be removed by open surgery. There were no major complications, such as perforations, due to the electrohydraulic lithotripsy itself. One perforation was caused when the endoscope was advanced into the ureter. No strictures were seen at the 6-month follow-up examination. An indwelling stent was placed in 48% of cases, as the stone burden or an inflamed stone bed suggested this was necessary. We conclude that electrohydraulic lithotripsy with adjustable energy resulting in various peak pressures of the shock wave is a safe and effective method of endoureteral stone treatment. PMID:1561730

  16. [A ureteral endoscopic approach--a minimally invasive method complementary to nephroureterectomy].

    PubMed

    Geavlete, P; Jora, T

    1998-01-01

    Nephroureterectomy with ureteral stump excision and perimeatal cystectomy is the "golden standard surgical approach" for urothelial upper urinary tract cancer. Nephroureterectomy is also necessary in renoureteral tuberculosis, with compromised renal unit. Since June 1995 we performed the endoscopic distal ureteral approach in 11 cases (9 cases with upper urinary tract cancer and 2 cases with renal tuberculosis and concomitant ureteral distal lesions). In 7 cases we performed ureteral stripping after nephrectomy and in 4 cases we performed endoscopic disconnection of the intramural ureter followed by nephroureterectomy (in one operative step). Ureteral stripping was realized in two ways: perimeatal resection of the ureter and 12 o'clock incision. There was only one intraoperative complication which consisted in the dislodgement of the ureteral catheter who needs conversion to open surgery. Mean follow-up period was 12 months (range 2 to 28). The evolution of the patients was satisfactory, with significant reduction of the hospitalization. According to our experience the endoscopic distal ureteral approach is a safer complementary proceeding to the one step nephroureterectomy, being performed faster and easier than open ureterectomy. PMID:9656599

  17. 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

  18. Lower intestinal modification of ureteral urine in hydrated house sparrows.

    PubMed

    Goldstein, D L; Braun, E J

    1986-01-01

    The ureters of birds empty into the posterior portion of the lower intestine, thereby providing the possibility for modification of ureteral urine by this latter organ. We have used in vivo perfusion to measure the transport of Na+, K+, and water across the lower intestine (colon and coprodaeum) of anesthetized house sparrows (Passer domesticus). Na+ was reabsorbed from (Vmax = approximately 22 mu eq . cm-2 . h-1, Km = approximately 69 meq/l) and K+ was secreted (at variable rates) into all saline perfusion fluids. The osmotic permeability of the intestinal epithelium was 0.39 microliter . cm-2 . h-1 . mosM-1 in the mucosal-to-serosal direction and 0.43 microliter . cm-2 . h-1 . mosM-1 in the serosal-to-mucosal direction. At isosmotic perfusion, Na+-linked water transport occurred at a rate of 1.7 microliter/mu eq Na+. In hydrated house sparrows the composition of ureteral urine (osmolarity = 351 mosM, Na+ = 86.5 meq/l, K+ = 60.5 meq/l) was significantly modified by transport in the lower intestine (voided fluid osmolarity = 344 mosM, Na+ = 60 meq/l, K+ = 90 meq/l). Interspecific comparisons of lower intestinal resorptive surface area and transport parameters at the level of the tissue, organ, and whole animal reveal no consistent pattern of adaptation related to habitat. PMID:3942257

  19. Sulfasalazine reduces inflammatory renal injury in unilateral ureteral obstruction.

    PubMed

    Demirbilek, Savas; Emre, Memet Hanefi; Aydin, Engin Nasuhi; Edali, Mehmet Naci; Aksoy, Rauf Tuğrul; Akin, Melih; Gürünlüoğlu, Kubilay; Tas, Erkan; Ay, Selma; Yilmaz, Zümrüt

    2007-06-01

    The purpose of this study was to test whether sulfasalazine has a protective action against interstitial inflammation and the development of renal fibrosis in obstructive nephropathy. Female rats were subjected to a sham (n = 10) or unilateral ureteral obstruction (UUO, n = 30). UUO was induced in rats by ligating the left ureter. Three days after operation, rats subjected to UUO were randomized to receive tretment with either sulfasalazine (100 mg/kg) or vehicle every day for the last 7 days of the experiment. At 10 days following UUO, the obstructed kidney exhibited tubulointerstitial injury and leukocyte infiltration (mainly monocytes) that were associated with high levels of reactive oxygen species, cytokines, transforming growth factor (TGF)-beta1, myeloperoxidase (MPO), and lipid peroxidation. Ten days after UUO, the obstructed kidney was also associated with increased nuclear factor kappa beta (NF-kappabeta) expression in saline-treated rats. Compared with sham-operated rats, UUO rat kidneys showed lower concentrations of antioxidant enzymes in the obstructed kidney tissue. All of these changes were significantly attenuated by treatment with sulfasalazine in the obstructed kidney. Sulfasalazine protected against the renal interstitial inflammation and tissue damage elicited by ureteral occlusion. Inhibition of the NF-kappabeta-dependent pathway and inflammatory response and oxidative stress inhibition is likely to be involved in the beneficial effects of sulfasalazine. PMID:17294223

  20. Canada's National Building Stone: Tyndall Stone from Manitoba

    NASA Astrophysics Data System (ADS)

    Pratt, Brian R.; Young, Graham A.; Dobrzanski, Edward P.

    2016-04-01

    Tyndall Stone is a distinctively mottled and highly fossiliferous dolomitic limestone that belongs to the Selkirk Member of the Red River Formation, of Late Ordovician (Katian) age. It has been quarried at Garson, Manitoba, 37 km northeast of Winnipeg, since 1895, although other quarries in the area go back to 1832. Tyndall Stone, so named because it was shipped by rail from nearby Tyndall, is currently produced by Gillis Quarries Limited. It has various uses as a dimension stone. Large slabs, most often cut parallel to bedding, face the exterior or interior of many important buildings such as the Parliament Buildings and the Canadian Museum of Civilization in the Ottawa area, the Empress Hotel in Victoria, and the provincial legislatures in Winnipeg and Regina, as well as many commercial buildings especially in the Canadian prairies. At the quarries, the stone is cut vertically, using eight foot (2.44 m) diameter saws mounted on one hundred foot (30.5 m) tracks, then split into 6-8 tonne blocks that are moved using front-end loaders. Gillis Quarries operates a large finishing plant with an area of about 4000 m2. Stone is processed along advanced cutting lines that feature eight primary saws and six gantry saw stations, allowing it to be made into a variety of sizes, shapes, and finishes. The Selkirk Member is 43 m thick and the stone is extracted from a 6-8 m thick interval within the lower part. The upper beds tend to be more buff-coloured than the grey lower beds due to weathering by groundwater. The stone is massive, but extracted blocks are less than ~1m thick due to splitting along stylolites. Consisting of bioturbated wackestone to packstone, the Tyndall Stone was deposited in a shallow-marine environment within the photic zone, in the central part of the vast equatorial epicontinental sea that covered much of Laurentia. Scattered thin, bioclastic grainstone lenses record brief, low-energy storm events. The distinctive mottles are formed by dolomitized

  1. 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.

  2. [Endoscopic management of biliary stones].

    PubMed

    Barinagarrementería, R

    1990-07-01

    Endoscopic sphincterotomy is one of the more effective therapeutic procedures for the management of some biliary tree abnormalities. In choledocolitiasis, a 90% succesfull rate has been obtained. Complications include bleeding, perforation, cholangitis, and pancreatitis. Mortality rates between 1.0 to 1.3% are informed. Contraindications are the same as for panendoscopy as well as the presence of stones greater than 2.5 cms. In giant stones, some other endoscopic approaches can be used, including mechanical lithotripsy, chemical treatment, electrohydraulic shockwaves, laser and biliary stent application. Endoscopic sphincterotomy is also indicated as an adjuvant therapy previous to extracorporeal lithotripsy. PMID:19256137

  3. Kidney stones - what to ask your doctor

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000186.htm Kidney stones - what to ask your doctor To use the ... features on this page, please enable JavaScript. A kidney stone is a solid piece of material that forms ...

  4. 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

  5. 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

  6. Kidney Stones in Children and Teens

    MedlinePlus

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

  7. "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)

  8. 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:...

  9. 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

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

    PubMed

    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

  11. 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

  12. Intraperitoneal stone migration during percutaneos nephrolithotomy.

    PubMed

    Diri, Akif; Karakan, Tolga; Resorlu, Mustafa; Kabar, Mucahit; Germiyanoglu, Cankon

    2014-12-01

    Percutaneos nephrolithotomy (PNL) is the standard care for renal stones larger than 2 cm. The procedure has some major and minor complications. Renal pelvis laceration and stone migration to the retroperitoneum is one of the rare condition. We report the first case of intraperitoneal stone migration during PNL. PMID:25641455

  13. 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

  14. The effect of indomethacin and metamizole on ureteral motility and urine flow in sheep.

    PubMed

    Khater, S; Angelo-Khattar, M; Thulesius, O

    1990-01-01

    The objective of this study was to evaluate the effect of two non-steroid anti-inflammatory drugs, indomethacin and metamizole, on ureteral peristalsis during acute occlusion similar to the situation in renal colic. In 12 pentobarbital anesthetized sheep, both ureters were cannulated and the frequency of ureteral contractions, urine flow, mean ureteral pressure and blood pressure were recorded during 10-min control and i.v. drug administration periods. Both indomethacin (1-2 mg/kg) and metamizole (60-120 mg/kg) showed a dose dependent reduction in peristaltic frequency without reduction of the mean pressure. In addition, the pressure amplitude of the peristaltic waves was also lowered, particularly with indomethacin. Only indomethacin reduced the urine flow. Arterial blood pressure was elevated by both drugs, particularly after the first dose of indomethacin. It can be concluded that indomethacin and metamizole reduce ureteral peristaltic frequency, probably blocking the impulse transmission at the ureteropelvic junction. PMID:2100421

  15. "Stone Cold": Worthy of Study?

    ERIC Educational Resources Information Center

    Douthwaite, Alison

    2015-01-01

    This article draws on my experiences of teaching "Stone Cold" to respond to a blog post suggesting that the novel holds little educational value. I argue that the novel's narrative style helps to foster criticality while its subject matter can help students see the relevance of literature to the world around them. Relating this to…

  16. 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...

  17. Unusually large submandibular gland stone.

    PubMed

    Al-Hussona, Aws Adel

    2015-01-01

    Submandibular gland calculi is the most common disease of the gland. In this article, we report a case with unusually large stone located at the hilum of the gland causing necrosis of the overlying duct and the oral mucosa (floor of mouth). PMID:25934409

  18. 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

  19. 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

  20. 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

  1. 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

  2. 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

  3. 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

  4. 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

  5. C/EBP homologous protein (CHOP) deficiency ameliorates renal fibrosis in unilateral ureteral obstructive kidney disease

    PubMed Central

    Wang, Ching-Chia; Guan, Siao-Syun; Chen, Li-Ping; Chiang, Chih-Kang

    2016-01-01

    Renal tubulointerstitial fibrosis is an important pathogenic feature in chronic kidney disease and end-stage renal disease, regardless of the initiating insults. A recent study has shown that CCAAT/enhancer binding protein (C/EBP) homologous protein (CHOP) is involved in acute ischemia/reperfusion-related acute kidney injury through oxidative stress induction. However, the influence of CHOP on chronic kidney disease-correlated renal fibrosis remains unclear. Here, we investigated the role of CHOP in unilateral ureteral obstruction (UUO)-induced experimental chronic tubulointerstital fibrosis. The CHOP knockout and wild type mice with or without UUO were used. The results showed that the increased expressions of renal fibrosis markers collagen I, fibronectin, α-smooth muscle actin, and plasminogen activator inhibitor-1 in the kidneys of UUO-treated wild type mice were dramatically attenuated in the kidneys of UUO-treated CHOP knockout mice. CHOP deficiency could also ameliorate lipid peroxidation and endogenous antioxidant enzymes depletion, tubular apoptosis, and inflammatory cells infiltration in the UUO kidneys. These results suggest that CHOP deficiency not only attenuates apoptotic death and oxidative stress in experimental renal fibrosis, but also reduces local inflammation, leading to diminish UUO-induced renal fibrosis. Our findings support that CHOP may be an important signaling molecule in the progression of chronic kidney disease. PMID:26942460

  6. C/EBP homologous protein (CHOP) deficiency ameliorates renal fibrosis in unilateral ureteral obstructive kidney disease.

    PubMed

    Liu, Shing-Hwa; Wu, Cheng-Tien; Huang, Kuo-How; Wang, Ching-Chia; Guan, Siao-Syun; Chen, Li-Ping; Chiang, Chih-Kang

    2016-04-19

    Renal tubulointerstitial fibrosis is an important pathogenic feature in chronic kidney disease and end-stage renal disease, regardless of the initiating insults. A recent study has shown that CCAAT/enhancer binding protein (C/EBP) homologous protein (CHOP) is involved in acute ischemia/reperfusion-related acute kidney injury through oxidative stress induction. However, the influence of CHOP on chronic kidney disease-correlated renal fibrosis remains unclear. Here, we investigated the role of CHOP in unilateral ureteral obstruction (UUO)-induced experimental chronic tubulointerstital fibrosis. The CHOP knockout and wild type mice with or without UUO were used. The results showed that the increased expressions of renal fibrosis markers collagen I, fibronectin, α-smooth muscle actin, and plasminogen activator inhibitor-1 in the kidneys of UUO-treated wild type mice were dramatically attenuated in the kidneys of UUO-treated CHOP knockout mice. CHOP deficiency could also ameliorate lipid peroxidation and endogenous antioxidant enzymes depletion, tubular apoptosis, and inflammatory cells infiltration in the UUO kidneys. These results suggest that CHOP deficiency not only attenuates apoptotic death and oxidative stress in experimental renal fibrosis, but also reduces local inflammation, leading to diminish UUO-induced renal fibrosis. Our findings support that CHOP may be an important signaling molecule in the progression of chronic kidney disease. PMID:26942460

  7. 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.

  8. Macromolecules Relevant to Stone Formation

    NASA Astrophysics Data System (ADS)

    Ryall, Rosemary L.; Cook, Alison F.; Thurgood, Lauren A.; Grover, Phulwinder K.

    2007-04-01

    Despite years of research, no single macromolecule in kidney calculi or in urine has yet been shown to fulfill a specific function in stone pathogenesis. In this paper we briefly review papers investigating the urinary excretion of individual macromolecules, their effects on calcium oxalate (CaOx) crystallization and attachment of crystals to renal epithelial cells, and the influence of lithogenic conditions on their renal expression in cultured cells and animal models. Using prothrombin fragment 1 (PTF1) and human serum albumin as examples, we show the types of patterns resulting from the binding of a fluorescently tagged protein to a specific CaOx monohydrate (COM) crystal face and its incorporation into the crystal structure. Molecular modeling is also used to illustrate how PTF1 can align with the atomic array on a COM crystal surface. We conclude that although many macromolecules are, by strict definition, relevant to stone formation, very few are probably truly influential.

  9. 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)

  10. 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.

  11. Absence of Canonical Smad Signaling in Ureteral and Bladder Mesenchyme Causes Ureteropelvic Junction Obstruction

    PubMed Central

    Tripathi, Piyush; Wang, Yinqiu; Casey, Adam M.

    2012-01-01

    Obstruction of the ureteropelvic junction (UPJ) is a common congenital anomaly frequently associated with ureteral defects. To study the molecular mechanisms that modulate ureteral development, we inactivated Smad4, the common Smad critical for transcriptional responses to TGF-β and Bmp signaling, in the ureteral and bladder mesenchyme during embryogenesis. Loss of canonical Smad signaling in these tissues caused bilateral UPJ obstruction and severe hydronephrosis beginning at embryonic day 17.5. Despite a reduction in quantity of ureteral smooth muscle, differentiation proceeded without Smad4, producing a less severe phenotype than Bmp4 mutants; this finding suggests that at least some Bmp4 functions in ureteral smooth muscle may be Smad-independent. The absence of canonical Smad signaling in the ureteral mesenchyme, but not in the urothelium itself, led to urothelial disorganization, highlighting the importance of mesenchymal support for epithelial development. Transcript profiling revealed altered expression in known Bmp targets, smooth muscle-specific genes, and extracellular matrix-related genes in mutant ureters before the onset of hydronephrosis. Expression of the Bmp target Id2 was significantly lower in Smad4 mutants, consistent with the observation that Id2 mutants develop UPJ obstruction. In summary, Smad4 deficiency reduces the number and contractility of ureteral smooth muscle cells, leading to abnormal pyeloureteral peristalsis and functional obstruction. The subsequent bending and luminal constriction of the ureter at the UPJ marks the transition from a functional obstruction to a more intractable physical obstruction, suggesting that early intervention for this disease may prevent more irreversible damage to the urinary tract. PMID:22282597

  12. 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

  13. 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.

  14. Percutaneous cholecystolithotomy: is gall stone recurrence inevitable?

    PubMed Central

    Donald, J J; Cheslyn-Curtis, S; Gillams, A R; Russell, R C; Lees, W R

    1994-01-01

    Using radiological interventional techniques the gall bladder can be cleared of stones with a high success rate. As with any treatment option that leaves the gall bladder in situ there is an accompanying risk of stone recurrence, which is currently unknown for the radiological method. One hundred patients were studied prospectively to determine the recurrence rate of stones and clinical outcome after successful percutaneous cholecystolithotomy. Follow up included both clinical assessment and ultrasound examination at 3, 6, and 12 months and then annual intervals thereafter. The overall stone recurrence rate was 31% at a mean follow up of 26 months (range, 3-50 months). By actuarial life table analysis, the cumulative proportion of gall stone recurrence was 7, 19, 28, 35, and 44% at 6, 12, 24, 36, and 48 months respectively. Of the 31 patients with recurrent stones; 17 remain asymptomatic, seven have experienced biliary colic, two abdominal pain, three non-specific upper gastrointestinal symptoms, and two jaundice secondary to common duct stones. Thirteen of the stone free patients have remained symptomatic; six with abdominal pain and seven with nonspecific upper gastrointestinal symptoms. Eight patients have subsequently had a cholecystectomy. No significant difference was found between the sex of the patient or the number of stones before treatment and the stone recurrence rates. The cumulative stone recurrence rate was significantly less in the 56 patients who received adjuvant chemolitholysis (p < 0.05). These data show that stone recurrence after successful percutaneous cholecystolithotomy occurs in the minority, and is usually asymptomatic. It is concluded that the technique remains justified in the management of selected patients with gall stones. PMID:8200568

  15. 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

  16. Effect of ipsilateral ureteric obstruction on contralateral kidney and role of renin angiotensin system blockade on renal recovery in experimentally induced unilateral ureteric obstruction

    PubMed Central

    Panda, Shasanka S.; Bajpai, Minu; Sinha, Anand; Mallick, Saumyaranjan; Sharma, Mehar C.

    2013-01-01

    Aims: To study, the effects of ipsilateral ureteric obstruction on contralateral kidney and the role of renin angiotensin system (RAS) blockade on renal recovery in experimentally induced unilateral ureteric obstruction. Materials and Methods: Unilateral upper ureteric obstruction was created in 96 adult Wistar rats that were reversed after pre-determined intervals. Losartan and Enalapril were given to different subgroups of rats following relief of obstruction. Results: The severity of dilatation on the contralateral kidney varied with duration of ipsilateral obstruction longer the duration more severe the dilatation. There is direct correlation between renal parenchymal damage, pelvi-ureteric junction (PUJ) fibrosis, inflammation and severity of pelvi-calyceal system dilatation of contralateral kidney with duration of ipsilateral PUJ obstruction. Conclusions: Considerable injury is also inflicted to the contralateral normal kidney while ipsilateral kidney remains obstructed. Use of RAS blocking drugs has been found to significantly improve renal recovery on the contralateral kidney. It can, thus, be postulated that contralateral renal parenchymal injury was mediated through activation of RAS. PMID:23798807

  17. 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

  18. 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.

  19. 6. GRIST MILL STONES IN CENTER (VERTICAL STAND WITH HANDLE ...

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

    6. GRIST MILL STONES IN CENTER (VERTICAL STAND WITH HANDLE TO LEFT OF STONES ADJUSTS SPACE BETWEEN STONES, THUS CONTROLING FINENESS OF FLOUR. STONE CRANE AT RIGHT USED TO LIFT STONES FOR DRESSING). OTHER EQUIPMENT NOT IDENTIFIED. NOTE STAIRS IN LEFT REAR. - Hildebrand's Mill, Flint, Delaware County, OK

  20. 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

  1. 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

  2. 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

  3. 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.

  4. 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

  5. A Case of Delayed Diagnosis of Bilateral Ureteral and Bladder Injury after Laparoscopic Hysterectomy: An Unusual Complication

    PubMed Central

    Goris-Gbenou, Maximilien C.; Arfi, Nicolas; Mitach, Abdel; Rashed, Sheer; Lopez, Jean-Gabriel

    2012-01-01

    The incidence of ureteral and bladder lesions after laparoscopic hysterectomy is the most encountered urinary complication in gynaecological surgery. We report the unusual case of 42-year-old woman who had a delayed diagnosis of bilateral ureteral injury associated with bladder lesion and loose of vaginal suture after undergoing laparoscopic hysterectomy for uterine adenomyosis. PMID:23198267

  6. 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

  7. 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.

  8. Microbial biofilms on building stone

    NASA Astrophysics Data System (ADS)

    Hoppert, M.; Kemmling, A.; Kämper, M.

    2003-04-01

    Microbial biofilms are ubiquitous in aquatic and terrestric ecosystems as well as on man-made material. The organisms take part in biogenic weathering on natural rocks as well as on building stone [1]. Though the presence of biofilms on stone monuments exposed to the outdoor environment is obvious, thin films also occur on monuments under controllable indoor environment conditions. Numerous biofilm organisms produce large volumes of extracellular polymer (EP), mainly polysaccharides. Hydrated, gel-like EP acts as glue between the organisms and the material surface and forms a protected environment for the microbial cells. The contact zone between EP and the material surface is the crucial reactive interface of the bio-organic cover and the underlying building material. At this interface, all hazardous compounds (e.g. organic acids), after diffusion transfer via EP, react with the material surface. Upon dehydration, volume of EP greatly decreases. The thin, varnish-like EP layer still protects the dormant cells from irreversible inactivation. Periodic shrinking and swelling of the EP induces mechanical stress on the stone surface, epecially when the polymer penetrates small pores and cavities in the underlying material surface. Thus, monitoring and structure/functional analysis of EP and EP production by organisms is important to understand biogenic weathering phenomena and building stone deterioration. The study presented here describes biofilms on the surfaces of building material in outdoor and indoor environments. The application of marker techniques and visualization of samples with light and electron microscopy illustrates the role of EP at microscale. EP forms the matrix that encloses microorganisms, dust particles and mineral grains in a rigid film. EP penetrates small pore spaces of the underlying substratum and may also facilitate subsequent penetration of the microorganisms into the material. EP seals the material surface and cements the superficial layer

  9. 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

  10. 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

  11. Management of alternative pathology detected using CT KUB in suspected ureteric colic.

    PubMed

    Sarofim, Mina; Teo, Adrian; Wilson, Robert

    2016-08-01

    Acute flank pain is a common presentation to the emergency department (ED), and imaging studies play an important role in establishing an accurate diagnosis. Computed Tomography of Kidneys, Ureters, Bladder (CT KUB) has surpassed all other imaging modalities to become the gold standard in detection of ureteric calculi. The purpose of this study is to identify the range and management of alternative diagnoses established by CT KUB in patients with suspected ureteric colic. Two hundred and fifteen consecutive CT KUB examinations ordered in the ED of a tertiary-care centre for suspected ureteric colic were retrospectively reviewed. This comprised of 134 male (62.3%) and 81 female (37.7%) patients with a mean age of 53 years old. The positive detection rate for ureteric calculi in males was 43.3% compared to a lower rate for females of 29.6% (p < 0.05). Almost two-thirds of patients were discharged following CT KUB imaging, and admission rates were significantly higher in those with alternative radiological findings (p < 0.04) Alternative radiological findings occurred in 72 patients (33.5%), including 15 patients (7.0%) who had clinically important alternative pathology. The rate of clinically important alternative findings was significantly higher in males than females, 9.7% versus 2.5% respectively (p = 0.04). Surgical intervention was more common in patients with alternative radiological findings classified as gastrointestinal (18.2%) compared to non-gastrointestinal (3.6%), however this did not reach statistical significance (p = 0.07). In conclusion, significant alternative pathology was identified using CT KUB in 7% of patients with suspected ureteric colic. The low rates of detection of ureteric calculi and significant alternative pathology in female patients suggests a more thorough clinical assessment is warranted to improve their management, prior to ordering investigations with exposure to radiation. PMID:27373521

  12. Renal Stone Associated with the Ketogenic Diet in a 5-Year Old Girl with Intractable Epilepsy

    PubMed Central

    Choi, Ji Na; Song, Ji Eun; Shin, Jae Il; Kim, Heung Dong; Kim, Myung Joon

    2010-01-01

    In this paper, we report on a 5-year-old girl who developed a renal stone while following the ketogenic diet to treat refractory seizure disorder. Three months after initiating the ketogenic diet, she developed severe abdominal pain and vomiting. The spot urine calcium-to-creatinine (Ca/Cr) ratio and 24-hour urine evaluation showed hypercalciuria. Computed tomography (CT) imaging revealed a stone in the right ureteropelvic junction, resulting in hydronephrosis of the right kidney. The renal stone disappeared 5 days after conservative treatment; the patien's microscopic hematuria resolved concurrently. In light of this case report, we recommend regularly monitoring the urine Ca/Cr ratio with ultrasonography for further development of renal stones in patients following the ketogenic diet. If these patients exhibit evidence of symptomatic hypercalciuria or cyristalluria, liberalization of fluid restriction and urine alkalization using oral potassium citrate should be considered. PMID:20376903

  13. [Ureteral obstruction: an unfrequent complication of Burch colposuspension. Report of two cases].

    PubMed

    Flores Rosas, Sergio Alberto; Cabrera Jácome, Rafael; Galeano Portillo, Alejandro

    2004-01-01

    The injury of the urinary tract in a pelvic surgery is inherent, its real frequency in which it presents, is difficult to establish, due that not all the lesions are published. In this article, two cases of ureteral obstruction posterior to a Burch-procedure, and the way they were resolved is reported. The ureteral obstruction is a very rare complication, but one that has the worst and severe medico-legal consequences, if they are not resolved opportunely. Its frequency in our service was of 0.41%, in 240 Burch-procedures that were realized during April of 1997 and June of 2000. PMID:15239563

  14. Ureterocalycostomy - final resort in the management of secondary pelvi-ureteric junction obstruction: our experience

    PubMed Central

    Gite, Venkat A.; Siddiqui, Ayub Karam Nabi; Bote, Sachin M.; Patil, Saurabh Ramesh; Kandi, Anita J.; Nikose, Jayant V.

    2016-01-01

    ABSTRACT Ureterocalycostomy can be performed in patients in whom desired methods of treating secondary PUJ (Pelvi-Ureteric Junction) obstructions either failed or could not be used. In our study, one child and two adults in whom one redo-ureterocalycostomy and two ureterocalycostomies were performed for severely scarred PUJ. The causes for secondary PUJ obstruction were post-pyelolithotomy in one case, post-pyeloplasty and ureterocalycostomy for PUJ obstruction in the second patient and the third patient had long upper ureteric stricture post-ureteropyeloplasty due to tuberculosis. In all these cases ureterocalycostomy proved to be salvage/final resort for preserving functional renal unit. PMID:27286113

  15. Delayed-onset Ureteral Obstruction and Calcification Masquerading as Renal Colic Following Deflux Injection.

    PubMed

    Romain, Julie; Fourcade, Laurent; Centi, Joachim; Blanc, Philippe; Masselin, Mathilde Casson; Lescure, Victor; Guigonis, Vincent; Descazeaud, Aurélien; Ballouhey, Quentin

    2016-08-01

    Vesicoureteral reflux is a common disorder in children, and its management has changed entirely as a result of widespread use of endoscopy procedures to inject filler materials. Complications with this type of treatment, particularly ureteral obstruction, are rare. Very few patients with delayed obstruction have been reported in the literature. We here present the case of an 8-year-old girl who exhibited symptoms of febrile renal colic and renal distension more than 5 years after undergoing endoscopic treatment. This is the first reported case of atypical late presentation combining pyelonephritis with ureteral obstruction and calcification. PMID:26970448

  16. Metastatic esophageal adenocarcinoma to the prostate presenting with bilateral ureteral obstruction.

    PubMed

    Marlin, Evan S; Hyams, Elias S; Dulabon, Lori; Shah, Ojas

    2010-02-01

    Carcinoma metastatic to the prostate occurs rarely and is most commonly associated with malignant bladder neoplasms. We present the case of a 73-year-old male with a history of gastroesophageal adenocarcinoma and clinically symptomatic benign prostatic hyperplasia who underwent photoselective vaporization of the prostate and presented several months later with gross hematuria, intermittent urinary retention and bilateral ureteral obstruction causing acute renal failure. After relieving the ureteral obstruction, subsequent transurethral resection of the prostate revealed locally invasive metastatic esophageal adenocarcinoma. To our knowledge, this is the first reported case of metastatic gastroesophageal carcinoma to the prostate. PMID:20156389

  17. Misplacement or migration? Extremely rare case of cardiac migration of a ureteral j stent.

    PubMed

    Kim, Tae Nam; Lee, Chan Ho; Kong, Do Hoon; Shin, Dong Kil; Lee, Jeong Zoo

    2014-05-01

    A 29-year-old woman with mild back pain when coughing and suprapubic discomfort after voiding was admitted to Pusan National University Hospital. Two weeks earlier, she had undergone a hysterectomy and right-sided ureteroneocystostomy for uterine atony and right ureteral injury with bladder rupture. Computed tomography showed that a ureteral J stent extended from the right ovarian vein to the right cardiac chamber. The stent was retrieved via both femoral veins with a snare loop and pigtail catheter. Computed tomography showed that the urinary and vascular tracts were normal 5 months after the procedure. PMID:24868342

  18. 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

  19. Gallstone Ileus following Endoscopic Stone Extraction

    PubMed Central

    Wakui, Noritaka; Asai, Yasutsugu; Dan, Nobuhiro; Takeda, Yuki; Ueki, Nobuo; Otsuka, Takahumi; Oba, Nobuyuki; Nisinakagawa, Shuta; Kojima, Tatsuya

    2014-01-01

    An 85-year-old woman was an outpatient treated at Tokyo Rosai Hospital for cirrhosis caused by hepatitis B. She had previously been diagnosed as having common bile duct stones, for which she underwent endoscopic retrograde cholangiopancreatography (ERCP). However, as stone removal was unsuccessful, a plastic stent was placed after endoscopic sphincterotomy. In October 2012, the stent was replaced endoscopically because she developed cholangitis due to stent occlusion. Seven days later, we performed ERCP to treat recurring cholangitis. During the procedure, the stone was successfully removed by a balloon catheter when cleaning the common bile duct. The next day, the patient developed abdominal pain, abdominal distension, and nausea and was diagnosed as having gallstone ileus based on abdominal computed tomography (CT) and abdominal ultrasonography findings of an incarcerated stone in the terminal ileum. Although colonoscopy was performed after inserting an ileus tube, no stone was visible. Subsequent CT imaging verified the disappearance of the incarcerated stone from the ileum, suggesting that the stone had been evacuated naturally via the transanal route. Although it is extremely rare for gallstone ileus to develop as a complication of ERCP, physicians should be aware of gallstone ileus and follow patients carefully, especially after removing huge stones. PMID:25328725

  20. 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.

  1. Nutrition and renal stone disease in space.

    PubMed

    Zerwekh, Joseph E

    2002-10-01

    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. PMID:12361779

  2. 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…

  3. 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

  4. [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

  5. Kidney Stone Risk Following Modern Bariatric Surgery

    PubMed Central

    Gonzalez, Ricardo D.

    2014-01-01

    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

  6. 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

  7. 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

  8. Management of anterior caliceal stones >15 mm.

    PubMed

    El-Shazly, M; Aziz, M; Omar, M; Al-Hunaidi, O; El-Nahas, A R

    2016-08-01

    Anterior caliceal stones represent a challenge to endourologist to select the best modality of management with the least morbidity. To study different treatment modalities of management of anterior caliceal stones >15 mm. It is an observational prospective study of patients with anterior caliceal stones more than 15 mm. Inclusion criteria were patients with isolated anterior caliceal stones, or branched anterior caliceal stones with posterior caliceal extension. Patients were evaluated using non-contrast CT preoperatively. They were divided into three groups: group 1 underwent PCNL through posterior caliceal puncture in cases with wide anterior calyx infundibulum or obtuse infundibulopelvic pelvic, group 2 underwent PCNL through anterior caliceal access in cases with narrow infundibulum or acute infundibulopelvic angel and group 3 underwent flexible ureteroscopy and laser lithotripsy. Intraoperative and postoperative findings were recorded and compared. Eighty eight patients were included in this study, Group 1 (44 patients) group 2 (28 patients), and group 3 (16 patients). Operative time was not significantly different across the three groups (68 ± 11.5, 72 ± 9 and 74 ± 11 min in group 1, 2 and 3, respectively, P = 0.053). Fluoroscopy time was significantly shorter for group 3 (2 ± 0.5 m, P = 0.0001) compared to group 1 and 2 (5.6 ± 4.6 and 4.5 ± 1.4 min), respectively. There were no significant differences in stone-free rates after initial treatment between the three groups; 84, 82, and 69 %, in groups 1, 2 and 3, respectively (P = 0.4). Postoperative hemoglobin drop was noted to be highest for group 2 and lowest for group 3 which was significantly different (1.7 ± 0.8, 2.2 ± 1.1, and 0.3 ± 0.3 g/dl, for patients in groups 1, 2 and 3 respectively, P = 0.0001). Group 2 showed the highest post-operative complication rate (21 %) in comparison to group 1 (11 %) and group 3 (6 %), however, differences were not statistically

  9. 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.

  10. 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.

  11. 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.

  12. 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

  13. Intra thoracic migration of ureteric stent after exstrophy bladder closure: Unusual complication

    PubMed Central

    Panda, Shasanka Shekhar; Bajpai, Minu; Singh, Amit; Chand, Karunesh

    2015-01-01

    Classic bladder exstrophy is a rare malformation of the genitourinary tract requiring surgical intervention either one-staged or staged fashion. Premature stent dislodgement is a well-known reported complication. We are reporting an unusual case of migration of ureteric stent to thoracic cavity leading to the pleural effusion and respiratory distress in early post-operative period. PMID:25659564

  14. 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

  15. Forgotten/retained double J ureteric stents: A source of severe morbidity in children

    PubMed Central

    Nerli, Rajendra B.; Magdum, Prasad V.; Sharma, Vikas; Guntaka, Ajay Kumar; Hiremath, Murigendra B.; Ghagane, Shridhar

    2016-01-01

    Background: The increase in the usage of double J (DJ) ureteral stents in the management of a variety of urinary tract disease processes mandates familiarity with these devices, their consequences and their potential complications, which at times can be devastating. We retrospectively reviewed our series of children with forgotten/retained DJ ureteric stents. Materials and Methods: Hospital records of all patients’ <18 years old who underwent removal of forgotten/retained DJ ureteral stent at our hospital were reviewed for age, gender, indication for insertion of DJ stent, duration of stent insertion, radiological images and surgical procedures performed. Results: During the study period, January 2000 to December 2014 (a 15-year period), a total of 14 children underwent removal of forgotten/retained DJ ureteral stent. A combination of extracorporeal shock wave lithotripsy, cystolitholapaxy and percutaneous nephrolithotomy was done to free the DJ stent and extract it. Conclusions: Forgotten/retained stents in children are a source of severe morbidity, additional/unnecessary hospitalisation and definitely financial strain. PMID:27251521

  16. Ectopic Ureteral Insertion into the Seminal Vesicle Causing Recurrent Epididymitis in a 24-Year-Old

    PubMed Central

    Marien, Tracy; Herrell, Stanley Duke

    2015-01-01

    Abstract A 24-year-old male was found to have recurrent epididymitis secondary to ectopic ureteral insertion to the seminal vesicle. His ipsilateral kidney was atrophic and ectopic in the pelvis, suggesting a complex failure of embryological development. He was successfully treated with robot-assisted laparoscopic nephroureterectomy.

  17. 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

  18. Analgesic effect and tolerance of Voltaren and Ketogan in acute renal or ureteric colic.

    PubMed

    Sommer, P; Kromann-Andersen, B; Lendorf, A; Lyngdorf, P; Møller, P

    1989-01-01

    Fifty-six patients with renal or ureteric colic were entered into a randomised, prospective, double-blind investigation of the analgesic efficacy and tolerance of Voltaren versus Ketogan, both administered intramuscularly. There were no significant differences regarding pain-relief but side effects were fewer in patients treated with Voltaren. PMID:2645969

  19. 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

  20. The pathogenesis of renal dysplasia. II. The significance of lateral and medial ectopy of the ureteric orifice.

    PubMed

    Schwarz, R D; Stephens, F D; Cussen, L J

    1981-09-01

    Renal hypoplasia and dysplasia may be primary malformations linked to a panureteric bud deformity or result from damage to the developing nephrons caused by abnormal urodynamic pressures, Kidneys with misplaced ureteric orifices were graded, according to histologic criteria, on the hypodysplasia scale. With lateral ectopy of the ureteric orifices with and without congenital urethral obstruction, the grades correlated with specific orifice positions. The grades of kidneys with caudal ectopy of the ureters indicated a more general correlation. Dysgenesis of the bud and nephrogenic mesenchyme may account for the renal hypodysplasia when the ureteric orifice is found to be ectopic. PMID:7275560

  1. A rare cause of ureteral injuries; simultaneous common iliac artery and ureter injury during posterior lumbar disc surgery

    PubMed Central

    Başer, Aykut; Alkış, Okan; Toktaş, Cihan; Zümrütbaş, Ali Ersin

    2016-01-01

    Major vascular injuries during lumbar disc surgery are rare but well-recognized complications. However, vascular injuries of the branches of the aorta and ureteral injuries are very rare. Although its incidence is not known definitely, it is estimated to be 1/1000. Ureteral injuries comprise less than 1% of all genitourinary traumas. In this article, we report clinical progress of a patient who had simultaneous internal iliac artery and ureteral injury during lumbar discectomy. The patient was managed with primary ureteroureterostomy. To our knowledge, this is the first case reported with simultaneous ureter and iliac artery trauma during lumbar disc surgery. PMID:27274898

  2. 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

  3. 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

  4. Extracorporeal shock wave lithotripsy: a study of renal stone differences.

    PubMed

    Powers, C J; Tinterow, M M; Burpee, J F

    1989-01-01

    The extracorporeal shock wave lithotriptor (ESWL or lithotriptor) is a new, revolutionary, noninvasive method of treating renal calculi. It offers a safer, cheaper and more effective method of treatment compared to the traditional open surgery. Its history dates back only to 1980--and to 1985 at HCA Wesley Medical Center in Wichita, where research is just beginning. Initial research focused on ESWL versus traditional open surgery, but more recent research is investigating elements within the ESWL treatment. This article presents an investigation of renal stone size in relation to number of ESWL treatments needed per stone, number of shock waves per treatment, length of hospital stay post-lithotripsy, and hospital costs per length of stay during HCA Wesley's first year of operation. The subjects in this study consisted of approximately every third patient who received an ESWL treatment and were grouped according to stone sizes of less than 2 cm and those greater than 2 cm. A questionnaire was used, and after data were collected from the patient's charts and billing, a t-test for independent samples was used for analysis. PMID:2709649

  5. Constraining the age and formation of stone runs in the Falkland Islands using Optically Stimulated Luminescence

    NASA Astrophysics Data System (ADS)

    Hansom, James D.; Evans, David J. A.; Sanderson, David C. W.; Bingham, Robert G.; Bentley, Michael J.

    2008-02-01

    The stone runs of the Falkland Islands are thought to be periglacial blockfields but their age and detailed origin remain enigmatic. We examine the fine sediments that underlie two stone runs in order to establish whether Optically Stimulated Luminescence (OSL) dating is an appropriate technique to constrain the date of emplacement of the fine sediments and, hence, the stone runs. Six samples were collected from two accessible sections during the Scotia Centenary Antarctic expedition in 2003. All samples were used to explore the main luminescence characteristics of the sediment, followed by quartz SAR dating procedures on four of the samples. Age estimates range from in excess of 54 ka to 16 ka, suggesting that the overlying stone runs remained active until 16 ka or later. Saturation of luminescence from quartz limits age estimates for the oldest samples in the sequences, however these are not critical to define the upper limit to the emplacement age for the overlying stone runs. The sediments also contain feldspars and initial results suggest that these may be useful in extending the timescale further, but require further samples to be obtained from other parts of the sequence. Extending the method to other stone runs in the Port Stanley Formation may allow estimates of the age of stabilisation of the stone runs to be extended into the 1-250 ka timescale. Luminescence dating of the underlying sediments, used in conjunction with cosmogenic isotope dating of the surface boulders from a range of locations along the stone runs, appears to offer a useful route towards decoding the depositional history of these impressive deposits.

  6. [Kidney stone as a cardiovascular risk marker].

    PubMed

    Ernandez, Thomas; Bonny, Olivier

    2014-09-10

    Most of the time, kidney stones are considered as minor, but painful events. However, several studies have recently shown an association between kidney stone and an increased cardio-vascular risk. We review here these studies and explore the underlying pathophysiological hypotheses. At the end, we propose that lithiasis should be considered as a red flag intervening early during life-time and allowing a check of cardiovascular risk factors and early preventive intervention. Such approach may be successful in reducing the incidence of cardio-vascular events in stone formers. PMID:25322624

  7. 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.

  8. Thomas Young and the Rosetta Stone.

    PubMed

    Robinson, Andrew

    2007-06-01

    Who deciphered the Rosetta Stone and the Egyptian hieroglyphs? The usual answer is Jean-François Champollion, beginning in 1822. But ever since that time, Egyptologists have debated the role of his rival, the polymath Thomas Young, the first person to publish a partially correct translation of the Rosetta Stone. A recent BBC television dramatisation rekindled the controversy by presenting Champollion as a 'lone genius' who succeeded independently of Young. While there is no doubt that Champollion deciphered the hieroglyphic script as a whole, the evidence suggests that Young's early detailed study of the Rosetta Stone created the conceptual framework that made possible Champollion's later breakthrough. PMID:17583792

  9. [Salivary stones: aetiology, composition and treatment].

    PubMed

    Kraaij, S; Brand, H S; Karagozoglu, K H; Forouzanfar, T; Veerman, E C I

    2014-11-01

    Salivary stones or sialoliths, are calcified concrements which are most frequently located in the submandibular glands and their ducts. Their size and weight show considerable variation. The aetiology is unknown. It has been suggested that salivary stones could be related to an altered saliva composition, the anatomy of the ducts of the salivary gland and/or the fusion of microsialoliths. Salivary stones consist mainly of anorganic material such as hydroxyapatite, whitlockite and calciumphosphate, but they also contain organic components such as proteins and lipids. Treatment can consist of salivary gland massage combined with an acid diet, ultrasonic pulverisation, and surgical or sialendoscopical removal. PMID:26188478

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

    PubMed

    Choi, Chang Il; Yu, Young Dong; Park, Dong Soo

    2016-05-01

    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

  11. 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

  12. A case of recurrent renal aluminum hydroxide stone.

    PubMed

    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

  13. 78 FR 3911 - Big Stone National Wildlife Refuge, Big Stone and Lac Qui Parle Counties, MN; Final Comprehensive...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-17

    ... Fish and Wildlife Service Big Stone National Wildlife Refuge, Big Stone and Lac Qui Parle Counties, MN... (CCP) and finding of no significant impact (FONSI) for the environmental assessment (EA) for Big Stone.../FONSI on the planning Web site at http://www.fws.gov/midwest/planning/BigStoneNWR/index.html . A...

  14. 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

  15. 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

  16. Adenoid Stones – “Adenoliths”

    PubMed Central

    Sakano, Hitomi; Thaker, Ameet I.; Davis, Greg E.

    2015-01-01

    Stones made of bacterial aggregates can be found in chronically inflamed lymphoid tissue such as hypertrophied tonsils. Although it is common to find tonsilloliths in cryptic tonsils, it is rare to find stones in adenoid tissue. Here we present an interesting case of a patient who underwent adenoidectomy for adenoid hypertrophy, recurrent malaise and upper respiratory infections. Intraoperatively we found numerous bright green stones in the crypts of the adenoid tissue, reminiscent of tonsilloliths in tonsillar crypts. Pathology revealed polymicrobial bacterial aggregates surrounded by neutrophils. Our findings suggest that the pathophysiology is similar to that of tonsillolith formation. Thus, we should at least consider the presence of adenoid stones and consider adenoidectomy for symptoms often attributed to tonsilloliths. We have coined the term “adenoliths” to describe this interesting finding and present it as a potential source of recurrent infection. PMID:26798664

  17. Pulmonary function tests in stone crushers.

    PubMed

    Rathod, Sachin B; Mane, Satish B; Handergulle, Sunita S; Kekan, Dinkar

    2014-01-01

    A cross-sectional type of observational study was conducted at 7 various stone crusher units on 120 male stone crushers and 120 healthy male controls. Values of FEF25-27% and PEFR were recorded on computerized spirometer and were compared between workers and age matched controls group. The value of FEF25-75% and PEFR was significantly reduced in stone crushers as compared to controls. Also as the duration of exposure increases the values of flow rates goes on decreasing among workers. Stone crushers of Marathwada region of Maharashtra exposed to silica dust were prone to develop lung disorders as indicated by reduced value of FEF25-75% and PEFR. PMID:25906617

  18. [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

  19. 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 10–19 (63%) and 20–29 (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

  20. 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 200μm-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

  1. The evolving epidemiology of stone disease.

    PubMed

    Roudakova, Ksenia; Monga, Manoj

    2014-01-01

    The epidemiology of kidney stones is evolving - not only is the prevalence increasing, but also the gender gap has narrowed. What drives these changes? Diet, obesity or environmental factors? This article will review the possible explanations for a shift in the epidemiology, with the hope of gaining a better understanding of the extent to which modifiable risk factors play a role on stone formation and what measures may be undertaken for disease prevention in view of these changing trends. PMID:24497682

  2. 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

  3. 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.

  4. Uric acid stones following hepatic transplantation.

    PubMed

    Hwang, Mei-Tsuey; Goldfarb, David S

    2004-12-01

    We report the case of a 52 year old man with a history of insulin-requiring diabetes and hepatitis B with cirrhosis who received an orthotopic liver transplant. One year later he developed renal colic and was found to have a 3 mm stone at the left ureterovesical junction. Numerous other stones formed and infrared spectroscopy analysis demonstrated all to be composed of 100% uric acid. Urine collections demonstrated a low urine pH of 5.1 without hyperuricosuria. His stones were effectively prevented with potassium citrate therapy. Few incidence data are available for uric acid stone occurrence in solid organ recipients. Calcineurin inhibitors are thought to often cause hyperuricemia on the basis of decreased urate excretion. However, this effect would not be expected to cause hyperuricosuria nor uric acid stones. This class of drugs may also be associated with low urine pH, perhaps on the basis of hypoaldosteronism, but the contribution of such a syndrome to uric acid stone formation is not established. PMID:15565437

  5. The role of open stone surgery

    PubMed Central

    El-Husseiny, Tamer; Buchholz, Noor

    2012-01-01

    Objective To highlight the role of open stone surgery in the management of urolithiasis in the current era of minimally invasive therapies. The introduction and continuous development of extracorporeal shockwave lithotripsy (ESWL), ureterorenoscopy and percutaneous nephrolithotomy (PCNL) over the past 30 years have led to a significant change in the current management of urolithiasis, where the indications for open stone surgery have been narrowed significantly, making it a second- or third-line treatment option. Methods We reviewed the most recent guidelines published by the European Association of Urology and the American Urological Association, and reviewed reports through a MEDLINE search to identify the indications and current role of open stone surgery. Results From the MEDLINE search, it was obvious that the number of papers published on open renal stone surgery has decreased during the last three decades, soon after the introduction of ESWL and PCNL. Conclusion Although currently most patients with stones can be managed by minimally invasive therapy, we believe that open surgery still has a role, and therefore it is of great importance to recognise that a small group of patients with complex stone disease, and those with anatomical and physiological anomalies, will benefit from this treatment option. PMID:26558038

  6. 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

  7. Is ureteral stent placement by the transurethral approach during robot-assisted radical prostatectomy an effective option to preoperative technique?

    PubMed

    Molinari, Alberto; Simonelli, Giovanni; De Concilio, Bernardino; Porcaro, Antonio Benito; Del Biondo, Dario; Zeccolini, Guglielmo; Celia, Antonio

    2014-08-01

    Ureteral stent placement may be needed in patients undergoing robot-assisted radical prostatectomy (RARP) in cases of a large median lobe or previous transurethral surgery to prevent damage to the ureteral orifices. Unpredictable anatomic variants or technical difficulties in bladder neck section may necessitate intraoperative stent placement. We describe our original, simple, and feasible transurethral stent placement technique during RARP, which could be a valid option to preoperative technique. PMID:24735391

  8. 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

  9. Total ureteral avulsion leading to early nephrectomy as a rare complication of simple lumbar discectomy; a case report

    PubMed Central

    Omidi-Kashani, Farzad; Mousavi, Seyed Mahdi

    2015-01-01

    Introduction: Lumbar discectomy constitutes the most common and probably easiest spine surgery but it is not without complications. The aim of this work is to report a case with total ureteral avulsion during lumbar discectomy due to careless advancement of the pituitary rongeur. Methods: A 59-year-old male presented with refractory left L5-S1 lumbar disc herniation. During the surgery, left sided total ureteral avulsion occurred. Early postoperative progressive abdominal pain was the main clue for further investigation and diagnostic work-up. Results: Abdominal ultrasonography, intravenous pyelography, and abdominal contrast-enhanced computed tomography (CT) detected a left ureteral injury. Although the injury was detected early, ureteral repair or renal autotransplantation was not possible and nephrectomy was finally indicated, due to a significant ureteral loss. Discussion: Careful use of discectomy instruments, avoidance of excessive advancement of pituitary rongeurs (more than 3 cm), and thorough knowledge of the relevant anatomy are critical in preventing ureteral injury. PMID:27163085

  10. 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

  11. 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

  12. 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

  13. Comparison of flexible ureterorenoscopy and mini-percutaneous nephrolithotomy in treatment of lower calyceal stones smaller than 2 cm.

    PubMed

    Akbulut, Fatih; Kucuktopcu, Onur; Kandemir, Emre; Sonmezay, Erkan; Simsek, Abdulmuttalip; Ozgor, Faruk; Binbay, Murat; Muslumanoglu, Ahmet Yaser; Gurbuz, Gokhan

    2016-01-01

    To compare the outcomes of flexible ureterorenoscopy (F-URS) and mini-percutaneous nephrolithotomy (mini-PNL) in the treatment of lower calyceal stones smaller than 2 cm. Patients who underwent F-URS and mini-PNL for the treatment of lower calyceal stones smaller than 2 cm between March 2009 and December 2014 were retrospectively evaluated. Ninety-four patients were divided into two groups by treatment modality: F-URS (Group 1: 63 patients) and mini-PNL (Group 2: 31 patients). All patients were preoperatively diagnosed with intravenous pyelography or computed tomography. Success rates for F-URS and mini-PNL at postoperative first month were 85.7% and 90.3%, respectively. Operation time, fluoroscopy time, and hospitalization time for F-URS and mini-PNL patients were 44.40 min, 2.9 min, 22.4 h, and 91.9 min, 6.4 min, and 63.8 h, respectively. All three parameters were significantly shorter among the F-URS group (p < 0.001). Postoperative hemoglobin drop was significantly lower in F-URS group compared to mini-PNL group (0.39 mg/dL vs. 1.15 mg/dL, p = 0.001). A comparison of complications according to the Clavien classification demonstrated significant differences between the groups (p = 0.001). More patients in the F-URS groups require antibiotics due to urinary tract infection, and more patients in the mini-PNL group required ureteral double J catheter insertion under general anesthesia. Although both F-URS and mini-PNL have similar success rates for the treatment of lower calyceal stones, F-URS appears to be more favorable due to shorter fluoroscopy and hospitalization times; and lower hemoglobin drops. Multicenter and studies using higher patient volumes are needed to confirm these findings. PMID:26727075

  14. Variable partial unilateral ureteral obstruction and its release in the neonatal and adult mouse.

    PubMed

    Thornhill, Barbara A; Chevalier, Robert L

    2012-01-01

    Obstructive nephropathy is the most important cause of renal failure in children. Unilateral ureteral obstruction (UUO) in the neonatal mouse provides a useful model to investigate the response of the developing kidney to urine flow obstruction. Creation of reversible variable partial UUO (compared to complete UUO) more closely approximates congenital lesions, and permits the study of recovery following release of the obstruction. Implementation of this technique requires the appropriate optical, surgical, and anesthetic equipment, as well as adaptations appropriate to the very small animals undergoing surgical procedures. Care of the pups must include minimizing trauma to delicate tissues, close monitoring of anesthesia and body temperature, and ensuring acceptance of the pups by the mother. It is important to document the severity and patency of the partial UUO by ureteral measurement and pelvic injection of India ink. Finally, removal of kidneys for histologic examination should be accomplished with gentle handling and processing. PMID:22639278

  15. 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.

  16. [Obstructive pyelonephritis caused by ureteral orifice catheterization with a bladder catheter].

    PubMed

    Arnaud, P; Carpentier, X; Pedulla, F; Sandid, M; Pernin, F

    2014-12-01

    This article reports a rare case of acute pyelonephritis secondary to left ureteral obstruction by a bladder catheter. The patient was 93years old man hospitalized in the hospital emergency department with a 39°C fever and pyuria from an indwelling catheter. Blood test found hyperleukocytosis, inflammatory syndrome and acute renal failure. Diagnosis was confirmed by non-contrast abdominal CT scan showing distal part of the catheter inside left ureteral orifice with ureterohydronephrosis. Treatment consisted in replacing the catheter by a three-way catheter for irrigation and parenteral antibiotics therapy. Clinico-biological evolution was successful and a urinary tract CT scan could be realized at day 9. The left upper urinary tract function was recovered. With a short review of the literature we propose to describe the different procedures to manage those obstructions. PMID:25288585

  17. 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

  18. 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].

  19. A Composite Kidney Stone Phantom with Mechanical Properties Controllable Across the Range of Properties of Human Kidney Stones

    PubMed Central

    Simmons, W. N.; Cocks, F. H.; Zhong, P.; Preminger, Glenn

    2013-01-01

    A novel composite kidney stone phantom has been developed. This stone phantom is producible with mechanical properties mimicking the range of tensile fracture strength and acoustic properties of human kidney stones and is an inorganic/organic composite material, as are natural kidney stones. Diametral compression testing was used to measure tensile fracture strength, which determines the acoustic comminution behavior of kidney stones. Ultrasound transmission tests were made to characterize the acoustic properties of these stone phantoms. Both the tensile fracture strength (controllable from 1 to ~ 5 MPa) and acoustic properties (CL = 2700 to 4400m/s and CT = 1600 – 2300 m/s) of these composite phantom stones match those of a wide variety of human kidney stones. These artificial stone phantoms should have wide utility in lithotripsy research. PMID:19878912

  20. 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

  1. 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

  2. "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

  3. Stone Morphology Suggestive of Randall's Plaque

    NASA Astrophysics Data System (ADS)

    Daudon, Michel; Traxer, Olivier; Jungers, Paul; Bazin, Dominique

    2007-04-01

    Randall's plaques are found in a number of calcium oxalate stone formers. Stones developed on a Randall's plaque typically present a small depressed zone ("umbilication") corresponding to the tip of the papilla and containing material detached from the plaque. By examining the morphology and infrared composition of 45,774 calculi referred to our laboratory over the past three decades, we identified 8,916 umbilicated calculi (19.5%). We have selected three periods of time corresponding to the first years of each decade. Over these periods, we analyzed 26,182 consecutive calculi. Among them, we identified 5,401 umbilicated calculi, of which 91.5% had an identifiable plaque. We analyzed the relative prevalence of umbilicated stones over time and the respective composition of Randall's plaque and stones. The proportion of umbilicated stones rose significantly from 10% in period 1 (1978-1984) to 21% in period 2 (1990-1993) and 22.2% in period 3 (2000-2006), with a parallel rise in the prevalence of stones with identifiable Randall's plaque. The main component of plaques was carbapatite in 90.8% of cases, whereas other components such as amorphous carbonated calcium phosphate, sodium hydrogen urate or uric acid were found in other cases. The morphology of plaques made of carbapatite was diverse, as was their carbonate content, thus suggesting variable pathophysiological mechanisms. Stones were made of whewellite as the main component in 51.4% of cases, or admixed with weddellite in 26.8%, predominant weddellite in 12.5% and other components (mainly uric acid) in 7.5% of cases. Our findings confirm that Randall's plaques are made of carbapatite in the great majority of cases, but with the stones more frequently composed of calcium oxalate monohydrate (which is associated with hyperoxaluria) than of calcium oxalate dihydrate (associated with hypercalciuria). In conclusion, in our country, stones developed on a carbapatite Randall's plaque are as frequently made of

  4. Long ureteric stricture replacement by buccal mucosa graft: an Armenian experience case series report

    PubMed Central

    Akopyan, Kristina; Levonyan, Arthur; Tsaturyan, Ashot

    2016-01-01

    Introduction The aim of this study is to demonstrate the results of a case series concerning the replacement of long ureteric strictures using buccal mucosa grafts. Material and methods Five patients (3 men, 2 women), with a mean age of 35 years old, underwent reconstructive ureteral surgery using buccal mucosa graft with omental wrapping during the period of 2010–2013. In all cases, the location of strictures was in the proximal ureters with the length of strictures varying from 2.5 to 5.0 cm. Results We did not observe any major complications postoperatively. Two patients complained of constipation, which was resolved on the second day without any special treatment. Only one patient experienced fever (39°C) on the seventh day after the surgery due to inadequate drainage of the nephrostomic tube. Mean follow-up time was 39.6 months (range 26–52 months), mean hospital stay length was 10.6 days. Intravenous and antegrade urography were performed after removing JJ stents. Results were favorable without any signs of stricture. Repetitive ultrasound and radiologic imaging was performed at month 3, 6, 12 in the first year and every half-year thereafter. Intravenous urography showed no signs of strictures. Hydronephrosis was resolved in all patients by the sixth month following the surgery. Conclusions Postoperatively, we observed favorable results in all patients in terms of absence of short term-surgical complications. This technique could be considered for patients with long ureteric strictures in whom ureteral replacement with bowel interposition or kidney auto-transplantation is contraindicated. PMID:27551561

  5. 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

  6. 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

  7. 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

  8. Analysis of stone-column reinforced foundations

    NASA Astrophysics Data System (ADS)

    Lee, J. S.; Pande, G. N.

    1998-12-01

    A numerical model is proposed to analyse elastic as well as elastoplastic behaviour of stone-column reinforced foundations. The stone-columns are assumed to be dispersed within the in situ soil and a homogenization technique is invoked to establish equivalent material properties for in situ soil and stone-column composite. The difficulties encountered in carrying out elastoplastic analyses of composite materials are overcome by adopting a separate yield function for each of the constituent materials and a sub-iteration procedure within an implicit backward Euler stress integration scheme. In the proposed procedure, equilibrium as well as kinematic conditions implied in the homogenization procedure are satisfied for both elastic as well as elastoplastic stress states.The proposed model is implemented in an axi-symmetric finite element code and numerical prediction is made for the behaviour of model circular footings resting on stone-column reinforced foundations. This prediction indicates good agreement with experimental observation. Finally, a new scheme in which the length of stone-column is variable is proposed and its behaviour is examined through a numerical example.

  9. Role of Wnt5a-Ror2 Signaling in Morphogenesis of the Metanephric Mesenchyme during Ureteric Budding

    PubMed Central

    Qiao, Sen; Miyamoto, Mari; Okinaka, Yuka; Yamada, Makiko; Hashimoto, Ryuju; Iijima, Kazumoto; Otani, Hiroki; Hartmann, Christine; Nishinakamura, Ryuichi

    2014-01-01

    Development of the metanephric kidney begins with the induction of a single ureteric bud (UB) on the caudal Wolffian duct (WD) in response to GDNF (glial cell line-derived neurotrophic factor) produced by the adjacent metanephric mesenchyme (MM). Mutual interaction between the UB and MM maintains expression of GDNF in the MM, thereby supporting further outgrowth and branching morphogenesis of the UB, while the MM also grows and aggregates around the branched tips of the UB. Ror2, a member of the Ror family of receptor tyrosine kinases, has been shown to act as a receptor for Wnt5a to mediate noncanonical Wnt signaling. We show that Ror2 is predominantly expressed in the MM during UB induction and that Ror2- and Wnt5a-deficient mice exhibit duplicated ureters and kidneys due to ectopic UB induction. During initial UB formation, these mutant embryos show dysregulated positioning of the MM, resulting in spatiotemporally aberrant interaction between the MM and WD, which provides the WD with inappropriate GDNF signaling. Furthermore, the numbers of proliferating cells in the mutant MM are markedly reduced compared to the wild-type MM. These results indicate an important role of Wnt5a-Ror2 signaling in morphogenesis of the MM to ensure proper epithelial tubular formation of the UB required for kidney development. PMID:24891614

  10. The Utility of Routine Ultrasound Imaging after Elective Transplant Ureteric Stent Removal

    PubMed Central

    Olsburgh, Jonathon

    2016-01-01

    Background. Ureteric stent insertion during kidney transplantation reduces the incidence of major urological complications (MUCs). We evaluated whether routine poststent removal graft ultrasonography (PSRGU) was useful in detecting MUCs before they became clinically or biochemically apparent. Methods. A retrospective analysis was undertaken of clinical outcomes following elective stent removals from adult single renal transplant recipients (sRTRs) at our centre between 1 January 2011 and 31 December 2013. Results. Elective stent removal was performed for 338 sRTRs. Of these patients, 222 had routine PSRGU (median (IQR) days after stent removal = 18 (11–31)), 79 had urgent PSRGU due to clinical or biochemical indications, 12 had CT imaging, and 25 had no further renal imaging. Of the 222 sRTRs who underwent routine PSRGU, 210 (94.6%) had no change of management, three (1.4%) required repeat imaging only, and eight patients (3.6%) had incidental (nonureteric) findings. One patient (0.5%) had nephrostomy insertion as a result of routine PSRGU findings, but no ureteric stenosis was identified. Of 79 patients having urgent PSRGU after elective stent removal, three patients required transplant ureteric reimplantation. Conclusions. This analysis found no evidence that routine PSRGU at two to three weeks after elective stent removal provides any added value beyond standard clinical and biochemical monitoring. PMID:27493793

  11. 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.

  12. Melatonin protects kidney against apoptosis induced by acute unilateral ureteral obstruction in rats

    PubMed Central

    Badem, Hüseyin; Cakmak, Muzaffer; Yilmaz, Hakki; Kosem, Bahadir; Karatas, Omer Faruk; Bayrak, Reyhan; Cimentepe, Ersin

    2016-01-01

    Introduction To investigate whether there was a protective effect of melatonin on apoptotic mechanisms after an acute unilateral obstruction of the kidney. Material and methods A total of 25 rats consisting of five groups were used in the study, designated as follows: Group 1: control, Group 2: sham, Group 3: unilateral ureteral obstruction treated with only saline, Group 4: unilateral ureteral obstruction treated with melatonin immediately, and Group 5: unilateral obstruction treated with melatonin one day after obstruction. Melatonin was administered as a 10 mg/kg dose intraperitoneally. The kidneys were evaluated according to the apoptotic index and Ki-67 scores. Results Comparison of all obstruction groups (Group 3, 4, and 5), revealed that the apoptotic index was significantly higher in Groups 1 and 2. Despite melatonin reduced apoptotic mechanisms in Groups 4 and 5, there was no significant difference between Groups 4 and 5 in terms of the reduction of apoptosis. However, the reduction of apoptosis in the melatonin treated group did not decrease to the level of Groups 1 and 2. Conclusions Despite melatonin administration, which significantly reduces the apoptotic index occurring after acute unilateral ureteral obstruction, the present study did not observe a return to normal renal histology in the obstruction groups. PMID:27551563

  13. Urological complications of renal transplantation: the impact of double J ureteric stents.

    PubMed Central

    Nicholson, M. L.; Veitch, P. S.; Donnelly, P. K.; Bell, P. R.

    1991-01-01

    In a 10 year series of 350 consecutive renal transplant operations, the overall urological complication rate was 7.7%. During this period double J stents were introduced and were used either in the treatment of actual urological complications or as a prophylactic measure to protect ureters which had been damaged at retrieval. A total of 34 double J stents were used in 33 patients. The indications were: ureteric obstruction (n = 13), urinary leak (n = 5), short transplant ureter anastomosed using an extravesical ureteroneocystostomy (n = 10) and ureteric injury at the time of organ retrieval (n = 6). Thirty-two double J stents were inserted at open operation and two were inserted by an antegrade method after percutaneous nephrostomy. Improvement in renal function occurred in 16 out of the 18 cases of urological complications. No kidneys were lost and there were no deaths as a direct result of these complications. In a number of cases the insertion of a double J stent was the only treatment, thus eliminating the need for more complex surgery. All 16 patients who had a ureteric stent inserted as a prophylactic measure at the time of transplantation made uncomplicated postoperative recoveries. Urinary tract infection was relatively common (27%) after double J stent insertion, but other complications were rare. In conclusion, double J stents have proved to be a useful adjunct in the management of renal transplant related urological complications. PMID:1929136

  14. 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

  15. 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

  16. 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

  17. Assessment of compatibility and durability of photocatalytic TiO2 for stone coating

    NASA Astrophysics Data System (ADS)

    Calia, Angela; Lettieri, Maria Teresa; Licciulli, Antonio; Masieri, Maurizio

    2014-05-01

    The use of Titanium dioxide nano-particles has received increasing attention in many fields as these particles can trap and decompose organic and inorganic soiling matter and air pollutants by a photocatalytic process, providing new functional properties in terms of self-cleaning and depolluting performances to the treated materials. Since recent years, the use of photocatalytic TiO2 as external coating for natural stones has been allowed thanks to the fine-tuning of nano-titania preparation, overcoming the initial limits of application related to a necessary thermal treatment. Notwithstanding nano-titania benefits, the potential of its application as stone coating needs to be assessed with respect to basic requirements involved for any surface stone treatment, especially in the field of the preservation of historical-architectural heritage. They concern the harmlessness with respect to the original characteristics of the stones, the effectiveness and durability of the treatments themselves. In this work we present the study for the assessment of compatibility of Titania coatings applied to calcareous stones paying attention to their effects on chromatic properties, water absorption by capillarity, permeability to water vapour, water wettability. The durability of the coatings under mechanical action in laboratory simulated conditions was also investigated.

  18. Kidney Stones 2012: Pathogenesis, Diagnosis, and Management

    PubMed Central

    Maalouf, Naim M.; Sinnott, Bridget

    2012-01-01

    Context: The pathogenetic mechanisms of kidney stone formation are complex and involve both metabolic and environmental risk factors. Over the past decade, major advances have been made in the understanding of the pathogenesis, diagnosis, and treatment of kidney stone disease. Evidence Acquisition and Synthesis: Both original and review articles were found via PubMed search reporting on pathophysiology, diagnosis, and management of kidney stones. These resources were integrated with the authors' knowledge of the field. Conclusion: Nephrolithiasis remains a major economic and health burden worldwide. Nephrolithiasis is considered a systemic disorder associated with chronic kidney disease, bone loss and fractures, increased risk of coronary artery disease, hypertension, type 2 diabetes mellitus, and the metabolic syndrome. Further understanding of the pathophysiological link between nephrolithiasis and these systemic disorders is necessary for the development of new therapeutic options. PMID:22466339

  19. 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

  20. 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.

  1. 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.

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  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. 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

  15. 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.

  16. 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...

  17. 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...

  18. 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...

  19. 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

  20. 25 CFR 301.6 - Stone for ornamentation.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 2 2014-04-01 2014-04-01 false Stone for ornamentation. 301.6 Section 301.6 Indians INDIAN ARTS AND CRAFTS BOARD, DEPARTMENT OF THE INTERIOR NAVAJO, PUEBLO, AND HOPI SILVER AND TURQUOISE PRODUCTS; STANDARDS § 301.6 Stone for ornamentation. In addition to turquoise, the use of other local stone is permitted. Turquoise, if used, must...