Kidney stones during pregnancy: an investigation into stone composition.

PubMed

Ross, Ashley E; Handa, Shelly; Lingeman, James E; Matlaga, Brian R

2008-05-01

Kidney stones can be a source of considerable morbidity for pregnant women. Although there is a body of literature confirming that different stone compositions predominate for different age and sex cohorts, there have been no similar reports characterizing the nature of stone disease during pregnancy. We performed a multi-institutional study to define the composition of renal calculi diagnosed during pregnancy. We retrospectively reviewed the records from two stone referral centers of all patients diagnosed with a de novo kidney stone during pregnancy who underwent a procedure for the purpose of stone removal from June 2001 through September 2007. A total of 27 patients were identified, with a mean age of 26.8 years (range, 21-34). Twenty patients (74%) had no history of prior stone formation. Seven patients (26%) had previously formed stones, although none of these patients had a known kidney stone at the time they became pregnant. Stones were removed in the first, second, third trimester and immediately post-partum in 4, 52, 22, and 22% respectively. Stone removal was performed without complication in all cases. Analysis found that in 74% of all cases (20 patients) stones were composed predominantly of calcium phosphate (hydroxyapatite). In 26% of cases, (7 patients) the stones were composed predominantly of calcium oxalate. Of the seven patients with prior stone history, three patients had previously formed calcium phosphate stones and four patients had previously formed calcium oxalate stones. Calcium oxalate calculi are the most common stone in non-pregnant women of a comparable age as our subjects. However, our present data suggest that stones detected during pregnancy are most commonly composed of calcium phosphate (hydroxyapatite). Indeed, it is the minority of stones that are composed of calcium oxalate. Although the reason for this unusual preponderance of calcium phosphate calculi is unclear, physiologic alterations that occur during pregnancy may be influential.

Guaifenesin stone matrix proteomics: a protocol for identifying proteins critical to stone formation.

PubMed

Kolbach-Mandel, A M; Mandel, N S; Cohen, S R; Kleinman, J G; Ahmed, F; Mandel, I C; Wesson, J A

2017-04-01

Drug-related kidney stones are a diagnostic problem, since they contain a large matrix (protein) fraction and are frequently incorrectly identified as matrix stones. A urine proteomics study patient produced a guaifenesin stone during her participation, allowing us to both correctly diagnose her disease and identify proteins critical to this drug stone-forming process. The patient provided three random midday urine samples for proteomics studies; one of which contained stone-like sediment with two distinct fractions. These solids were characterized with optical microscopy and Fourier transform infrared spectroscopy. Immunoblotting and quantitative mass spectrometry were used to quantitatively identify the proteins in urine and stone matrix. Infrared spectroscopy showed that the sediment was 60 % protein and 40 % guaifenesin and its metabolite guaiacol. Of the 156 distinct proteins identified in the proteomic studies, 49 were identified in the two stone-components with approximately 50 % of those proteins also found in this patient's urine. Many proteins observed in this drug-related stone have also been reported in proteomic matrix studies of uric acid and calcium containing stones. More importantly, nine proteins were highly enriched and highly abundant in the stone matrix and 8 were reciprocally depleted in urine, suggesting a critical role for these proteins in guaifenesin stone formation. Accurate stone analysis is critical to proper diagnosis and treatment of kidney stones. Many matrix proteins were common to all stone types, but likely not related to disease mechanism. This protocol defined a small set of proteins that were likely critical to guaifenesin stone formation based on their high enrichment and high abundance in stone matrix, and it should be applied to all stone types.

Evaluation of stone volume distribution in renal collecting system as a predictor of stone-free rate after percutaneous nephrolithotomy: a retrospective single-center study.

PubMed

Atalay, Hasan Anıl; Canat, Lutfi; Bayraktarlı, Recep; Alkan, Ilter; Can, Osman; Altunrende, Fatih

2017-06-23

We analyzed our stone-free rates of PNL with regard to stone burden and its ratio to the renal collecting system volume. Data of 164 patients who underwent PNL were analyzed retrospectively. Volume segmentation of renal collecting system and stones were done using 3D segmentation software with the images obtained from CT data. Analyzed stone volume (ASV) and renal collecting system volume (RCSV) were measured and the ASV-to-RCSV ratio was calculated after the creation of a 3D surface volume rendering of renal stones and the collecting system. Univariate and multivariate statistical analyses were performed to determine factors affecting stone-free rates; also we assessed the predictive accuracy of the ASV-to-RCSV ratio using the receiving operating curve (ROC) and AUC. The stone-free rate of PNL monotherapy was 53% (164 procedures).The ASV-to-RCSV ratio and calyx number with stones were the most influential predictors of stone-free status (OR 4.15, 95% CI 2.24-7.24, <0.001, OR 2.62, 95% CI 1.38-4.97, p < 0.001, respectively). Other factors associated with the stone-free rate were maximum stone size (p < 0.029), stone surface area (p < 0.010), and stone burden volume (p < 0.001). Predictive accuracy of the ASV-to-RCSV ratio was AUC 0.76. Stone burden volume distribution in the renal collecting system, which is calculated using the 3D volume segmentation method, is a significant determinant of the stone-free rate before PCNL surgery. It could be used as a single guide variable by the clinician before renal stone surgery to predict extra requirements for stone clearance.

Cystine Stone Formers Have Impaired Health-Related Quality of Life Compared with Noncystine Stone Formers: A Case-Referent Study Piloting the Wisconsin Stone Quality of Life Questionnaire Among Patients with Cystine Stones.

PubMed

Streeper, Necole M; Wertheim, Margaret L; Nakada, Stephen Y; Penniston, Kristina L

2017-04-01

Cystinuria is a rare cause of urolithiasis. Affected patients have an earlier onset and more aggressive disease than patients with other stone etiologies. We assessed the health-related quality of life (HRQOL) of cystine stone-forming patients using the disease-specific Wisconsin Stone Quality of Life questionnaire (WISQOL). Cystine patients treated in our stone clinics (n = 12) completed the WISQOL; information about medical and stone histories was gathered. Patients were matched with noncystine stone formers (n = 12) for gender, age, and comorbidities. In addition, a second control group (n = 90), also from our institution and consisting of mixed calcium stone formers, was included. WISQOL responses were compared between groups. Cystine patients had significantly lower total WISQOL scores than noncystine patients. Compared with noncystine stone formers, cystine stone formers also had lower HRQOL scores for subscales (domains) related to social impact, emotional impact, disease impact, and vitality (p ≤ 0.04 for all). On specific items, cystine patients reported significantly more sleep problems (p = 0.02), more bother with nocturia (p = 0.03), and feeling tired or fatigued (p = 0.02). Among those with current stones, cystine patients scored lower than noncystine patients for total score and in two of four domains. Using a stone-specific questionnaire, patients with cystine stones have lower HRQOL compared with noncystine stone formers. Identifying and addressing specific areas of decrement in patients with cystine stones may improve disease management and patients' HRQOL.

Definition and Facts for Kidney Stones in Adults

MedlinePlus

... Eating, Diet, & Nutrition Clinical Trials Definition & Facts for Kidney Stones What are kidney stones? Kidney stones are hard, pebble-like pieces ... stone may get stuck along the way. Do kidney stones have another name? The scientific name for ...

Spontaneous passage of ureteral stones in patients with indwelling ureteral stents.

PubMed

Baumgarten, Lee; Desai, Anuj; Shipman, Scott; Eun, Daniel D; Pontari, Michel A; Mydlo, Jack H; Reese, Adam C

2017-10-01

To determine rates of spontaneous ureteral stone passage in patients with indwelling ureteral stents, and to identify factors associated with the spontaneous passage of stones while a ureteral stent is in place. From our institutional database, we identified patients who underwent ureteroscopic procedures for stone disease between January 1, 2013 and March 1, 2015. We compared the rates of spontaneous stone passage between patients who had previously undergone ureteral stent placement and those who had not. In patients with indwelling stents, multivariate logistic regression was performed to identify factors associated with spontaneous stone passage. A total of 194 patients met inclusion criteria. Spontaneous stone passage rates were similar in the stented (17/119, 14%) and non-stented (15/75, 20%) groups (p = 0.30). In bivariate analysis of stented patients, smaller stone size (p < 0.001) and distal stone location (p = 0.01) were significantly associated with spontaneous stone passage. Multivariate logistic regression analysis of stented patients showed that only small stone size was significantly associated with the likelihood of stone passage (p = 0.01), whereas stent duration, stone location, and stone laterality were not. A small, but clinically significant percentage of ureteral stones pass spontaneously with a ureteral stent in place. Small stone size is associated with an increased likelihood of spontaneous passage in patients with indwelling stents. These findings may help to identify patients who can potentially avoid additional surgical procedures for definitive stone removal after ureteral stent placement.

Extracorporeal shock wave lithotripsy of proximal and distal ureteral stones.

PubMed

Pettersson, B; Tiselius, H G

1988-01-01

Extracorporeal shock wave lithotripsy (ESWL) was used for treatment of 105 patients with ureteral stones. There were 77 stones in the upper part of the ureter, i.e. above the pelvic brim, and 28 in the lower part, i.e. below the sacroiliac joint. Successful fragmentation was attained in 101 (96%). In 93% of the patients with stones in the upper ureter and in 100% with stones in the lower ureter the fragments were eliminated completely. In 87% of the patients with stones in the upper ureter, a ureteral catheter was introduced under local anesthesia but without fluoroscopic control. It was thereby possible to remove 30% of the stones from the ureter to the kidney. For the remaining stones, saline was infused through the catheter during ESWL. For patients with stones in the lower part of the ureter, a ureteral catheter was passed in 79% and saline infused during treatment. Whereas some form of anesthesia was used for treatment of all upper ureteral stones, 89% of the treatments for lower ureteral stones were performed without anesthesia. Auxiliary procedures after ESWL were limited to four ureteral catheter manipulations for distal stones. Four proximal stones which remained unaffected by ESWL had to be treated by open surgery (3 stones) or percutaneous surgery (1 stone). Of 82 ureteric stones treated in situ the success fragmentation rate was 95%. The average number of ESWL sessions was 1.04 for both proximal and distal ureteral stones.

Metabolic Characteristics and Risks Associated with Stone Recurrence in Korean Young Adult Stone Patients.

PubMed

Kang, Ho Won; Seo, Sung Pil; Kim, Won Tae; Kim, Yong-June; Yun, Seok-Joong; Kim, Wun-Jae; Lee, Sang-Cheol

2017-08-01

The aim of this study was to assess the metabolic characteristics and risks of stone recurrence in young adult stone patients in Korea. The medical records of 1532 patients presenting with renal or ureteric stones at our stone clinic between 1994 and 2015 were retrospectively reviewed. Patients were grouped according to age (young adult, 18-29 years; intermediate onset, 30-59 years; old age, ≥60 years) at first presentation, and measurements of clinicometabolic characteristics and risks of stone recurrence were compared. Overall, excretion of urinary stone-forming substances was highest in the intermediate onset group, followed by the young adult and old age groups. Importantly, excretion of urinary citrate was lowest in the young adult group. Kaplan-Meier analyses identified a significant difference between the three age groups in terms of stone recurrence (log rank test, p < 0.001). Multivariate Cox regression analyses revealed that age at first stone presentation was an independent risk factor for stone recurrence. Urinary citrate excretion was an independent risk factor for stone recurrence in young adult stone patients. Younger age (18-29 years) at first stone presentation was a significant risk factor for stone recurrence, and urinary citrate excretion was an independent risk factor affecting recurrence in this group. Metabolic evaluation and potassium citrate therapy should be considered for young adult stone patients to prevent recurrence.

Appropriate kidney stone size for ureteroscopic lithotripsy: When to switch to a percutaneous approach

PubMed Central

Takazawa, Ryoji; Kitayama, Sachi; Tsujii, Toshihiko

2015-01-01

Flexible ureteroscopy (fURS) has become a more effective and safer treatment for whole upper urinary tract stones. Percutaneous nephrolithotomy (PNL) is currently the first-line recommended treatment for large kidney stones ≥ 20 mm and it has an excellent stone-free rate for large kidney stones. However, its invasiveness is not negligible considering its major complication rates. Staged fURS is a practical treatment for such large kidney stones because fURS has a minimal blood transfusion risk, short hospitalization and few restrictions on daily routines. However, as the stone size becomes larger, the stone-free rate decreases, and the number of operations required increases. Therefore, in our opinion, staged fURS is a practical option for kidney stones 20 to 40 mm. Miniaturized PNL combined with fURS should be considered to be a preferred option for stones larger than 40 mm. Moreover, URS is an effective treatment for multiple upper urinary tract stones. Especially for patients with a stone burden < 20 mm, URS is a favorable option that promises a high stone-free rate after a single session either unilaterally or bilaterally. However, for patients with a stone burden ≥ 20 mm, a staged operation should be considered to achieve stone-free status. PMID:25664253

Is scoring system of computed tomography based metric parameters can accurately predicts shock wave lithotripsy stone-free rates and aid in the development of treatment strategies?

PubMed Central

Badran, Yasser Ali; Abdelaziz, Alsayed Saad; Shehab, Mohamed Ahmed; Mohamed, Hazem Abdelsabour Dief; Emara, Absel-Aziz Ali; Elnabtity, Ali Mohamed Ali; Ghanem, Maged Mohammed; ELHelaly, Hesham Abdel Azim

2016-01-01

Objective: The objective was to determine the predicting success of shock wave lithotripsy (SWL) using a combination of computed tomography based metric parameters to improve the treatment plan. Patients and Methods: Consecutive 180 patients with symptomatic upper urinary tract calculi 20 mm or less were enrolled in our study underwent extracorporeal SWL were divided into two main groups, according to the stone size, Group A (92 patients with stone ≤10 mm) and Group B (88 patients with stone >10 mm). Both groups were evaluated, according to the skin to stone distance (SSD) and Hounsfield units (≤500, 500–1000 and >1000 HU). Results: Both groups were comparable in baseline data and stone characteristics. About 92.3% of Group A rendered stone-free, whereas 77.2% were stone-free in Group B (P = 0.001). Furthermore, in both group SWL success rates was a significantly higher for stones with lower attenuation <830 HU than with stones >830 HU (P < 0.034). SSD were statistically differences in SWL outcome (P < 0.02). Simultaneous consideration of three parameters stone size, stone attenuation value, and SSD; we found that stone-free rate (SFR) was 100% for stone attenuation value <830 HU for stone <10 mm or >10 mm but total number SWL sessions and shock waves required for the larger stone group were higher than in the smaller group (P < 0.01). Furthermore, SFR was 83.3% and 37.5% for stone <10 mm, mean HU >830, SSD 90 mm and SSD >120 mm, respectively. On the other hand, SFR was 52.6% and 28.57% for stone >10 mm, mean HU >830, SSD <90 mm and SSD >120 mm, respectively. Conclusion: Stone size, stone density (HU), and SSD is simple to calculate and can be reported by radiologists to applying combined score help to augment predictive power of SWL, reduce cost, and improving of treatment strategies. PMID:27141192

Fire effects on flaked stone, ground stone, and other stone artifacts [Chapter 4

Treesearch

Krista Deal

2012-01-01

Lithic artifacts can be divided into two broad classes, flaked stone and ground stone, that overlap depending on the defining criteria. For this discussion, flaked stone is used to describe objects that cut, scrape, pierce, saw, hack, etch, drill, or perforate, and the debris (debitage) created when these items are manufactured. Objects made of flaked stone include...

Novel ultrasound method to reposition kidney stones

PubMed Central

Shah, Anup; Owen, Neil R.; Lu, Wei; Cunitz, Bryan W.; Kaczkowski, Peter J.; Harper, Jonathan D.; Bailey, Michael R.; Crum, Lawrence A.

2011-01-01

The success of surgical management of lower pole stones is principally dependent on stone fragmentation and residual stone clearance. Choice of surgical method depends on stone size, yet all methods are subject to post-surgical complications resulting from residual stone fragments. Here we present a novel method and device to reposition kidney stones using ultrasound radiation force delivered by focused ultrasound and guided by ultrasound imaging. The device couples a commercial imaging array with a focused annular array transducer. Feasibility of repositioning stones was investigated by implanting artificial and human stones into a kidney-mimicking phantom that simulated a lower pole and collecting system. During experiment, stones were located by ultrasound imaging and repositioned by delivering short bursts of focused ultrasound. Stone motion was concurrently monitored by fluoroscopy, ultrasound imaging, and video photography, from which displacement and velocity were estimated. Stones were seen to move immediately after delivering focused ultrasound and successfully repositioned from the lower pole to the collecting system. Estimated velocities were on the order of 1 cm/s. This in vitro study demonstrates a promising modality to facilitate spontaneous clearance of kidney stones and increased clearance of residual stone fragments after surgical management. PMID:20967437

[Factors affecting residual stones after percutaneous nephrolithotomy in patients with renal calculus].

PubMed

Qiao, Mingzhou; Zhang, Haifang; Zhou, Chenlong

2015-11-24

To explore the factors affecting the residual stones after percutaneous nephrolithotomy (PCNL) in patients with renal calculus. A retrospective analysis was performed for 1 200 patients who were affected by renal calculus and treated with PCNL between Jan 2008 and May 2014 in People's Hospital of Anyang City. Among those patients, 16 were diagnosed as bilateral renal stone and had two successive operations. The size, location and number of stones, previous history of surgery, the degree of hydronephrosis, urinary infection were included in the univariate analysis. Significant factors in univariate analysis were included in the multivariate analysis to determine factors affecting stone residual. A total of 385 cases developed stone residual after surgery. The overall residual rate was 31.7%. In univariate analysis, renal pelvis combined with caliceal calculus (P=0.006), stone size larger than 4 cm (P=0.005), stone number more than 4 (P=0.002), the amount of bleeding more than 200 ml (P=0.025), operation time longer than 120 minutes (P=0.028) were associated with an increased rate of stone residual. When subjected to the Cox multivariate analysis, the independent risk factors for residual stones were renal pelvis combined with caliceal calculus (P=0.049), stone size larger than 4 cm (P=0.038) and stone number more than 4 (P=0.018). Factors affecting the incidence of residual stones after PCNL are the size, location and number of stones. Larger size stone and the presence of renal pelvis combined with caliceal calculus are significantly associated with residual stones. Nevertheless, stone number less than 4 indicates an increased stone clearance rate.

Significance of lower-pole pelvicaliceal anatomy on stone clearance after shockwave lithotripsy in nonobstructive isolated renal pelvic stones.

PubMed

Sozen, Sinan; Kupeli, Bora; Acar, Cenk; Gurocak, Serhat; Karaoglan, Ustunol; Bozkirli, Ibrahim

2008-05-01

To investigate the probable effect of lower-pole pelvicaliceal anatomy on stone clearance after shockwave lithotripsy (SWL) in patients with nonobstructive renal pelvic stones. The clinical records of patients with isolated renal pelvic stones who underwent SWL between 1996 and 2005 were reviewed. After excluding patients with obstruction leading to dilatation, major anatomic abnormalities, noncalcium stones, metabolic abnormalities, history of recurrent stone disease, multiple stones, and previous renal surgery, 153 patients were enrolled in the study. Lower pole infundibulopelvic angle (IPA) and infundibular length and width were measured from intravenous urography. Patients were classified into three groups according to stone burden (group 1, <100 mm(2); group 2, 101-200 mm(2); group 3, 201-400 mm(2)). The mean stone size was 142.08+/-86.3 mm(2). Overall stone-free rate was 53.6%. Localization of clinically significant or insignificant residual fragments was in the lower calix, renal pelvis, and both in 50 (32.6%), 29 (18.9%), and 8 (5.2%) patients, respectively. There was no statistically significant difference in pelvicaliceal anatomic features except narrower IPA (P=0.02) in group 1 patients with residual stones. The falling of stone fragments to the lower calix in spite of the ureter whether clinically significant or not after SWL of pelvic stones initially seems to be related to stone burden rather than lower caliceal anatomy. However, existence of a more narrow IPA in group 1 patients with residual fragments led us to believe that lower-pole IPA can play a role in stone clearance, especially for smaller stones, probably because of smaller residual fragment size or the more mobile nature of the primary stone.

In Idiopathic Calcium Oxalate Stone Formers, Unattached Stones Show Evidence of Having Originated as Attached Stones on Randall’s Plaque

PubMed Central

Miller, Nicole L.; Williams, James C.; Evan, Andrew P.; Bledsoe, Sharon B.; Coe, Fredric L.; Worcester, Elaine M.; Munch, Larry C.; Handa, Shelly E.; Lingeman, James E.

2009-01-01

Objective To analyze the structure and composition of unattached stones in idiopathic calcium oxalate stone formers (ICSF) and compare them to attached stones from the same cohort in order to investigate whether more than one pathogenic mechanism exists for stone formation in ICSF. Patients and methods ICSF undergoing percutaneous nephrolithotomy or ureteroscopy for treatment of nephrolithiasis were consented for this study. All accessible renal papillae were endoscopically imaged using a digital endoscope. All stones were removed and determined by the operating surgeon to be attached or unattached to the underlying papilla. Micro-computed tomography (micro-CT), which provides three-dimensional analysis of entire stones, was used to compare the structure and composition of attached versus unattached stones. Results Of 115 stones collected from 9 patients (12 renal units), only 25 stones were found not to be attached to renal papillae. Of these 25 stones, 4 were lost and 12 showed definite morphological evidence of having been attached to tissue, probably having been knocked off of papillae during access. For the remaining 9 stones, micro-CT analysis revealed at least one internal region of calcium phosphate within each of these unattached calcium oxalate (CaOx) stones. That is, the internal structure of the unattached stones is consistent with their having originated attached to RP, and then having become detached but retained in the kidney, with new layers of CaOx eventually covering the original attachment site. Conclusions Micro CT analysis supports the hypothesis that in ICSF, both attached and unattached stones occur as a result of a common pathogenic mechanism. That is, in this type of stone former, CaOx stones—even those not showing morphology that betrays attachment—all originate attached to interstitial plaque on the renal papilla. PMID:19549258

Combined Burst Wave Lithotripsy and Ultrasonic Propulsion for Improved Urinary Stone Fragmentation.

PubMed

Zwaschka, Theresa A; Ahn, Justin S; Cunitz, Bryan W; Bailey, Michael R; Dunmire, Barbrina; Sorensen, Mathew D; Harper, Jonathan D; Maxwell, Adam D

2018-04-01

Burst wave lithotripsy (BWL) is a new technology in development to fragment urinary stones. Ultrasonic propulsion (UP) is a separate technology under investigation for displacing stones. We measure the effect of propulsion pulses on stone fragmentation from BWL. Two artificial stone models (crystalline calcite, BegoStone plaster) and human calcium oxalate monohydrate (COM) stones measuring 5 to 8 mm were subjected to ultrasound exposures in a polyvinyl chloride tissue phantom within a water bath. Stones were exposed to BWL with and without propulsion pulses interleaved for set time intervals depending on stone type. Fragmentation was measured as a fraction of the initial stone mass fragmented to pieces smaller than 2 mm. BegoStone model comminution improved from 6% to 35% (p < 0.001) between BWL and BWL with interleaved propulsion in a 10-minute exposure. Propulsion alone did not fragment stones, whereas addition of propulsion after BWL slightly improved BegoStone model comminution from 6% to 11% (p < 0.001). BegoStone model fragmentation increased with rate of propulsion pulses. Calcite stone fragmentation improved from 24% to 39% in 5 minutes (p = 0.047) and COM stones improved from 17% to 36% (p = 0.01) with interleaved propulsion. BWL with UP improved stone fragmentation compared with BWL alone in vitro. The improvement was greatest when propulsion pulses are interleaved with BWL treatment and when propulsion pulses are applied at a higher rate. Thus, UP may be a useful adjunct to enhance fragmentation in lithotripsy in vivo.

Black and brown pigment gallstones differ in microstructure and microcomposition.

PubMed

Malet, P F; Takabayashi, A; Trotman, B W; Soloway, R D; Weston, N E

1984-01-01

The two subtypes of pigment gallstones, black and brown stones, differ in chemical composition and pathogenesis. We examined a black bilirubinate stone and a black phosphate stone (which represented opposite ends of the compositional spectrum of black noncarbonate stones), a black carbonate stone, and a brown pigment stone using scanning electron microscopy and microchemical techniques to determine if stone microstructure and microcomposition reflected different patterns of formation. The cross-sectional surfaces of the black bilirubinate and black phosphate stones were smooth and homogenous. Electron probe microanalysis demonstrated high concentrations of sulfur and copper in the center of the black bilirubinate stone; sulfur was in a low valence state consistent with disulfide linkages in proteins. The brown stone was rough-surfaced with lamellated bands on cross-section. The lighter-colored bands in this stone contained virtually all of the detected calcium palmitate, while the darker sections contained much more calcium bilirubinate. Plasma oxygen etching demonstrated a network of protein interdigitating with calcium bilirubinate salts in the black bilirubinate and black phosphate stones but not in the black carbonate or brown stones. Argon ion etching demonstrated that calcium bilirubinate was in a closely packed rod-shaped arrangement in all three black stones but not in the brown stone. We conclude that the marked differences in structure and composition between the black noncarbonate and brown pigment gallstones support the hypothesis that the two major pigment gallstone types form by different mechanisms. In addition, the layered structures of the black carbonate and brown stones suggest that stone growth is affected by cyclic changes in biliary composition.

Is retrograde intrarenal surgery the game changer in the management of upper tract calculi? A single-center single-surgeon experience of 131 cases.

PubMed

Parikh, Kandarp Priyakant; Jain, Ravi Jineshkumar; Kandarp, Aditya Parikh

2018-01-01

Success of any modality for stone disease needs to be evaluated in terms of Stone Free Rates (SFR), auxiliary procedures needed; complications and follow up. SFR in RIRS is subject to parameters like stone burden, location, number, hardness, composition; calyceal and ureter anatomy; use of ureteric access sheath (UAS); surgeon experience etc. The aim of this study is to evaluate the efficacy and safety of RIRS for managing upper tract stones. The objectives include evaluating SFR in RIRS in relation to stone burden, location and number. Other objectives include evaluating SFR after re RIRS in relation to stone burden, necessity of pre DJ stenting, use of UAS and post operative complication rate. 131 patients operated by single surgeon for single/multiple renal and/or upper ureteric stones were evaluated. Stone size > 3 mm on follow up CT KUB was considered as residual. Re RIRS was required for residual stones. The overall SFR was 76%. SFR were statistically lower with stone burden > 1.5 cm, lower calyceal stones and single stones with stone burden > 1.5 cm. SFR was 90% after 2 nd RIRS and 98.5% after 3 rd RIRS procedure. No significant difference in SFR was noted between single v/s multiple stones, single calyx v/s multiple calyx stones and renal v/s upper ureteric stones. No major complication was noted. Larger stone burden and lower calyceal location are important factors deciding SFR in RIRS. With auxiliary procedure, RIRS is safe and effective compared to PCNL.

Impact of stone density on outcomes in percutaneous nephrolithotomy (PCNL): an analysis of the clinical research office of the endourological society (CROES) pcnl global study database.

PubMed

Anastasiadis, Anastasios; Onal, Bulent; Modi, Pranjal; Turna, Burak; Duvdevani, Mordechai; Timoney, Anthony; Wolf, J Stuart; De La Rosette, Jean

2013-12-01

This study aimed to explore the relationship between stone density and outcomes of percutaneous nephrolithotomy (PCNL) using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database. Patients undergoing PCNL treatment were assigned to a low stone density [LSD, ≤ 1000 Hounsfield units (HU)] or high stone density (HSD, > 1000 HU) group based on the radiological density of the primary renal stone. Preoperative characteristics and outcomes were compared in the two groups. Retreatment for residual stones was more frequent in the LSD group. The overall stone-free rate achieved was higher in the HSD group (79.3% vs 74.8%, p = 0.113). By univariate regression analysis, the probability of achieving a stone-free outcome peaked at approximately 1250 HU. Below or above this density resulted in lower treatment success, particularly at very low HU values. With increasing radiological stone density, operating time decreased to a minimum at approximately 1000 HU, then increased with further increase in stone density. Multivariate non-linear regression analysis showed a similar relationship between the probability of a stone-free outcome and stone density. Higher treatment success rates were found with low stone burden, pelvic stone location and use of pneumatic lithotripsy. Very low and high stone densities are associated with lower rates of treatment success and longer operating time in PCNL. Preoperative assessment of stone density may help in the selection of treatment modality for patients with renal stones.

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.

Open stone surgery: a still-in-use approach for complex stone burden.

PubMed

Çakici, Özer Ural; Ener, Kemal; Keske, Murat; Altinova, Serkan; Canda, Abdullah Erdem; Aldemir, Mustafa; Ardicoglu, Arslan

2017-06-30

Urinary stone disease is a major urological condition. Endourologic techniques have influenced the clinical approach and outcomes. Open surgery holds a historic importance in the management of most conditions. However, complex kidney stone burden may be amenable to successful results with open stone surgery. In this article, we report our eighteen cases of complex urinary stone disease who underwent open stone removal. A total of 1701 patients have undergone surgical treatment for urinary stone disease in our clinic between July 2012 and July 2016, comprising eighteen patients who underwent open stone surgery. Patients' demographic data, stone analysis results, postoperative clinical data, and stone status were evaluated retrospectively. The choice of surgical approach is mostly dependent on the surgeon's preference. In two patients, open surgery was undertaken because of perioperative complications. We did not observe any Clavien-Dindo grade 4 or 5 complications. Three patients were managed with a course of antibiotics due to postoperative fever. One patient had postoperative pleurisy, one patient had urinoma, and two patients had postoperative ileus. Mean operation time was 84 (57-124) minutes and mean hospitalization time was 5.5 (3-8) days. Stone-free status was achieved in 15 patients (83.3%). Endourologic approaches are the first options for treatment of urinary stone disease. However, open stone surgery holds its indispensable position in complicated cases and in complex stone burden. Open stone surgery is also a valid alternative to endourologic techniques in all situations.

[Infrared spectrophotometry for crystalline composition of staghorn calculi].

PubMed

Ma, Kai; Huang, Xiao-bo; Xu, Qing-quan; Li, Jian-xing; Xiong, Liu-lin; Yang, Bo; Ye, Xiong-jun; Chen, Liang; Wang, Xiao-feng; Na, Yan-qun

2010-11-30

To provide theoretic rationales for treatment and prevention of staghorn calculi by analyzing stone composition and studying the relationship between stone and urinary tract infections. The clinical data of 51 staghorn calculi patients were analyzed retrospectively. The stone compositions were studied by infrared spectrophotometry. Six types of stone compositions were obtained. There were calcium oxalate monohydrate, calcium oxalate dehydrate, carbonate apatite, magnesium ammonium phosphate hexahydrate, uric acid and L-cystine. The majority of stones were of mixed compositions, pure stones were found in 15 cases (29.4%). Among all stones, calcium oxalate stones were found in 41 cases (80.4%) and uric stones in 10 cases (19.6%). Infectious stones were found in 26 cases (51.0%). Urinary tract infections were found in 40 (78.4%) patients and positive urine/stone culture was detected in 33 (64.7%) patients. With multiple crystalline compositions and etiological factors, the staghorn calculi are closely correlated with urinary tract infections.

Salivary stones: symptoms, aetiology, biochemical composition and treatment.

PubMed

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

2014-12-05

Salivary stones, also known as sialoliths, are calcified concrements in the salivary glands. Sialoliths are more frequently located in the submandibular gland (84%), than in the parotid gland (13%). The majority of the submandibular stones are located in Wharton's duct (90%), whereas parotid stones are more often located in the gland itself. Salivary stones consist of an amorphous mineralised nucleus, surrounded by concentric laminated layers of organic and inorganic substances. The organic components of salivary stones include collagen, glycoproteins, amino acids and carbohydrates. The major inorganic components are hydroxyapatite, carbonate apatite, whitlockite and brushite. The management of salivary stones is focused on removing the salivary stones and preservation of salivary gland function which depends on the size and location of the stone. Conservative management of salivary stones consists of salivary gland massage and the use of sialogogues. Other therapeutic options include removal of the stone or in some cases surgical removal of the whole salivary gland.

Single-session ureteroscopic pneumatic lithotripsy for the management of bilateral ureteric stones.

PubMed

Isen, Kenan

2012-01-01

In nowadays there is no consensus on single-session ureteroscopic lithotripsy (URSL) for the management of bilateral ureteric stones. The aim of this study was to evaluate efficacy and safety of single-session URSL in patients with bilateral ureteric stones. 41 patients who have undergone bilateral single-session URSL were evaluted in this study. A 8/9.8 Fr Wolf semi-rigid ureteroscope was used for the procedures, and the stones were fragmented with pneumatic lithotripter. A high stone-free rate was achieved (90.2%) after single endoscopic procedure with a retreatment rate of 9.8%. The procedure was most successful for distal ureteric stones with a 96.2% stone-free rate followed by middle ureteric stones with a 81.8% stone-free rate while the least success was achieved for proximal ureteric stones with a 77.7% stone-free rate (p < 0.05). A greater stone-free rate was obtained in those with stones less than 10 mm (93.7%) than in those with stones larger than 10 mm (77.7%) (p < 0.05). Ureteral perforation occurred in only one patient (2.4%). No long-term complication was observed in any patient. Bilateral single-session URSL can be performed effectively and safely with a low complication rate in patients with bilateral ureteric stones. It can reduce the need of anaesthetics and hospital stay.

Using Helical CT to Predict Stone Fragility in Shock Wave Lithotripsy (SWL)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Williams, James C. Jr.; Zarse, Chad A.; Jackson, Molly E.

2007-04-05

Great variability exists in the response of urinary stones to SWL, and this is true even for stones composed of the same mineral. Efforts have been made to predict stone fragility to shock waves using computed tomography (CT) patient images, but most work to date has focused on the use of stone CT number (i.e., Hounsfield units). This is an easy number to measure on a patient stone, but its value depends on a number of factors, including the relationship of the size of the stone to me resolution (i.e., the slicewidth) of the CT scan. Studies that have shownmore » a relationship between stone CT number and failure in SWL are reviewed, and all are shown to suffer from error due to stone size, which was not accounted for in the use of Hounsfield unit values. Preliminary data are then presented for a study of calcium oxalate monohydrate (COM) stones, in which stone structure-rather than simple CT number values-is shown to correlate with fragility to shock waves. COM stones that were observed to have structure by micro CT (e.g., voids, apatite regions, unusual shapes) broke to completion in about half the number of shock waves required for COM stones that were observed to be homogeneous in structure by CT. This result suggests another direction for the use of CT in predicting success of SWL: the use of CT to view stone structure, rather than simply measuring stone CT number. Viewing stone structure by CT requires the use of different viewing windows than those typically used for examining patient scans, but much research to date indicates that stone structure can be observed in the clinical setting. Future clinical studies will need to be done to verify the relationship between stone structure observed by CT and stone fragility in SWL.« less

Characteristics of renal papillae in kidney stone formers.

PubMed

Marien, Tracy P; Miller, Nicole L

2016-12-01

The mechanism of kidney stone formation is not well understood. In order to better understand the pathophysiology for specific kidney stone compositions and systemic diseases associated with kidney stones, endoscopic papillary mapping studies with concurrent biopsies have been conducted. This review will summarize the findings of these studies and proposed mechanisms for thirteen disease processes associated with kidney stones. A review of the literature was performed identifying thirteen studies that endoscopically mapped and biopsied renal papillae of different stone formers. These studies characterized renal papillae based on amount of Randall's plaque, Bellini's duct pathology, papillary contour changes, presence of attached stones, pitting, and frequently papillary and cortical biopsies. The groups studied and reviewed here are kidney stone formers who have a history of idiopathic calcium oxalate stone formation, cystinuria, brushite stones, gastric bypass, ileostomy, small bowel resection, primary hyperparathyroidism, distal renal tubular acidosis (dRTA), primary hyperoxaluria, idiopathic calcium phosphate stone formation, medullary sponge kidney (MSK), uric acid stones, and struvite stones. A proposed standardized scoring system for papillary pathology was also reviewed. The series showed various degrees and types of changes to the renal papillae and corresponding histopathologic changes for each type of stone former reviewed. Those with predominantly alone Randall's plaque pathology had less tissue damage versus those with extensive Bellini's duct lesions who had more interstitial fibrosis and cortical pathology. Randall's plaques are associated with stone formers who have low urinary volume, high urinary calcium, and acidic urine and thus are frequently seen in those with brushite stones, primary hyperparathyroidism, small bowel resection, and idiopathic calcium phosphate stone formers. Bellini's duct plugging and pathology is theorized to occur via free solution crystallization, ductal obstruction, inflammation, cellular injury, fibrosis, and acidification defects. Ureteroscopic manifestations of stone disease can vary from normal appearing papillae to significantly diseased appearing papillae. Some diseases have very characteristic papillary changes. Further studies are necessary to fully elucidate the mechanisms of stone formation in patients with nephrolithiasis.

Advances in lithotripsy and stone disease treatment.

PubMed

Newman, J

1996-01-01

Stone disease can be traced back as far as the human record. This article traces the diagnosis and treatment of stone disease from primitive attempts at stone removal in ancient civilizations to the advent of extracorporeal shock wave lithotripsy (ESWL) in the 1970s. ESWL revolutionized the treatment of stone disease, offering patients a less painful alternative to the traditional surgical removal of stones. This article discusses recent advances in ESWL, describes the radiologic technologist's role in diagnosing and managing stone disease, and outlines future prospects in the treatment of stone disease.

Infection (urease) stones.

PubMed

Griffith, D P; Osborne, C A

1987-01-01

Infection-induced stones in man probably form solely as a consequence of urealysis which is catalyzed by the bacterial protein urease. Urease stones composed of struvite and carbonate-apatite may form primarily, or as secondary stones or pre-existent metabolic stones. Struvite stones form and grow rapidly owing to (a) supersaturation of urine with stone forming salts, (b) 'salting out' of poorly soluble organic substances normally dissolved in urine and (c) ammonia-induced destruction of the normally protective urothelial glycosaminoglycan layer. Immature (predominantly organic) matrix stones mature into densely mineralized stones. Curative treatment is possible only by eliminating all of the stone and by eradicating all urinary and parenchymal infection. A variety of operative and pharmaceutical approaches are available. Patient treatment must be individualized inasmuch as some patients are better candidates for one type of treatment than another.

Risk factors for recurrent symptomatic pigmented biliary stones after percutaneous transhepatic biliary extraction.

PubMed

Kim, Dong Won; Lee, Sang Yun; Cho, Jin-Han; Kang, Myong Jin; Noh, Myung Hwan; Park, Byeong-Ho

2010-07-01

To evaluate risk factors for the recurrence of biliary stones after a percutaneous transhepatic biliary stone extraction. The procedures were performed on 339 patients between July 2004 and December 2008 (54 months). Medical records and images were retrospectively reviewed for 135 patients (mean age, 66.4 years; 83 men and 52 women) who had undergone follow-up for a mean of 13.2 months (range, 3-37 months). To evaluate risk factors for the recurrence of biliary stones, variables were evaluated with univariate and multivariate analyses. Variables included sex, age, stone location, number of stones, stone size, presence of a peripapillary diverticulum, application of antegrade sphincteroplasty, presence of a biliary stricture, largest biliary diameter before the procedure, and gallbladder status. Thirty-three of the 135 patients (24%) had recurrent symptomatic biliary stones and underwent an additional extraction. The mean time to recurrence was 17.2 months +/- 8.7. Univariate analysis of risk factors for recurrence of biliary stones demonstrated that location, number of stones, stone size, application of antegrade sphincteroplasty, presence of a biliary stricture, and biliary diameter were significant factors (P < .05). With use of multivariate analysis, the number of stones (> or =6; relative risk, 64.8; 95% confidence interval: 5.8, 717.6) and stone size (> or =14 mm; relative risk, 3.8; 95% confidence interval: 1.138, 13.231) were determined to be significant risk factors. The independent risk factors for recurrence of symptomatic biliary stones after percutaneous transhepatic biliary stone extraction were a stone size of at least 14 mm and the presence of at least six stones. Copyright 2010 SIR. Published by Elsevier Inc. All rights reserved.

Stone clearance after extracorporeal shockwave lithotripsy in patients with solitary pure calcium oxalate stones smaller than 1.0 cm in the proximal ureter, with special reference to monohydrate and dihydrate content.

PubMed

Ichiyanagi, Osamu; Nagaoka, Akira; Izumi, Takuji; Kawamura, Yuko; Tsukigi, Masaaki; Ishii, Tatsuya; Ohji, Hiroshi; Kato, Tomoyuki; Tomita, Yoshihiko

2013-04-01

The aim of this study was to assess stone-free rates following extracorporeal shockwave lithotripsy (ESWL) of pure calcium oxalate (CaOx) stones in the proximal ureter. The investigators retrospectively examined 53 patients with 5-10 mm pure CaOx stones in the proximal ureter from the medical archives of 593 consecutive patients treated with ESWL. The compositions of calcium oxalate monohydrate (COM) and dihydrate (COD) in a given stone were determined by infrared spectrometry. Stone size, attenuation number and stone-to-skin distance (SSD) were measured using plain radiography and computed tomography (CT). ESWL success was evaluated by stone-free status after the first single session. On average, calculi were 8.0 × 5.3 mm in size, with an SSD of 11.0 cm. The mean CT attenuation value was 740.1 HU. Attenuation numbers correlated significantly with stone diameter (r = 0.49), but had no correlation with the stone content of COM or COD. A negative correlation was observed between COM and COD content (r = -0.925). With regard to patients' physical characteristics and COM and COD content, no differences were found between study subgroups with stone-free and residual status (n = 38 and 15, respectively). There were also no differences in clinical features between patient subgroups with COM- or COD-predominant stones (n = 22 and 31, respectively). The findings indicated that the differences in COM and COD content of CaOx stones had no impact on stone clearance after ESWL and that a favorable stone-free rate of the stones treated with ESWL may be achieved independently of CaOx hydration.

Combined retrograde flexible ureteroscopic lithotripsy with holmium YAG laser for renal calculi associated with ipsilateral ureteral stones.

PubMed

Cocuzza, Marcello; Colombo, Jose R; Ganpule, Arvind; Turna, Burak; Cocuzza, Antonio; Dhawan, Divyar; Santos, Bruno; Mazzucchi, Eduardo; Srougi, Miguel; Desai, Mahesh; Desai, Mihir

2009-02-01

The purpose of this study was to evaluate the effectiveness of combined ureteroscopic holmium YAG lithotripsy for renal calculi associated with ipsilateral ureteral stones. Between August 2002 and March 2007, retrograde flexible ureteroscopic stone treatment was attempted in 351 cases. Indication for treatment was concurrent symptomatic ureteral stones in 63 patients (group I). Additional operative time and perioperative complication rates were compared to a group of 39 patients submitted to ureteroscopic treatment for ureteral calculi exclusively (group II). Mean ureteral stone size was 8.0 +/- 2.6 mm and 8.1 +/- 3.4 mm for groups I and II, respectively. Mean operative time for group I was 67.9 +/- 29.5 minutes and for group 2 was 49.3 +/- 13.2 minutes (p < 0.001). Flexible ureteroscopic therapy for renal calculi increased 18 minutes in the mean operative time. The overall complication rate was 3.1% and 2.5% for groups I and II, respectively (p = 0.87). Mean renal stone size was 10.7 +/- 6.4 mm, overall stone free rate in group I was 81%. However, considering only patients with renal stones smaller than 15 mm, the stone free rate was 88%. Successful treatment occurred in 81% of patients presenting lower pole stones, but only 76% of patients with multiple renal stones became stone free. As expected, stone free rate showed a significant negative correlation with renal stone size (p = 0.03; r = -0.36). Logistic regression model indicated an independent association of renal stones smaller than 15 mm and stone free rate (OR = 13.5; p = 0.01). Combined ureteroscopic treatment for ureteral and ipsilateral renal calculi is a safe and attractive option for patients presenting for symptomatic ureteral stone and ipsilateral renal calculi smaller than 15 mm.

Stone-Mode Ultrasound for Determining Renal Stone Size.

PubMed

May, Philip C; Haider, Yasser; Dunmire, Barbrina; Cunitz, Bryan W; Thiel, Jeff; Liu, Ziyue; Bruce, Matthew; Bailey, Michael R; Sorensen, Mathew D; Harper, Jonathan D

2016-09-01

The purpose of this study was to measure the accuracy of stone-specific algorithms (S-mode) and the posterior acoustic shadow for determining kidney stone size with ultrasound (US) in vivo. Thirty-four subjects with 115 renal stones were prospectively recruited and scanned with S-mode on a research US system. S-mode is gray-scale US adjusted to enhanced stone contrast and resolution by minimizing compression and averaging, and increasing line density and frequency. Stone and shadow width were compared with a recent CT scan and, in 5 subjects with 18 stones, S-mode was compared with a clinical US system. Overall, 84% of stones identified on CT were detected on S-mode and 66% of these shadowed. Seventy-three percent of the stone measurements and 85% of the shadow measurements were within 2 mm of the size on CT. A posterior acoustic shadow was present in 89% of stones over 5 mm versus 53% of stones under 5 mm. S-mode visualized 78% of stones, versus 61% for the clinical system. S-mode stone and shadow measurements differed from CT by 1.6 ± 1.0 mm and 0.8 ± 0.6 mm, respectively, compared with 2.0 ± 1.5 mm and 1.6 ± 1.0 mm for the clinical system. S-mode offers improved visualization and sizing of renal stones. With S-mode, sizing of the stone itself and the posterior acoustic shadow were similarly accurate. Stones that do not shadow are most likely <5 mm and small enough to pass spontaneously.

Natural history of asymptomatic renal stones and prediction of stone related events.

PubMed

Kang, Ho Won; Lee, Sang Keun; Kim, Won Tae; Kim, Yong-June; Yun, Seok-Joong; Lee, Sang-Cheol; Kim, Wun-Jae

2013-05-01

The appropriate management for asymptomatic renal stones remains unclear. We assessed the natural history and progression rate of such stones and identified clinical factors associated with an increased risk of stone related events. We retrospectively reviewed the medical records of 201 male and 146 female patients with asymptomatic renal stones. It was recommended that patients be followed every 6 months. Mean followup was 31 months (range 6 to 180). Patients were divided into 2 groups by stone related events, including spontaneous stone passage, flank pain, stone growth or the need for intervention during followup. Spontaneous passage occurred in 101 patients (29.1%). Of the patients 186 (53.6%) and 161 (46.4%) did and did not have stone related events, respectively. Of the whole cohort 85 patients (24.5%) required intervention but only 4.6% needed surgery. At 19 months after diagnosis 50% of the patients had a symptom. Those with stone related events were more likely to be younger (mean ± SD age 46.6 ± 12.7 vs 49.3 ± 12.6 years) and male, and have a stone history (p = 0.047, 0.017 and 0.014, respectively). Male gender significantly decreased the probability of freedom from stone related events (log rank test p = 0.0135) and it was an independent predictor of stone related events (HR 1.521, p = 0.009). Younger patients, and those with smaller stones and no stone growth were more likely to experience spontaneous passage and less likely to undergo intervention (each p <0.05). Asymptomatic renal stones can be followed safely but long-term followup is necessary. Periodic followup and early intervention should be recommended in patients with risk factors. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2015-01-01

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

KIDNEY STONES: AN UPDATE ON CURRENT PHARMACOLOGICAL MANAGEMENT AND FUTURE DIRECTIONS

PubMed Central

Xu, Hongshi; Zisman, Anna L.; Coe, Fredric L.; Worcester, Elaine M.

2013-01-01

Introduction Kidney stones are a common problem worldwide with substantial morbidities and economic costs. Medical therapy reduces stone recurrence significantly. Much progress has been made in the last several decades in improving therapy of stone disease. Areas covered 1) effect of medical expulsive therapy on spontaneous stone passage, 2) pharmacotherapy in the prevention of stone recurrence, 3) future directions in the treatment of kidney stone disease. Expert Opinion fluid intake to promote urine volume of at least 2.5L each day is essential to prevent stone formation. Dietary recommendations should be adjusted based on individual metabolic abnormalities. Properly dosed thiazide treatment is the standard therapy for calcium stone formers with idiopathic hypercalciuria. Potassium alkali therapy is considered for hypocitraturia, but caution should be taken to prevent potential risk of calcium phosphate stone formation. For absorptive hyperoxaluria, low oxalate diet and increased dietary calcium intake are recommended. Pyridoxine has been shown effective in some cases of primary hyperoxaluria type I. Allopurinol is used in calcium oxalate stone formers with hyperuricosuria. Treatment of cystine stones remains challenging. Tiopronin can be used if urinary alkalinization and adequate fluid intake are insufficient. For struvite stones, complete surgical removal coupled with appropriate antibiotic therapy is necessary. PMID:23438422

Retrograde intrarenal surgery for the treatment of renal stones in children: factors influencing stone clearance and complications.

PubMed

Azili, Mujdem Nur; Ozcan, Fatma; Tiryaki, Tugrul

2014-07-01

Retrograde intrarenal surgery (RIRS) is a known option for the treatment of upper tract calculi with an excellent success. However, the reports of RIRS in prepubertal children are limited. In this study, we evaluated the factors which affected the success rate and the complications of RIRS at renal stone treatment in childhood. We retrospectively reviewed the records of children under 14 years old who underwent RIRS for renal stone disease between January 2009 and December 2012. Patients' age, gender, body mass index (BMI), stone size, stone location, stone number, intraoperative complications, stone free status, postoperative complications were recorded. There were 80 ureterorenoscopic procedures performed in 58 renal units of 47 children (23 males and 24 females). The patients' ages ranged from 8 months to 14 years (mean age 4.7 ± 3.4 years). There was a difference in the distribution of symptoms in age groups. UTI was higher in the 1-4 years age group, abdominal pain was seen mostly in children aged 5-14 years. Multiple stones (included staghorn stone) were noted in 60.4% of patients. In 27.6% of patients, ureteral stones were accompanied by renal stones in our series. In the infancy group, cystine and staghorn stones were more frequently seen, mostly bilateral. After a single ureteroscopic procedure for intrarenal stones in children, we achieved stone free status in 50.9% of the ureters (n=26). After the repeated sessions, the stone clearance rate reached to 85.1%. Retrograde intrarenal surgery can be used as a first line therapy to treat renal stones in children. This is especially important if an associated ureteral stone is present that requires treatment; or in patients with cystinuria, which is not favorably treated with ESWL. Complications were seen more frequently in patients with cystine stones. Extravasation was noted more frequently in patients admitted with UTIs. There was a significant relationship between the conversion to open procedures and the age groups, with most procedures occurring in infancy. The parents should be informed about the probability of multiple procedures to achieve stone free status. Copyright © 2014 Elsevier Inc. All rights reserved.

What happens to asymptomatic lower pole kidney stones smaller than 10 mm in children during watchful waiting?

PubMed

Telli, Onur; Hamidi, Nurullah; Bagci, Uygar; Demirbas, Arif; Hascicek, Ahmet Metin; Soygur, Tarkan; Burgu, Berk

2017-05-01

The optimal management of lower pole kidney (LPK) stones in children is controversial. The aim of this study was to determine the outcomes of children with asymptomatic isolated LPK stones smaller than 10 mm during follow-up. A total of 242 patients with 284 stones presenting at our institution between June 2004 and December 2014 with an asymptomatic, single LPK stone with a diameter of <10 mm were enrolled in the study. All children were assigned to receive first-line therapy and then categorized according to the need for medical intervention. Age, gender, stone laterality, stone size and type, associated urinary tract problems, and uncontrolled metabolic status were assessed as predictive factors of medical treatment for small (<10 mm) asymptomatic LPK stones. Stone-free rates were compared between interventions. The mean age and mean stone size were 9.4 ± 1.9 years and 7.4 ± 0.6 mm at admission, respectively. Stone progression rate was 61.2%, and the mean time for intervention was 19.2 ± 4.6 months. Flexible ureterorenoscopy (n = 68) or micro-percutaneous nephrolithotomy (n = 4) were performed for 72 stones (25.4%; group 1), and extracorporeal shock wave lithotripsy was performed for 102 stones (35.9%; group 2). The stone-free rates were 81.8 and 79.3% in group 1 and 2, respectively (p > 0.05). The remaining asymptomatic stones (110, 38.8%; group 3) were managed by continued observation, and at the end of the observation time (mean 40.8 ± 20.8 months) the spontaneous passage rate was 9.1% in this group. In the multivariate analysis, stone size of >7 mm, concurrent renal anomalies, and stones composed of magnesium ammonium phosphate (struvite) and cystine were statistically significant predictors of the need for intervention. Children with stones larger than 7 mm, renal anomalies, or stones composed of metabolically active cystine or struvite are more likely to require intervention, and those with asymptomatic LPK stones smaller than 10 mm can be managed by continued observation.

Noncontrast computed tomography can predict the outcome of shockwave lithotripsy via accurate stone measurement and abdominal fat distribution determination.

PubMed

Geng, Jiun-Hung; Tu, Hung-Pin; Shih, Paul Ming-Chen; Shen, Jung-Tsung; Jang, Mei-Yu; Wu, Wen-Jen; Li, Ching-Chia; Chou, Yii-Her; Juan, Yung-Shun

2015-01-01

Urolithiasis is a common disease of the urinary system. Extracorporeal shockwave lithotripsy (SWL) has become one of the standard treatments for renal and ureteral stones; however, the success rates range widely and failure of stone disintegration may cause additional outlay, alternative procedures, and even complications. We used the data available from noncontrast abdominal computed tomography (NCCT) to evaluate the impact of stone parameters and abdominal fat distribution on calculus-free rates following SWL. We retrospectively reviewed 328 patients who had urinary stones and had undergone SWL from August 2012 to August 2013. All of them received pre-SWL NCCT; 1 month after SWL, radiography was arranged to evaluate the condition of the fragments. These patients were classified into stone-free group and residual stone group. Unenhanced computed tomography variables, including stone attenuation, abdominal fat area, and skin-to-stone distance (SSD) were analyzed. In all, 197 (60%) were classified as stone-free and 132 (40%) as having residual stone. The mean ages were 49.35 ± 13.22 years and 55.32 ± 13.52 years, respectively. On univariate analysis, age, stone size, stone surface area, stone attenuation, SSD, total fat area (TFA), abdominal circumference, serum creatinine, and the severity of hydronephrosis revealed statistical significance between these two groups. From multivariate logistic regression analysis, the independent parameters impacting SWL outcomes were stone size, stone attenuation, TFA, and serum creatinine. [Adjusted odds ratios and (95% confidence intervals): 9.49 (3.72-24.20), 2.25 (1.22-4.14), 2.20 (1.10-4.40), and 2.89 (1.35-6.21) respectively, all p < 0.05]. In the present study, stone size, stone attenuation, TFA and serum creatinine were four independent predictors for stone-free rates after SWL. These findings suggest that pretreatment NCCT may predict the outcomes after SWL. Consequently, we can use these predictors for selecting the optimal treatment for patients with urinary stones. Copyright © 2014. Published by Elsevier Taiwan.

Factors affecting stone-free rate and complications of percutaneous nephrolithotomy for treatment of staghorn stone.

PubMed

el-Nahas, Ahmed R; Eraky, Ibrahim; Shokeir, Ahmed A; Shoma, Ahmed M; el-Assmy, Ahmed M; el-Tabey, Nasr A; Soliman, Shady; Elshal, Ahmed M; el-Kappany, Hamdy A; el-Kenawy, Mahmoud R

2012-06-01

To determine factors affecting the stone-free rate and complications of percutaneous nephrolithotomy (PNL) for treatment of staghorn stones. The computerized database of patients who underwent PNL for treatment of staghorn stones between January 2003 and January 2011 was reviewed. All perioperative complications were recorded and classified according to modified Clavien classification system. The stone-free rate was evaluated with low-dose noncontrast computed tomography (CT). Univariate and multivariate statistical analyses were performed to determine factors affecting stone-free and complication rates. The study included 241 patients (125 male and 116 female) with a mean age of 48.7 ±14.3 years. All patients underwent 251 PNL (10 patients had bilateral stones). The stone-free rate of PNL monotherapy was 56% (142 procedures). At 3 months, the stone-free rate increased to 73% (183 kidneys) after shock wave lithotripsy. Independent risk factors for residual stones were complete staghorn stone and presence of secondary calyceal stones (relative risks were 2.2 and 3.1, respectively). The complication rate was 27% (68 PNL). Independent risk factors for development of complications were performance of the procedure by urologists other than experienced endourologist and positive preoperative urine culture (relative risks were 2.2 and 2.1, respectively). Factors affecting the incidence of residual stones after PNL are complete staghorn stones and the presence of secondary calyceal stones. Complications are significantly high if PNL is not performed by an experienced endourologist or if preoperative urine culture is positive. Copyright © 2012 Elsevier Inc. All rights reserved.

Cholecystolithiasis is associated with Clonorchis sinensis infection.

PubMed

Qiao, Tie; Ma, Rui-hong; Luo, Xiao-bing; Luo, Zhen-liang; Zheng, Pei-ming

2012-01-01

The objective of this study was to analyze gallbladder stones for direct evidence of a relationship between Clonorchis sinensis infection and gallbladder stones formation. We investigated one hundred eighty-three gallbladder stones for the presence of Clonorchis sinensis eggs using microscopy, and analyzed their composition using Fourier transform infrared spectroscopy. We confirmed the presence of Clonorchis sinensis eggs in the gallbladder stones using real-time fluorescent PCR and scanning electron microscopy. Clonorchis sinensis eggs were detected in 122 of 183 gallbladder stones based on morphologic characteristics and results from real-time fluorescent PCR. The proportion of pigment stones, cholesterol stones and mixed gallstones in the egg-positive stones was 79.5% (97/122), 3.3% (4/122) and 17.2% (21/122), respectively, while 29.5% (18/61), 31.1% (19/61) and 39.3% (24/61) in the egg-negative stones. The proportion of pigment stone in the Clonorchis sinensis egg-positive stones was higher than in egg-negative stones (P<0.0001). In the 30 egg-positive stones examined by scanning electron microscopy, dozens or even hundreds of Clonorchis sinensis eggs were visible (×400) showing a distinct morphology. Many eggs were wrapped with surrounding particles, and in some, muskmelon wrinkles was seen on the surface of the eggs. Also visible were pieces of texture shed from some of the eggs. Some eggs were depressed or without operculum while most eggs were adhered to or wrapped with amorphous particles or mucoid matter (×3000). Clonorchis sinensis eggs were detected in the gallbladder stones which suggests an association between Clonorchis sinensis infection and gallbladder stones formation, especially pigment stones.

[Composition of 359 kidney stones from the East region of Algeria].

PubMed

Bouslama, S; Boutefnouchet, A; Hannache, B; Djemil, T; Kadi, A; Dahdouh, A; Saka, S; Daudon, M

2016-01-01

Determine stones composition of the upper urinary tract in the eastern region of Algeria. Our study focuses on a set of 359 stones of the upper urinary tract collected between January 2007 and December 2012 at hospitals in the eastern region of Algeria and analyzed by Fourier transform infrared spectroscopy. The male/female ratio was only 1.32. Calcium oxalate prevailed in 68.5% of stones and 49.3% of nuclei, mainly as whewellite (51.8% of stones and 37.9% of nuclei vs 16.7% and 11.4% respectively for weddellite). Carbapatite prevailed in 15% of stones and 29.8% of nuclei. The struvite, identified in 11.1% of calculi, prevailed in 3.9% of stones and 3.1% of nuclei. Among purines, uric acid prevailed with frequencies quite close to 8.9% and 7% respectively in the stone and in the nucleus while the ammonium urate prevailed in only 0.3% of stones and 3.3% of nuclei. The cystine frequency was 3.6% in both stone and nucleus. The frequency of stone with umbilication was 26.2%. Whewellite was the main component of umbilicated stones with Randall's plaque. Our results suggest that stones of the urinary tract in the Algerian east region resemble those observed in industrialized countries. Some features such as stones location, the whewellite prevalence, the frequencies of main components in both the stone and the nucleus as well as the formation of stones on renal papilla confirm this trend. 4. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

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

Kidney Stones (For Parents)

MedlinePlus

... Staying Safe Videos for Educators Search English Español Kidney Stones KidsHealth / For Parents / Kidney Stones What's in ... other treatments to help remove the stones. How Kidney Stones Form It's the kidneys' job to remove ...

Pediatric ureteroscopic management of intrarenal calculi.

PubMed

Tanaka, Stacy T; Makari, John H; Pope, John C; Adams, Mark C; Brock, John W; Thomas, John C

2008-11-01

Data addressing ureteroscopic management of intrarenal calculi in prepubertal children are limited. We reviewed our experience from January 2002 through December 2007. We retrospectively reviewed ureteroscopic procedures for intrarenal calculi in children younger than 14 years. Stone-free status was determined with postoperative imaging. Multiple logistic regression analysis was used to assess the influence of preoperative factors on initial stone-free status and the need for additional procedures. Intrarenal calculi were managed ureteroscopically in 52 kidneys in 50 children with a mean age of 7.9 years (range 1.2 to 13.6). Mean stone size was 8 mm (range 1 to 16). Stone-free rate after a single ureteroscopic procedure was 50% (25 of 50 patients) on initial postoperative imaging and 58% (29 of 50) with extended followup. Initial stone-free status was dependent on preoperative stone size (p = 0.005) but not stone location. Additional stone procedures were required in 18 upper tracts. Younger patient age (p = 0.04) and larger preoperative stone size (p = 0.002) were associated with the need for additional procedures. Additional procedures were required in more than half of the stones 6 mm or larger but in no stone smaller than 6 mm. Ureteroscopy is a safe method for the treatment of intrarenal calculi in the prepubertal population. Our ureteroscopic stone-free rate for intrarenal stones is lower than that reported for ureteral stones. Parents should be informed that additional procedures will likely be required, especially in younger patients and those with stones larger than 6 mm.

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.

Laser-induced breakdown spectroscopy is a reliable method for urinary stone analysis

PubMed Central

Mutlu, Nazım; Çiftçi, Seyfettin; Gülecen, Turgay; Öztoprak, Belgin Genç; Demir, Arif

2016-01-01

Objective We compared laser-induced breakdown spectroscopy (LIBS) with the traditionally used and recommended X-ray diffraction technique (XRD) for urinary stone analysis. Material and methods In total, 65 patients with urinary calculi were enrolled in this prospective study. Stones were obtained after surgical or extracorporeal shockwave lithotripsy procedures. All stones were divided into two equal pieces. One sample was analyzed by XRD and the other by LIBS. The results were compared by the kappa (κ) and Spearman’s correlation coefficient (rho) tests. Results Using LIBS, 95 components were identified from 65 stones, while XRD identified 88 components. LIBS identified 40 stones with a single pure component, 20 stones with two different components, and 5 stones with three components. XRD demonstrated 42 stones with a single component, 22 stones with two different components, and only 1 stone with three different components. There was a strong relationship in the detection of stone types between LIBS and XRD for stones components (Spearman rho, 0.866; p<0.001). There was excellent agreement between the two techniques among 38 patients with pure stones (κ index, 0.910; Spearman rho, 0.916; p<0.001). Conclusion Our study indicates that LIBS is a valid and reliable technique for determining urinary stone composition. Moreover, it is a simple, low-cost, and nondestructive technique. LIBS can be safely used in routine daily practice if our results are supported by studies with larger numbers of patients. PMID:27011877

Direct peroral cholangioscopy using an ultraslim upper endoscope for management of residual stones after mechanical lithotripsy for retained common bile duct stones.

PubMed

Lee, Y N; Moon, J H; Choi, H J; Min, S K; Kim, H I; Lee, T H; Cho, Y D; Park, S-H; Kim, S-J

2012-09-01

The incidence of residual stones after mechanical lithotripsy for retained common bile duct (CBD) stones is relatively high. Peroral cholangioscopy using a mother-baby system may be useful for confirming complete extraction of stones, but has several limitations regarding routine use. We evaluated the role of direct peroral cholangioscopy (DPOC) using an ultraslim upper endoscope for the evaluation and removal of residual CBD stones after mechanical lithotripsy. From August 2006 to November 2010, 48 patients who had undergone mechanical lithotripsy for retained CBD stones with no evidence of filling defects in balloon cholangiography were recruited. The bile duct was inspected by DPOC after balloon cholangiography. Detected residual CBD stones were directly retrieved with a basket or balloon catheter under DPOC. The incidence of residual stones detected by DPOC, and the success rate of residual stone retrieval under DPOC were investigated. DPOC was successfully performed in 46 of the 48 patients (95.8%). Of these, 13 patients (28.3%) had residual CBD stones (mean number 1.4, range 1-3; mean diameter 4.5 mm, range 2.3-9.6). The residual stones were removed directly under DPOC in 11 of these patients (84.6%). There were no complications associated with DPOC or stone removal. DPOC using an ultraslim upper endoscope is a useful endoscopic procedure for the evaluation and extraction of residual stones after mechanical lithotripsy for retained CBD stones. © Georg Thieme Verlag KG Stuttgart · New York.

Calcium carbonate gallstones in children.

PubMed

Stringer, Mark D; Soloway, Roger D; Taylor, Donald R; Riyad, Kallingal; Toogood, Giles

2007-10-01

In the United States, cholesterol stones account for 70% to 95% of adult gallstones and black pigment stones for most of the remainder. Calcium carbonate stones are exceptionally rare. A previous analysis of a small number of pediatric gallstones from the north of England showed a remarkably high prevalence of calcium carbonate stones. The aims of this study were to analyze a much larger series of pediatric gallstones from our region and to compare their chemical composition with a series of adult gallstones from the same geographic area. A consecutive series of gallbladder stones from 63 children and 50 adults from the north of England were analyzed in detail using Fourier transform infrared microspectroscopy. Demographic and clinical data were collected on all patients. The relative proportions of each major stone component were assessed: cholesterol, protein and calcium salts of bilirubin, fatty acids, calcium carbonate, and hydroxyapatite. Thirty-nine (78%) adults had typical cholesterol stones, 7 (14%) had black pigment bilirubinate stones, and only 2 (4%) had calcium carbonate stones. In contrast, 30 (48%) children had black pigment stones, 13 (21%) had cholesterol stones, 15 (24%) had calcium carbonate stones, 3 (5%) had protein dominant stones, and 2 (3%) had brown pigment stones. In children, cholesterol stones were more likely in overweight adolescent girls with a family history of gallstones, whereas black pigment stones were equally common in boys and girls and associated with hemolysis, parenteral nutrition, and neonatal abdominal surgery. Calcium carbonate stones were more common in boys, and almost half had undergone neonatal abdominal surgery and/or required neonatal intensive care. The composition of pediatric gallstones differs significantly from that found in adults. In particular, one quarter of the children in this series had calcium carbonate stones, previously considered rare. Geographic differences are not the major reason for the high prevalence of calcium carbonate gallstones in children.

Compositional analysis of various layers of upper urinary tract stones by infrared spectroscopy

PubMed Central

He, Zhang; Jing, Zhang; Jing-Cun, Zheng; Chuan-Yi, Hu; Fei, Gao

2017-01-01

The objective of the present study was to determine the composition of various layers of upper urinary stones and assess the mechanisms of stone nucleation and aggregation. A total of 40 integrated urinary tract stones with a diameter of >0.8 cm were removed from the patients. All of the stones were cut in half perpendicularly to the longitudinal axis. Samples were selected from nuclear, internal and external layers of each stone. Fourier transform infrared spectroscopy (FT-IR) was adopted for qualitative and quantitative analysis of all of the fragments and compositional differences among nuclear, internal and external layers of various types of stone were subsequently investigated. A total of 25 cases of calcium oxalate (CaOx) stones and 10 cases of calcium phosphate (CaP) stones were identified to be mixed stones, while 5 uric acid (UA) calculi were pure stones (purity, >95%). In addition, the contents of CaOx and carbapatite (CA.AP) crystals in various layers of the mixed stones were found to be variable. In CaOx stones, the content of CA.AP in nuclear layers was significantly higher than that of the outer layers (32.0 vs. 6.8%; P<0.05), while the content of CaOx was lower in the inner than in the outer layers (57.6 vs. 86.6%; P<0.05). In CaP stones, the content of CA.AP in the nuclear layers was higher than that in the outer layers (74.0 vs. 47.3%; P<0.05), while the content of CaOx was lower in the inner than in the outer layers (7.0 vs. 40.0%; P<0.05). The UA stones showed no significant differences in their composition among different layers. In conclusion, FT-IR analysis of various layers of human upper urinary tract stones revealed that CaOx and CaP stones showed differences in composition between their core and surface, while all of the UA calculi were pure stones. The composition showed a marked variation among different layers of the stones, indicating that metabolism has an important role in different phases of the evolution of stones. The present study provided novel insight into the pathogenesis of urinary tract stones and may contribute to their prevention and treatment. PMID:28912866

Surgical management of pediatric urolithiasis

PubMed Central

Mishra, Shashi K.; Ganpule, A.; Manohar, T.; Desai, Mahesh R.

2007-01-01

Pediatric urolithiasis poses a technical challenge to the urologist. A review of the recent literature on the subject was performed to highlight the various treatment modalities in the management of pediatric stones. A Medline search was used to identify manuscripts dealing with management options such as percutaneous nephrolithotomy, shock wave lithotripsy, ureteroscopy and cystolithotripsy in pediatric stone diseases. We also share our experience on the subject. Shock wave lithotripsy should be the treatment modality for renal stone less than 1cm or < 150 mm2 and proximal non-impacted ureteric stone less than 1 cm with normal renal function, no infection and favorable anatomy. Indications for PCNL in children are large burden stone more than 2cm or more than 150mm2 with or without hydronephrosis, urosepsis and renal insufficiency, more than 1cm impacted upper ureteric stone, failure of SWL and significant volume of residual stones after open surgery. Shock wave lithotripsy can be offered for more soft (< 900 HU on CT scan) renal stones between 1-2cm. Primary vesical stone more than 1cm can be tackled with percutaneous cystolithomy or open cystolithotomy. Open renal stone surgery can be done for renal stones with associated structural abnormalities, large burden infective and staghorn stones, large impacted proximal ureteric stone. The role of laparoscopic surgery for stone disease in children still needs to be explored. PMID:19718300

Analysis of the utility of stone gram stain in urolithiasis treated with percutaneous nephrolithotomy.

PubMed

Cockerill, Patrick A; Rivera, Marcelino E; Krambeck, Amy E

2014-06-01

To define the sensitivity and specificity of stone gram stain for infected urolithiasis treated with percutaneous nephrolithotomy (PCNL). PCNL procedures performed at our institution were analyzed between January 2009 and May 2013. Stone fragments were sent in a sterile fashion for aerobic and fungal cultures. A gram stain and fungal smear were performed on the stones and reported within 24 hours of collection. A total of 228 patients underwent 248 PCNLs. Of the 248 stones, 81 (33%) had a positive stone culture. Stone gram stain was positive in 31 cases and negative in 50. There were 167 negative stone cultures, and in these cases, gram stain was positive in 5 and negative in 162. The calculated sensitivity and specificity of stone gram stain were 38% and 97%. The positive and negative predictive values were 86% and 76%, respectively. In the subset of 16 patients with positive stone fungal cultures, fungal smear was performed in 12 and was positive in 4, giving fungal smear a sensitivity of 33%. The results of this study suggest that stone gram stain cannot be relied on to detect a positive stone culture and may fail to detect up to 62% of infected stones. However, when positive, gram stain accurately predicts a positive stone culture in 86% of cases. Copyright © 2014 Elsevier Inc. All rights reserved.

Treatment and prevention of kidney stones: an update.

PubMed

Frassetto, Lynda; Kohlstadt, Ingrid

2011-12-01

The incidence of nephrolithiasis (kidney stones) is rising worldwide, especially in women and with increasing age. Kidney stones are associated with chronic kidney disease. Preventing recurrence is largely specific to the type of stone (e.g., calcium oxalate, calcium phosphate, cystine, struvite [magnesium ammonium phosphate]), and uric acid stones); however, even when the stone cannot be retrieved, urine pH and 24-hour urine assessment provide information about stone-forming factors that can guide prevention. Medications, such as protease inhibitors, antibiotics, and some diuretics, increase the risk of some types of kidney stones, and patients should be counseled about the risks of using these medications. Managing diet, medication use, and nutrient intake can help prevent the formation of kidney stones. Obesity increases the risk of kidney stones. However, weight loss could undermine prevention of kidney stones if associated with a high animal protein intake, laxative abuse, rapid loss of lean tissue, or poor hydration. For prevention of calcium oxalate, cystine, and uric acid stones, urine should be alkalinized by eating a diet high in fruits and vegetables, taking supplemental or prescription citrate, or drinking alkaline mineral waters. For prevention of calcium phosphate and struvite stones, urine should be acidified; cranberry juice or betaine can lower urine pH. Antispasmodic medications, ureteroscopy, and metabolic testing are increasingly being used to augment fluid and pain medications in the acute management of kidney stones.

Development of upper tract stones in patients with congenital neurogenic bladder.

PubMed

Stephany, Heidi A; Clayton, Douglass B; Tanaka, Stacy T; Thomas, John C; Pope, John C; Brock, John W; Adams, Mark C

2014-02-01

Patients with neurogenic bladder are at increased risk of developing upper tract stones. We hypothesized that patients with lower urinary tract stone disease are at greater risk of developing upper tract stones. We performed a 10-year retrospective case-control study of patients with neurogenic bladder to determine the association between bladder and upper tract stones. Independent risk factors for upper tract stones were assessed. Cases and controls were matched 1:1. Univariable analysis was performed by Fisher's exact test and the Mann-Whitney U test. Multivariable logistic regression was performed. 52 cases and controls were identified. Cases were significantly more likely to be non-ambulatory, have bowel-urinary tract interposition, thoracic level dysraphism, and history of bladder stones. On multivariable analysis, independent predictors of stone formation were male sex (OR 2.82; p = 0.02), dysraphism involving the thoracic spine (OR 3.37; p = 0.014) bowel-urinary tract interposition (OR 2.611; p = 0.038), and a history of bladder stones (OR 3.57; p = 0.015). Patients with neurogenic bladder are at increased risk for upper tract stones. The presence of bladder stones may herald the development of upper tract stones. The predictors of stone disease identified should guide prospective studies to better understand the natural history of upper tract stone development in this population. Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Protein content of human apatite and brushite kidney stones: significant correlation with morphologic measures.

PubMed

Pramanik, Rocky; Asplin, John R; Jackson, Molly E; Williams, James C

2008-10-01

Apatite and brushite kidney stones share calcium and phosphate as their main inorganic components. We tested the hypothesis that these stone types differ in the amount of proteins present in the stones. Intact stones were intensively analyzed by microcomputed tomography (micro CT) for both morphology (including the volume of voids, i.e., space devoid of X-ray dense material) and mineral type. To extract all proteins present in kidney stones in soluble form we developed a three-step extraction procedure using the ground stone powder. Apatite stones had significantly higher levels of total protein content and void volume compared to brushite stones. The void volume was highly correlated with the total protein contents in all stones (r2 = 0.61, P < 0.0001), and brushite stones contained significantly fewer void regions and proteins than did apatite stones (3.2 +/- 4.5% voids for brushite vs. 10.8 +/- 11.2% for apatite, P < 0.005; 4.1 +/- 1.6% protein for brushite vs. 6.0 +/- 2.4% for apatite, P < 0.03). Morphological observations other than void volume did not correlate with protein content of stones, and neither did the presence or absence of minor mineral components. Our results show that protein content of brushite and apatite stones is higher than that was previously thought, and also suggest that micro CT-visible void regions are related to the presence of protein.

Epidemiological study of urinary tract stones in a northern Italian city.

PubMed

Borghi, L; Ferretti, P P; Elia, G F; Amato, F; Melloni, E; Trapassi, M R; Novarini, A

1990-03-01

An epidemiological study of stone disease in a Northern Italian city was carried out by means of a postal questionnaire mailed to 6000 individuals (2.5% of the entire population). It was found that the incidence of stone disease was comparable to that of industrialised Western Europe. There was a relationship between stone disease and gout and stone disease and a positive family history. The frequency of uric acid stones was high (26.5%). Stone-formers showed no alimentary differences from non-stone formers apart from the use of spices and herbs. Stone-formers used less water from public aqueducts and more uncarbonated mineral water, but only 19% of these drank at least 2 litres a day.

Motion artifacts in kidney stone imaging using single-source and dual-source dual-energy CT scanners: a phantom study.

PubMed

Ibrahim, El-Sayed H; Cernigliaro, Joseph G; Pooley, Robert A; Williams, James C; Haley, William E

2015-10-01

Dual-energy computed tomography (DECT) has shown the capability of differentiating uric acid (UA) from non-UA stones with 90-100% accuracy. With the invention of dual-source (DS) scanners, both low- and high-energy images are acquired simultaneously. However, DECT can also be performed by sequential acquisition of both images on single-source (SS) scanners. The objective of this study is to investigate the effects of motion artifacts on stone classification using both SS-DECT and DS-DECT. 114 kidney stones of different types and sizes were imaged on both DS-DECT and SS-DECT scanners with tube voltages of 80 and 140 kVp with and without induced motion. Postprocessing was conducted to create material-specific images from corresponding low- and high-energy images. The dual-energy ratio (DER) and stone material were determined and compared among different scans. For the motionless scans, all stones were correctly classified with SS-DECT, while two cystine stones were misclassified with DS-DECT. When motion was induced, 94% of the stones were misclassified with SS-DECT versus 11% with DS-DECT (P < 0.0001). Stone size was not a factor in stone misclassification under motion. Stone type was not a factor in stone misclassification under motion with SS-DECT, although with DS-DECT, cystine showed higher number of stone misclassification. Motion artifacts could result in stone misclassification in DECT. This effect is more pronounced in SS-DECT versus DS-DECT, especially if stones of different types lie in close proximity to each other. Further, possible misinterpretation of the number of stones (i.e., missing one, or thinking that there are two) in DS-DECT could be a potentially significant problem.

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

Retrospective comparison of measured stone size and posterior acoustic shadow width in clinical ultrasound images.

PubMed

Dai, Jessica C; Dunmire, Barbrina; Sternberg, Kevan M; Liu, Ziyue; Larson, Troy; Thiel, Jeff; Chang, Helena C; Harper, Jonathan D; Bailey, Michael R; Sorensen, Mathew D

2018-05-01

Posterior acoustic shadow width has been proposed as a more accurate measure of kidney stone size compared to direct measurement of stone width on ultrasound (US). Published data in humans to date have been based on a research using US system. Herein, we compared these two measurements in clinical US images. Thirty patient image sets where computed tomography (CT) and US images were captured less than 1 day apart were retrospectively reviewed. Five blinded reviewers independently assessed the largest stone in each image set for shadow presence and size. Shadow size was compared to US and CT stone sizes. Eighty percent of included stones demonstrated an acoustic shadow; 83% of stones without a shadow were ≤ 5 mm on CT. Average stone size was 6.5 ± 4.0 mm on CT, 10.3 ± 4.1 mm on US, and 7.5 ± 4.2 mm by shadow width. On average, US overestimated stone size by 3.8 ± 2.4 mm based on stone width (p < 0.001) and 1.0 ± 1.4 mm based on shadow width (p < 0.0098). Shadow measurements decreased misclassification of stones by 25% among three clinically relevant size categories (≤ 5, 5.1-10, > 10 mm), and by 50% for stones ≤ 5 mm. US overestimates stone size compared to CT. Retrospective measurement of the acoustic shadow from the same clinical US images is a more accurate reflection of true stone size than direct stone measurement. Most stones without a posterior shadow are ≤ 5 mm.

Cholecystolithiasis Is Associated with Clonorchis sinensis Infection

PubMed Central

Qiao, Tie; Ma, Rui-hong; Luo, Xiao-bing; Luo, Zhen-liang; Zheng, Pei-ming

2012-01-01

Background The objective of this study was to analyze gallbladder stones for direct evidence of a relationship between Clonorchis sinensis infection and gallbladder stones formation. Methodology We investigated one hundred eighty-three gallbladder stones for the presence of Clonorchis sinensis eggs using microscopy, and analyzed their composition using Fourier transform infrared spectroscopy. We confirmed the presence of Clonorchis sinensis eggs in the gallbladder stones using real-time fluorescent PCR and scanning electron microscopy. Principal Findings Clonorchis sinensis eggs were detected in 122 of 183 gallbladder stones based on morphologic characteristics and results from real-time fluorescent PCR. The proportion of pigment stones, cholesterol stones and mixed gallstones in the egg-positive stones was 79.5% (97/122), 3.3% (4/122) and 17.2% (21/122), respectively, while 29.5% (18/61), 31.1% (19/61) and 39.3% (24/61) in the egg-negative stones. The proportion of pigment stone in the Clonorchis sinensis egg-positive stones was higher than in egg-negative stones (P<0.0001). In the 30 egg-positive stones examined by scanning electron microscopy, dozens or even hundreds of Clonorchis sinensis eggs were visible (×400) showing a distinct morphology. Many eggs were wrapped with surrounding particles, and in some, muskmelon wrinkles was seen on the surface of the eggs. Also visible were pieces of texture shed from some of the eggs. Some eggs were depressed or without operculum while most eggs were adhered to or wrapped with amorphous particles or mucoid matter (×3000). Conclusion Clonorchis sinensis eggs were detected in the gallbladder stones which suggests an association between Clonorchis sinensis infection and gallbladder stones formation, especially pigment stones. PMID:22905137

Incidence and characteristics of kidney stones in patients with horseshoe kidney: A systematic review and meta-analysis

PubMed Central

Pawar, Aditya S.; Thongprayoon, Charat; Cheungpasitporn, Wisit; Sakhuja, Ankit; Mao, Michael A.; Erickson, Stephen B.

2018-01-01

Introduction: The horseshoe kidney (HSK) is the most common type of renal fusion anomaly. The incidence and characteristics of kidney stones in patients with HSK are not well studied. The aim of this meta-analysis was to evaluate the incidence and types of kidney stones in patients with HSK. Methods: A systematic literature search was performed using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from the databases' inception through November 2016. Studies assessing the incidence and types of kidney stones in patients with HSK were included. We applied a random-effects model to estimate the incidence of kidney stones. The study protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42016052037). Results: A total of 14 observational studies with 943 patients (522 adults and 421 pediatric) with HSK were enrolled. The estimated pooled incidence of kidney stones was 36% (95% confidence interval [CI], 15%–59%) in adults with the HSK. Kidney stones were less common in pediatric patients with HSK with an estimated pooled incidence of 3% (95% CI, 2%–5%). The mean age of adult stone formers with HSK was 44.9 ± 6.2 years, and 75% were males. Within reported studies, 89.2% of kidney stones were calcium-based stones (64.2% calcium oxalate [CaOx], 18.8% calcium phosphate [CaP], and 6.2% mixed CaOx/CaP), followed by struvite stones (4.2%), uric acid stones (3.8%), and others (2.8%). Conclusions: Kidney stones are very common in adult patients with HSK with an estimated incidence of 36%. Calcium-based stones are the most prevalent kidney stones in adults with HSKs. These findings may impact the prevention and clinical management of kidney stones in patients with HSK. PMID:29416282

The natural history of nonobstructing asymptomatic renal stones managed with active surveillance.

PubMed

Dropkin, Benjamin M; Moses, Rachel A; Sharma, Devang; Pais, Vernon M

2015-04-01

We documented the natural history of asymptomatic nonobstructing renal calculi managed with active surveillance and explored factors predicting stone related events to better inform shared decision making. Patients with asymptomatic nonobstructing renal calculi electing active surveillance of their stone(s) were retrospectively reviewed. Stone characteristics, patient characteristics, and stone related events were collected. We evaluated the effects of stone size and location on development of symptoms, spontaneous passage, requirement for surgical intervention, and stone growth. We identified 160 stones with an average size of 7.0 ± 4.2 mm among 110 patients with average followup of 41 ± 19 months. Forty-five (28% of total) stones caused symptoms during followup. Notably 3 stones (3% of asymptomatic subgroup, 2% of total stones) caused painless silent obstruction necessitating intervention after an average of 37 ± 17 months. The only significant predictor of spontaneous passage or symptom development was location. Upper pole/mid renal stones were more likely than lower pole stones to become symptomatic (40.6% vs 24.3%, p = 0.047) and to pass spontaneously (14.5% vs 2.9%, p = 0.016). Among asymptomatic nonobstructing renal calculi managed with active surveillance, most remained asymptomatic through an average followup of more than 3 years. Less than 30% caused renal colic, less than 20% were operated on for pain and 7% spontaneously passed. Lower poles stones were significantly less likely to cause symptoms or pass spontaneously. Despite 3 stones causing silent hydronephrosis suggestive of obstruction, regular followup imaging facilitated interventions that prevented renal loss. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Accurately Diagnosing Uric Acid Stones from Conventional Computerized Tomography Imaging: Development and Preliminary Assessment of a Pixel Mapping Software.

PubMed

Ganesan, Vishnu; De, Shubha; Shkumat, Nicholas; Marchini, Giovanni; Monga, Manoj

2018-02-01

Preoperative determination of uric acid stones from computerized tomography imaging would be of tremendous clinical use. We sought to design a software algorithm that could apply data from noncontrast computerized tomography to predict the presence of uric acid stones. Patients with pure uric acid and calcium oxalate stones were identified from our stone registry. Only stones greater than 4 mm which were clearly traceable from initial computerized tomography to final composition were included in analysis. A semiautomated computer algorithm was used to process image data. Average and maximum HU, eccentricity (deviation from a circle) and kurtosis (peakedness vs flatness) were automatically generated. These parameters were examined in several mathematical models to predict the presence of uric acid stones. A total of 100 patients, of whom 52 had calcium oxalate and 48 had uric acid stones, were included in the final analysis. Uric acid stones were significantly larger (12.2 vs 9.0 mm, p = 0.03) but calcium oxalate stones had higher mean attenuation (457 vs 315 HU, p = 0.001) and maximum attenuation (918 vs 553 HU, p <0.001). Kurtosis was significantly higher in each axis for calcium oxalate stones (each p <0.001). A composite algorithm using attenuation distribution pattern, average attenuation and stone size had overall 89% sensitivity, 91% specificity, 91% positive predictive value and 89% negative predictive value to predict uric acid stones. A combination of stone size, attenuation intensity and attenuation pattern from conventional computerized tomography can distinguish uric acid stones from calcium oxalate stones with high sensitivity and specificity. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Risk Factors for Stone Recurrence after Percutaneous Nephrolithotomy

NASA Astrophysics Data System (ADS)

Krambeck, Amy E.; Rangel, Laureano J.; LeRoy, Andrew J.; Patterson, David E.; Gettman, Matthew T.

2008-09-01

Recent studies have demonstrated more than 30% of percutaneous nephrolithotomy (PCNL) patients will experience a stone recurrence over a 20 year period. The goal of our study was to identify risk factors for stone recurrence after PCNL. Chart review identified 754 patients treated with PCNL for urolithiasis from March of 1983 to July 1984 at our institution. Of this cohort, 87 patients continued to receive medical care at our clinic and had been evaluated within the last 5 years. Of the 87 patients, 80 had recent radiographic imaging. Average follow-up was 19.2 years and 32 (40.0%) experienced at least 1 stone recurrence. There was no difference in preoperative BMI (p = 0.453) or change in BMI (p = 0.964) between patients that did and did not have a stone recurrence. Renal stone location (p = 0.605) and stone size (p = 0.238) were not predictive of recurrence. Patients with calcium oxalate monohydrate stones were less likely to recur (38.7% vs. 41.6%, p = 0.004) and those with calcium oxalate dihydrate (COD) were more likely to recur (31.1% vs. 19.6%, p = 0.006) compared to other compositions. Diabetes mellitus was not associated with recurrent stones (p = 0.810). Those patients with residual stones or fragments <3 mm were more likely to recur and to recur earlier than patients rendered entirely stone free at time of PCNL (p = 0.015). Stone recurrences were associated with the late development of renal insufficiency (25% vs. 2.1%, p = 0.002). In conclusion, stone composition, as well as the presence of residual fragments was associated with recurrent symptomatic stone events after PCNL. Recurrent stone events were significantly associated with the risk of developing renal insufficiency, further stressing the need for complete stone clearance at time of PCNL.

A neural network - based algorithm for predicting stone -free status after ESWL therapy

PubMed Central

Seckiner, Ilker; Seckiner, Serap; Sen, Haluk; Bayrak, Omer; Dogan, Kazım; Erturhan, Sakip

2017-01-01

ABSTRACT Objective: The prototype artificial neural network (ANN) model was developed using data from patients with renal stone, in order to predict stone-free status and to help in planning treatment with Extracorporeal Shock Wave Lithotripsy (ESWL) for kidney stones. Materials and Methods: Data were collected from the 203 patients including gender, single or multiple nature of the stone, location of the stone, infundibulopelvic angle primary or secondary nature of the stone, status of hydronephrosis, stone size after ESWL, age, size, skin to stone distance, stone density and creatinine, for eleven variables. Regression analysis and the ANN method were applied to predict treatment success using the same series of data. Results: Subsequently, patients were divided into three groups by neural network software, in order to implement the ANN: training group (n=139), validation group (n=32), and the test group (n=32). ANN analysis demonstrated that the prediction accuracy of the stone-free rate was 99.25% in the training group, 85.48% in the validation group, and 88.70% in the test group. Conclusions: Successful results were obtained to predict the stone-free rate, with the help of the ANN model designed by using a series of data collected from real patients in whom ESWL was implemented to help in planning treatment for kidney stones. PMID:28727384

Chronic Kidney Disease in Kidney Stone Formers

PubMed Central

Krambeck, Amy E.; Lieske, John C.

2011-01-01

Summary Recent population studies have found symptomatic kidney stone formers to be at increased risk for chronic kidney disease (CKD). Although kidney stones are not commonly identified as the primary cause of ESRD, they still may be important contributing factors. Paradoxically, CKD can be protective against forming kidney stones because of the substantial reduction in urine calcium excretion. Among stone formers, those with rare hereditary diseases (cystinuria, primary hyperoxaluria, Dent disease, and 2,8 dihydroxyadenine stones), recurrent urinary tract infections, struvite stones, hypertension, and diabetes seem to be at highest risk for CKD. The primary mechanism for CKD from kidney stones is usually attributed to an obstructive uropathy or pyelonephritis, but crystal plugs at the ducts of Bellini and parenchymal injury from shockwave lithotripsy may also contribute. The historical shift to less invasive surgical management of kidney stones has likely had a beneficial impact on the risk for CKD. Among potential kidney donors, past symptomatic kidney stones but not radiographic stones found on computed tomography scans were associated with albuminuria. Kidney stones detected by ultrasound screening have also been associated with CKD in the general population. Further studies that better classify CKD, better characterize stone formers, more thoroughly address potential confounding by comorbidities, and have active instead of passive follow-up to avoid detection bias are needed. PMID:21784825

Regional differences in constituents of gall stones.

PubMed

Ashok, M; Nageshwar Reddy, D; Jayanthi, V; Kalkura, S N; Vijayan, V; Gokulakrishnan, S; Nair, K G M

2005-01-01

The pathogenesis of pigment and mixed gall stone formation remains elusive. The elemental constituents of gall stones from southern states of Tamil Nadu, Kerala and Karnataka have been characterized. Our aim was to determine the elemental concentration of representative samples of pigment, mixed and cholesterol gall stones from Andhra Pradesh using proton-induced X-ray emission (PIXE) using a 3 MV horizontal pelletron accelerator. Pigment gall stones had significantly high concentrations of copper, iron and lead; chromium was absent. Except for iron all these elements were significantly low in cholesterol gall stones and intermediate levels were seen in mixed gall stones. Highest concentrations of chromium was seen in cholesterol and titanium in mixed gall stones respectively; latter similar to other southern states. Arsenic was distinctly absent in cholesterol and mixed gall stones. The study has identified differences in elemental components of the gall stones from Andhra Pradesh.

Cholecystectomy for Prevention of Recurrence after Endoscopic Clearance of Bile Duct Stones in Korea.

PubMed

Song, Myung Eun; Chung, Moon Jae; Lee, Dong Jun; Oh, Tak Geun; Park, Jeong Youp; Bang, Seungmin; Park, Seung Woo; Song, Si Young; Chung, Jae Bock

2016-01-01

Cholecystectomy in patients with an intact gallbladder after endoscopic removal of stones from the common bile duct (CBD) remains controversial. We conducted a case-control study to determine the risk of recurrent CBD stones and the benefit of cholecystectomy for prevention of recurrence after endoscopic removal of stones from the CBD in Korean patients. A total of 317 patients who underwent endoscopic CBD stone extraction between 2006 and 2012 were included. Possible risk factors for the recurrence of CBD stones including previous cholecystectomy history, bile duct diameter, stone size, number of stones, stone composition, and the presence of a periampullary diverticulum were analyzed. The mean duration of follow-up after CBD stone extraction was 25.4±22.0 months. A CBD diameter of 15 mm or larger [odds ratio (OR), 1.930; 95% confidence interval (CI), 1.098 to 3.391; p=0.022] and the presence of a periampullary diverticulum (OR, 1.859; 95% CI, 1.014 to 3.408; p=0.045) were independent predictive factors for CBD stone recurrence. Seventeen patients (26.6%) in the recurrence group underwent elective cholecystectomy soon after endoscopic extraction of CBD stones, compared to 88 (34.8%) in the non-recurrence group; the difference was not statistically significant (p=0.212). A CBD diameter of 15 mm or larger and the presence of a periampullary diverticulum were found to be potential predictive factors for recurrence after endoscopic extraction of CBD stones. Elective cholecystectomy after clearance of CBD stones did not reduce the incidence of recurrent CBD stones in Korean patients.

[Correlation between urinary stones and urinary tract infections].

PubMed

Chen, Peilin; Zhang, Liguo; Meng, Bin

2014-05-01

To explore the correlation of urinary stones and urinary tract infections. 300 cases with urinary tract stones received in our hospital from Feb. 2010 to Oct. 2013 were chosen as study samples. Urine routine index, situation of urine positivity and urinary tract infection after surgery were analyzed while, intraoperative cotton swabs were tested after being dipped in liquid near stones. Main components of stones in non-infected and infected stone group were analyzed and compared. Data on urolithiasis was collected. 96 infected stones were found in 300 patients, accounting for 32%, which including 35 cases of E. coli (36.5%), 28 cases of Staphylococcus epidermidis (29.2%), and 15 cases of Proteus mirabilis (15.6%). Numbers of urine abnormalities, urine positivities, positive intraoperative cotton swabs and urinary tract infections in patients in the group with infected stones, were significantly higher than in the group without infected stones and the differences were statistically significant (χ² = 8.203, 73.99, 178.9, 24.26, P < 0.05). The incidence rates of hexahydrate magnesium ammonium phosphate, carbonate apatite and hydroxyapatite stones in the group with infected stones were significantly higher than those in the non-infected-rock group while the incidence rates of calcium oxalate and uric acid stones were found significantly lower than those in the non-infected-stone group, with differences statistically significant (χ² = 167.6, 21.00, 8.586, 73.17, 48.79, P < 0.05). Bacteria could cause urinary tract stones, and infected stones were always associated with urinary tract infections. Bacteria detection in patients with urinary calculi was particularly important to avoid the urinary tract infections.

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

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

NASA Astrophysics Data System (ADS)

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

2013-04-01

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

Extensive characterizations of bacteria isolated from catheterized urine and stone matrices in patients with nephrolithiasis.

PubMed

Tavichakorntrakool, Ratree; Prasongwattana, Vitoon; Sungkeeree, Seksit; Saisud, Phitsamai; Sribenjalux, Pipat; Pimratana, Chaowat; Bovornpadungkitti, Sombat; Sriboonlue, Pote; Thongboonkerd, Visith

2012-11-01

Urinary tract infections are generally known to be associated with nephrolithiasis, particularly struvite stone, in which the most common microbe found is urea-splitting bacterium, i.e. Proteus mirabilis. However, our observation indicated that it might not be the case of stone formers in Thailand. We therefore extensively characterized microorganisms associated with all types of kidney stones. A total of 100 kidney stone formers (59 males and 41 females) admitted for elective percutaneous nephrolithotomy were recruited and microorganisms isolated from catheterized urine and cortex and nidus of their stones were analyzed. From 100 stone formers recruited, 36 cases had a total of 45 bacterial isolates cultivated from their catheterized urine and/or stone matrices. Among these 36 cases, chemical analysis by Fourier-transformed infrared spectroscopy revealed that 8 had the previously classified 'infection-induced stones', whereas the other 28 cases had the previously classified 'metabolic stones'. Calcium oxalate (in either pure or mixed form) was the most common and found in 64 and 75% of the stone formers with and without bacterial isolates, respectively. Escherichia coli was the most common bacterium (approximately one-third of all bacterial isolates) found in urine and stone matrices (both nidus and periphery). Linear regression analysis showed significant correlation (r = 0.860, P < 0.001) between bacterial types in urine and stone matrices. Multidrug resistance was frequently found in these isolated bacteria. Moreover, urea test revealed that only 31% were urea-splitting bacteria, whereas the majority (69%) had negative urea test. Our data indicate that microorganisms are associated with almost all chemical types of kidney stones and urea-splitting bacteria are not the major causative microorganisms found in urine and stone matrices of the stone formers in Thailand. These data may lead to rethinking and a new roadmap for future research regarding the role of microorganisms in kidney stone formation.

Contribution of stone size to chronic kidney disease in kidney stone formers.

PubMed

Ahmadi, Farrokhlagha; Etemadi, Samira Motedayen; Lessan-Pezeshki, Mahbob; Mahdavi-Mazdeh, Mitra; Ayati, Mohsen; Mir, Alireza; Yazdi, Hadi Rokni

2015-01-01

To determine whether stone burden correlates with the degree of chronic kidney disease in kidney stone formers. A total of 97 extracorporeal shockwave lithotripsy candidates aged 18 years and older were included. Size, number and location of the kidney stones, along with cumulative stone size, defined as the sum of diameters of all stones) were determined. Estimated glomerular filtration rate was determined using the Chronic Kidney Disease Epidemiology Collaboration cystatin C/creatinine equation, and chronic kidney disease was defined as estimated glomerular filtration rate <60 mL/min/1.73 m(2). In individuals with cumulative stone size <20 mm, estimated glomerular filtration rate significantly decreased when moving from the first (estimated glomerular filtration rate 75.5 ± 17.8 mL/min/1.73 m(2)) to the fourth (estimated glomerular filtration rate 56.4 ± 20.44 mL/min/1.73 m(2) ) quartile (P = 0.004). When patients with a cumulative stone size ≥ 20 mm were included, the observed association was rendered non-significant. In individuals with a cumulative stone size < 20 mm, each 1-mm increase in cumulative stone size was associated with a 20% increased risk of having chronic kidney disease. The relationship persisted even after adjustment for age, sex, body mass index, C-reactive protein, fasting plasma glucose, thyroid stimulating hormone, presence of microalbuminuria, history of renal calculi, history of extracorporeal shockwave lithotripsy, number and location of the stones (odds ratio 1.24, 95% confidence interval 1.02-1.52). The same was not observed for individuals with a cumulative stone size ≥ 20 mm. In kidney stone formers with a cumulative stone size up to 20 mm, estimated glomerular filtration rate linearly declines with increasing cumulative stone size. Additionally, cumulative stone size is an independent predictor of chronic kidney disease in this group of patients. © 2014 The Japanese Urological Association.

Risk of Hypertension among First-Time Symptomatic Kidney Stone Formers

PubMed Central

Kittanamongkolchai, Wonngarm; Mara, Kristin C.; Mehta, Ramila A.; Vaughan, Lisa E.; Denic, Aleksandar; Knoedler, John J.; Enders, Felicity T.; Lieske, John C.

2017-01-01

Background and objectives Prior work has suggested a higher risk of hypertension in kidney stone formers but lacked disease validation and adjustment for potential confounders. Certain types of stone formers may also be at higher risk of hypertension. Design, setting, participants, & measurements In our study, incident symptomatic stone formers in Olmsted County from 2000 to 2011 were manually validated by chart review and age and sex matched to Olmsted County controls. We followed up patients through November 20, 2015. Hypertension was also validated by manual chart review, and the risk of hypertension in stone formers compared with controls was assessed both univariately and after adjusting for comorbidities. The risk of hypertension among different subtypes of stone formers was also evaluated. Results Among 3023 coded stone formers from 2000 to 2011, a total of 1515 were validated and matched to 1515 controls (mean age was 45 years old, and 56% were men). After excluding those with baseline hypertension (20% of stone formers and 18% of controls), 154 stone formers and 110 controls developed hypertension. Median follow-up time was 7.8 years in stone formers and 9.6 years in controls. Stone formers were found to have a higher risk of hypertension compared with controls (hazard ratio, 1.50; 95% confidence interval, 1.18 to 1.92), even after adjusting for age, sex, body mass index, serum creatinine, CKD, diabetes, gout, coronary artery disease, dyslipidemia, tobacco use, and alcohol abuse (hazard ratio, 1.58; 95% confidence interval, 1.12 to 2.21). Results were similar after excluding patients who were ever on a thiazide diuretic (hazard ratio, 1.65; 95% confidence interval, 1.16 to 2.38). Stone composition, radiographic stone burden, number of subsequent stone events, and stone removal surgeries were not associated with hypertension (P>0.05 for all). Conclusions The risk of hypertension was higher after the first symptomatic kidney stone event. However, kidney stone severity, type, and treatment did not associate with hypertension. PMID:28148559

Has the pelvic renal stone position inside the upper loop of JJ stent any influence on the extracorporeal shock wave lithotripsy results?

PubMed

Pricop, Catalin; Serban, Dragomir N; Serban, Ionela Lacramioara; Cumpanas, Alin-Adrian; Gingu, Constantin-Virgil

2016-01-01

JJ stents are often encountered in patients with pelvic renal stones referred for shock wave lithotripsy, most of them being placed either for obstructive renal pelvic stones or for ureteric stones mobilized retrograde during the JJ stent insertion. The aim of the study was to determine whether the relative stone position in the upper loop of the JJ stent during extracorporeal shock wave lithotripsy (SWL) influences the efficiency of the procedure. The study was designed as a prospective cohort study on 162 patients addressing the same urological department, with single renal pelvic stone (primary or mobilized to the renal pelvis during the insertion of JJ stent), smaller than 15 mm, with JJ stent, treated by SWL using a second generation spark gap lithotripter, 18 kV, 3000 waves/session. Patients were divided in three groups according to the relative position of the stone to the upper loop of the JJ stent as appears on plain X-ray: stone-inside-loop, loop-crossing-stone and stone-outside the loop. The SWL success rate was the primary outcome of the study. p Value, Chi square and Kruskal-Wallis tests were used for statistical analysis. For stone-inside-loop cases, SWL efficiency was 22.7 versus 42 % for all the other cases (p = 0.002). Other factors for decreased SWL success rate were: higher stone radio-opacity, larger JJ of stent and obese patients. Study limitation is represented by the relative small study group and by the evaluation of stone density using plain X-ray instead of computer tomography. For pelvic renal stones having the same density characteristics studied by plain X-ray, the SWL efficiency is lower in stone-inside-loop cases comparing with the other positions. The overall stone free rate for renal pelvic stones could be explained by the second generation lithotripter used for all procedures.

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

NASA Astrophysics Data System (ADS)

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

2012-04-01

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

Urinary Tract Stones and Osteoporosis: Findings From the Women’s Health Initiative

PubMed Central

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

2017-01-01

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

Should metabolic evaluation be performed in patients with struvite stones?

PubMed

Iqbal, Muhammad Waqas; Shin, Richard H; Youssef, Ramy F; Kaplan, Adam G; Cabrera, Fernando J; Hanna, Jonathan; Scales, Charles D; Ferrandino, Michael N; Preminger, Glenn M; Lipkin, Michael E

2017-04-01

Previous studies suggested that patients with pure struvite calculi rarely have underlying metabolic abnormalities. Therefore, most of these patients do not undergo metabolic studies. We report our experience with these patients and their response to directed medical therapy. Between 1/2005 and 9/2012, 75 patients treated with percutaneous nephrolithotomy for struvite stones were identified. Of these, 7 had pure struvite stones (Group 1), 32 had mixed struvite stones (Group 2), both with metabolic evaluation, and 17 had pure struvite stones without metabolic evaluation (Group 3). The frequency of metabolic abnormalities and stone activity (defined as stone growth or stone-related events) was compared between groups. The median age was 55 years and 64 % were female. No significant difference in race, infection history, family history, stone location or volume existed between groups. Metabolic abnormalities were found in 57 % of Group 1 and 81 % of Group 2 patients. A similar proportion of Group 1 and 2 patients received modification to or continuation of metabolic therapy, whereas no Group 3 patients received any directed therapy. In patients with >6 months follow-up, the stone activity rate between Groups 1 and 2 appeared similar whereas Group 3 trended towards higher stone activity rate. Metabolic abnormalities in pure struvite stone formers appear to be more common than previously reported. Directed medical therapy in these patients may reduce stone activity. The role of metabolic evaluation and directed medical therapy needs reconsideration in patients with pure struvite stones.

[Management of Intrahepatic Duct Stone].

PubMed

Cha, Sang Woo

2018-05-25

Intrahepatic duct (IHD) stone is the presence of calculi within the intrahepatic bile duct specifically located proximal to the confluence of the left and right hepatic ducts. This stone is characterized by its intractable nature and frequent recurrence, requiring multiple therapeutic interventions. Without proper treatment, biliary strictures and retained stones can lead to repeated episodes of cholangitis, liver abscesses, secondary biliary cirrhosis, portal hypertension, and death from sepsis or hepatic failure. The ultimate treatment goals for IHD stones are complete removal of the stone, the correction of the associated strictures, and the prevention of recurrent cholangitis. A surgical resection can satisfy the goal of treatment for hepatolithiasis, i.e., complete removal of the IHD stones, stricture, and the risk of cholangiocarcinogenesis. On the other hand, in some cases, such as bilateral IHD stones, surgery alone cannot achieve these goals. Therefore, the optimal treatments require a multidisciplinary approach, including endoscopic and radiologic interventional procedures before and/or after surgery. Percutaneous transhepatic cholangioscopic lithotomy (PTCS-L) is particularly suited for patients at poor surgical risk or who refuse surgery and those with previous biliary surgery or stones distributed in multiple segments. PTCS-L is relatively safe and effective for the treatment of IHD stones, and complete stone clearance is mandatory to reduce the sequelae of IHD stones. An IHD stricture is the main factor contributing to incomplete clearance and stone recurrence. Long-term follow-up is required because of the overall high recurrence rate of IHD stones and the association with cholangiocarcinoma.

Preventing stone retropulsion during intracorporeal lithotripsy.

PubMed

Elashry, Osama M; Tawfik, Ahmad M

2012-12-01

Several studies of ureteroscopic treatment for ureteral stones have reported that most stone clearance failures can be attributed to stone fragment retropulsion. Stone retropulsion can result in increased operative time and cost-resulting from the need to change from the semi-rigid ureteroscope to a flexible instrument to chase migrated calculi-and additional procedures to treat residual migrated fragments are often required. The degree of migration depends mainly on the energy source used for lithotripsy; pneumatic and electrohydraulic lithotripters are associated with a greater degree of retropulsion than lasers. Different stone-trapping strategies and devices have been developed to minimize stone migration. Novel devices include the Lithovac(®) suction device, the Passport(™) balloon, the Stone Cone(™), the PercSys Accordion(®), the NTrap(®), and stone baskets such as the LithoCatch(™), the Parachute(™), and the Escape(®). Some authors have also reported on the use of lubricating jelly and BackStop(®) gel (a reverse thermosensitive polymeric plug); these devices are instilled proximal to the stone prior to the application of kinetic energy in order to prevent retrograde stone migration.

Evaluation of biochemical urinary stone composition and its relationship to tap water hardness in Qom province, central Iran.

PubMed

Moslemi, Mohammad Kazem; Saghafi, Hossein; Joorabchin, Seyed Mohammad Amin

2011-01-01

The aim of this study was to evaluate the biochemical stone composition in general population of Qom province, central Iran, and its relationship with high tap water hardness. In a prospective study, from March 2008 to July 2011, biochemical analysis of urinary stones in patients living in Qom province for at least 5 years was performed. Stones were retrieved by spontaneous passage, endoscopic or open surgery, and after extracorporeal shockwave lithotripsy. Demographic findings and the drinking water supply of patients were evaluated and compared with biochemical stone analysis. Stone analysis was performed in 255 patients. The most dominant composition of urinary stones was calcium oxalate (73%), followed by uric acid (24%), ammonium urate (2%), and cystine (1%). The peak incidence of urinary stone was in patients in their forties. Overall male to female ratio was 4.93:1. The dominant stone composition in inhabitants of central Iran, where tap water hardness is high, was calcium oxalate stones. On the basis of this study, biochemical urinary stone composition of Qom does not differ from other regions of Iran with lower water hardness.

Pathophysiology of kidney, gallbladder and urinary stones treatment with herbal and allopathic medicine: A review

PubMed Central

Alok, Shashi; Jain, Sanjay Kumar; Verma, Amita; Kumar, Mayank; Sabharwal, Monika

2013-01-01

Medicinal plants have been known for millennia and are highly esteemed all over the world as a rich source of therapeutic agents for the prevention of various ailments. Today large number of population suffers from kidney stone, gall stone and urinary calculi. Stone disease has gained increasing significance due to changes in living conditions i.e. industrialization and malnutrition. Changes in prevalence and incidence, the occurrence of stone types and stone location, and the manner of stone removal are explained. Medicinal plants are used from centuries due to its safety, efficacy, cultural acceptability and lesser side effects as compared to synthetic drugs. The present article deals with measures to be adopted for the potential of medicinal plants in stone dissolving activity. The problem of urinary stones or calculi is a very ancient one and many remedies have been employed during the ages these stones are found in all parts of the urinary tract, the kidney, the ureters and the urinary bladder and may vary considerably in size. In the present article, an attempt has been made to emphasis on herbal option for urinary stone.

Prediction of calcium level in melamine-related urinary calculi with helical CT: diagnostic performance evaluation and clinical significance.

PubMed

Yuan, Li; Xiaorui, Ru; Gang, Huang; Xinsheng, Xi; Xiaogang, Huang; Li, Dong; Yirong, Chen

2012-06-01

The aim of the study was to investigate the relationship between CT-attenuation and stone calcium level in melamine-related urinary calculi (MRUC). A total of 25 MRUC with known composition and calcium level were included (11 uric acid stones, 2 calcium oxalate stones and 12 mixture stones of uric acid and calcium oxalate). Of all, 18 renal stones accepted alkalization therapy except for 5 lower urinary tract stones and 2 stones of unknown position. With well-matched composition, 61 adult urinary stones were included as controls. Every stone was scanned by helical CT (80 kV/120 kV, 300 mA, pitch 0.625 mm) and the highest CT-attenuation value measured. CT-attenuation values of MRUC increased gradually from uric acid stones, mixture stones to calcium oxalate stones, but were always lower than the values of controls. Furthermore, a strong positive correlation was found between stone CT-attenuation value and stone calcium level (n = 25, r (80kV) = 0.883, p = 0.000; r (120kV) = 0.855, p = 0.000). Compared with alkalization-therapy-alone group, stone CT-attenuation values and stone calcium level in the comprehensive-therapy group were significantly greater (CT(80kV) 1,057 ± 639 vs. 172 ± 61 HU, p = 0.001; CT(120kV) 783 ± 476 vs. 162 ± 60 HU, p = 0.001; Ca 19.83 ± 7.48% vs. 1.30 ± 1.51%, p = 0.000). Fisher's exact test suggested that the stones with higher CT-attenuation values tended to resist alkalization when 400 HU served as the cutoff value (P (80kV) = 0.002, P (120kV) = 0.000). In conclusion, the study was the first to illustrate that the CT-attenuation value could reflect calcium level in MRUC and found that stones with higher CT-attenuation value were not amenable to alkalization because they probably contained greater calcium. For those patients, we believe that comprehensive therapy will be the best choice.

Mineralogy and chemistry of urinary stones: patients from North Jordan.

PubMed

Abboud, Iyad Ahmed

2008-10-01

Urinary stone diseases are increasing in the Middle East. The majority of urinary stone cases are found in the northern part of the country. Stone samples taken from patients living in the Irbid area were collected from Princess Basma Hospital. The present study concentrates on the mineralogical and chemical composition of the urinary stones and on the effective environmental factors that assist in developing the different types of urinary stones. Using X-ray diffraction techniques, the mineralogical composition of the urinary stones was found to be as follows: oxalate, cholesten, and uric acid, with cystine stones occuring more frequently than the others. Cholesten and calcium oxalate stones are the most dominant types of stones. Calcium oxalate is the most common type of oxalate stone. Calcium oxalate is represented in: whewellite, wheddellite, and calcium carbonate oxalate hydrate minerals, in addition to other minerals such as brushite, ammonium phosphate, vaterite, valleriite, and bobierrite from other types of stones. Bobierrite (phosphate group) is a new mineral reported in urinary stones, and this has not been determined in any previous study worldwide. Apatite (calcium phosphate) is deduced using scanning electron microscope (SEM) images. The SEM technique determined crystal forms and systems, shapes, morphological features, and the names of the minerals forming urine stones, while optical properties are studied by polarizing microscope. X-ray fluorescence technique determined the concentrations of major and some trace elements. It revealed that Ca is the main constituent of the urinary stones, especially those composed of calcium oxalate and calcium phosphate. The concentration of trace elements was Ba = 1.57, P = 3.61, Fe = 1.78, S = 2.08, Zr = 4.63, Mo = 3.92, Cu = 1.89, Co = 1.56, and F = 4.2% and was higher in the urinary stones of Jordanian patients than in foreigners in the country. Questionnaires completed by patients suggest that the most significant factors directly effecting the formation of stones are water, climate conditions, food rich in protein and rich in different chemicals. Moreover, some drugs and diseases might also help in developing other stones.

Calcium Tartrate Tetrahydrate, Case Report of a Novel Human Kidney Stone.

PubMed

Kleinguetl, Colin; Williams, James C; Ibrahim, Samar A; Daudon, Michel; Bird, Erin T; El Tayeb, Marawan M

2017-01-01

Background: Calcium tartrate tetrahydrate has been reported as the main mineral in urinary stones in rats that have significant tartrate in their diet, but in humans, there has been only one mention of calcium tartrate stones in the form of bladder stone, and that case was in Africa. Case Presentation: Patient is a 34-year-old Caucasian male who presented with typical symptoms of nephrolithiasis. CT abd/pelvis (renal stone protocol) revealed a 2 cm nonobstructing stone of the right renal pelvis. Patient underwent an uncomplicated right percutaneous nephrolithotomy and was noted to be stone free after surgery. Stone analysis was difficult with regard to determining composition, but was finally identified as calcium tartrate tetrahydrate. Conclusion: This was an unusual case, as this is the first recorded case of a calcium tartrate tetrahydrate outside of Africa. This type of stone had only been mainly described in rat models with dl- bitartrate in their diet. Our patient was an otherwise healthy, relatively muscular individual with no obvious source for this stone other than a vitamin and amino acid supplement that he takes regularly that contains l-carnitine (as tartrate) and choline (as bitartrate and citrate). The prevalence of this stone type is presently unknown, as stone analysis laboratories have not had the ability to recognize it. Although a connection between the supplement and stone formation is conjecture at this time, we believe this necessitates further investigation.

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.

Pathogenesis of pigment gallstones in Western societies: the central role of bacteria.

PubMed

Stewart, Lygia; Oesterle, Adair L; Erdan, Ihsan; Griffiss, J MacLeod; Way, Lawrence W

2002-01-01

Bacteria are traditionally accorded a greater role in pigment gallstone formation in Eastern populations. Stone color is thought to predict the presence of bacteria; that is, black stones (Western predominant) are supposedly sterile and brown stones (Eastern predominant) contain bacteria. We previously reported that, regardless of appearance, most pigment gallstones contain bacteria. This study examined, in a large Western population (370 patients), the incidence, appearance, and chemical composition of pigment stones, and the characteristics of gallstone bacteria. One hundred eighty-six pigment stones were obtained aseptically. Bacteria were detected by means of scanning electron microscopy and gallstone culture. Chemical composition was determined by infrared spectroscopy. Bacteria were tested for slime and beta-glucuronidase production. Seventy-three percent of pigment stones contained bacteria. Choledocholithiasis was associated with gallstone bacteria. Ca-bilirubinate was present in all pigment stones. Ca-palmitate was characteristic of infected stones, and more than 75% Ca-carbonate was characteristic of sterile stones. Neither chemical composition nor stone appearance predicted the presence of bacteria. Ninety-five percent and 67% of infected pigment stones contained bacteria that produced slime and beta-glucuronidase, respectively. Most pigment stones contained bacteria that produced beta-glucuronidase, slime, and phospholipase, factors that facilitate stone formation. Thus bacteria have a major role in Western pigment gallstone formation. Furthermore, gallstone color did not predict composition or bacterial presence.

Sedimentary rocks in our mouth: dental pulp stones made by nanobacteria

NASA Astrophysics Data System (ADS)

Ciftcioglu, Neva; Ciftcioglu, Vefa; Vali, Hojatollah; Turcott, Eduardo; Kajander, E. Olavi

1998-07-01

The mechanisms of dental pulp stone formation are still largely unknown. Pulp stones are mainly composed of carbonate apatite. Only few experimental reports have elucidated the potential of some selected bacteria to produce apatite under in vitro conditions using special calcification media. The tested stone forming bacteria were, in fact, often better known for their cariogenic potential. Our preliminary work with 18 dental pulp stones from Turkey, selected only by severity of the stone formation, indicated the presence of nanobacterial antigens in the demineralized stones. Furthermore, high incidence of kidney stones and gall stones in the patient group and in their parents was found. This raises the implication that nanobacteria may enter the body also via oral route, in addition to the parenteral and transplacental routes. The role of nanobacteria in dental pulp stone formation was further studied by following nanobacterial colonization and mineral formation on human tooth in vitro. Two molar teeth, one having pulp stone and one without, were vertically cut into two pieces, sterilized by autoclaving and incubated with or without nanobacteria in DMEM. Electron microscopic observations indicate that nanobacteria can cause apatite stone formation on tooth surface. The sever from of dental pulp stone formation might be associated with nanobacteria. This form of dental disease results in loss of teeth due to osteolytic processes. This addresses the necessity for a study on unconventional mineral-forming bacteria as a cause for human diseases.

Wild capuchin monkeys spontaneously adjust actions when using hammer stones of different mass to crack nuts of different resistance.

PubMed

Liu, Qing; Fragaszy, Dorothy M; Visalberghi, Elisabetta

2016-09-01

Expert tool users are known to adjust their actions skillfully depending on aspects of tool type and task. We examined if bearded capuchin monkeys cracking nuts with stones of different mass adjusted the downward velocity and the height of the stone when striking palm nuts. During a field experiment carried out in FBV (Piauí, Brazil), eight adult wild capuchin monkeys (five males) cracked Orbygnia nuts of varied resistance with hammer stones differing in mass. From recorded videos, we identified the highest strike per nut-cracking episode, and for this strike, we calculated the height to which the monkey lifted the stone, the maximum velocity of the stone during the downward phase, the work done on the stone, and the kinetic energy of the strike. We found that individual capuchins achieved average maximum kinetic energy of 8.7-16.1 J when using stones between 0.9 and 1.9 kg, and maximum kinetic energy correlated positively with mass of the stone. Monkeys lifted all the stones to an individually consistent maximum height but added more work to the stone when using lighter stones. One male and one female monkey lifted stones higher when they cracked more resistant nuts. The high resistance of the Orbygnia nut elicits production of maximum kinetic energy, which the monkeys modulate to some degree by adding work to lighter stones. Capuchin monkeys, like chimpanzees, modulate their actions in nut-cracking, indicating skilled action, although neither species regulates kinetic energy as precisely as skilled human stone knappers. Kinematic analyses promise to yield new insights into the ways and extent to which nonhuman tool users develop expertise. Am J Phys Anthropol 161:53-61, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Kidney Stones in Primary Hyperoxaluria: New Lessons Learnt

PubMed Central

Jacob, Dorrit E.; Grohe, Bernd; Geßner, Michaela; Beck, Bodo B.; Hoppe, Bernd

2013-01-01

To investigate potential differences in stone composition with regard to the type of Primary Hyperoxaluria (PH), and in relation to the patient’s medical therapy (treatment naïve patients versus those on preventive medication) we examined twelve kidney stones from ten PH I and six stones from four PH III patients. Unfortunately, no PH II stones were available for analysis. The study on this set of stones indicates a more diverse composition of PH stones than previously reported and a potential dynamic response of morphology and composition of calculi to treatment with crystallization inhibitors (citrate, magnesium) in PH I. Stones formed by PH I patients under treatment are more compact and consist predominantly of calcium-oxalate monohydrate (COM, whewellite), while calcium-oxalate dihydrate (COD, weddellite) is only rarely present. In contrast, the single stone available from a treatment naïve PH I patient as well as stones from PH III patients prior to and under treatment with alkali citrate contained a wide size range of aggregated COD crystals. No significant effects of the treatment were noted in PH III stones. In disagreement with findings from previous studies, stones from patients with primary hyperoxaluria did not exclusively consist of COM. Progressive replacement of COD by small COM crystals could be caused by prolonged stone growth and residence times in the urinary tract, eventually resulting in complete replacement of calcium-oxalate dihydrate by the monohydrate form. The noted difference to the naïve PH I stone may reflect a reduced growth rate in response to treatment. This pilot study highlights the importance of detailed stone diagnostics and could be of therapeutic relevance in calcium-oxalates urolithiasis, provided that the effects of treatment can be reproduced in subsequent larger studies. PMID:23940605

The impact of pelvicaliceal anatomy on the success of retrograde intrarenal surgery in patients with lower pole renal stones.

PubMed

Resorlu, Berkan; Oguz, Ural; Resorlu, Eylem Burcu; Oztuna, Derya; Unsal, Ali

2012-01-01

To evaluate the impact of pelvicaliceal anatomy on the success of retrograde intrarenal surgery (RIRS) for lower pole renal stones and determine which of these factors can be used to select patients who will benefit from RIRS. We evaluated 67 patients who underwent RIRS between 2009 and 2010 for isolated lower pole renal stones. The infundibular length (IL), infundibular width (IW), pelvicaliceal height (PCH), and infundibulopelvic angle (IPA) were measured by preoperative intravenous urogram. Success was defined as either complete clearance or clearance with insignificant residual fragments≤3 mm in size at 2-months follow-up. Mean IL was 26.7±7.9 and 28.2±5.3 mm, mean PCH was 20.7±6.6 and 23.2±4.9 mm in stone-free and non-stone-free patients, respectively. These were slightly larger in the non-stone-free group but not statistically significant (P=.140 and P=.072, respectively). Mean IW was 5.8±3.5 and 5.6±2.2 mm in stone-free and non-stone-free patients, respectively, which had no significant impact on the stone-free rate (P=.719). There were significant differences between the groups in terms of stone length (P=.001) and IPA (P=.003). The mean IPA was 49.37±11.83 and 37.61±13.22 mm in stone-free and non-stone-free patients, respectively. In addition to the influence of stone size, lower pole anatomy, especially IPA, has a significant impact on stone clearance for lower pole stones after RIRS. Copyright © 2012 Elsevier Inc. All rights reserved.

Renal geology (quantitative renal stone analysis) by 'Fourier transform infrared spectroscopy'.

PubMed

Singh, Iqbal

2008-01-01

To prospectively determine the precise stone composition (quantitative analysis) by using infrared spectroscopy in patients with urinary stone disease presenting to our clinic. To determine an ideal method for stone analysis suitable for use in a clinical setting. After routine and a detailed metabolic workup of all patients of urolithiasis, stone samples of 50 patients of urolithiasis satisfying the entry criteria were subjected to the Fourier transform infrared spectroscopic analysis after adequate sample homogenization at a single testing center. Calcium oxalate monohydrate and dihydrate stone mixture was most commonly encountered in 35 (71%) followed by calcium phosphate, carbonate apatite, magnesium ammonium hexahydrate and xanthine stones. Fourier transform infrared spectroscopy allows an accurate, reliable quantitative method of stone analysis. It also helps in maintaining a computerized large reference library. Knowledge of precise stone composition may allow the institution of appropriate prophylactic therapy despite the absence of any detectable metabolic abnormalities. This may prevent and or delay stone recurrence.

[Uroliths of cats in Switzerland from 2002 to 2009].

PubMed

Gerber, B; Brandenberger-Schenk, F; Rothenanger, E; Müller, C

2016-10-01

In this study data on composition of uroliths collected from cats and epidemiologic data of affected cats in Switzerland from 2002 to 2009 are summarised. Of 884 stones analysed 50% (n=441) were composed of calcium oxalate, 45% (n=398) of struvite, 3% (n=18) of ammonium urate, 1% (n=12) were mixed stones, 1% (n=9) were composed of silica, 3 stones were solidified blood, 2 consisted of cystine and 1of xanthine. 40% of the ureteral stones were composed of struvite. Domestic cats had significantly less calcium oxalate stones compared to British Shorthair or Persian cats. Cats with calcium oxalate stones were older and cats with struvite stones were younger than other affected cats. Female and male cats were equally affected with stones. Compared to studies from other countries, in Switzerland silica stones occurred more often and ureteral stones were more often composed of Struvite. The present study shows that occurrence and prevalence of urinary calculi of cats from Switzerland exhibited only slight differences to studies from other countries.

Wait-and-see policy versus cholecystectomy after endoscopic sphincterotomy for bile-duct stones in high-risk patients with co-existing gallbladder stones: a prospective randomised trial.

PubMed

Zargar, Showkat A; Mushtaq, Mosin; Beg, Mashkoor A; Javaid, Gul; Khan, Bashir A; Hassan, Rayhana; Kasana, Reyaz A; Tabassum, Sameena

2014-03-01

Endoscopic sphincterotomy (ES) is one of the most important advances in the treatment of common bile duct (CBD) stones. However, the use of ES to remove CBD stones in high-risk patients without cholecystectomy is still debatable. The aim of this study was to compare the efficacy of a wait-and-see policy versus cholecystectomy after ES for CBD stones in high-risk patients with co-existing cholelithiasis. A total of 162 patients after undergoing ES with the clearance of CBD stones were randomised after informed consent to cholecystectomy or conservative management of their gallbladder stones. The results indicated that cholecystectomy after ES for CBD stones significantly reduced the biliary complications in high-risk patients. Every patient who has both CBD stones and gallstones with significant co-morbid illnesses, after clearance of CBD stones by ES, should undergo early cholecystectomy. Copyright © 2014 Arab Journal of Gastroenterology. Published by Elsevier Ltd. All rights reserved.

Efficacy of combining flexible and rigid ureteroscopy for transurethral lithotripsy.

PubMed

Shigemura, Katsumi; Yasufuku, Tomihiko; Yamashita, Masuo; Arakawa, Soichi; Fujisawa, Masato

2010-08-23

Transurethral lithotripsy (TUL) is a common procedure in urology. However, controversy persists about how to deal with stones pushed up into kidney from the ureter during the procedure of TUL. This study investigated the efficacy of combining flexible ureteroscopy and rigid ureteroscopy for pushed-up stones into kidney during TUL. Fotry-one patients underwent TUL by a single surgeon from July 2007 to May 2009. Eight cases resulted in pushed-up stones during operation or involved existing kidney stones. We used a Zero-tip or Litho Catch Basket catheter and a flexible ureteroscope to carry these stones in kidney down into the ureter where the rigid ureteroscope could then reach and handle the stone for lithotripsy or being taken away. A Lithoclast system was used for lithotripsy. Five cases involved stones pushed up during surgery and 3 cases involved stones already in the kidney in detail. We pulled the stones down into the ureter in all cases and successfully completed lithotripsy or removed the stone, thus avoiding the performance of additional extracorporeal shock wave lithotripsy (ESWL). In conclusions, combined use of flexible ureteroscopy and rigid ureteroscopy for upper urinary tract stones pushed up into the kidney during TUL or renal stones could be useful for avoiding additional ESWL.

Nephrolithiasis: Molecular Mechanism of Renal Stone Formation and the Critical Role Played by Modulators

PubMed Central

Aggarwal, Kanu Priya; Narula, Shifa; Kakkar, Monica

2013-01-01

Urinary stone disease is an ailment that has afflicted human kind for many centuries. Nephrolithiasis is a significant clinical problem in everyday practice with a subsequent burden for the health system. Nephrolithiasis remains a chronic disease and our fundamental understanding of the pathogenesis of stones as well as their prevention and cure still remains rudimentary. Regardless of the fact that supersaturation of stone-forming salts in urine is essential, abundance of these salts by itself will not always result in stone formation. The pathogenesis of calcium oxalate stone formation is a multistep process and essentially includes nucleation, crystal growth, crystal aggregation, and crystal retention. Various substances in the body have an effect on one or more of the above stone-forming processes, thereby influencing a person's ability to promote or prevent stone formation. Promoters facilitate the stone formation while inhibitors prevent it. Besides low urine volume and low urine pH, high calcium, sodium, oxalate and urate are also known to promote calcium oxalate stone formation. Many inorganic (citrate, magnesium) and organic substances (nephrocalcin, urinary prothrombin fragment-1, osteopontin) are known to inhibit stone formation. This review presents a comprehensive account of the mechanism of renal stone formation and the role of inhibitors/promoters in calcium oxalate crystallisation. PMID:24151593

Diversity in Protein Profiles of Individual Calcium Oxalate Kidney Stones

PubMed Central

Okumura, Nobuaki; Tsujihata, Masao; Momohara, Chikahiro; Yoshioka, Iwao; Suto, Kouzou; Nonomura, Norio; Okuyama, Akihiko; Takao, Toshifumi

2013-01-01

Calcium oxalate kidney stones contain low amounts of proteins, some of which have been implicated in progression or prevention of kidney stone formation. To gain insights into the pathophysiology of urolithiasis, we have characterized protein components of calcium oxalate kidney stones by proteomic approaches. Proteins extracted from kidney stones showed highly heterogeneous migration patterns in gel electrophoresis as reported. This was likely to be mainly due to proteolytic degradation and protein-protein crosslinking of Tamm-Horsfall protein and prothrombin. Protein profiles of calcium oxalate kidney stones were obtained by in-solution protease digestion followed by nanoLC-MALDI-tandem mass spectrometry, which resulted in identification of a total of 92 proteins in stones from 9 urolithiasis patients. Further analysis showed that protein species and their relative amounts were highly variable among individual stones. Although proteins such as prothrombin, osteopontin, calgranulin A and calgranulin B were found in most stones tested, some samples had high contents of prothrombin and osteopontin, while others had high contents of calgranulins. In addition, calgranulin-rich stones had various neutrophil-enriched proteins such as myeloperoxidase and lactotransferrin. These proteomic profiles of individual kidney stones suggest that multiple systems composed of different groups of proteins including leucocyte-derived ones are differently involved in pathogenesis of individual kidney stones depending on situations. PMID:23874695

Metabolic syndrome: a multifaceted risk factor for kidney stones.

PubMed

Domingos, Fernando; Serra, Adelaide

2014-10-01

Kidney stones and metabolic syndrome (MetS) are common conditions in industrialized countries. There is growing evidence of associations between kidney stone disease and MetS or some of its components. The link between uric acid stones and MetS is well understood, but the link with calcium oxalate (CaOx) stones, the most common kidney stone composition, is more complex, and MetS is frequently overlooked as a risk factor for calcium nephrolithiasis. The physiopathological mechanisms of kidney stone disease in MetS are reviewed in this article. Uric acid stones are a consequence of the excessively acidic urine that results from insulin resistance. The pathophysiology of CaOx stones may include: increased excretion of lithogenesis promoters and decreased excretion of inhibitors; increased risk of Randall's plaque development; and inflammatory damage to renal epithelia by oxidative stress, as a consequence of the insulin-resistant milieu that characterizes MetS. The last mechanism contributes to the adhesion of CaOx crystals to subepithelial calcium deposits working as anchor sites where stones can grow. The predominant MetS features could determine the chemical composition of the stones in each patient. Kidney stones may be a renal manifestation of MetS and features of this syndrome should be looked for in patients with idiopathic nephrolithiasis.

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

NASA Astrophysics Data System (ADS)

van Cauwelaert, Javier; Cleveland, Robin O.

2003-10-01

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

Changes in urinary stone composition in the Tunisian population: a retrospective study of 1,301 cases.

PubMed

Alaya, Akram; Nouri, Abdellatif; Belgith, Mohsen; Saad, Hammadi; Jouini, Riadh; Najjar, Mohamed Fadhel

2012-05-01

Studies that evaluate the effect of age on stone composition are scarce. The aim of this study was to highlight the changes in epidemiological characteristics (stone composition and location) of urolithiasis according to patients' age. We studied 1,301 urolithiasis patients with age ranging from 6 months to 92 yr (781 males and 520 females). Stone analysis was performed using a stereomicroscope and infrared spectroscopy to determine the morphological type and molecular composition of each stone. The annual average incidence of new stone formation was 31.7 per 100,000 persons. In 71.8% of cases, calculi were located in the upper urinary tract. Compared to other age groups, children and old men were more affected by bladder stones. Calcium oxalate monohydrate was the most frequent stone component, even though its frequency decreased with age (59.5% in young adults and 43.7% in the elderly, P<0.05) in favor of an increase in uric acid stones (11.5% in young adults and 36.4% in the elderly, P<0.05). Struvite stones were rare (3.8%) and more frequent in children than in adults. The analysis of these data showed that urinary stones in Tunisian patients are tending to evolve in the same direction as the stones in patients from industrialized countries.

Impaction and Prediction: Does Ureteral Wall Thickness Affect the Success of Medical Expulsive Therapy in Pediatric Ureteral Stones?

PubMed

Tuerxun, Aierken; Batuer, Abudukahaer; Erturhan, Sakip; Eryildirim, Bilal; Camur, Emre; Sarica, Kemal

2017-01-01

The study aimed to evaluate the predictive value of ureteral wall thickness (UWT) and stone-related parameters for medical expulsive therapy (MET) success with an alpha blocker in pediatric upper ureteral stones. A total of 35 children receiving MET ureteral stones (<10 mm) were evaluated. Patients were divided into 2 subgroups where MET was successful in 18 children (51.4%) and unsuccessful in 17 children (48.6%). Prior to management, stone size, stone density (in Hounsfield unit), degree of hydronephrosis, and UWT were evaluated with patient demographics and recorded. The possible predictive value of these parameters in success rates and time to stone expulsion were evaluated in a comparative manner between the 2 groups. The overall mean patient age and stone size values were 5.40 ± 0.51 years and 6.24 ± 0.28 mm, respectively. Regarding the predictive values of these parameters for the success of MET, while stone size and UWT were found to be highly predictive for MET success, patients age, body mass index, stone density, and degree of hydronephrosis had no predictive value on this aspect. Our findings indicated that some stone and anatomical factors may be used to predict the success of MET in pediatric ureteral stones in an effective manner. With this approach, unnecessary use of these drugs that may cause a delay in removing the stone will be avoided, and the possible adverse effects of obstruction as well as stone-related clinical symptoms could be minimized. © 2017 S. Karger AG, Basel.

First in Human Clinical Trial of Ultrasonic Propulsion of Kidney Stones.

PubMed

Harper, Jonathan D; Cunitz, Bryan W; Dunmire, Barbrina; Lee, Franklin C; Sorensen, Mathew D; Hsi, Ryan S; Thiel, Jeff; Wessells, Hunter; Lingeman, James E; Bailey, Michael R

2016-04-01

Ultrasonic propulsion is a new technology using focused ultrasound energy applied transcutaneously to reposition kidney stones. We report what are to our knowledge the findings from the first human investigational trial of ultrasonic propulsion toward the applications of expelling small stones and dislodging large obstructing stones. Subjects underwent ultrasonic propulsion while awake without sedation in clinic, or during ureteroscopy while anesthetized. Ultrasound and a pain questionnaire were completed before, during and after propulsion. The primary outcome was to reposition stones in the collecting system. Secondary outcomes included safety, controllable movement of stones and movement of stones less than 5 mm and 5 mm or greater. Adverse events were assessed weekly for 3 weeks. Kidney stones were repositioned in 14 of 15 subjects. Of the 43 targets 28 (65%) showed some level of movement while 13 (30%) were displaced greater than 3 mm to a new location. Discomfort during the procedure was rare, mild, brief and self-limited. Stones were moved in a controlled direction with more than 30 fragments passed by 4 of the 6 subjects who had previously undergone a lithotripsy procedure. The largest stone moved was 10 mm. One patient experienced pain relief during treatment of a large stone at the ureteropelvic junction. In 4 subjects a seemingly large stone was determined to be a cluster of small passable stones after they were moved. Ultrasonic propulsion was able to successfully reposition stones and facilitate the passage of fragments in humans. No adverse events were associated with the investigational procedure. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Inaccurate reporting of mineral composition by commercial stone analysis laboratories: implications for infection and metabolic stones.

PubMed

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

2010-10-01

We determined the accuracy of stone composition analysis at commercial laboratories. A total of 25 human renal stones with infrared spectroscopy determined composition were fragmented into aliquots and studied with micro computerized tomography to ensure fragment similarity. Representative fragments of each stone were submitted to 5 commercial stone laboratories for blinded analysis. All laboratories agreed on the composition of 6 pure stones. Only 2 of 4 stones (50%) known to contain struvite were identified as struvite at all laboratories. Struvite was reported as a component by some laboratories for 4 stones previously determined not to contain struvite. Overall there was disagreement regarding struvite in 6 stones (24%). For 9 calcium oxalate stones all laboratories reported some mixture of calcium oxalate but the quantity of subtypes differed significantly among laboratories. In 6 apatite containing stones apatite was missed by the laboratories in 20% of samples. None of the laboratories identified atazanavir in a stone containing that antiviral drug. One laboratory reported protein in every sample while all others reported it in only 1. Nomenclature for apatite differed among laboratories with 1 reporting apatite as carbonate apatite and never hydroxyapatite, another never reporting carbonate apatite and always reporting hydroxyapatite, and a third reporting carbonate apatite as apatite with calcium carbonate. Commercial laboratories reliably recognize pure calculi. However, variability in the reporting of mixed calculi suggests a problem with the accuracy of stone analysis results. There is also a lack of standard nomenclature used by laboratories. Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

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

PubMed Central

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

2011-01-01

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

Lessons from a Stone Farm

NASA Astrophysics Data System (ADS)

Kavanagh, John P.; Rao, P. Nagaraj

2007-04-01

The stone farm is a system for measuring macroscopic stone growth of 12 calcium stones simultaneously. It is based on mixed suspension, mixed product removal continuous crystallization principles and the stones are grown continuously for about 500 hours or more. The growth of the stones follows a surface area dependent pattern and the growth rate constants are very similar irrespective of whether the stating materials are fragments of human stone or pieces of marble chip. Increasing citrate from 2mM to 6mM caused a significant growth inhibition which persisted in the presence of urinary macromolecules. Phytate was a very effective inhibitor (about 50% at sub-μM concentrations) but the effective concentration was increased by an order of magnitude in the presence of urinary macromolecules. The effective concentration for inhibition in a crystallization assay was a further two orders of magnitude higher. Urinary macromolecules or almost whole urine were also strongly inhibitory although neither human serum albumin nor bovine mucin had any great effect. The relationship between the size distribution of crystals in suspension and the stone enlargement rate suggests that the primary enlargement mechanism for these in vitro stones is through aggregation. The stone farm is a powerful tool with which to study crystallization inhibitors in a new light. Some differences between inhibition of crystallization and inhibition of stone growth have emerged and we have obtained quantitative evidence on the mechanism of stone enlargement in vitro. Our findings suggest that the interface between crystals in suspension and the stone surface is the key to controlling stone enlargement.

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. © 2015 American Society for Bone and Mineral Research.

The clinical research office of the endourological society percutaneous nephrolithotomy global study: staghorn versus nonstaghorn stones.

PubMed

Desai, Mahesh; De Lisa, Antonello; Turna, Burak; Rioja, Jorge; Walfridsson, Helena; D'Addessi, Alessandro; Wong, Carson; Rosette On Behalf Of The Croes Pcnl Study Group, Jean

2011-08-01

The study compared characteristics and outcomes in patients with staghorn or nonstaghorn stones who were treated with percutaneous nephrolithotomy (PCNL) within the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study. Data over a 1-year period from consecutively treated patients from 96 centers worldwide were collated. The following variables in patients with staghorn or nonstaghorn stones were compared: National prevalence, patient characteristics, access method, puncture frequency and outcomes, including bleeding rates, operative time, and duration of hospital stay. Data from 5335 eligible patients were collated; 1466 (27.5%) with staghorn and 3869 (72.5%) with nonstaghorn stones. Staghorn stone presentation varied between centers from 67% in Thailand to 13% in Argentina. The frequencies of previous procedures were similar between groups, but shockwave lithotripsy was less frequent in patients with staghorn stones compared with nonstaghorn (16.8% vs 22.6%) and positive preoperative urine cultures were more frequent in patients with staghorn than nonstaghorn stones (23.4% vs 13.1%). Patients with staghorn stones underwent multiple punctures more frequently than those with nonstaghorn stones (16.9% vs 5.0%). Postoperative fever, bleeding, and the need for blood transfusion were more frequent, the median operative time and duration of hospital stay were longer, while the proportion of patients remaining stone free was lower (56.9% vs 82.5%) in patients with staghorn than nonstaghorn stones. The proportion of patients with staghorn stones varies widely between centers. Stone-free rates were lower, complications more frequent, and operative time and hospital stay were longer in patients with staghorn stones.

Natural History of Conservatively Managed Ureteral Stones: Analysis of 6600 Patients.

PubMed

Yallappa, Sachin; Amer, Tarik; Jones, Patrick; Greco, Francesco; Tailly, Thomas; Somani, Bhaskar K; Umez-Eronini, Nkem; Aboumarzouk, Omar M

2018-05-01

Ureteral colic has a lifetime prevalence of 10%-15% and is one of the most common emergency urologic presentations. Current European Association of Urology recommends conservative management for "small" (<6 mm) ureteral stones if active removal is not indicated. It is important to understand the natural history of ureteral stone disease to help counsel patients with regard to their likelihood of stone passage and anticipated time frame with which they could be safely observed. We aimed to conduct a systematic review to better establish the natural history of stone expulsion. Literature search was performed using Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Outcome measures were patient and stone demographics, expulsion rates, expulsion times, and side effect of the medication. A cumulative analysis, with subgroup analysis, was performed on stone location and size. The results were depicted as percentages and an intention-to-treat basis was used. The literature search identified 70 studies and a total of 6642 patients, with a median age of 46 and range of 18-74 years. Overall, 64% of patients successfully passed their stones spontaneously. About 49% of upper ureteral stones, 58% of midureteral stones, and 68% of distal ureteral stones passed spontaneously. Almost 75% of stones <5 mm and 62% of stones ≥5 mm passed spontaneously. The average time to stone expulsion was about 17 days (range 6-29 days). Nearly 5% of participants required rehospitalization due to a deterioration of their condition and only about 1% of patients experienced side effects from analgesia provided. We believe this current review is the largest study for the evaluation of natural history of ureteral stones. The evidence suggests that ureteral stones will pass without intervention in 64% of patients, however, this varies from nearly 50%-75% depending on the size and location, in the span of 1-4 weeks.

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

NASA Technical Reports Server (NTRS)

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

2002-01-01

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

A clinical nomogram to predict the successful shock wave lithotripsy of renal and ureteral calculi.

PubMed

Wiesenthal, Joshua D; Ghiculete, Daniela; Ray, A Andrew; Honey, R John D'A; Pace, Kenneth T

2011-08-01

Although shock wave lithotripsy is dependent on patient and stone related factors, there are few reliable algorithms predictive of its success. In this study we develop a comprehensive nomogram to predict renal and ureteral stone shock wave lithotripsy outcomes. During a 5-year period data from patients treated at our lithotripsy unit were reviewed. Analysis was restricted to patients with a solitary renal or ureteral calculus 20 mm or less. Demographic, stone, patient, treatment and 3-month followup data were collected from a prospective database. All patients were treated using the Philips Lithotron® lithotripter. A total of 422 patients (69.7% male) were analyzed. Mean stone size was 52.3±39.3 mm2 for ureteral stones and 78.9±77.3 mm2 for renal stones, with 95 (43.6%) of the renal stones located in the lower pole. The single treatment success rates for ureteral and renal stones were 60.3% and 70.2%, respectively. On univariate analysis predictors of shock wave lithotripsy success, regardless of stone location, were age (p=0.01), body mass index (p=0.01), stone size (p<0.01), mean stone density (p<0.01) and skin to stone distance (p<0.01). By multivariate logistic regression for renal calculi, age, stone area and skin to stone distance were significant predictors with an AUC of 0.75. For ureteral calculi predictive factors included body mass index and stone size (AUC 0.70). Patient and stone parameters have been identified to create a nomogram that predicts shock wave lithotripsy outcomes using the Lithotron lithotripter, which can facilitate optimal treatment based decisions and provide patients with more accurate single treatment success rates for shock wave lithotripsy tailored to patient specific situations. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Study of stone composition changes in melamine-related urinary calculi and its clinical significance.

PubMed

Li, Yuan; Chen, YiRong; Zhang, Wei; Huang, XiaoGang; Li, WenHui; Ru, XiaoRui; Meng, Min; Xi, Xinsheng; Huang, Gang; Shi, BaoGuang; Liu, Gang; Li, WeiHua; Xu, Hui

2011-08-01

To investigate the composition changes in melamine-related urinary calculi and their clinical significance. A total of 49 melamine-related urinary calculi were included from 49 children (age 4-82 months, mean 22). The qualitative analysis of stone composition was determined using Fourier transform infrared. The quantitative analysis of the stone computed tomography (CT) attenuation value, stone uric acid level, and stone calcium level were measured using spiral CT, high-performance liquid chromatography, and flame atomic absorption spectrum, respectively. Fourier transform infrared showed that 41 (84%) of the 49 stones contained uric acid and 25 (51%) contained calcium compounds. The data from the qualitative and quantitative analysis were available for 15 stones because of sample consumption in the detection process (Fourier transform infrared, atomic absorption spectrum, and high-performance liquid chromatography). A negative correlation was observed between stone uric acid level and stone calcium level (n = 15, r = -0.629, P = .009). A positive correlation was observed between the stone calcium level and stone CT attenuation value (n = 25, r = 0.855, P = .000). Compared with the ≤1-year-age group and the 1-2-year-age group, the stone calcium level in the >2-year-age group was significantly greater (27.51% ± 12.65% vs 1.60% ± 1.68% or 10.12% ± 8.69%, P = .000 and P = .003, respectively). Compared with the alkalization-alone group, the stone calcium level in the nonalkalization-alone group was significant greater (19.83% ± 7.48% vs 1.25% ± 1.43%, n = 19, P = .000). The stones from children >2 years old were not amenable to medical treatment because they contained greater levels of calcium, which can be demonstrated by the radiologic "positive stone image" or stone CT attenuation value. We believe that surgical invention will be the best choice for such patients if extracorporeal shock wave lithotripsy has failed. Copyright © 2011 Elsevier Inc. All rights reserved.

Prevalence of kidney stones in the United States.

PubMed

Scales, Charles D; Smith, Alexandria C; Hanley, Janet M; Saigal, Christopher S

2012-07-01

The last nationally representative assessment of kidney stone prevalence in the United States occurred in 1994. After a 13-yr hiatus, the National Health and Nutrition Examination Survey (NHANES) reinitiated data collection regarding kidney stone history. Describe the current prevalence of stone disease in the United States, and identify factors associated with a history of kidney stones. A cross-sectional analysis of responses to the 2007-2010 NHANES (n=12 110). Self-reported history of kidney stones. Percent prevalence was calculated and multivariable models were used to identify factors associated with a history of kidney stones. The prevalence of kidney stones was 8.8% (95% confidence interval [CI], 8.1-9.5). Among men, the prevalence of stones was 10.6% (95% CI, 9.4-11.9), compared with 7.1% (95% CI, 6.4-7.8) among women. Kidney stones were more common among obese than normal-weight individuals (11.2% [95% CI, 10.0-12.3] compared with 6.1% [95% CI, 4.8-7.4], respectively; p<0.001). Black, non-Hispanic and Hispanic individuals were less likely to report a history of stone disease than were white, non-Hispanic individuals (black, non-Hispanic: odds ratio [OR]: 0.37 [95% CI, 0.28-0.49], p<0.001; Hispanic: OR: 0.60 [95% CI, 0.49-0.73], p<0.001). Obesity and diabetes were strongly associated with a history of kidney stones in multivariable models. The cross-sectional survey design limits causal inference regarding potential risk factors for kidney stones. Kidney stones affect approximately 1 in 11 people in the United States. These data represent a marked increase in stone disease compared with the NHANES III cohort, particularly in black, non-Hispanic and Hispanic individuals. Diet and lifestyle factors likely play an important role in the changing epidemiology of kidney stones. Published by Elsevier B.V.

Determining the composition of urinary tract calculi using stone-targeted dual-energy CT: evaluation of a low-dose scanning protocol in a clinical environment

PubMed Central

Chaytor, Richard J; Rajbabu, Krishnamoorthy; Jones, Paul A

2016-01-01

Objective: This study will evaluate the accuracy of dual-energy CT (DECT) in characterizing urinary tract stone composition on patients presenting to a UK hospital with renal colic. The study will also assess the additional radiation dose burden of DECT over standard protocol. Methods: Data from 106 DECTs between October 2011 and October 2015 were retrospectively analyzed. Patients were imaged using a Toshiba Aquilion ONE™ CT scanner (Toshiba Medical Systems, Otawara-shi, Japan). All patients received a low-dose non-contrast CT of the abdomen and pelvis prior to stone-targeted DECT at 80 and 135 kVp and 40-mm field of view. Radiation dose output was evaluated using dose–length product (DLP). 19 stones were recovered and their compositions were analyzed using Fourier transform infrared spectroscopy. Results: 137 stones were characterized. Mean stone diameter was 8.8 mm (range 3–48 mm). There was an 18.7% increase in mean DLP for DECT over standard CT protocol (319.4 vs 269.1 mGy cm; p < 0.001). Infrared spectroscopy analysis of 19 recovered stones identified 15 stones as calcium, 2 stones as cystine and 2 stones as mixed composition. Dual energy correctly predicted 11 (78.6%) of 14 calcium stones, 2 (100%) of 2 mixed composition stones and 0 (0%) of 2 cystine stones, resulting in a fair agreement (Cohen's κ = 0.374, p = 0.009). Conclusion: DECT is able to determine the composition of urinary tract stones with fair accuracy. Its utility is offset by a small but significant supplementary radiation exposure. Advances in knowledge: DECT can provide urological surgeons with useful diagnostic stone material information prior to planning optimal management of stone disease. PMID:27587309

Ureteroscopy

MedlinePlus

Ureteral stone surgery; Kidney stone - ureteroscopy; Ureteral stone removal - ureteroscopy; Calculi - ureteroscopy ... sent through the scope to grab and remove kidney stones or break them up using a laser. Place ...

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

The sports science of curling: a practical review.

PubMed

Bradley, John L

2009-01-01

Curling is a sport played on ice in which two teams each deliver 8 granite stones towards a target, or 'house'. It is the only sport in which the trajectory of the projectile can be influenced after it has been released by the athlete. This is achieved by sweeping the ice in front of the stone to change the stone-ice friction and thereby enable to stone to travel further, curl more or stay straight. Hard sweeping is physically demanding. Different techniques of sweeping can also have different effects on the stone. This paper will review the current research behind sweeping a curling stone, outline the physiological demands of sweeping, the associated performance effects and suggest potential strategies of sweeping that can be used by both coaches and curling teams. Key pointsSweeping a curling stone can be highly physically demanding.Effective sweeping requires a combination of downward force and brush head speed, determined by the stone velocity.Sweeping on the left or right of a stone can help the stone to remain straight or curl more depending on the rotation of the stone.This can lead to the development of sweeping and playing tactics and contribute to team selection.

Evaluation of biochemical urinary stone composition and its relationship to tap water hardness in Qom province, central Iran

PubMed Central

Moslemi, Mohammad Kazem; Saghafi, Hossein; Joorabchin, Seyed Mohammad Amin

2011-01-01

Purpose The aim of this study was to evaluate the biochemical stone composition in general population of Qom province, central Iran, and its relationship with high tap water hardness. Materials and methods In a prospective study, from March 2008 to July 2011, biochemical analysis of urinary stones in patients living in Qom province for at least 5 years was performed. Stones were retrieved by spontaneous passage, endoscopic or open surgery, and after extracorporeal shockwave lithotripsy. Demographic findings and the drinking water supply of patients were evaluated and compared with biochemical stone analysis. Results Stone analysis was performed in 255 patients. The most dominant composition of urinary stones was calcium oxalate (73%), followed by uric acid (24%), ammonium urate (2%), and cystine (1%). The peak incidence of urinary stone was in patients in their forties. Overall male to female ratio was 4.93:1. Conclusion The dominant stone composition in inhabitants of central Iran, where tap water hardness is high, was calcium oxalate stones. On the basis of this study, biochemical urinary stone composition of Qom does not differ from other regions of Iran with lower water hardness. PMID:22163171

The Sports Science of Curling: A Practical Review

PubMed Central

Bradley, John L.

2009-01-01

Curling is a sport played on ice in which two teams each deliver 8 granite stones towards a target, or ‘house’. It is the only sport in which the trajectory of the projectile can be influenced after it has been released by the athlete. This is achieved by sweeping the ice in front of the stone to change the stone-ice friction and thereby enable to stone to travel further, curl more or stay straight. Hard sweeping is physically demanding. Different techniques of sweeping can also have different effects on the stone. This paper will review the current research behind sweeping a curling stone, outline the physiological demands of sweeping, the associated performance effects and suggest potential strategies of sweeping that can be used by both coaches and curling teams. Key points Sweeping a curling stone can be highly physically demanding. Effective sweeping requires a combination of downward force and brush head speed, determined by the stone velocity. Sweeping on the left or right of a stone can help the stone to remain straight or curl more depending on the rotation of the stone. This can lead to the development of sweeping and playing tactics and contribute to team selection. PMID:24149588

Single energy micro CT SkyScan 1173 for the characterization of urinary stone

NASA Astrophysics Data System (ADS)

Fitri, L. A.; Asyana, V.; Ridwan, T.; Anwary, F.; Soekersi, H.; Latief, F. D. E.; Haryanto, F.

2016-08-01

A urinary stone is a solid piece of material produced from crystallization of excreted substances in the urine. Knowledge of the composition of urinary stones is essential to determine the suitable treatment for the patient. The aim of this research was to characterize urinary stones using single energy micro CT SkyScan 1173. Six human urinary stones were scanned in vitro using 80 kV in micro CT SkyScan 1173. The produced projection, images, were reconstructed using NRecon (in-house software from SkyScan). The images of urinary stones were analyzed using CT Analyser (CT An) to obtain information of the internal structure and the Hounsfield Unit (HU) value to determine the information regarding the composition of the urinary stones, respectively. The average HU values from certain region of interests in the same slice were compared with spectral curves of known materials from National Institute of Standards and Technology (NIST). From the analysis, the composition of the six scanned stones were obtained. Two stones are composed of cystine, two are composed of struvite, two other stones are composed of struvite+cystine. In conclusion, the single energy micro CT with 80 kV can be used identifying cystine and struvite urinary stone.

In vitro comparison of renal stone laser treatment using fragmentation and popcorn technique.

PubMed

Klaver, Paul; de Boorder, Tjeerd; Rem, Alex I; Lock, Tycho M T W; Noordmans, Herke Jan

2017-09-01

To study the effectiveness of two laser techniques clinically used to fragment renal stones: fragmenting technique (FT) and popcorn technique (PT). Phantom stones were placed in a test tube filled with water, mimicking a renal calyx model. A Holmium:YAG laser was used for fragmentation using both techniques. Four series of experiments were performed with two parameters: the technique (FT or PT) and the number of stones in the test tube (one or four). The mass decrease of the phantom stones was measured before, during, and after the experiment to quantify the effect of both techniques. Visualization of PT showed that the main effect of PT takes place, when the stone moves in front of the laser fiber and is subject to direct radiant exposure. Both FT and PT resulted in a decrease in stone weight; the mass decrease of the stones subjected to FT exceeded that of the stones subjected to PT, even with less laser energy applied. This difference in mass decrease was evident in both the experiments with one and four stones. PT was less effective in decreasing stone weight compared with FT. The FT is more effective regarding the applied energy than PT, even in a shorter time period and regardless of the number of stones. This study suggests that FT is to be preferred over PT, when stones are accessible by the laser fiber. Lasers Surg. Med. 49:698-704, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Effect of Stone Size and Composition on Ultrasonic Propulsion Ex Vivo.

PubMed

Janssen, Karmon M; Brand, Timothy C; Bailey, Michael R; Cunitz, Bryan W; Harper, Jonathan D; Sorensen, Mathew D; Dunmire, Barbrina

2018-01-01

To evaluate in more detail the effectiveness of a new designed more efficient ultrasonic propulsion for large stones and specific stone compositions in a tissue phantom model. In the first clinical trial of noninvasive ultrasonic propulsion, urinary stones of unknown compositions and sizes up to 10 mm were successfully repositioned. The study included 8- to 12-mm stones of 4 different primary compositions (calcium oxalate monohydrate, ammonium acid urate, calcium phosphate, and struvite) and a renal calyx phantom consisting of a 12 mm × 30 mm well in a 10-cm block of tissue-mimicking material. Primary outcome was the number of times a stone was expelled over 10 attempts, with ultrasonic propulsion burst duration varying from 0.5 seconds to 5 seconds. Overall success rate at expelling stones was 95%. All calcium oxalate monohydrate and ammonium acid urate stones were expelled 100% of the time. The largest stone (12 mm) became lodged within the 12-mm phantom calyx 25% of the time regardless of the burst duration. With the 0.5-second burst, there was insufficient energy to expel the heaviest stone (0.88 g), but there was sufficient energy at the longer burst durations. With a single burst, ultrasonic propulsion successfully moved most stones at least 3 cm and, regardless of size or composition, expelled them from the calyx. Ultrasonic propulsion is limited to the stones smaller than the calyceal space, and for each burst duration, related to maximum stone mass. Published by Elsevier Inc.

Effect of Stone Size and Composition on Ultrasonic Propulsion Ex Vivo

PubMed Central

Janssen, Karmon M.; Brand, Timothy C.; Bailey, Michael R.; Cunitz, Bryan W.; Harper, Jonathan D.; Sorensen, Mathew D.; Dunmire, Barbrina

2018-01-01

OBJECTIVE To evaluate in more detail the effectiveness of a new designed more efficient ultrasonic propulsion for large stones and specific stone compositions in a tissue phantom model. In the first clinical trial of noninvasive ultrasonic propulsion, urinary stones of unknown compositions and sizes up to 10 mm were successfully repositioned. MATERIALS AND METHODS The study included 8- to 12-mm stones of 4 different primary compositions (calcium oxalate monohydrate, ammonium acid urate, calcium phosphate, and struvite) and a renal calyx phantom consisting of a 12 mm × 30 mm well in a 10-cm block of tissue-mimicking material. Primary outcome was the number of times a stone was expelled over 10 attempts, with ultrasonic propulsion burst duration varying from 0.5 seconds to 5 seconds. RESULTS Overall success rate at expelling stones was 95%. All calcium oxalate monohydrate and ammonium acid urate stones were expelled 100% of the time. The largest stone (12 mm) became lodged within the 12-mm phantom calyx 25% of the time regardless of the burst duration. With the 0.5-second burst, there was insufficient energy to expel the heaviest stone (0.88 g), but there was sufficient energy at the longer burst durations. CONCLUSION With a single burst, ultrasonic propulsion successfully moved most stones at least 3 cm and, regardless of size or composition, expelled them from the calyx. Ultrasonic propulsion is limited to the stones smaller than the calyceal space, and for each burst duration, related to maximum stone mass. PMID:28964820

Percutaneous suprapubic stone extraction for posterior urethral stones in children: efficacy and safety.

PubMed

Safwat, Ahmed S; Hameed, Diaa A; Elgammal, Mohamed A; Abdelsalam, Yasser M; Abolyosr, Ahmad

2013-08-01

To evaluate the safety and efficacy of percutaneous suprapubic stone extraction (PSPSE) for pediatric posterior urethral stones. Between July 2007 and June 2010, 54 boys presenting with acute urinary retention due to posterior urethral stones underwent PSPSE. Patients were a mean age of 66.4 months (range, 8-180 months). The stone size was 0.7-1.9 cm. Patients were placed under general anesthesia, and a 7F urethroscope was used to pushback the stone to the bladder. A 3-mm suprapubic puncture with a scalpel was performed, followed by insertion of a straight narrow hemostat through the puncture aided with cystoscopic guidance. The stone was grasped with the hemostat in its narrowest diameter and was extracted percutaneously or crushed if friable. The suprapubic puncture was closed with a single 4-0 Vicryl (Ethicon) suture. Intact stone retrieval was achieved in 45 patients, and the stone was crushed into minute fragments in 9 patients. Intraperitoneal extravasation developed in 1 patient that required open surgical intervention. Mean operative time was 22 minutes. Patients were monitored for up to 17 months, with complete resolution of symptoms and stone clearance. PSPSE provides a minimally invasive approach for the extraction of urethral and bladder stones in the pediatric population. The use of a straight hemostat for suprapubic stone extraction or crushing is a good alternative to suprapubic tract dilation, with minimal morbidity. Copyright © 2013 Elsevier Inc. All rights reserved.

Journey of a cystinuric patient with a long-term follow-up from a medical stone clinic: necessity to be SaFER (stone and fragments entirely removed).

PubMed

Moore, Sacha L; Somani, Bhaskar K; Cook, Paul

2018-04-25

There is a lack of studies looking at the longitudinal follow-up of patients with cystine stones. We wanted to assess the journey of cystinuric patients through our specialist metabolic stone clinic to improve the understanding of episodes, interventions and current outcomes in this patient cohort. After ethical approval, all patients who attended our metabolic stone clinic from 1994 to 2014 with at least one cystine stone episode were included in our study. Data were retrospectively analysed for patient demographics, stone episodes or intervention, clinical parameters and patient compliance. Over a period of 21 years, 16 patients with a median age of 15.5 years underwent a mean follow-up of 8.6 years (1-21 years). The mean number of surgical interventions was 3.1 (1-8/patient), but patients who were stone free after their first treatment had lower recurrences (p = 0.91) and lower number of interventions during their follow-up (2.7/patient, compared to those who were not stone free at 4/patient). During their follow-up period, patients with < 3 interventions had a significantly better renal function than those with ≥ 3 surgical interventions (p = 0.04). Additionally, linear regression analysis showed that eGFR was demonstrated to decline with increasing numbers of stone episodes (r 2  = 0.169). It was also noted that patients who began early medical management remained stone free during follow-up compared to those who had medical management after ≥ 2 stone episodes, of whom all had a recurrent episode. Our long-term longitudinal study of cystine stone formers highlights that patients who are stone free and receive early metabolic stone screening and medical management after their initial presentation have the lowest recurrence rates and tend to preserve their renal function. Hence, prompt referral for metabolic assessment, and the stone and fragments entirely removed (SaFER) principles are key to preventing stone episodes and improving long-term function.

A Prospective Evaluation of High-Resolution CT Parameters in Predicting Extracorporeal Shockwave Lithotripsy Success for Upper Urinary Tract Calculi.

PubMed

Abdelhamid, Mahmoud; Mosharafa, Ashraf A; Ibrahim, Hamdy; Selim, Hany M; Hamed, Mohamed; Elghoneimy, Mohamed N; Salem, Hosny K; Abdelazim, Mohamed S; Badawy, Hesham

2016-11-01

To evaluate the ability of noncontrast CT parameters (stone size, stone attenuation, and skin-to-stone distance [SSD]) to predict the outcome of extracorporeal shockwave lithotripsy (SWL) in a prospective cohort of patients with renal and upper ureteric stones. Patients with stones 5 to 20 mm were prospectively enrolled from 2011 to 2014. Patients had NCCT with recording of stone size, stone mean attenuation, and SSD, as well as various stone and patient parameters. The numbers of needed sessions as well as the final outcome were determined, with SWL failure defined as residual fragments >3 mm. Predictors of SWL failure were assessed by multiple regression analysis. Two hundred twenty patients (mean ± standard deviation [SD] age 41.5 ± 12.4 years) underwent SWL. Mean ± SD stone size was 11.3 ± 4.1 mm, while mean ± SD stone attenuation was 795.1 ± 340.4 HU. Mean ± SD SSD was 9.4 ± 2.1 cm. The average number of sessions was 1.64. SWL was effective in 186 (84.5%) patients (group A), while 34 (15.5%) patients had significant residual fragments (>3 mm). On univariate analysis, predictors of SWL failure included stone attenuation >1000 HU, older age, higher body mass index, higher attenuation value, larger stone size, and longer SSD. Increased SSD and higher stone attenuation retained their significance as independent predictors of SWL failure (p < 0.05) on multiple regression analysis both after first session and as final SWL outcome. A positive correlation was found between number of SWL sessions and mean stone attenuation (r = 0.6, p < 0.001) and SSD (r = 4, p < 0.001). Stone mean attenuation and SSD on noncontrast CT are significant independent predictors of SWL outcome in patients with renal and ureteric stones. These parameters should be included in clinical decision algorithms for patients with urolithiasis. For patients with stones having mean attenuation of >1000 HU and/or large SSDs, alternatives to SWL should be considered.

[Gallbladder Stone Types in Patients with Cholelithiasis and Clonorchis sinensis Infection in the Endemic Area of Clonorchiasis].

PubMed

Ma, Rui-hong; Qiao, Tie; Luo, Zhen-liang; Luo, Xiao-bing; Zheng, Pei-ming; Yang, Liu-qing

2015-06-01

To investigate the relationship between Clonorchis sinensis infection and the gallbladder stone type in patients with cholelithiasis in the endemic area of clonorchiasis. Gallbladder stones were collected from 598 patients with cholelithiasis through minimally invasive gallbladder-preserving cholelithotomy in the Sixth People's Hospital of Nansha District from May 2009 to October 2012. The stone samples were analyzed for composition by Fourier transform infrared spectroscopy to identify their types. The Clonorchis sinensis eggs were detected in the stones by microscopic examination, and the detection rates of eggs were calculated for different stone types. Then the clinical characteristics and biochemical indicators were compared among patients with different types of stones, as well as between Clonorchis sinensis egg-positive and -negative patients with the calcium-carbonate type of stones. Some calcium-carbonate stones positive for Clonorchis sinensis eggs were randomly selected for further scanning electron microscopy (SEM) examination. Of the stones from 598 patients, 234 (39.1%) were cholesterol type, 133 (22.2%) bile pigment type, 112(18.7%) calcium-carbonate type, 86 (14.4%) mixed types and 33(5.5%) were others. The detection rate of Clonorchis sinensis eggs in these types was 6% (15/234), 44% (59/133), 60% (67/112), 36% (31/ 86) and 30% (10/33), respectively, being highest in calcium-carbonate stones while lowest in cholesterol stones. The Co2-combining power of the plasma was higher in patients with calcium-carbonate and mixed stones than in those with cholesterol stones (P < 0.05), and the CO2-combining power of the bile and biliary pH were both higher in patients with calcium-carbonate types than in those with other types (P < 0.05). In addition, in patients with calcium-carbonate stones, the CO2-combining powers of the plasma and the bile, as well as biliary pH were all higher in the egg-positives than in the egg-negatives. Further, both light microscopy and SEM revealed adherence of the Clonorchis sinensis eggs to calcium-carbonate crystals. The infection rate of Clonorchis sinensis is higher in patients with calcium-carbonate gallbladder stones than in those with other types of stones.

COMPUTED TOMOGRAPHY VERSUS PLAIN RADIOGRAM IN EVALUATION OF RESIDUAL STONES AFTER PERCUTANEOUS NEPHROLITHOTOMY OR PYELONEPHROLITHOTOMY FOR COMPLEX MULTIPLE AND BRANCHED KIDNEY STONES.

PubMed

Wishahi, Mohamed; Elganzoury, Hossam; Elkhouly, Amr; Kamal, Ahmed M; Badawi, Mohamed; Eseaily, Khalid; Kotb, Samir; Morsy, Mohamed

2015-08-01

This study compared the efficacy of computed tomography of the urinary tract (CT urography) versus plain X-ray of the urinary tract (KUB) in detection and evaluation of the significance of residual stone after percutaneous nephrolithotripsy (PCNL) or surgical pyelonephrolithotomy (SPNL) for complex branching or multiple stones in the kidney. A retrospective prospective archival cohort of 168 patients underwent PCNL or SPNL for large stag horn or multiple stones in the kidney were evaluated, they were 113 patients who underwent SPNL, and 55 patients underwent PCNL. In all patients they had KUB second day of the operation, those who had multiple kidney punctures in the PCNL procedure for multiple stones, or multiple nephrotomies in the SPNL procedure, or had a radiolucent stones had an additional imaging with CT urography. Indications for the CT urography were cases of radiolucent stones and multiple small calyceal stones detected pre-operatively. The study was conducted between March 2010 and December 2014, data weie retrospectively analyzed. Preoperatively multiple or branching stones were diagnosed with intravenous urography and CT urography. Stone size and location were mapped pre-operatively on a real-size drawing, and three dimensional computed construction images in multiple planes. All patients were informed about the advantages, disadvantages and probable complications of both PCNL and SPNL before the selection of the procedure. Patients decided the type of the surgery type by themselves and written informed consent was obtained from all patients prior to the surgery. Patients were in two groups according to the patient's preference of surgery type. Group 1 consisted of 113 patients who underwent SPNL and Group 2 consisted of 55 patients treated with PCNL. Detection of residual stones stone postoperatively using KUB and CT urography was evaluated in both groups. There was statistical significance between the two imaging methodology in detection of residual stones after PCNL and/or SPNL. CT urography detected stones of 2 mm and up to 5mm which was not visualized with KUB. CT urography was statistically significant and precise in detecting the radiolucent stones of uric acid, urate, and phostate stones which were not detected by KUB.

IGCP 637 Heritage Stone Designation: A UNESCO and IUGS project on natural stones

NASA Astrophysics Data System (ADS)

Pereira, Dolores; Cooper, Barry; Schouenborg, Björn; Marker, Brian; Kramar, Sabina

2017-04-01

IGCP 637 was approved in 2015 to facilitate establishment of a new international geological standard for building and ornamental stones. Formal international recognition of those natural stone types that have achieved widespread utilization in human culture is now underway and the term "Global Heritage Stone Resource" (GHSR) has been proposed for this designation. Stones that have been used in heritage construction, sculptural masterpieces, as well as in utilitarian (yet culturally important) applications are obvious GHSR candidates. In co-ordination with these aims the project has an associated role to promote the adoption and use of the GHSR designation. Consequently an interim list of potential GHSRs is maintained and a register of GHSR approved stones is being created. IGCP 637 also enhances the capacity of the International Union of Geological Sciences (IUGS) in the realm of dimension stone and geological standards as it is the first IUGS involvement in this subject. As a consequence, the largest known international grouping of dimension stone professionals has been established. Within IGCP 637 a web page has been created at www.globalheritagestone.com, including information on the Working Group and also specific information on the evolution of the project. Several researchers were funded to attend the Heritage Stone working group activities, including researchers from Algeria, Malawi, India, Italy and Russia. We also have produced many publications, both as individual papers and special issues in journals included in the Journal Citation Reports. Monographs are being prepared at present. Hopefully, IGCP 637 will help to widen the circle of researchers interested in natural stones as part of our geoheritage. Heritage Stone references: articles and special issues - Pereira, D. and Marker, B. (2016) The value of original natural stone in the context of architectural heritage. Geosciences, 6, 13. - Heritage Stone 1. Ed. Pereira and Pratt. (2016). Geoscience Canada, Series, vol. 43. - Global Heritage Stone Resource: An Update. Ed.: Pereira et al. (2015) Episodes, 38-2. - Global Heritage Stone: Towards International Recognition of Building and Ornamental Stones. Ed.: Pereira et al. (2015) Geological Society Special Publications, 407. - Pereira, D. and Baltuille, J.M. (2014) Documenting natural stone to preserve our cultural and architectonic heritage, Materiales de Construccion, 64 (314) - Engineering Geology for Society and Territory - Volume 5. Urban Geology, Sustainable Planning and Landscape Exploitation. Ed.: Lollino, G., et al. (2014). Springer International Publishing Switzerland.

Management of late biliary complications in patients with gallbladder stones in situ after endoscopic papillary balloon dilation.

PubMed

Tsujino, Takeshi; Kawabe, Takao; Isayama, Hiroyuki; Yashima, Yoko; Yagioka, Hiroshi; Kogure, Hirofumi; Sasaki, Takashi; Arizumi, Toshihiko; Togawa, Osamu; Ito, Yukiko; Matsubara, Saburo; Nakai, Yousuke; Sasashira, Naoki; Hirano, Kenji; Tada, Minoru; Omata, Masao

2009-04-01

Patients with untreated gallbladder stones in situ are at high risk for late biliary complications after endoscopic papillary balloon dilation (EPBD) and bile duct stone extraction. Few data exist on the short-term and long-term results in these patients after the recurrence of bile duct stones and acute cholecystitis. The aim of this study was to evaluate the outcome of late biliary complications in patients with gallbladder stones in situ after EPBD. Fifty-six patients who developed late biliary complications, including bile duct stone recurrence (n=43) and acute cholecystitis (n=13), were managed at our institutions. We investigated the short-term and long-term outcomes after the management of late biliary complications. Complete removal of recurrent bile duct stones was achieved in 38 of 43 patients (88%) by repeated EPBD alone. Pancreatitis after repeated EPBD occurred in two patients (5%). After successful bile duct stone extraction by EPBD, none of the 16 patients who underwent cholecystectomy developed late biliary complications (mean follow-up period of 5.2 years), wheras re-recurrent bile duct stones occurred in three of the 21 patients (14%) with gallbladder stones left in situ (mean follow-up period of 4.4 years)(P=0.1148). Re-recurrent bile duct stones were successfully treated endoscopically. One of the eight patients who did not undergo cholecystectomy for acute cholecystitis had a recurrence of cholecystitis, which was managed conservatively. The long-term outcomes of late biliary complications are favorable when patients with concomitant gallbladder stones undergo cholecystectomy. Re-recurrent bile duct stones are considerable when gallbladder stones are left in situ, but should be treated endoscopically.

Management of late biliary complications in patients with gallbladder stones in situ after endoscopic papillary balloon dilation.

PubMed

Tsujino, Takeshi; Kawabe, Takao; Isayama, Hiroyuki; Yashima, Yoko; Yagioka, Hiroshi; Kogure, Hirofumi; Sasaki, Takashi; Arizumi, Toshihiko; Togawa, Osamu; Ito, Yukiko; Matsubara, Saburo; Nakai, Yousuke; Sasashira, Naoki; Hirano, Kenji; Tada, Minoru; Omata, Masao

2009-04-01

Patients with untreated gallbladder stones in situ are at high risk for late biliary complications after endoscopic papillary balloon dilation (EPBD) and bile duct stone extraction. Few data exist on the short-term and long-term results in these patients after the recurrence of bile duct stones and acute cholecystitis. The aim of this study was to evaluate the outcome of late biliary complications in patients with gallbladder stones in situ after EPBD. Fifty-six patients who developed late biliary complications, including bile duct stone recurrence (n=43) and acute cholecystitis (n=13), were managed at our institutions. We investigated the short-term and long-term outcomes after the management of late biliary complications. Complete removal of recurrent bile duct stones was achieved in 38 of 43 patients (88%) by repeated EPBD alone. Pancreatitis after repeated EPBD occurred in two patients (5%). After successful bile duct stone extraction by EPBD, none of the 16 patients who underwent cholecystectomy developed late biliary complications (mean follow-up period of 5.2 years), whereas re-recurrent bile duct stones occurred in three of the 21 patients (14%) with gallbladder stones left in situ (mean follow-up period of 4.4 years)(P=0.1148). Re-recurrent bile duct stones were successfully treated endoscopically. One of the eight patients who did not undergo cholecystectomy for acute cholecystitis had a recurrence of cholecystitis, which was managed conservatively. The long-term outcomes of late biliary complications are favorable when patients with concomitant gallbladder stones undergo cholecystectomy. Re-recurrent bile duct stones are considerable when gallbladder stones are left in situ, but should be treated endoscopically.

Effects of Stone Size on the Comminution Process and Efficiency in Shock Wave Lithotripsy

PubMed Central

Zhang, Ying; Nault, Isaac; Mitran, Sorin; Iversen, Edwin S.; Zhong, Pei

2016-01-01

The effects of stone size on the process and comminution efficiency in shock wave lithotripsy (SWL) are investigated by experiments, numerical simulations, and scale analysis. Cylindrical BegoStone phantoms with approximately equal height and diameter of either 4-, or 7- or 10-mm, in a total aggregated mass of about 1.5 g, were treated in an electromagnetic shock wave lithotripter field. The resultant stone comminution (SC) was found to correlate closely with the average peak pressure, P+(avg), incident on the stones. The P+(avg) threshold to initiate stone fragmentation in water increased from 7.9 to 8.8 to 12.7 MPa, respectively, when the stone size decreased from 10 to 7 to 4 mm. Similar changes in the P+(avg) threshold were observed for the 7- and 10-mm stones treated in 1,3-butanediol where cavitation is suppressed, suggesting that the observed size dependency is due to changes in stress distribution within different size stones. Moreover, the slope of the correlation curve between SC and ln(P‒+(avg)) in water increased with decreasing stone size, while the opposite trend was observed in 1,3-butanediol. The progression of stone comminution in SWL showed a size-dependency with the 7- and 10-mm stones fragmented into progressively smaller pieces while a significant portion (> 30%) of the 4-mm stones were stalemated within the size range of 2.8 ~ 4 mm even after 1,000 shocks. Analytical scaling considerations suggest size-dependent fragmentation behaviour, a hypothesis further supported by numerical model calculations that exhibit changing patterns of constructive and destructive wave interference, and thus variations in the maximum tensile stress or stress integral produced in cylindrical and spherical stone of different sizes. PMID:27515177

The effect of climate variability on urinary stone attacks: increased incidence associated with temperature over 18 °C: a population-based study.

PubMed

Park, Hyoung Keun; Bae, Sang Rak; Kim, Satbyul E; Choi, Woo Suk; Paick, Sung Hyun; Ho, Kim; Kim, Hyeong Gon; Lho, Yong Soo

2015-02-01

The aim of this study was to evaluate the effect of seasonal variation and climate parameters on urinary tract stone attack and investigate whether stone attack is increased sharply at a specific point. Nationwide data of total urinary tract stone attack numbers per month between January 2006 and December 2010 were obtained from the Korean Health Insurance Review and Assessment Service. The effects of climatic factors on monthly urinary stone attack were assessed using auto-regressive integrated moving average (ARIMA) regression method. A total of 1,702,913 stone attack cases were identified. Mean monthly and monthly average daily urinary stone attack cases were 28,382 ± 2,760 and 933 ± 85, respectively. The stone attack showed seasonal trends of sharp incline in June, a peak plateau from July to September, and a sharp decline after September. The correlation analysis showed that ambient temperature (r = 0.557, p < 0.001) and relative humidity (r = 0.513, p < 0.001) were significantly associated with urinary stone attack cases. However, after adjustment for trends and seasonality, ambient temperature was the only climate factor associated with the stone attack cases in ARIMA regression test (p = 0.04). Threshold temperature was estimated as 18.4 °C. Risk of urinary stone attack significantly increases 1.71% (1.02-2.41 %, 95% confidence intervals) with a 1 °C increase of ambient temperature above the threshold point. In conclusion, monthly urinary stone attack cases were changed according to seasonal variation. Among the climates variables, only temperature had consistent association with stone attack and when the temperature is over 18.4 °C, urinary stone attack would be increased sharply.

Do Urinary Cystine Parameters Predict Clinical Stone Activity?

PubMed

Friedlander, Justin I; Antonelli, Jodi A; Canvasser, Noah E; Morgan, Monica S C; Mollengarden, Daniel; Best, Sara; Pearle, Margaret S

2018-02-01

An accurate urinary predictor of stone recurrence would be clinically advantageous for patients with cystinuria. A proprietary assay (Litholink, Chicago, Illinois) measures cystine capacity as a potentially more reliable estimate of stone forming propensity. The recommended capacity level to prevent stone formation, which is greater than 150 mg/l, has not been directly correlated with clinical stone activity. We investigated the relationship between urinary cystine parameters and clinical stone activity. We prospectively followed 48 patients with cystinuria using 24-hour urine collections and serial imaging, and recorded stone activity. We compared cystine urinary parameters at times of stone activity with those obtained during periods of stone quiescence. We then performed correlation and ROC analysis to evaluate the performance of cystine parameters to predict stone activity. During a median followup of 70.6 months (range 2.2 to 274.6) 85 stone events occurred which could be linked to a recent urine collection. Cystine capacity was significantly greater for quiescent urine than for stone event urine (mean ± SD 48 ± 107 vs -38 ± 163 mg/l, p <0.001). Cystine capacity significantly correlated inversely with stone activity (r = -0.29, p <0.001). Capacity also correlated highly negatively with supersaturation (r = -0.88, p <0.001) and concentration (r = -0.87, p <0.001). Using the suggested cutoff of greater than 150 mg/l had only 8.0% sensitivity to predict stone quiescence. Decreasing the cutoff to 90 mg/l or greater improved sensitivity to 25.2% while maintaining specificity at 90.9%. Our results suggest that the target for capacity should be lower than previously advised. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Evaluating factors that dictate struvite stone composition: A multi-institutional clinical experience from the EDGE Research Consortium.

PubMed

Flannigan, Ryan K; Battison, Andrew; De, Shubha; Humphreys, Mitchell R; Bader, Markus; Lellig, Ekaterina; Monga, Manoj; Chew, Ben H; Lange, Dirk

2018-04-01

Struvite stones account for 15% of urinary calculi and are typically associated with urease-producing urinary tract infections and carry significant morbidity. This study aims to characterize struvite stones based on purity of stone composition, bacterial speciation, risk factors, and clinical features. Retrospective data was collected from patients diagnosed with infection stones between 2008 and 2012. Stone analysis, perioperative urine cultures, bacterial speciation, and clinical data were collected and analyzed. The purity of struvite stones was determined. Statistical comparisons were made among homogeneous and heterogeneous struvite stones. From the four participating centres, 121 struvite stones were identified. Only 13.2% (16/121) were homogenous struvite. Other components included calcium phosphate (42.1%), calcium oxalate (33.9%), calcium carbonate (27.3%), and uric acid (5.8%). Partial or full staghorn calculi occurred in 23.7% of cases. Urease-producing bacteria were only present in 30% of cases. Proteus, E. coli, and Enterococcus were the most common bacterial isolates from perioperative urine, and percutaneous nephrolithotomy was the most common modality of treatment. Only 40% of patients had a urinalysis that was nitrite-positive, indicating that urinalysis alone is not reliable for diagnosing infection stones. The study's limitation is its retrospective nature; as such, the optimal timing of cultures with respect to stone analysis or treatment was not always possible, urine cultures were often not congruent with stone cultures in the same patient, and our findings of E. coli commonly cultured does not suggest causation. Struvite stones are most often heterogeneous in composition. Proteus remains a common bacterial isolate; however, E. coli and Enterococcus were also frequently identified. This new data provides evidence that patients with struvite stones can have urinary tract pathogens other than urease-producing bacteria, thus challenging previous conventional dogma.

Evaluation of renal function in patients with a main renal stone larger than 1 cm and perioperative renal functional change in minimally invasive renal stone surgery: a prospective, observational study.

PubMed

Piao, Songzhe; Park, Juhyun; Son, Hwancheol; Jeong, Hyeon; Cho, Sung Yong

2016-05-01

To compare the perioperative relative renal function and determine predictors of deterioration and recovery of separate renal function in patients with renal stones >10 mm and who underwent mini-percutaneous nephrolithotomy or retrograde intra-renal surgery. A main stone >10 mm or stones growing, high-risk stone formers and extracorporeal shock-wave lithotripsy-resistant stones were prospectively included in 148 patients. Patients with bilateral renal stones and anatomical deformities were excluded. Renal function was evaluated by estimated glomerular filtration rate, 99m-technetium dimercaptosuccinic acid and 99m-technetium diethylenetriamine pentaacetate prior to intervention and at postoperative 3 months. Logistic regression analyses were performed to find predictors of functional deterioration and recovery. The overall stone-free rate was 85.1 %. A third of patients (53/148, 35.8 %) with renal stones >10 mm showed deterioration of separate renal function. Mean renal function of operative sites showed 58.2 % (36.8 %/63.2 %) of that of contralateral sites in these patients. Abnormal separate renal function showed postoperative recovery in 31 patients (58.5 %). Three cases (5.7 %) showed deterioration of separate renal function despite no presence of remnant stones. Improvement rates of the abnormal separate renal function did not differ according to the type of surgery. The presence of hydronephrosis and three or more stones were significant predictors for renal function deterioration. Female gender and three or more stones were significantly correlated with postoperative recovery. Mini-percutaneous nephrolithotomy or retrograde intra-renal surgery was effective and safe for renal function preservation. Patients with multiple large stones should be considered for candidates of active surgical removal.

Pattern of urinary tract stone diseases in Mekelle, Ethiopia.

PubMed

Alemu, Mekonnen Hagos

2008-07-01

To evaluate and analyze the pattern of patients with urinary stone diseases admitted to Mekelle Hospital. Between Sept 2003 to Sept 2006, 102 patients with urinary stone disease were admitted to Mekelle Hospital. In this descriptive retrospective audit, case notes were obtained from medical record office and were analyzed for age, sex, localization of the stone disease and the geographic back grounds. Seventy six (74.5%) of the patients were males and 26 (25.5%) were females. There were 102 (13.6%) cases of urinary stone disease admitted to Mekelle Hospital out of 750 total admissions for urological disease for intervention in the surgical ward during the study period. There were 76 (74.5%) males and 26 (25.5%) females and the sex ratio was (M: F: 2.9:1). Most (46.0%) of the urinary stone diseases were between 0-19 year age group both in males and females. The median age was 20 years (range from 2-74 years) and the mean was 25.4 years. Urinary bladder stones were the most common urinary tract stone diseases accounting for 47 (46.0%) followed by renal stones 29 (28.4%), ureteric 16 (15.6%) and urethral 10 (9.8%) stone disease; in that order of frequency. The geographical back ground of the patients with urinary tract stone disease in this report has shown that majorities (53.7%) were from urban and the remaining (44.2%) were from the rural areas. This study has depicted that urinary bladder stone diseases are the most common stone diseases affecting the younger age group. Since this is an institutional based study, it underestimates the magnitude and the pattern of urinary stone diseases at all level. Nevertheless, the audit provides useful information on the socio demographic variables, localization and the geographic back ground of the patients.

Interpreting the results of chemical stone analysis in the era of modern stone analysis techniques

PubMed Central

Gilad, Ron; Williams, James C.; Usman, Kalba D.; Holland, Ronen; Golan, Shay; Ruth, Tor; Lifshitz, David

2017-01-01

Introduction and Objective Stone analysis should be performed in all first-time stone formers. The preferred analytical procedures are Fourier-transform infrared spectroscopy (FT-IR) or X-ray diffraction (XRD). However, due to limited resources, chemical analysis (CA) is still in use throughout the world. The aim of the study was to compare FT-IR and CA in well matched stone specimens and characterize the pros and cons of CA. Methods In a prospective bi-center study, urinary stones were retrieved from 60 consecutive endoscopic procedures. In order to assure that identical stone samples were sent for analyses, the samples were analyzed initially by micro-computed tomography to assess uniformity of each specimen before submitted for FTIR and CA. Results Overall, the results of CA did not match with the FTIR results in 56% of the cases. In 16% of the cases CA missed the major stone component and in 40% the minor stone component. 37 of the 60 specimens contained CaOx as major component by FTIR, and CA reported major CaOx in 47/60, resulting in high sensitivity, but very poor specificity. CA was relatively accurate for UA and cystine. CA missed struvite and calcium phosphate as a major component in all cases. In mixed stones the sensitivity of CA for the minor component was poor, generally less than 50%. Conclusions Urinary stone analysis using CA provides only limited data that should be interpreted carefully. Urinary stone analysis using CA is likely to result in clinically significant errors in its assessment of stone composition. Although the monetary costs of CA are relatively modest, this method does not provide the level of analytical specificity required for proper management of patients with metabolic stones. PMID:26956131

Calcium Stone Growth in Urine from Cystic Fibrosis Patients and Healthy Controls

NASA Astrophysics Data System (ADS)

McSorley, Anita; Jones, Andrew M.; Webb, A. Kevin; Rao, P. Nagaraj; Kavanagh, John P.

2007-04-01

Cystic fibrosis patients have an increased risk of renal stone disease. There is some evidence that this may be related to a different excretory pattern of stone risk factors, but an alternative hypothesis, that the urine of cystic fibrosis patients is deficient in urinary inhibitors of crystallization and stone formation has not been tested. Here we have grown calcium stones, in vitro, in the presence of urine from healthy controls and compared this with growth in the presence of urine from cystic fibrosis patients. A stone farm was used to grow twelve calcium stones simultaneously, firstly in artificial urine for about 200 hours and then in 90% whole human urine for another 500 hours. Six of the stones received urine from healthy controls and six received urine from adult cystic fibrosis patients. There were no significant differences in stone mass at any of the key time points or in the overall growth pattern (p>0.05) between stones destined for, or treated with, urine from CF patients and the controls. Human urine greatly inhibited stone growth in vitro but there was no difference in the growth rate in urine from healthy controls and CF patients. This refutes the hypothesis that a tendency for a higher prevalence of urinary stones in CF patients is related to a deficiency in inhibitory activity.

Outcomes of Conservative Management of Asymptomatic Live Donor Kidney Stones.

PubMed

Sarier, Mehmet; Duman, Ibrahim; Callioglu, Mehmet; Soylu, Ahmet; Tekin, Sabri; Celep, Emrah; Turan, Hasan; Yavuz, Asuman Havva; Demirbas, Alper; Kukul, Erdal

2018-05-10

To evaluate the long-term outcomes of asymptomatic stones ≤4 mm which are left in situ during renal transplantation (RT). Between 2009 and 2017, 31 patients who received stone-bearing (≤4 mm) kidneys were analyzed. At their last follow-up, the patients were evaluated with CT imaging and the results were compared to the initial CT findings obtained during donor evaluation. The mean stone size was 2.9mm (range 1-4.3). The mean follow-up period after RT was 43.1 months (range 12-97). According to the CT findings of the last follow-up, the stone had passed spontaneously in 26(83.9%) patients. Three patients (9.6%) with a stone size of 4 mm required surgical intervention because the stone became symptomatic within the first year after transplantation. In the remaining 2 patients (6.4%), the stone remained in situ, without a change in its size. In terms of spontaneous passage rate, there was no significant difference between lower and mid-upper pole stones (p=0.948). De novo stone formation was observed in 2(6.4%) patients. Asymptomatic stones <4 mm which are detected on donor evaluation may safely be left in situ during RT. Regardless of their localization in the kidney, these stones have high spontaneous passage rates after RT, and the long-term recurrence rates are also considerably low. Copyright © 2018 Elsevier Inc. All rights reserved.

The surgical management of upper tract stone disease among spinal cord-injured patients.

PubMed

Welk, B; Shariff, S; Ordon, M; Catharine Craven, B; Herschorn, S; Garg, A X

2013-06-01

Retrospective cohort study, using linked, population-based health-care data. To describe the incidence, management and outcomes of surgically treated kidney stones after spinal cord injury (SCI). To evaluate the impact of a past history of kidney stones on the occurrence of kidney stones. Ontario, Canada. A total of 5121 patients were followed a median of 4 years after an incident SCI (occurring between 2002 and 2011). The primary outcome was surgical intervention for upper tract kidney stones. In follow-up, 66 patients (1.3%) had 89 episodes of surgically treated kidney stones. Treatments included: ureteroscopic lithotripsy (34%), ureteral stent/percutaneous nephrostomy (30%), shockwave lithotripsy (19%) or percutaneous nephrolithotripsy (17%). Following stone treatment, the 30-day mortality rate was low, and the 30-day admission rate to an intensive care unit was 12%. A history of surgically treated kidney stones before SCI (compared with no such history) was associated with a higher risk of kidney stones after SCI (27 vs 3 per 1000 person-years; adjusted hazard ratio 14.74, 95% confidence interval 5.69-38.22). During intermediate follow-up after SCI, surgically treated upper tract kidney stones occur in 1.3% of patients. Ureteroscopy with lithotripsy is the most common treatment. A history of surgically managed kidney stones before SCI portends a higher risk of stones after SCI.

Kidney stones: Composition, frequency and relation to metabolic diagnosis.

PubMed

Spivacow, Francisco R; Del Valle, Elisa E; Lores, Ernesto; Rey, Paula G

Nephrolithiasis is one of the most frequent urologic diseases. The aim of this paper is to study the composition and frequency of 8854 patient kidney stones and in a subset of them their metabolic risk factors to be related to their type of calculi. Physicochemical and crystallographic methods were used to assess kidney stone composition. In a subset of 715 patients, we performed an ambulatory metabolic protocol with diagnostic purposes. From the total sample 79% of stones were made of calcium salts (oxalate and phosphate), followed by uric acid stones in 16.5%, calcium salts and uric acid in 2%, other salts in 1.9% and cystine in 0.6%. Male to female ratio was almost three times higher in calcium salts and other types of stones, reaching a marked male predominance in uric acid stones, M/F 18.8 /1.0. The major risk factors for calcium stones are idiopathic hypercalciuria, followed by unduly acidic urine pH and hyperuricosuria. In uric acid stones unduly acidic urine pH and less commonly hyperuricosuria are the most frequent biochemical diagnosis. Our results show that analysis of kidney stones composition and the corresponding metabolic diagnosis may provide a scientific basis for the best management and prevention of kidney stone formation, as well as it may help us to study the mechanisms of urine stone formation.

Rapid vaporization of kidney stones, ex vivo, using a Thulium fiber laser at pulse rates up to 500 Hz with a stone basket

NASA Astrophysics Data System (ADS)

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

2014-03-01

The Holmium:YAG laser (λ = 2120 nm) is currently the preferred laser for fragmenting kidney stones in the clinic. However, this laser has some limitations, including operation at low pulse rates and a multimode spatial beam profile which prohibits its use with smaller, more flexible optical fibers. Our laboratory is studying the Thulium fiber laser (λ = 1908 nm) as an alternative lithotripter. The TFL has several advantages, including lower stone ablation thresholds, use with smaller and more flexible fibers, and operation at arbitrary pulse lengths and pulse rates. Previous studies have reported increased stone ablation rates with TFL operation at higher pulse rates, however, stone retropulsion remains an obstacle to even more efficient stone ablation. This study explores TFL operation at high pulse rates in combination with a stone stabilization device (e.g. stone basket) for improved efficiency. A TFL beam with pulse energy of 35 mJ, pulse duration of 500-μs, and pulse rates of 10-500 Hz was coupled into 100-μm-core, low-OH, silica fibers, in contact mode with uric acid and calcium oxalate monohydrate stones, ex vivo. TFL operation at 500 Hz produced UA and COM stone ablation rates up to 5.0 mg/s and 1.3 mg/s, respectively. High TFL pulse rates produced increased stone ablation rates sufficient for use in the clinic.

Differentiation of uric acid versus non-uric acid kidney stones in the presence of iodine using dual-energy CT

NASA Astrophysics Data System (ADS)

Wang, J.; Qu, M.; Leng, S.; McCollough, C. H.

2010-04-01

In this study, the feasibility of differentiating uric acid from non-uric acid kidney stones in the presence of iodinated contrast material was evaluated using dual-energy CT (DECT). Iodine subtraction was accomplished with a commercial three material decomposition algorithm to create a virtual non-contrast (VNC) image set. VNC images were then used to segment stone regions from tissue background. The DE ratio of each stone was calculated using the CT images acquired at two different energies with DECT using the stone map generated from the VNC images. The performance of DE ratio-based stone differentiation was evaluated at five different iodine concentrations (21, 42, 63, 84 and 105 mg/ml). The DE ratio of stones in iodine solution was found larger than those obtained in non-iodine cases. This is mainly caused by the partial volume effect around the boundary between the stone and iodine solution. The overestimation of the DE ratio leads to substantial overlap between different stone types. To address the partial volume effect, an expectation-maximization (EM) approach was implemented to estimate the contribution of iodine and stone within each image pixel in their mixture area. The DE ratio of each stone was corrected to maximally remove the influence of iodine solutions. The separation of uric-acid and non-uric-acid stone was improved in the presence of iodine solution.

Metabolic stone composition in Egyptian children.

PubMed

Aggour, Ashraf; Ziada, Ali M; AbdelHamid, Ahmad Z; AbdelRahman, Sherif; Morsi, Ahmad

2009-04-01

The composition of urinary stones in children depends on socioeconomic conditions, geography and dietary habits. Pediatric urolithiasis remains endemic in developing countries. The aim of this study was to analyze stone composition in an Egyptian patient population. We analyzed prospectively urinary stones from 100 consecutive children (73 males, 27 females), aged 14 months to 12 years. The stones were located in the upper urinary tract in 78%, lower urinary tract in 19% and both in 3%. Male patients had more lower urinary tract stones. On presentation 67% had flank pain and 37% had hematuria. Stones were treated by open surgery in 69% of patients, shockwave lithotripsy in 20% and endoscopic extraction in 13%. The components of the upper urinary tract calculi were calcium oxalate (47%), ammonium acid urate (26%) and calcium carbonate (21%), whereas the main components of the lower urinary tract calculi were ammonium acid urate (27.2%), struvite (27.2%) and calcium carbonate (22.7%). Urinary tract infection was involved in the development of one third of the stones. Endemic stones were present in 17% of patients, and stones of metabolic origin in 15%. The etiology of stone formation remained unknown in one third of patients. The epidemiological profile of urinary stones in Egyptian children can now be considered intermediate between developing countries where dietary deficiencies are the main causes and developed countries where infectious and metabolic calculi are observed.

7 CFR 330.302 - Domestic movements of earth (including soil), stone, etc.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 5 2010-01-01 2010-01-01 false Domestic movements of earth (including soil), stone...; GENERAL; PLANT PESTS; SOIL, STONE, AND QUARRY PRODUCTS; GARBAGE Movement of Soil, Stone, And Quarry Products § 330.302 Domestic movements of earth (including soil), stone, etc. The interstate movement from...

7 CFR 330.302 - Domestic movements of earth (including soil), stone, etc.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 5 2012-01-01 2012-01-01 false Domestic movements of earth (including soil), stone...; GENERAL; PLANT PESTS; SOIL, STONE, AND QUARRY PRODUCTS; GARBAGE Movement of Soil, Stone, And Quarry Products § 330.302 Domestic movements of earth (including soil), stone, etc. The interstate movement from...

7 CFR 330.302 - Domestic movements of earth (including soil), stone, etc.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 5 2011-01-01 2011-01-01 false Domestic movements of earth (including soil), stone...; GENERAL; PLANT PESTS; SOIL, STONE, AND QUARRY PRODUCTS; GARBAGE Movement of Soil, Stone, And Quarry Products § 330.302 Domestic movements of earth (including soil), stone, etc. The interstate movement from...

7 CFR 330.302 - Domestic movements of earth (including soil), stone, etc.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 5 2014-01-01 2014-01-01 false Domestic movements of earth (including soil), stone...; GENERAL; PLANT PESTS; SOIL, STONE, AND QUARRY PRODUCTS; GARBAGE Movement of Soil, Stone, And Quarry Products § 330.302 Domestic movements of earth (including soil), stone, etc. The interstate movement from...

7 CFR 330.302 - Domestic movements of earth (including soil), stone, etc.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 5 2013-01-01 2013-01-01 false Domestic movements of earth (including soil), stone...; GENERAL; PLANT PESTS; SOIL, STONE, AND QUARRY PRODUCTS; GARBAGE Movement of Soil, Stone, And Quarry Products § 330.302 Domestic movements of earth (including soil), stone, etc. The interstate movement from...

Effect of Cystone® on urinary composition and stone formation over a one year period.

PubMed

Erickson, S B; Vrtiska, T J; Lieske, J C

2011-07-15

Kidney stones are a common problem for which inadequate prevention exists. We recruited ten recurrent kidney stone formers with documented calcium oxalate stones into a two phased study to assess safety and effectiveness of Cystone(®), an herbal treatment for prevention of kidney stones. The first phase was a randomized double-blinded 12 week cross over study assessing the effect of Cystone(®) vs. placebo on urinary supersaturation. The second phase was an open label one year study of Cystone(®) to determine if renal stone burden decreased, as assessed by quantitative and subjective assessment of CT. Results revealed no statistically significant effect of Cystone(®) on urinary composition short (6 weeks) or long (52 weeks) term. Average renal stone burden increased rather than decreased on Cystone(®). Therefore, this study does not support the efficacy of Cystone(®) to treat calcium oxalate stone formers. Future studies will be needed to assess effects on stone passage, or on other stone types. Copyright © 2011 Elsevier GmbH. All rights reserved.

Absence of bacterial imprints on struvite-containing kidney stones: a structural investigation at the mesoscopic and atomic scale.

PubMed

Bazin, Dominique; André, Gilles; Weil, Raphael; Matzen, Guy; Emmanuel, Veron; Carpentier, Xavier; Daudon, M

2012-04-01

Bacterial imprints are always observed on highly carbonated apatite kidney stones but not struvite kidney stones. Struvite and carbonated apatite stones with a high CO(3)(2-)/PO(4)(3-) rate are believed to develop from infections, but their structural differences at the mesoscopic scale lack explanation. We investigated 17 urinary calculi composed mainly of struvite or carbonated apatite by Fourier transform infrared, scanning electron microscopy, and powder neutron diffraction techniques. Carbonated apatite but not struvite stones showed bacterial imprints. If the same stone contained both carbonated apatite and struvite components, bacterial imprints were observed on the carbonated apatite but not the struvite part. Moreover, neutron powder diffraction experiments revealed the crystal size of struvite stones were larger than that of carbonated apatite stones (250 ± 50 vs 50 nm). Bacterial imprints may appear more easily on kidney stones with small nanocrystals, such as carbonated apatite than with large nanocrystals, such as struvite. This approach may help identify bacteria contributing to stone formation, perhaps with negative results of urine culture. Copyright © 2012 Elsevier Inc. All rights reserved.

What can the microstructure of stones tell us?

PubMed Central

Williams, James C.; Worcester, Elaine; Lingeman, James E.

2016-01-01

How stones are retained within the kidney while small in size is still not fully understood. In this paper we show two examples of how stones are retained during early growth: One is growth on Randall’s (interstitial) plaque, and the other is growth on mineral that has formed as a luminal plug in a terminal collecting duct. These two mechanisms of stone retention during early growth have distinctive morphologic features that can be seen by methods that show the microscopic structure of the stones. Stones growing on Randall’s plaque display an apatite region that is typically not large in size (less than 0.5 mm across) but which usually shows luminal spaces, which are signs of its origin in the connective tissue of the papilla. Stones growing on ductal plugs also show attachment to a piece of apatite, but the apatite regions are typically larger (often >1 mm long and >0.5 mm wide), and they are solid, without spaces running through them. We propose that knowing the mechanisms of stone retention during early stone formation could allow for better treatment of stone diseases. PMID:27913855

Analysis of stone fragility in vitro and in vivo with piezoelectric shock waves using the EDAP LT-01.

PubMed

Wang, Y H; Grenabo, L; Hedelin, H; Pettersson, S; Wikholm, G; Zachrisson, B F

1993-04-01

A total of 100 whole stones was fragmented in vitro at 3-minute intervals with piezoelectric shock waves using the EDAP LT-01 device until all fragments were less than 2 mm. Larger stones and stones with a high computerized tomography attenuation needed longer treatments for fragmentation. Smoothly bulging stones with an even structure according to plain x-ray films were also more resistant to the shock wave treatment. Calcium oxalate monohydrate stones were not more difficult to break than other types of calculi. Stone fragments from 100 patients after extracorporeal shock wave lithotripsy were also analyzed. The average size of the fragments collected was less than 1 mm. Larger stones produced larger fragments and required more treatment sessions.

Gallstone disease. The clinical manifestations of infectious stones.

PubMed

Smith, A L; Stewart, L; Fine, R; Pellegrini, C A; Way, L W

1989-05-01

Gallstones from 82 patients were examined under a scanning electron microscope for evidence of bacteria, and the findings were compared with the clinical manifestations of the disease. Bacteria were present in 68% of pigment stones and the pigment portions of 80% of composite stones. These gallstones were referred to as infectious stones. No bacteria were found in cholesterol gallstones. Acute cholangitis was diagnosed in 52% of patients with infectious stones and in 18% of patients with noninfectious stones. Over half of the patients with noninfectious stones presented with mild symptoms. Infectious stones were more often associated with a previous common duct exploration, an urgent operation, infected bile, a common duct procedure, and complications. These data show that gallstone disease is more virulent in patients whose gallstones contain bacteria.

Tools to Improve the Accuracy of Kidney Stone Sizing with Ultrasound

PubMed Central

Dunmire, Barbrina; Hsi, Ryan S.; Cunitz, Bryan W.; Paun, Marla; Bailey, Michael R.; Sorensen, Mathew D.; Harper, Jonathan D.

2015-01-01

Abstract Purpose: Ultrasound (US) overestimates stone size when compared with CT. The purpose of this work was to evaluate the overestimation of stone size with US in an in vitro water bath model and investigate methods to reduce overestimation. Materials and Methods: Ten human stones (3–12 mm) were measured using B-mode (brightness mode) US by a sonographer blinded to the true stone size. Images were captured and compared using both a commercial US machine and software-based research US device. Image gain was adjusted between moderate and high stone intensities, and the transducer-to-stone depth was varied from 6 to 10 cm. A computerized stone-sizing program was developed to outline the stone width based on a grayscale intensity threshold. Results: Overestimation with the commercial device increased with both gain and depth. Average overestimation at moderate and high gain was 1.9±0.8 and 2.1±0.9 mm, respectively (p=0.6). Overestimation increased an average of 22% with an every 2-cm increase in depth (p=0.02). Overestimation using the research device was 1.5±0.9 mm and did not vary with depth (p=0.28). Overestimation could be reduced to 0.02±1.1 mm (p<0.001) with the computerized stone-sizing program. However, a standardized threshold consistent across depth, system, or system settings could not be resolved. Conclusion: Stone size is consistently overestimated with US. Overestimation increased with increasing depth and gain using the commercial machine. Overestimation was reduced and did not vary with depth, using the software-based US device. The computerized stone-sizing program shows the potential to reduce overestimation by implementing a grayscale intensity threshold for defining the stone size. More work is needed to standardize the approach, but if successful, such an approach could significantly improve stone-sizing accuracy and lead to automation of stone sizing. PMID:25105243

Self-organization of sorted patterned ground.

PubMed

Kessler, M A; Werner, B T

2003-01-17

Striking circular, labyrinthine, polygonal, and striped patterns of stones and soil self-organize in many polar and high alpine environments. These forms emerge because freeze-thaw cycles drive an interplay between two feedback mechanisms. First, formation of ice lenses in freezing soil sorts stones and soil by displacing soil toward soil-rich domains and stones toward stone-rich domains. Second, stones are transported along the axis of elongate stone domains, which are squeezed and confined as freezing soil domains expand. In a numerical model implementing these feedbacks, circles, labyrinths, and islands form when sorting dominates; polygonal networks form when stone domain squeezing and confinement dominate; and stripes form as hillslope gradient is increased.

Changing imperatives of architecture affecting dimension stone use in world commerce

USGS Publications Warehouse

Mcdonald, W.H.; Darr, D.D.

1996-01-01

The use of stone in building construction predates written history. From the time that stone was first used, builders have constructed stone buildings predominately from local or regional materials. However, since World War II, the stone business has become increasingly global. For example, French limestone is now sold to builders in the United States, and American granite is shipped to Japan. The internationalization of architectural and construction firms has encouraged this trend. Differences among nations in trade practices, environmental demands and the level of knowledge of dimension-stone characteristics make international trading in stone a risky and potentially disastrous business for unwary participants.

The "Global Heritage Stone Resource": Past, Present and Future

NASA Astrophysics Data System (ADS)

Cooper, Barry

2013-04-01

The "Global Heritage Stone Resource" designation arose in 2007 as a suggested mechanism to enhance international recognition of famous dimension stones. There were also many aspects of dimension stone study that had no formal recognition in mainstream geology and which could be recognised in a formal geological sense via an internationally acceptable geological standard. Such a standard could also receive recognition by other professionals and the wider community. From the start, it was appreciated that active quarrying would an important aspect of the designation so a designation different to any other standard was needed. Also the project was linked to the long-established Commission C-10 Building Stone and Ornamental Rocks of the International Association of Engineering Geology and the Environment (IAEG C-10). Since 2007, the "Global Heritage Stone Resource" (GHSR) proposal has evolved in both in stature and purpose due to an increasing number of interested international correspondents that were actively sought via conference participation. The "English Stone Forum" in particular was pursuing similar aims and was quick to advise that English dimension stone types were being recognised as having international, national or regional importance. Furthermore the proposed designation was suggested as to having significant value in safeguarding designated stone types whilst also providing a potential mechanism in preventing heritage stone replacement by cheap substitutes. During development it also became apparent that stone types having practical applications such as roofing slates and millstones or even stone types utilised by prehistoric man can also be recognised by the new designation. The heritage importance of architects was also recognised. Most importantly an international network evolved, primarily including geologists, that now seems to be the largest international grouping of dimension stone professionals. This has assisted the project to affiliate with the International Union of Geological Sciences (IUGS) in 2011 as its Heritage Stone Task Group (HSTG). The future is likely to hold further surprises. There could be benefits in establishing a permanent organisation or "Commission" within IUGS. There may also be value in preparing and maintaining an "International Guide to Heritage Stone Designation" that considers, not only those stone types that have international significance, but also those of national, regional and local importance. It is now considered that all dimension stone types may be considered a "potential heritage stone". Publications of all types that describe, discuss and promote nominated stone types will be beneficial. For good administration of the designation, the current HSTG "Terms of Reference" will likely require revision. For the immediate future, the major effort should focus on preparing and approving GHSR nominations. Over time the focus will likely move onto promoting community recognition of the designation, protecting recognised GHSRs and revising the existing heritage status of designated stones.

Multiple sclerosis and nephrolithiasis: a matched-case comparative study.

PubMed

Ganesan, Vishnu; Chen, Wen Min; Jain, Rajat; De, Shubha; Monga, Manoj

2017-06-01

To compare stone composition and serum/urine biochemistries in stone formers with multiple sclerosis (MS) against stone formers without MS and to examine the association between mobility, methods of bladder emptying, and stone formation. In this retrospective case-control study, we identified patients diagnosed with MS and kidney stone disease who were seen at our institution between 2001 and 2016. For the first part of the study, up to two controls (stone formers without a history of MS) were identified for each case and matched on age, body mass index, and sex. For the second part of this study, matched controls (MS patients without a history of stones) were identified in a 1:1 ratio in a similar fashion. Results of 24-h urine biochemistry studies, stone compositions, serum laboratory measures, medications, history of stone surgeries, mobility, and method of bladder emptying were collected. In all, 587 patients were identified who had both MS and a history of stone disease. Of these, 118 patients had a stone composition available. When compared to matched controls, patients with MS were significantly more likely to have calcium phosphate stones (42% vs 15%, P < 0.001) and struvite stones (8% vs 3%, P = 0.03) and less likely to have calcium oxalate monohydrate stones (39% vs 64%, P < 0.001). Among those patients with a composition available, those with MS were more likely to have undergone a percutaneous nephrolithotomy (PCNL; 25% vs 12%, P = 0.005) or a cystolithopaxy (16% vs 3%, P < 0.001) compared to their matched controls. In all, 61 patients had a complete 24-h urinary stone panel. There were no significant differences in urinary pH, volume, creatinine, calcium, citrate, oxalate, sodium, and uric acid as well as rates of hypocitraturia, hyperoxaluria, hypercalciuria, and hyperuricosuria among patients with MS. Use of intermittent straight catheterisation [ISC; odds ratio (OR) 3.50, 95% confidence interval (CI) 1.89-6.47]; P < 0.001] or an indwelling catheter (OR 9.78, 95% CI 4.81-19.88; P < 0.001) for bladder emptying was significantly associated with stone disease. There was no association between level of mobility and stone disease (P = 0.10). Similar to findings seen in patients with spinal cord injuries, patients with MS have a high incidence of calcium phosphate stones and struvite stones when compared with matched controls. Additionally, they were more likely to undergo PCNL. The method of bladder management appears to be a risk factor in the development of stone disease. These findings suggest the importance of prompt treatment of urinary tract infections in this population and delay the use of ISC, suprapubic tube, or an indwelling Foley, when possible. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

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

PubMed

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

2015-02-01

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

Urinary stone composition in Israel: current status and variation with age and sex--a bicenter study.

PubMed

Usman, Kalba D; Golan, Shay; Abdin, Tamer; Livne, Pinhas M; Pode, Dov; Duvdevani, Mordechai; Lifshitz, David

2013-12-01

The epidemiologic data regarding stone composition in Israel are based on anachronistic methods of stone analysis. Historically, Israel was noted for an unusually high percentage of uric acid stones. The aim of the study was to describe the current stone composition distribution in Israel, using modern techniques of urinary stone analysis. Age and sex correlations were investigated. In a bicenter study, using infrared spectroscopy and X-ray diffraction, stones from five hundred and thirty eight (538) patients were analyzed and demographic data recorded. The study cohort included 401 men (74.5%) and 137 women (25.5%) with a male to female ratio of 2.9:1 and a median age of 48 years (range 2-85 years). While calcium oxalate monohydrate was the predominant component in both sexes, it was lower in female patients (77.3% vs 65%). The rate of infection stones (struvite+carbonate apatite) was significantly higher in women (35.7% vs 10.2%). Uric acid stones were found in only 14.5% of the patients and increased with age. Conversely, the rate of calcium oxalate dihydrate decreased with age. Modern techniques of urinary stone analysis showed that the most frequent stone component in Israel is calcium oxalate monohydrate. In contrast to earlier reports and in accordance with reports from other countries, the overall frequency of uric acid is 14.5%. With age, the frequency of uric acid increases reaching 21% in persons >60 years old. A significant sex difference was noted in the distribution of calcium oxalate stones and infection stones. The classic 3:1 ratio was maintained, however.

Intrarenal Surgery vs Percutaneous Nephrolithotomy in the Management of Lower Pole Stones Greater than 2 cm.

PubMed

Koyuncu, Hakan; Yencilek, Faruk; Kalkan, Mehmet; Bastug, Yavuz; Yencilek, Esin; Ozdemir, Ahmet Tunc

2015-01-01

To compare the efficacy of RIRS and PNL in lower pole stones ≥ 2 cm. Materials and and Methods: A total of 109 patients who underwent PNL or RIRS for solitary lower pole stone between April 2009 and December 2012, were retrospectively analyzed. Lower pole stone was diagnosed with CT scan. Stone size was assessed as the longest axis of the stone. All patients were informed about the advantages, disadvantages and probable complications of both PNL and RIRS before the selection of the procedure. Patients decided the surgery type by themselves without being under any influences and written informed consent was obtained from all patients prior to the surgery. Patients were divided into two groups according to the patients' preference of surgery type. Group 1 consisted of 77 patients who underwent PNL and Group 2 consisted of 32 patients treated with RIRS. Stone free statuses, postoperative complications, operative time and hospitalization time were compared in both groups. There was no statistical significance between the two groups in mean age, stone size, stone laterality, mean follow-up periods and mean operative times. In PNL group, stone-free rate was 96.1% at first session and 100% after the additional procedure. In Group 2, stone-free rate was 90.6% at the first procedure and 100% after the additional procedure. The final stone-free rates and operative times were similar in both groups. RIRS should be an effective treatment alternative to PNL in lower pole stones larger than 2 cm, especially in selected patients.

Percutaneous nephrolithotomy versus extracorporeal shock wave lithotripsy for moderate sized kidney stones.

PubMed

Deem, Samuel; Defade, Brian; Modak, Asmita; Emmett, Mary; Martinez, Fred; Davalos, Julio

2011-10-01

To compare the outcomes of percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (ESWL) for moderate sized (1-2 cm) upper and middle pole renal calculi in regards to stone clearance rate, morbidity, and quality of life. All patients diagnosed with moderate sized upper and middle pole kidney stones by computed tomography (CT) were offered enrollment. They were randomized to receive either ESWL or PNL. The SF-8 quality of life survey was administered preoperatively and at 1 week and 3 months postoperatively. Abdominal radiograph at 1 week and CT scan at 3 months were used to determine stone-free status. All complications and outcomes were recorded. PNL established a stone-free status of 95% and 85% at 1 week and 3 months, respectively, whereas ESWL established a stone-free status of 17% and 33% at 1 week and 3 months, respectively. Retreatment in ESWL was required in 67% of cases, with 0% retreatment in PNL. Stone location, stone density, and skin-to-stone distance had no impact on stone-free rates at both visits, irrespective of procedure. Patient-reported outcomes, including overall physical and mental health status, favored a better quality of life for patients who had PNL performed. PNL more often establishes stone-free status, has a more similar complication profile, and has similar reported quality of life at 3 months when compared with ESWL for moderate-sized kidney stones. PNL should be offered as a treatment option to all patients with moderate-sized kidney stones in centers with experienced endourologists. Copyright © 2011 Elsevier Inc. All rights reserved.

Intrarenal Surgery vs Percutaneous Nephrolithotomy in the Management of Lower Pole Stones Greater than 2 cm

PubMed Central

Koyuncu, Hakan; Yencilek, Faruk; Kalkan, Mehmet; Bastug, Yavuz; Yencilek, Esin; Ozdemir, Ahmet Tunc

2015-01-01

Purpose To compare the efficacy of RIRS and PNL in lower pole stones ≥2 cm. Materials and and Methods: A total of 109 patients who underwent PNL or RIRS for solitary lower pole stone between April 2009 and December 2012, were retrospectively analyzed. Lower pole stone was diagnosed with CT scan. Stone size was assessed as the longest axis of the stone. All patients were informed about the advantages, disadvantages and probable complications of both PNL and RIRS before the selection of the procedure. Patients decided the surgery type by themselves without being under any influences and written informed consent was obtained from all patients prior to the surgery. Patients were divided into two groups according to the patients’ preference of surgery type. Group 1 consisted of 77 patients who underwent PNL and Group 2 consisted of 32 patients treated with RIRS. Stone free statuses, postoperative complications, operative time and hospitalization time were compared in both groups. Results There was no statistical significance between the two groups in mean age, stone size, stone laterality, mean follow-up periods and mean operative times. In PNL group, stone-free rate was 96.1% at first session and 100% after the additional procedure. In Group 2, stone-free rate was 90.6% at the first procedure and 100% after the additional procedure. The final stone-free rates and operative times were similar in both groups. Conclusions RIRS should be an effective treatment alternative to PNL in lower pole stones larger than 2 cm, especially in selected patients. PMID:26005965

Scanning electron microscopy of real and artificial kidney stones before and after Thulium fiber laser ablation in air and water

NASA Astrophysics Data System (ADS)

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

2018-02-01

We investigated proposed mechanisms of laser lithotripsy, specifically for the novel, experimental Thulium fiber laser (TFL). Previous lithotripsy studies with the conventional Holmium:YAG laser noted a primary photothermal mechanism (vaporization). Our hypothesis is that an additional mechanical effect (fragmentation) occurs due to vaporization of water in stone material from high absorption of energy, called micro-explosions. The TFL irradiated calcium oxalate monohydrate (COM) and uric acid (UA) stones, as well as artificial stones (Ultracal30 and BegoStone), in air and water environments. TFL energy was varied to determine the relative effect on the ablation mechanism. Scanning electron microscopy (SEM) was used to study qualitative and characteristic changes in surface topography with correlation to presumed ablation mechanisms. Laser irradiation of stones in air produced charring and melting of the stone surface consistent with a photothermal effect and minimal fragmentation, suggesting no mechanical effect from micro-explosions. For COM stones ablated in water, there was prominent fragmentation in addition to recognized photothermal effects, supporting dual mechanisms during TFL lithotripsy. For UA stones, there were minimal photothermal effects, and dominant effects were mechanical. By increasing TFL pulse energy, a greater mechanical effect was demonstrated for both stone types. For artificial stones, there was no significant evidence of mechanical effects. TFL laser lithotripsy relies on two prominent mechanisms for stone ablation, photothermal and mechanical. Water is necessary for the mechanical effect which can be augmented by increasing pulse energy. Artificial stones may not provide a predictive model for mechanical effects during laser lithotripsy.

Antioxidants and self-reported history of kidney stones: the National Health and Nutrition Examination Survey.

PubMed

Holoch, Peter A; Tracy, Chad R

2011-12-01

Animal studies have demonstrated the likely role of oxidative tissue damage in the pathophysiology of stone disease; however, the effect of antioxidants on stone formation in the human population is unknown. We evaluated the association between serum antioxidant levels and the self-reported prevalence of kidney stones in a large cross-sectional population in a retrospective cohort study. Serum levels of antioxidants among adult participants in the National Health and Nutrition Examination Survey (NHANES III) 1988-1994 were compared between those with and without a self-reported history of kidney stones, adjusting for covariates of age, sex, body mass index (BMI), race/ethnicity, diabetes, and hypertension. The prevalence of kidney stones was 5.25% (95% confidence interval: 4.60%, 5.90%). The prevalence of kidney stones was higher in males, white/non-Hispanics, diabetics, and those with hypertension. The prevalence of kidney stones increased with BMI. After adjusting for covariates, mean levels of alpha-carotene, beta-carotene, and beta-cryptoxanthin were significantly lower in those with kidney stones (-9.36%, -10.79%, and -8.48%, respectively). When analyzed by quartile, higher serum levels of beta-carotene and beta-cryptoxanthin,, trended toward a decreasing prevalence of stones (P=0.007 and P=0.03, respectively), indicating that the highest levels of these antioxidants may protect against the formation of kidney stones. Lower levels of alpha-carotene, beta-carotene, and beta-cryptoxanthin are associated with a history of kidney stones and may indicate a role for these antioxidants in preventing stone formation.

An update and practical guide to renal stone management.

PubMed

Johri, Nikhil; Cooper, Bruce; Robertson, William; Choong, Simon; Rickards, David; Unwin, Robert

2010-01-01

Renal stone disease covers kidney and lower urinary tract stones caused by a variety of conditions, including metabolic and inherited disorders, and anatomical defects with or without chronic urinary infection. Most cases are idiopathic, in which there is undoubtedly a genetic predisposition, but where environmental and lifestyle factors play an important role. Indeed, it is becoming apparent that renal stone disease is often part of a larger 'metabolic picture' commonly associated with type 2 diabetes, obesity, dyslipidaemia, and hypertension. Renal stone disease is a growing problem in the UK (and other developed and developing populations) with a cross-sectional prevalence of ∼1.2%. This means that there are currently ∼720,000 individuals with a history of kidney stones in the UK. Almost 40% of first-time stone formers will form a second stone within 3 years of the first episode if no prophylactic measures are instituted to prevent stone recurrence, since removal or disintegration of the first stone does not treat the underlying cause of stones in the majority of patients. The age of onset is getting younger and the sex ratio (until recently more men than women) is becoming almost even. Metabolic screening remains an important part of investigating renal stone disease, but to the disappointment and frustration of many doctors, medical treatment is still essentially pragmatic, except perhaps in cystinuria, and to a limited extent in primary hyperoxaluria (if pyridoxine-sensitive); although newer treatments may be emerging. This review summarizes current thinking and provides a practical basis for the management of renal stone disease. Copyright © 2010 S. Karger AG, Basel.

Effect of size and site on the outcome of extracorporeal shock wave lithotripsy of proximal urinary stones in children.

PubMed

Habib, Enmar I; Morsi, Hany A; Elsheemy, Mohammed S; Aboulela, Waseem; Eissa, Mohamed A

2013-06-01

To determine the effect of location and size of stones on the outcome of extracorporeal shock wave lithotripsy (ESWL) in children. In 2008-2010, 150 children (median age 6.6 years) with radio-opaque ureteric and renal stones measuring ≤4 cm were treated. Exclusion criteria were coagulation disorders, pyelonephritis, distal obstruction, non-functioning kidney and hypertension. ESWL was performed under general anesthesia. Follow up period was 5-22 months. 186 stones were treated: 76 calyceal, 92 pelvic and 18 proximal ureteral. Mean stone size was 1.3 cm. A total of 312 sessions were performed (mean per stone = 1.67 sessions). The mean number of shock waves per session was 2423.68. Overall stone-free rate was 89.24%. Having a calyceal location did not significantly affect the stone-free rate (p = 0.133). The failure rate was significantly higher (66.7%) in stones >3 cm in size (p < 0.001). Complications were encountered in 18 patients; 2 underwent auxillary ureteroscopy and 4 uretrolithotomy for treatment of steinstrasse. ESWL is a safe and effective method for treatment of stones up to 2 cm in children. Rate of auxillary procedures increases in stones >2 cm in size. About 80% of failures were associated with stone size >1.35 cm while 52.3% of completely cleared stones were associated with size <1.35 cm. Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Prevalence of Coronal Pulp Stones and Its Relation with Systemic Disorders in Northern Indian Central Punjabi Population

PubMed Central

Bains, Sandeep Kumar; Bhatia, Archana; Singh, Harkanwal Preet; Biswal, Swati Swagatika; Kanth, Shashi; Nalla, Srinivas

2014-01-01

Aim. To estimate the prevalence of coronal pulp stones in the molar teeth of dental outpatients of Sunam, Sangrur district, Punjab, India, to report any association between occurrence of pulp stones with age, gender, dental arch, side, and dental status and to find out correlation between pulp stones with dental and systemic diseases. Materials and Methods. 500 routine dental outpatients within age group of 18–67 years were involved in the study. Molar bitewing of left and right side of each patient was taken with XCP bitewing instrument and size 2 film. The presence or absence of pulp stones was recorded. Chi-square analysis was used to record the prevalence of pulp stones and to compare it with demographic and systemic factors. Results. Overall prevalence of pulp stones was 41.8%. Pulp stones were significantly higher in maxilla (11.59%) than mandible (6.54%), left side than right side, and first molar than other molars. Higher numbers of pulp stones were recorded in patients with cardiovascular disease (38.89%) than with cholelithiasis and renal lithiasis. Conclusion. Pulp stones were higher in maxillary arch than mandibular arch and in females than males. Cardiovascular patients had higher number of pulp stones than other groups. PMID:24944821

Management of staghorn renal stones

PubMed Central

Diri, Akif; Diri, Banu

2018-01-01

Abstract Staghorn stones are large branching stones that fill part of all of the renal pelvis and renal calyces and they can be complete or partial depending on the level of occupancy of the collecting system. Although kidney stones are commoner in men, staghorn stones are less often reported in men compared to women and they are usually unilateral. Due to the significant morbidity and potential mortality attributed to staghorn stones, prompt assessment and treatment is mandatory. Conversely, conservative treatment has been shown to carry a mortality rate of 28% in 10-year period and 36% risk of developing significant renal impairment. Staghorn stones are, therefore, significant disease entity that should be managed aggressively and effectively. Generally, the gold standard treatment for staghorn stones is surgical with a view to achieve stone-free collecting system and preserve renal function. Percutaneous nephrolithotomy should be the recommended first-line treatment for staghorn stones. Other non-surgical options are usually considered in combination with surgery or as monotherapy only if patients are surgically unfit. The decision for optimal treatment of staghorn stones should be individualized according to the circumstances of the patient involved and in order to do so, a closer look at the advantages and disadvantages of each option is necessary. PMID:29658394

Can a dual-energy computed tomography predict unsuitable stone components for extracorporeal shock wave lithotripsy?

PubMed

Ahn, Sung Hoon; Oh, Tae Hoon; Seo, Ill Young

2015-09-01

To assess the potential of dual-energy computed tomography (DECT) to identify urinary stone components, particularly uric acid and calcium oxalate monohydrate, which are unsuitable for extracorporeal shock wave lithotripsy (ESWL). This clinical study included 246 patients who underwent removal of urinary stones and an analysis of stone components between November 2009 and August 2013. All patients received preoperative DECT using two energy values (80 kVp and 140 kVp). Hounsfield units (HU) were measured and matched to the stone component. Significant differences in HU values were observed between uric acid and nonuric acid stones at the 80 and 140 kVp energy values (p<0.001). All uric acid stones were red on color-coded DECT images, whereas 96.3% of the nonuric acid stones were blue. Patients with calcium oxalate stones were divided into two groups according to the amount of monohydrate (calcium oxalate monohydrate group: monohydrate≥90%, calcium oxalate dihydrate group: monohydrate<90%). Significant differences in HU values were detected between the two groups at both energy values (p<0.001). DECT improved the characterization of urinary stone components and was a useful method for identifying uric acid and calcium oxalate monohydrate stones, which are unsuitable for ESWL.

Solo Sonographically Guided PCNL under Spinal Anesthesia: Defining Predictors of Success.

PubMed

Nouralizadeh, Akbar; Pakmanesh, Hamid; Basiri, Abbas; Aayanifard, Mohammad; Soltani, Mohammad Hossein; Tabibi, Ali; Sharifiaghdas, Farzaneh; Ziaee, Seyed Amir Mohsen; Shakhssalim, Naser; Valipour, Reza; Narouie, Behzad; Radfar, Mohammad Hadi

2016-01-01

Aim. Sonography has been brought in percutaneous nephrolithotripsy (PCNL) as an adjunct to or substitute for X-ray to restrict radiation exposure. This study was designed to investigate the possible predictors for the success of the solo sonographically guided PCNL. Methods. 148 consecutive cases were prospectively enrolled. All steps of PCNL were performed solely with sonography guidance under spinal anesthesia. Residual stones were evaluated the day after surgery using sonography and plain radiography. Results. The mean age was 46 ± 15 years; 40% of kidneys had hydronephrosis. The mean stone burden was 504 ± 350 mm(2). The mean duration of surgery was 43 ± 21 minutes. The early stone-free rate was 92% in inferior or middle calyceal stones, 89.5% in single pelvic stones, 81.5% in partial staghorn stones, and 61.9% in staghorn stones. The mean residual stone size was 13 ± 8 mm. Logistic regression showed that a lower age and a larger stone burden significantly predicted positive residual stones. Fifteen percent of patients presented with grade I or II and six percent showed grade III complication based on Clavien classification. There was no cases of organ injury or death. Conclusion. Solo ultrasonographically guided PCNL under spinal anesthesia is feasible with an acceptable stone-free rate and complication rate.

Kidney stones - self-care

MedlinePlus

... self-care; Nephrolithiasis and self-care; Stones and kidney - self-care; Calcium stones and self-care; Oxalate ... provider or the hospital because you have a kidney stone. You will need to take self-care ...

Absolute Hounsfield unit measurement on noncontrast computed tomography cannot accurately predict struvite stone composition.

PubMed

Marchini, Giovanni Scala; Gebreselassie, Surafel; Liu, Xiaobo; Pynadath, Cindy; Snyder, Grace; Monga, Manoj

2013-02-01

The purpose of our study was to determine, in vivo, whether single-energy noncontrast computed tomography (NCCT) can accurately predict the presence/percentage of struvite stone composition. We retrospectively searched for all patients with struvite components on stone composition analysis between January 2008 and March 2012. Inclusion criteria were NCCT prior to stone analysis and stone size ≥4 mm. A single urologist, blinded to stone composition, reviewed all NCCT to acquire stone location, dimensions, and Hounsfield unit (HU). HU density (HUD) was calculated by dividing mean HU by the stone's largest transverse diameter. Stone analysis was performed via Fourier transform infrared spectrometry. Independent sample Student's t-test and analysis of variance (ANOVA) were used to compare HU/HUD among groups. Spearman's correlation test was used to determine the correlation between HU and stone size and also HU/HUD to % of each component within the stone. Significance was considered if p<0.05. Fourty-four patients met the inclusion criteria. Struvite was the most prevalent component with mean percentage of 50.1%±17.7%. Mean HU and HUD were 820.2±357.9 and 67.5±54.9, respectively. Struvite component analysis revealed a nonsignificant positive correlation with HU (R=0.017; p=0.912) and negative with HUD (R=-0.20; p=0.898). Overall, 3 (6.8%) had <20% of struvite component; 11 (25%), 25 (56.8%), and 5 (11.4%) had 21% to 40%, 41% to 60%, and 61% to 80% of struvite, respectively. ANOVA revealed no difference among groups regarding HU (p=0.68) and HUD (p=0.37), with important overlaps. When comparing pure struvite stones (n=5) with other miscellaneous stones (n=39), no difference was found for HU (p=0.09) but HUD was significantly lower for pure stones (27.9±23.6 v 72.5±55.9, respectively; p=0.006). Again, significant overlaps were seen. Pure struvite stones have significantly lower HUD than mixed struvite stones, but overlap exists. A low HUD may increase the suspicion for a pure struvite calculus.

Risk factors for CKD in persons with kidney stones: a case-control study in Olmsted County, Minnesota.

PubMed

Saucier, Nathan A; Sinha, Mukesh K; Liang, Kelly V; Krambeck, Amy E; Weaver, Amy L; Bergstralh, Eric J; Li, Xujian; Rule, Andrew D; Lieske, John C

2010-01-01

Kidney stones are associated with increased risk of chronic kidney disease (CKD); however, risk factors in the general community are poorly defined. A nested case-control study was performed in residents of Olmsted County, MN, who presented with a kidney stone at the Mayo Clinic in 1980-1994 to contrast patients with kidney stones who developed CKD with a group that did not. Participants were selected from the Rochester Epidemiology Project, an electronic linkage system among health care providers in Olmsted County, MN. Cases were identified by diagnostic code for CKD and confirmed to have an estimated glomerular filtration rate < 60 mL/min/1.73 m(2). Controls were matched 2:1 to cases for age, sex, date of first kidney stone, and length of medical record. Charts were abstracted to characterize stone disease, hypertension, diabetes, obesity, tobacco use, ileal conduit, symptomatic stones, type and number of stones, urinary tract infections, number and type of surgical procedures, and medical therapy. Kidney stone patients with CKD were compared with matched stone patients without CKD. There were 53 cases and 106 controls with a mean age of 57 years at first stone event and 59% men. In kidney stone patients, cases with CKD were significantly more likely (P < 0.05) than controls to have had a history of diabetes (41.5% vs 17.0%), hypertension (71.7% vs 49.1%), frequent urinary tract infections (22.6% vs 6.6%), struvite stones (7.5% vs 0%), and allopurinol use (32.1% vs 4.7%) based on univariate analysis. Potential limitations include limited statistical power to detect associations, incomplete data from 24-hour urine studies, and that stone composition was not always available. As in the general population, hypertension and diabetes are associated with increased risk of CKD in patients with kidney stones. However, other unique predictors were identified in patients with kidney stones that increased the possibility of CKD. Further studies are warranted to elucidate the nature of these associations. Copyright 2009 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Proof of principle in vitro study of a prototype ultrasound technology to size stone fragments during ureteroscopy.

PubMed

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

2009-07-01

Proof-of-principle in vitro experiments evaluated a prototype ultrasound technology to size kidney stone fragments. Nineteen human stones were measured using manual calipers. A 10-MHz, 1/8'' (10F) ultrasound transducer probe pinged each stone on a kidney tissue phantom submerged in water using two methods. In Method 1, the instrument was aligned such that the ultrasound pulse traveled through the stone. In Method 2, the instrument was aligned partially over the stone such that the ultrasound pulse traveled through water. For Method 1, the correlation between caliper- and ultrasound-determined stone size was r(2) = 0.71 (P < 0.0001). All but two stone measurements were accurate and precise to within 1 mm. For Method 2, the correlation was r(2) = 0.99 (P < 0.0001), and measurements were accurate and precise to within 0.25 mm. The prototype technology and either method measured stone size with good accuracy and precision. This technology may be possible to incorporate into ureteroscopy.

Correlation between chemical components of billary calculi and bile & sera and bile of gallstone patients.

PubMed

Chandran, Prasheeda; Garg, Pradeep; Pundir, Chandra S

2005-07-01

Total cholesterol, total bilirubin, calcium, oxalate, inorganic phosphate, magnesium, iron, copper, sodium and potassium were analyzed quantitatively in gallstones, bile of gall bladder and sera of 200 patients of cholelithiasis (52 cholesterol, 76 mixed and 72 pigment stone patients) and their contents were correlated between calculi and bile and sera and bile in these three type of stone patients. A significant positive correlation was observed between total cholesterol, total bilirubin of calculi and bile, copper of bile and sera of cholesterol stone patients, copper of calculi and bile, total bilirubin, oxalate, magnesium, potassium of sera and bile of pigment stone patients and oxalate and iron of stone and bile, total bilirubin, oxalate, sodium of sera and bile of mixed stone patients. A significant negative correlation was found between magnesium of serum and bile of cholesterol stone patients, oxalate of calculi and bile of pigment stone patients and magnesium of serum and bile of mixed stone patients.

Predicting the stone composition of children preoperatively by Hounsfield unit detection on non-contrast computed tomography.

PubMed

Altan, Mesut; Çitamak, Burak; Bozaci, Ali Cansu; Güneş, Altan; Doğan, Hasan Serkan; Haliloğlu, Mithat; Tekgül, Serdar

2017-10-01

Many studies have been performed on adult patients to reveal the relationship between Hounsfield unit (HU) value and composition of stone, but none have focused on childhood. We aimed to predict stone composition by HU properties in pre-intervention non-contrast computed tomography (NCCT) in children. This could help to orient patients towards more successful interventions. Data of 94 children, whose pre-intervention NCCT and post-interventional stone analysis were available were included. Stones were grouped into three groups: calcium oxalate (CaOx), cystine, and struvite. Besides spot urine PH value, core HU, periphery HU, and Hounsfield density (HUD) values were measured and groups were compared statistically. The mean age of patients was 7 ± 4 (2-17) years and the female/male ratio was 51/43. The mean stone size was 11.7 ± 5 (4-24) mm. There were 50, 38, and 6 patients in the CaOx, cystine, and struvite groups, respectively. The median values for core HU, periphery HU, and mean HU in the CaOx group were significantly higher than the corresponding median values in the cystine and struvite groups. Significant median HUD difference was seen only between the CaOx and cystine groups. No difference was seen between the cystine and struvite groups in terms of HU parameters. To distinguish these groups, mean spot urine PH values were compared and were found to be higher in the struvite group than the cystine group (Table). The retrospective nature and small number of patients in some groups are limitations of this study, which also does not include all stone compositions. Our cystine stone rate was higher than childhood stone composition distribution in the literature. This is because our center is a reference center in a region with high recurrence rates of cystine stones. In fact, high numbers of cystine stones helped us to compare them with calcium stones more accurately and became an advantage for this study. NCCT at diagnosis can provide some information for determination of stone composition. While CaOx stones can be discriminated from cystine and struvite stones using HU parameters, a simple spot urine pH assessment must be added to distinguish cystine stones from struvite stones. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Estimating the Rate of Occurrence of Renal Stones in Astronauts

NASA Technical Reports Server (NTRS)

Myers, J.; Goodenow, D.; Gokoglu, S.; Kassemi, M.

2016-01-01

Changes in urine chemistry, during and post flight, potentially increases the risk of renal stones in astronauts. Although much is known about the effects of space flight on urine chemistry, no inflight incidence of renal stones in US astronauts exists and the question "How much does this risk change with space flight?" remains difficult to accurately quantify. In this discussion, we tackle this question utilizing a combination of deterministic and probabilistic modeling that implements the physics behind free stone growth and agglomeration, speciation of urine chemistry and published observations of population renal stone incidences to estimate changes in the rate of renal stone presentation. The modeling process utilizes a Population Balance Equation based model developed in the companion IWS abstract by Kassemi et al. (2016) to evaluate the maximum growth and agglomeration potential from a specified set of urine chemistry values. Changes in renal stone occurrence rates are obtained from this model in a probabilistic simulation that interrogates the range of possible urine chemistries using Monte Carlo techniques. Subsequently, each randomly sampled urine chemistry undergoes speciation analysis using the well-established Joint Expert Speciation System (JESS) code to calculate critical values, such as ionic strength and relative supersaturation. The Kassemi model utilizes this information to predict the mean and maximum stone size. We close the assessment loop by using a transfer function that estimates the rate of stone formation from combining the relative supersaturation and both the mean and maximum free stone growth sizes. The transfer function is established by a simulation analysis which combines population stone formation rates and Poisson regression. Training this transfer function requires using the output of the aforementioned assessment steps with inputs from known non-stone-former and known stone-former urine chemistries. Established in a Monte Carlo system, the entire renal stone analysis model produces a probability distribution of the stone formation rate and an expected uncertainty in the estimate. The utility of this analysis will be demonstrated by showing the change in renal stone occurrence predicted by this method using urine chemistry distributions published in Whitson et al. 2009. A comparison to the model predictions to previous assessments of renal stone risk will be used to illustrate initial validation of the model.

Potential therapeutic activity of Phlogacanthus thyrsiformis Hardow (Mabb) flower extract and its biofabricated silver nanoparticles against chemically induced urolithiasis in male Wistar rats.

PubMed

Das, Poppy; Kumar, Kiran; Nambiraj, Arunai; Rajan, Reshma; Awasthi, Rajendra; Dua, Kamal; M, Himaja

2017-10-01

Urolithiasis is a painful disorder in which stones are formed in the kidney, bladder or urethra. There are no proper therapeutic treatments available for kidney stones and people suffering from larger stones have to undergo surgery which has many side effects. A natural remedy with therapeutic effects that can dissipate and remove even the larger stones would eliminate the need of a surgery and the risks associated with it. The flowers of Phlogacanthus thyrsiformis used in culinary recipes in the north eastern India are also widely used as a folklore medicine for the treatment of kidney stones and liver disorders. The aim of this study was to evaluate the prophylactic and therapeutic activity of the aqueous extract of P. thyrsiformis flowers and its biofabricated silver nanoparticles against struvite urinary stones and calcium oxalate kidney stones. A kidney stone inhibition study was carried out on struvite stones grown in gel medium and calcium oxalate stones in rat models using an aqueous extract of P. thyrsiformis flowers and its biofabricated silver nanoparticles. The aqueous extract of P. thyrsiformis flowers and their biofabricated silver nanoparticles, obtained by a green synthetic method, were used to treat struvite urinary stones in vitro and calcium oxalate kidney stones in vivo. Struvite stones were grown in tubes by gel diffusion technique and were treated with varying concentrations of the extract and its nanoparticles. The size of the struvite stones was monitored for 96h using a travelling microscope. Calcium oxalate stones were induced in male Wistar rats by feeding ethylene glycol-ammonium chloride mixture for 14days. Both, prophylactic and therapeutic activities were evaluated by analyzing the urine, serum and histopathological parameters of the rats. The qualitative screening of water extract unveiled the presence of flavonoids as a major constituent. Both, the extract and the nanoparticles effectively reduced the size of struvite stones in vitro and eliminated calcium oxalate stones in Wistar rats in vivo. The potent therapeutic activity of both extract and silver nanoparticles was observed as compared to preventive activity. Anti-urolithiatic potency can be attributed to the presence of flavonoids. Copyright © 2017 Elsevier B.V. All rights reserved.

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

Risk factors for pancreatic stone formation in autoimmune pancreatitis over a long-term course.

PubMed

Maruyama, Masahiro; Arakura, Norikazu; Ozaki, Yayoi; Watanabe, Takayuki; Ito, Tetsuya; Yoneda, Suguru; Maruyama, Masafumi; Muraki, Takashi; Hamano, Hideaki; Matsumoto, Akihiro; Kawa, Shigeyuki

2012-05-01

Autoimmune pancreatitis (AIP) has the potential to progress to a chronic state that forms pancreatic stones. The aim of this study was to clarify the risk factors underlying pancreatic stone formation in AIP. Sixty-nine patients with AIP who had been followed for at least 3 years were enrolled for evaluation of clinical and laboratory factors as well as computed tomography and endoscopic retrograde cholangiopancreatography findings. During the course of this study, increased or de novo stone formation was seen in 28 patients, who were defined as the stone-forming group. No stones were observed in 32 patients, who were defined as the non-stone-forming group. Nine patients who had stones at diagnosis but showed no change during the course of this study were excluded from our cohort. Univariate analysis revealed no significant differences in clinical or laboratory factors associated with AIP-specific inflammation between the two groups. However, pancreatic head swelling (P = 0.006) and narrowing of both Wirsung's and Santorini's ducts in the pancreatic head region (P = 0.010) were significantly more frequent in the stone-forming group. Furthermore, multivariate analysis identified Wirsung and Santorini duct narrowing at diagnosis as a significant independent risk factor for pancreatic stone formation (OR 4.4, P = 0.019). A primary risk factor for pancreatic stone formation in AIP was narrowing of both Wirsung's and Santorini's ducts, which most presumably led to pancreatic juice stasis and stone development.

Fragmentation of salivary stones with a 980nm diode laser.

PubMed

Luers, Jan Christoffer; Petry-Schmelzer, Jan Niklas; Hein, Wolfgang G; Gostian, Antoniu-Oreste; Hüttenbrink, Karl-Bernd; Beutner, Dirk

2014-02-01

Intraductal laser lithotripsy is a preferred method to fragment large, immobile intraglandular salivary stones. A number of different laser systems has been investigated for this purpose. It was our aim to study the effectiveness of a 980nm diode laser when fragmenting salivary stones in an experimental set up. In an experimental set up we used a 980nm diode laser for the lithotripsy of 9 salivary stones. The temperature circle around the laser fibre tip was measured and stone remnants were chemically analysed for their composition. The salivary stones had a mean diameter of 6.7mm×5.6mm×3.0mm. Laser fragmentation with the diode laser was successful at all stones. The temperature next to the salivary stone increased to around 30°C during the active lithotripsy with continuous rinsing (fluid temperature 21°C). At a distance of 2mm the temperature around the laser fibre's tip is reduced by already about 50%. The salivary stones mainly consisted of carbonate apatite, followed by β-calcium phosphate and other calcium phosphates. The fragmentation of salivary stones with a 980nm diode laser is possible in principle. Under a continuous irrigation with a positioning of the laser fibre's tip at the centre of the stone, no relevant temperature increase in the vicinity of the stone occurs. However, before the laser is used in humans, in vivo experiments on animal material seem to be advisable. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

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

2016-04-01

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.

Detecting Fragmentation of Kidney Stones in Lithotripsy by Means of Shock Wave Scattering

NASA Astrophysics Data System (ADS)

Sapozhnikov, Oleg A.; Trusov, Leonid A.; Owen, Neil R.; Bailey, Michael R.; Cleveland, Robin O.

2006-05-01

Although extracorporeal shock wave lithotripsy (a procedure of kidney stone comminution using focused shock waves) has been used clinically for many years, a proper monitoring of the stone fragmentation is still undeveloped. A method considered here is based on recording shock wave scattering signals with a focused receiver placed far from the stone, outside the patient body. When a fracture occurs in the stone or the stone becomes smaller, the elastic waves in the stone will propagate differently (e.g. shear waves will not cross a fracture) which, in turn, will change the scattered acoustic wave in the surrounding medium. Theoretical studies of the scattering phenomenon are based on a linear elastic model to predict shock wave scattering by a stone, with and without crack present in it. The elastic waves in the stone and the nearby liquid were modeled using a finite difference time domain approach. The subsequent acoustic propagation of the scattered waves into the far-field was calculated using the Helmholtz-Kirchhoff integral. Experimental studies were conducted using a research electrohydraulic lithotripter that produced the same acoustic output as an unmodified Dornier HM3 clinical lithotripter. Artificial stones, made from Ultracal-30 gypsum and acrylic, were used as targets. The stones had cylindrical shape and were positioned co-axially with the lithotripter axis. The scattered wave was measured by focused broadband PVDF hydrophone. It was shown that the size of the stone noticeably changed the signature of the reflected wave.

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

... DEPARTMENT OF THE INTERIOR Fish and Wildlife Service [FWS-R3-R-2012-N259; FXRS1265030000-134-FF03R06000] Big Stone National Wildlife Refuge, Big Stone and Lac Qui Parle Counties, MN; Final Comprehensive... significant impact (FONSI) for the environmental assessment (EA) for Big Stone National Wildlife Refuge...

Ultrasonic propulsion of kidney stones.

PubMed

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

2016-05-01

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. 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 ureteropelvic junction with relief of pain, and differentiating large stones from a collection of small fragments. 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 ureteropelvic junction stones into the kidney to alleviate acute renal colic.

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

Cholecystectomy improves long-term success after endoscopic treatment of CBD stones.

PubMed

Hoem, D; Viste, A; Horn, A; Gislason, H; Søndenaa, K

2006-01-01

The aim was to study prospectively primary endoscopic treatment of CBD stones and further the long-term need for renewed gallstone disease interventions, defined as short- and long-term outcome. Seven years prospective follow-up of 101 consecutive patients with CBD stones who underwent endoscopic treatment with the intent of primarily achieving duct clearance. Many patients underwent several endoscopy sessions before stone clearance was completed in 83%. Eleven patients were treated surgically, 2 patients received a permanent stent, and the remaining 3 became stone free with other means. Complications occurred in 47 patients. During follow-up, 31 patients were readmitted for gallstone disease and 15 of these had recurrent CBD stones. Ten percent (8/78) of patients with the gallbladder in situ had acute cholecystitis during follow-up and late cholecystectomy was carried out in 22%. Risk factors for new gallstone disease were an in situ gallbladder containing stones and previous episodes of CBD stones. A goal of complete CBD stone clearance with ERC and ES proved to be relatively resource consuming. Subsequent cholecystectomy after duct clearance for CBD should be advised when the gallbladder lodges gallstones, especially in younger patients. Recurrent CBD stones were not influenced by cholecystectomy.

Incidental kidney stones: a single center experience with kidney donor selection

PubMed Central

Kim, Irene K.; Tan, Jane C.; Lapasia, Jessica; Elihu, Arvand; Busque, Stephan; Melcher, Marc L.

2014-01-01

The presence of kidney stones has been a relative contraindication for living donation. With the widespread use of more sensitive imaging techniques as part of the routine living donor workup, kidney stones are more frequently detected, and their clinical significance in this setting is largely unknown. Records from 325 potential kidney donors who underwent MRA or CT-angiography were reviewed; 294 proceeded to donation. The prevalence of kidney stones found incidentally during donor evaluation was 7.4% (24 of 325). Sixteen donors with stones proceeded with kidney donation. All incidental calculi were nonobstructing and small (median 2 mm; range 1–9 mm). Eleven recipients were transplanted with allografts containing stones. One recipient developed symptomatic nephrolithasis after transplantation. This recipient was found to have newly formed stones secondary to hyperoxaluria, suggesting a recipient-driven propensity for stone formation. The remaining ten recipients have stable graft function, postoperative ultrasound negative for nephrolithiasis, and no sequelae from stones. No donor developed symptomatic nephrolithiasis following donation. Judicious use of allografts with small stones in donors with normal metabolic studies may be acceptable, and careful follow-up in recipients of such allografts is warranted. PMID:22168332

Kidney stones.

PubMed

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

2016-02-25

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.

Influence of Black and Brown Pigment Stone in Cholecystectomized Patients With Acute Biliary Pancreatitis

PubMed Central

Lee, Shou-Wu; Chang, Chi-Sen; Lien, Han-Chung; Lee, Teng-Yu; Yeh, Hong-Zen; Tung, Chun-Fang

2012-01-01

Background Biliary tract stones account for the majority of cases with acute pancreatitis, and include black and brown pigment stones. The aim of the study was to compare the presentation and outcome in cholecystectomized patients with acute biliary pancreatits caused by black and brown pigment stones. Method Data from patients with prior cholecystectomy and acute biliary pancreatitis were collected from January 2009 to August 2011. These cases were assigned to black or brown pigment stone groups according to the stone pattern. The general data, laboratory data, image findings and outcomes of the two groups were collected and analyzed. Results A total of 98 enrolled patients, with 30 (30.6%) and 68 cases (69.4%) assigned to the black and brown pigment stone groups, respectively. The cases with black pigment stone had higher CT Severity Index scores, bilirubin, ALP, ALT, rates of cholangitis, and positive blood culture. In those with brown pigment stone, there was a higher number of ERCP evaluations performed. Conclusion Cholecystectomized cases with biliary pancreatitis due to black pigment stone had a higher prevalence of laboratory cholestasis and a higher rate of cholangitis. PMID:27785202

Concurrent urinary tract infection and stone disease: pathogenesis, diagnosis and management.

PubMed

Thomas, Ben; Tolley, David

2008-12-01

Urinary tract stones and urinary tract infection are strongly associated. Infection is implicated as the cause of stones in about 15% of stone formers, and the development of infection can complicate the management of pre-existing stones. Left untreated, both situations can result in loss of kidney function, and can, on occasion, be life threatening. The underlying pathophysiology of infection stones is generally well understood, but factors dictating why a particular individual should be affected are less clear, although obstruction is a uniformly recognized risk factor. Surgery is the mainstay of treatment for infection calculi: stone clearance is the goal and a range of minimally invasive treatments is available. Systemic sepsis remains the most serious complication of treatment, and, although rare, still occurs despite antibiotic prophylaxis. Once the stone and the causative infection have been removed, various strategies can be employed to minimize the risk of recurrence. When infection complicates pre-existing stone disease, the primary aim of management is to treat the infective episode and delay definitive stone management until the infection has cleared. In such cases where obstruction is also present, prompt drainage of the affected kidney is likely to prevent permanent renal damage, and may be life saving.

Percutaneous trans-papillary elimination of common bile duct stones using an existing gallbladder drain for access.

PubMed

Atar, Eli; Neiman, Chaim; Ram, Eduard; Almog, Mazal; Gadiel, Itai; Belenky, Alexander

2012-06-01

The presence of stones in the common bile duct (CBD) may cause complications such as obstructing jaundice or ascending cholangitis, and the stones should be removed. To assess the efficacy of percutaneous elimination of CBD stones from the gallbladder through the papilla. During a 4 year period, six patients (five men and one woman, mean age 71.5 years) who had CBD stones and an existing gallbladder drain underwent percutaneous stone push into the duodenum after balloon dilatation of the papilla, with a diameter equal to that of the largest stone. Access into the CBD was from the gallbladder, using an already existing percutaneous gallbladder drain (cholecystostomy tube). Each patient had one to three CBD stones measuring 7-14 mm. Successful CBD stone elimination into the duodenum was achieved in five of the six patients. The single failure occurred in a patient with choledochal diverticulum, who was operated successfully. There were no major or minor complications during or after the procedures. Trans-cholecystic CBD stone elimination is a safe and feasible percutaneous technique that utilizes existing tracts, thus obviating the need to create new percutaneous access. This procedure can replace endoscopic or surgical CBD exploration.

Biochemical profile of stone-forming patients with diabetes mellitus.

PubMed

Pak, Charles Y C; Sakhaee, Khashayar; Moe, Orson; Preminger, Glenn M; Poindexter, John R; Peterson, Roy D; Pietrow, Paul; Ekeruo, Wesley

2003-03-01

To test the hypothesis that stone-forming patients with type II diabetes (DM-II) have a high prevalence of uric acid (UA) stones and present with some of the biochemical features of gouty diathesis (GD). The demographic and initial biochemical data from 59 stone-forming patients with DM-II (serum glucose greater than 126 mg/dL, no insulin therapy, older than 35 years of age) from Dallas, Texas and Durham, North Carolina were retrieved and compared with data from 58 patients with GD and 116 with hyperuricosuric calcium oxalate urolithiasis (HUCU) without DM. UA stones were detected in 33.9% of patients with DM-II compared with 6.2% of stone-forming patients without DM (P <0.001). Despite similar ingestion of alkali, the urinary pH in patients with DM-II and UA stones (n = 20) was low (pH = 5.5), as it is in patients with GD, and was significantly lower than in patients with HUCU. The urinary pH in patients with DM-II and calcium stones (n = 39) was intermediate between that in those with DM-II and UA stones and those with HUCU. However, both DM groups had fractional excretion of urate that was not depressed, as it is in those with GD, and was comparable to the value obtained in those with HUCU. The urinary content of undissociated UA was significantly higher, and the saturation of calcium phosphate (brushite) and sodium urate was significantly lower in those with DM-II and UA stones than in those with HUCU. Stone-forming patients with DM-II have a high prevalence of UA stones. Diabetic patients with UA stones share a key feature of those with GD, namely the passage of unusually acid urine, but not the low fractional excretion of urate.

Efficacy and safety of Ho:YAG laser lithotripsy for ureteroscopic removal of proximal and distal ureteral calculi.

PubMed

Khoder, Wael Y; Bader, Markus; Sroka, Ronald; Stief, Christian; Waidelich, Raphaela

2014-08-08

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. 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). 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 dependent on the stone location. No laser induced complications were noticed. 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.

[Influence of lithotripsy modalities on complication rate].

PubMed

Radulović, Slobodan; Milenković-Petronić, Dragica; Vuksanović, Aleksandar; Vavić, Bozo

2009-01-01

Localization of ureteric stones and difference in disintegration success are the most important factors in determining the first treatment approach for ureteric stones. The aim of our study was to evaluate the difference in complication rate between different ureteric stone litho-tripsy modalities. Two hundred sixty patients with ureteric stones were analyzed in a prospective bicentric study that lasted 1 year.The patients were divided into two groups: 1-120 patients who underwent ESWL (extracorporeal shockwave lithotripsy) treatment and II-140 patients who were treated endoscopically with ballistic lithotripsy. RESULTS Ureteroscopic lithotripsy of all pelvic and iliac stones was significantly more successful comparing to ESWL, while lumbar ureteric stone treatment with ureteroscopic lithotripsy was not significantly more successful than ESWL, except for lumbar stones larger than 100mm2 that were significantly better treated endoscopically. In the I group complications after lithotripsy were recorded in 64 (59.3%) and in the II group in 58 (42.0%) patients, meaning that complications were statistically significantly more frequent in the I than in the II group. In the II group complications were significantly more often recorded after treatment of proximal comparing to ureteric stones of other localizations, while in the I group complica-tions were significantly more often detected after treatment of impacted stones than in the II group. Being significantly successful comparing to ESWL, ureteric stone treatment with ureteroscopic lithotripsy should be considered as the first therapeutic option for all, especially impacted stones located in the iliac and pelvic ureteric portion. In spite of absent statistical difference in the success rate, ESWL should be chosen as the first treatment option in all cases of lumbar ureteric stones due to lower complication rate except for stones larger than 100mm2that should be primarily treated endoscopically.

Randomized controlled trial of febuxostat versus allopurinol or placebo in individuals with higher urinary uric acid excretion and calcium stones.

PubMed

Goldfarb, David S; MacDonald, Patricia A; Gunawardhana, Lhanoo; Chefo, Solomon; McLean, Lachy

2013-11-01

Higher urinary uric acid excretion is a suspected risk factor for calcium oxalate stone formation. Febuxostat, a xanthine oxidoreductase inhibitor, is effective in lowering serum urate concentration and urinary uric acid excretion in healthy volunteers and people with gout. This work studied whether febuxostat, compared with allopurinol and placebo, would reduce 24-hour urinary uric acid excretion and prevent stone growth or new stone formation. In this 6-month, double-blind, multicenter, randomized controlled trial, hyperuricosuric participants with a recent history of calcium stones and one or more radio-opaque calcium stone ≥ 3 mm (as seen by multidetector computed tomography) received daily febuxostat at 80 mg, allopurinol at 300 mg, or placebo. The primary end point was percent change from baseline to month 6 in 24-hour urinary uric acid. Secondary end points included percent change from baseline to month 6 in size of index stone and change from baseline in the mean number of stones and 24-hour creatinine clearance. Of 99 enrolled participants, 86 participants completed the study. Febuxostat led to significantly greater reduction in 24-hour urinary uric acid (-58.6%) than either allopurinol (-36.4%; P=0.003) or placebo (-12.7%; P<0.001). Percent change from baseline in the size of the largest calcium stone was not different with febuxostat compared with allopurinol or placebo. There was no change in stone size, stone number, or renal function. No new safety concerns were noted for either drug. Febuxostat (80 mg) lowered 24-hour urinary uric acid significantly more than allopurinol (300 mg) in stone formers with higher urinary uric acid excretion after 6 months of treatment. There was no change in stone size or number over the 6-month period.

Impact of Colic Pain as a Significant Factor for Predicting the Stone Free Rate of One-Session Shock Wave Lithotripsy for Treating Ureter Stones: A Bayesian Logistic Regression Model Analysis

PubMed Central

Chung, Doo Yong; Cho, Kang Su; Lee, Dae Hun; Han, Jang Hee; Kang, Dong Hyuk; Jung, Hae Do; Kown, Jong Kyou; Ham, Won Sik; Choi, Young Deuk; Lee, Joo Yong

2015-01-01

Purpose This study was conducted to evaluate colic pain as a prognostic pretreatment factor that can influence ureter stone clearance and to estimate the probability of stone-free status in shock wave lithotripsy (SWL) patients with a ureter stone. Materials and Methods We retrospectively reviewed the medical records of 1,418 patients who underwent their first SWL between 2005 and 2013. Among these patients, 551 had a ureter stone measuring 4–20 mm and were thus eligible for our analyses. The colic pain as the chief complaint was defined as either subjective flank pain during history taking and physical examination. Propensity-scores for established for colic pain was calculated for each patient using multivariate logistic regression based upon the following covariates: age, maximal stone length (MSL), and mean stone density (MSD). Each factor was evaluated as predictor for stone-free status by Bayesian and non-Bayesian logistic regression model. Results After propensity-score matching, 217 patients were extracted in each group from the total patient cohort. There were no statistical differences in variables used in propensity- score matching. One-session success and stone-free rate were also higher in the painful group (73.7% and 71.0%, respectively) than in the painless group (63.6% and 60.4%, respectively). In multivariate non-Bayesian and Bayesian logistic regression models, a painful stone, shorter MSL, and lower MSD were significant factors for one-session stone-free status in patients who underwent SWL. Conclusions Colic pain in patients with ureter calculi was one of the significant predicting factors including MSL and MSD for one-session stone-free status of SWL. PMID:25902059

Milk of calcium stones: radiological signs and management outcome.

PubMed

El-Shazly, M

2015-06-01

Milk of calcium (MOC) is a rare type of stone that was first described in 1940 by Ludin and Howald who reported MOC in renal cysts. Milk of calcium is a viscous colloidal suspension of calcium salts. Stasis, obstruction and infection are important predisposing factors. Due to a layering effect, characteristic radiological signs especially in CT can help in diagnosis to avoid unsuccessful shock wave lithotripsy. This is the largest reported case series, in which radiological signs by CT scan to predict renal MOC stones, clinical picture and management outcome are described in detail. Cases with suspected renal milk of calcium stones were studied over 7 years (2008-2015). All cases were diagnosed preoperatively by non-contrast CT. Urine cultures were performed in all patients preoperatively. Intra-operative and postoperative findings were reported. Stones retrieved were sent for chemical analysis using an infrared method. Seven cases of milk of calcium renal stones were included in this study. These stones were faint radio-opaque in two cases and radiolucent in five cases. All cases were diagnosed preoperatively with non-contrast CT. Their Hounsfield units (HU) ranged from 114 to 612. All stones were located in a dependent position (gravitational effect) in the posterior aspect of dilated calyces. Five cases exhibited the typical fluid level and two cases demonstrated semilunar (half moon) pattern in the anterior surface of the stones. All cases underwent PCNL with suction and retrieval of soft stones without the need for disintegration. When stones demonstrate a low Hounsfield unit, are arranged in dependent positions within dilated calyces and exhibit fluid level or semilunar pattern on non-contrast CT, milk of calcium stones should be considered. PCNL is an effective modality for management of renal milk of calcium stones.

Stone-isolated carbonatogenic bacteria as inoculants in bioconsolidation treatments for historical limestone.

PubMed

Jroundi, Fadwa; Gómez-Suaga, Patricia; Jimenez-Lopez, Concepción; González-Muñoz, Maria Teresa; Fernandez-Vivas, Maria Antonia

2012-05-15

Stone consolidation treatments that use bacterial biomineralization are mainly based on two strategies: (1) the inoculation of a bacterial culture with proven carbonatogenic ability and/or (2) the application of a culture medium capable of activating those bacteria able to induce the formation of calcium carbonate, from amongst the bacterial community of the stone. While the second strategy has been demonstrated to be effective and, unlike first strategy, it does not introduce any exogenous microorganism into the stone, problems may arise when the bacterial community of the stone is altered, for instance by the use of biocides in the cleaning process. In this study we isolate bacteria that belong to the natural microbial community of the stone and which have proven biomineralization capabilities, with the aim of preparing an inoculum that may be used in stone consolidation treatments wherein the natural community of those stones is altered. With this aim, outdoor experiments were undertaken to activate and isolate bacteria that display high biomineralization capacity from altered calcarenite stone. Most of the bacteria precipitated calcium carbonate in the form of calcite. The selected bacteria were phylogenetically affiliated with members of Actinobacteria, Gamma-proteobacteria and Firmicutes. Furthermore, the capability of these selected carbonatogenic bacteria to consolidate altered calcarenite stone slabs was studied in in vitro experiments, both in the presence and the absence of Myxococcus xanthus, as a potential reinforcement for the bacterial biomineralization. Herein, Acinetobacter species, belonging to the microbial community of the stone, are proposed as powerful carbonatogenic bacteria that, inoculated under appropriate conditions, may be used as inoculum for calcareous stone conservation/consolidation in restoration interventions where the microbial community of the stone is altered. Copyright © 2012 Elsevier B.V. All rights reserved.

Distribution of ureteral stones and factors affecting their location and expulsion in patients with renal colic.

PubMed

Moon, Young Joon; Kim, Hong-Wook; Kim, Jin Bum; Kim, Hyung Joon; Chang, Young-Seop

2015-10-01

To evaluate the distribution of ureteral stones and to determine their characteristics and expulsion rate based on their location. We retrospectively reviewed computed tomography (CT) findings of 246 patients who visited our Emergency Department (ED) for renal colic caused by unilateral ureteral stones between January 2013 and April 2014. Histograms were constructed to plot the distribution of stones based on initial CT findings. Data from 144 of the 246 patients who underwent medical expulsive therapy (MET) for 2 weeks were analyzed to evaluate the factors responsible for the stone distribution and expulsion. The upper ureter and ureterovesical junction (UVJ) were 2 peak locations at which stones initially lodged. Stones lodged at the upper ureter and ureteropelvic junction (group A) had a larger longitudinal diameter (4.21 mm vs. 3.56 mm, p=0.004) compared to those lodged at the lower ureter and UVJ (group B). The expulsion rate was 75.6% and 94.9% in groups A and B, respectively. There was no significant difference in the time interval from initiation of renal colic to arrival at the ED between groups A and B (p=0.422). Stone diameter was a significant predictor of MET failure (odds ratio [OR], 1.795; p=0.005) but the initial stone location was not (OR, 0.299; p=0.082). The upper ureter and UVJ are 2 peak sites at which stones lodge. For stone size 10 mm or less, initial stone lodge site is not a significant predictor of MET failure in patients who have no previous history of active stone treatment in the ureter.

Targeted microbubbles: a novel application for the treatment of kidney stones.

PubMed

Ramaswamy, Krishna; Marx, Vanessa; Laser, Daniel; Kenny, Thomas; Chi, Thomas; Bailey, Michael; Sorensen, Mathew D; Grubbs, Robert H; Stoller, Marshall L

2015-07-01

Kidney stone disease is endemic. Extracorporeal shockwave lithotripsy was the first major technological breakthrough where focused shockwaves were used to fragment stones in the kidney or ureter. The shockwaves induced the formation of cavitation bubbles, whose collapse released energy at the stone, and the energy fragmented the kidney stones into pieces small enough to be passed spontaneously. Can the concept of microbubbles be used without the bulky machine? The logical progression was to manufacture these powerful microbubbles ex vivo and inject these bubbles directly into the collecting system. An external source can be used to induce cavitation once the microbubbles are at their target; the key is targeting these microbubbles to specifically bind to kidney stones. Two important observations have been established: (i) bisphosphonates attach to hydroxyapatite crystals with high affinity; and (ii) there is substantial hydroxyapatite in most kidney stones. The microbubbles can be equipped with bisphosphonate tags to specifically target kidney stones. These bubbles will preferentially bind to the stone and not surrounding tissue, reducing collateral damage. Ultrasound or another suitable form of energy is then applied causing the microbubbles to induce cavitation and fragment the stones. This can be used as an adjunct to ureteroscopy or percutaneous lithotripsy to aid in fragmentation. Randall's plaques, which also contain hydroxyapatite crystals, can also be targeted to pre-emptively destroy these stone precursors. Additionally, targeted microbubbles can aid in kidney stone diagnostics by virtue of being used as an adjunct to traditional imaging methods, especially useful in high-risk patient populations. This novel application of targeted microbubble technology not only represents the next frontier in minimally invasive stone surgery, but a platform technology for other areas of medicine. © 2014 The Authors BJU International © 2014 BJU International Published by John Wiley & Sons Ltd.

Thiazide diuretic prophylaxis for kidney stones and the risk of diabetes mellitus.

PubMed

Singh, Prince; Knoedler, John J; Krambeck, Amy E; Lieske, John C; Bergstralh, Eric J; Rule, Andrew D

2014-12-01

Thiazide diuretics used to treat hypertension are associated with a modest risk of diabetes mellitus. It is unknown if there is a similar risk with kidney stone prevention. We identified and validated incident stone formers in Olmsted County, Minnesota from 1984 to 2011 with manual review of medical records using the Rochester Epidemiology Project. The risk of diabetes mellitus after thiazide therapy was evaluated with and without multivariate adjustment for hypertension, age, gender, race, family history of stones, body mass index and number of stone events. Among 2,350 incident stone formers with a median followup of 10 years, 332 (14%) were treated with thiazide diuretics at some point after the first stone event and 84 (3.6%) received the thiazide diuretic only for kidney stone prevention. Stone formers who received thiazide diuretics were more likely to be older, have hypertension, have higher body mass index and have more stone events. The incidence of diabetes mellitus at 10 years after the first stone event was 9.2% in the group that received thiazide diuretics vs 4.2% in those who did not (HR 2.91; 95% CI 2.02, 4.20). After multivariate adjustment the risk of diabetes mellitus was attenuated (HR 1.20; 95% CI 0.78, 1.83). The risk of diabetes mellitus among those receiving thiazide diuretics solely for kidney stones was further attenuated (multivariate adjusted HR 0.80; 95% CI 0.28, 2.23). Thiazide diuretic use for kidney stone prophylaxis was not associated with a high risk of diabetes mellitus. Larger studies are needed to determine if there is a modest risk of diabetes mellitus with thiazide diuretics. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Development of an instrument to assess the health related quality of life of kidney stone formers.

PubMed

Penniston, Kristina L; Nakada, Stephen Y

2013-03-01

Urolithiasis is associated with pain and other decreases in health related quality of life, yet there is no urolithiasis specific instrument to measure quality of life. Quality of life is an important end point in the management of urolithiasis. Therefore, we developed the Wisconsin StoneQOL, a disease specific instrument to assess the quality of life of patients with urolithiasis. Patients and urology providers identified important concepts related to quality of life of stone formers in groups and in individual cognitive interviews. Patients were recurrent stone formers including those with and those without current stones. A preliminary instrument was created, followed by patient feedback and item reduction. A 28-question instrument was ultimately developed which was tested for reliability as well as internal face, construct and discriminant validity in 248 stone formers. The internal consistency (for questions within domains) was high (mean Cronbach's α = 0.81). Correlation between domains was confirmed (Cronbach's α = 0.86). Discriminant validity was shown as stone formers with current stones scored lower than those who were stone-free. Among patients with active stones, those with symptoms scored lower on most questions and for the total score (p <0.0001) than those who were asymptomatic. The Wisconsin StoneQOL holds promise as a disease specific instrument that captures the unique symptoms and challenges associated with urolithiasis. As such, the Wisconsin StoneQOL is capable of assessing the health related quality of life of stone formers at various points along the disease continuum. Future assessment will establish minimal clinically important differences for use in individual patients. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Can the Presence of Crystalluria Predict Stone Formation in Patients with Cystinuria?

PubMed

Wong, Kathie A; Pardy, Caroline; Pillay, Soma; Athanasiou, Thanos; Rottenberg, Giles; Bultitude, Matthew; Chandra, Ashish; Thomas, Kay

2016-05-01

To determine the feasibility of crystalluria as a biomarker for stone disease in patients with cystinuria. All patients attending a multidisciplinary cystinuria clinic provided early morning urine (EMU) and clinic urine (CU) samples for crystal measurement over a 2-year period (August 1, 2010, to July 31, 2012). Association between presence of crystals, presence of stone(s), and new stone growth (NSG) was determined using the chi-square test. Crystal numbers in EMU and CU were compared in patients with stones/NSG and no stones/stable disease using the Mann-Whitney U test. There was a statistically significant difference between the presence of crystalluria and presence of stones for CU (chi-square test = 5.86, df = 1, p = 0.02) but not EMU (chi-square test = 1.92, df = 1, p = 0.17) and between the presence of crystalluria and NSG for CU (chi-square test = 8.10, df = 1, p = 0.004) but not EMU (chi-square test = 1.32, df = 1, p = 0.25). Patients with stones and NSG have higher levels of crystalluria in CU than patients with no stones or stable disease (stones, median = 41, interquartile range [IQR] = 600 vs median = 0, IQR = 21, p = 0.01; NSG, median = 49, IQR = 525 vs median = 0, IQR = 40, p = 0.01). The presence of crystalluria in CU samples is associated with the presence of stones. Crystalluria is comparable to ultrasound and may serve as a useful adjunct to predict whether a patient with cystinuria has stones, which could guide the frequency of clinic review and imaging.

Pediatric ureteroscopic stone management.

PubMed

Thomas, John C; DeMarco, Romano T; Donohoe, Jeffrey M; Adams, Mark C; Brock, John W; Pope, John C

2005-09-01

We reviewed our experience of 5 years using ureteroscopy with laser lithotripsy to treat stone disease in prepubertal children. A retrospective review was performed of all ureteroscopic procedures performed in prepubertal children. A total of 33 ureteroscopic procedures were performed in 29 prepubertal children (15 males and 14 females) 5 to 144 months old (mean age 94 months, including 3 patients 24 months or younger). Stones were located in the renal pelvis in 1 case (3%), proximal ureter in 3 (9%), mid ureter in 5 (15%) and distal ureter in 24 (73%). Stone size ranged from 3 to 14 mm (mean 6). Eight patients required balloon dilation of the ureteral orifice. Followup ranged from 1 to 66 months (mean 11). Stone-free rate after initial ureteroscopy and laser lithotripsy was 88%, with all distal and mid ureteral stones (3 to 9 mm, mean 5) successfully treated. Three patients with proximal ureteral stones 7 to 14 mm in diameter (mean 10.3) required a secondary procedure (repeat ureteroscopy in 2 and shock wave lithotripsy in 1) to become stone-free. One patient with cystinuria and a renal pelvic stone measuring 14 mm required shock wave lithotripsy and percutaneous nephrostolithotomy. There were no major complications of ureteroscopy but there was 1 case of extravasation at the ureterovesical junction after balloon dilation that was managed with stent placement. Although more patients and longer followup are needed, ureteroscopy with laser lithotripsy is an excellent first line treatment for children with stones in whom conservative therapy fails, especially those with distal and mid ureteral stones. Patients with a stone burden of 10 mm or greater, especially in the proximal ureter, likely will require a secondary procedure to become stone-free.

Variability of protein content in calcium oxalate monohydrate stones.

PubMed

Williams, James C; Zarse, Chad A; Jackson, Molly E; Witzmann, Frank A; McAteer, James A

2006-08-01

Urinary stones are heterogeneous in their fragility to lithotripter shockwaves. As a first step in gaining a better understanding of the role of matrix in stone fragility, we measured extractible protein in calcium oxalate monohydrate (COM) stones that were extensively characterized by micro-computed tomography (micro CT). Stones were scanned using micro CT (Scanco mCT20, 34 microm). They were ground, and the protein extracted using four methods: 0.25M EDTA, 2% SDS reducing buffer, 9M urea buffer, and 10% acetic acid. Protein was measured using NanoOrange. The SDS extracts were also examined using polyacrylamide electrophoresis (PAGE). Extracted protein was highest with the SDS or urea methods (0.28% +/- 0.13% and 0.24% +/- 0.11%, respectively) and lower using the EDTA method (0.17% +/- 0.05%; P < 0.02). Acetic acid extracted little protein (0.006 +/- 0.002%; P < 0.001). Individual stones were significantly different in extractability of protein by the different methods, and SDS-PAGE revealed different protein patterns for individual stones. Extracted protein did not correlate with X-ray-lucent void percentage, which ranged from 0.06% to 2.8% of stone volume, or with apatite content. Extractible stone-matrix protein differs for individual COM stones, and yield is dependent on the extraction method. The presence of X-ray-lucent voids or minor amounts of apatite in stones did not correlate with protein content. The amounts of protein recovered were much lower than reported by Boyce, showing that these methods extracted only a fraction of the protein bound up in the stones. The results suggest that none of the methods tested will be useful for helping to answer the question of whether matrix content differs among stones of differing fragility to lithotripter shockwaves.

Of stones and monkeys: testing ecological constraints on stone handling, a behavioral tradition in Japanese macaques.

PubMed

Leca, Jean-Baptiste; Gunst, Noëlle; Huffman, Michael A

2008-02-01

Japanese macaques are known to manipulate stones by displaying various seemingly functionless behavioral patterns, including carrying a stone, rubbing two stones together, or gathering several stones into a pile. This form of solitary object play called stone handling (SH) is a behavioral tradition in Japanese macaques, showing striking intertroop differences in frequency and form. Here, we evaluated two ecologically based hypotheses invoked to account for these differences. We hypothesized that the occurrence and form of SH would be affected by stone availability and the degree of terrestriality. We used standardized sampling methods to assess differences in SH and terrestriality among four captive and six free-ranging troops of Japanese macaques, and determine site-specific stone availability. Although we demonstrated that SH is almost exclusively a terrestrial activity, our comparative analyses showed that the number of stones readily available and the relative amount of time spent on the ground by the macaques were not associated with the intertroop differences in the occurrence of SH. Failure to accept the terrestriality and stone availability hypotheses suggests that the performance of SH and the motivation to engage in this activity are both more diverse and more complex than the direct links to time spent on the ground or the number of stones locally available. Other environmental influences and sociodemographic factors should be jointly considered to identify the sources of variation in SH, as a beginning to better understand the constraints on the appearance and subsequent diffusion of stone-use traditions in nonhuman primates. Am J Phys Anthropol, 2008. (c) 2007 Wiley-Liss, Inc. Copyright 2007 Wiley-Liss, Inc.

Incidental renal stones in potential live kidney donors: prevalence, assessment and donation, including role of ex vivo ureteroscopy.

PubMed

Olsburgh, Jonathon; Thomas, Kay; Wong, Kathie; Bultitude, Matthew; Glass, Jonathan; Rottenberg, Giles; Silas, Lisa; Hilton, Rachel; Koffman, Geoff

2013-05-01

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Previously, donors with asymptomatic stones found incidentally on CT were not considered ideal donor candidates because of the presumed risk of morbidity to both the donor and recipient. Increasingly, studies show that these risks are low. This study aims to evaluate the long-term safety of using ex vivo ureteroscopy to remove the stones from the donor kidney on the bench before donation. Outcomes so far suggest that this technique can safely render a kidney stone-free before transplantation. This has led to 20 more transplants in our institution than would otherwise be possible. To evaluate the prevalence of asymptomatic renal stones in our potential donor population. To assess the safety and success of ex vivo ureteroscopy (ExURS) to remove stones from explanted donor kidneys before transplantation. We conducted a retrospective analysis of 377 computed tomography (CT) angiograms of potential kidney donors between October 2004 and May 2007 to assess the prevalence of asymptomatic renal stones in our donor population. Between October 2005 and October 2011, kidneys from suitable donors underwent ExURS. Stones were removed using basket extraction or were fragmented with holmium laser on bench before transplantation. Immediate and long-term complications of the transplanted recipients were recorded. Donors were followed with yearly ultrasonography of the remaining kidney in addition to standard follow-up protocol. Review of 377 CT angiograms between October 2004 to May 2007 showed a 5% prevalence of asymptomatic renal stones. Out of 55 potential donors (19 identified between October 2004 to May 2007 and a further 36 identified since May 2007), 20 donors with stones proceeded to donation, with stone size ranging from 2 to 12 mm. Of the patients, 17 proceeded to ExURS. Stones were removed in 10 patients; five with basket retrieval, four with laser fragmentation and one with both laser fragmentation and basket retrieval. There were no early or late allograft stone-related complications and no evidence of stones on follow-up imaging at a mean (range) of 10 (1-24) months. There has been no reported stone recurrence in any of the donors to date and no stone on ultrasonography of eight donors with >1-year follow-up (mean 26 months, range 12-49 months). Asymptomatic renal stones are present in 5% of our donors. ExURS can be safely used to remove stones in these kidneys before transplantation, without the risk of subjecting the donor to an additional stone-removing procedure. Continued long-term follow-up of donors and recipients is still required to ensure the safety of this approach. © 2012 The Authors. BJU International © 2012 BJU International.

Ureteroscopy and laser stone fragmentation (URSL) for large (≥1 cm) paediatric stones: Outcomes from a university teaching hospital.

PubMed

Featherstone, N C; Somani, B K; Griffin, S J

2017-04-01

The treatment of large renal stones (≥1 cm) in paediatric patients is challenging. The usual treatment options include percutaneous nephrolithotomy (PCNL) or shockwave lithotripsy (SWL). There is a rise in the use of ureteroscopy and laser stone fragmentation (URSL) for paediatric stones; however, outcomes of treatment for large renal stones in this age group are still largely unknown. To investigate the outcome of URSL for large paediatric renal stones ≥1 cm treated at the present institution over the last 5 years. A retrospective review was performed of outcomes from the prospectively maintained stone database. Only paediatric patients undergoing ureteroscopic (rigid or flexible ureteroscopy (URS)) procedures for stones ≥1 cm were included. Patient demographics, operative details, stone burden, hospital stay, complications and stone clearance were recorded and analysed. From April 2010 to June 2015, 18 paediatric patients with a mean age of 10.4 years (range 3.6-15) underwent 35 ureteroscopic procedures for large stones (≥1 cm). The stone location was in the kidney (n = 14), ureter (n = 1), and in both the kidney and ureter for the remaining three patients. Nine patients had multiple stones. There was a preceding history of PCNL in four patients, with one patient having URS combined with a PCNL. The mean follow-up was 2.7 years (range 0-5). A postoperative stent was inserted in 21 (60%) patients. The overall stone-free rate (SFR) was 89% for a mean of 1.8 procedures per patient (range 1-4) - see Summary Table below. There was an inability to access stone within a lower pole calyx in one patient, despite maximum deflection of the ureteroscope. No intra- or post-operative complications were noted, and mean hospital stay was 1.1 days (range 0-5). Published papers in adult literature have shown that ureteroscopy and laser fragmentation (URSL) is a viable alternative to PCNL. Newer equipment and improved techniques have resulted in SFRs being comparable with PCNL. A recent systematic review reported an SFR of 91% for large adult stones (>2 cm) for a mean 1.45 procedures per patient, and an overall complication rate of 8.6%. The present study has also demonstrated excellent outcomes in the use of ureteroscopy and laser fragmentation for the management of large paediatric stones with no complications. The results show that paediatric URSL for large stones achieves a good SFR with minimal morbidity and is a good treatment option in established endourological units. Copyright © 2016. Published by Elsevier Ltd.

Kidney stones: pathophysiology, diagnosis and management.

PubMed

Cunningham, Priscilla; Noble, Helen; Al-Modhefer, Abdul-Kadhum; Walsh, Ian

2016-11-10

The prevalence of kidney stones is increasing, and approximately 12 000 hospital admissions every year are due to this condition. This article will use a case study to focus on a patient diagnosed with a calcium oxalate kidney stone. It will discuss the affected structures in relation to kidney stones and describe the pathology of the condition. Investigations for kidney stones, differential diagnosis and diagnosis, possible complications and prognosis, will be discussed. Finally, a detailed account of management strategies for the patient with kidney stones will be given, looking at pain management, medical procedures and dietary interventions.

Long term follow up of kidney donors with asymptomatic renal stones.

PubMed

Serur, David; Charlton, Marian; Juluru, Krishna; Salama, Gayle; Locastro, Eve; Bretzlaff, Gretchen; Hartono, Choli

2017-08-01

Patients with asymptomatic kidney stones have a high rate of progression to becoming symptomatic kidney stones when followed for several years. Small kidney stones are often found incidentally on imaging when evaluating patients for kidney donation, and there is a concern that after nephrectomy, the donor may become symptomatic and incur damage to the remaining kidney. We reviewed kidney donors at our institution with asymptomatic stones and surveyed them several years after donation to see if the stones became clinically active. © 2017 Asian Pacific Society of Nephrology.

Accuracy of endoscopic intraoperative assessment of urologic stone size.

PubMed

Patel, Nishant; Chew, Ben; Knudsen, Bodo; Lipkin, Michael; Wenzler, David; Sur, Roger L

2014-05-01

Endoscopic treatment of renal calculi relies on surgeon assessment of residual stone fragment size for either basket removal or for the passage of fragments postoperatively. We therefore sought to determine the accuracy of endoscopic assessment of renal calculi size. Between January and May 2013, five board-certified endourologists participated in an ex vivo artificial endoscopic simulation. A total of 10 stones (pebbles) were measured (mm) by nonparticipating urologist (N.D.P.) with electronic calibers and placed into separate labeled opaque test tubes to prevent visualization of the stones through the side of the tube. Endourologists were blinded to the actual size of the stones. A flexible digital ureteroscope with a 200-μm core sized laser fiber in the working channel as a size reference was placed through the ureteroscope into the test tube to estimate the stone size (mm). Accuracy was determined by obtaining the correlation coefficient (r) and constructing an Altman-Bland plot. Endourologists tended to overestimate actual stone size by a margin of 0.05 mm. The Pearson correlation coefficient was r=0.924, with a p-value<0.01. The estimation of small stones (<4 mm) had a greater accuracy than large stones (≥4 mm), r=0.911 vs r=0.666. Altman-bland plot analysis suggests that surgeons are able to accurately estimate stone size within a range of -1.8 to +1.9 mm. This ex vivo simulation study demonstrates that endoscopic assessment is reliable when assessing stone size. On average, there was a slight tendency to overestimate stone size by 0.05 mm. Most endourologists could visually estimate stone size within 2 mm of the actual size. These findings could be generalized to state that endourologists are accurately able to intraoperatively assess residual stone fragment size to guide decision making.

Detection of different kidney stone types: an ex vivo comparison of ultrashort echo time MRI to reference standard CT.

PubMed

Ibrahim, El-Sayed H; Cernigliaro, Joseph G; Pooley, Robert A; Bridges, Mellena D; Giesbrandt, Jamie G; Williams, James C; Haley, William E

2016-01-01

With the development of ultrashort echo time (UTE) sequences, it may now be possible to detect kidney stones by using magnetic resonance imaging (MRI). In this study, kidney stones of varying composition and sizes were imaged using both UTE MRI as well as the reference standard of computed tomography (CT), with different surrounding materials and scan setups. One hundred and fourteen kidney stones were inserted into agarose and urine phantoms and imaged both on a dual-energy CT (DECT) scanner using a standard renal stone imaging protocol and on an MRI scanner using the UTE sequence with both head and body surface coils. A subset of the stones representing all composition types and sizes was then inserted into the collecting system of porcine kidneys and imaged in vitro with both CT and MRI. All of the stones were visible on both CT and MRI imaging. DECT was capable of differentiating between uric acid and nonuric acid stones. In MRI imaging, the choice of coil and large field of view (FOV) did not affect stone detection or image quality. The MRI images showed good visualization of the stones' shapes, and the stones' dimensions measured from MRI were in good agreement with the actual values (R(2)=0.886, 0.895, and 0.81 in the agarose phantom, urine phantom, and pig kidneys, respectively). The measured T2 relaxation times ranged from 4.2 to 7.5ms, but did not show significant differences among different stone composition types. UTE MRI compared favorably with the reference standard CT for imaging stones of different composition types and sizes using body surface coil and large FOV, which suggests potential usefulness of UTE MRI in imaging kidney stones in vivo. Copyright © 2015 Elsevier Inc. All rights reserved.

CT Texture Analysis of Ex Vivo Renal Stones Predicts Ease of Fragmentation with Shockwave Lithotripsy.

PubMed

Cui, Helen W; Devlies, Wout; Ravenscroft, Samuel; Heers, Hendrik; Freidin, Andrew J; Cleveland, Robin O; Ganeshan, Balaji; Turney, Benjamin W

2017-07-01

Understanding the factors affecting success of extracorporeal shockwave lithotripsy (SWL) would improve informed decision-making on the most appropriate treatment modality for an individual patient. Although stone size and skin-to-stone distance do correlate with fragmentation efficacy, it has been shown that stone composition and architecture, as reflected by structural heterogeneity on CT, are also important factors. This study aims to determine if CT texture analysis (CTTA), a novel, nondestructive, and objective tool that generates statistical metrics reflecting stone heterogeneity, could have utility in predicting likelihood of SWL success. Seven spontaneously passed, intact renal tract stones, were scanned ex vivo using standard CT KUB and micro-CT. The stones were then fragmented in vitro using a clinical lithotripter, after which, chemical composition analysis was performed. CTTA was used to generate a number of metrics that were correlated to the number of shocks needed to fragment the stone. CTTA metrics reflected stone characteristics and composition, and predicted ease of SWL fragmentation. The strongest correlation with number of shocks required to fragment the stone was mean Hounsfield unit (HU) density (r = 0.806, p = 0.028) and a CTTA metric measuring the entropy of the pixel distribution of the stone image (r = 0.804, p = 0.039). Using multiple linear regression analysis, the best model showed that CTTA metrics of entropy and kurtosis could predict 92% of the outcome of number of shocks needed to fragment the stone. This was superior to using stone volume or density. CTTA metrics entropy and kurtosis have been shown in this experimental ex vivo setting to strongly predict fragmentation by SWL. This warrants further investigation in a larger clinical study for the contribution of CT textural metrics as a measure of stone heterogeneity, along with other known clinical factors, to predict likelihood of SWL success.

Evaluating factors that dictate struvite stone composition: A multi-institutional clinical experience from the EDGE Research Consortium

PubMed Central

Battison, Andrew; De, Shubha; Humphreys, Mitchell R.; Bader, Markus; Lellig, Ekaterina; Monga, Manoj; Chew, Ben H.; Lange, Dirk

2018-01-01

Introduction Struvite stones account for 15% of urinary calculi and are typically associated with urease-producing urinary tract infections and carry significant morbidity. This study aims to characterize struvite stones based on purity of stone composition, bacterial speciation, risk factors, and clinical features. Methods Retrospective data was collected from patients diagnosed with infection stones between 2008 and 2012. Stone analysis, perioperative urine cultures, bacterial speciation, and clinical data were collected and analyzed. The purity of struvite stones was determined. Statistical comparisons were made among homogeneous and heterogeneous struvite stones. Results From the four participating centres, 121 struvite stones were identified. Only 13.2% (16/121) were homogenous struvite. Other components included calcium phosphate (42.1%), calcium oxalate (33.9%), calcium carbonate (27.3%), and uric acid (5.8%). Partial or full staghorn calculi occurred in 23.7% of cases. Urease-producing bacteria were only present in 30% of cases. Proteus, E. coli, and Enterococcus were the most common bacterial isolates from perioperative urine, and percutaneous nephrolithotomy was the most common modality of treatment. Only 40% of patients had a urinalysis that was nitrite-positive, indicating that urinalysis alone is not reliable for diagnosing infection stones. The study’s limitation is its retrospective nature; as such, the optimal timing of cultures with respect to stone analysis or treatment was not always possible, urine cultures were often not congruent with stone cultures in the same patient, and our findings of E. coli commonly cultured does not suggest causation. Conclusions Struvite stones are most often heterogeneous in composition. Proteus remains a common bacterial isolate; however, E. coli and Enterococcus were also frequently identified. This new data provides evidence that patients with struvite stones can have urinary tract pathogens other than urease-producing bacteria, thus challenging previous conventional dogma. PMID:29319486

Can ureteral stones cause pain without causing hydronephrosis?

PubMed

Song, Yan; Hernandez, Natalia; Gee, Michael S; Noble, Vicki E; Eisner, Brian H

2016-09-01

While computerized tomography (CT) is the gold standard for diagnosis of ureterolithiasis, ultrasound is a less costly and radiation-free alternative which is commonly used to evaluate patients with ureteral colic. The purpose of this study was to evaluate the frequency with which patients with ureteral stones and renal colic demonstrate hydronephrosis in order to better understand the evaluation of these patients. Two hundred and forty-eight consecutive patients presenting with ureteral colic and diagnosed with a single unilateral ureteral stone on CT scan in an urban tertiary care emergency department were retrospectively reviewed. Radiology reports were reviewed for stone size, diagnosis, and degree of hydronephrosis. Of the 248 patients evaluated for suspected ureteral stone, 221 (89.1 %) demonstrated any hydronephrosis, while 27 (10.9 %) did not. Hydronephrosis grade, available in 194 patients, was as follows: mild-70.6 %, moderate-27.8 %, and severe-1.5 %. Mean patient age was 47.0 years (SD 15.5), gender distribution was 35.9 % female and 64.1 % male, and mean stone axial diameter was 4.1 mm (SD 2.4). Stone location was as follows: ureteropelvic junction-4.1 %, proximal ureter-21 %, distal ureter-24.9 %, and ureterovesical junction-47.1 %. Axial stone diameter and coronal length (craniocaudal) were both significant predictors of degree of hydronephrosis (ANOVA, p < 0.001 for both). Age (ANOVA, p = NS), stone location (Chi square, p = NS), and gender (Chi square, p = NS) were not associated with degree of hydronephrosis. In patients with ureteral stones and colic, nearly 11 % do not demonstrate any hydronephrosis and a majority (nearly 71 %) will demonstrate only mild hydronephrosis. Stone diameter appears to be related to degree of hydronephrosis, whereas age, gender, and stone location are not. The lower incidence of hydronephrosis for small stones causing renal colic may explain the lower diagnostic accuracy of ultrasound when compared to CT for detecting ureteral stones.

Comparison of STONE, CROES and Guy's nephrolithometry scoring systems for predicting stone-free status and complication rates after percutaneous nephrolithotomy in obese patients.

PubMed

Ozgor, Faruk; Yanaral, Fatih; Savun, Metin; Ozdemir, Harun; Sarilar, Omer; Binbay, Murat

2017-07-29

In this study, we aim to evaluate the accuracy of STONE (stone size, tract length, obstruction, number of involved calyces, and essence/stone density), Clinical Research Office of the Endourological Society (CROES), and Guy's nephrolithometry scoring systems (NSS) in obese patients. The charts of patients who underwent percutaneous nephrolithotomy (PNL) between June 2008 and June 2016 were retrospectively analyzed. Calculations of the STONE, CROES, and Guy's NSS were performed by a resident who was well informed regarding each NSS. Patients were classified under nine scores according to STONE, four grades according to CROES, and four grades according to Guy's NSS. In total, 248 obese patients were enrolled in the study. Stone size was significantly higher in patients without stone-free status (p = 0.001). In patients who were stone-free and those with residual stones, the mean STONE score was 9.71 and 9.23 (p = 0.160), CROES was 172 and 129 (p = 0.001), and Guy's NSS was 1.67 and 2.75 (p = 0.001). Multivariate regression analysis identified the CROES and Guy's NSS were independent factors for PNL success in obese patients (p = 0.01 and p = 0.01, respectively). The CROES and Guy's NSS showed good accuracy with PNL success (AUC = 0.777 and AUC = 0.844, respectively). None of the three NSS systems were statically associated with a complication rate (p = 0.23 for STONE, p = 0.14 for CROES, and p = 0.51 for Guy's NSS). Our study demonstrated that CROES and Guy's NSS were independent predictors of stone-free rate following PNL in obese patients. Our study also revealed that three of the NSSs were not useful for predicting PNL complications in obese patients.

[Infrared spectroscopy of urinary calculi before 1900 in votive offerings of the Bavarian pilgrimage church at Grafrath].

PubMed

Döhlemann, C; Ellert, A; Güntner, M; Durner, J; Gockerell, N; Messmer, E; Vogeser, M

2011-04-01

The old urinary calculi of the votive offerings in the pilgrimage church at Grafrath offer the possibility of analysing the components by infrared spectroscopy to give insights into factors that might influence their formation. A total of 166 specimens were taken from 139 objects (134 stones, 5 bones), in some stones from different layers. Spectral analysis showed typical components for urinary calculi in 127 stones. These were compared with a control group of 98 urinary stones from carriers (77 male, 21 female) during 2007/2008 in Bavaria. The percentage of occurrence of ammonium acid urate (NH(4)U) was high in the old stones (68.0%) versus the 2007/2008 group (1.0%). In uric acid (HS) there was no relevant difference between the two groups, whereas the occurrence of the oxalates whewellite (Whe) and weddellite (Wed) was much less in the old stones (Whe 18.1-69.4%, Wed 7.9-26.5 %). The phosphates differ in the components in favour of brushite in the old stones. The high occurrence of NH(4) in the old stones is comparable with (a) the old pre-1900 collection of Norwich (England), especially with the pre-1800 juvenile bladder stones, and (b) urinary stones in endemic areas of stone disease in children such as in North Thailand. Data about the Grafrath stone carriers (name, age, hometown) are not available but can indirectly be derived from the miracle books (1444-1728) of Grafrath with 12,131 reports; 1,165 had urologic disease of which 70% were children with urinary calculi coming from areas of Upper Bavaria and Swabia. The finding of a high NH(4)U content indicates that this area might have been a stone belt for bladder stones in children. Under- or malnutrition with low protein and low fluid intake may be the aetiologic factor.

Fourier transform infrared spectroscopy for analysis of kidney stones.

PubMed

Khan, Aysha Habib; Imran, Sheharbano; Talati, Jamsheer; Jafri, Lena

2018-01-01

To compare the results of a chemical method of kidney stone analysis with the results of Fourier transform infrared (FT-IR) spectroscopy. Kidney stones collected between June and October 2015 were simultaneously analyzed by chemical and FT-IR methods. Kidney stones (n=449) were collected from patients from 1 to 81 years old. Most stones were from adults, with only 11.5% from children (aged 3-16 years) and 1.5% from children aged <2 years. The male to female ratio was 4.6. In adults, the calcium oxalate stone type, calcium oxalate monohydrate (COM, n=224), was the most common crystal, followed by uric acid and calcium oxalate dihydrate (COD, n=83). In children, the most frequently occurring type was predominantly COD (n=21), followed by COM (n=11), ammonium urate (n=10), carbonate apatite (n=6), uric acid (n=4), and cystine (n=1). Core composition in 22 stones showed ammonium urate (n=2), COM (n=2), and carbonate apatite (n=1) in five stones, while uric acid crystals were detected (n=13) by FT-IR. While chemical analysis identified 3 stones as uric acid and the rest as calcium oxalate only. Agreement between the two methods was moderate, with a kappa statistic of 0.57 (95% confidence interval, 0.5-0.64). Disagreement was noted in the analysis of 77 stones. FT-IR analysis of kidney stones can overcome many limitations associated with chemical analysis.

Internal Structure of Kidney Calculi as a Predictor for Shockwave Lithotripsy Success.

PubMed

Christiansen, Frederikke Eichner; Andreassen, Kim Hovgaard; Osther, Susanne Sloth; Osther, Palle Joern Sloth

2016-03-01

The internal structure of renal calculi can be determined on CT using bone windows and may be classified as homogeneous or inhomogeneous with void regions. In vitro studies have shown homogeneous stones to be less responsive to extracorporeal shockwave lithotripsy (SWL). The objective was to evaluate whether the internal morphology of calculi defined by CT bone window influences SWL outcome in vivo. One hundred eleven patients with solitary renal calculi treated with SWL were included. Treatment data were registered prospectively and follow-up data were collected retrospectively. All patients had noncontrast computed tomography (NCCT) performed before SWL and at 3-month follow-up. The stones were categorized as homogeneous or inhomogeneous. At follow-up, the patient's stone status was registered. Stone-free status was defined as no evidence of calculi on NCCT. Treatment was considered successful if the patient was either stone free or had clinically insignificant residual fragments. Using simple logistic regression, the odds for being stone free 3 months post-SWL were significantly reduced in the patients with inhomogeneous stones compared with patients with homogeneous stones (odds ratio 0.43 [95% confidence interval 0.20, 0.92; p < 0.05]). However, when adjusting for stone size by multiple logistic regression, including stone size (area) as a covariate, this difference became insignificant. The internal structure of kidney stones did not predict the outcome of SWL in vivo.

Inflammatory and fibrotic proteins proteomically identified as key protein constituents in urine and stone matrix of patients with kidney calculi.

PubMed

Boonla, Chanchai; Tosukhowong, Piyaratana; Spittau, Björn; Schlosser, Andreas; Pimratana, Chaowat; Krieglstein, Kerstin

2014-02-15

To uncover whether urinary proteins are incorporated into stones, the proteomic profiles of kidney stones and urine collected from the same patients have to be explored. We employed 1D-PAGE and nanoHPLC-ESI-MS/MS to analyze the proteomes of kidney stone matrix (n=16), nephrolithiatic urine (n=14) and healthy urine (n=3). We identified 62, 66 and 22 proteins in stone matrix, nephrolithiatic urine and healthy urine, respectively. Inflammation- and fibrosis-associated proteins were frequently detected in the stone matrix and nephrolithiatic urine. Eighteen proteins were exclusively found in the stone matrix and nephrolithiatic urine, considered as candidate biomarkers for kidney stone formation. S100A8 and fibronectin, representatives of inflammation and fibrosis, respectively, were up-regulated in nephrolithiasis renal tissues. S100A8 was strongly expressed in infiltrated leukocytes. Fibronectin was over-expressed in renal tubular cells. S100A8 and fibronectin were immunologically confirmed to exist in nephrolithiatic urine and stone matrix, but in healthy urine they were undetectable. Conclusion, both kidney stones and urine obtained from the same patients greatly contained inflammatory and fibrotic proteins. S100A8 and fibronectin were up-regulated in stone-baring kidneys and nephrolithiatic urine. Therefore, inflammation and fibrosis are suggested to be involved in the formation of kidney calculi. Copyright © 2013 Elsevier B.V. All rights reserved.

[The frequency-doubled double-pulse Neodym:YAG laser lithotripter (FREDDY) in lithotripsy of urinary stones. First clinical experience].

PubMed

Ebert, A; Stangl, J; Kühn, R; Schafhauser, W

2003-06-01

Laser lithotripsy does not play an important role in urinary stone treatment, mostly due to ineffective fragmentation efficiency, and high purchase and maintenance costs. The aim of the following retrospective study was to show the clinical significance and efficiency of an innovative laser lithotripsy system for urinary stone treatment. Between November 1998 and October 1999, 48 patients were treated with the innovative frequency- doubled double-pulse Neodym: YAG laser lithotripter FREDDY. A total of 50 renal units were treated, 43 ureteroscopically, four ureterorenoscopically, three percutaneous-nephroscopically, and one bladder stone cystoscopically. With a median laser operation time of 5 min (range: 1-30 min) and a total procedure duration of 60 min (range: 15-180 min), a stone-free rate of upper ureteral stones of 62%, middle ureteral stones of 91% and distal ureteral stones of 100% were documented on the first day after treatment. In an observation period of 6 months, no complications were seen. In our experience Laser lithotripsy with FREDDY is an effective, simple and reliable method for the treatment of ureteral stones, with low purchase and maintenance costs. The extremely thin and highly flexible quartz fibre may extend the endoscopic spectrum to otherwise poorly accessible upper ureteral stones, the renal pelvis and renal calix stones. Therefore, a prospective validation study for comparison with ballistic lithotriptors is of great interest.

Kidney pain (image)

MedlinePlus

A kidney stone is a solid piece of material that forms in a kidney. Kidney stones may be the size of sand or ... A kidney stone is a solid piece of material that forms in a kidney. Kidney stones may be the ...

Diet for Kidney Stone Prevention

MedlinePlus

... Diet, & Nutrition Clinical Trials Eating, Diet, & Nutrition for Kidney Stones Can I help prevent kidney stones by changing what I eat or drink? ... help you lose weight. Does the type of kidney stone I had affect food choices I should ...

Dry stone masonry culvert restoration.

DOT National Transportation Integrated Search

2007-05-01

A damaged dry stone masonry culvert on KY 1268 Jessamine County was restored by the Kentucky Transportation Cabinet. The work was performed by the Dry Stone Conservancy, a non-profit agency promoting dry stone masonry. The work included replacement o...

Avian infectious bronchitis virus: a possible cause of reduced fertility in the rooster.

PubMed

Boltz, David A; Nakai, Masaaki; Bahra, Janice M

2004-12-01

The formation of epididymal stones in the rooster epididymis is a widespread problem that has detrimental effects on sperm production and fertility. The cause of epididymal stones is unknown, but an infectious agent, the avian infectious bronchitis virus (AIBV), has been implicated. The goal of this study was to determine if administering the live attenuated AIBV vaccine to male chicks increases the incidence of stones in the epididymal region of the adult rooster. Specific pathogen free (SPF) Leghorn roosters were divided into two groups: a vaccine-free group (n = 7) and a group vaccinated with AIBV (n = 12). The vaccine was administered orally at 2, 4, 10, and 14 wk of age. Blood was drawn weekly to monitor antibodies to AIBV. At 26 wk of age, blood was obtained to determine testosterone concentrations, and reproductive tracts were removed to analyze daily sperm production and to detect epididymal stones. Nine of 12 vaccinated roosters developed stones, whereas those not given the vaccine did not develop stones. Serum testosterone concentrations were significantly (P < 0.05) reduced in vaccinated roosters with epididymal stones (3.6 +/- 0.30 ng/ml) when compared with nonvaccinated roosters that did not have epididymal stones (7.0 +/- 1.63 ng/ml). Testis weight was significantly (P < 0.05) reduced in vaccinated roosters with epididymal stones (12.1 +/- 0.76 g), as compared with nonvaccinated roosters without epididymal stones (15.2 +/- 0.81 g). Daily sperm production was significantly (P < 0.05) decreased in vaccinated roosters with epididymal stones (5.03 +/- 0.31 x 10(8) sperm/testis/day) when compared with nonvaccinated roosters without epididymal stones (7.43 +/- 0.52 x 10(8) sperm/testis/day). Comparing daily sperm production on a per gram basis, vaccinated roosters with epididymal stones had 4.38 +/- 0.14 x 10(7) sperm/g of testis, which was significantly (P < 0.05) smaller than nonvaccinated roosters without epididymal stones, which had 5.17 +/- 0.17 x 10(7) sperm/g of testis. We conclude that the use of a live attenuated AIBV vaccine increases the incidence of epididymal stones in roosters, resulting in decreased sperm production and decreased serum testosterone concentrations.

Effect of stone coverage on soil erosion

NASA Astrophysics Data System (ADS)

Jomaa, S.; Barry, D. A.; Heng, B. P.; Brovelli, A.; Sander, G. C.; Parlange, J.

2010-12-01

Soil surface coverage has a significant impact on water infiltration, runoff and soil erosion yields. In particular, surface stones protect the soils from raindrop detachment, they retard the overland flow therefore decreasing its sediment transport capacity, and they prevent surface sealing. Several physical and environmental factors control to what extent stones on the soil surface modify the erosion rates and the related hydrological response. Among the most important factors are the moisture content of the topsoil, stone size, emplacement, coverage density and soil texture. Owing to the different inter-related processes, there is ambiguity concerning the quantitative effect of stones, and process-based understanding is limited. Experiments were performed (i) to quantify how stone features affect sediment yields, (ii) to understand the local effect of isolated surface stones, that is, the changes of the soil particle size distribution in the vicinity of a stone and (iii) to determine how stones attenuate the development of surface sealing and in turn how this affects the local infiltration rate. A series of experiments using the EPFL 6-m × 2-m erosion flume were conducted at different rainfall intensities (28 and 74 mm h-1) and stone coverage (20 and 40%). The total sediment concentration, the concentration of the individual size classes and the flow discharge were measured. In order to analyze the measurements, the Hairsine and Rose (HR) erosion model was adapted to account for the shielding effect of the stone cover. This was done by suitably adjusting the parameters based on the area not covered by stones. It was found that the modified HR model predictions agreed well with the measured sediment concentrations especially for the long time behavior. Changes in the bulk density of the topsoil due to raindrop-induced compaction with and without stone protection revealed that the stones protect the upper soil surface against the structural seals resulting in negligible changes in the bulk density during the erosion event. Since the main process contributing to surface sealing development is the compaction due to the raindrop kinetic energy and associated physico-chemical changes, the protection provided by the stone cover is consistent with the area-averaging approach used in applying the HR model.

Use of the National Health and Nutrition Examination Survey to calculate the impact of obesity and diabetes on cost and prevalence of urolithiasis in 2030.

PubMed

Antonelli, Jodi A; Maalouf, Naim M; Pearle, Margaret S; Lotan, Yair

2014-10-01

The prevalence of urolithiasis and its risk factors such as obesity and diabetes have increased over time. Determine the future cost and prevalence of kidney stones using current and projected estimates for stones, obesity, diabetes, and population rates. The stone prevalence in 2000 was estimated from the National Health and Nutrition Examination Survey (NHANES) 1988-1994 and 2007-2010. The cost per percentage prevalence of stones in 2000, calculated using Urologic Diseases in America Project data, was used to estimate the annual cost of stones in 2030, adjusting for inflation and increases in population, stone prevalence, obesity and diabetes rates. The primary outcome was prevalence and cost of stones in 2030. The secondary outcomes were the impact of obesity and diabetes on these values, calculated using odds ratios for stones by body mass index and diabetes status. The annual cost of stone disease in 2000, adjusted for inflation to 2014 US dollars, was approximately $2.81 billion. After accounting for increases in population and stone prevalence from 2000, the estimated cost of stones in 2007 in 2014 US dollars was $3.79 billion. Future population growth alone would increase the cost of stone disease by $780 million in 2030. Based on projected estimates for 2030, obesity will independently increase stone prevalence by 0.36%, with an annual cost increase of $157 million. Diabetes will independently increase stone prevalence by 0.72%, associated with a cost increase of $308 million annually by 2030. NHANES data, however, capture patient self-assessment rather than medical diagnosis, which is a potential bias. The rising prevalence of obesity and diabetes, together with population growth, is projected to contribute to dramatic increases in the cost of urolithiasis, with an additional $1.24 billion/yr estimated by 2030. Obesity, diabetes, and population rates will contribute to an estimated $1.24 billion/yr increase in the cost of kidney stones by 2030. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Study on the Ancient Star Map Carved on the Stone in DPR Korea: Present Status and Prospect

NASA Astrophysics Data System (ADS)

Miley, George; Kim, Kyong Chol; Jong, Sok; Ji, Kwang Nam

2015-08-01

Korean Dolmens are the most distinctive and impressive megalithic monuments in Korean history. It has been known that Korean dolmens are typical funerary monuments of the New Stone Age and Bronze Age.We have searched and analyzed some Korean dolmens in astronomical aspects. Korean dolmen consists of two foundation stones, two dammed stones and one cover stone. Two foundation stones were put up on both sides and two small stones were dammed right and left so as to make a room for grave. Then tens of ton stone was covered on them. For example, one of the cover stones of Korean dolmens is 6.3m in length, 4m in width and 70cm in thickness. And the height of this dolmen is about 1.75m.More than twenty thousand dolmens are scattered around the Korean peninsula. Especially the Taedong River basin including Pyongyang that was a capital of Ancient Korea is the birthplace and centre of dolmens in our country, where about fourteen thousand dolmens are distributed. This region is of the highest density in terms of the distribution of dolmen and has every different kind of dolmens. Korean dolmen was very popular from BC.3000 to BC.2000 and began to disappear in the late BC.2000.It is interesting that we have found dolmens with star map on the cover stone. We found two hundred dolmens with various star atlas-like patterns of cup-marks. We analyzed the star maps on the cover stones of some dolmens and identified the constellations such as Big Dipper, Aquila, Cygnus, Draco and so on.It is thought that ancestor carved stars in the sky at that time on the cover stone of Korean dolmens, archaeological stone tombs. We also consider that Korean Dolmen is one of the oldest stone monuments relative to astronomy.We assume that there are many unidentified dolmens with star map on the cover stone and also many unexcavated dolmens in northern part of Korean peninsula yet, which are expected to arouse the great interest of astronomers and archaeologists.

Treatment alternatives for urinary system stone disease in preschool aged children: results of 616 cases.

PubMed

Sen, Haluk; Seckiner, Ilker; Bayrak, Omer; Erturhan, Sakip; Demirbağ, Asaf

2015-02-01

The treatment of stone disease is mostly similar in those adult and children. The standard treatment procedures are as follows: extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS), percutaneous nephrolithotomy (PCNL), and laparoscopic surgery in selected cases. Open surgery (OS) is another option particularly in such cases with anatomic abnormalities of urinary tract. The present study aims to provide comparative results of stone removal procedures in preschool aged patients who were diagnosed with urinary system stone disease. The retrospective data of 616 pediatric preschool patients consulted with urinary system stone disease between January 2009 and July 2013 were evaluated. All patients were evaluated with Kidney-Ureter-Bladder (KUB) Xray and abdomino-pelvic ultrasound. Intravenous pyelography, unenhanced computed tomography (CT), and renal scintigraphy were performed when needed. Patients were categorized according to the procedures as: Group ESWL, Group URS, Group PNL, Group micro-PNL and Group OS. Following the procedures, opaque residual stones were evaluated with KUB Xray, and non-opaque residual stones were evaluated with unenhanced CT. In groups (ESWL, URS, PNL, micro-PNL, OS), the stone-free rate was 68%, 66%, 85%, 100% and 94 %, respectively. The stone analysis were observed as, calcium oxalate in 377 patients (61.2%), uric acid in 106 patients (17.2%), infection stone in 73 patients (11.8 %), and cysteine in 60 patients (9.7%). There was no significant difference in stone analysis between the groups (p > 0.05) (Table). Minimally invasive procedures are frequently preferred in the pediatric age urinary system stone disease. These procedures are ESWL, PCNL, and ureteroscopy [10,11]. Open surgery is reserved only for rare cases [12]. Similarly the current literature, 18 (2.9%) patients had anatomical anomaly and had high complex stone burden were treated with open surgery in our study. ESWL is a preferred treatment method for pediatric urolithiasis patients with a stone size <20 mm, and the rate of stone-free after ESWL ranges between 57 and 92% [13]. In a study showed the effect of stone size on the success rate in ESWL, the success rate was 91% for stones <10 mm, and 75% for stones >10 mm [15]. In the present study, stone-free rate was noted as 68% on 15 mm or lower stone size. PNL is commonly used to treat stone disease in preschool children [18-20]. In the beginning, urologists hesitated to use instruments suited for adults in case of pediatric kidneys. While some authors accept a cut-off value of 24 F for tract dilatation in the pediatric age, Desai et al. recommended a threshold value <22 F [19,21]. In our study, we used adult PNL instruments in the early period, whereas mini-PERC was performed in the later years. The success rate in PNL group was found as 85%. In recent years, the micro-PNL procedure has been developed to reduce/prevent the complications of standard PNL. In our study, the success rate was calculated as 100% with micro-PNL. This study has certain limitations. The major limitation of our study is its retrospective nature. In addition, sample size of micro-PNL group is fewer than other groups. The goal of kidney stone treatment is to achieve minimal kidney damage and a high success rate. Thus, the procedures are important in the pediatric age group where life expectancy is high, and particularly in the preschool age group. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

[The Management of Common Bile Duct Stones].

PubMed

Park, Chang Hwan

2018-05-25

Common bile duct (CBD) stone is a relatively frequent disorder with a prevalence of 10-20% in patients with gallstones. This is also associated with serious complications, including obstructive jaundice, acute suppurative cholangitis, and acute pancreatitis. Early diagnosis and prompt treatment is the most important for managing CBD stones. According to a recent meta-analysis, endoscopic ultrasonography and magnetic resonance cholangiopancreatography have high sensitivity, specificity, and accuracy for the diagnosis of CBD stones. Endoscopic ultrasonography, in particular, has been reported to have higher sensitivity between them. A suggested management algorithm for patients with symptomatic gallstones is based on whether they are at low, intermediate, or high probability of CBD stones. Single-stage laparoscopic CBD exploration and cholecystectomy is superior to endoscopic retrograde cholangiopancreatography (ERCP) plus laparoscopic cholecystectomy with respect to technical success and shorter hospital stay in high risk patients with gallstones and CBD stones, where expertise, operative time, and instruments are available. ERCP plus laparoscopic cholecystectomy is usually performed to treat patients with CBD stones and gallstones in many institutions. Patients at intermediate probability of CBD stones after initial evaluation benefit from additional biliary imaging. Patients with a low probability of CBD stones should undergo cholecystectomy without further evaluation. Endoscopic sphincterotomy and endoscopic papillary balloon dilation in ERCP are the primary methods for dilating the papilla of Vater for endoscopic removal of CBD stones. Endoscopic papillary large balloon dilation is now increasingly performed due to the usefulness in the management of giant or difficult CBD stones. Scheduled repeated ERCP may be considered in patients with high risk of recurrent CBD stones.

DEVELOPING COMPLETE ULTRASONIC MANAGEMENT OF KIDNEY STONES FOR SPACEFLIGHT.

PubMed

Simon, Julianna C; Dunmire, Barbrina; Bailey, Michael R; Sorensen, Mathew D

2016-09-01

Bone demineralization, dehydration, and stasis put astronauts at an increased risk of forming kidney stones in space. The incidence of kidney stones and the potential for a mission-critical event are expected to rise as expeditions become longer and immediate transport to Earth becomes more problematic. At the University of Washington, we are developing an ultrasound-based stone management system to detect stones with S-mode ™ ultrasound imaging, break stones with burst wave lithotripsy (BWL ™ ), and reposition stones with ultrasonic propulsion (UP ™ ) on Earth and in space. This review discusses the development and current state of these technologies, as well as integration on the flexible ultrasound system sponsored by NASA and the National Space Biomedical Research Institute.

Impact of renal anatomy on shock wave lithotripsy outcomes for lower pole kidney stones: results of a prospective multifactorial analysis controlled by computerized tomography.

PubMed

Torricelli, Fabio C M; Marchini, Giovanni S; Yamauchi, Fernando I; Danilovic, Alexandre; Vicentini, Fabio C; Srougi, Miguel; Monga, Manoj; Mazzucchi, Eduardo

2015-06-01

We evaluated which variables impact fragmentation and clearance of lower pole calculi after shock wave lithotripsy. We prospectively evaluated patients undergoing shock wave lithotripsy for a solitary 5 to 20 mm lower pole kidney stone between June 2012 and August 2014. Patient body mass index and abdominal waist circumference were recorded. One radiologist blinded to shock wave lithotripsy outcomes measured stone size, area and density, stone-to-skin distance, infundibular length, width and height, and infundibulopelvic angle based on baseline noncontrast computerized tomography. Fragmentation, success (defined as residual fragments less than 4 mm in asymptomatic patients) and the stone-free rate were evaluated by noncontrast computerized tomography 12 weeks postoperatively. Univariate and multivariate analysis was performed. A total of 100 patients were enrolled in the study. Mean stone size was 9.1 mm. Overall fragmentation, success and stone-free rates were 76%, 54% and 37%, respectively. On logistic regression body mass index (OR 1.27, 95% CI 1.11-1.49, p = 0.004) and stone density (OR 1.0026, 95% CI 1.0008-1.0046, p = 0.005) significantly impacted fragmentation. Stone size (OR 1.24, 95% CI 1.07-1.48, p = 0.039) and stone density (OR 1.0021, 95% CI 1.0007-1.0037, p = 0.012) impacted the success rate while stone size (OR 1.24, 95% CI 1.04-1.50, p = 0.029), stone density (OR 1.0015, 95% CI 1.0001-1.0032, p = 0.046) and infundibular length (OR 1.1035, 95% CI 1.015-1.217, p = 0.015) impacted the stone-free rate. The best outcomes were found in patients with a body mass index of 30 kg/m(2) or less, stones 10 mm or less and 900 HU or less, and an infundibular length of 25 mm or less. The coexistence of significant unfavorable variables led to a stone-free rate of less than 20%. Obese patients with higher than 10 mm density stones (greater than 900 HU) in the lower pole of the kidney with an infundibular length of greater than 25 mm should be discouraged from undergoing shock wave lithotripsy. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Imaging-based logics for ornamental stone quality chart definition

NASA Astrophysics Data System (ADS)

Bonifazi, Giuseppe; Gargiulo, Aldo; Serranti, Silvia; Raspi, Costantino

2007-02-01

Ornamental stone products are commercially classified on the market according to several factors related both to intrinsic lythologic characteristics and to their visible pictorial attributes. Sometimes these latter aspects prevail in quality criteria definition and assessment. Pictorial attributes are in any case also influenced by the performed working actions and the utilized tools selected to realize the final stone manufactured product. Stone surface finishing is a critical task because it can contribute to enhance certain aesthetic features of the stone itself. The study was addressed to develop an innovative set of methodologies and techniques able to quantify the aesthetic quality level of stone products taking into account both the physical and the aesthetical characteristics of the stones. In particular, the degree of polishing of the stone surfaces and the presence of defects have been evaluated, applying digital image processing strategies. Morphological and color parameters have been extracted developing specific software architectures. Results showed as the proposed approaches allow to quantify the degree of polishing and to identify surface defects related to the intrinsic characteristics of the stone and/or the performed working actions.

Preoperative Bladder Urine Culture as a Predictor of Intraoperative Stone Culture Results: Clinical Implications and Relationship to Stone Composition

PubMed Central

Paonessa, Jessica E.; Gnessin, Ehud; Bhojani, Naeem; Williams, James C.; Lingeman, James E.

2018-01-01

Purpose We examine the relationship between urine and stone cultures in a large cohort of patients undergoing percutaneous stone removal and compare the findings in infectious vs metabolic calculi. Materials and Methods A total of 776 patients treated with percutaneous nephrolithotomy who had preoperative urine cultures and intraoperative stone cultures were included in the study. Statistical analysis used chi-square or logistic fit analysis as appropriate. Results Preoperative urine culture was positive in 352 patients (45.4%) and stone cultures were positive in 300 patients (38.7%). There were 75 patients (9.7%) with negative preoperative cultures who had positive stone cultures, and in patients with both cultures positive the organisms differed in 103 (13.3%). Gram-positive organisms predominated in preoperative urine and stone cultures. Conclusions Preoperative urine cultures in patients undergoing percutaneous nephrolithotomy are unreliable as there is a discordance with intraoperative stone cultures in almost a quarter of cases. There has been a notable shift toward gram-positive organisms in this cohort of patients. PMID:27038771

Prevention of stone migration with the Accordion during endoscopic ureteral lithotripsy.

PubMed

Pagnani, Christopher J; El Akkad, Magdy; Bagley, Demetrius H

2012-05-01

Endoscopic lithotripsy is often prolonged secondary to the retrograde migration of calculous fragments. Various balloons, baskets, and other devices have been used to prevent this migration. Our purpose is to analyze the effect of the Accordion(®) on stone migration and overall efficiency during lithotripsy. We prospectively evaluated 21 patients with a total of 23 distal ureteral stones. Patients underwent lithotripsy using an endoscopic impact lithotriptor. The Accordion was randomly used in 11 of these 21 patients. Data were collected regarding stone migration, stone size, stone ablation, ureteral clearing, and lengths of time for various stages of each procedure. Patients who were treated with the Accordion device experienced significantly less retrograde migration during fragmentation (P=0.0064). When stone volume was taken into account (but not on a per stone basis), ablation and ureteral clearing were also expedited, and fewer lithotripter "hits" and basket "sweeps" were needed. The Accordion device is effective in preventing the migration of stone fragments during endoscopic ureteral lithotripsy. Our data suggest that this device may also increase efficiency of the fragmentation and clearance of ureteral calculi.

Nucleation time of gall bladder bile in gall stone patients: influence of bile acid treatment.

PubMed Central

Sahlin, S; Ahlberg, J; Angelin, B; Reihnér, E; Einarsson, K

1991-01-01

The time required for precipitation of cholesterol crystals (nucleation time, NT) was determined and related to the cholesterol saturation in gall bladder bile of gall stone free subjects (n = 11), patients with pigment stones (n = 3), and patients with cholesterol gall stones (n = 30) undergoing cholecystectomy. Seven of the gall stone patients had been treated with chenodeoxycholic acid (CDCA) and nine with ursodeoxycholic acid (UDCA), 15 mg/kg/day for three weeks before operation. NT was longer in gall stone free subjects (mean, 20 days), patients with pigment stones (14 days) and patients treated with CDCA (24 days) and UDCA (17 days) compared with untreated patients with cholesterol gall stones (1.5 days). In spite of low cholesterol saturation and prolonged NT, and in contrast to those treated with CDCA, four of the nine patients treated with UDCA had cholesterol crystals in their bile. These observations give further support to the concept that the mechanism for inducing gall stone dissolution may be different for CDCA and UDCA. PMID:1773966

[Economic aspects of evidence-based metaphylaxis].

PubMed

Strohmaier, W L

2006-11-01

The calculation model which we developed for the cost of stone therapy and metaphylaxis in Germany some years ago with a social health insurance company is based on estimates of stone incidence, types and recurrence rates, actual costs for stone removal, and metaphylaxis (based on data from a district of the social health care system). There are 200,000 stone recurrences per year in Germany. Costs for treatment of these stones amount to $687,000,000. Stone metaphylaxis reduces the recurrence rate by some 40%. The annual cost for stone removal could be lowered by $275,300,000. Metabolic evaluation/metaphylaxis amount to $70,100,000 per year, resulting in a net saving of $205,200,000. In 1997, there were 96 days off work per stone patient resulting in 5,800,000 days off work in Germany per year. Metaphylaxis is not only medically effective in stone formers but also can lower health care cost significantly. Although health care conditions may vary from country to country, in principle this calculation model is applicable also to other countries.

Sarsen Stones of Stonehenge: How and by what route were the stones transported? What is the significance of their markings?

PubMed

Hill, P A

1961-04-21

A route via Lockeridge and the Avon Valley, involving a slide down the chalk escarpment, is postulated for the sarsen stones of Stonehenge. The transportation problem would have been greatly simplified if the stones had been relayed from point to point over snow or slush during successive winters. Markings on the stones hitherto undescribed are interpreted.

Spontaneous dissolution of a guaifenesin stone.

PubMed

Nguyen, Thai T; Fallon, Bernard; Winfield, Howard N

2005-08-01

Guaifenesin is a commonly used expectorant whose use may lead to the occasional formation of guaifenesin urinary stones. We herein describe a patient who was taking 2400 mg Guaifenesin per day as part of his treatment for asthma. He had a past history of a guaifenesin stone removed ureteroscopically. His current presentation was with a 9 mm by 6 mm stone in the upper left ureter, seen on CT scan, and treated initially with a ureteral stent and hydration. After 3 weeks, the stone had disappeared, as confirmed by repeat CT scan. The genesis and treatment of guaifenesin stones is discussed.

Kidney stone erosion by micro scale hydrodynamic cavitation and consequent kidney stone treatment.

PubMed

Perk, Osman Yavuz; Şeşen, Muhsincan; Gozuacik, Devrim; Koşar, Ali

2012-09-01

The objective of this study is to reveal the potential of micro scale hydrodynamic bubbly cavitation for the use of kidney stone treatment. Hydrodynamically generated cavitating bubbles were targeted to the surfaces of 18 kidney stone samples made of calcium oxalate, and their destructive effects were exploited in order to remove kidney stones in in vitro experiments. Phosphate buffered saline (PBS) solution was used as the working fluid under bubbly cavitating conditions in a 0.75 cm long micro probe of 147 μm inner diameter at 9790 kPa pressure. The surface of calcium oxalate type kidney stones were exposed to bubbly cavitation at room temperature for 5 to 30 min. The eroded kidney stones were visually analyzed with a high speed CCD camera and using SEM (scanning electron microscopy) techniques. The experiments showed that at a cavitation number of 0.017, hydrodynamic bubbly cavitation device could successfully erode stones with an erosion rate of 0.31 mg/min. It was also observed that the targeted application of the erosion with micro scale hydrodynamic cavitation may even cause the fracture of the kidney stones within a short time of 30 min. The proposed treatment method has proven to be an efficient instrument for destroying kidney stones.

Association of serum electrolytes and smoking with salivary gland stone formation.

PubMed

Yiu, A J; Kalejaiye, A; Amdur, R L; Todd Hesham, H N; Bandyopadhyay, B C

2016-06-01

To further define potential factors that may contribute to stone formation in salivary glands (sialolithiasis), a retrospective chart review was performed of patients diagnosed with sialolithiasis between March 1, 1998 and February 29, 2012. Information on salivary gland stone number, location and size, medical history, medications, and serum electrolyte levels were collected. Associations between electrolyte levels and stone characteristics (such as stone number and size) were examined. Fifty-nine patients were identified; their median age was 58 years (range 25-89 years) and most were male (95%). Salivary stones were most commonly located in the submandibular glands (83%). Thirty-five patients (59%) had a smoking history, with 16 (27%) reported as current smokers. There was a significant association between current smoker status and stone size (mean largest stone size 12.4±8.8mm vs. 7.5±4.8mm in current smokers vs. non-smokers; P=0.03). Serum sodium levels (r=0.32, P=0.014) and serum potassium levels (r=0.31, P=0.017) showed significant positive correlations with stone size. While the aetiology of sialolithiasis remains unclear, smoking (which can contribute to reduced saliva flow) and higher serum sodium levels (which can reflect volume depletion) are associated with larger salivary stones. Published by Elsevier Ltd.

Consolidation of degraded ornamental porous limestone stone by calcium carbonate precipitation induced by the microbiota inhabiting the stone.

PubMed

Jimenez-Lopez, C; Rodriguez-Navarro, C; Piñar, G; Carrillo-Rosúa, F J; Rodriguez-Gallego, M; Gonzalez-Muñoz, M T

2007-08-01

Although it has already been shown that calcareous stone can be consolidated by using a bacterially inoculated culture medium, a more user-friendly method is the in situ application of a sterile culture medium that is able to activate, among the microbial community of the stone, those bacteria with a potential for calcium carbonate precipitation. In order to test this new method for stone consolidation, non-sterilized decayed porous limestone was immersed in sterile nutritional media. Results were compared to those of the runs in which stone sterilized prior to the treatment was used. The effects of the microbial community on stone consolidation were determined by recording the evolution of the culture media chemistry. The treated stone was tested for mechanical resistance and porosity. Results demonstrate that the tested media were able to activate bacteria from the microbial community of the stone. As a consequence of the growth of these bacteria, an alkalinization occurred that resulted in calcium carbonate precipitation. The new precipitate was compatible with the substrate and consolidated the stone without pore plugging. Therefore, a good candidate to in situ consolidate decayed porous limestone is the application of a sterile culture medium with the characteristics specified in the present study.

Kidney stones

PubMed Central

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

2017-01-01

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

[Prostatic calculi: silent stones].

PubMed

Köseoğlu, H; Aslan, G; Sen, B H; Tuna, B; Yörükoğlu, K

2010-06-01

Prostate stones are frequently encountered during transurethral resection of the prostate in urology practice. We aimed to demonstrate the physical and chemical properties of prostate stones. We also aimed to determine possible relationship between inflammation of prostate gland and prostate stones. The consecutive patients (excluding subjects with PSA>or=4ng/ml and urolithiasis), who underwent TURP operation and who were observed to have prostatic calculi during TURP, were included in the study. The prostatic stones obtained from each patient during TURP were analysed for chemical composition and observed under electron microscopy (SEM) for structure and surface morphology. The pathological specimens were assessed by the uropathologist for the final diagnosis and existence and degree of inflammation. Five patients were included in the study. From each patient at least three (range 3-8) samples of stones (diameter varying from 1mm up to 5mm) were obtained. The stones were made of mixed composition of calcium phosphate and calcium carbonate. The stones were found to have lobular surface made up of small spheres under SEM. Histopathological examination of the TURP specimens revealed being prostatic hyperplasia accompanied with inflammation of mild to severe degree. Prostatic stones are concentrically precipitated calcium stones within the prostatic ductuli with granular grape like morphology. Histopathological inflammation seems to be associated with these prostatic calculi.

Urine risk factors in children with calcium kidney stones and their siblings

PubMed Central

Bergsland, Kristin J.; Coe, Fredric L.; White, Mark D.; Erhard, Michael J.; DeFoor, William R.; Mahan, John D.; Schwaderer, Andrew L.; Asplin, John R.

2012-01-01

Calcium nephrolithiasis in children is increasing in prevalence and tends to be recurrent. Although children have a lower incidence of nephrolithiasis than adults, its etiology in children is less well understood; hence treatments targeted for adults may not be optimal in children. To better understand metabolic abnormalities in stone forming children, we compared chemical measurements and the crystallization properties of 24-hour urine collections from 129 stone formers matched to 105 non-stone forming siblings and 183 normal, healthy children with no family history of stones; all aged 6 to 17 years. The principal risk factor for calcium stone formation was hypercalciuria. Stone formers have strikingly higher calcium excretion along with high supersaturation for calcium oxalate and calcium phosphate, and a reduced distance between the upper limit of metastability and supersaturation for calcium phosphate, indicating increased risk of calcium phosphate crystallization. Other differences in urine chemistry that exist between adult stone formers and normal individuals such as hyperoxaluria, hypocitraturia, abnormal urine pH and low urine volume were not found in these children. Hence, hypercalciuria and a reduction in the gap between calcium phosphate upper limit of metastability and supersaturation are crucial determinants of stone risk. This highlights the importance of managing hypercalciuria in children with calcium stones. PMID:22358148

Urine risk factors in children with calcium kidney stones and their siblings.

PubMed

Bergsland, Kristin J; Coe, Fredric L; White, Mark D; Erhard, Michael J; DeFoor, William R; Mahan, John D; Schwaderer, Andrew L; Asplin, John R

2012-06-01

Calcium nephrolithiasis in children is increasing in prevalence and tends to be recurrent. Although children have a lower incidence of nephrolithiasis than adults, its etiology in children is less well understood; hence, treatments targeted for adults may not be optimal in children. To better understand metabolic abnormalities in stone-forming children, we compared chemical measurements and the crystallization properties of 24-h urine collections from 129 stone formers matched to 105 non-stone-forming siblings and 183 normal, healthy children with no family history of stones, all aged 6 to 17 years. The principal risk factor for calcium stone formation was hypercalciuria. Stone formers have strikingly higher calcium excretion along with high supersaturation for calcium oxalate and calcium phosphate, and a reduced distance between the upper limit of metastability and supersaturation for calcium phosphate, indicating increased risk of calcium phosphate crystallization. Other differences in urine chemistry that exist between adult stone formers and normal individuals such as hyperoxaluria, hypocitraturia, abnormal urine pH, and low urine volume were not found in these children. Hence, hypercalciuria and a reduction in the gap between calcium phosphate upper limit of metastability and supersaturation are crucial determinants of stone risk. This highlights the importance of managing hypercalciuria in children with calcium stones.

Association of serum electrolytes and smoking with salivary gland stone formation

PubMed Central

Yiu, A. J.; Kalejaiye, A.; Amdur, R. L.; Hesham, H. N. Todd; Bandyopadhyay, B. C.

2016-01-01

To further define potential factors that may contribute to stone formation in salivary glands (sialolithiasis), a retrospective chart review was performed of patients diagnosed with sialolithiasis between March 1, 1998 and February 29, 2012. Information on salivary gland stone number, location, and size, medical history, medications, and serum electrolyte levels were collected. Associations between electrolyte levels and stone characteristics (such as stone number and size) were examined. Fifty-nine patients were identified; their median age was 58 years (range 25–89 years) and most were male (95%). Salivary stones were most commonly located in the submandibular glands (83%). Thirty-five patients (59%) had a smoking history, with 16 (27%) reported as current smokers. There was a significant association between current smoker status and stone size (mean largest stone size 12.4 ± 8.8 mm vs. 7.5 ± 4.8 mm in current smokers vs. non-smokers; P = 0.03). Serum sodium levels (r = 0.32, P = 0.014) and serum potassium levels (r = 0.31, P = 0.017) showed significant positive correlations with stone size. While the etiology of sialolithiasis remains unclear, smoking (which can contribute to reduced saliva flow) and higher serum sodium levels (which can reflect volume depletion) are associated with larger salivary stones. PMID:26969301

Preventive saline irrigation of the bile duct after the endoscopic removal of common bile duct stones.

PubMed

Jang, Sang Eon; Ahn, Dong-Won; Lee, Sang Hyub; Lee, Ban Seok; Jeong, Ji Bong; Hwang, Jin-Hyeok; Ryu, Ji Kon; Kim, Yong-Tae; Lee, Kyoung Ho; Kim, Young Hoon

2013-08-01

Small stone fragments after an endoscopic stone extraction for choledocholithiasis may act as the nidus for recurrent choledocholithiasis. Therefore, efforts to eliminate the nidus might reduce the recurrence of choledocholithiasis and cholangitis related to choledocholithiasis. The purpose of this study was to determine whether an additional preventive saline irrigation of the bile duct after the endoscopic removal of common bile duct stones would decrease residual stones and the recurrence of cholangitis. A retrospective analysis was performed for the consecutively collected data about the patients who underwent the complete endoscopic treatment for common bile duct stone. Among 99 patients, 45 patients underwent saline irrigation. Residual stones were detected in 18 patients (18.2 %). The incidences of residual stones were 8.9 % (4 of 45 patients) in the irrigation group and 25.9 % (14 of 54 patients) in the non-irrigation group (P = 0.037). In multivariate analysis, preventive saline irrigation was found to be the only significant factor for the decrease of residual stones (HR = 0.258, P = 0.039). When analyzing the occurrence of recurrent cholangitis and the procedure related to complications, there were no significant differences according to the performance of preventive saline irrigation of the bile duct. Preventive saline irrigation could reduce the residual common bile duct stones without complications.

New records of Anastrepha (Diptera: Tephritidae) primarily from Colombia.

PubMed

Clavijo, Pedro Alexander Rodriguez; Norrbom, Allen L; PeÑaranda, Emilio arÉvalo; Tehran, Francisco Balseiro; DÍaz, Paula Andrea; Benitez, Maria Clara; Gallego, Jeisson; Cruz, Maria Isabel; Montes, JosÉ M; Rodriguez, Erick J; Steck, Gary J; Sutton, Bruce D; Ramos, Elizabeth Quisberth; SÁnchez, Juan josÉ Lagrava; Colque, Freddy

2018-03-06

New distribution information, primarily from Colombia, is provided for 60 species of Anastrepha, including the first records of 33 species from Colombia: A. acca Norrbom, A. acris Stone, A. amita Zucchi, A. amplidentata Norrbom, A. atrox (Aldrich), A. barbiellinii Lima, A. bezzii Lima, A. canalis Stone, A. cocorae Norrbom Korytkowski, A. compressa Stone, A. cordata Aldrich, A. crebra Stone, A. cryptostrepha Hendel, A. cryptostrephoides Norrbom Korytkowski, A. furcata Lima, A. fuscicauda Norrbom Korytkowski, A. galbina Stone, A. grandicarina Norrbom Korytkowski, A. hamata (Loew), A. katiyari Norrbom, A. macrura Hendel, A. margarita Caraballo, A. minuta Stone, A. nigripalpis Hendel, A. normalis Norrbom, A. pastranai Blanchard, A. pseudanomala Norrbom, A. pulchra Stone, A. similis Greene, A. speciosa Stone, A. urichi Greene, A. willei Korytkowski, and A. zuelaniae Stone. In addition, A. acris is reported from Costa Rica, A. alveata Stone from El Salvador, A. antunesi Lima and A. bahiensis Lima from Bolivia, A. barbiellinii from Trinidad Tobago, A. bezzii, A. canalis, A. coronilli Carrejo González, A. cryptostrepha and A. minuta from Bolivia, and A. willei from Argentina and Bolivia. A list of the 83 species of Anastrepha now known to occur in Colombia is provided, as well as illustrations of at least the wing and aculeus tip or male genitalia for 60 species.

Analysis of Urinary Calculi Using Infrared Spectroscopic Imaging

NASA Astrophysics Data System (ADS)

Sablinskas, Valdas; Lesciute, Daiva; Hendrixson, Vaiva

2009-06-01

Kidney stone disease is a cosmopolitan disease, occurring in both industrialized and developing countries and mainly affecting adults aged 2060 years. The formation of kidney stones is a process that includes many factors. Its primary and contributing pathogenic factors are genetic, nutritional and environmental, but also include personal habits. Information about the chemical structure of kidney stones is of great importance to the treatment of the kidney diseases. The usefulness of such information was first recognized in early 1950s. Analysis of urinary stones by various chemical methods, polarization microscopy, x-ray diffraction, porosity determination, solid phase NMR, and thermo analytical procedures have been widely used. Unfortunately, no one method is sufficient to provide all the clinically useful information about the structure and composition of the stones. Infrared spectroscopy can be considered a relatively new method of kidney stone analysis. It allows to identify any organic or inorganic molecules the constituents of kidney stones. So far this method had never been used to collect information about kidney stone component patterns in Lithuania. Since no epidemiological studies have been performed in this field, the medical treatment of kidney stone disease is empirical and often ineffective in hospitals around the country. The aim of this paper is to present some results of analysis of kidney stones extracted from local patients using FTIR spectroscopical microscopy.

Histology and cell wall biochemistry of stone cells in the physical defence of conifers against insects.

PubMed

Whitehill, Justin G A; Henderson, Hannah; Schuetz, Mathias; Skyba, Oleksandr; Yuen, Macaire Man Saint; King, John; Samuels, A Lacey; Mansfield, Shawn D; Bohlmann, Jörg

2016-08-01

Conifers possess an array of physical and chemical defences against stem-boring insects. Stone cells provide a physical defence associated with resistance against bark beetles and weevils. In Sitka spruce (Picea sitchensis), abundance of stone cells in the cortex of apical shoots is positively correlated with resistance to white pine weevil (Pissodes strobi). We identified histological, biochemical and molecular differences in the stone cell phenotype of weevil resistant (R) or susceptible (S) Sitka spruce genotypes. R trees displayed significantly higher quantities of cortical stone cells near the apical shoot node, the primary site for weevil feeding. Lignin, cellulose, xylan and mannan were the most abundant components of stone cell secondary walls, respectively. Lignin composition of stone cells isolated from R trees contained a higher percentage of G-lignin compared with S trees. Transcript profiling revealed higher transcript abundance in the R genotype of coumarate 3-hydroxylase, a key monolignol biosynthetic gene. Developing stone cells in current year apical shoots incorporated fluorescent-tagged monolignol into the secondary cell wall, while mature stone cells of previous year apical shoots did not. Stone cell development is an ephemeral process, and fortification of shoot tips in R trees is an effective strategy against insect feeding. © 2015 John Wiley & Sons Ltd.

[Changes in kidney stones type according to sex and age in Tunisian patients].

PubMed

Alaya, A; Nouri, A; Belgith, M; Saad, H; Hell, I; Hellara, W; Jouini, R; Najjar, M F

2012-03-01

Studies that evaluate the effect of age and gender on the stone composition are scarce. The aim of this study is to highlight the modification of epidemiological characteristics of this pathology according to patients' sex and age. We studied 1269 urolithiasic patients ranging from 6 months to 92 years old and known as having urinary stones (752 males and 517 females). Stone analysis was performed respectively using a stereomicroscope and infrared spectroscopy to determine, respectively, the morphological type and molecular composition of each. The annual average incidence of new stone formation was 30.25 per 100,000 inhabitants. In 1041 patients (81%), calculi were located in the upper urinary tract. Children and old man were more affected by bladder stone. Calcium oxalate monohydrate remains the most frequent stone component even if its frequency fell according to age (63.2% in teenagers and 40.6% in elderly [p<0.05]) in favour of the increase of uric acid stones (3,5% in teenagers and 41.5% in elderly [p<0.05]). Struvite stones were rare (3.5%) and more frequent in children. The analysis of these data shows that urinary stones in Tunisia are tending to evolve in the same direction as in industrialized countries. Copyright © 2011 AEU. Published by Elsevier Espana. All rights reserved.

Dual energy micro CT SkyScan 1173 for the characterization of urinary stone

NASA Astrophysics Data System (ADS)

Fitri, L. A.; Asyana, V.; Ridwan, T.; Anwary, F.; Soekersi, H.; Latief, F. D. E.; Haryanto, F.

2016-03-01

Knowledge of the composition of urinary stones is an essential part to determine suitable treatments for patients. The aim of this research is to characterize the urinary stones by using dual energy micro CT SkyScan 11173. This technique combines high-energy and low- energy scanning during a single acquisition. Six human urinary stones were scanned in vitro using 80 kV and 120 kV micro CT SkyScan 1173. Projected images were produced by micro CT SkyScan 1173 and then reconstructed using NRecon (in-house software from SkyScan) to obtain a complete 3D image. The urinary stone images were analysed using CT analyser to obtain information of internal structure and Hounsfield Unit (HU) values to determine the information regarding the composition of the urinary stones, respectively. HU values obtained from some regions of interest in the same slice are compared to a reference HU. The analysis shows information of the composition of the six scanned stones obtained. The six stones consist of stone number 1 (calcium+cystine), number 2 (calcium+struvite), number 3 (calcium+cystine+struvite), number 4 (calcium), number 5 (calcium+cystine+struvite), and number 6 (calcium+uric acid). This shows that dual energy micro CT SkyScan 1173 was able to characterize the composition of the urinary stone.

Evaluating the importance of mean stone density and skin-to-stone distance in predicting successful shock wave lithotripsy of renal and ureteric calculi.

PubMed

Wiesenthal, Joshua D; Ghiculete, Daniela; D'A Honey, R John; Pace, Kenneth T

2010-08-01

Shock wave lithotripsy (SWL) is considered the first line treatment for the majority of patients with renal and ureteric calculi, with success rates from contemporary series varying from 60 to 90%. Success is dependent on many patient and stone-related factors. We conducted a retrospective analysis of mean stone CT density (MSD) and skin-to-stone distance (SSD) to determine their influence on the success of SWL of renal and ureteric calculi. Data from all patients treated at the St. Michael's Hospital Lithotripsy Unit from May 2004 to June 2009 were reviewed. Analysis was restricted to those patients with a pre-treatment non-contrast CT scan conducted at our center demonstrating a solitary renal or ureteric calculus < or =20 mm in maximal diameter. Successful treatment of renal stones was defined as those patients who were stone free or had asymptomatic, clinically insignificant residual fragments < or =4 mm in diameter, as measured by KUB X-ray, 3 months after a single SWL treatment. Successful treatment of ureteric stones was defined as being stone free on KUB X-ray, 2-weeks post-SWL. Demographic, stone, patient, treatment and follow-up data were collected from a prospective database and review of CT and KUB imaging by two independent urologists and one radiologist. Data were analyzed with logistic regression, Chi square analysis and ANOVA where appropriate. 422 patients (69.7% male) with a mean age of 51.4 years (SD 12.9) and mean BMI 27.0 kg/m(2) (SD 4.9) were analyzed. Mean stone size was 78.9 mm(2) (SD 77.3) for ureteral stones and 66.1 mm(2) (SD 63.2) for renal stones, with 95 (43.6%) of the renal stones located in the lower pole. The single-treatment success rates for ureteral and renal stones were 62.3% and 68.8%, respectively. On univariate analysis, predictors of SWL success, regardless of stone location, were age (p = 0.01), BMI (p = 0.01), stone size (p < 0.01), MSD (p < 0.01) and SSD (p < 0.01). On multivariate analysis, MSD >900 HU (OR = 0.49, CI: 0.32-0.75) and SSD >110 mm (OR = 0.49, CI: 0.31-0.78) were both significant predictors of outcome. We have identified in a large series of renal and ureteric calculi that both MSD and SSD can reliably predict SWL outcomes. This data can be used in combination with other patient and stone-related factors to facilitate optimal treatment-based decisions and provide patients with more accurate single-treatment success rates for SWL.

Drropulli Stone and Gjirokastra World Heritage in Albania

NASA Astrophysics Data System (ADS)

Serjani, Afat; Kramar, Sabina

2013-04-01

Ancient Gjirokastra City and Dervician stone deposit, there are located next to each other, in south of Albania, at foots of eastern slope of "Wide Mountain". Building stone it is represented by micritic limestone of white, red and blue colour, formed during Palaeocene-Eocene Period. It contains fossils of rounded forms and it is known and exploited since the ancient times. Argjirokastra, Argjiro's City, appeared since the IV-th Century BC (V.Tola, 2011). Stone City has in its centre Majestic Fortress of a big cruiser view, which is seen from long distance, from all sides of Drinos Valley. "This Majestic Monument of Albanian vigour has an astonishing elegance" has written E. Hoxha (1983). Watching Gjirokastra you will remind "Chronic in Stone", the book of Ismail Kadare, great writer, born in Gjirokastra. All buildings here are of stone. The Large Fortress and high houses as castles are built by stone, and covered by stone tiles. The walls and minarets of religious buildings are of stone. The gates of houses and yards are of engraved stone, protected by metallic nets of artistic forms. The house's walls are built by big stone, while the walls of yards are by small stone of white colour, some times intercalated with lines of red, blue stone. The combination of different colour stone is another one artistic beauty of walls. The roads are paved by black cobblestones of flysch sandstone for protection by slips, some times combined with white limestone mosaics. Steps of houses and roads are by white stone, often reworked masterfully. "Such stones, reworked by very fine skilfully, can not be found in any other place of the World, only in Anadoll" has written on 1 665 Evliya Celepi (2003). Buildings are of specific architecture and by good style. The accounts of the basis are done to keep "houses as castle". The walls have wood antiseismic layers. The architecture of houses, gates, angles, windows, with predomination of arc forms, with engraved stones and ornaments it is everywhere evident. The ceilings of houses there are with artistic works and ornaments of different times. Houses are of balconies with balustrades, and from characteristic windows are hanging down flowers. Architecture feature of Medieval period, there are symbolised in most of houses and in Qafa e Pazarit ("Bazaar Pass"), where are crossed all roads of the ancient City. From the Fortress below your foots there are different parts of stone City. If you like to be astonished, please, get up to the Keculla Point and watch the Stone City, Drinos Valley, and Lunxheria Mountains! In Gjirokastra Region there are Antigonea Archaeological Park and Sofratika Amphitheatre. Gjirokastra has a very rich geoheritage and bioheritage such as: Viroi artesian spring, Skotini Cave, Cajupi Field Landscape etc. Since 1961, Gjirokastra was proclaimed Museum City under the protection, and on 2005 was included in UNESCO World Cultural Heritage.

The role of trapped bubbles in kidney stone detection with the color Doppler ultrasound twinkling artifact.

PubMed

Simon, Julianna C; Sapozhnikov, Oleg A; Kreider, Wayne; Breshock, Michael; Williams, James C; Bailey, Michael R

2018-01-09

The color Doppler ultrasound twinkling artifact, which highlights kidney stones with rapidly changing color, has the potential to improve stone detection; however, its inconsistent appearance has limited its clinical utility. Recently, it was proposed stable crevice bubbles on the kidney stone surface cause twinkling; however, the hypothesis is not fully accepted because the bubbles have not been directly observed. In this paper, the micron or submicron-sized bubbles predicted by the crevice bubble hypothesis are enlarged in kidney stones of five primary compositions by exposure to acoustic rarefaction pulses or hypobaric static pressures in order to simultaneously capture their appearance by high-speed photography and ultrasound imaging. On filming stones that twinkle, consecutive rarefaction pulses from a lithotripter caused some bubbles to reproducibly grow from specific locations on the stone surface, suggesting the presence of pre-existing crevice bubbles. Hyperbaric and hypobaric static pressures were found to modify the twinkling artifact; however, the simple expectation that hyperbaric exposures reduce and hypobaric pressures increase twinkling by shrinking and enlarging bubbles, respectively, largely held for rough-surfaced stones but was inadequate for smoother stones. Twinkling was found to increase or decrease in response to elevated static pressure on smooth stones, perhaps because of the compression of internal voids. These results support the crevice bubble hypothesis of twinkling and suggest the kidney stone crevices that give rise to the twinkling phenomenon may be internal as well as external.

The role of trapped bubbles in kidney stone detection with the color Doppler ultrasound twinkling artifact

NASA Astrophysics Data System (ADS)

Simon, Julianna C.; Sapozhnikov, Oleg A.; Kreider, Wayne; Breshock, Michael; Williams, James C., Jr.; Bailey, Michael R.

2018-01-01

The color Doppler ultrasound twinkling artifact, which highlights kidney stones with rapidly changing color, has the potential to improve stone detection; however, its inconsistent appearance has limited its clinical utility. Recently, it was proposed stable crevice bubbles on the kidney stone surface cause twinkling; however, the hypothesis is not fully accepted because the bubbles have not been directly observed. In this paper, the micron or submicron-sized bubbles predicted by the crevice bubble hypothesis are enlarged in kidney stones of five primary compositions by exposure to acoustic rarefaction pulses or hypobaric static pressures in order to simultaneously capture their appearance by high-speed photography and ultrasound imaging. On filming stones that twinkle, consecutive rarefaction pulses from a lithotripter caused some bubbles to reproducibly grow from specific locations on the stone surface, suggesting the presence of pre-existing crevice bubbles. Hyperbaric and hypobaric static pressures were found to modify the twinkling artifact; however, the simple expectation that hyperbaric exposures reduce and hypobaric pressures increase twinkling by shrinking and enlarging bubbles, respectively, largely held for rough-surfaced stones but was inadequate for smoother stones. Twinkling was found to increase or decrease in response to elevated static pressure on smooth stones, perhaps because of the compression of internal voids. These results support the crevice bubble hypothesis of twinkling and suggest the kidney stone crevices that give rise to the twinkling phenomenon may be internal as well as external.

Focused ultrasound guided relocation of kidney stones.

PubMed

Abrol, Nitin; Kekre, Nitin S

2015-01-01

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. 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. 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. 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.

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.

Cystone® for 1 year did not change urine chemistry or decrease stone burden in cystine stone formers.

PubMed

Erickson, Stephen B; Vrtiska, Terri J; Canzanello, Vincent J; Lieske, John C

2011-06-01

Cystine kidney stones frequently recur because inadequate prevention exists. We recruited documented recurrent cystine kidney stone formers (6 men, 4 women, 44 ± 17 years) into a 2-phased study to assess safety and effectiveness of Cystone®, a herbal treatment used to prevent and facilitate passage of cystine kidney stones. The first phase was a randomized double-blinded 12 weeks crossover study assessing the effect of Cystone® versus placebo (2 tablets BID) on urinary chemistries. The second phase was an open label 1 year study of Cystone® to determine if renal stone burden decreased, as assessed by quantitative and subjective assessment of CT. There was no statistically significant change of urinary composition from baseline short (6 weeks) or long (52 weeks) term on Cystone®, including volume (2525, 2611, 2730 ml), pH (6.7, 6.7, 7.05), and cystine excretion (2770, 2889, 4025 μmol). Pre and post-CT was available in nine patients. Although seven kidneys lost stones spontaneously or surgically, overall stone burden increased in seven kidneys, was unchanged in nine, and fell in only two. Quantitative scoring increased in both the left and right kidneys (1602-1667 and 301-2064 volumetric units, respectively). Therefore, this study does not suggest that Cystone® has a favorable effect on urinary chemistries that could decrease cystine stone formation, nor does it appear to prevent stone growth or promote stone passage over a 1-year period.

Risk of recurrence of idiopathic calcium kidney stones: analysis of data from the literature.

PubMed

Ferraro, Pietro Manuel; Curhan, Gary C; D'Addessi, Alessandro; Gambaro, Giovanni

2017-04-01

Nephrolithiasis is a frequent condition. While it is generally accepted that such condition carries a risk of recurrence over time, the exact risk and its predictors have been rarely quantitated. We aimed to estimate recurrence of kidney stones, overall and in specific subgroups, from randomized controlled trials (RCTs) of calcium stone formers. Systematic review of RCTs of adult patients with idiopathic calcium kidney stones. Recurrence rates analyzed in subgroups based on type of intervention and other characteristics, using Poisson regression models. The analysis included 21 RCTs with 2168 participants over a median follow-up of 3.2 years (range 0.5-9.7). The median recurrence of kidney stones was 15 per 100 person-years (range 0-110). Recurrence was higher in those with two or more previous stone episodes compared to those with a single episode at enrolment (16 vs. 6 per 100 person-years, p < 0.001) and in those untreated or treated with dietary changes compared to those treated with drugs (26 vs. 23 vs. 9 per 100 person-years, p < 0.001). The effect of drugs on recurrence seemed to be beneficial only among those with two or more previous stone episodes. The overall recurrence rate of stones depends on factors such as previous stone history and type of treatment. Dietary approaches seem to be more effective among single stone formers, whereas drugs seem to be more effective among recurrent stone formers.

Effects of water uptake on melamine renal stone formation in mice.

PubMed

Peng, Jiao; Li, Daxu; Chan, Yee Kwan; Chen, Yan; Lamb, Jonathan R; Tam, Paul K H; El-Nezami, Hani

2012-06-01

Melamine-tainted food can induce kidney stones both in humans and animals and in domestic animals, severe cases caused acute kidney failure and death. Although increasing water intake can ameliorate kidney stone formation, its effect on melamine (Mel)-induced kidney stones has not been studied. We have analysed the effect of restricted ingestion of drinking water on melamine stone formation in mice. They were given melamine and cyanuric acid orally and received drinking water either freely or for a restricted time. Kidney stone formation and renal function were monitored. Mice receiving drinking water for a restricted 10-h period initially lost body weight, which returned to normal within 2 days. No other abnormalities were observed. Ingestion of melamine alone failed to induce kidney stones even under conditions of restricted drinking water. In mice treated with melamine together with cyanuric acid for 3 days, no renal stones were formed when the supply of drinking was normal. However, when drinking water was limited, stone formation was observed and accompanied by high levels of serum urea and creatinine. An increase in urine haemoglobin and glucose levels was also found. The administration resulted in up-regulated tissue osteopontin, kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin messenger RNA expression and macrophage infiltration. Our results indicate the importance of water intake in the formation of melamine-induced renal stone formation in the mouse and provide new information on the mechanisms of melamine stone formation.

Changes in Renal Function and Blood Pressure in Patients with Stone Disease

NASA Astrophysics Data System (ADS)

Worcester, Elaine M.

2007-04-01

Stone disease is a rare cause of renal failure, but a history of kidney stones is associated with an increased risk for chronic kidney disease, particularly in overweight patients. Loss of renal function seems especially notable for patients with stones associated with cystinuria, hyperoxaluria, and renal tubular acidosis, in whom the renal pathology shows deposits of mineral obstructing inner medullary collecting ducts, often diffusely. However, even idiopathic calcium oxalate stone formers have a mild but significant decrease in renal function, compared to age, sex and weight-matched normals, and appear to lose renal function with age at a slightly faster rate than non-stone formers. There is also an increased incidence of hypertension among stone formers, although women are more likely to be affected than men.

Quantitative Prediction of Stone Fragility From Routine Dual Energy CT: Ex vivo proof of Feasibility.

PubMed

Ferrero, Andrea; Montoya, Juan C; Vaughan, Lisa E; Huang, Alice E; McKeag, Ian O; Enders, Felicity T; Williams, James C; McCollough, Cynthia H

2016-12-01

Previous studies have demonstrated a qualitative relationship between stone fragility and internal stone morphology. The goal of this study was to quantify morphologic features from dual-energy computed tomography (CT) images and assess their relationship to stone fragility. Thirty-three calcified urinary stones were scanned with micro-CT. Next, they were placed within torso-shaped water phantoms and scanned with the dual-energy CT stone composition protocol in routine use at our institution. Mixed low- and high-energy images were used to measure volume, surface roughness, and 12 metrics describing internal morphology for each stone. The ratios of low- to high-energy CT numbers were also measured. Subsequent to imaging, stone fragility was measured by disintegrating each stone in a controlled ex vivo experiment using an ultrasonic lithotripter and recording the time to comminution. A multivariable linear regression model was developed to predict time to comminution. The average stone volume was 300 mm 3 (range: 134-674 mm 3 ). The average comminution time measured ex vivo was 32 seconds (range: 7-115 seconds). Stone volume, dual-energy CT number ratio, and surface roughness were found to have the best combined predictive ability to estimate comminution time (adjusted R 2  = 0.58). The predictive ability of mixed dual-energy CT images, without use of the dual-energy CT number ratio, to estimate comminution time was slightly inferior, with an adjusted R 2 of 0.54. Dual-energy CT number ratios, volume, and morphologic metrics may provide a method for predicting stone fragility, as measured by time to comminution from ultrasonic lithotripsy. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Optimal Skin-to-Stone Distance Is a Positive Predictor for Successful Outcomes in Upper Ureter Calculi following Extracorporeal Shock Wave Lithotripsy: A Bayesian Model Averaging Approach

PubMed Central

Cho, Kang Su; Jung, Hae Do; Ham, Won Sik; Chung, Doo Yong; Kang, Yong Jin; Jang, Won Sik; Kwon, Jong Kyou; Choi, Young Deuk; Lee, Joo Yong

2015-01-01

Objectives To investigate whether skin-to-stone distance (SSD), which remains controversial in patients with ureter stones, can be a predicting factor for one session success following extracorporeal shock wave lithotripsy (ESWL) in patients with upper ureter stones. Patients and Methods We retrospectively reviewed the medical records of 1,519 patients who underwent their first ESWL between January 2005 and December 2013. Among these patients, 492 had upper ureter stones that measured 4–20 mm and were eligible for our analyses. Maximal stone length, mean stone density (HU), and SSD were determined on pretreatment non-contrast computed tomography (NCCT). For subgroup analyses, patients were divided into four groups. Group 1 consisted of patients with SSD<25th percentile, group 2 consisted of patients with SSD in the 25th to 50th percentile, group 3 patients had SSD in the 50th to 75th percentile, and group 4 patients had SSD≥75th percentile. Results In analyses of group 2 patients versus others, there were no statistical differences in mean age, stone length and density. However, the one session success rate in group 2 was higher than other groups (77.9% vs. 67.0%; P = 0.032). The multivariate logistic regression model revealed that shorter stone length, lower stone density, and the group 2 SSD were positive predictors for successful outcomes in ESWL. Using the Bayesian model-averaging approach, longer stone length, lower stone density, and group 2 SSD can be also positive predictors for successful outcomes following ESWL. Conclusions Our data indicate that a group 2 SSD of approximately 10 cm is a positive predictor for success following ESWL. PMID:26659086

Diagnosis of rare inherited glyoxalate metabolic disorders through in-situ analysis of renal stones

NASA Astrophysics Data System (ADS)

Jacob, D. E.; Grohe, B.; Hoppe, B.; Beck, B. B.; Tessadri, R.

2012-04-01

The primary hyperoxalurias type I - III constitute rare autosomal-recessive inherited disorders of the human glyoxylate metabolism. By mechanisms that are ill understood progressive nephrocalcinosis and recurrent urolithiasis (kidney stone formation) often starting in early childhood, along with their secondary complications results in loss of nephron mass which progresses to end-stage renal failure over time. In the most frequent form, end-stage renal failure (ESRF) is the rule and combined liver/kidney transplantation respectively pre-emptive liver transplantation are the only causative treatment today. Hence, this contributes significantly to healthcare costs and early diagnosis is extremely important for a positive outcome for the patient. We are developing a stone-based diagnostic method by in-detail multi-methods investigation of the crystalline moiety in concert with urine and stone proteomics. Stone analysis will allow faster analysis at low-impact for the patients in the early stages of the disease. First results from combined spectroscopic (Raman, FTIR)and geochemical micro-analyses (Electron Microprobe and Laser Ablation ICP-MS) are presented here that show significant differences between stones from hyperoxaluria patients and those formed by patients without this disorder (idiopathic stones). Major differences exist in chemistry as well as in morphology and phase composition of the stones. Ca/P ratios and Mg contents differentiate between oxalate-stones from hyperoxaluria patients and idiopathic stones. Results show that also within the different subtypes of primary hyperoxaluria significant differences can be found in stone composition. These imply differences in stone formation which could be exploited for new therapeutic pathways. Furthermore, the results provide important feedback for suspected but yet unconfirmed cases of primary hyperoxaluria when used in concert with the genetic methods routinely applied.

Dietary intake of fiber, fruit and vegetables decreases the risk of incident kidney stones in women: a Women's Health Initiative report.

PubMed

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

2014-12-01

We evaluated the relationship between dietary fiber, fruit and vegetable intake, and the risk of kidney stone formation. Overall 83,922 postmenopausal women from the Women's Health Initiative observational study were included in the analysis and followed prospectively. Cox proportional hazards regression analyses were used to evaluate the associations between total dietary fiber, fruit 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 and calibrated caloric intake; and dietary water, sodium, animal protein and calcium intake). Women with a history of kidney stones (3,471) were analyzed separately. Mean age of the women was 64±7 years, 85% were white and 2,937 (3.5%) experienced a kidney stone in a median followup of 8 years. In women with no history of kidney stones higher total dietary fiber (6% to 26% decreased risk, p <0.001), greater fruit intake (12% to 25% decreased risk, p <0.001) and greater vegetable intake (9% to 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, fruit or vegetable intake on the risk of kidney stone recurrence. Greater dietary intake of fiber, fruits and vegetables was 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. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Combining Mean and Standard Deviation of Hounsfield Unit Measurements from Preoperative CT Allows More Accurate Prediction of Urinary Stone Composition Than Mean Hounsfield Units Alone.

PubMed

Tailly, Thomas; Larish, Yaniv; Nadeau, Brandon; Violette, Philippe; Glickman, Leonard; Olvera-Posada, Daniel; Alenezi, Husain; Amann, Justin; Denstedt, John; Razvi, Hassan

2016-04-01

The mineral composition of a urinary stone may influence its surgical and medical treatment. Previous attempts at identifying stone composition based on mean Hounsfield Units (HUm) have had varied success. We aimed to evaluate the additional use of standard deviation of HU (HUsd) to more accurately predict stone composition. We identified patients from two centers who had undergone urinary stone treatment between 2006 and 2013 and had mineral stone analysis and a computed tomography (CT) available. HUm and HUsd of the stones were compared with ANOVA. Receiver operative characteristic analysis with area under the curve (AUC), Youden index, and likelihood ratio calculations were performed. Data were available for 466 patients. The major components were calcium oxalate monohydrate (COM), uric acid, hydroxyapatite, struvite, brushite, cystine, and CO dihydrate (COD) in 41.4%, 19.3%, 12.4%, 7.5%, 5.8%, 5.4%, and 4.7% of patients, respectively. The HUm of UA and Br was significantly lower and higher than the HUm of any other stone type, respectively. HUm and HUsd were most accurate in predicting uric acid with an AUC of 0.969 and 0.851, respectively. The combined use of HUm and HUsd resulted in increased positive predictive value and higher likelihood ratios for identifying a stone's mineral composition for all stone types but COM. To the best of our knowledge, this is the first report of CT data aiding in the prediction of brushite stone composition. Both HUm and HUsd can help predict stone composition and their combined use results in higher likelihood ratios influencing probability.

Stone Attenuation Values Measured by Average Hounsfield Units and Stone Volume as Predictors of Total Laser Energy Required During Ureteroscopic Lithotripsy Using Holmium:Yttrium-Aluminum-Garnet Lasers.

PubMed

Ofude, Mitsuo; Shima, Takashi; Yotsuyanagi, Satoshi; Ikeda, Daisuke

2017-04-01

To evaluate the predictors of the total laser energy (TLE) required during ureteroscopic lithotripsy (URS) using the holmium:yttrium-aluminum-garnet (Ho:YAG) laser for a single ureteral stone. We retrospectively analyzed the data of 93 URS procedures performed for a single ureteral stone in our institution from November 2011 to September 2015. We evaluated the association between TLE and preoperative clinical data, such as age, sex, body mass index, and noncontrast computed tomographic findings, including stone laterality, location, maximum diameter, volume, stone attenuation values measured using average Hounsfield units (HUs), and presence of secondary signs (severe hydronephrosis, tissue rim sign, and perinephric stranding). The mean maximum stone diameter, volume, and average HUs were 9.2 ± 3.8 mm, 283.2 ± 341.4 mm 3 , and 863 ± 297, respectively. The mean TLE and operative time were 2.93 ± 3.27 kJ and 59.1 ± 28.1 minutes, respectively. Maximum stone diameter, volume, average HUs, severe hydronephrosis, and tissue rim sign were significantly correlated with TLE (Spearman's rho analysis). Stepwise multiple linear regression analysis defining stone volume, average HUs, severe hydronephrosis, and tissue rim sign as explanatory variables showed that stone volume and average HUs were significant predictors of TLE (standardized coefficients of 0.565 and 0.320, respectively; adjusted R 2  = 0.55, F = 54.7, P <.001). Stone attenuation values measured by average HUs and stone volume were strong predictors of TLE during URS using Ho:YAG laser procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

Retrograde Ureteroscopic Management of Large Renal Calculi: A Single Institutional Experience and Concise Literature Review.

PubMed

Scotland, Kymora B; Rudnick, Benjamin; Healy, Kelly A; Hubosky, Scott G; Bagley, Demetrius H

2018-06-06

Advances in flexible ureteroscope design and accessory instrumentation have allowed for more challenging cases to be treated ureteroscopically. Here, we evaluate our experience with ureteroscopy (URS) for the management of large renal calculi (≥2 cm) and provide a concise review of recent reports. A retrospective review was undertaken of all URS cases between 2004 and 2014 performed by the endourologic team at a single academic tertiary care institution. We identified patients with at least one stone ≥2 cm managed with retrograde URS. Stone size was defined as the largest linear diameter of the index stone. Small diameter flexible ureteroscopes were used primarily with holmium laser. Patient demographics, intraoperative data, and postoperative outcomes were evaluated. We evaluated 167 consecutive patients who underwent URS for large renal stones ≥2 cm. The initial reason for choosing URS included patient preference (29.5%), failure of other therapies (8.2%), anatomic considerations/body habitus (30.3%), and comorbidities (28.8%). Mean patient age was 55.5 years (22-84). The mean stone size was 2.75 cm with mean number of procedures per patient of 1.65 (1-6). The single session stone-free rate was 57.1%, two-stage procedure stone-free rate was 90.2% and three-stage stone-free rate was 94.0%. Access sheaths were used in 47% of patients. An association was identified between stone size and patient outcomes; smaller stones correlated with decreased number of procedures. Postoperative complications were minor. Single or multi-stage retrograde ureteroscopic lithotripsy is a safe and effective mode of surgical management of large renal calculi. Total stone burden is a reliable predictor of the need for a staged procedure and of stone-free rate.

Is flexible ureterorenoscopy and laser lithotripsy the new gold standard for lower pole renal stones when compared to shock wave lithotripsy: Comparative outcomes from a University hospital over similar time period.

PubMed

Burr, Jacob; Ishii, Hiro; Simmonds, Nick; Somani, Bhaskar K

2015-01-01

Renal lower pole stones pose difficulty in management due to anatomical variation, stone size, hardness and patient demographics. Flexible ureterorenoscopy and laser lithotripsy (FURSL) and shock wave lithotripsy (SWL) are preferred for stones 1-2 cm in size. We wanted to compare the outcomes of FURSL and SWL for lower pole stones during the same time period. All patients who were treated for lower pole stones with FURSL and SWL during a 19-month period were included. The stone free rate (SFR) was defined as ≤3 mm fragments on follow-up imaging or stone free endoscopically. Data was recorded in an excel spreadsheet with SPSS version 21 used for statistical analysis. A total of 161 lower pole procedures were done (93 SWL and 63 FURSL). The mean stone size for SWL (7.4 mm; range: 4-16 mm) was significantly smaller than for FURSL (13.4 mm; 4-53 mm). The mean operating time and hospital stay for FURSL was 65 minutes (range: 30-160 minutes) and 0.5 days (range: 0-7 days) respectively. The SFR was significantly better (p <0.001) for FURSL (n = 63, 93%) compared to SWL (n = 23, 25%). There were 4 (6%) complications (3 Clavien II and 1 Clavien I) in the FURSL group (2 urosepsis, 1 UTI and 1 stent pain). Three patients in the SWL group (Clavien I) were readmitted with renal colic but there were no other complications. FURSL for lower pole stones seems to be a much better alternative than SWL with a high SFR even for larger stones and seems to be the new gold standard for lower pole stone management.

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

PubMed

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

2015-01-01

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. 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. 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. 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.

Quantitative prediction of stone fragility from routine single and dual energy CT: proof of feasibility

PubMed Central

Ferrero, Andrea; Montoya, Juan C.; Vaughan, Lisa E.; Huang, Alice E.; McKeag, Ian O.; Enders, Felicity T.; Williams, James C.; McCollough, Cynthia H.

2016-01-01

Rationale and Objectives Previous studies have demonstrated a qualitative relationship between stone fragility and internal stone morphology. The goal of this study was to quantify morphological features from dual-energy CT images and assess their relationship to stone fragility. Materials and Methods Thirty-three calcified urinary stones were scanned with micro CT. Next, they were placed within torso-shaped water phantoms and scanned with the dual-energy CT stone composition protocol in routine use at our institution. Mixed low-and high-energy images were used to measure volume, surface roughness, and 12 metrics describing internal morphology for each stone. The ratios of low- to high-energy CT numbers were also measured. Subsequent to imaging, stone fragility was measured by disintegrating each stone in a controlled ex vivo experiment using an ultrasonic lithotripter and recording the time to comminution. A multivariable linear regression model was developed to predict time to comminution. Results The average stone volume was 300 mm3 (range 134–674 mm3). The average comminution time measured ex vivo was 32 s (range 7–115 s). Stone volume, dual-energy CT number ratio and surface roughness were found to have the best combined predictive ability to estimate comminution time (adjusted R2= 0.58). The predictive ability of mixed dual-energy CT images, without use of the dual-energy CT number ratio, to estimate comminution time was slightly inferior, with an adjusted R2 of 0.54. Conclusion Dual-energy CT number ratios, volume, and morphological metrics may provide a method for predicting stone fragility, as measured by time to comminution from ultrasonic lithotripsy. PMID:27717761

Uric acid versus non-uric acid urinary stones: differentiation with single energy CT texture analysis.

PubMed

Zhang, G-M-Y; Sun, H; Shi, B; Xu, M; Xue, H-D; Jin, Z-Y

2018-05-21

To evaluate the accuracy of computed tomography (CT) texture analysis (TA) to differentiate uric acid (UA) stones from non-UA stones on unenhanced CT in patients with urinary calculi with ex vivo Fourier transform infrared spectroscopy (FTIR) as the reference standard. Fourteen patients with 18 UA stones and 31 patients with 32 non-UA stones were included. All the patients had preoperative CT evaluation and subsequent surgical removal of the stones. CTTA was performed on CT images using commercially available research software. Each texture feature was evaluated using the non-parametric Mann-Whitney test. Receiver operating characteristic (ROC) curves were created and the area under the ROC curve (AUC) was calculated for texture parameters that were significantly different. The features were used to train support vector machine (SVM) classifiers. Diagnostic accuracy was evaluated. Compared to non-UA stones, UA stones had significantly lower mean, standard deviation and mean of positive pixels but higher kurtosis (p<0.001) on both unfiltered and filtered texture scales. There were no significant differences in entropy or skewness between UA and non-UA stones. The average SVM accuracy of texture features for differentiating UA from non-UA stones ranged from 88% to 92% (after 10-fold cross validation). A model incorporating standard deviation, skewness, and kurtosis from unfiltered texture scale images resulted in an AUC of 0.965±00.029 with a sensitivity of 94.4% and specificity of 93.7%. CTTA can be used to accurately differentiate UA stones from non-UA stones in vivo using unenhanced CT images. Copyright © 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Natural stones of historic and future importance in Sweden

NASA Astrophysics Data System (ADS)

Schouenborg, Björn; Andersson, Jenny; Göransson, Mattias

2013-04-01

Several activities and responsibilities of the Geological Survey of Sweden (SGU) are related to the work of the newly formed international Heritage Stone Task Group (HSTG) for designating historically important stones. SGU is among other things a referral organization, frequently dealing with the preparation of statements in connection with the quarrying permit applications of stone producers. When preparing these statements, SGU takes into account a number of parameters, e.g. the importance for local and regional business development, historic importance, area of occurrence, quality of the geological documentation of the stone type, peculiarities of the stone types and technical properties relevant for the intended use. Traditionally, SGU has not worked with bedrock mapping looking at the potential of natural stones production but more commonly looking at the potential production of aggregates, industrial minerals and metals. The competence is, therefore, presently being built up with new databases over important natural stone types and definition of criteria for their selection etc. In this respect the criteria defined by the HSTG provide important help. This work goes hand in hand with the task of proposing stone-deposits and quarries of "national interest". The criteria for selection of a stone type, quarry etc as one of national interest are currently being revised. SGU plays an important role in this work. However, the final decision and appointment lies in the hands of the Swedish Board of Housing, Building and Planning (Boverket), an authority dealing with sustainable land use and regional development, town and country planning. Boverket supervises how the planning legislation is handled by the municipal authorities and the county administrative boards. The two latter organizations are those in charge of giving extraction permits for stone quarrying. The "Hallandia gneiss", of SW Sweden, is described as a case story and presented in this paper. Keywords: Hallandia gneiss, natural stones, historic stones, urban planning and building

An association between urinary cadmium and urinary stone disease in persons living in cadmium-contaminated villages in northwestern Thailand: A population study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Swaddiwudhipong, Witaya, E-mail: swaddi@hotmail.com; Mahasakpan, Pranee; Limpatanachote, Pisit

Excessive urinary calcium excretion is the major risk of urinary stone formation. Very few population studies have been performed to determine the relationship between environmental cadmium exposure and urinary stone disease. This population-based study examined an association between urinary cadmium excretion, a good biomarker of long-term cadmium exposure, and prevalence of urinary stones in persons aged 15 years and older, who lived in the 12 cadmium-contaminated villages in the Mae Sot District, Tak Province, northwestern Thailand. A total of 6748 persons were interviewed and screened for urinary cadmium and urinary stone disease in 2009. To test a correlation between urinarymore » excretion of cadmium and calcium, we measured urinary calcium content in 1492 persons, who lived in 3 villages randomly selected from the 12 contaminated villages. The rate of urinary stones significantly increased from 4.3% among persons in the lowest quartile of urinary cadmium to 11.3% in the highest quartile. An increase in stone prevalence with increasing urinary cadmium levels was similarly observed in both genders. Multiple logistic regression analysis revealed a positive association between urinary cadmium levels and stone prevalence, after adjusting for other co-variables. The urinary calcium excretion significantly increased with increasing urinary cadmium levels in both genders, after adjusting for other co-variables. Elevated calciuria induced by cadmium might increase the risk of urinary stone formation in this environmentally exposed population. - Research highlights: {yields} Excessive calciuria is the major risk of urinary stone formation. {yields} We examine cadmium-exposed persons for urinary cadmium, calcium, and stones. {yields} The rate of urinary stones increases with increasing urinary cadmium. {yields} Urinary calcium excretion increases with increasing urinary cadmium. {yields} Elevated calciuria induced by cadmium may increase the risk of urinary stones.« less

PROMIS® Pain is Independent of Stone Burden and Predicts Surgical Intervention in Patients with Ureteral Stones.

PubMed

Portis, Jennifer L; Neises, Suzanne M; Portis, Andrew J

2018-04-30

Patients with obstructing ureteral stones typically experience sudden onset, severe pain. We examine the National Institutes of Health's Patient Reported Outcome Measurement Information System (PROMIS®) pain instruments in patients with acute ureteral stones. PROMIS® pain measures were obtained from a complete cohort of patients presenting to a subspecialty kidney stone clinic after discharge from emergency department (ED). Patients were followed longitudinally through course of care. Raw scores were translated into population-normed T-scores (T-score 50 = US pain population mean). Objective and patient-centered factors were evaluated with reference to T-score thresholds for pain intensity (60 = 1 standard deviation (SD) above mean) and pain interference (70 = 2 SD). Multivariable logistic regression in 650 patients demonstrated absence of association between PROMIS® pain scores and stone size or location. Pain scores were associated with age, gender and ED pain scores (p<0.05). Initial stone surgery was predicted by stone size <4mm (0.14, 0.07-0.3 [odds ratio, 95% confidence interval]), >6 mm (19.1, 0.22-39.58), proximal location (1.75, 1.34-2.3), and pain intensity >60 (7.03, 3.63-13.6) but not pain interference (p<0.001). Failure of attempted stone passage was less likely for stone size <4 mm (0.26, 0.14-0.48, p<0.001), and more likely for proximal stone location (1.61, 1.21-2.14, p<0.01) and pain intensity >60 (2.74, 1.23-6.07, p<0.05). PROMIS® pain scores are independent of stone size and location. Attention to ED discharge symptom control offers potential to improve patient care. PROMIS® pain intensity is an independent predictor of surgical intervention for patients with ureteral stones ≤1 cm. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Serum Estradiol and Testosterone Levels in Kidney Stones Disease with and without Calcium Oxalate Components in Naturally Postmenopausal Women

PubMed Central

Ou, Lili; Duan, Xiaolu; Zeng, Guohua

2013-01-01

Objective Epidemiological data reveal that the overall risk for kidney stones disease is lower for women compared to age-matched men. However, the beneficial effect for the female sex is lost upon menopause, a time corresponding to the onset of fall in estrogen levels. The aim of this study was to describe the serum estradiol (E2) and testosterone (T) characteristics of naturally postmenopausal women with kidney stones. Methods 113 naturally postmenopausal women with newly diagnosed kidney stones (aged 57.4±4.98 years) and 84 age frequency matched stone-free controls (56.9±4.56 years) were validly recruited in the case-control study. The odds ratios (ORs) for the associations between sex hormones and kidney stones were estimated with logistic regression models, adjusting for demographic data and medical history. Patients were also stratified analyzed according to stone components (calcium oxalate stones [COS]; non-calcium oxalate stones [NCOS]). Results Serum E2 (21.1 vs. 31.1 pg/ml) was significantly lower in kidney stones patients compared to controls. Post-hoc analysis demonstrated that this effect was driven by COS patients (p<0.001). According to tertiles of the E2 levels, a significant higher frequency of COS was seen in the lowest E2 group (p <0.001). Multiple logistic regression analysis identified E2 level as a strong factor that was independently associated with the risk for COS (per 1 SD increase, OR=0.951, 95% confidence interval [CI] = 0.919-0.985; highest: lowest tertile, OR=0.214, 95%CI = 0.069-0.665). However, serum T levels did not significantly differ among the groups. Conclusions Naturally postmenopausal women with higher remaining estradiol levels appear less likely to suffer from kidney calcium oxalate stones. However, no correlation was found between serum T level and kidney stones. These findings support the hypothesis that higher postmenopausal endogenous estrogens may protect against kidney stones with ageing. PMID:24086550

Serum estradiol and testosterone levels in kidney stones disease with and without calcium oxalate components in naturally postmenopausal women.

PubMed

Zhao, Zhijian; Mai, Zanlin; Ou, Lili; Duan, Xiaolu; Zeng, Guohua

2013-01-01

Epidemiological data reveal that the overall risk for kidney stones disease is lower for women compared to age-matched men. However, the beneficial effect for the female sex is lost upon menopause, a time corresponding to the onset of fall in estrogen levels. The aim of this study was to describe the serum estradiol (E2) and testosterone (T) characteristics of naturally postmenopausal women with kidney stones. 113 naturally postmenopausal women with newly diagnosed kidney stones (aged 57.4±4.98 years) and 84 age frequency matched stone-free controls (56.9±4.56 years) were validly recruited in the case-control study. The odds ratios (ORs) for the associations between sex hormones and kidney stones were estimated with logistic regression models, adjusting for demographic data and medical history. Patients were also stratified analyzed according to stone components (calcium oxalate stones [COS]; non-calcium oxalate stones [NCOS]). Serum E2 (21.1 vs. 31.1 pg/ml) was significantly lower in kidney stones patients compared to controls. Post-hoc analysis demonstrated that this effect was driven by COS patients (p<0.001). According to tertiles of the E2 levels, a significant higher frequency of COS was seen in the lowest E2 group (p <0.001). Multiple logistic regression analysis identified E2 level as a strong factor that was independently associated with the risk for COS (per 1 SD increase, OR=0.951, 95% confidence interval [CI] = 0.919-0.985; highest: lowest tertile, OR=0.214, 95%CI = 0.069-0.665). However, serum T levels did not significantly differ among the groups. Naturally postmenopausal women with higher remaining estradiol levels appear less likely to suffer from kidney calcium oxalate stones. However, no correlation was found between serum T level and kidney stones. These findings support the hypothesis that higher postmenopausal endogenous estrogens may protect against kidney stones with ageing.

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

Prognostic Impact of Stone-Scoring Systems After Percutaneous Nephrolithotomy for Staghorn Calculi: A Single Center's Experience Over 10 Years.

PubMed

Choi, Sae Woong; Bae, Woong Jin; Ha, U-Syn; Hong, Sung-Hoo; Lee, Ji Youl; Kim, Sae Woong; Cho, Hyuk Jin

2016-09-01

To investigate the prognostic factors associated with stone-free rate (SFR) and complications after percutaneous nephrolithotomy (PCNL) for the treatment of staghorn stone and to compare the predictive value and accuracy of three stone-scoring systems for the treatment success of staghorn stone. We retrospectively reviewed all patients undergoing PCNL at our center from June 2003 to June 2014. On the basis of noncontrast computed tomography (NCCT) scan images, we calculated Guy's score, S.T.O.N.E. nephrolithometry, and Clinical Research Office of the Endourological Society (CROES) nomogram to assess the association with stone-free status and complications. For statistical evaluation, univariate and multivariate logistic regression analyses were used. During the study period, 886 cases had medical records available. Cases who underwent PCNL for the treatment of staghorn calculi accounted for 34.4% (305/886 cases). Preoperative NCCT was performed in 217 cases. The 217 procedures (205 patients, 12 simultaneous bilateral PCNLs) had a mean stone size of 1358.3 ± 760.7 mm(2), with 111 (51.2%) partial staghorn and 106 (48.8%) complete staghorn stones. The initial and overall SFRs of PCNL were 53.9% and 70.1%, respectively. The overall complication rate was 32.7% (71/217 cases). On a multivariate logistic regression analysis, independent predictors for SFR were number of involved calices, S.T.O.N.E. nephrolithometry, and pre-existent urinary tract infection (UTI) (odds ratios [ORs] = 1.311, 1.933, and 2.340, respectively). Stone burden was an independent risk factor for the development of complications on multivariate analysis (OR = 2.846 and p = 0.001). The results of this study show that multiple involved calices, high grades of S.T.O.N.E. nephrolithometry, and pre-existent UTIs were associated with lower SFR after PCNL for staghorn calculi. Stone burden was an independent risk factor for the development of complications.

An experimental study on compressive behavior of rubble stone walls retrofitted with BFRP grids

NASA Astrophysics Data System (ADS)

Huang, Hui; Jia, Bin; Li, Wenjing; Liu, Xiao; Yang, Dan; Deng, Chuanli

2018-03-01

An experimental study was conducted to investigate the compressive behavior of rubble stone walls retrofitted with BFRP grids. The experimental program consisted of four rubble stone walls: one unretrofitted rubble stone wall (reference wall) and three BFRP grids retrofitted rubble stone walls. The main purpose of the tests was to gain a better understanding of the compressive behavior of rubble stone walls retrofitted with different amount of BFRP grids. The experimental results showed that the reference wall failed with out-of-plane collapse due to poor connection between rubble stone blocks and the three BFRP grids retrofitted walls failed with BFRP grids rupture followed by out-of-plane collapse. The measured compressive strength of the BFRP grids retrofitted walls is about 1.4 to 2.5 times of that of the reference wall. Besides, the rubble stone wall retrofitted with the maximum amount of BFRP grids showed the minimum vertical and out-of-plane displacements under the same load.

Endoscopically-controlled electrohydraulic intracorporeal shock wave lithotripsy (EISL) of salivary stones.

PubMed

Königsberger, R; Feyh, J; Goetz, A; Kastenbauer, E

1993-02-01

Twenty-nine patients with salivary stones were treated with the endoscopically-controlled electrohydraulic shock wave lithotripsy (EISL). This new minimally invasive treatment of sialolithiasis is performed under local anesthesia on an outpatient basis with little inconvenience to the patient. For endoscopy, a flexible fibroscope with an additional probe to generate shock waves is placed into the submandibular duct and advanced until the stone is identified. For shock wave-induced stone disintegration, the probe electrode must be placed 1 mm in front of the concrement. The shock waves are generated by a sparkover at the tip of the probe. By means of the endoscopically-controlled shock wave lithotripsy it was possible to achieve complete stone fragmentation in 20 out of 29 patients without serious side effects. In three patients, only partial stone fragmentation could be achieved due to the stone quality. Endoscopically-controlled electrohydraulic intracorporeal shock wave lithotripsy represents a novel minimally invasive therapy for endoscopically accessible salivary gland stones. The advantage in comparison to the endoscopically-controlled laser lithotripsy will be discussed.

Evidence suggesting a genetic contribution to kidney stone in northeastern Thai population.

PubMed

Sritippayawan, Suchai; Borvornpadungkitti, Sombat; Paemanee, Atchara; Predanon, Chagkrapan; Susaengrat, Wattanachai; Chuawattana, Duangporn; Sawasdee, Nunghathai; Nakjang, Sirintra; Pongtepaditep, Suttikarn; Nettuwakul, Choochai; Rungroj, Nanyawan; Vasuvattakul, Somkiat; Malasit, Prida; Yenchitsomanus, Pa-thai

2009-06-01

Genetic factor may play a role in the pathogenesis of kidney stone that is found in the northeastern (NE) Thai population. Herein, we report initial evidence suggesting genetic contribution to the disease in this population. We examined 1,034 subjects including 135 patients with kidney stone, 551 family members, and 348 villagers by radiography of kidney-ureter-bladder (KUB) and other methods, and also analyzed stones removed by surgical operations. One hundred and sixteen of 551 family members (21.05%) and 23 of the 348 villagers (6.61%) were affected with kidney stone. The relative risk (lambda(R)) of the disease among family members was 3.18. Calcium stones (whewellite, dahllite, and weddellite) were observed in about 88% of stones analyzed. Our data indicate familial aggregation of kidney stone in this population supporting that genetic factor should play some role in its pathogenesis. Genetic and genomic studies will be conducted to identify the genes associated with the disease.

Determinants of holmium:yttrium-aluminum-garnet laser time and energy during ureteroscopic laser lithotripsy.

PubMed

Molina, Wilson R; Marchini, Giovanni S; Pompeo, Alexandre; Sehrt, David; Kim, Fernando J; Monga, Manoj

2014-04-01

To evaluate the association of preoperative noncontrast computed tomography stone characteristics, laser settings, and stone composition with cumulative holmium:yttrium-aluminum-garnet (Ho:YAG) laser time/energy. We retrospectively reviewed patients who underwent semirigid/flexible ureteroscopy and Ho:YAG laser lithotripsy (200 or 365 μm laser fiber; 0.8-1.0 J energy; and 8-10 Hz rate) at 2 tertiary care centers (April 2010-May 2012). Studied parameters were as follows: patient's characteristics; stone characteristics (location, burden, hardness, and composition); total laser time and energy; and surgical outcomes. One hundred patients met our inclusion criteria. Mean stone size was 1.01 ± 0.42 cm and volume 0.33 ± 0.04 cm(3). Mean stone radiodensity was 990 ± 296 HU, and Hounsfield units density 13.8 ± 6.0 HU/mm. All patients were considered stone free. Stone size and volume had a significant positive correlation with laser energy (R = 0.516, P <.001; R = 0.621, P <.001) and laser time (R = 0.477, P <.001; R = 0.567, P <.001). When controlling for stone size, only the correlation between HU and laser time was significant (R = 0.262, P = .011). In the multivariate analysis, with exception of stone composition (P = .103), all parameters significantly increased laser energy (R(2) = 0.524). Multivariate analysis revealed a positive significant association of laser time with stone volume (P <.001) and Hounsfield units density (P <.001; R(2) = 0.512). In multivariate analysis for laser energy, only calcium phosphate stones required less energy to fragment compared with uric acid stones. No significant differences were found in the multivariate laser time model. Ho:YAG laser cumulative energy and total time are significantly affected by stone dimensions, hardness location, fiber size, and power. Kidney location, laser fiber size, and laser power have more influence on the final laser energy than on the total laser time. Calcium phosphate stones require less laser energy to fragment. Copyright © 2014 Elsevier Inc. All rights reserved.

Forecasting the Change of Renal Stone Occurrence Rates in Astronauts

NASA Technical Reports Server (NTRS)

Myers, J.; Goodenow, D.; Gokoglu, S.; Kassemi, M.

2016-01-01

Changes in urine chemistry, during and post flight, potentially increases the risk of renal stones in astronauts. Although much is known about the effects of space flight on urine chemistry, no inflight incidences of renal stones in US astronauts exists and the question How much does this risk change with space flight? remains difficult to accurately quantify. In this discussion, we tackle this question utilizing a combination of deterministic and probabilistic modeling that implements the physics behind free stone growth and agglomeration, speciation of urine chemistry and published observations of population renal stone incidences to estimate changes in the rate of renal stone occurrence.

Ureteroscopy and stones: Current status and future expectations

PubMed Central

Wright, Anna E; Rukin, Nicholas J; Somani, Bhaskar K

2014-01-01

Urolithaisis is becoming an ever increasing urological, nephrological and primary care problem. With a lifetime prevalence approaching 10% and increasing morbidity due to stone disease, the role of ureteroscopy and stone removal is becoming more important. We discuss the current status of stone disease and review the ever increasing role that ureteroscopy has to play in its management. We discuss technological advances that have been made in stone management and give you an overview of when, how and why ureteroscopy is the most common treatment option for stone management. We touch on the role of robotic ureteroscopy and the future of ureteroscopy in the next 10 years. PMID:25374818

Modeling elastic wave propagation in kidney stones with application to shock wave lithotripsy.

PubMed

Cleveland, Robin O; Sapozhnikov, Oleg A

2005-10-01

A time-domain finite-difference solution to the equations of linear elasticity was used to model the propagation of lithotripsy waves in kidney stones. The model was used to determine the loading on the stone (principal stresses and strains and maximum shear stresses and strains) due to the impact of lithotripsy shock waves. The simulations show that the peak loading induced in kidney stones is generated by constructive interference from shear waves launched from the outer edge of the stone with other waves in the stone. Notably the shear wave induced loads were significantly larger than the loads generated by the classic Hopkinson or spall effect. For simulations where the diameter of the focal spot of the lithotripter was smaller than that of the stone the loading decreased by more than 50%. The constructive interference was also sensitive to shock rise time and it was found that the peak tensile stress reduced by 30% as rise time increased from 25 to 150 ns. These results demonstrate that shear waves likely play a critical role in stone comminution and that lithotripters with large focal widths and short rise times should be effective at generating high stresses inside kidney stones.

Endoscopic Stone Measurement During Ureteroscopy.

PubMed

Ludwig, Wesley W; Lim, Sunghwan; Stoianovici, Dan; Matlaga, Brian R

2018-01-01

Currently, stone size cannot be accurately measured while performing flexible ureteroscopy (URS). We developed novel software for ureteroscopic, stone size measurement, and then evaluated its performance. A novel application capable of measuring stone fragment size, based on the known distance of the basket tip in the ureteroscope's visual field, was designed and calibrated in a laboratory setting. Complete URS procedures were recorded and 30 stone fragments were extracted and measured using digital calipers. The novel software program was applied to the recorded URS footage to obtain ureteroscope-derived stone size measurements. These ureteroscope-derived measurements were then compared with the actual-measured fragment size. The median longitudinal and transversal errors were 0.14 mm (95% confidence interval [CI] 0.1, 0.18) and 0.09 mm (95% CI 0.02, 0.15), respectively. The overall software accuracy and precision were 0.17 and 0.15 mm, respectively. The longitudinal and transversal measurements obtained by the software and digital calipers were highly correlated (r = 0.97 and 0.93). Neither stone size nor stone type was correlated with error measurements. This novel method and software reliably measured stone fragment size during URS. The software ultimately has the potential to make URS safer and more efficient.

Kidney Stones After Bariatric Surgery: Risk Assessment and Mitigation.

PubMed

Espino-Grosso, Pedro Mario; Canales, Benjamin Kirk

2017-03-01

Obesity is rampant across the spectrum of age, gender, and race in the Unites States. Paralleling this epidemic, kidney stone prevalence is also rising, affecting nearly 1 in 11 individuals. Bariatric surgical procedures, such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), are the most effective weight loss options for morbidly obese or severely obese individuals with comorbidities. A number of studies have linked kidney stone development to bariatric surgical history, particularly RYGB, which portends up to a threefold increase in calcium oxalate stone risk compared with age-matched, obese controls. Stone development after malabsorptive (RYGB) and restrictive (SG) bariatric procedures are driven primarily by alterations in 24-h urine profiles, such as increased urinary oxalate, decreased urine volume, and reduced urinary citrate levels-all of which have been linked to increased kidney stone risk. What clinical recommendations, if any, can be given to reduce kidney stone risk in bariatric kidney stone patients? This review provides not only updated stone incidence and 24-h urine data in this population, but also reassurance-the metabolic alterations that result from bariatric surgery can be successfully mitigated by increased provider awareness, patient education, and a combination of dietary and pharmacological adjustments.

Vitamin D, Hypercalciuria and Kidney Stones

PubMed Central

Letavernier, Emmanuel; Daudon, Michel

2018-01-01

The estimated lifetime risk of nephrolithiasis is growing nowadays, and the formation of kidney stones is frequently promoted by hypercalciuria. Vitamin D, and especially its active metabolite calcitriol, increase digestive calcium absorption—as urinary calcium excretion is directly correlated with digestive calcium absorption, vitamin D metabolites could theoretically increase calciuria and promote urinary stone formation. Nevertheless, there was, until recently, low evidence that 25-hydroxyvitamin D serum levels would be correlated with kidney stone formation, even if high calcitriol concentrations are frequently observed in hypercalciuric stone formers. Low 25-hydroxyvitamin D serum levels have been associated with a broad spectrum of diseases, leading to a huge increase in vitamin D prescription in the general population. In parallel, an increased frequency of kidney stone episodes has been observed in prospective studies evaluating vitamin D alone or in association with calcium supplements, and epidemiological studies have identified an association between high 25-hydroxyvitamin D serum levels and kidney stone formation in some groups of patients. Moreover, urinary calcium excretion has been shown to increase in response to vitamin D supplements, at least in some groups of kidney stone formers. It seems likely that predisposed individuals may develop hypercalciuria and kidney stones in response to vitamin D supplements. PMID:29562593

Idiopathic hypercalciuria and formation of calcium renal stones

PubMed Central

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

2018-01-01

The most common presentation of nephrolithiasis is idiopathic calcium stones in patients without systemic disease. Most stones are primarily composed of calcium oxalate and form on a base of interstitial apatite deposits, known as Randall’s plaque. By contrast some stones are composed largely of calcium phosphate, as either hydroxyapatite or brushite (calcium monohydrogen phosphate), and are usually accompanied by deposits of calcium phosphate in the Bellini ducts. These deposits result in local tissue damage and might serve as a site of mineral overgrowth. Stone formation is driven by supersaturation of urine with calcium oxalate and brushite. The level of supersaturation is related to fluid intake as well as to the levels of urinary citrate and calcium. Risk of stone formation is increased when urine citrate excretion is <400 mg per day, and treatment with potassium citrate has been used to prevent stones. Urine calcium levels >200 mg per day also increase stone risk and often result in negative calcium balance. Reduced renal calcium reabsorption has a role in idiopathic hypercalciuria. Low sodium diets and thiazide-type diuretics lower urine calcium levels and potentially reduce the risk of stone recurrence and bone diseas PMID:27452364

The elementome of calcium-based urinary stones and its role in urolithiasis

PubMed Central

Ramaswamy, Krishna; Killilea, David W.; Kapahi, Pankaj; Kahn, Arnold J.; Chi, Thomas; Stoller, Marshall L.

2016-01-01

Urolithiasis affects around 10% of the US population with an increasing rate of prevalence, recurrence and penetrance. The causes for the formation of most urinary calculi remain poorly understood, but obtaining the chemical composition of these stones might help identify key aspects of this process and new targets for treatment. The majority of urinary stones are composed of calcium that is complexed in a crystalline matrix with organic and inorganic components. Surprisingly, mitigation of urolithiasis risk by altering calcium homeostasis has not been very effective. Thus, studies to identify other therapeutic stone-specific targets, using proteomics, metabolomics and microscopy techniques, have been conducted, revealing a high level of complexity. The data suggest that numerous metals other than calcium and many nonmetals are present within calculi at measurable levels and several have distinct distribution patterns. Manipulation of the levels of some of these elemental components of calcium-based stones has resulted in clinically beneficial changes in stone chemistry and rate of stone formation. The elementome—the full spectrum of elemental content—of calcium-based urinary calculi is emerging as a new concept in stone research that continues to provide important insights for improved understanding and prevention of urinary stone disease. PMID:26334088

How effective is ureteroscopy in the treatment of pediatric stone disease?

PubMed

Thomas, John C

2010-08-01

Pediatric ureteroscopy has been increasingly used to manage both ureteral and renal stones. Unfortunately, there are no current standardized recommendations when treating pediatric stone disease so the modality chosen is left to the treating surgeon. A review of the current literature on pediatric ureteroscopy was used to compile this article. For the purposes of this review, the majority of series include stones < or =1 cm. Ureteroscopy is considered to be first-line therapy in treating mid- to distal ureteral stones and is rapidly evolving as an acceptable first-line therapy for renal stones as well. Limitations do exist and include stone composition, location, size, as well as the unique anatomic challenges faced by pediatric urologists in terms of anomalous kidneys and/or reconstructed urinary tracts. In conclusion, ureteroscopy can be considered first-line therapy for mid- or distal ureteral stones, however, it shares a similar efficacy rate as extracorporeal shock wave lithotripsy for the treatment of renal calculi. There is a need for direct comparison in the literature of all modalities treating pediatric stone disease to facilitate guidelines that help treating surgeons choose the most efficacious modality offering the highest success rates with the lowest morbidity.

Investigation of Renal Stones by X-ray and Neutron Diffraction

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baeva, M.; Boianova, A.; Beskrovnyi, A. I.

2007-04-23

Renal stones were investigated by X-ray diffraction. The obtained results showed only one crystal phase in every sample. With the aim to verify eventual availability of second phase (under 3 volume %) the same renal stones were investigated by neutron diffraction. The neutron spectra proved that additional crystal phase was absent in the renal stones. The obtained results are scientific-practical, in aid of the medicine, especially in the case of renal stone disease.

Treatment of gallbladder stone with common bile duct stones in the laparoscopic era.

PubMed

Zhang, Wei-jie; Xu, Gui-fang; Huang, Qin; Luo, Kun-lun; Dong, Zhi-tao; Li, Jie-ming; Wu, Guo-zhong; Guan, Wen-xian

2015-01-26

Laparoscopic common bile duct exploration (LCBDE) for stone can be carried out by either laparoscopic transcystic stone extraction (LTSE) or laparoscopic choledochotomy (LC). It remains unknown as to which approach is optimal for management of gallbladder stone with common bile duct stones (CBDS) in Chinese patients. From May 2000 to February 2009, we prospective treated 346 consecutive patients with gallbladder stones and CBDS with laparoscopic cholecystectomy and LCBDE. Intraoperative findings, postoperative complications, postoperative hospital stay and costs were analyzed. Because of LCBDE failure,16 cases (4.6%) required open surgery. Of 330 successful LCBDE-treated patients, 237 underwent LTSE and 93 required LC. No mortality occurred in either group. The bile duct stone clearance rate was similar in both groups. Patients in the LTSE group were significantly younger and had fewer complications with smaller, fewer stones, shorter operative time and postoperative hospital stays, and lower costs, compared to those in the LC group. Compared with patients with T-tube insertion, patients in the LC group with primary closure had shorter operative time, shorter postoperative hospital stay, and lower costs. In cases requiring LCBDE, LTSE should be the first choice, whereas LC may be restricted to large, multiple stones. LC with primary closure without external drainage of the CBDS is as effective and safe as the T-tube insertion approach.

Ultrasonic propulsion of kidney stones: preliminary results of human feasibility study.

PubMed

Bailey, Michael; Cunitz, Bryan; Dunmire, Barbrina; Paun, Marla; Lee, Franklin; Ross, Susan; Lingeman, James; Coburn, Michael; Wessells, Hunter; Sorensen, Mathew; Harper, Jonathan

2014-09-03

One in 11 Americans has experienced kidney stones, with a 50% average recurrence rate within 5-10 years. Ultrasonic propulsion (UP) offers a potential method to expel small stones or residual fragments before they become a recurrent problem. Reported here are preliminary findings from the first investigational use of UP in humans. The device uses a Verasonics ultrasound engine and Philips HDI C5-2 probe to generate real-time B-mode imaging and targeted "push" pulses on demand. There are three arms of the study: de novo stones, post-lithotripsy fragments, and the preoperative setting. A pain questionnaire is completed prior to and following the study. Movement is classified based on extent. Patients are followed for 90 days. Ten subjects have been treated to date: three de novo , five post-lithotripsy, and two preoperative. None of the subjects reported pain associated with the treatment or a treatment related adverse event, beyond the normal discomfort of passing a stone. At least one stone was moved in all subjects. Three of five post-lithotripsy subjects passed a single or multiple stones within 1-2 weeks following treatment; one subject passed two (1-2 mm) fragments before leaving clinic. In the pre-operative studies we successfully moved 7 - 8 mm stones. In four subjects, UP revealed multiple stone fragments where the clinical image and initial ultrasound examination indicated a single large stone.

Stenting or not prior to extracorporeal shockwave lithotripsy for ureteral stones? Results of a prospective randomized study.

PubMed

Sfoungaristos, Stavros; Polimeros, Nikolaos; Kavouras, Adamantios; Perimenis, Petros

2012-06-01

To determine the need for pre-treatment stenting in patients undergoing extracorporeal shockwave lithotripsy (ESWL) for ureteral stones sized 4-10 mm. A prospective randomized study was conducted between September 2009 and March 2011. Included 156 patients randomized in stented and non-stented groups and underwent a maximum of 3 ESWL sessions. Radiographic follow-up was used to assess the stone fragmentation and clearance. Results were compared in terms of stone-free rates, post-treatment morbidity and complications. Overall efficacy was 76.9%. Stone-free rates were statistically significantly lower (P = 0.026) in the stented group (68.6%) compared to the non-stented ones (83.7%). Furthermore, stenting was significantly correlated with post-treatment lower urinary tract symptoms (P ≤ 0.001), need for more ESWL sessions (P = 0.019) and possibility for operation due to ESWL failure (P = 0.026). A multivariate analysis was conducted to identify the parameters which may predict complete stone removal after ESWL. Stone size (P = 0.026), stone location (P = 0.011) and stenting (P = 0.007) were the most significant factors. ESWL is an efficient and safe treatment for 4- to 10-mm ureteral stones. Pre-treatment stenting is limiting stone-free rates and is significantly influencing post-ESWL morbidity and quality of life in a negative manner, while it contributes minimally to the prophylaxis of complications.

BIOPSY PROVEN MEDULLARY SPONGE KIDNEY: Clinical findings, histopathology, and role of osteogenesis in stone and plaque formation

PubMed Central

Evan, Andrew P.; Worcester, Elaine M.; Williams, James C.; Sommer, Andre J.; Lingeman, James E.; Phillips, Carrie L.; Coe, Fredric L.

2015-01-01

Medullary sponge kidney (MSK) is associated with recurrent stone formation, but the clinical phenotype is unclear because patients with other disorders may be incorrectly labeled MSK. We studied 12 patients with histologic findings pathognomonic of MSK. All patients had an endoscopically recognizable pattern of papillary malformation, which may be segmental or diffuse. Affected papillae are enlarged and billowy, due to markedly enlarged inner medullary collecting ducts (IMCD), which contain small, mobile ductal stones. Patients had frequent dilation of Bellini ducts, with occasional mineral plugs. Stones may form over white (Randall’s) plaque, but most renal pelvic stones are not attached, and have a similar morphology as ductal stones, which are a mixture of calcium oxalate and apatite. Patients had no abnormalities of urinary acidification or acid excretion; the most frequent metabolic abnormality was idiopathic hypercalciuria. Although both Runx2 and Osterix are expressed in papillae of MSK patients, no mineral deposition was seen at the sites of gene expression, arguing against a role of these genes in this process. Similar studies in idiopathic calcium stone formers showed no expression of these genes at sites of Randall’s plaque. The most likely mechanism for stone formation in MSK appears to be crystallization due to urinary stasis in dilated IMCD with subsequent passage of ductal stones into the renal pelvis where they may serve as nuclei for stone formation. PMID:25615853

An extended chemical analysis of gallstone.

PubMed

Chandran, P; Kuchhal, N K; Garg, P; Pundir, C S

2007-09-01

Chemical composition of gall stones is essential for aetiopathogensis of gallstone disease. We have reported quantitative chemical analysis of total cholesterol bilirubin, calcium, iron and inorganic phosphate in 120 gallstones from haryana. To extend this chemical analysis of gall stones by studying more cases and by analyzing more chemical constituents. A quantitative chemical analysis of total cholesterol, total bilirubin, fatty acids, triglycerides, phospholipids, bile acids, soluble proteins, sodium potassium, magnesium, copper, oxalate and chlorides of biliary calculi (52 cholesterol, 76 mixed and 72 pigment) retrieved from surgical operation of 200 patients from Haryana state was carried out. Total cholesterol as the major component and total bilirubin, phospholipids, triglycerides, bile acids, fatty acids (esterified), soluble protein, calcium, magnesium, iron, copper, sodium, potassium, inorganic phosphate, oxalate and chloride as minor components were found in all types of calculi. The cholesterol stones had higher content of total cholesterol, phospholipids, fatty acids (esterified), inorganic phosphate and copper compared to mixed and pigment stones. The mixed stones had higher content of iron and triglycerides than to cholesterol and pigment stones. The pigment stones were richer in total bilirubin, bile acids, calcium, oxalate, magnesium, sodium, potassium, chloride and soluble protein compared to cholesterol and mixed stones. Although total cholesterol was a major component of cholesterol, mixed and pigment gall stone in Haryana, the content of most of the other lipids, cations and anions was different in different gall stones indicating their different mechanism of formation.

Effectiveness of Treatment Modalities on Kidney Stone Recurrence.

PubMed

Zisman, Anna L

2017-10-06

Nephrolithiasis is highly prevalent across all demographic groups in the Western world and beyond, and its incidence rates are rising. In addition to the morbidity of the acute event, stone disease often becomes a lifelong problem that requires preventative therapy to diminish ongoing morbidity. Across the majority of stone types, increased fluid intake and targeted dietary modifications are mainstays of therapy. Specific dietary interventions associated with reduced calcium stone risk include adequate dietary calcium intake and restriction of sodium, protein, and oxalate intake, among others. Pharmaceutical therapy may be required if lifestyle changes are insufficient to minimize risk of stone recurrence, and must be targeted to the specific metabolic abnormalities portending risk for a given patient. Therapeutic options for idiopathic calcium stone disease include thiazides, citrate salts, and uric acid-lowering agents. Alkali salts are also the treatment of choice for uric acid stone disease. Management of struvite stone disease is largely surgical, but acetohydroxamic acid is a proven second line therapy. Cystinuria requires lifestyle modifications and may call for thiol-binding agents. Significant heterogeneity of the clinical population with stone disease has previously limited opportunities for large randomized controlled trials. However, as clinical phenotypes and genotypes are increasingly clarified, there are mounting opportunities for targeted randomized controlled trials in stone prevention. In the meantime, the currently available evidence for both lifestyle and pharmacologic interventions is reviewed herein. Copyright © 2017 by the American Society of Nephrology.

Programmatic Considerations to Reduce the Risk of Adverse Renal Stone Events in Spaceflight

NASA Technical Reports Server (NTRS)

Antonsen, Erik; Pietrzyk, Robert

2017-01-01

Introduction: Microgravity exposure may alter the likelihood that astronauts will experience renal stones. The potential risk includes both acute and chronic health issues, with the potential for significant impact on mission objectives. Methods: To understand the role of the NASA's Human Research Program (HRP) research agenda in both preventing and addressing renal stones in spaceflight, current astronaut epidemiologic data and a summary of programmatic considerations are reviewed. Results: Although there has never been a symptomatic renal stone event in a U.S. crewmember during spaceflight, urine chemistry has been altered - likely due to induced changes in renal physiology as a result of exposure to microgravity. This may predispose astronauts to stone formation, leading the HRP to conduct and sponsor research to: 1) understand the risk of stone formation in space; 2) prevent stones from forming; and 3) address stones that may form by providing novel diagnostic and therapeutic approaches. Discussion: The development of a renal stone during spaceflight is a significant medical concern that requires the HRP to minimize this risk by providing the ability to prevent, diagnose, monitor and treat the condition during spaceflight. A discussion of the risk as NASA understands it is followed by an overview of the multiple mitigations currently under study, including novel ultrasound techniques for stone detection and manipulation, and how they may function as part of a larger exploration medical system.

Building stones can be of geoheritage significance

NASA Astrophysics Data System (ADS)

Brocx, Margaret; Semeniuk, Vic

2017-04-01

Building stones have generally been assigned values according to their cultural, aesthetic, and rarity significance, amongst other criteria, but they also may have geoheritage significance. This is akin to the geoheritage significance ascribed to minerals and fossils housed as ex situ specimens in museums. We proffer the notion that building stones can be of geoheritage value particularly where they comprise permanent buildings, they illustrate significant windows into the history of the Earth, and they can be visited as an ex situ museum locality (e.g., the "Blue Granite" of Iceland) for education as part of building-stone tours. For some rocks the quarries that supplied the building stone are no longer in existence and hence the building stones provide the only record of that type of material; for other rocks, the building stone may illustrate features in the lithology no longer present in the quarry itself (e.g., rare and large xenoliths). Building stones are particularly significant as they are often polished and manifest structures, fabrics, and textures not evident in outcrop. We illustrate here examples of building stone of geoheritage significance using Australian and International examples. Australian designated stones could include the "Sydney Sandstone" or "Victorian Bluestone". For international examples, there is the famous "Carrara Marble" in Italy and the widely known "Portland Limestone" from southern England, the latter having been utilized for St Pauls Cathedral in London and the UN building in New York City.

Uric acid stones increase the risk of chronic kidney disease.

PubMed

Li, Ching-Chia; Chien, Tsu-Ming; Wu, Wen-Jeng; Huang, Chun-Nung; Chou, Yii-Her

2018-02-28

The aim of this study was to compare the clinical characteristics of uric acid stones and their potential risk for chronic kidney disease (CKD). A total of 401 patients (196 with uric acid stone and 205 without) were enrolled from our database of patients with urolithiasis. We analyzed the clinical demographic features, stone location, urine chemistries, and renal function. There was a significant difference (p < 0.001) between the two groups in terms of age, with the higher mean age in the uric acid group. Patients with uric acid stones had much lower pH of urine (p < 0.001) and higher serum uric acid level (p = 0.002). Notably, those with uric acid stones had worse eGFR than those with non-uric acid stones. Multivariate analysis confirmed that age over 60 years (ORs = 9.19; 95% CI 3.5-24.3), female sex (ORs = 4.01; 95% CI 1.8-9.0), hyperuricemia (ORs = 8.47; 95% CI 1.6-43.5), and uric acid stone (OR = 2.86; 95% CI 1.2-6.7) were the independent predictors of poor prognoses in CKD. Therefore, an association exists between uric acid stones and higher prevalence of CKD. Patients with uric acid stones may need close monitoring of renal function during follow-up.

Safety and efficacy of percutaneous nephrolithotomy for the treatment of paediatric urolithiasis

PubMed Central

Veeratterapillay, R; Shaw, MBK; Williams, R; Haslam, P; Lall, A; De la Hunt, M; Hasan, ST; Thomas, DJ

2012-01-01

INTRODUCTION Paediatric percutaneous nephrolithotomy (PCNL) has revolutionised the treatment of paediatric nephrolithiasis. Paediatric PCNL has been performed using both adult and paediatric instruments. Stone clearance rates and complications vary according to the technique used and surgeon experience. We present our experience with PCNL using adult instruments and a 28Fr access tract for large renal calculi in children under 18 years. METHODS All patients undergoing PCNL at our institution between 2000 and 2009 were reviewed. Demographics, surgical details and post-operative follow-up information were obtained to identify stone clearance rates and complications. RESULTS PCNL was performed in 32 renal units in 31 patients (mean age: 10.8 years). The mean stone diameter was 19mm (range: 5–40mm). Twenty-six cases required single puncture and six required multiple tracts. Overall, 11 staghorn stones, 10 multiple calyceal stones and 11 single stones were treated. Twenty-seven patients (84%) were completely stone free following initial PCNL. Two cases had extracorporeal shock wave lithotripsy for residual fragments, giving an overall stone free rate of 91% following treatment. There was no significant bleeding or sepsis encountered either during the operation or in the post-operative setting. No patient required or received a blood transfusion. CONCLUSIONS Paediatric PCNL can be performed safely with minimal morbidity using adult instruments for large stone burden, enabling rapid and complete stone clearance. PMID:23131231

Safety and efficacy of percutaneous nephrolithotomy for the treatment of paediatric urolithiasis.

PubMed

Veeratterapillay, R; Shaw, M B K; Williams, R; Haslam, P; Lall, A; De la Hunt, M; Hasan, S T; Thomas, D J

2012-11-01

Paediatric percutaneous nephrolithotomy (PCNL) has revolutionised the treatment of paediatric nephrolithiasis. Paediatric PCNL has been performed using both adult and paediatric instruments. Stone clearance rates and complications vary according to the technique used and surgeon experience. We present our experience with PCNL using adult instruments and a 28Fr access tract for large renal calculi in children under 18 years. All patients undergoing PCNL at our institution between 2000 and 2009 were reviewed. Demographics, surgical details and post-operative follow-up information were obtained to identify stone clearance rates and complications. PCNL was performed in 32 renal units in 31 patients (mean age: 10.8 years). The mean stone diameter was 19mm (range: 5-40mm). Twenty-six cases required single puncture and six required multiple tracts. Overall, 11 staghorn stones, 10 multiple calyceal stones and 11 single stones were treated. Twenty-seven patients (84%) were completely stone free following initial PCNL. Two cases had extracorporeal shock wave lithotripsy for residual fragments, giving an overall stone free rate of 91% following treatment. There was no significant bleeding or sepsis encountered either during the operation or in the post-operative setting. No patient required or received a blood transfusion. Paediatric PCNL can be performed safely with minimal morbidity using adult instruments for large stone burden, enabling rapid and complete stone clearance.

Influence of stone content on soil hydraulic properties: experimental investigation and test of existing model concepts

NASA Astrophysics Data System (ADS)

Naseri, Mahyar; Richter, Niels; Iden, Sascha C.; Durner, Wolfgang

2017-04-01

Rock fragments in soil, in this contribution referred to as "stones", play an important role for water flow in the subsurface. To successfully model soil hydraulic processes such as evaporation, redistribution and drainage, an understanding of how stones affect soil hydraulic properties (SHP) is crucial. Past investigations on the role of stones in soil have focused on their influence on the water retention curve (WRC) and on saturated hydraulic conductivity Ks, and have led to some simple theoretical models for the influence of stones on effective SHP. However, studies that measure unsaturated SHP directly, i.e., simultaneously the WRC and hydraulic conductivity curve (HCC) are still missing. Also, studies so far were restricted to low or moderate stone contents of less than 40%. We conducted a laboratory study in which we examined the effect of stone content on effective WRC and HCC of stony soils. Mixtures of soil and stones were generated by substituting background soil with stones in weight fractions between 0% (fine material only) to 100% (pure gravel). Stone sizes were 2-5 mm and 7-15 mm, respectively, and background soils were Sand and Sandy Loam. Packed samples were fully saturated under vacuum and subsequently subjected to evaporation in the laboratory. All experiments were done in three replicates. The soil hydraulic properties were determined by the simplified evaporation method using the UMS HYPROP setup. Questions were whether the applied measurement methodology is applicable to derive the SHP of the mixtures and how the gradual increase of stone content will affect the SHP, particularly the HCC. The applied methodology was successful in identifying effective SHP with a high precision over the full moisture range. WRC and HCC were successfully obtained by HYPROP, even for pure gravel with a size of 7-15 mm. WRCs changed qualitatively in the expected manner, i.e., an increase of stone content reduced porosity and soil water content at all suctions. However, the effect on SHP could not be modelled by assuming stones to be simply impermeable objects that occupy a part of the soil space. This was indicated by a nonlinear increase of the van Genuchten shape parameter α and a decrease of n with increasing gravel content, the latter indicating a widening of the effective pore-size distribution. Saturated conductivity decreased with increasing stone content, but then steeply increased for stone contents > 40%. Unsaturated hydraulic conductivity curves of stone-soil mixtures showed a less pronounced decrease with increasing suction as compared to the pure components, again indicating a widening of the effective pore-size distribution and a nonlinear dependence of the effective unsaturated conductivity on stone content.

[Usefullness of the StoneBreaker lithotripter for percutaneous nephrolithotomy].

PubMed

del Peso, Almudena Coloma; González, Inmaculada Fernández; Gálvez, Milagros Jiménez; Abad, Pablo Garrido; Fajardo, Gloria Bocardo; Fernández, Luis Miguel Herranz; Arjona, Manuel Fernández; Torres, Lorenzo Herrero; Sanz, Ignacio Pereira

2008-01-01

Throughout the history, many devices have been used for breaking urinary tract stones. StoneBreaker (LMA Urology, Gland, Switzerland) is a second generation of intracorporeal lithotripter, pneumatic and portable, which adds several new advantages, like effectiveness in stone fragmentation and easy handling, very useful during percutaneous lithotripsy. We report the case of a 40 year-old male patient, with a left kidney pyelic lithiasis, who was treated by percutaneous lithotripsy, under general anaesthesia, with StoneBreaker (LMA Urology, Gland, Switzerland) as lithotripter. StoneBreaker (LMA Urology, Gland, Switzerland) is a lithotripter usable with rigid and semirigid ureteroscopes, much more powerful than its predecessors. It is able to decrease the number of shocks necessary for stone fragmentation, without bigger tissue reaction. It also has a more comfortable design due to the absence of connections, and its power by replaceable carbon dioxide cartridges.

[Urologic interventional therapy of kidney calculi (I)--extracorporeal shockwave lithotripsy].

PubMed

Knoll, Th; Michel, M S; Köhrmann, K U; Alken, P

2003-02-01

With a prevalence of around 5% in western countries, urolithiasis is a frequently occurring disease but with a poorly understood pathogenesis. Effective prevention is not possible for most stone types, in particular for calcium-containing stones, which occur most frequently. Additionally, after occurrence, patient compliance is often inadequate. Interventional therapy becomes necessary after stone manifestation within the urinary tract. Not all stone compositions respond to a drug treatment. Whereas in the seventies, stone treatment meant open surgery newly developed minimally-invasive procedures have displaced this treatment. The clinical introduction of extracorporal shock wave lithotripsy (ESWL) has played a crucial role in this process. Today, more than 80% of all urinary stones can be treated by modern lithotripters. Combination with other minimally-invasive procedures further improve stone free rate. This article provides an overview of technique, application and results of ESWL treatment.

Vitamin D receptor gene Alw I, Fok I, Apa I, and Taq I polymorphisms in patients with urinary stone.

PubMed

Seo, Ill Young; Kang, In-Hong; Chae, Soo-Cheon; Park, Seung Chol; Lee, Young-Jin; Yang, Yun Sik; Ryu, Soo Bang; Rim, Joung Sik

2010-04-01

To evaluate vitamin D receptor (VDR) gene polymorphisms in Korean patients so as to identify the candidate genes associated with urinary stones. Urinary stones are a multifactorial disease that includes various genetic factors. A normal control group of 535 healthy subjects and 278 patients with urinary stones was evaluated. Of 125 patients who presented stone samples, 102 had calcium stones on chemical analysis. The VDR gene Alw I, Fok I, Apa I, and Taq I polymorphisms were evaluated using the polymerase chain reaction-restriction fragment length polymorphism analysis. Allelic and genotypic frequencies were calculated to identify associations in both groups. The haplotype frequencies of the VDR gene polymorphisms for multiple loci were also determined. For the VDR gene Alw I, Fok I, Apa I, and Taq I polymorphisms, there was no statistically significant difference between the patients with urinary stones and the healthy controls. There was also no statistically significant difference between the patients with calcium stones and the healthy controls. A novel haplotype (Ht 4; CTTT) was identified in 13.5% of the patients with urinary stones and in 8.3% of the controls (P = .001). The haplotype frequencies were significantly different between the patients with calcium stones and the controls (P = .004). The VDR gene Alw I, Fok I, Apa I, and Taq I polymorphisms does not seem to be candidate genetic markers for urinary stones in Korean patients. However, 1 novel haplotype of the VDR gene polymorphisms for multiple loci might be a candidate genetic marker. Copyright 2010 Elsevier Inc. All rights reserved.

Data Package for Secondary Waste Form Down-Selection—Cast Stone

DOE Office of Scientific and Technical Information (OSTI.GOV)

Serne, R. Jeffrey; Westsik, Joseph H.

2011-09-05

Available literature on Cast Stone and Saltstone was reviewed with an emphasis on determining how Cast Stone and related grout waste forms performed in relationship to various criteria that will be used to decide whether a specific type of waste form meets acceptance criteria for disposal in the Integrated Disposal Facility (IDF) at Hanford. After the critical review of the Cast Stone/Saltstone literature, we conclude that Cast Stone is a good candidate waste form for further consideration. Cast stone meets the target IDF acceptance criteria for compressive strength, no free liquids, TCLP leachate are below the UTS permissible concentrations andmore » leach rates for Na and Tc-99 are suiteably low. The cost of starting ingredients and equipment necessary to generate Cast Stone waste forms with secondary waste streams are low and the Cast Stone dry blend formulation can be tailored to accommodate variations in liquid waste stream compositions. The database for Cast Stone short-term performance is quite extensive compared to the other three candidate waste solidification processes. The solidification of liquid wastes in Cast Stone is a mature process in comparison to the other three candidates. Successful production of Cast Stone or Saltstone has been demonstrated from lab-scale monoliths with volumes of cm3 through m3 sized blocks to 210-liter sized drums all the way to the large pours into vaults at Savannah River. To date over 9 million gallons of low activity liquid waste has been solidified and disposed in concrete vaults at Savannah River.« less

Distinguishing characteristics of idiopathic calcium oxalate kidney stone formers with low amounts of Randall's plaque.

PubMed

Wang, Xiangling; Krambeck, Amy E; Williams, James C; Tang, Xiaojing; Rule, Andrew D; Zhao, Fang; Bergstralh, Eric; Haskic, Zejfa; Edeh, Samuel; Holmes, David R; Herrera Hernandez, Loren P; Lieske, John C

2014-10-07

Overgrowth of calcium oxalate on Randall's plaque is a mechanism of stone formation among idiopathic calcium oxalate stone-formers (ICSFs). It is less clear how stones form when there is little or no plaque. Participants were a consecutive cohort of ICSFs who underwent percutaneous nephroscopic papillary mapping in the kidney or kidneys containing symptomatic stones and a papillary tip biopsy from a representative calyx during a stone removal procedure between 2009 and 2013. The distribution of Randall's plaque coverage was analyzed and used to divide ICSFs into those with a high (≥5%; mean, 10.5%; n=10) versus low (<5%; mean, 1.5%; n=32) amount of plaque coverage per papilla. Demographic and laboratory features were compared between these two groups. Low-plaque stone formers tended to be obese (50% versus 10%; P=0.03) and have a history of urinary tract infection (34% versus 0%; P=0.04). They were less likely to have multiple prior stone events (22% versus 80%; P=0.002) and had a lower mean 24-hour urine calcium excretion (187±86 mg versus 291±99 mg; P<0.01). Morphologically, stones from patients with low amounts of plaque lacked a calcium phosphate core by microcomputed tomography. Papillary biopsies from low plaque stone-formers revealed less interstitial and basement membrane punctate crystallization. These findings suggest that other pathways independent of Randall's plaque may contribute to stone pathogenesis among a subgroup of ICSFs who harbor low amounts of plaque. Copyright © 2014 by the American Society of Nephrology.

Multimodal treatments of cystine stones: an observational, retrospective single-center analysis of 14 cases.

PubMed

Shim, Myungsun; Park, Hyung Keun

2014-08-01

To document the experiences of a single institution in evaluating the clinical courses and treatment outcomes of patients with cystine stones. The clinical data of 14 patients with cystine stones who were treated at our institution from March 1994 to July 2012 were reviewed. These data included age at first visit, gender, family history, body mass index, presence of a single kidney, stone locations, stone burden, routine urinalysis, and culture. In addition, we also analyzed data on surgery, shock wave lithotripsy, medical treatment, stone recurrence or regrowth, and overall treatment success rates. The mean age of our patients at their first visit was 19.6±5.0 years, and eight patients were males. The median stone burden and mean urine pH before each surgery were 6.5 cm(2) and 6.5±0.9, respectively. Two patients had a family history of cystine stones. Patients underwent surgery an average of 2.7 times. The median interval between surgeries was 27.3 months, and 1 open surgery, 12 percutaneous nephrolithotomies, and 25 ureterorenoscopies were performed. Potassium citrate or sodium bicarbonate was used in nine cases. D-Penicillamine was continuously used in three patients. Patients had an average incidence of 3.2 recurrences or regrowth of stones during the median follow-up period of 60.5 months. Patients with cystine stones have high recurrence or regrowth rates and relatively large stone burdens. Adequate treatment schedules must therefore be established in these cases to prevent possible deterioration of renal function.

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.

Stone former urine proteome demonstrates a cationic shift in protein distribution compared to normal.

PubMed

Kolbach-Mandel, Ann M; Mandel, Neil S; Hoffmann, Brian R; Kleinman, Jack G; Wesson, Jeffrey A

2017-08-01

Many urine proteins are found in calcium oxalate stones, yet decades of research have failed to define the role of urine proteins in stone formation. This urine proteomic study compares the relative amounts of abundant urine proteins between idiopathic calcium oxalate stone forming and non-stone forming (normal) cohorts to identify differences that might correlate with disease. Random mid-morning urine samples were collected following informed consent from 25 stone formers and 14 normal individuals. Proteins were isolated from urine using ultrafiltration. Urine proteomes for each sample were characterized using label-free spectral counting mass spectrometry, so that urine protein relative abundances could be compared between the two populations. A total of 407 unique proteins were identified with the 38 predominant proteins accounting for >82% of all sample spectral counts. The most highly abundant proteins were equivalent in stone formers and normals, though significant differences were observed in a few moderate abundance proteins (immunoglobulins, transferrin, and epidermal growth factor), accounting for 13 and 10% of the spectral counts, respectively. These proteins contributed to a cationic shift in protein distribution in stone formers compared to normals (22% vs. 18%, p = 0.04). Our data showing only small differences in moderate abundance proteins suggest that no single protein controls stone formation. Observed increases in immunoglobulins and transferrin suggest increased inflammatory activity in stone formers, but cannot distinguish cause from effect in stone formation. The observed cationic shift in protein distribution would diminish protein charge stabilization, which could lead to protein aggregation and increased risk for crystal aggregation.

Quality Assessment of Urinary Stone Analysis: Results of a Multicenter Study of Laboratories in Europe

PubMed Central

Siener, Roswitha; Buchholz, Noor; Daudon, Michel; Hess, Bernhard; Knoll, Thomas; Osther, Palle J.; Reis-Santos, José; Sarica, Kemal; Traxer, Olivier; Trinchieri, Alberto

2016-01-01

After stone removal, accurate analysis of urinary stone composition is the most crucial laboratory diagnostic procedure for the treatment and recurrence prevention in the stone-forming patient. The most common techniques for routine analysis of stones are infrared spectroscopy, X-ray diffraction and chemical analysis. The aim of the present study was to assess the quality of urinary stone analysis of laboratories in Europe. Nine laboratories from eight European countries participated in six quality control surveys for urinary calculi analyses of the Reference Institute for Bioanalytics, Bonn, Germany, between 2010 and 2014. Each participant received the same blinded test samples for stone analysis. A total of 24 samples, comprising pure substances and mixtures of two or three components, were analysed. The evaluation of the quality of the laboratory in the present study was based on the attainment of 75% of the maximum total points, i.e. 99 points. The methods of stone analysis used were infrared spectroscopy (n = 7), chemical analysis (n = 1) and X-ray diffraction (n = 1). In the present study only 56% of the laboratories, four using infrared spectroscopy and one using X-ray diffraction, fulfilled the quality requirements. According to the current standard, chemical analysis is considered to be insufficient for stone analysis, whereas infrared spectroscopy or X-ray diffraction is mandatory. However, the poor results of infrared spectroscopy highlight the importance of equipment, reference spectra and qualification of the staff for an accurate analysis of stone composition. Regular quality control is essential in carrying out routine stone analysis. PMID:27248840

Quality Assessment of Urinary Stone Analysis: Results of a Multicenter Study of Laboratories in Europe.

PubMed

Siener, Roswitha; Buchholz, Noor; Daudon, Michel; Hess, Bernhard; Knoll, Thomas; Osther, Palle J; Reis-Santos, José; Sarica, Kemal; Traxer, Olivier; Trinchieri, Alberto

2016-01-01

After stone removal, accurate analysis of urinary stone composition is the most crucial laboratory diagnostic procedure for the treatment and recurrence prevention in the stone-forming patient. The most common techniques for routine analysis of stones are infrared spectroscopy, X-ray diffraction and chemical analysis. The aim of the present study was to assess the quality of urinary stone analysis of laboratories in Europe. Nine laboratories from eight European countries participated in six quality control surveys for urinary calculi analyses of the Reference Institute for Bioanalytics, Bonn, Germany, between 2010 and 2014. Each participant received the same blinded test samples for stone analysis. A total of 24 samples, comprising pure substances and mixtures of two or three components, were analysed. The evaluation of the quality of the laboratory in the present study was based on the attainment of 75% of the maximum total points, i.e. 99 points. The methods of stone analysis used were infrared spectroscopy (n = 7), chemical analysis (n = 1) and X-ray diffraction (n = 1). In the present study only 56% of the laboratories, four using infrared spectroscopy and one using X-ray diffraction, fulfilled the quality requirements. According to the current standard, chemical analysis is considered to be insufficient for stone analysis, whereas infrared spectroscopy or X-ray diffraction is mandatory. However, the poor results of infrared spectroscopy highlight the importance of equipment, reference spectra and qualification of the staff for an accurate analysis of stone composition. Regular quality control is essential in carrying out routine stone analysis.

Experimental study on the friction effect of plastic stents for biliary stone fragmentation (with video).

PubMed

Kwon, Chang-Il; Kim, Gwangil; Jeong, Seok; Choi, Sung Hoon; Ko, Kwang Hyun; Lee, Don Haeng; Cho, Joo Young; Hong, Sung Pyo

2018-01-01

In patients with irretrievable or intractable bile duct stone, temporary insertion of a plastic stent (PS) followed by further endoscopic retrograde cholangiopancreatography (ERCP) or surgery has been recommended as a 'bridge' therapy. However, the exact mechanism of stone fragmentation has not been discovered. The aim of the present study was to evaluate whether PS shape can facilitate stone fragmentation. Using a new in vitro bile flow phantom model, we compared the friction effect among three different PS groups (straight PS group, double pigtail-shaped PS group, and screw-shaped PS group) and a control group. Each group had 10 silicon tube blocks that separately contained one stone and two PS. The control group had 10 blocks each with only a stone and no PS. We carried out analysis of the friction effect by stone weight and volume changes among the groups, excluding fragmented stones. After 8 weeks, complete fragmentation was noted in one out of 34 cholesterol stones (2.9%) and in four out of six pigmented stones (66.7%). Fragmentation tended to be more prominent in the screw-shaped PS group than in the straight PS group, double pigtail-shaped group, and control group (volume change: -11.33%, 7.94%, 4.43%, and 2.05%, respectively, P = 0.1390; weight change: -9.30%, 0.71%, -0.10%, and -1.23%, respectively, P = 0.3553). Stone fragmentation may be induced by PS friction effect. Also, screw-shaped plastic stents may improve friction effect. These results may help guide future PS development and clinical decisions. © 2017 Japan Gastroenterological Endoscopy Society.

Relationship Between Ureteral Jet Flow, Visual Analogue Scale, and Ureteral Stone Size.

PubMed

Ongun, Sakir; Teken, Abdurrazak; Yılmaz, Orkun; Süleyman, Sakir

2017-06-01

To contribute to the diagnosis and treatment of ureteral stones by investigating the relationship between the ureteral jet flow measurements of patients with ureteral stones and the size of the stones and the patients' pain scores. The sample consisted of patients who presented acute renal colic between December 2014 and 2015 and from a noncontrast computed tomography were found to have a urinary stone. The ureteral jet flow velocities were determined using Doppler ultrasonography. The patients were all assessed in terms of stone size, localization and area, anteroposterior pelvis (AP) diameter, and visual analogue scale (VAS) scores. A total of 102 patients were included in the study. As the VAS score decreased, the peak jet flow velocity on the stone side increased, whereas the flow velocity on the other side, AP diameter, and stone area were reduced (P < .05). As the stone size increased, the peak jet flow velocity was reduced and the AP diameter increased significantly (P < .05). Ureteral jet flow was not observed in 17 patients on the stone side. A statistically significant difference was found between these patients and the remaining patients in terms of all parameters (P < .05). For patients, in whom the peak flow velocity of ureteral jet is low and with a severe level of pain or the peak flow velocity of ureteral jet cannot be measured, there is a low possibility of spontaneous passage and a high possibility of a large stone, and therefore the treatment should be started immediately. Copyright © 2017 Elsevier Inc. All rights reserved.

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

Case report: endoscopic management of seminal vesicle stones with cutaneous fistula.

PubMed

Modi, Pranjal R

2006-06-01

Stones in the seminal vesicle are rare. Open surgery to remove either the seminal vesicle or the stone usually is required. We report a case of seminal-vesicle stones compounded by cutaneous fistula that was treated by ureteroscopy, intracorporeal lithotripsy, and fulguration of the fistulous tract.

78 FR 14697 - Final Flood Elevation Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-07

... Communities affected elevation above ground [caret] Elevation in meters (MSL) Modified Cecil County, Maryland... 1 to Stone Run At the Stone Run +271 Town of Rising Sun, confluence. Unincorporated Areas of Cecil County. Approximately 460 feet +359 downstream of Pierce Road. Tributary 2 to Stone Run At the Stone Run...

DNA FROM ANCIENT STONE TOOLS AND BONES EXCAVATED AT BUGAS-HOLDING, WYOMING

EPA Science Inventory

Traces of DNA may preserve on ancient stone tools. We examined 24 chipped stone artifacts recovered from the Bugas-Holding site in northwestern Wyoming for the presence of DNA residues, and we compared DNA preservation in bones and stone tools from the same stratigraphic context...

Update on endoscopic management of main pancreatic duct stones in chronic calcific pancreatitis.

PubMed

Choi, Eun Kwang; Lehman, Glen A

2012-03-01

Pancreatic duct stones are a common complication during the natural course of chronic pancreatitis and often contribute to additional pain and pancreatitis. Abdominal pain, one of the major symptoms of chronic pancreatitis, is believed to be caused in part by obstruction of the pancreatic duct system (by stones or strictures) resulting in increasing intraductal pressure and parenchymal ischemia. Pancreatic stones can be managed by surgery, endoscopy, or extracorporeal shock wave lithotripsy. In this review, updated management of pancreatic duct stones is discussed.

Deterioration Types of Stones Used in Suleymaniye Mosque (Istanbul, Turkey)

NASA Astrophysics Data System (ADS)

Alptekin Bilen, Candan; Erisis, Sinem; Er, Selman; Yilmaz, Murat; Angi, Serkan; Tugrul, Atiye

2016-10-01

Suleymaniye Mosque located in the historic peninsula of Istanbul, is one of the most important monument of classical Ottoman Architecture. Different types of natural stones having varied lithological characteristics were used in the mosque. Chemical composition, mineralogical, petrographic characteristics and external conditions such as atmospheric effects, earthquake and human impacts have deteriorated these stones over time. The aim of this study is to investigate different natural stones and their deterioration types used in Suleymaniye Mosque. According to the results obtained, generally different types of granites, marbles, limestones, pudding stones, porphyry, serpentinite were used in Suleymaniye Mosque. Detachment, material loss, biological colonization, discoloration and deposits have been determined as a deterioration types on these stones.

On the growth rate of gallstones in the human gallbladder

NASA Astrophysics Data System (ADS)

Nudelman, I.

1993-05-01

The growth rate of a single symmetrically oval shaped gallbladder stone weighing 10.8 g was recorded over a period of six years before surgery and removal. The length of the stone was measured by ultrasonography and the growth rate was found to be linear with time, with a value of 0.4 mm/year. A smaller stone growing in the wall of the gallbladder was detected only three years before removal and grew at a rate of ˜ 1.33 mm/year. The morphology and metallic ion chemical composition of the large stone and of a randomly selected small stone weighing about 1.1 g, extracted from another patient, were analyzed and compared. It was found that the large stone contained besides calcium also lead, whereas the small stone contained mainly calcium. It is possible that the lead causes a difference in mechanism between the growth of a single large and growth of multiple small gallstones.

[Kidney stone formation during space flight and long-term bed rest].

PubMed

Okada, Atsushi; Ichikawa, Jun; Tozawa, Keiichi

2011-10-01

Microgravity environment like space flight or a condition requiring long-term bed-rest increase bone resorption and decrease bone formation, inducing the rapid decrease of bone minerals to osteoporosis. Bone mineral loss increases urinary calcium excretion and the risk of urinary stone formation. To clarify the influence of the conditions on renal stone formation, a 90-day bed rest test was performed to analyze the mechanism of microgravity or bed rest-induced stone formation and prevention by bisphosphonate medication and bed-rest exercise. As the results, renal stone formation was observed in control and exercise groups and no stone was seen in the medication group. In the medication group, urinary calcium excretion and relative supersaturation of calcium oxalate were lower than in the control group throughout the bed-rest and recovery period. Bisphosphonate is useful for the prevention of renal stone formation during space flight and long-term bed-rest.

Bioremediation of weathered-building stone surfaces.

PubMed

Webster, Alison; May, Eric

2006-06-01

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

Assessment of kidney stone and prevalence of its chemical compositions.

PubMed

Pandeya, A; Prajapati, R; Panta, P; Regmi, A

2010-09-01

Kidney stone analysis is the test done on the stone which cause problems when they block the flow of urine through or out of the kidneys. The stones cause severe pain and are also associated with morbidity and renal damage. There is also no clear understanding on the relative metabolic composition of renal calculi. Hence, the study is aimed to find out the chemical composition of it which can guide treatment and give information that may prevent more stones from forming. The study was carried out on the stones that had been sent to the department of Biochemistry (n = 99; M = 61; F = 38; Mean age: 33.6 +/- 14.4 years) Approximately 98.9% of stones were composed of oxalate, 95.9% of Calcium, 85.8% of phosphate, 62.6% of Urate, 46.4% of Ammonium and very few percentages of Carbonate.

Prediction of axial limit capacity of stone columns using dimensional analysis

NASA Astrophysics Data System (ADS)

Nazaruddin A., T.; Mohamed, Zainab; Mohd Azizul, L.; Hafez M., A.

2017-08-01

Stone column is the most favorable method used by engineers in designing work for stabilization of soft ground for road embankment, and foundation for liquid structure. Easy installation and cheaper cost are among the factors that make stone column more preferable than other method. Furthermore, stone column also can acts as vertical drain to increase the rate of consolidation during preloading stage before construction work started. According to previous studied there are several parameters that influence the capacity of stone column. Among of them are angle friction of among the stones, arrangement of column (two pattern arrangement most applied triangular and square), spacing center to center between columns, shear strength of soil, and physical size of column (diameter and length). Dimensional analysis method (Buckingham-Pi Theorem) has used to carry out the new formula for prediction of load capacity stone columns. Experimental data from two previous studies was used for analysis of study.

Application research of CO2 laser cutting natural stone plates

NASA Astrophysics Data System (ADS)

Ma, Lixiu; Song, Jijiang

2009-08-01

Now, the processing of natural stone plates is the high performance sawing machine primarily,many researchers deeply studied the processing characters in the sawing process and the strength characters during the processing. In order to realize the profiled-processing and pattern- carving of the natural stone, It lays a solid foundation for the laser cutting and the pattern-carving technology of natural stone plate. The working principle, type and characteristics of laser cutting are briefly described. The paper selects 6 kinds stone plates of natural taken as experimental sample,the experimental sample was China Shanxi Black, Old Spain Golden Yellow, New Spain Golden Yellow, Jazz White, Maple Leaf Red, Cream White respectively. Use high power CO2 laser cutting system,the stone plates cutting experiment of 6 kinds different hardness, the best working speed are obtained,The experimental results indicate that: The laser cutting speed has no correlation with the ingredient content of stone plate.

Cavitation Bubble Cluster Activity in the Breakage of Kidney Stones by Lithotripter Shock Waves

PubMed Central

Pishchalnikov, Yuriy A.; Sapozhnikov, Oleg A.; Bailey, Michael R.; Williams, James C.; Cleveland, Robin O.; Colonius, Tim; Crum, Lawrence A.; Evan, Andrew P.; McAteer, James A.

2008-01-01

High-speed photography was used to analyze cavitation bubble activity at the surface of artificial and natural kidney stones during exposure to lithotripter shock waves in vitro. Numerous individual bubbles formed at the surface of stones, but these bubbles did not remain independent and combined with one another to form bubble clusters. Bubble clusters formed at the proximal end, the distal end, and at the sides of stones. Each cluster collapsed to a narrow point of impact. Collapse of the proximal cluster caused erosion at the leading face of the stone and the collapse of clusters at the sides of stones appeared to contribute to the growth of cracks. Collapse of the distal cluster caused minimal damage. We conclude that cavitation-mediated damage to stones was due not to the action of solitary bubbles, but to the growth and collapse of bubble clusters. PMID:14565872

Optimal management of lower pole stones: the direction of future travel

PubMed Central

Moore, Sacha L.; Bres-Niewada, Ewa; Cook, Paul; Wells, Hannah

2016-01-01

Introduction Kidney stone disease is increasing worldwide with its most common location being in the lower pole. A clear strategy for effective management of these stones is essential in the light of ever increasing choice, effectiveness, and complications of different treatment options. Material and methods This review identifies the latest and clinically relevant publications focused on optimal management of lower pole stones. Results We present an up-to-date European Association of Urology and American Urological Association algorithm for lower pole stones, risks and benefits of different treatments, and changing landscape with the miniaturization of percutaneous stone treatments. Conclusions Available literature seems to be deficient on quality of life, patient centered decision making, and cost analysis of optimal management with no defined standard of ‘stone free rate’, all of which are critical in any surgical consultation and outcome analysis. PMID:27729994

40 CFR 436.20 - Applicability; description of the crushed stone subcategory.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS MINERAL MINING AND PROCESSING POINT SOURCE CATEGORY Crushed... stone and riprap. This subpart includes all types of rock and stone. Rock and stone that is crushed or broken prior to the extraction of a mineral are elsewhere covered. The processing of calcite, however, in...

40 CFR 436.20 - Applicability; description of the crushed stone subcategory.

Code of Federal Regulations, 2012 CFR

2012-07-01

... (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS (CONTINUED) MINERAL MINING AND PROCESSING POINT SOURCE CATEGORY... stone and riprap. This subpart includes all types of rock and stone. Rock and stone that is crushed or broken prior to the extraction of a mineral are elsewhere covered. The processing of calcite, however, in...

40 CFR 436.20 - Applicability; description of the crushed stone subcategory.

Code of Federal Regulations, 2013 CFR

2013-07-01

... (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS (CONTINUED) MINERAL MINING AND PROCESSING POINT SOURCE CATEGORY... stone and riprap. This subpart includes all types of rock and stone. Rock and stone that is crushed or broken prior to the extraction of a mineral are elsewhere covered. The processing of calcite, however, in...

40 CFR 436.20 - Applicability; description of the crushed stone subcategory.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS MINERAL MINING AND PROCESSING POINT SOURCE CATEGORY Crushed... stone and riprap. This subpart includes all types of rock and stone. Rock and stone that is crushed or broken prior to the extraction of a mineral are elsewhere covered. The processing of calcite, however, in...

40 CFR 436.20 - Applicability; description of the crushed stone subcategory.

Code of Federal Regulations, 2014 CFR

2014-07-01

... (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS (CONTINUED) MINERAL MINING AND PROCESSING POINT SOURCE CATEGORY... stone and riprap. This subpart includes all types of rock and stone. Rock and stone that is crushed or broken prior to the extraction of a mineral are elsewhere covered. The processing of calcite, however, in...

25 CFR 301.6 - Stone for ornamentation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 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...

75 FR 1591 - Proposed Information Collection; Comment Request; Economic Performance in the Commercial Stone...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-12

... Collection; Comment Request; Economic Performance in the Commercial Stone Crab and Lobster Fisheries in... commercial fishermen in Florida's stone crab and lobster fisheries. The survey intends to collect economic... from approximately 1,000 commercial stone crab and lobster fishermen who do not live in the Florida...

21 CFR 876.4650 - Water jet renal stone dislodger system.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Water jet renal stone dislodger system. 876.4650... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4650 Water jet renal stone dislodger system. (a) Identification. A water jet renal stone dislodger system is a device used to...

21 CFR 876.4650 - Water jet renal stone dislodger system.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Water jet renal stone dislodger system. 876.4650... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4650 Water jet renal stone dislodger system. (a) Identification. A water jet renal stone dislodger system is a device used to...

78 FR 52984 - Stone Age Interiors, Inc.; d/b/a Colorado Springs Marble and Granite Including On-Site Leased...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-27

... the production of finished stone fabrication products. The workers are not separately identifiable by product line. The subject worker group includes on-site leased workers from Express Employment... articles like or directly competitive with the finished stone fabrication products produced by Stone Age...

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

Ursodeoxycholic acid after bile duct stone removal and risk factors for recurrence: a randomized trial.

PubMed

Yamamoto, Ryuichi; Tazuma, Susumu; Kanno, Keishi; Igarashi, Yoshinori; Inui, Kazuo; Ohara, Hirotaka; Tsuyuguchi, Toshio; Ryozawa, Shomei

2016-02-01

Currently, no established pharmacologic treatment exists for the prevention of recurrent common bile duct (CBD) stones. Here, we present a multi-center randomized trial that compared the CBD recurrence rate after bile duct stone removal between patients given ursodeoxycholic acid (UDCA) and the untreated group. A total of 36 patients were randomly assigned to either the UDCA (n = 15) or the untreated group (n = 21). The primary end-point was the recurrence rate of CBD stones. The recurrence rate of CBD stones was 6.6% in the UDCA group and 18.6% in the untreated group (P = 0.171). A multivariate analysis found that not receiving UDCA was an independent risk factor for stone recurrence. The recurrence rates of CBD stones did not differ by sex, past history of cholecystectomy, or the presence of gallstones. Our findings indicate that UDCA may be a novel treatment strategy to prevent the recurrence of CBD stones. However, further evaluation of UDCA in a larger number of subjects will be required to confirm the applicability of these results. © 2015 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

Stone comminution correlates with the average peak pressure incident on a stone during shock wave lithotripsy.

PubMed

Smith, N; Zhong, P

2012-10-11

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 (R(h)=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 1000 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. Copyright © 2012 Elsevier Ltd. All rights reserved.

Proteomic analysis of a rare urinary stone composed of calcium carbonate and calcium oxalate dihydrate: a case report.

PubMed

Kaneko, Kiyoko; Matsuta, Yosuke; Moriyama, Manabu; Yasuda, Makoto; Chishima, Noriharu; Yamaoka, Noriko; Fukuuchi, Tomoko; Miyazawa, Katsuhito; Suzuki, Koji

2014-03-01

The objective of the present study was to investigate the matrix protein of a rare urinary stone that contained calcium carbonate. A urinary stone was extracted from a 34-year-old male patient with metabolic alkalosis. After X-ray diffractometry and infrared analysis of the stone, proteomic analysis was carried out. The resulting mass spectra were evaluated with protein search software, and matrix proteins were identified. X-ray diffraction and infrared analysis confirmed that the stone contained calcium carbonate and calcium oxalate dihydrate. Of the identified 53 proteins, 24 have not been previously reported from calcium oxalate- or calcium phosphate-containing stones. The protease inhibitors and several proteins related to cell adhesion or the cytoskeleton were identified for the first time. We analyzed in detail a rare urinary stone composed of calcium carbonate and calcium oxalate dihydrate. Considering the formation of a calcium carbonate stone, the new identified proteins should play an important role on the urolithiasis process in alkaline condition. © 2013 The Japanese Urological Association.

Methanotrophs and methanogens in masonry

PubMed

Kussmaul; Wilimzig; Bock

1998-11-01

Methanotrophs were present in 48 of 225 stone samples which were removed from 19 historical buildings in Germany and Italy. The average cell number of methanotrophs was 20 CFU per g of stone, and their activities ranged between 11 and 42 pmol of CH4 g of stone-1 day-1. Twelve strains of methane-oxidizing bacteria were isolated. They belonged to the type II methanotrophs of the genera Methylocystis, Methylosinus, and Methylobacterium. In masonry, growth substrates like methane or methanol are available in very low concentrations. To determine if methane could be produced by the stone at rates sufficient to support growth of methanotrophs, methane production by stone samples under nonoxic conditions was examined. Methane production of 0.07 to 215 nmol of CH4 g of stone-1 day-1 was detected in 23 of 47 stone samples examined. This indicated the presence of the so-called "mini-methane"-producing bacteria and/or methanogenic archaea. Methanotrophs occurred in nearly all samples which showed methane production. This finding indicated that methanotrophs depend on biogenic methane production in or on stone surfaces of historical buildings.

Kidney Stones as an Underrecognized Clinical Sign in Pediatric Cushing Disease.

PubMed

Rahman, Sara H; Papadakis, Georgios Z; Keil, Margaret F; Faucz, Fabio R; Lodish, Maya B; Stratakis, Constantine A

2016-03-01

To investigate the prevalence of kidney stones in a population of children with Cushing disease (CD) and to compare it with the prevalence of kidney stones in healthy children. Clinical and biochemical data from 139 pediatric patients with CD (68 females, 71 males) were analyzed retrospectively. Computed tomography scans were reviewed for kidney stones. Among 139 patients, 27 with CD (19.4%) had either radiographic evidence and/or a history of kidney stones. Those with kidney stones had higher urine free cortisol (P = .008) and transsphenoidal surgery at an older age (P = .007). The average urinary calcium/creatinine ratio was elevated in patients with CD (0.22 ± 0.11). The prevalence of kidney stones was higher in children with CD than in normal children (19.42% vs 1.0%; P < .001). Our results illustrate that kidney stones are an underestimated complication of pediatric CD, especially when compared with the prevalence of nephrolithiasis in the general pediatric population. Long-term consequences for kidney function are not known and need to be studied. Published by Elsevier Inc.

[Quantitative mineralogical analyzes of kidney stones and diagnosing metabolic disorders in female patients with calcium oxalate urolithiasis].

PubMed

Kustov, A V; Moryganov, M A; Strel'nikov, A I; Zhuravleva, N I; Airapetyan, A O

2016-02-01

To conduct a complex examination of female patients with calcium oxalate urolithiasis to detect metabolic disorders, leading to stone formation. The study was carried out using complex physical and chemical methods, including quantitative X-ray phase analysis of urinary stones, pH measurement, volumetry, urine and blood spectrophotometry. Quantitative mineralogical composition of stones, daily urine pH profile, daily urinary excretion of ions of calcium, magnesium, oxalate, phosphate, citrate and uric acid were determined in 20 female patients with calcium oxalate stones. We have shown that most of the stones comprised calcium oxalate monohydrate or mixtures of calcium oxalate dihydrate and hydroxyapatite. Among the identified abnormalities, the most frequent were hypocitraturia and hypercalciuria - 90 and 45%, respectively. Our findings revealed that the daily secretion of citrate and oxalate in patients older than 50 years was significantly lower than in younger patients. In conclusion, daily urinary citrate excretion should be measured in female patients with calcium oxalate stones. This is necessary both to determine the causes of stone formation, and to monitor the effectiveness of citrate therapy.

Computer aided detection of ureteral stones in thin slice computed tomography volumes using Convolutional Neural Networks.

PubMed

Längkvist, Martin; Jendeberg, Johan; Thunberg, Per; Loutfi, Amy; Lidén, Mats

2018-06-01

Computed tomography (CT) is the method of choice for diagnosing ureteral stones - kidney stones that obstruct the ureter. The purpose of this study is to develop a computer aided detection (CAD) algorithm for identifying a ureteral stone in thin slice CT volumes. The challenge in CAD for urinary stones lies in the similarity in shape and intensity of stones with non-stone structures and how to efficiently deal with large high-resolution CT volumes. We address these challenges by using a Convolutional Neural Network (CNN) that works directly on the high resolution CT volumes. The method is evaluated on a large data base of 465 clinically acquired high-resolution CT volumes of the urinary tract with labeling of ureteral stones performed by a radiologist. The best model using 2.5D input data and anatomical information achieved a sensitivity of 100% and an average of 2.68 false-positives per patient on a test set of 88 scans. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Is pre-operative imaging essential prior to ureteric stone surgery?

PubMed

Youssef, F R; Wilkinson, B A; Hastie, K J; Hall, J

2012-09-01

The aim of this study was to identify patients not requiring ureteric stone surgery based on pre-operative imaging (within 24 hours) prior to embarking on semirigid ureteroscopy (R-URS) for urolithiasis. The imaging of all consecutive patients on whom R-URS for urolithiasis was performed over a 12-month period was reviewed. All patients had undergone a plain x-ray of the kidney, ureters and bladder (KUB), abdominal non-contrast computed tomography (NCCT-KUB) or both on the day of surgery. A total of 96 patients were identified for the study. Stone sizes ranged from 3 mm to 20 mm. Thirteen patients (14%) were cancelled as no stone(s) were identified on pre-operative imaging. Of the patients cancelled, 8 (62%) required NCCT-KUB to confirm spontaneous stone passage. One in seven patients were stone free on the day of surgery. This negates the need for unnecessary anaesthetic and instrumentation of the urinary tract, with the associated morbidity. Up-to-date imaging prior to embarking on elective ureteric stone surgery is highly recommended.

Urinary stone risk and cola consumption.

PubMed

Herrel, Lindsey; Pattaras, John; Solomon, Tania; Ogan, Kenneth

2012-11-01

To evaluate the effect of cola consumption on urinary stone risk factors in a controlled metabolic environment with a prospective cross-over study. Thirteen participants (10 normal and 3 calcium oxalate stone-formers) underwent 2 6-day phases on a controlled metabolic diet. During phase 1, subjects ingested 1 liter of cola daily, followed by a 3-week washout period. During phase 2, subjects ingested 1 liter of deionized water daily. Twenty-four-hour urine collections and serum metabolic panels were obtained for stone risk factors at the end of each phase. Urine and serum results of the cola phase were compared with those of the water phase. Normal subjects and stone-formers were combined for analysis after determining no significant difference between the 2 groups. No significant differences were found among cola and water treatment groups for normal subjects, stone-formers, or the pooled group. Cola exerts no detectable change in urinary risk factors associated with calcium oxalate stone formation. Cola consumption may not increase stone risk and may be an acceptable alternative source of daily fluid for patients unwilling to increase water consumption. Copyright © 2012 Elsevier Inc. All rights reserved.

The Association of Household Food Insecurity and the Risk of Calcium Oxalate Stones.

PubMed

Shafi, Hamid; Dorosty Motlagh, Ahmad-Reza; Bagherniya, Mohammad; Daeezadeh, Atefeh; Safarian, Mohammad

2017-08-29

Food insecurity has been defined as 'limited or uncertain availability of nutritionally adequate and safe foods', which associated with adverse health consequences in human. Another alarming condition, which is related to several comorbidities is kidney stone. This study aimed to determine the association of household food insecurity and developing kidney stones (calcium oxalate) in adults referred to medical centers of Babol. This case-control study included 200 participants 18-65 years of ages (100 cases, 100 controls). An 18-items food insecurity questionnaire (USDA), a valid and reliable 147-item food frequency questionnaire (FFQ) and demographic characteristics were obtained via interviewing. Sixty eight percent of cases and 40% of controls were food insecure, respectively. Food insecurity was significantly associated with the risk of kidney stone (P < .05). Furthermore, body mass index (BMI) and family history of kidney stone were significantly associated with the risk of kidney stones (P < .05). Food insecurity and BMI were significantly associated with the kidney stone, which shows the importance of availability of nutritionally adequate and safe foods in prevention of the kidney stone.

Primary in situ extracorporeal shock wave lithotripsy in the management of ureteric calculi: results with a third-generation lithotripter.

PubMed

Gnanapragasam, V J; Ramsden, P D; Murthy, L S; Thomas, D J

1999-11-01

To review the results of primary in situ extracorporeal shock wave lithotripsy (ESWL) for the treatment of ureteric stones using a third-generation lithotripter, the Dornier MFL 5000 (Dornier Medizentechnic, Germany). The study comprised a retrospective review of treatment outcome in 180 patients with 196 stones who were treated with primary in situ ESWL, assessing the success of this approach and establishing reasons for failure. At the 3-month follow-up, 88% of patients were stone-free; 21 patients failed ESWL and were treated by ureteroscopic stone extraction with no complications. Stone-free rates were 90% for upper ureteric, 89% for middle-third and 86% for lower-third calculi. Twenty-one patients required auxiliary procedures in the form of JJ stenting or nephrostomy. Failure of ESWL was associated with stone size (>1.3 cm) but not location or inadequate treatment. Where prompt access to ESWL is available, primary in situ ESWL remains an effective form of treatment for all ureteric calculi, although stone-free rates are lower for larger stones.

Cystinuria-a urologist's perspective.

PubMed

Thomas, Kay; Wong, Kathie; Withington, John; Bultitude, Matthew; Doherty, Angela

2014-05-01

Cystinuria is a genetic disease that leads to frequent formation of stones. In patients with recurrent stone formation, particularly patients <30 years old or those who have siblings with stone disease, urologists should maintain a high index of suspicion of the diagnosis of cystinuria. Patients with cystinuria require frequent follow-up and a multidisciplinary approach to diagnosis, prevention and management. Patients have reported success in preventing stone episodes by maintaining dietary changes using a tailored review from a specialist dietician. For patients who do not respond to conservative lifestyle measures, medical therapy to alkalinize urine and thiol-binding drugs can help. A pre-emptive approach to the surgical management of cystine stones is recommended by treating smaller stones with minimally invasive techniques before they enlarge to a size that makes management difficult. However, a multimodal approach can be required for larger complex stones. Current cystinuria research is focused on methods of monitoring disease activity, novel drug therapies and genotype-phenotype studies. The future of research is collaboration at a national and international level, facilitated by groups such as the Rare Kidney Stone Consortium and the UK Registry of Rare Kidney Diseases.

Minimally invasive radiologically guided intervention for the treatment of salivary calculi.

PubMed

Brown, Jackie E; Drage, Nicholas A; Escudier, Michael P; Wilson, Ron F; McGurk, Mark

2002-01-01

To describe the technique and examine the value of salivary stone extraction using a minimally invasive, radiologically guided approach as an alternative to salivary gland surgery for the treatment of benign salivary gland obstruction. Eighty-six cases of sialolithiasis (83 patients) were treated by stone removal using a Dormia basket under local anesthesia and fluoroscopic guidance. Postoperative assessment was made clinically at review, by sialogram and by questionnaire. Of 86 cases of sialolithiasis treated, in 55 (64%) it was possible to remove all stones. In 12 cases (14%) part of a stone or some of a number of calculi were removed and in 19 cases (22%) the procedure failed. The commonest reason for failure was fixation of the stone within the duct. Symptoms at review (range 1-49 months, mean 17 months) were relieved in 55 of 67 (82%) of cases where a stone or portion of stone was removed. Stone removal from the salivary duct system by radiologically guided, minimally invasive approach is a simple procedure with low morbidity and high patient acceptance when appropriate selection criteria are applied. These criteria are considered and recommendations made.

Shock wave lithotripsy: advances in technology and technique

PubMed Central

Lingeman, James E.; McAteer, James A.; Gnessin, Ehud; Evan, Andrew P.

2010-01-01

Shock wave lithotripsy (SWL) is the only noninvasive method for stone removal. Once considered as a primary option for the treatment of virtually all stones, SWL is now recognized to have important limitations that restrict its use. In particular, the effectiveness of SWL is severely limited by stone burden, and treatment with shock waves carries the risk of acute injury with the potential for long-term adverse effects. Research aiming to characterize the renal response to shock waves and to determine the mechanisms of shock wave action in stone breakage and renal injury has begun to suggest new treatment strategies to improve success rates and safety. Urologists can achieve better outcomes by treating at slower shock wave rate using a step-wise protocol. The aim is to achieve stone comminution using as few shock waves and at as low a power level as possible. Important challenges remain, including the need to improve acoustic coupling, enhance stone targeting, better determine when stone breakage is complete, and minimize the occurrence of residual stone fragments. New technologies have begun to address many of these issues, and hold considerable promise for the future. PMID:19956196

Application of spectroscopic techniques for the analysis of kidney stones: a pilot study

NASA Astrophysics Data System (ADS)

Shameem, K. M., Muhammed; Chawla, Arun; Bankapur, Aseefhali; Unnikrishnan, V. K.; Santhosh, C.

2016-03-01

Identification and characterization of kidney stone remains one of the important analytical tasks in the medical field. Kidney stone is a common health complication throughout the world, which may cause severe pain, obstruction and infection of urinary tract, and can lead to complete renal damage. It commonly occurs in both sexes regardless of age. Kidney stones have different composition, although each stones have a major single characteristic component. A complete understanding of a sample properties and their function can only be feasible by utilizing elemental and molecular information simultaneously. Two laser based analytical techniques; Laser Induced Breakdown spectroscopy (LIBS) and Raman spectroscopy have been used to study different types of kidney stones from different patients. LIBS and Raman spectroscopy are highly complementary spectroscopic techniques, which provide elemental and molecular information of a sample. Q-switched Nd:YAG laser at 355 nm laser having energy 17mJ per pulse at 10 Hz repetition rate was used for getting LIBS spectra. Raman measurements were carried out using a home assembled micro-Raman spectrometer. Using the recorded Raman spectra of kidney stones, we were able to differentiate different kinds of kidney stones. LIBS spectra of the same stones are showing the evidence of C, Ca, H, and O and also suggest the presence of certain pigments.

Acoustic Radiation Force of a Quasi-Gaussian Beam on an Elastic Sphere in a Fluid.

PubMed

Nikolaeva, A V; Sapozhnikov, O A; Bailey, M R

2016-09-01

Acoustic radiation force has many applications. One of the related technologies is the ability to noninvasively expel stones from the kidney. To optimize the procedure it is important to develop theoretical approaches that can provide rapid calculations of the radiation force depending in stone size and elastic properties, together with ultrasound beam diameter, intensity, and frequency. We hypothesize that the radiation force nonmonotonically depends on the ratio between the acoustic beam width and stone diameter because of coupling between the acoustic wave in the fluid and shear waves in the stone. Testing this hypothesis by considering a spherical stone and a quasi-Gaussian beam was performed in the current work. The calculation of the radiation force was conducted for elastic spheres of two types. Dependence of the magnitude of the radiation force on the beam diameter at various fixed values of stone diameters was modeled. In addition to using real material properties, speed of shear wave in the stone was varied to reveal the importance of shear waves in the stone. It was found that the radiation force reaches its maximum at the beamwidth comparable to the stone diameter; the gain in the force magnitude can reach 40% in comparison with the case of a narrow beam.

Pears and renal stones: possible weapon for prevention? A comprehensive narrative review.

PubMed

Manfredini, R; De Giorgi, A; Storari, A; Fabbian, F

2016-01-01

Urinary stones have been recognized as a human disease since dawn of history and treatment of this condition is reported by Egyptian medical writings. Also, pears have a very long history, being one of the earliest cultivated fruit trees and also known for medicinal use. Urinary tract stone formation represents a common condition and also a significant burden for health care service, due also to possible frequent relapses. Furthermore, urinary stones have been reported to have relationship with different metabolic derangements, and appropriate diet could contribute to avoid or reduce urinary stone formation. Citrate is an inhibitor of crystal growth in the urinary system, and hypocitraturia represents a main therapeutical target in stone formers. Pears contain a significant amount of malic acid, a precursor of citrate, and have antioxidant activity as well. A diet supplemented with pears, and associated with low consumption of meat and salt could impact positively cardiometabolic risk and urinary tract stone formation. However, very few studies evaluated the impact of pears utilization on health, and none on urinary tract stone formation in particular. High content in malate could warrant protection against stone formation, avoiding patients at high risk to be compelled to assume a considerable and expensive amount of pills.

The value of radiology in predicting gallstone type when selecting patients for medical treatment.

PubMed Central

Bell, G D; Dowling, R H; Whitney, B; Sutor, D J

1975-01-01

Since medical treatment of gallstones is confined to cholesterol-rich stones, the ability of clinical radiographs to predict gallstone type was tested prospectively by comparing the preoperative radiological appearance of gallstones from 57 unselected patients with cholelithiasis coming to cholecystectomy with the subsequent analysis of the stones both by X-ray diffraction and by chemical techniques. Fifty-two per cent of the patients had 'non-functioning' gallbladders which failed to opacify after at least two contrast examinations and 25 out of 50 had radioopaque stones. Of the 25 patients with radiolucent stones, the stones in 20 ((80%) were predominantly cholesterol in type but radiology was misleading in five; three contained 40-55% calcium salts but were still radiolucent while two were amorphous and contained less than 10% cholesterol by weight on chemical analysis. While radiology was sometimes misleading when the stones were small and irregular, large radiolucent stones with a smooth profile were invariably cholesterol-rich stones. The results also show that in men calcified stones were commoner than in women and that in older women the gallstones contained more calcium salts and less cholesterol than in younger women less than 50 yr). This paper analyses critically the value and limitations of clinical radiology in predicting gallstone type. PMID:1140634

Duct Diameter and Size of Stones Predict Successful Extracorporeal Shock Wave Lithotripsy and Endoscopic Clearance in Patients With Chronic Pancreatitis and Pancreaticolithiasis.

PubMed

Lapp, Robert T; Wolf, J Stuart; Faerber, Gary J; Roberts, William W; McCarthy, Sean T; Anderson, Michelle A; Wamsteker, Erik-Jan; Elta, Grace H; Scheiman, James M; Kwon, Richard S

2016-09-01

The need for endoscopic therapy before extracorporeal shock wave lithotripsy (SWL) to facilitate pancreatic duct stone removal is unclear. Predictive factors associated with successful fragmentation and subsequent complete duct clearance are variable. We hypothesize pancreatic duct strictures and large stones, but not pre-SWL endotherapy, correlate with successful fragmentation and complete duct clearance. A retrospective cohort study of patients with pancreaticolithiasis who underwent SWL and endoscopic retrograde cholangiopancreatography between January 2009 and June 2014 was evaluated. Thirty-seven patients were treated. Technical success (TS) of fragmentation was achieved in 22 patients (60%). Technical success was associated with fewer stones and SWL sessions and smaller stone and duct size. By multivariate logistic regression, only duct dilation was associated with TS. Endoscopic success of complete duct clearance was achieved in 29 patients (80%). Endoscopic success was more frequent with stones 12 mm or less and with successful TS. By multivariate logistic regression, stones greater than 12 mm were associated with endoscopic failure. Pre-SWL endotherapy does not affect stone fragmentation. Patients with a dilated duct (>8 mm) and pancreatic stones 12 mm or greater were associated with unsuccessful TS and endoscopic success, respectively, and may benefit from early referral for surgical decompression.

Simple resection of the lesion bile duct branch for treatment of regional hepatic bile duct stones

PubMed Central

Enliang, Li; Rongshou, Wu; Shidai, Shi; Jingling, Zhang; Qian, Feng; Wenjun, Liao; Linquan, Wu

2017-01-01

Abstract To evaluate the effectiveness and safety of simple resections of bile duct branch lesions for the treatment of regional hepatic bile duct stones. A retrospective analysis of the clinical data from patients in our hospital from November 2008 to November 2015, who only underwent a simple resection of the lesion bile duct branch. The patients’ clinical characteristics, surgical features, postoperative complications, stone clear rate, residual stone rate, and recurrence stone rate were analyzed. This study of 32 patients included 13 males and 19 females with intrahepatic bile duct stones confined to the right hepatic bile duct branch. The intraoperative blood loss, operation time, and postoperative hospital stay were 478.0 ± 86.5, 210.7 ± 6.6, and 10.8 ± 3.5, respectively. Postoperative complications occurred in 6 patients (18.8%), all of whom recovered with conservative management. There were no deaths during hospitalization. The intraoperative stone clearance rate was 95.8%. Three patients had a recurrence of stones at a mean of 22 months of follow-up (range, 4–36 months). Simple resection of bile duct branch lesions is safe and feasible for patients who have regional hepatic bile duct stones limited to the right hepatic bile duct branches. PMID:28682899

Urolithiasis in Tunisian children: a study of 100 cases.

PubMed

Alaya, Akram; Nouri, Abdellatif; Najjar, Mohamed Fadhel

2009-11-01

The aim of this study is to assess the clinical and biological characteristics of renal stone disease among children living in the coastal region of Tunisia. This retrospective multi-center study included 100 children under the age of 16 years, who presented with urinary stones. The patients' charts were reviewed with regard to age at diagnosis, sex, history and physical examination as well as laboratory and radiologic findings. Stone analysis was performed by infrared spectrophotometry. The male/female sex ratio was 1.5 to 1. The clinical presentation of this pathology was dominated by dysuria. Stones were located in the upper urinary tract in 76 cases (76%). A total of 13% of the study subjects had positive urine cultures. Metabolic investigations were performed in all patients and were normal in 80 cases. Whewellite (calcium oxalate) was found in 77 stones (77.0%). Stone section was made of whewellite in 69.0% of cases and ammonium urate in 47.0%. Struvite stones were more frequently seen in the lower urinary tract. Our study suggests that the epidemiological profile of renal stones in Tunisia has changed towards a predominance of calcium oxalate stones and upper tract location. Also, the male predominance of pediatric urolithiasis is becoming less obvious in Tunisia.

Renal-Stone Risk Assessment During Space Shuttle Flights

NASA Technical Reports Server (NTRS)

Whitson, Peggy A.; Pietrzyk, Robert A.; Pak, Charles Y. C.

1996-01-01

The metabolic and environmental factors influencing renal stone formation before, during, and after Space Shuttle flights were assessed. We established the contributing roles of dietary factors in relationship to the urinary risk factors associated with renal stone formation. 24-hr urine samples were collected prior to, during space flight, and following landing. Urinary factors associated with renal stone formation were analyzed and the relative urinary supersaturation ratios of calcium oxalate, calcium phosphate (brushite), sodium urate, struvite and uric acid were calculated. Food and fluid consumption was recorded for a 48-hr period ending with the urine collection. Urinary composition changed during flight to favor the crystallization of stone-forming salts. Factors that contributed to increased potential for stone formation during space flight were significant reductions in urinary pH and increases in urinary calcium. Urinary output and citrate, a potent inhibitor of calcium-containing stones, were slightly reduced during space flight. Dietary intakes were significantly reduced for a number of variables, including fluid, energy, protein, potassium, phosphorus and magnesium. This is the first in-flight characterization of the renal stone forming potential in astronauts. With the examination of urinary components and nutritional factors, it was possible to determine the factors that contributed to increased risk or protected from risk. In spite of the protective components, the negative contributions to renal stone risk predominated and resulted in a urinary environment that favored the supersaturation of stone-forming salts. The importance of the hypercalciuria was noted since renal excretion was high relative to the intake.

"Silent" kidney stones in "asymptomatic" primary hyperparathyroidism-a comparison of multidetector computed tomography and ultrasound.

PubMed

Selberherr, Andreas; Hörmann, Marcus; Prager, Gerhard; Riss, Philipp; Scheuba, Christian; Niederle, Bruno

2017-03-01

The purpose of this study was to demonstrate the high number of kidney stones in primary hyperparathyroidism (PHPT) and the low number of in fact "asymptomatic" patients. Forty patients with PHPT (28 female, 12 male; median age 58 (range 33-80) years; interquartile range 17 years [51-68]) without known symptoms of kidney stones prospectively underwent multidetector computed tomography (MDCT) and ultrasound (US) examinations of the urinary tract prior to parathyroid surgery. Images were evaluated for the presence and absence of stones, as well as for the number of stones and sizes in the long axis. The MDCT and US examinations were interpreted by two experienced radiologists who were blinded to all clinical and biochemical data. Statistical analysis was performed using the Wilcoxon signed-rank test. US revealed a total of 4 kidney stones in 4 (10 %) of 40 patients (median size 6.5 mm, interquartile range 11.5 mm). MDCT showed a total of 41 stones (median size was 3 mm, interquartile range 2.25 mm) in 15 (38 %) of 40 patients. The number of kidney stones detected with MDCT was significantly higher compared to US (p = 0.00124). MDCT is a highly sensitive method for the detection of "silent" kidney stones in patients with PHPT. By widely applying this method, the number of asymptomatic courses of PHPT may be substantially reduced. MDCT should be used primarily to detect kidney stones in PHPT and to exclude asymptomatic PHPT.

Renal stone risk assessment during Space Shuttle flights

NASA Technical Reports Server (NTRS)

Whitson, P. A.; Pietrzyk, R. A.; Pak, C. Y.

1997-01-01

PURPOSE: The metabolic and environmental factors influencing renal stone formation before, during, and after Space Shuttle flights were assessed. We established the contributing roles of dietary factors in relationship to the urinary risk factors associated with renal stone formation. MATERIALS AND METHODS: 24-hr. urine samples were collected prior to, during space flight, and following landing. Urinary and dietary factors associated with renal stone formation were analyzed and the relative urinary supersaturation of calcium oxalate, calcium phosphate (brushite), sodium urate, struvite and uric acid were calculated. RESULTS: Urinary composition changed during flight to favor the crystallization of calcium-forming salts. Factors that contributed to increased potential for stone formation during space flight were significant reductions in urinary pH and increases in urinary calcium. Urinary output and citrate, a potent inhibitor of calcium-containing stones, were slightly reduced during space flight. Dietary intakes were significantly reduced for a number of variables, including fluid, energy, protein, potassium, phosphorus and magnesium. CONCLUSIONS: This is the first in-flight characterization of the renal stone forming potential in astronauts. With the examination of urinary components and nutritional factors, it was possible to determine the factors that contributed to increased risk or protected from risk. In spite of the protective components, the negative contributions to renal stone risk predominated and resulted in a urinary environment that favored the supersaturation of stone-forming salts. Dietary and pharmacologic therapies need to be assessed to minimize the potential for renal stone formation in astronauts during/after space flight.

Experience of extracorporeal shockwave lithotripsy for kidney and upper ureteric stones by electromagnetic lithotriptor.

PubMed

Wazir, Bakhtawar Gul; Iftikhar ul Haq, Mian; Faheem ul Haq; Nawaz, Akhtar; Ikramullah, Ahmed Nawaz; Jamil, Mohammad

2010-01-01

Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive treatment of urinary stones which breaks them, by using externally applied, focused, high intensity acoustic pulse, into smaller pieces so that they can pass easily through ureter. Shock wave generation, focusing, coupling and stone localisation by fluoroscope or ultrasound are the basic components of ESWL. ESWL has some complications and is contraindicated in certain situations. The aim of this study was to evaluate the effectiveness and safety of ESWL in kidney and upper ureteric stones by Electromagnetic Lithotriptor. All adult patients with renal and upper ureteric stones having a diameter of up to 1 Cm were included in the study. Basic evaluation such as history, examination, ultrasound and excretory urography were performed. Electromagnetic lithotripsy was done and data were collected on a printed proforma from 1st January 2008 to 30th March 2009 in Institute of Kidney Diseases, Peshawar. Out of a total of 625 patients 463 were male and 162 were female; 67.36% of patients were having renal stones, 23.84% upper ureteric and 8.8% both renal and ureteric stones. Complications noted were renal colic in 9.76%, haematuria in 3.2%, steinstrasse in 2.72%, and fever in 1.12% of patients. The stone free rate was 89% and 7% of patients were having stone fragments <4 mm. ESWL failed in 4% of patients. ESWL is a safe and effective way of treating kidney and upper ureteric stones.

Safety and efficacy of a novel plastic stent coated with stone-dissolving agents for the treatment of biliary stones in a porcine model.

PubMed

Cai, Xiao Bo; Zhang, Wei Xing; Zhang, Ru Ling; Dong Yuan, Xiao; Yang, Qin; Qi, Xiao Shen; Li, Bai Wen; Qin Qian, Yue; Wang, Xing Peng; Lu, Lun Gen; Xu, Zheng Jie; Wan, Xin Jian

2015-05-01

We previously reported on a plastic stent that was coated with ethylenediaminetetraacetic acid (EDTA) and sodium cholate, which dissolved common bile duct (CBD) stones ex vivo. The aim of this study was to investigate the safety and efficacy of such stents on biliary stones in a live porcine model. Stents without coating or with degradable membranes containing 0 % or 50 % EDTA and sodium cholate were inserted together with human CBD stones into the porcine CBD. Serum laboratory variables, histological examinations of the bile duct, and the weight change in stones were compared during and after stent placement for 6 months. A total of 16 pigs were included (5 no coating, 5 0 % coating, 6 50 % coating). Biliary stones showed decreased weight in all groups; however, stones in the group with 50 % coated stents showed a greater reduction in weight compared with the no coating and the 0 % coating groups (269 ± 66 mg vs. 179 ± 51 mg [P = 0.09]; 269 ± 66 mg vs. 156 ± 26 mg [P = 0.01], respectively). The plastic stent coated with 50 % agent enhanced CBD stone dissolution in vivo and may be a promising tool for patients with difficult biliary stones. © Georg Thieme Verlag KG Stuttgart · New York.

Determination of minor and trace elements in kidney stones by x-ray fluorescence analysis

NASA Astrophysics Data System (ADS)

Srivastava, Anjali; Heisinger, Brianne J.; Sinha, Vaibhav; Lee, Hyong-Koo; Liu, Xin; Qu, Mingliang; Duan, Xinhui; Leng, Shuai; McCollough, Cynthia H.

2014-03-01

The determination of accurate material composition of a kidney stone is crucial for understanding the formation of the kidney stone as well as for preventive therapeutic strategies. Radiations probing instrumental activation analysis techniques are excellent tools for identification of involved materials present in the kidney stone. In particular, x-ray fluorescence (XRF) can be very useful for the determination of minor and trace materials in the kidney stone. The X-ray fluorescence measurements were performed at the Radiation Measurements and Spectroscopy Laboratory (RMSL) of department of nuclear engineering of Missouri University of Science and Technology and different kidney stones were acquired from the Mayo Clinic, Rochester, Minnesota. Presently, experimental studies in conjunction with analytical techniques were used to determine the exact composition of the kidney stone. A new type of experimental set-up was developed and utilized for XRF analysis of the kidney stone. The correlation of applied radiation source intensity, emission of X-ray spectrum from involving elements and absorption coefficient characteristics were analyzed. To verify the experimental results with analytical calculation, several sets of kidney stones were analyzed using XRF technique. The elements which were identified from this techniques are Silver (Ag), Arsenic (As), Bromine (Br), Chromium (Cr), Copper (Cu), Gallium (Ga), Germanium (Ge), Molybdenum (Mo), Niobium (Nb), Rubidium (Rb), Selenium (Se), Strontium (Sr), Yttrium (Y), Zirconium (Zr). This paper presents a new approach for exact detection of accurate material composition of kidney stone materials using XRF instrumental activation analysis technique.

Changing patterns of gallstone disease in Korea.

PubMed

Park, Yong-Hyun; Park, Sang-Jae; Jang, Jin-Young; Ahn, Young Joon; Park, Youn-Chan; Yoon, Yong Bum; Kim, Sun-Whe

2004-02-01

The aim of this study was to investigate the epidemiologic characteristics and changing patterns of gallstone disease in Korea over a recent 20-year period. A total of 4020 gallstone patients who had undergone surgery at Seoul National University Hospital during 1981-2000 were analyzed according to periods: period I (1981-1985: 831 cases); period II (1986-1990: 888 cases); period III (1991-1995: 1040 cases); period IV (1996-2000: 1261 cases). The literature from 13 institutes in Korea reporting a total of 13,101 gallstone cases were reviewed to elucidate the nationwide trend. The number of gallstone cases gradually increased. A female predominance was not noted (F/M = 1.17-1.37) as is seen in Western countries. The patients with common bile duct (CBD) stones were older than those with gallbladder (GB) stones or intrahepatic duct (IHD) stones. Over time, the relative proportion of those with a GB stone increased, plateauing (80-85%) during the 1990s; that of patients with CBD stones decreased (34% --> 19%); and that of those with IHD stones remained unchanged (11-15%). Over the entire period, the rural pattern of gallstone formation (low number of GB stones, high numbers of CBD and IHD stones) has become similar to the urban pattern. The body mass index (BMI) of the GB stone group was above average, as were the BMIs of the CBD stone and IHD stone groups. Throughout the literature review, this same changing pattern of the relative proportion of gallstone disease was confirmed. Thus the pattern of gallstone disease in Korea has become similar to that seen in Western countries except for a high prevalence of hepatolithiasis.

Treatment of pouch stones after augmentation ileocystoplasty in children: is it always bothersome?

PubMed

Helmy, Tamer E; Elawdy, Mohammed M; AbdelHalim, Ahmed; Orban, Hesham; Nabeeh, Hossam; Dawaba, Mohammed; Hafez, Ashraf T

2015-01-01

To report our experience with different approaches for management of pouch stones in children with ileal-based urinary reservoir. Charts of children who underwent ileal-based urinary reservoirs between 2000 and 2009 were retrospectively reviewed. Patients who were diagnosed with reservoir calculi were identified; medical records were reviewed for patients' demographics, diversion details, stone criteria, mode of treatment, perioperative complications, and recurrence rate. We identified 26 children with pouch stones after urinary diversion. There were 11 boys (42%) and 15 girls (58%). Mean age was 11 years (range, 4-16 years). Mean time for diagnosis was 42 months (24-120 months). Pouch stones were asymptomatic in 10 patients (38%). Fifteen cases were postbladder augmentation and 11 cases postcontinent cutaneous diversion. The mean stone size was 4 cm (range, 1-10 cm), and mean Hounsfield Unit was 585 (205-1090). Seventeen children (65%) had positive urine culture result, whereas 9 children were sterile. Seven children (27%) required open poucholithotomy, whereas 19 patients (73%) were managed endoscopically. Percutaneous approach was done in 5 children, whereas urethral access was used in 7 children. Mechanical extraction was performed in 12 cases, and stone disintegration was required in 7 cases. Eight children developed stone recurrence. Mean time for recurrence was 11 months (range, 3-19 months). Six children were after endoscopic disintegration, and all required redo endoscopic extraction. Stone analysis was available in 15 patients (struvite stones in 10 cases and calcium phosphate in 5 cases). Pouch stones are established long-term complication of urinary diversion. Open and endoscopic approaches are valid treatment strategies. Copyright © 2015 Elsevier Inc. All rights reserved.

Urine specific gravity and water hardness in relation to urolithiasis in persons with spinal cord injury.

PubMed

Chen, Y; Roseman, J M; Funkhouser, E; DeVivo, M J

2001-11-01

A matched case-control study. To clarify the influence of urine specific gravity and drinking water quality on the formation of urinary stones in persons with spinal cord injury (SCI). A rehabilitation center within a university hospital. Between 1992 and 1998, 63 stone cases (31 kidney, 27 bladder, and five both) and 289 age-duration-matched controls were recruited from a cohort of SCI patients enrolled in an on-going longitudinal study. Data on urine specific gravity and other characteristics of study participants were retrieved from the database and medical charts. Community water supply information was provided by the Alabama Department of Environmental Management. Multivariable conditional logistic regression analysis was performed to evaluate the association with stone formation. SCI individuals who had urinary stones were more likely than control subjects to use indwelling catheters and have decreased renal function. The occurrence of stones was not significantly related to gender, race, severity of injury, urinary tract infection, nor urine pH. After controlling for the potential confounding from other factors, a continuously increasing stone occurrence with increasing specific gravity was observed (P=0.05); this association was stronger for kidney (odds Ratio [OR]=1.8 per 0.010 g/cm(3)) versus bladder stones (OR=1.2) and for recurrent (OR=2.0) versus first stones (OR=1.5). Increased water hardness was not significantly associated with a decreased stone occurrence. Study results suggest that maintaining urine specific gravity below a certain level might reduce the occurrence of urinary stones. This could be easily achieved by using a dipstick for self-feedback along with appropriate fluid intake. For persons with SCI who are at an increased risk of a devastating stone disease, this prophylactic approach could be very cost-effective; however, this requires further confirmation.

Determinants of Brushite Stone Formation: A Case-Control Study

PubMed Central

Siener, Roswitha; Netzer, Linda; Hesse, Albrecht

2013-01-01

Purpose The occurrence of brushite stones has increased during recent years. However, the pathogenic factors driving the development of brushite stones remain unclear. Methods Twenty-eight brushite stone formers and 28 age-, sex- and BMI-matched healthy individuals were enrolled in this case-control study. Anthropometric, clinical, 24 h urinary parameters and dietary intake from 7-day weighed food records were assessed. Results Pure brushite stones were present in 46% of patients, while calcium oxalate was the major secondary stone component. Urinary pH and oxalate excretion were significantly higher, whereas urinary citrate was lower in patients as compared to healthy controls. Despite lower dietary intake, urinary calcium excretion was significantly higher in brushite stone patients. Binary logistic regression analysis revealed pH>6.50 (OR 7.296; p = 0.035), calcium>6.40 mmol/24 h (OR 25.213; p = 0.001) and citrate excretion <2.600 mmol/24 h (OR 15.352; p = 0.005) as urinary risk factors for brushite stone formation. A total of 56% of patients exhibited distal renal tubular acidosis (dRTA). Urinary pH, calcium and citrate excretion did not significantly differ between patients with or without dRTA. Conclusions Hypercalciuria, a diminished citrate excretion and an elevated pH turned out to be the major urinary determinants of brushite stone formation. Interestingly, urinary phosphate was not associated with urolithiasis. The increased urinary oxalate excretion, possibly due to decreased calcium intake, promotes the risk of mixed stone formation with calcium oxalate. Neither dietary factors nor dRTA can account as cause for hypercalciuria, higher urinary pH and diminished citrate excretion. Further research is needed to define the role of dRTA in brushite stone formation and to evaluate the hypothesis of an acquired acidification defect. PMID:24265740

The challenge of cystine and struvite stone formers: clinical, metabolic and surgical assessment

PubMed Central

Yamaçake, Kleiton G. R.; Marchini, Giovanni S.; Reis, Sabrina; Danilovic, Alexandre; Vicentini, Fábio C.; Torricelli, Fábio C. M.; Srougi, Miguel; Mazzucchi, Eduardo

2016-01-01

ABSTRACT Purpose: To compare the clinical, metabolic, and calculi characteristics of cystine and struvite stone patients after percutaneous nephrolithotripsy (PCNL). Material and Methods: Between January/2006-July/2013, 11 cystine stone patients were treated in our clinic. Of those, 3 were excluded due to incomplete follow-up. Eight cystine stone patients (2 with bilateral disease; 10 renal units-RU) were considered for further analysis. A cohort of 8 struvite stone formers (10RU) was matched having the same age, gender, body mass index (BMI) and Guys stone score. Analyzed parameters comprised demographic data, serum/urinary metabolic evaluation and surgical outcomes. Results: Both groups had 6 female patients. Groups were similar in regards to age, gender, BMI, stone burden, and serum creatinine (p=NS). All patients had PCNL as the first surgical treatment modality. Stone free rate (SFR) after the first PCNL tended to be lower (0%) in the cystine compared to the struvite group (40%)(p=0.08). Final SFR after secondary procedures increased to 70% in cystine and 80% in struvite patients (p=1.0); mean number of procedures to achieve stone free status was higher in the first group (3.57 vs. 2.0;p=0.028). Hypocitraturia was found in all patients, but struvite cases presented with lower mean urinary citrate levels (p=0.016). Other common abnormalities were elevated urinary pH (cystine 75% and struvite 62.5%;p=1.0) and low urinary volume (62.5%,37.5%;p=0.63). Conclusion: Multiple interventions and suboptimal stone free rates are trait of the significant stone burden of struvite and cystine patients. Underlying metabolic abnormalities characterized by increased urinary pH, hypocitraturia and low urinary volume are often encountered in both populations. PMID:27622279

Optimum nutrition for kidney stone disease.

PubMed

Heilberg, Ita P; Goldfarb, David S

2013-03-01

We summarize the data regarding the associations of individual dietary components with kidney stones and the effects on 24-hour urinary profiles. The therapeutic recommendations for stone prevention that result from these studies are applied where possible to stones of specific composition. Idiopathic calcium oxalate stone-formers are advised to reduce ingestion of animal protein, oxalate, and sodium while maintaining intake of 800 to 1200 mg of calcium and increasing consumption of citrate and potassium. There are few data regarding dietary therapy of calcium phosphate stones. Whether the inhibitory effect of citrate sufficiently counteracts increasing urine pH to justify more intake of potassium and citrate is not clear. Reduction of sodium intake to decrease urinary calcium excretion would also be expected to decrease calcium phosphate stone recurrence. Conversely, the most important urine variable in the causation of uric acid stones is low urine pH, linked to insulin resistance as a component of obesity and the metabolic syndrome. The mainstay of therapy is weight loss and urinary alkalinization provided by a more vegetarian diet. Reduction in animal protein intake will reduce purine ingestion and uric acid excretion. For cystine stones, restriction of animal protein is associated with reduction in intake of the cystine precursor methionine as well as cystine. Reduction of urine sodium results in less urine cystine. Ingestion of vegetables high in organic anion content, such as citrate and malate, should be associated with higher urine pH and fewer stones because the amino acid cystine is soluble in more alkaline urine. Because of their infectious origin, diet has no definitive role for struvite stones except for avoiding urinary alkalinization, which may worsen their development. Published by Elsevier Inc.

Comparison of retrograde intrarenal surgery versus a single-session percutaneous nephrolithotomy for lower-pole stones with a diameter of 15 to 30 mm: A propensity score-matching study.

PubMed

Jung, Gyoo Hwan; Jung, Jae Hyun; Ahn, Tae Sik; Lee, Joong Sub; Cho, Sung Yong; Jeong, Chang Wook; Lee, Seung Bae; Kim, Hyeon Hoe; Oh, Seung-June

2015-07-01

To investigate surgical outcomes between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) groups for a main stone sized 15 to 30 mm and located in the lower-pole calyx. Patients who underwent PNL or RIRS for a main stone sized 15 to 30 mm and located in the lower-pole calyx were retrospectively reviewed. Each patient in the RIRS group was matched to one in the PNL group on the basis of calculated propensity scores by use of age, sex, body mass index, previous treatment history, stone site, maximum stone size, and stone volume. We compared perioperative outcomes between the unmatched and matched groups. Patients underwent PNL (n=87, 66.4%) or RIRS (n=44, 33.6%). After matching, 44 patients in each group were included. Mean patient age was 54.4 ± 13.7 years. Perioperative hemoglobin drop was significantly higher and the hospital stay was longer in the PNL group than in the RIRS group. The operative time was significantly longer in the RIRS group than in the PNL group. Stone-free rates were higher and complications rates were lower in the RIRS group than in the PNL group without statistical significance. The presence of a stone located in the lower-anterior minor calyx was a predictor of stone-free status. RIRS and single-session PNL for patients with a main stone of 15 to 30 mm located in the lower-pole calyx showed comparable surgical results. However, RIRS can be performed more safely than PNL with less bleeding. Stones in the lower-anterior minor calyx should be carefully removed during these procedures.

Comparison of retrograde intrarenal surgery versus a single-session percutaneous nephrolithotomy for lower-pole stones with a diameter of 15 to 30 mm: A propensity score-matching study

PubMed Central

Jung, Gyoo Hwan; Jung, Jae Hyun; Ahn, Tae Sik; Lee, Joong Sub; Cho, Sung Yong; Jeong, Chang Wook; Lee, Seung Bae; Kim, Hyeon Hoe

2015-01-01

Purpose To investigate surgical outcomes between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) groups for a main stone sized 15 to 30 mm and located in the lower-pole calyx. Materials and Methods Patients who underwent PNL or RIRS for a main stone sized 15 to 30 mm and located in the lower-pole calyx were retrospectively reviewed. Each patient in the RIRS group was matched to one in the PNL group on the basis of calculated propensity scores by use of age, sex, body mass index, previous treatment history, stone site, maximum stone size, and stone volume. We compared perioperative outcomes between the unmatched and matched groups. Results Patients underwent PNL (n=87, 66.4%) or RIRS (n=44, 33.6%). After matching, 44 patients in each group were included. Mean patient age was 54.4±13.7 years. Perioperative hemoglobin drop was significantly higher and the hospital stay was longer in the PNL group than in the RIRS group. The operative time was significantly longer in the RIRS group than in the PNL group. Stone-free rates were higher and complications rates were lower in the RIRS group than in the PNL group without statistical significance. The presence of a stone located in the lower-anterior minor calyx was a predictor of stone-free status. Conclusions RIRS and single-session PNL for patients with a main stone of 15 to 30 mm located in the lower-pole calyx showed comparable surgical results. However, RIRS can be performed more safely than PNL with less bleeding. Stones in the lower-anterior minor calyx should be carefully removed during these procedures. PMID:26175872

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.

The risk of kidney cancer in patients with kidney stones: a systematic review and meta-analysis.

PubMed

Cheungpasitporn, W; Thongprayoon, C; O'Corragain, O A; Edmonds, P J; Ungprasert, P; Kittanamongkolchai, W; Erickson, S B

2015-03-01

The objective of this meta-analysis was to evaluate the association between a history of kidney stones and kidney cancer. A literature search was performed from inception until June 2014. Studies that reported odds ratios or hazard ratios comparing the risk of renal cell carcinoma (RCC) and transitional cell carcinoma (TCC) of the upper urinary tract in patients with the history of kidney stones versus those without the history of kidney stones were included. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Seven studies were included in our analysis to assess the association between a history of kidney stones and RCC. The pooled RR of RCC in patients with kidney stones was 1.76 (95% CI, 1.24-2.49). The subgroup analysis found that the history of kidney stones was associated with increased RCC risk only in males (RR, 1.41 [95% CI, 1.11-1.80]), but not in females (RR, 1.13 [95% CI, 0.86-1.49]). Five studies were selected to assess the association between a history of kidney stones and TCC. The pooled RR of TCC in patients with kidney stones was 2.14 (95% CI, 1.35-3.40). Our study demonstrates a significant increased risk of RCC and TCC in patients with prior kidney stones. However, the increased risk of RCC was noted only in male patients. This finding suggests that a history of kidney stones is associated with kidney cancer and may impact clinical management and cancer surveillance. © The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Intake of Trace Metals and the Risk of Incident Kidney Stones.

PubMed

Ferraro, Pietro Manuel; Gambaro, Giovanni; Curhan, Gary C; Taylor, Eric N

2018-06-01

The association between the intake of trace metals and the risk of incident stones has not been longitudinally investigated. We performed a prospective analysis of 193,551 participants in the Health Professionals Follow-up Study, and the Nurses' Health Study I and II. During a followup of 3,316,580 person-years there was a total of 6,576 incident stones. We used multivariate regression models to identify associations of the intake of zinc, iron, copper and manganese with the risk of stones. In a subset of participants with 24-hour urine collections we examined the association between the intake of trace metals and urine composition. After multivariate adjustment total and dietary intakes of zinc and iron were not significantly associated with incident stones. A higher intake of manganese was associated with a lower risk of stones. The pooled HR of the highest quintile of total manganese intake compared with the lowest intake was 0.82 (95% CI 0.68-0.98, p = 0.02). Total but not dietary copper intake was marginally associated with a higher risk of stones (pooled HR 1.14, 95% CI 1.02-1.28, p = 0.01). There were no statistically significant associations of the total intake of manganese and copper with urinary supersaturation. Zinc and iron intake was not associated with a risk of stones. Copper intake may be associated with a higher risk in some individuals. Higher total manganese intake was associated with a lower risk of stones but not with traditional 24-hour urinary composite markers of stone risk. Further research is needed to elucidate the mechanisms by which manganese may reduce kidney stone formation. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Automated analysis of urinary stone composition using Raman spectroscopy: pilot study for the development of a compact portable system for immediate postoperative ex vivo application.

PubMed

Miernik, Arkadiusz; Eilers, Yvan; Bolwien, Carsten; Lambrecht, Armin; Hauschke, Dieter; Rebentisch, Gunter; Lossin, Phillipp S; Hesse, Albrecht; Rassweiler, Jens J; Wetterauer, Ulrich; Schoenthaler, Martin

2013-11-01

We evaluate a compact portable system for immediate automated postoperative ex vivo analysis of urinary stone composition using Raman spectroscopy. Analysis of urinary stone composition provides essential information for the treatment and metaphylaxis of urolithiasis. Currently infrared spectroscopy and x-ray diffraction are used for urinary stone analysis. However, these methods may require complex sample preparation and costly laboratory equipment. In contrast, Raman spectrometers could be a simple and quick strategy for immediate stone analysis. Pure samples of 9 stone components and 159 human urinary calculi were analyzed by Raman spectroscopy using a microscope coupled system at 2 excitation wavelengths. Signal-to-noise ratio, peak positions and the distinctness of the acquired Raman spectra were analyzed and compared. Background fluorescence was removed mathematically. Corrected Raman spectra were used as a reference library for automated classification of native human urinary stones (50). The results were then compared to standard infrared spectroscopy. Signal-to-noise ratio was superior at an excitation wavelength of 532 nm. An automated, computer based classifier was capable of matching spectra from patient samples with those of pure stone components. Consecutive analysis of 50 human stones demonstrated 100% sensitivity and specificity compared to infrared spectroscopy (for components with more than 25% of total composition). Our pilot study indicates that Raman spectroscopy is a valid and reliable technique for determining urinary stone composition. Thus, we propose that the development of a compact and portable system based on Raman spectroscopy for immediate, postoperative stone analysis could represent an invaluable tool for the metaphylaxis of urolithiasis. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

The Role of the Tamsulosin in the Medical Expulsion Therapy for Distal Ureteral Stones

PubMed Central

Nuraj, Petrit; Hyseni, Nexhmi

2017-01-01

Background: This research aims to evaluate the role of tamsulosin in the medical expulsion therapy for distal ureteral stones, including her effects in stone expulsion time, expulsion rates, stone size, pain episodes and analgesic dosage usage. Material and methods: The 104 patients with distal ureteral calculi were examined, with the size of the stones 4-10 mm. They were randomly divided into two groups: study group (n=52), received tamsulosin 0.4 mg in morning, for 28 days, analgesic (diclofenac 75 mg), high fluid intake and Control group (n=52) received analgesic (diclofenac 75 mg), high fluid intake. Results: There is no significant difference between groups, based on sex (P=0.835) and age (P=0.987). Average size of the stones was 6.5 mm (SD ± 1.6 mm), with no significant difference (P=0.996). Stone expulsion rate is 90.4% in the study group and 71.2% from the control group, with statistical significance (P=0.023). The average time of the expulsion of stones in the study group was 9.6 days (SD ± 7.1 days), control group 13.7 days (SD ± 7.3 days), with statistical significance, (P=0.034). Average dose of analgesics in the study group was 63.7 mg (SD ± 45.2 mg), control group is 109.2 (SD ± 53.3), with statistical significance (P=0.019). Conclusion: Our study reveals that tamsulosin is efficient for the treatment of distal ureteral stones. Tamsulosin decrease the number of ureteral colic episodes, by acting as a spasmolytic, increase and hasten stone expulsion rates, reduce days of stone expulsion, decrease analgesic dose usage. PMID:28790547

Calculating the number of shock waves, expulsion time, and optimum stone parameters based on noncontrast computerized tomography characteristics.

PubMed

Foda, Khaled; Abdeldaeim, Hussein; Youssif, Mohamed; Assem, Akram

2013-11-01

To define the parameters that accompanied a successful extracorporeal shock wave lithotripsy (ESWL), namely the number of shock waves (SWs), expulsion time (ET), mean stone density (MSD), and the skin-to-stone distance (SSD). A total of 368 patients diagnosed with renal calculi using noncontrast computerized tomography had their MSD, diameter, and SSD recorded. All patients were treated using a Siemens lithotripter. ESWL success meant a stone-free status or presence of residual fragments <3 mm, ET was the time in days for the successful clearance of stone fragments. Correlation was performed between the stone characteristics, number of SWs, and ET. Two multiple regression analysis models defined the number of SWs and ET. Two receiver operating characteristic curves plotted the best MSD cutoff value and optimum SSD for a successful ESWL. Three hundred one patients were ESWL successes. A significant positive correlation was elicited between number of SWs and stone diameter, density and SSD; between ET and stone diameter and density. Multiple regressions concluded 2 equations: Number of SWs = 265.108 + 5.103 x1 + 22.39 x2 + 10.931 x3 ET (days) = -10.85 + 0.031 x1 + 2.11 x2 x1 = stone density (Hounsfield unit [HUs]), x2 = stone diameter (mm), and x3 = SSD (mm). Receiver operating characteristic curves demonstrated a cutoff value of ≤ 934 HUs with 94.4% sensitivity and 66.7% specificity and P = .0211. The SSD curve showed that a distance ≤ 99 mm was 85.7% sensitive, 87.5% specific, P <.0001. Stone disintegration is not recommended if MSD is >934 HUs and SSD >99 mm. The required number of SWs and the expected ET can be anticipated. Copyright © 2013 Elsevier Inc. All rights reserved.

Estimating the Risk of Renal Stone Events during Long-Duration Spaceflight

NASA Technical Reports Server (NTRS)

Reyes, David; Kerstman, Eric; Gray, Gary; Locke, James

2014-01-01

Introduction: Given the bone loss and increased urinary calcium excretion in the microgravity environment, persons participating in long-duration spaceflight may have an increased risk for renal stone formation. Renal stones are often an incidental finding of abdominal imaging studies done for other reasons. Thus, some crewmembers may have undiscovered, asymptomatic stones prior to their mission. Methods: An extensive literature search was conducted concerning the natural history of asymptomatic renal stones. For comparison, simulations were done using the Integrated Medical Model (IMM). The IMM is an evidence-based decision support tool that provides risk analysis and has the capability to optimize medical systems for missions by minimizing the occurrence of adverse mission outcomes such as evacuation and loss of crew life within specified mass and volume constraints. Results: The literature of the natural history of asymptomatic renal stones in the general medical population shows that the probability of symptomatic event is 8% to 34% at 1 to 3 years for stones < 7 mm. Extrapolated to a 6-month mission, for stones < 5 to 7 mm, the risk for any stone event is about 4 to 6%, with a 0.7% to 4% risk for intervention, respectively. IMM simulations compare favorably with risk estimates garnered from the terrestrial literature. The IMM forecasts that symptomatic renal stones may be one of the top drivers for medical evacuation of an International Space Station (ISS) mission. Discussion: Although the likelihood of a stone event is low, the consequences could be severe due to limitations of current ISS medical capabilities. Therefore, these risks need to be quantified to aid planning, limit crew morbidity and mitigate mission impacts. This will be especially critical for missions beyond earth orbit, where evacuation may not be an option.

Feasibility and safety of bilateral same-session flexible ureteroscopy (FURS) for renal and ureteral stone disease

PubMed Central

Drake, Tamsin; Ali, Ahmed

2015-01-01

Introduction With rising incidence of urolithiasis, treatment of stones (both symptomatic and asymptomatic) in multiple locations including bilateral stones can be controversial and challenging. We report our experience and treatment outcomes in patients undergoing bilateral, same-session ureterorenoscopy (BS-URS) for bilateral ureteric and/or renal calculi, and discuss the advantages and disadvantages of such procedures. Material and methods Between May 2012 and October 2013, 251 patients underwent ureteroscopic surgery for stone disease at our institution. Of these, 21 patients underwent 25 bilateral same-session ureterorenoscopy (BS-URS) procedures during this period. Stone-free status was defined as endoscopically stone-free or radiological fragments <2 mm. Results The mean bilateral stone size was 21mm (range: 4-63 mm) with a mean operating time of 70 minutes (range 35-129 minutes). Fifteen procedures (60%) were done as day case procedures with a mean stay of 0.9 days (range 0-7 days). Of the 42 renal units treated, 80% (34/42) were stone-free after a single bilateral ureteroscopy session. A further 12% (5/42) were cleared after a re-look procedure making the overall stone free rate 92.8% (39/42). There were no major complications and 3 minor complications (2 early stent removals due to stent symptoms and 1 pyelonephritis requiring intravenous antibiotics). Conclusions Bilateral same-session ureteroscopy is a safe and effective treatment option for patients with bilateral ureteric and/or renal calculi, even with stones in multiple locations and increasing stone loads. However, as with all surgery, proper patient and equipment selection is crucial in terms of reducing complication rates and improving treatment outcomes. PMID:26251740

Estimating the Risk of Renal Stone Events During Long-Duration Spaceflight

NASA Technical Reports Server (NTRS)

Reyes, David; Kerstman, Eric; Locke, James

2014-01-01

Introduction: Given the bone loss and increased urinary calcium excretion in the microgravity environment, persons participating in long-duration spaceflight may have an increased risk for renal stone formation. Renal stones are often an incidental finding of abdominal imaging studies done for other reasons. Thus, some crewmembers may have undiscovered, asymptomatic stones prior to their mission. Methods: An extensive literature search was conducted concerning the natural history of asymptomatic renal stones. For comparison, simulations were done using the Integrated Medical Model (IMM). The IMM is an evidence-based decision support tool that provides risk analysis and has the capability to optimize medical systems for missions by minimizing the occurrence of adverse mission outcomes such as evacuation and loss of crew life within specified mass and volume constraints. Results: The literature of the natural history of asymptomatic renal stones in the general medical population shows that the probability of symptomatic event is 8% to 34% at 1 to 3 years for stones < 7 mm. Extrapolated to a 6-month mission, for stones < 5 to 7 mm, the risk for any stone event is about 4 to 6%, with a 0.7% to 4% risk for intervention, respectively. IMM simulations compare favorably with risk estimates garnered from the terrestrial literature. The IMM forecasts that symptomatic renal stones may be one of the top drivers for medical evacuation of an International Space Station (ISS) mission. Discussion: Although the likelihood of a stone event is low, the consequences could be severe due to limitations of current ISS medical capabilities. Therefore, these risks need to be quantified to aid planning, limit crew morbidity and mitigate mission impacts. This will be especially critical for missions beyond earth orbit, where evacuation may not be an option.

Human stones.

PubMed

Lonsdale, K

1968-03-15

X-ray diffraction studies have shown that there are several different kinds of human urinary calculi, with different age, sex, period, and geographical distributions. Juvenile bladder stones are typically urate and oxalate in small boys in certain stone belts. They have disappeared in some areas, particularly in Britain, but are still common in Thailand. India. and Turkey. Their cause is unknown. Adult bladder stones, formerly common in elderly men, were largely of uric acid and were due to a faulty diet. Juvenile kidney stones are rare, except in Turkey where they are similar to juvenile bladder stones. Adult kidney stones are by far the most universally common, especially in technically developed communities. They are found in both sexes (equally at postmortem), and in the United States and in Czechoslovakia the average number of hospital entries for stones, relative to the whole population, is about 1 per 1000 per annum (increasing) although the incidence in different districts varies by 4 to 1 or more. Such stones are mainly calcium oxalates and calcium and MgNH(4) phosphates. The incidence among the administrative class is at least 20 times that among agricultural workers, relative to their numbers. Stones are reported also to be an occupational hazard for air pilots. It is probably that much more exercise and the drinking of more water to prevent kidney dehydration (spirits and coffee are not effective for this purpose) would lower the high rate of incidence. Moderate acidification would prevent phosphate supersaturation of the urine, but is not effective for oxalates. It seems certain that, once a suitable seed is formed, epitaxy is largely responsible for deposition from urines that would otherwise remain supersaturated until voided. This would explain the curioLls radial and layered texture of many stones. Laboratory experiments might suggest ways of preventing orientated overgrowth.

Use of the Escape nitinol stone retrieval basket facilitates fragmentation and extraction of ureteral and renal calculi: a pilot study.

PubMed

Kesler, Stuart S; Pierre, Sean A; Brison, Daniel I; Preminger, Glenn M; Munver, Ravi

2008-06-01

Advances in ureteroscope and stone basket design have catapulted ureteroscopy to the forefront of surgical stone management; however, persistent problems such as stone migration continue to challenge urologists. The Escape nitinol stone retrieval basket (Boston Scientific, Natick, MA) is a stone basket designed to capture calculi and facilitate simultaneous laser lithotripsy in situ. We report our initial experience with the Escape basket for the management of urinary calculi and compare the use of this device with other methods of optimizing ureteroscopic stone management. A prospective evaluation of 23 patients undergoing ureteroscopic holmium:yttrium-aluminum-garnet laser lithotripsy of urinary calculi was performed at two institutions by two surgeons (R.M. and G.M.P). The Escape basket was used to prevent retrograde ureteral stone migration or to facilitate fragmentation and extraction of large renal calculi. Patient demographics and perioperative parameters were assessed. Twenty-three patients (16 men, 7 women), with a mean age of 55.5 years (range 33-74 yrs) were treated for renal (n = 9) or ureteral (n = 14) calculi. The mean stone diameter was 1.4 cm (range 0.4-2.5 cm), mean fragmentation time was 44.1 minutes (range 10-75 min), and mean energy used was 3.1 kJ (range 0.4-10.6 kJ). No complications were encountered. Eighty-seven percent (20/23) of patients were rendered completely stone free after ureteroscopic laser lithotripsy using the Escape basket. Of the three patients with residual calculi, one patient with a 2.5-cm renal calculus had residual fragments larger than 3 mm, and two patients with large renal calculi had residual fragments smaller than 3 mm. The Escape basket appears to be safe and effective in preventing stone migration and facilitating ureteroscopic laser lithotripsy and stone extraction.

Minimally invasive percutaneous nephrolithotomy: an effective treatment for kidney stones in infants under 1 year of age. A single-center experience.

PubMed

Dağgülli, Mansur; Sancaktutar, Ahmet Ali; Dede, Onur; Utanğaç, Mehmet Mazhar; Bodakçi, Mehmet Nuri; Penbegül, Necmettin; Hatipoğlu, Namık Kemal; Çakmakçı, Süleyman

2015-11-01

We aimed to present the outcomes of PNL surgery performed in infantile patients with small renal stones who were younger than 1 year of age. A single-center prospective trial was initiated and during the period between Jan 2013 and Jan 2015, PNL was applied to 20 renal units of 16 infants (6 girls and 10 boys), including 4 patients with bilateral kidney stones. PNL was performed in patients with renal stones larger than 2 cm, as well as stones resistant to SWL or renal stones that were undetectable during SWL. The mean age of the patients was 9.55 (5-12) months. Of the 20 renal units, 1 had complete staghorn stones, 3 had partial staghorn stones, 13 had renal pelvic stones, and 3 had lower pole stones. The mean stone size was 18.5 mm (range 12-36 mm). Mean operative time for PNL was 88 (25-135 min). Mean fluoroscopy time was estimated as 3.4 min. Mean hemoglobin loss was 0.72 g/L (0.2-3). The mean hospital stay was 4.1 days (2-8 days). On postoperative day 1, a complete stone-free state was achieved in 70% of renal units (14 of 20). At the end of the first postoperative week, the remaining two patients had insignificant residual fragments of 3 mm and were followed conservatively without any specific intervention. Thus, the total SFR was 80% (16 of 20) at discharge. In infants aged less than 1 year, minimal access tract dilation during PNL, the use of smaller caliber pediatric instruments, and the realization of this procedure by surgeons with adequate experience in adults carry utmost importance. In addition, special care should be taken to avoid hypothermia and radiation exposure during PNL.

When routine D-J implantation necessary during PNL?

PubMed

Bayrak, Omer; Seckiner, Ilker; Erturhan, Sakip M; Bulut, Ersan; Demirbag, Asaf; Erbagci, Asaf

2015-03-01

We investigated the characteristics of patients who underwent Double-J catheter (D-J) implantation, the risk factors for prolonged urine leakage (PUL), and prediction of patients who require medical treatment. The data of 535 adult patients who underwent PNL due to kidney stone disease between January 2005 and December 2011 in our clinic were analyzed retrospectively. Patients were divided into 2 groups: Group 1 (n=77) (14.39%) included patients with Double-J catheter due to prolonged (> 24 h) urinary leakage and Group 2 (n=458) (85.61%) patients without urinary leakage. The mean stone burden was 951.94 ± 539.09 mm2 in Group 1, and 676.35 ±296.65 mm2 in Group 2 (p<0.05). DJ catheter was implanted in 11.33% of the patients with stone burden below 1000 mm2 versus in 51.21% of the patients with stone burden above 1000 mm2. In Group 1, the number of patients with two or more accesses performed was 18.18, whereas in Group 2 it was 8.5% (p<0.05). Among all patients, DJ implantation was performed in 13.07% of patients with a single access versus 26.41% of patients with two or more accesses. Also, DJ catheter was implanted in 41.46%of patients with residual stones versus 12.14% of stone-free patients. Three patients with stone burden above 1000 mm2, two or more accesses, and residual stone, all of them required DJ implantation. DJ implantation due to PUL had approximately 5-fold increase stone burden above 1000 mm2, 2-fold increase in patients undergoing two or more access and 3-fold increase in patients with residual stones. Therefore, we think that the D-J implantation is highly advisable in case of a stone load above 1000 mm2, two or more accesses, and in patients with residual stones.

Comparison of the efficacy and morbidity of flexible ureterorenoscopy for lower pole stones compared with other renal locations.

PubMed

Jacquemet, Baptiste; Martin, Lucille; Pastori, Julie; Bailly, Vincent; Guichard, Guillaume; Bernardini, Stéphane; Chabannes, Eric; Bittard, Hugues; Kleinclauss, François

2014-10-01

Flexible ureterorenoscopy (f-URS) for lower pole stones (LPS) compared with other renal locations can be challenging because of anatomic and technical considerations. We aimed to compare the stone-free rate (SFR) and surgical complication rate with f-URS for LPS vs other renal locations. We performed a retrospective, single-center study including 371 f-URS for renal stone retrieval performed in our institution between January 2004 and December 2010. Among the 371 procedures included in this analysis, 139 were performed for stones located in a single renal location other than the lower pole (group 1), and 232 for at least one stone located in the lower pole (group 2). We compared the efficacy (SFR) and the morbidity of f-URS between the two groups. The success of the procedure was defined as a complete SFR 6 months after f-URS. Age, sex, history of urolithiasis, body mass index, and preoperative stent placement did not differ between the two groups. No differences in stone characteristics were observed between both groups except stone size under 10 mm that was significantly higher in group 2 (P=0.018). Technical aspects of the procedure did not differ between the groups, except for more frequent use of an access sheath in group 2 (P=0.007). SFR was comparable between groups (P=0.774). The complication rate was similar in both groups, as was the severity of complications. By multivariate analysis, stone size >10 mm (P<0.0001) and multiple stone locations (P=0.001) were associated with f-URS failure, but lower pole location did not impact on SFR. In our study, stone location, in particular LPS, did not have any impact on efficacy and morbidity of f-URS. Only multiple locations and stone size >10 mm seemed to significantly decrease the SFR, without impacting morbidity.

Safety and Effectiveness of a Longer Focal Beam and Burst Duration in Ultrasonic Propulsion for Repositioning Urinary Stones and Fragments.

PubMed

Janssen, Karmon M; Brand, Timothy C; Cunitz, Bryan W; Wang, Yak-Nam; Simon, Julianna C; Starr, Frank; Liggitt, H Denny; Thiel, Jeff; Sorensen, Mathew D; Harper, Jonathan D; Bailey, Michael R; Dunmire, Barbrina

2017-08-01

In the first-in-human trial of ultrasonic propulsion, subjects passed collections of residual stone fragments repositioned with a C5-2 probe. Here, effectiveness and safety in moving multiple fragments are compared between the C5-2 and a custom (SC-50) probe that produces a longer focal beam and burst duration. Effectiveness was quantified by the number of stones expelled from a calyx phantom consisting of a 30-mm deep, water-filled well in a block of tissue mimicking material. Each probe was positioned below the phantom to move stones against gravity. Single propulsion bursts of 50 ms or 3 s duration were applied to three separate targets: 10 fragments of 2 different sizes (1-2 and 2-3 mm) and a single 4 × 7 mm human stone. Safety studies consisted of porcine kidneys exposed to an extreme dose of 10-minute burst duration, including a 7-day survival study and acute studies with surgically implanted stones. Although successful in the clinical trial, the shorter focal beam and maximum 50 ms burst duration of the C5-2 probe moved stones, but did not expel any stones from the phantom's 30-mm deep calyx. The results were similar with the SC-50 probe under the same 50 ms burst duration. Longer (3 s) bursts available with the SC-50 probe expelled all stones at both 4.5 and 9.5 cm "skin-to-stone" depths with lower probe heating compared to the C5-2. No abnormal behavior, urine chemistry, serum chemistry, or histological findings were observed within the kidney or surrounding tissues for the 10 min burst duration used in the animal studies. A longer focal beam and burst duration improved expulsion of a stone and multiple stone fragments from a phantom over a broad range of clinically relevant penetration depths and did not cause kidney injury in animal studies.

Are We Banging Our Heads Against the Wall? The Effect of Treatment Head Wear on the Outcomes of Extracorporeal Shockwave Lithotripsy.

PubMed

Hoy, Nathan Y; Shapka, Larissa; Rudzinski, Jan; Schuler, Trevor D; Wollin, Timothy A; Bochinski, Derek; De, Shubha K

2016-09-01

The manufacturer for the Storz Modulith SLX-F2 lithotripter recommends treatment head exchange after 1.65 million shocks. However, there is no documentation describing longevity of the treatment head with continued usage. The objective of this study is to determine whether there is a difference in stone fragmentation effectiveness with the treatment head at the beginning versus the end of its treatment life. We conducted a retrospective chart review of 200 patients-50 consecutive patients treated immediately preceding, and following, two separate treatment head exchanges. Primary outcome measures were stone-free rate (no stone), total stone fragmentation (any decrease in size), and fragmentation rate ≤4 mm (decrease in size with largest residual fragment ≤4 mm), based on most recent follow-up imaging post shockwave. There were no baseline characteristic differences between the pre-exchange and postexchange groups with respect to first time lithotripsy for the stone (85% vs. 77%), stone location, preoperative stenting (3% vs. 4%), mean stone density (912 hounsfield units [HU] vs. 840 HU), mean stone size (9.0 mm vs. 8.1 mm), stone location, and mean number of shocks delivered (3105 vs. 3089). Mean time to follow-up was 2.7 weeks in both groups, with most follow-up imaging consisting of a kidney ureter bladder X-ray (87% pre-exchange vs. 85% postexchange). Stone free (34% vs. 27%), total stone fragmentation (76% vs. 76%), fragmentation ≤4 mm (48% vs. 42%), re-treatment rates (38% vs. 51%), and complication rates (6% vs. 7%), were not statistically different between the pre and postexchange groups, respectively. Exchanging the Storz Modulith F2 lithotripter head at the manufacturer recommended 1.65 million shocks does not affect the stone-free or fragmentation rate. If the manufacturer's recommendation for treatment head longevity is based on clinical outcomes, then there is likely room to extend this number without affecting treatment efficacy.

A Prospective Randomized Controlled Trial of the Efficacy of External Physical Vibration Lithecbole after Extracorporeal Shock Wave Lithotripsy for a Lower Pole Renal Stone Less Than 2 cm.

PubMed

Long, Qilai; Zhang, Jian; Xu, Zhibing; Zhu, Yanjun; Liu, Li; Wang, Hang; Guo, Jianming; Wang, Guomin

2016-04-01

We evaluate the efficacy and safety of external physical vibration lithecbole in improving the clearance rates of lower pole renal stones after shock wave lithotripsy. A total of 71 patients with lower pole renal stones (6 to 20 mm) were prospectively randomized into 2 groups. In the treatment group 34 patients were treated with external physical vibration lithecbole after shock wave lithotripsy. In the control group 37 patients underwent shock wave lithotripsy only. External physical vibration lithecbole was performed without anesthesia by the same team using the Friend-I External Physical Vibration Lithecbole (Fu Jian Da Medical Instrument Co., Ltd, Zhengzhou, China). The stone-free rate, stone expulsion rate, stone expulsion time and incidence of complications were monitored. External physical vibration lithecbole was successful in assisting the discharge of stone fragments. The stone-free status was 76.5% in the treatment group and 48.6% in the control group (p=0.008). Stone expulsion rates at day 1, week 1 and week 3 were 76.5% (26), 94.1% (32) and 94.1% (32) in the treatment group vs 43.2% (16), 73.0% (27) and 89.2% (33) in the control group, respectively. Mean stone fragment expulsion time was 11.2 minutes in the treatment group and 9.17 hours in the control group (p=0.016). There was no significant difference in complications between the 2 groups (p >0.05). External physical vibration lithecbole was efficacious in assisting the discharge of lower pole renal stone fragments and can be used as an adjunctive method of minimally invasive stone treatment. However, additional investigations are needed to confirm the efficacy. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

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

Is flexible ureterorenoscopy and laser lithotripsy the new gold standard for lower pole renal stones when compared to shock wave lithotripsy: Comparative outcomes from a University hospital over similar time period

PubMed Central

Burr, Jacob; Ishii, Hiro; Simmonds, Nick

2015-01-01

Introduction Renal lower pole stones pose difficulty in management due to anatomical variation, stone size, hardness and patient demographics. Flexible ureterorenoscopy and laser lithotripsy (FURSL) and shock wave lithotripsy (SWL) are preferred for stones 1-2 cm in size. We wanted to compare the outcomes of FURSL and SWL for lower pole stones during the same time period. Material and methods All patients who were treated for lower pole stones with FURSL and SWL during a 19-month period were included. The stone free rate (SFR) was defined as ≤3 mm fragments on follow-up imaging or stone free endoscopically. Data was recorded in an excel spreadsheet with SPSS version 21 used for statistical analysis. Results A total of 161 lower pole procedures were done (93 SWL and 63 FURSL). The mean stone size for SWL (7.4 mm; range: 4-16 mm) was significantly smaller than for FURSL (13.4 mm; 4-53 mm). The mean operating time and hospital stay for FURSL was 65 minutes (range: 30-160 minutes) and 0.5 days (range: 0-7 days) respectively. The SFR was significantly better (p <0.001) for FURSL (n = 63, 93%) compared to SWL (n = 23, 25%). There were 4 (6%) complications (3 Clavien II and 1 Clavien I) in the FURSL group (2 urosepsis, 1 UTI and 1 stent pain). Three patients in the SWL group (Clavien I) were readmitted with renal colic but there were no other complications. Conclusions FURSL for lower pole stones seems to be a much better alternative than SWL with a high SFR even for larger stones and seems to be the new gold standard for lower pole stone management. PMID:26251738

Dual-energy dual-source CT with additional spectral filtration can improve the differentiation of non-uric acid renal stones: An ex vivo phantom study

PubMed Central

Qu, Mingliang; Ramirez Giraldo, Juan C.; Leng, Shuai; Williams, James C.; Vrtiska, Terri J.; Lieske, John C.; McCollough, Cynthia H.

2014-01-01

Purpose To determine the ex vivo ability of dual-energy, dual-source computed tomography (DE-DSCT) with additional tin filtration to differentiate between five groups of human renal stone types. Methods Forty-three renal stones of ten types were categorized into five primary groups based on effective atomic numbers, which were calculated as the weighted average of the atomic numbers of constituent atoms. Stones were embedded in porcine kidneys and placed in a 35cm water phantom. DE-DSCT scans were performed with and without tin filtration at 80/140kV. The CT number ratio [CTR=CT(low)/CT(high)] was calculated on a volumetric voxel-by-voxel basis for each stone. Statistical analysis was performed and receiver operating characteristic (ROC) curves were plotted to compare the difference in CTR with and without tin filtration, and to measure the discrimination between stone groups. Results CTR of non-uric acid stones increased on average by 0.17 (range 0.03–0.36) with tin filtration. The CTR values for non-uric acid stone groups were not significantly different (p>0.05) between any of the two adjacent groups without tin filtration. Use of the additional tin filtration on the high-energy x-ray tube significantly improved the separation of non-uric acid stone types by CTR (p<0.05). The area under the ROC curve increased from 0.78–0.84 without fin filtration to 0.89–0.95 with tin filtration. Conclusion Our results demonstrated better separation between different stone types when additional tin filtration was used on DE-DSCT. The increased spectral separation allowed a 5-group stone classification scheme. Some overlapping between particular stone types still exists, including brushite and calcium oxalate. PMID:21606290

Multiphase fluid-solid coupled analysis of shock-bubble-stone interaction in shockwave lithotripsy.

PubMed

Wang, Kevin G

2017-10-01

A novel multiphase fluid-solid-coupled computational framework is applied to investigate the interaction of a kidney stone immersed in liquid with a lithotripsy shock wave (LSW) and a gas bubble near the stone. The main objective is to elucidate the effects of a bubble in the shock path to the elastic and fracture behaviors of the stone. The computational framework couples a finite volume 2-phase computational fluid dynamics solver with a finite element computational solid dynamics solver. The surface of the stone is represented as a dynamic embedded boundary in the computational fluid dynamics solver. The evolution of the bubble surface is captured by solving the level set equation. The interface conditions at the surfaces of the stone and the bubble are enforced through the construction and solution of local fluid-solid and 2-fluid Riemann problems. This computational framework is first verified for 3 example problems including a 1D multimaterial Riemann problem, a 3D shock-stone interaction problem, and a 3D shock-bubble interaction problem. Next, a series of shock-bubble-stone-coupled simulations are presented. This study suggests that the dynamic response of a bubble to LSW varies dramatically depending on its initial size. Bubbles with an initial radius smaller than a threshold collapse within 1 μs after the passage of LSW, whereas larger bubbles do not. For a typical LSW generated by an electrohydraulic lithotripter (p max  = 35.0MPa, p min  =- 10.1MPa), this threshold is approximately 0.12mm. Moreover, this study suggests that a noncollapsing bubble imposes a negative effect on stone fracture as it shields part of the LSW from the stone. On the other hand, a collapsing bubble may promote fracture on the proximal surface of the stone, yet hinder fracture from stone interior. Copyright © 2016 John Wiley & Sons, Ltd.

Flexible Ureterorenoscopy versus Mini-Percutaneous Nephrolithotomy for the Treatment of Renal Stones.

PubMed

Ergin, Giray; Kirac, Mustafa; Kopru, Burak; Ebiloglu, Turgay; Biri, Hasan

2018-04-22

To compare the pain status and stone free rates of flexible ureterorenoscopy (F-URS) versus mini-percutaneousnephrolithotomy (mini-PNL) for the treatment of 1-to 2-cm renal stones. This study was retrospectively designed with match paired method. Between January 2013 and December 2016, 387 patients underwent stone surgery for renal stones, 45 patients underwent FURS and 45 patients underwent mini-PNL. 90 patients were divided into two groups according to the surgical procedures. Group 1 patients underwent F-URS, and Group 2 patients underwent mini-PNL. During the intraoperative andpostoperative periods, pain management for all patients was standardized. Pain scores were determined using a visual analogue scale (VAS) completed at 2, 6, 12 and 24 hours postoperatively. The stone free status, hemoglobin levels, fluoroscopy time (FT), operation time (OT), hospitalization time (HT), return to work time (RWT), and complications were noted for each patient. Of all patients, the mean age was 41.1 ± 12.1 years and the mean stone size was 13.9 ± 2.9 mm. The VAS scores were significantly higher in the mini-PNL group at 2, 6, 12 and 24 hours (P < .05). The stone-free status and complication rates were similar between the two groups (P > .05); however, the hemoglobin decreases and the fluoroscopy, operation, hospitalization and return to work times were higher in the mini-PNL group than in the F-URS group (P < .05). F-URS is less painful than mini-PNL for the treatment of 1- to 2-cm renal stones. However, the stone free rate is similar between the two procedures while mini-PNL is superior in terms of fluoroscopy, operation, hospitalization and return to work duration. We think that F-URS is more comfortable and less painful than mini-PNL and achieves a similar stone free rate for the treatment of 1- to 2-cm renal stones.

Prevalence of renal uric acid stones in the adult.

PubMed

Trinchieri, Alberto; Montanari, Emanuele

2017-12-01

The aim of this study was to estimate uric acid renal stone prevalence rates of adults in different countries of the world. PubMed was searched for papers dealing with "urinary calculi and prevalence or composition" for the period from January 1996 to June 2016. Alternative searches were made to collect further information on specific topics. The prevalence rate of uric acid stones was computed by the general renal stone prevalence rate and the frequency of uric acid stones in each country. After the initial search, 2180 papers were extracted. Out of them, 79 papers were selected after the reading of the titles and of the abstracts. For ten countries, papers relating to both the renal stone prevalence in the general population and the frequency of uric stones were available. Additional search produced 13 papers that completed information on 11 more countries in 5 continents. Estimated prevalence rate of uric acid stones was >0.75% in Thailand, Pakistan, Saudi Arabia, Iran, South Africa (white population), United States and Australia; ranged 0.50-0.75% in Turkey, Israel, Italy, India (Southern), Spain, Taiwan, Germany, Brazil; and <0.50% in Tunisia, China, Korea, Japan, Caribe, South Africa (blacks), India (Northern). Climate and diet are major determinants of uric acid stone formation. A hot and dry climate increases fluid losses reducing urinary volume and urinary pH. A diet rich in meat protein causes low urinary pH and increased uric acid excretion. On the other hand, uric acid stone formation is frequently associated with obesity, metabolic syndrome and diabetes type 2 that are linked to dietary energy excess mainly from carbohydrate and saturated fat and also present with low urine pH values. An epidemic of uric acid stone formation could be if current nutritional trends will be maintained both in developed countries and in developing countries and the areas of greater climatic risk for the formation of uric acid stones will enlarge as result of the "global warming".

Which is better? Guy's versus S.T.O.N.E. nephrolithometry scoring systems in predicting stone-free status post-percutaneous nephrolithotomy.

PubMed

Noureldin, Yasser A; Elkoushy, Mohamed A; Andonian, Sero

2015-11-01

The aim of the present study was to compare the accuracy of the Guy's and S.T.O.N.E. scoring systems in predicting percutaneous nephrolithotomy (PCNL) outcomes. After obtaining ethics approval, medical records of patients undergoing PCNL between 2009 and 2013 at a tertiary stone center were retrospectively reviewed. Guy's and S.T.O.N.E. scoring systems were calculated. Regression analysis and ROC curves were performed. A total of 185 PCNLs were reviewed. The overall stone-free rate was 71.9 % with a complication rate of 16.2 %. When compared to patients with residual fragments, stone-free patients had significantly lower Guy's grade (2.7 vs. 2; p < 0.001) and S.T.O.N.E. score (8.3 vs. 7.4; p = 0.004). Logistic regression analysis showed that both Guy's and S.T.O.N.E. systems were significantly associated with stone-free status, OR 0.4 (p < 0.001), and OR 0.7 (p = 0.001), respectively. Furthermore, both scoring systems were significantly associated with the estimated blood loss (p = 0.01 and p = 0.005). There was good correlation between both scoring systems and operative time (r = 0.3, p < 0.001 and r = 0.4, p < 0.001) and length of hospital stay (r = 0.2, p = 0.001 and r = 0.3, p < 0.001). However, there were no significant associations between both scoring systems and complications (p = 0.7 and p = 0.6). There was no significant difference in the areas under the curves for the Guy's and S.T.O.N.E. scoring systems (0.74 [95 % CI 0.66-0.82] vs. 0.63 [95 % CI 0.54-0.72]; p = 0.06). Both Guy's and S.T.O.N.E scoring systems have comparable accuracies in predicting post-PCNL stone-free status. Other factors not included in either scoring system may need to be incorporated in the future to increase their accuracy.

Personalized Intervention in Monogenic Stone Formers.

PubMed

Policastro, Lucas J; Saggi, Subodh J; Goldfarb, David S; Weiss, Jeffrey P

2017-10-20

Treatment of a first-time renal stone consists of acute management followed by medical efforts to prevent stone recurrence. Although nephrolithiasis is roughly 50% heritable, the presence of a family history usually does not affect treatment since most stone disease is regarded as polygenic, ie not attributable to a single gene. Recent evidence has suggested that single mutations could be responsible for a larger proportion of renal stones than previously thought. This intriguing possibility holds the potential to change the management paradigm in stone prevention from metabolically directed therapy to more specific approaches informed by genetic screening and testing. This review synthesizes new findings concerning monogenic kidney stone disease, and provides a concise and clinically useful reference for monogenic causes. It is expected that increased awareness of these etiologies will lead to increased use of genetic testing in recurrent stone formers and further research into the prevalence of monogenic stone disease. We assembled a complete list of genes known to cause or influence nephrolithiasis based on recent reviews and commentaries. We then comprehensively searched PubMed® and Google Scholar™ for all research on each gene having a pertinent role in nephrolithiasis. We determined which genes could be considered monogenic causes of nephrolithiasis. One gene, ALPL, was excluded since nephrolithiasis is a relatively minor aspect of the disorder associated with the gene (hypophosphatasia). We summarized selected studies and assembled clinically relevant details. A total of 27 genes were reviewed in terms of recent findings, mode of inheritance of stone disease, known or supposed prevalence of mutations in the general population of stone patients and specific therapies or considerations. There is a distinct opportunity for increased use of genetic testing to improve the lives of pediatric and adult stone patients. Several genes first reported in association with rare disease may be loci for novel mutations, heterozygous disease and forme frustes as causes of stones in the broader population. Cases of idiopathic nephrolithiasis should be considered as potentially having a monogenic basis. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

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

PubMed

Yan, Zejun; Xie, Guohai; Yuan, Hesheng; Cheng, Yue

2015-10-01

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.

Mini vs standard percutaneous nephrolithotomy for renal stones: a comparative study.

PubMed

ElSheemy, Mohammed S; Elmarakbi, Akram A; Hytham, Mohammed; Ibrahim, Hamdy; Khadgi, Sanjay; Al-Kandari, Ahmed M

2018-03-16

To compare the outcome of mini-percutaneous nephrolithotomy (Mini-PNL) versus standard-PNL for renal stones. Retrospective study was performed between March 2010 and May 2013 for patients treated by Mini-PNL or standard-PNL through 18 and 30 Fr tracts, respectively, using pneumatic lithotripsy. Semirigid ureteroscope (8.5/11.5 Fr) was used for Mini-PNL and 24 Fr nephroscope for standard-PNL. Both groups were compared in stone free rate(SFR), complications and operative time using Student-t, Mann-Whitney, Chi square or Fisher's exact tests as appropriate in addition to logistic regression analysis. P < 0.05 was considered statistically significant. Mini-PNL (378) and standard-PNL (151) were nearly comparable in patients and stones criteria including stone burden (3.77 ± 2.21 vs 3.77 ± 2.43 cm 2 ; respectively). There was no significant difference in number of tracts or supracostal puncture. Mini-PNL had longer operative time (68.6 ± 29.09 vs 60.49 ± 11.38 min; p = 0.434), significantly shorter hospital stay (2.43 ± 1.46 vs 4.29 ± 1.28 days) and significantly higher rate of tubeless PNL (75.1 vs 4.6%). Complications were significantly higher in standard-PNL (7.9 vs 20.5%; p < 0.001). SFR was significantly lower in Mini-PNL (89.9 vs 96%; p = 0.022). This significant difference was found with multiple stones and large stone burden (> 2 cm 2 ), but the SFR was comparable between both groups with single stone or stone burden ≤ 2 cm. Logistic regression analysis confirmed significantly higher complications and SFR with standard-PNL but with significantly shorter operative time. Mini-PNL has significantly lower SFR when compared to standard-PNL (but clinically comparable) with markedly reduced complications and hospital stay. Most of cases can be performed tubeless. The significant difference in SFR was found with multiple stones or large stone burden (> 2 cm 2 ), but not with single stones or stone burden ≤ 2 cm 2 .

Medical management to prevent recurrent nephrolithiasis in adults: a systematic review for an American College of Physicians Clinical Guideline.

PubMed

Fink, Howard A; Wilt, Timothy J; Eidman, Keith E; Garimella, Pranav S; MacDonald, Roderick; Rutks, Indulis R; Brasure, Michelle; Kane, Robert L; Ouellette, Jeannine; Monga, Manoj

2013-04-02

Optimum management to prevent recurrent kidney stones is uncertain. To evaluate the benefits and harms of interventions to prevent recurrent kidney stones. MEDLINE, Cochrane, and other databases through September 2012 and reference lists of systematic reviews and randomized, controlled trials (RCTs). 28 English-language RCTs that studied treatments to prevent recurrent kidney stones and reported stone outcomes. One reviewer extracted data, a second checked accuracy, and 2 independently rated quality and graded strength of evidence. In patients with 1 past calcium stone, low-strength evidence showed that increased fluid intake halved recurrent composite stone risk compared with no treatment (relative risk [RR], 0.45 [95% CI, 0.24 to 0.84]). Low-strength evidence showed that reducing soft-drink consumption decreased recurrent symptomatic stone risk (RR, 0.83 [CI, 0.71 to 0.98]). In patients with multiple past calcium stones, most of whom were receiving increased fluid intake, moderate-strength evidence showed that thiazides (RR, 0.52 [CI, 0.39 to 0.69]), citrates (RR, 0.25 [CI, 0.14 to 0.44]), and allopurinol (RR, 0.59 [CI, 0.42 to 0.84]) each further reduced composite stone recurrence risk compared with placebo or control, although the benefit from allopurinol seemed limited to patients with baseline hyperuricemia or hyperuricosuria. Other baseline biochemistry measures did not allow prediction of treatment efficacy. Low-strength evidence showed that neither citrate nor allopurinol combined with thiazide was superior to thiazide alone. There were few withdrawals among patients with increased fluid intake, many among those with other dietary interventions and more among those who received thiazide and citrate than among control patients. Reporting of adverse events was poor. Most trial participants had idiopathic calcium stones. Nearly all studies reported a composite (including asymptomatic) stone recurrence outcome. In patients with 1 past calcium stone, increased fluid intake reduced recurrence risk. In patients with multiple past calcium stones, addition of thiazide, citrate, or allopurinol further reduced risk. Agency for Healthcare Research and Quality.

Stone volume is best predictor of operative time required in retrograde intrarenal surgery for renal calculi: implications for surgical planning and quality improvement.

PubMed

Sorokin, Igor; Cardona-Grau, Diana K; Rehfuss, Alexandra; Birney, Alan; Stavrakis, Costas; Leinwand, Gabriel; Herr, Allen; Feustel, Paul J; White, Mark D

2016-11-01

Retrograde intrarenal surgery (RIRS) is highly successful at eliminating renal stones of various sizes and compositions. As urologists are taking on more complex procedures using RIRS, this has led to an increase in operative (OR) times. Our objective was to determine the best predictor of OR time in patients undergoing RIRS. We retrospectively reviewed the records of patients undergoing unilateral RIRS for solitary stones over a 10 year time span. Stones were fragmented and actively extracted using a basket. Variables potentially affecting OR time such as patient age, sex, BMI, lower pole stone location, volume, Hounsfield units (HU), composition, ureteral access sheath (UAS) use, and pre-operative stenting were collected. Multivariable linear and stepwise regression was used to evaluate the predictors of OR time. There were 118 patients that met inclusion criteria. The median stone volume was 282.6 mm 3 (IQR 150.7-644.7) and the mean OR time was 50 min (±25.9 SD). On univariate linear regression, stone volume had a moderate correlation with OR time (y = 0.022x + 38.2, r 2  = 0.363, p < 0.01). On multivariable stepwise regression, stone volume had the strongest impact on OR time, increasing time by 2.0 min for each 100 mm 3 increase in stone volume (p < 0.001). UAS added 13.5 (SE 3.9, p = 0.001) minutes and renal lower pole location added 9 min (SE 4.3, p = 0.03) in each case they were used. Pre-operative stenting, HU, calcium oxalate stone composition, sex, and age had no significant effect on OR time. Amongst the main stone factors in RIRS, stone volume has the strongest impact on operative time. This can be used to predict the length of the procedure by roughly adding 2 min per 100 mm 3 increase in stone volume.

Renal Stone Risk During Space Flight: Assessment and Countermeasure Validation

NASA Technical Reports Server (NTRS)

Whitson, P. A.; Sams, C. F.; Jones, J. A.; Pietrzke, R. A.; Nelman-Gonzalez, M. A.; Hudson, E. K.

2007-01-01

NASA has focused its future on exploration class missions including the goal of returning to the moon and landing on Mars. With these objectives, humans will experience an extended exposure to the harsh environment of microgravity and the associated negative effects on all the physiological systems of the body. Exposure to microgravity affects human physiology and results in changes to the urinary chemical composition during and after space flight. These changes are associated with an increased risk of renal stone formation. The development of a renal stone would have health consequences for the crewmember and negatively impact the success of the mission. As of January 2007, 15 known symptomatic medical events consistent with urinary calculi have been experienced by 13 U.S. astronauts and Russian cosmonauts. Previous results from both MIR and Shuttle missions have demonstrated an increased risk for renal stone formation. These data have shown decreased urine volume, urinary pH and citrate levels and increased urinary calcium. Citrate, an important urinary inhibitor of calcium-containing renal stones binds with calcium in the urine, thereby reducing the amount of calcium available to form calcium oxalate stones. Urinary citrate also prevents calcium oxalate crystals from aggregating into larger crystals and into renal stones. In addition, citrate makes the urine less acidic which inhibits the development of uric acid stones. Potassium citrate supplementation has been successfully used to treat patients who have formed renal stones. The evaluation of potassium citrate as a countermeasure has been performed during the ISS Expeditions 3-6, 8, 11-13 and is currently in progress during the ISS Expedition 14 mission. Together with the assessment of stone risk and the evaluation of a countermeasure, this investigation provides an educational opportunity to all crewmembers. Individual urinary biochemical profiles are generated and the risk of stone formation is estimated. Increasing fluid intake is recommended to all crewmembers. These results can be used to lower the risk for stone formation through lifestyle, diet changes or therapeutic administration to minimize the risk for stone development. With human presence in microgravity a continuing presence and exploration class missions being planned, maintaining the health and welfare of all crewmembers is critical to the exploration of space.

Effects of acid deposition on dissolution of carbonate stone during summer storms in the Adirondack Mountains, New York, 1987-89

USGS Publications Warehouse

Schuster, Paul F.; Reddy, Michael M.; Sherwood, S.I.

1994-01-01

This study is part of a long-term research program designed to identify and quantify acid rain damage to carbonate stone. Acidic deposition accelerates the dissolution of carbonate-stone monuments and building materials. Sequential sampling of runoff from carbonate-stone (marble) and glass (reference) microcatchments in the Adirondack Mountains in New York State provided a detailed record of the episodic fluctuations in rain rate and runoff chemistry during individual summer storms. Rain rate and chemical concentrations from carbonate-stone and glass runoff fluctuated three to tenfold during storms. Net calcium-ion concentrations from the carbonatestone runoff, a measure of stone dissolution, typically fluctuated twofold during these storms. High net sulfate and net calcium concentrations in the first effective runoff at the start of a storm indicated that atmospheric pollutants deposited on the stone surface during dry periods formed calcium sulfate minerals, an important process in carbonate stone dissolution. Dissolution of the carbonate stone generally increased up to twofold during coincident episodes of low rain rate (less than 5 millimeters per hour) and decreased rainfall (glass runoff) pH (less than 4.0); episodes of high rain rate (cloudbursts) were coincident with a rapid increase in rainfall pH and also a rapid decrease in the dissolution of carbonate-stone. During a storm, it seems the most important factors causing increased dissolution of carbonate stone are coincident periods of low rain rate and decreased rainfall pH. Dissolution of the carbonate stone decreased slightly as the rain rate exceeded about 5 millimeters per hour, probably in response to rapidly increasing rainfall pH during episodes of high rain rate and shorter contact time between the runoff and the stone surface. High runoff rates resulting from cloudbursts remove calcium sulfate minerals formed during dry periods prior to storms and also remove dissolution products formed in large measure by chemical weathering as a result of episodes of low rain rate and decreased rainfall pH during a storm.

Intestinal Calcium Absorption among Hypercalciuric Patients with or without Calcium Kidney Stones.

PubMed

Vezzoli, Giuseppe; Macrina, Lorenza; Rubinacci, Alessandro; Spotti, Donatella; Arcidiacono, Teresa

2016-08-08

Idiopathic hypercalciuria is a frequent defect in calcium kidney stone formers that is associated with high intestinal calcium absorption and osteopenia. Characteristics distinguishing hypercalciuric stone formers from hypercalciuric patients without kidney stone history (HNSFs) are unknown and were explored in our study. We compared 172 hypercalciuric stone formers with 36 HNSFs retrospectively selected from patients referred to outpatient clinics of the San Raffaele Hospital in Milan from 1998 to 2003. Calcium metabolism and lumbar bone mineral density were analyzed in these patients. A strontium oral load test was performed: strontium was measured in 240-minute urine and serum 30, 60, and 240 minutes after strontium ingestion; serum strontium concentration-time curve and renal strontium clearance were evaluated to estimate absorption and excretion of divalent cations. Serum strontium concentration-time curve (P<0.001) and strontium clearance (4.9±1.3 versus 3.5±2.7 ml/min; P<0.001) were higher in hypercalciuric stone formers than HNSFs, respectively. The serum strontium-time curve was also higher in hypercalciuric stone formers with low bone mineral density (n=42) than in hypercalciuric stone formers with normal bone mineral density (n=130; P=0.03) and HNSFs with low (n=22; P=0.01) or normal bone mineral density (n=14; P=0.02). Strontium clearance was greater in hypercalciuric stone formers with normal bone mineral density (5.3±3.4 ml/min) than in hypercalciuric stone formers and HNSFs with low bone mineral density (3.6±2.5 and 3.1±2.5 ml/min, respectively; P=0.03). Multivariate regression analyses displayed that strontium absorption at 30 minutes was positively associated calcium excretion (P=0.03) and negatively associated with lumbar bone mineral density z score (P=0.001) in hypercalciuric stone formers; furthermore, hypercalciuric patients in the highest quartile of strontium absorption had increased stone production risk (odds ratio, 5.06; 95% confidence interval, 1.2 to 20.9; P=0.03). High calcium absorption in duodenum and jejunum may expose hypercalciuric patients to the risk of stones because of increased postprandial calcium concentrations in urine and tubular fluid. High calcium absorption may identify patients at risk of bone loss among stone formers. Copyright © 2016 by the American Society of Nephrology.

Evaluation and medical management of kidney stones in children.

PubMed

Tasian, Gregory E; Copelovitch, Lawrence

2014-11-01

We review the current literature on the diagnostic evaluation and dietary and pharmacological management of children with nephrolithiasis. We searched MEDLINE(®), Embase(®) and the Cochrane Library from their inceptions to March 2014 for published articles in English on kidney stones and therapy in children 0 to 18 years old. Based on review of the titles and abstracts, 110 of the 1,014 articles (11%) were potentially relevant to the diagnostic evaluation and medical management of nephrolithiasis in children. We summarized this literature and drew on studies performed in adult populations to augment areas in which no studies of sufficient quality have been performed in children, and to highlight areas in need of research. During the last 25 years the incidence of nephrolithiasis in children has increased by approximately 6% to 10% annually and is now 50 per 100,000 adolescents. Kidney stones that form during childhood have a similar composition to those that form in adulthood. Approximately 75% to 80% of stones are composed of predominantly calcium oxalate, 5% to 10% are predominantly calcium phosphate, 10% to 20% are struvite and 5% are pure uric acid. The recurrence rate of nephrolithiasis in patients with stones that form during childhood is poorly defined. Ultrasound should be used as the initial imaging study to evaluate children with suspected nephrolithiasis, with noncontrast computerized tomography reserved for those in whom ultrasound is nondiagnostic and the suspicion of nephrolithiasis remains high. Current treatment strategies for children with kidney stone disease are based largely on extrapolation of studies performed in adult stone formers and single institution cohort or case series studies of children. Tamsulosin likely increases the spontaneous passage of ureteral stones in children. Increased water intake and reduction of salt consumption should be recommended for all children with a history of kidney stones. Potassium citrate is a potentially effective medication for children with calcium oxalate stones and concomitant hypocitraturia, as well as children with uric acid stones. However, long-term compliance with therapy and the effect on decreasing stone recurrence in children are unknown. Based largely on efficacy in adult populations, thiazide diuretics should be considered in the treatment of children with calcium based stones and persistent hypercalciuria refractory to reductions in salt intake. The incidence of kidney stone disease in children is increasing, yet few randomized clinical trials or high quality observational studies have assessed whether dietary or pharmacological interventions decrease the recurrence of kidney stones in children. Collaborative efforts and randomized clinical trials are needed to determine the efficacy and effectiveness of alternative treatments for children with nephrolithiasis, particularly those with calcium oxalate stones and concomitant hypercalciuria and hypocitraturia. Additional areas in need of study are the optimal length of time for a trial of stone passage in children, the cost-effectiveness of medical expulsive therapy vs analgesics alone, and the size and location of stones for which medical expulsive therapy is most effective. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

The use of local natural stone in construction of St. Petersburg region and south-east Finland

NASA Astrophysics Data System (ADS)

Luodes, Hannu; Härmä, Paavo; Panova, Elena; Pirinen, Heikki; Selonen, Olavi

2013-04-01

A three-year project, started in 2012, "Efficient use of natural stone in the Leningrad region and South-East Finland", studies the use and durability of natural stone in the city environments in the Nordic climate and especially along the Eastern Baltic Sea coastline between Helsinki and St. Petersburg. The project is lead by the Geological Survey of Finland (GTK) and the partners in the project are Saimaa University of Applied Sciences from Finland and Federal State Unitary Enterprise "Petersburg Complex Geological Expedition" Russian together with Saint-Petersburg State University from the Russian Federation. As associates in this project are also natural stone companies from Finland, Ylämaa Group Oy and Palin Granit Oy. The project is co-funded by the European Union, the Russian Federation and the Republic of Finland through the European Neighbourhood and Partnership Instrument (ENPI). A great potential of natural stone that can be used in construction is located in the border zone between South-East Finland and the Leningrad region. Rapakivi granite from that area has been utilized for several important buildings worldwide since 18th century and the area holds still potential for future economic growth. The use of the stone particularly from this area is based on its visual expression and good properties with high durability and long life cycle that can be used as arguments in the future development. Strengthening of the knowledge of the material reserves in the area gives a long term basement for economic development. Special aim of the project is to promote the use of natural stone in the city construction, especially the use of left-over stone generated in the production. In the project the use of natural stone in larger cities from the 18th century until today including the towns St. Petersburg, Vyborg, Helsinki, Kuopio and Kotka will be reported. Also an analysis of the near future needs of natural stone (qualities and quantities) in reconstruction and construction in the southern Finland and St. Petersburg regions will be documented. That is to generate ideas for definition of new environmental building products using left-over natural stone from quarrying. The project will provide detailed data about long term durability of stone structures in the cities that are along the Baltic Sea shoreline (St. Petersburg, Helsinki) and subject to both mechanical and biological weathering. Mechanical weathering by several annual freeze-thaw cycles is especially typical in these coastal climate conditions. The data will be used in characterization of the durability and weathering mechanisms of different stone types and is used in preparation of guidelines of stone selection for construction and renovation. The data on natural stone resources in the project area will be evaluated and collected in a database. Also the best natural stone evaluation methods from Finland and Russia will be assessed to produce a guidance of best practices for prospecting and evaluation of natural stone occurrences. The project will also generate suggestions for making the natural stone trade between the EU and Russia easier.

21 CFR 876.4650 - Water jet renal stone dislodger system.

Code of Federal Regulations, 2012 CFR

2012-04-01

... dislodge stones from renal calyces (recesses of the pelvis of the kidney) by means of a pressurized stream of water through a conduit. The device is used in the surgical removal of kidney stones. (b... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Water jet renal stone dislodger system. 876.4650...

21 CFR 876.4650 - Water jet renal stone dislodger system.

Code of Federal Regulations, 2014 CFR

2014-04-01

... dislodge stones from renal calyces (recesses of the pelvis of the kidney) by means of a pressurized stream of water through a conduit. The device is used in the surgical removal of kidney stones. (b... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Water jet renal stone dislodger system. 876.4650...

Stone Soup: The Teacher Leader's Contribution

ERIC Educational Resources Information Center

Bambrick-Santoyo, Paul

2013-01-01

In the tale of "Stone Soup," a stranger vows to make soup for everyone in a village using only a stone--and convinces everyone in town to throw an ingredient into the stewpot. Schools that need to improve teacher practice quickly can also make stone soup, the author says, by harnessing the power of well-prepared teacher leaders to…

Hemiacidrin irrigations to dissolve stone remnants after nephrolithotomy. Problems with solution flow.

PubMed

Rodman, J S; Reckler, J M; Israel, A R

1981-08-01

Following surgery for branched renal calculi, hemiacidrin irrigation may be useful to dissolve any residual stones. Struvite, the mineral in these stones, is itself an alkaline buffer and can raise the pH of the irrigating solution rendering it ineffective. Large volumes of hemiacidrin must reach the stone remnants or they are unlikely to dissolve. Two cases are described in which creative positioning of the patient or the irrigation catheters was necessary to permit adequate amounts of hemiacidrin to reach and dissolve stone remnants.

Chemical Resistance of Ornamental Compound Stone Produced with Marble Waste and Unsaturated Polyester

NASA Astrophysics Data System (ADS)

Ribeiro, Carlos E. Gomes; Rodriguez, Rubén J. Sánchez; Vieira, Carlos M. Fontes

Ornamental compound stone are produced by industry for decades, however, few published studies describe these materials. Brazil has many deposits of stone wastes and a big potential to produce these materials. This work aims to evaluate the chemical resistance of ornamental compound stones produced with marble waste and unsaturated polyester. An adaptation of Annex H of ABNT NBR 13818:97 standard, with reagents commonly used in household products, was used. The results were compared with those obtained for natural stone used in composite production.

Assessing applicants to the NASA flight program for their renal stone-forming potential

NASA Technical Reports Server (NTRS)

Pak, Charles Y. C.; Hill, Kathy; Cintron, Nitza M.; Huntoon, Carolyn

1989-01-01

Because spaceflight can provoke the formation of kidney stones, 24-hour urine samples for 104 male applicants were analyzed for stone-forming risk factors prior to their selection into the NASA astronaut-mission specialist corps. A high level of supersaturation (with either calcium oxalate, brushite, or monosodium urate) was noted in these applicants which predisposes them to the crystallization of stone-forming calcium salts. It is suggested that most of the abnormal stone risk factors found were environmental, rather than metabolic, in origin.

Archaeological Investigations at the San Gabriel Reservoir Districts Central Texas. Volume I.

DTIC Science & Technology

1982-06-01

277 14.6 Pecked and Ground Stone, Hammerstones and Cores - Duane Peter and Marie-Anne Demuynck 14-299 14.7 Bone Artifacts - Bonnie C. Yates 14-335 VI...10 Stone Tools: Burins and Composite Tools 5-34 5.3-11 Stone Tools: Retouched Pieces 5-38 5.3-12 Stone Tools: Retouched Pieces 5-40 5.3-13 Stone Tools...12-142 12.21-4 Feature 4 in BHT 9 showing the distribution of in situ components 12-145 12.21-5 Comparison of General Artifact Composition of Feature

The economics of stone disease.

PubMed

Canvasser, Noah E; Alken, Peter; Lipkin, Michael; Nakada, Stephen Y; Sodha, Hiren S; Tepeler, Abdulkadir; Lotan, Yair

2017-09-01

The rising prevalence of kidney stone disease is associated with significant costs to healthcare systems worldwide. This is in part due to direct procedural and medical management costs, as well as indirect costs to health systems, patients, and families. A number of manuscripts evaulating the economics of stone disease have been published since the 2008s International Consultation on Stone Disease. These highlight costs associated with stone disease, including acute management, surgical management, and medical management. This work hopes to highlight optimization in care by reducing inefficient treatments and maximizing cost-efficient preventative strategies.

Wild monkeys flake stone tools.

PubMed

Proffitt, Tomos; Luncz, Lydia V; Falótico, Tiago; Ottoni, Eduardo B; de la Torre, Ignacio; Haslam, Michael

2016-11-03

Our understanding of the emergence of technology shapes how we view the origins of humanity. Sharp-edged stone flakes, struck from larger cores, are the primary evidence for the earliest stone technology. Here we show that wild bearded capuchin monkeys (Sapajus libidinosus) in Brazil deliberately break stones, unintentionally producing recurrent, conchoidally fractured, sharp-edged flakes and cores that have the characteristics and morphology of intentionally produced hominin tools. The production of archaeologically visible cores and flakes is therefore no longer unique to the human lineage, providing a comparative perspective on the emergence of lithic technology. This discovery adds an additional dimension to interpretations of the human Palaeolithic record, the possible function of early stone tools, and the cognitive requirements for the emergence of stone flaking.

Rapid formation of cholesterol crystals in gallbladder bile is associated with stone recurrence after laparoscopic cholecystotomy.

PubMed

Jüngst, D; del Pozo, R; Dolu, M H; Schneeweiss, S G; Frimberger, E

1997-03-01

Laparoscopic cholecystotomy (LCT) with subsequent extraction of gallstones and primary closure of the gallbladder has been introduced as an alternative therapy for patients with cholecystolithiasis and preserved gallbladder function. However, stone recurrence has to be considered as a major drawback that might be related to lithogenic factors of gallbladder bile or the composition of gallbladder stones. Therefore, these were studied in relation to stone recurrence within an observation period of 1 to 5 years (median, 3.6 years) in 50 patients after LCT. The concentrations of total and individual bile acids, phospholipids, cholesterol, total lipids, mucin, protein, and the cholesterol saturation indices in gallbladder bile were not significantly different between 10 patients with and 40 patients without stone recurrence. However, the crystal observation time was significantly (P < .02) shorter (range, 1-2 days; median, 1.5) in the bile of patients with stone recurrence compared to those without (range, 1-21 days, median 3.5). Moreover, all 10 stone recurrences were observed in the 28 patients with a crystal observation time in the bile of less than or equal to 2 days (approximate annual risk: 12%-15%), and no recurrences were observed in the 22 patients with a crystal observation time greater than 2 days (P < .0001) or in patients with pigment stones. The rapid formation of cholesterol monohydrate crystals in bile seems to be the major risk factor for recurrent stones after LCT. These are most likely cholesterol stones and, therefore, are amenable to oral bile-acid prevention or treatment.

Kidney stone composition in the Kingdom of Saudi Arabia
.

PubMed

Amir, Abdulrazack; Matlaga, Brian R; Ziemba, Justin B; Sheikh, Salwa

2018-05-01

Urolithiasis is a globally-distributed disease; however, its prevalence varies across countries and regions. Countries in the Middle East have been reported to have particularly high nephrolithiasis prevalence rates. To date, however, we have an incomplete understanding of the composition of stones seen in this region. Therefore, we performed a study to characterize stone composition over a 14-year period in the Eastern Province of the Kingdom of Saudi Arabia (KSA). A retrospective review of all adult patients who had the composition of their upper urinary tract calculi analyzed at Johns Hopkins Aramco Healthcare (JHAH) between 1999 and 2013 was performed. Patient demographics and pathology results were obtained from the electronic medical record. A total of 1,747 stones were analyzed in the study period. The results are presented in the Table. Male patients predominated (79%). For both men and women, the majority of stones were calcium oxalate: 85.2% male, 85.9% female. Uric acid stones were the next most common: 10.1% male; 9.0% female. Overall, there were no significant differences between gender with regards to the distribution of stone types. This study represents one of the largest characterizations of stone composition in the Middle East. There remains a significant gender disparity in stone prevalence in the Eastern Province of KSA, with males affected to a significantly greater extent. Calcium oxalate is the most common type of stone, and this is true for both men and women. Future investigations of dietary and environmental factors can build on these initial epidemiologic findings.
.

Comparison of the outcomes of complete supine percutaneous nephrolithotomy in patients with radiopaque and radiolucent kidney stones

PubMed Central

Falahatkar, Siavash; Mokhtari, Gholamreza; Amin, Atiyeh; Kazemnezhad, Ehsan; Esmaeili, Samaneh; Herfeh, Nadia Rastjou; Falahatkar, Reza

2017-01-01

Objective This study compared the stone opacity effect in patients who had radiopaque and radiolucent stones in percutaneous nephrolithotomy (PCNL) results. Material and methods The medical records of 171 complete supine PCNL procedures were gathered. Patients were categorized into two groups: those with radiopaque (n=141) and those with radiolucent (n=30) stones. Kidney, ureter and bladder x-ray was done a day after PCNL and Ultrasound imaging was done two weeks later to evaluate the stone free rate. A stone free result was defined as having less than 4 mm residual stone size. Outcome parameters were compared by univariate analysis and those which were significantly different between the two groups were assessed by multivariate binary logistic regression analysis. Results There were no significant differences in age, sex, body mass index, hypertension, diabetes mellitus, pre-surgery hemoglobin, pre-surgery serum creatinine, stone and also surgery-related parameters between the two groups. Stone free rate, surgery time, complication-related parameters, hemoglobin drop, serum creatinine and glomerular filtration rate (GFR) changes were similar in both groups based on univariate analysis. The radiopaque group had higher post-surgery GFR (p=0.04) and longer hospital stay (p=0.009). However, opacity had no effect on these outcomes after multivariate analysis. Higher post-surgery GFR was seen in patient with higher GFR before surgery (p<0.0001). Also, higher hemoglobin before surgery was correlated with less hospital stay (p=0.001). Conclusion The complete supine percutaneous nephrolithotomy outcomes are similar in patients with radiopaque and radiolucent stones. PMID:29201513

Comparison of the outcomes of complete supine percutaneous nephrolithotomy in patients with radiopaque and radiolucent kidney stones.

PubMed

Falahatkar, Siavash; Mokhtari, Gholamreza; Amin, Atiyeh; Kazemnezhad, Ehsan; Esmaeili, Samaneh; Herfeh, Nadia Rastjou; Falahatkar, Reza

2017-12-01

This study compared the stone opacity effect in patients who had radiopaque and radiolucent stones in percutaneous nephrolithotomy (PCNL) results. The medical records of 171 complete supine PCNL procedures were gathered. Patients were categorized into two groups: those with radiopaque (n=141) and those with radiolucent (n=30) stones. Kidney, ureter and bladder x-ray was done a day after PCNL and Ultrasound imaging was done two weeks later to evaluate the stone free rate. A stone free result was defined as having less than 4 mm residual stone size. Outcome parameters were compared by univariate analysis and those which were significantly different between the two groups were assessed by multivariate binary logistic regression analysis. There were no significant differences in age, sex, body mass index, hypertension, diabetes mellitus, pre-surgery hemoglobin, pre-surgery serum creatinine, stone and also surgery-related parameters between the two groups. Stone free rate, surgery time, complication-related parameters, hemoglobin drop, serum creatinine and glomerular filtration rate (GFR) changes were similar in both groups based on univariate analysis. The radiopaque group had higher post-surgery GFR (p=0.04) and longer hospital stay (p=0.009). However, opacity had no effect on these outcomes after multivariate analysis. Higher post-surgery GFR was seen in patient with higher GFR before surgery (p<0.0001). Also, higher hemoglobin before surgery was correlated with less hospital stay (p=0.001). The complete supine percutaneous nephrolithotomy outcomes are similar in patients with radiopaque and radiolucent stones.

[New ultrasound navigational system in extracorporeal lithotripsy: decreased fluoroscopy and radiation].

PubMed

Abid, N; Ravier, E; Codas, R; Crouzet, S; Martin, X

2013-09-01

Extracorporeal shock wave lithotripsy is the most common method of treatment for kidney stones. Both fluoroscopy and ultrasound imaging can be used to locate stones, but fluoroscopy is more frequently employed. Evaluation of a new stereotaxic navigational system: the stone was located using an ultrasound probe, and its 3D location was saved. The table automatically moved to position the stone at the focal point. A real-time follow-up was possible during treatment. Our objective was to demonstrate a decrease in the use of fluoroscopy to locate kidney stones for extracorporeal shock wave lithotripsy through the use of a 3D ultrasound stone locking system. Prospective analysis of the case records of the 20 patients preceding and the 20 patients succeeding the arrival of the ultrasound stone locking system Visio-Track (EDAP-TMS). We used a Student test to compare age, BMI, kidney stone size, number of shock waves and administered energy. Patient characteristics were comparable. The average age was 55 years old and the average kidney stone size was 10.7 mm. Radiation duration was 174.8 seconds in the group without Visio-Track versus 57.1 seconds in the group with it (P<0.0001). A similar result was observed for radiation doses: 5197.25 mGy x cm2 for the group without versus 1987.6 mGy x cm2 for the group with Visio-Track (P=0.0033). The stone locking system Visio-Track reduced fluoroscopy in our first group of patients, which decreased the patient's individual absorbed irradiation dose. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Epidemiology of stone disease across the world.

PubMed

Sorokin, Igor; Mamoulakis, Charalampos; Miyazawa, Katsuhito; Rodgers, Allen; Talati, Jamsheer; Lotan, Yair

2017-09-01

Nephrolithiasis is a highly prevalent disease worldwide with rates ranging from 7 to 13% in North America, 5-9% in Europe, and 1-5% in Asia. Due to high rates of new and recurrent stones, management of stones is expensive and the disease has a high level of acute and chronic morbidity. The goal of this study is to review the epidemiology of stone disease in order to improve patient care. A review of the literature was conducted through a search on Pubmed ® , Medline ® , and Google Scholar ® . This review was presented and peer-reviewed at the 3rd International Consultation on Stone Disease during the 2014 Société Internationale d'Urologie Congress in Glasgow. It represents an update of the 2008 consensus document based on expert opinion of the most relevant studies. There has been a rising incidence in stone disease throughout the world with a narrowing of the gender gap. Increased stone prevalence has been attributed to population growth and increases in obesity and diabetes. General dietary recommendations of increased fluid, decreased salt, and moderate intake of protein have not changed. However, specific recommended values have either changed or are more frequently reported. Geography and environment influenced the likelihood of stone disease and more information is needed regarding stone disease in a large portion of the world including Asia and Africa. Randomized controlled studies are lacking but are necessary to improve recommendations regarding diet and fluid intake. Understanding the impact of associated conditions that are rapidly increasing will improve the prevention of stone disease.

A simple objective method to assess the radiopacity of urinary calculi and its use to predict extracorporeal shock wave lithotripsy outcomes.

PubMed

el-Gamal, Osama; el-Badry, Amr

2009-07-01

We describe an objective method to evaluate kidney stone radiopacity for use in selection of cases suitable for ESWL. We recruited 76 adult patients with a solitary 1 to 2 cm renal pelvic stone. All patients underwent routine plain x-ray of the urinary tract but an aluminum step wedge (Gammex) was adapted to the cassette before x-ray exposure. This x-ray was then digitized and analyzed by histogram to calculate the gray level of the stone and of each step of the aluminum step wedge. This allowed radiographic stone density to be expressed in mm aluminum equivalent. All patients also underwent abdominopelvic computerized tomography and then ESWL was started. Stone density on plain x-ray was 1.83 to 5.93 mm aluminum equivalent. There was a positive correlation between these values and stone attenuation values on computerized tomography (r(2) 0.83, p <0.005). The 12 patients in whom ESWL failed were found to have stones of significantly higher density than stones in patients with complete stone fragmentation (mean +/- SD 4.8 +/- 0.74 vs 3.35 +/- 0.88 mm aluminum equivalent, p <0.005). There was also a positive correlation between stone radiopacity in mm aluminum equivalent and the total number of shock waves required to achieve complete fragmentation (r(2) 0.66, p <0.005). The aluminum step wedge with plain x-ray of the urinary tract provides a good reference for objectively assessing the radiopacity of renal calculi.

Percutaneous Transhepatic Removal of Bile Duct Stones: Results of 261 Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ozcan, Nevzat, E-mail: nevzatcan@yahoo.com; Kahriman, Guven, E-mail: guvenkahriman@hotmail.com; Mavili, Ertugrul, E-mail: ertmavili@yahoo.com

2012-08-15

Purpose: To determine the effectiveness of percutaneous transhepatic removal of bile duct stones when the procedure of endoscopic therapy fails for reasons of anatomical anomalies or is rejected by the patient. Methods: Between April 2001 and May 2010, 261 patients (138 male patients and 123 female patients; age range, 14-92 years; mean age, 64.6 years) with bile duct stones (common bile duct [CBD] stones = 248 patients and hepatolithiasis = 13 patients) were included in the study. Percutaneous transhepatic cholangiography was performed, and stones were identified. Percutaneous transhepatic balloon dilation of the papilla of Vater was performed. Then stones weremore » pushed out into the duodenum with a Fogarty balloon catheter. If the stone diameter was larger than 15 mm, then basket lithotripsy was performed before balloon dilation. Results: Overall success rate was 95.7%. The procedure was successful in 97.5% of patients with CBD stones and in 61.5% of patients with hepatolithiasis. A total of 18 major complications (6.8%), including cholangitis (n = 7), subcapsular biloma (n = 4), subcapsular hematoma (n = 1), subcapsular abscess (n = 1), bile peritonitis (n = 1), duodenal perforation (n = 1), CBD perforation (n = 1), gastroduodenal artery pseudoaneurysm (n = 1), and right hepatic artery transection (n = 1), were observed after the procedure. There was no mortality. Conclusion: Our experience suggests that percutaneous transhepatic stone expulsion into the duodenum through the papilla is an effective and safe approach in the nonoperative management of the bile duct stones. It is a feasible alternative to surgery when endoscopic extraction fails or is rejected by the patient.« less

[Calcium kidney stones. Diagnostic and preventive prospects].

PubMed

Arcidiacono, T; Terranegra, A; Biasion, R; Soldati, L; Vezzoli, G

2007-01-01

Kidney stone disease is one of the main causes of hospitalization in Italy. Its prevalence increased in the last century and is probably still increasing. The pathogenesis of the disease is not known, although two main theories have been elaborated. The first hypothesizes that hydroxyapatite deposition in the interstitium of the renal papillae (Randall's plaque) precedes urinary calcium oxalate precipitation on the ulcered surface of the papilla to form a stone. The second presumes the tubular lumen of Bellini's duct to be the site where calcium-oxalate salts precipitate to form the nucleus for stone formation within the urinary tract. These pathogenetic processes may be favored by different dietary and genetic factors. The genes involved are not known, although many studies have been performed. Polymorphisms of genes coding for the vitamin D receptor, calcium-sensing receptor, interleukin-1 receptor antagonist, and urokinase were found to be associated with kidney stones, but these results have not been replicated. Different nutrients are suspected to predispose patients to calcium kidney stone disease. A high intake of animal proteins, sodium, vitamin C and oxalate has been implicated in stone formation, whereas calcium, alkalis and phytate may have a protective effect. The prevention of calcium stone formation is based on the recognition of risk factors like those already mentioned here. Furthermore, a family history of kidney stones may be useful in identifying subjects predisposed to become calcium stone formers. However, the expectations of the scientific community are turned to the advances in genetics and to the findings of genetic studies, which may provide diagnostic tools and criteria to define the risk profile of the single individual.

A Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy for Management of Renal Stones ?2 CM.

PubMed

Sari, Sercan; Ozok, Hakki Ugur; Cakici, Mehmet Caglar; Ozdemir, Harun; Bas, Okan; Karakoyunlu, Nihat; Sagnak, Levent; Senturk, Aykut Bugra; Ersoy, Hamit

2017-01-18

In this retrospective study, we aimed to compare the outcomes in patients who have been treated withpercutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) on renal stones ≥ 2 cm size. We evaluated patients who underwent PNL or RIRS for renal stones ≥ 2 cm size betweenNovember 2011 and November 2014. Stone size, operation, fluoroscopy and hospitalization time, success rates,stone-free rates and complication rates were compared in both groups. Patients were followed for three months. 254 patients were in the PNL Group. 185 patients were in the RIRS Group. The mean age was 46.88 and48.04 years in PNL and RIRS groups, respectively.The patient and stone characteristics (age, gender, Body Mass Index, kidney anomaly, SWL history and stoneradioopacity) were similar between two groups.The mean stone size preoperatively was significantly larger in patients who were treated with PNL (26.33mm.vs24.04mm.; P = .006). In the RIRS group, the mean stone number was significantly higher than PNL group (P <.001).The mean operative, fluoroscopy and hospitalization time were significantly higher in PNL group (P < .001). Thestone-free rate was 93.3% for the PNL group and 73.5% for the RIRS group after first procedure (P < .001). Nomajor complication (Clavien III-V) occurred in the RIRS group. Although the primary treatment method for renal stones ≥ 2cm size is PNL, serious complicationscan be seen. Therefore, RIRS can be an alternative treatment option in the management of renal stones ≥2 cm size.

Determination of minor and trace elements concentration in kidney stones using elemental analysis techniques

NASA Astrophysics Data System (ADS)

Srivastava, Anjali

The determination of accurate material composition of a kidney stone is crucial for understanding the formation of the kidney stone as well as for preventive therapeutic strategies. Radiations probing instrumental activation analysis techniques are excellent tools for identification of involved materials present in the kidney stone. The X-ray fluorescence (XRF) and neutron activation analysis (NAA) experiments were performed and different kidney stones were analyzed. The interactions of X-ray photons and neutrons with matter are complementary in nature, resulting in distinctly different materials detection. This is the first approach to utilize combined X-ray fluorescence and neutron activation analysis for a comprehensive analysis of the kideny stones. Presently, experimental studies in conjunction with analytical techniques were used to determine the exact composition of the kidney stone. The use of open source program Python Multi-Channel Analyzer was utilized to unfold the XRF spectrum. A new type of experimental set-up was developed and utilized for XRF and NAA analysis of the kidney stone. To verify the experimental results with analytical calculation, several sets of kidney stones were analyzed using XRF and NAA technique. The elements which were identified from XRF technique are Br, Cu, Ga, Ge, Mo, Nb, Ni, Rb, Se, Sr, Y, Zr. And, by using Neutron Activation Analysis (NAA) are Au, Br, Ca, Er, Hg, I, K, Na, Pm, Sb, Sc, Sm, Tb, Yb, Zn. This thesis presents a new approach for exact detection of accurate material composition of kidney stone materials using XRF and NAA instrumental activation analysis techniques.

The 'modified prone position': a new approach for treating pre-vesical stones with extracorporeal shock wave lithotripsy.

PubMed

Köse, A C; Demirbas, M

2004-02-01

To investigate the utility of a new 'modified-prone' position for treating pre-vesical stones with extracorporeal shock wave lithotripsy (ESWL), usually considered an acceptable and effective treatment for such stones, but for which many different body positions have been used in an attempt to increase its efficacy. The study included 268 consecutive patients with a solitary pre-vesical stone who underwent ESWL either prone (69) or in the modified-prone position (199) between May 1999 and August 2001. Only those with one stone between the ureteric orifice and 1 cm proximal to the vesico-ureteric junction were included. In each case the stone diameter, days to stone clearance, number of shock waves applied per treatment, and number of sessions required to become stone-free were recorded. If the treatment failed this was also noted. Success rates in the prone and modified-prone groups were compared and analysed to assess which of the variables influenced success with ESWL. After ESWL, 95.5% of the 268 patients were stone-free; the rates in the prone and modified-prone groups were 89.9% and 97.5%, respectively (P = 0.015). The probability of success with ESWL therapy for pre-vesical calculi in modified-prone position was about five times (odds ratio 4.56, 95% confidence interval 1.2-17.7) greater than that expected with when prone. The modified-prone position was an independent factor most significantly influencing success with ESWL in these patients. The modified-prone position for ESWL is a new and very effective way to treat patients with pre-vesical stones.

Therapy-resistant nephrolithiasis following renal artery coil embolization

PubMed Central

2013-01-01

Background Transcatheter renal artery embolization is an effective and minimally invasive treatment option for acute renal bleeding. Early post-interventional complications include groin hematoma, incomplete embolization, coil misplacement and coil migration. Late complications are rare and mostly related to coil migration. Case presentation A 22-year-old woman with a history of recurrent stone disease and a lumbal meningomyelocele underwent bilateral open pyelolithotomy for bilateral staghorn calculi. Post-operatively, acute hemorrhage of the left kidney occurred and selective arterial coil embolization of a lower pole interlobular renal artery was performed twice. Four years after this intervention the patient presented with a new 15.4 mm stone in the lower calyx of the left kidney. After two extracorporeal shock wave lithotripsy treatments disintegration of the stone was not detectable. Therefore, flexible ureterorenoscopy was performed and revealed that the stone was adherent to a partially intraluminal metal coil in the lower renal calyx. The intracalyceal part of the coil and the adherent stone were successfully removed using the holmium laser. Conclusion Therapy-resistant nephrolithiasis was caused by a migrated metal coil, which was placed four years earlier for the treatment of acute post-operative renal bleeding. Renal coils in close vicinity to the renal pelvis can migrate into the collecting system and trigger renal stone formation. Extracorporeal shock wave lithotripsy seems to be inefficient for these composite stones. Identification of these rare stones is possible during retrograde intrarenal surgery. It also enables immediate stone disintegration and removal of the stone fragments and the intraluminal coil material. PMID:23758632

Influence of Pelvicaliceal Anatomy on Stone Clearance After Flexible Ureteroscopy and Holmium Laser Lithotripsy for Large Renal Stones.

PubMed

Inoue, Takaaki; Murota, Takashi; Okada, Shinsuke; Hamamoto, Shuzo; Muguruma, Kouei; Kinoshita, Hidefumi; Matsuda, Tadashi

2015-09-01

This study was performed to evaluate the impact of pelvicaliceal anatomy on stone clearance in patients with remnant fragments in the lower pole after flexible ureteroscopy and holmium laser lithotripsy (fURSL) for renal stones >15 mm. This retrospective study included 67 patients with radiopaque residual fragments (>2 mm) in the lower pole after fURSL for large renal stones (>15 mm). The preoperative infundibular length (IL), infundibular width (IW), infundibulopelvic angle (IPA), and caliceal pelvic height (CPH) were measured using intravenous urography. Multivariate analysis was performed to determine whether any of these measurements affected stone clearance. Of the 67 patients, 55 (82.1%) were stone free (SF) 3 months after fURSL. The anatomic factors significantly favorable for an SF status were a short IL, broad IW, wide IPA, and low CPH. On multivariate analysis, the IPA had a significant influence on an SF status after fURSL (p=0.010). An IPA <30° was a negative risk factor (p=0.019). Postoperative complications occurred in nine patients (13.4%), including Clavien grade I complications in two patients (2.9%), grade II in six patients (8.9%), and grade IIIa in one patient (1.8%). Almost all complications were minor. An IPA <30° is the only negative risk factor for stone clearance after fURSL for large renal stones according to our multivariate analysis. Additional studies are required to further evaluate the characteristics of the pelvicaliceal anatomy influencing stone clearance.

Usefulness of dual-energy computed tomography with and without dedicated software in identifying uric acid kidney stones.

PubMed

Salvador, R; Luque, M P; Ciudin, A; Paño, B; Buñesch, L; Sebastia, C; Nicolau, C

2016-01-01

To prospectively evaluate the usefulness of dual-energy computed tomography (DECT) with and without dedicated software in identifying uric acid kidney stones in vivo. We studied 65 kidney stones in 63 patients. All stones were analyzed in vivo by DECT and ex vivo by spectrophotometry. We evaluated the diagnostic performance in identifying uric acid stones with DECT by analyzing the radiologic densities with dedicated software and without using it (through manual measurements) as well as by analyzing the attenuation ratios of the stones in both energies with and without the dedicated software. The six uric acid stones included were correctly identified by evaluating the attenuation ratios with a cutoff of 1.21, both with the dedicated software and without it, yielding perfect diagnostic performance without false positives or false negatives. The study of the attenuations of the stones obtained the following values on the receiver operating characteristic curves in the classification of the uric acid stones: 0.92 for the measurements done with the software and 0.89 for the manual measurements; a cutoff of 538 HU yielded 84% (42/50) diagnostic accuracy for the software and 83.1% (54/65) for the manual measurements. DECT enabled the uric acid stones to be identified correctly through the calculation of the ratio of the attenuations in the two energies. The results obtained with the dedicated software were similar to those obtained manually. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

Percutaneous nephrolithotomy in the supine position: Safety and outcomes in a single-centre experience

PubMed Central

Nour, Hani H.; Kamal, Ahmed M.; Ghobashi, Samir E.; Zayed, Ahmed S.; Rushdy, Mamdouh M.; El-Baz, Ahmed G.; Kamel, Ahmed I.; El-Leithy, Tarek

2013-01-01

Objectives To assess the feasibility of performing percutaneous nephrolithotomy (PCNL) with the patient supine. Although PCNL with the patient prone is the standard technique for treating large (>2 cm) renal stones including staghorn stones, we evaluated the safety and efficacy of supine PCNL for managing large renal stones, with special attention to evaluating the complications. Patients and method In a prospective study between January 2010 and December 2011, 54 patients with large and staghorn renal stones underwent cystoscopy with a ureteric catheter inserted, followed by puncture of the collecting system while they were supine. Tract dilatation to 30 F was followed by nephroscopy, stone disintegration using pneumatic lithotripsy, and retrieval using a stone forceps. All patients had a nephrostomy tube placed at the end of the procedure. The results were compared with those from recent large series of supine PCNL. Results The median (range) operative duration was 130 (90–210) min, and the mean (SD) volume of irrigant was 22.2 (3.7) L. One puncture was used to enter the collecting system in 51 renal units (94%), while three units (6%) with a staghorn stone needed two punctures. The stone clearance rate was 91%, and five patients had an auxiliary procedure. There were complications in 15 patients (28%). All patients were stone-free at a 3-month follow-up. Conclusion Supine PCNL is technically feasible; it has several advantages to patients, urologists and anaesthesiologists. It gives stone-free rates and a low incidence of organ injury comparable to those in standard prone PCNL. PMID:26579247

Bladder stone management: an update.

PubMed

Cicione, Antonio; DE Nunzio, Cosimo; Manno, Stefano; Damiano, Rocco; Posti, Alessandro; Lima, Estevao; Tubaro, Andrea; Balloni, Filippo

2018-02-01

Bladder stone (BS) is a rare disease curable with several options. Herein, we reviewed the specific literature in order to update the current BS management. A comprehensive systematic MEDLINE search was performed for English language reports published before April 2017 using the BS related terms, i.e. bladder-vesical calculi, lithotripsy. Then manuscripts references were screened to identify unfounded studies. Studies regarding BS in children were excluded. Retrieved studies were classified according to their main item as: etiology, diagnosis, treatment, treatment in specific illnesses and advances in BS management. Treatment option was mainly related to stone size and number as well as concomitant causative disease. However, stone nature was not analyzed in all the retrieved studies. Both trans-urethral and percutaneous lithotripsy were efficacy for stone fragmentation although the last one was suggested to avoid urethral injuries. Holmiun:Yag laser lithotripsy has made stone fragmentation feasible by using local anesthesia however in selected patients only. The urological dogma to perform concomitant prostate surgery in men with BS has been recently questioned by some observational case-series studies however, the lack of randomization and long follow up preserve that knowledge. Bladder stone is a rare and ancient disease. Nowadays new technologies have been developed in the effort to make less invasive stone treatment. The retrieved studies show that stone fragmentation can be archived by using several surgical approaches and devices whereas comparative randomized studies are still unavailable to identify the best option.

The "Guidewire-Coil"-Technique to prevent retrograde stone migration of ureteric calculi during intracorporeal lithothripsy.

PubMed

Dreger, Nici Markus; von Rundstedt, Friedrich Carl; Roth, Stephan; Brandt, Alexander Sascha; Degener, Stephan

2017-01-05

Stone retropulsion represents a challenge for intracorporeal lithotripsy of ureteral calculi. The consequences are an increased duration and cost of surgery as well as decreased stone-free rates. The use of additional tools to prevent proximal stone migration entails further costs and risks for ureteral injuries. We present the simple technique of using a coil of the routinely used guidewire to prevent stone retropulsion. We retrospectively evaluated all patients with mid-to-proximal ureteral stones in 2014, which were treated by ureteroscopic lithotripsy (Ho: YAG and/or pneumatic lithotripsy). The preoperative stone burden was routinely assessed using low dose CT scan (if available) and/or intravenous pyelogram. The study population consisted of 55 patients with 61 mid-to-proximal calculi. Twentyseven patients underwent semirigid ureterorenoscopy using the "Guidewire-Coil-Technique", the second group (n = 28) served as control group using the guidewire as usual. There has been a statistically significant reduction of accidental stone retropulsion (2/27 vs. 8/28, p < 0.05) as well as a decreased use of auxiliary procedures (p < 0.05) compared to the control group. No difference was observed in operative time. One ureteral injury in the control group required a prolonged ureteral stenting. The "Guidewire-Coil-Technique" is a simple and safe procedure that may help to prevent proximal calculus migration and therefore may increase stone-free rates without causing additional costs.

Renal staghorn calculosis: our experience with the percutaneous treatment with or without extracorporeal shock wave lithotripsy.

PubMed

Bianchi, G; Malossini, G; Beltrami, P; Mobilio, G; Giusti; Caluccio, G

1998-04-01

In this paper we report our results in the treatment of renal staghorn stones by percutaneous lithotripsy (PCNL) with or without extracorporeal shock wave lithotripsy (ESWL). Over a period of 5 years, 244 patients with renal calculosis were treated by PCNL in our Department. Seventy-four of these were cases of renal staghorn calculosis: 44 presented a partial staghorn stone and in 30 cases the stone formation completely occupied the pyelocalieal cavity. We performed first a PCNL via a rigid nephroscope. Stones were crushed using an ultrasonic lithotrite; an electrohydraulic probe was used when the calculus was resistant to ultrasound. The patients were submitted to one or more percutaneous treatments followed by extracorporeal lithotripsy to complete the operation, when required. The patients were divided into two groups according to the type of stone: the first group comprised 59 patients with a partial or complete simple staghorn stone and the second comprised 15 patients with a complete complex staghorn stone. Complete resolution was achieved in 55 of the 59 cases (93.2%) in the first group and in 9 of the 15 cases (60%) in the second. We had no complications. Our experience confirms that PCNL is the elective treatment for partial and complete staghorn stones and ESWL in these types of stones must be utilized only as ancillary treatment for residual fragments.

Can Ureteral Jet Flow Measurement Predict Spontaneous Passage of Distal Ureteral Stones?

PubMed

Ongun, Sakir; Teken, Abdurrazak; Yılmaz, Orkun; Süleyman, Sakir

2018-06-27

The study aimed to investigate the relationship between the spontaneous passage of distal ureteral stones and ureteral jet flow measurement. The study included 74 patients with acute renal colic between June 2015 and June 2016, and distal ureteral stones of 10 mm or less in a non-contrast CT were comprised in a prospective study. The ureteral jet was measured by Doppler ultrasonography. At the fourth week follow-up, kidney-ureter-bladder radiography was taken and the patients who no longer had a stone were considered to have spontaneously passed it. The average stone size of the patients was 5.6 ± 2.0 mm. After 4 weeks of follow-up, 55 patients (74.3%) had passed the stone spontaneously whereas 19 (25.6%) had not. The patients in the former group were found to have a higher peak flow velocity of ureteral jet on the stone side than those in the latter group. In regression analysis ureteral jet on the stone side was independently associated with spontaneous passage (p = 0.027). For the spontaneous passage, a ureteral jet flow peak velocity above 15.25 cm/s had an 85.4% sensitivity and 63.1% specificity. Measurement of the ureteral jet flow peak velocity can be beneficial in predicting the potential spontaneous passage of distal ureteral stones. © 2018 S. Karger AG, Basel.

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.

Guaifenesin- and ephedrine-induced stones.

PubMed

Assimos, D G; Langenstroer, P; Leinbach, R F; Mandel, N S; Stern, J M; Holmes, R P

1999-11-01

We report a new type of drug-induced stone that is caused by overconsumption of preparations containing guaifenesin and ephedrine. Clinical and stone analysis data from the Molecular Structure Laboratory at the Veterans Affairs Medical Center in Milwaukee, Wisconsin, were reviewed. Stone analysis was performed by Fourier transform infrared spectroscopy, high-resolution X-ray crystallographic powder diffraction, or both. The urine and stone material from one of the subjects were analyzed with high-performance liquid chromatography. Stone analysis from seven patients demonstrated metabolites of guaifenesin. High-performance liquid chromatography revealed that the stone and urine from one subject had a high content of guaifenesin metabolites and a small amount of ephedrine. Demographic data were available on five patients. Three had a history of alcohol or drug dependency. All were consuming over-the-counter preparations containing ephedrine and guaifenesin. Four admitted to taking excessive quantities of these agents, mainly as a stimulant. Hypocitraturia was identified in two individuals subjected to urinary metabolic testing. These stones are radiolucent on standard X-ray imaging but can be demonstrated on unenhanced CT. Shockwave lithotripsy was performed in two patients, and the calculi fragmented easily. Individuals consuming large quantities of preparations containing ephedrine and guaifenesin may be at risk to develop stones derived mainly from metabolites of guaifenesin and small quantities of ephedrine. These patients may be prone to drug or alcohol dependency.

Determination of chemical composition of gall bladder stones: Basis for treatment strategies in patients from Yaounde, Cameroon

PubMed Central

III, Fru F. Angwafo; Takongmo, Samuel; Griffith, Donald

2004-01-01

AIM: Gallstone disease is increasing in sub-saharan Africa (SSA). In the west, the majority of stones can be dissolved with bile salts, since the major component is cholesterol. This medical therapy is expensive and not readily accessible to poor populations of SSA. It was therefore necessary to analyze the chemical composition of biliary stones in a group of patients, so as to make the case for introducing bile salt therapy in SSA. METHODS: All patients with symptomatic gallstones were recruited in the study. All stones removed during cholecystectomy were sent to Houston for x-ray diffraction analysis. Data on age, sex, serum cholesterol, and the percentage by weight of cholesterol, calcium carbonate, and amorphous material in each stone was entered into a pre-established proforma. Frequencies of the major components of the stones were determined. RESULTS: Sixteen women and ten men aged between 27 and 73 (mean 44.9) years provided stones for the study. The majority of patients (65.38%) had stones with less than 25% of cholesterol. Amorphous material made up more than 50% and 100% of stones from 16 (61.53%) and 9 (34.61%) patients respectively. CONCLUSION: Cholesterol is present in small amounts in a minority of gallstones in Yaounde. Dissolution of gallstones with bile salts is unlikely to be successful. PMID:14716845

Extended Multiscale Image Segmentation for Castellated Wall Management

NASA Astrophysics Data System (ADS)

Sakamoto, M.; Tsuguchi, M.; Chhatkuli, S.; Satoh, T.

2018-05-01

Castellated walls are positioned as tangible cultural heritage, which require regular maintenance to preserve their original state. For the demolition and repair work of the castellated wall, it is necessary to identify the individual stones constituting the wall. However, conventional approaches using laser scanning or integrated circuits (IC) tags were very time-consuming and cumbersome. Therefore, we herein propose an efficient approach for castellated wall management based on an extended multiscale image segmentation technique. In this approach, individual stone polygons are extracted from the castellated wall image and are associated with a stone management database. First, to improve the performance of the extraction of individual stone polygons having a convex shape, we developed a new shape criterion named convex hull fitness in the image segmentation process and confirmed its effectiveness. Next, we discussed the stone management database and its beneficial utilization in the repair work of castellated walls. Subsequently, we proposed irregular-shape indexes that are helpful for evaluating the stone shape and the stability of the stone arrangement state in castellated walls. Finally, we demonstrated an application of the proposed method for a typical castellated wall in Japan. Consequently, we confirmed that the stone polygons can be extracted with an acceptable level. Further, the condition of the shapes and the layout of the stones could be visually judged with the proposed irregular-shape indexes.

Coupled CFD-PBE Predictions of Renal Stone Size Distributions in the Nephron in Microgravity

NASA Technical Reports Server (NTRS)

Kassemi, Mohammad; Griffin, Elise; Thompson, David

2016-01-01

In this paper, a deterministic model is developed to assess the risk of critical renal stone formation for astronauts during space travel. A Population Balance Equation (PBE) model is used to compute the size distribution of a population of nucleating, growing and agglomerating renal calculi as they are transported through different sections of the nephron. The PBE model is coupled to a Computational Fluid Dynamics (CFD) model that solves for steady state flow of urine and transport of renal calculi along with the concentrations of ionic species, calcium and oxalate, in the nephron using an Eulerian two-phase mathematical framework. Parametric simulation are performed to study stone size enhancement and steady state volume fraction distributions in the four main sections of the nephron under weightlessness conditions. Contribution of agglomeration to the stone size distribution and effect of wall friction on the stone volume fraction distributions are carefully examined. Case studies using measured astronaut urinary calcium and oxalate concentrations in microgravity as input indicate that under nominal conditions the largest stone sizes developed in Space will be still considerably below the critical range for problematic stone development. However, results also indicate that the highest stone volume fraction occurs next to the tubule and duct walls. This suggests that there is an increased potential for wall adhesion with the possibility of evolution towards critical stone sizes.

A Guideline for the Management of Renal Stones in Astronauts

NASA Technical Reports Server (NTRS)

Reyes, David; Locke, James; Johnston, Smith

2014-01-01

There are no specific guidelines for the management of renal stones in astronauts. Given the increased risk for bone loss, hypercalcuria, and stone formation due to microgravity, a clinical practice guideline is needed. Methods An extensive review of the literature and current aeromedical standards for the management of renal stones was done. The NASA Flight Medicine Clinic's electronic medical record and Longitudinal Survey of Astronaut Health were also reviewed. This information was used to create an algorithm for the management of renal stones in astronauts. Results Guidelines are proposed based on accepted standards of care, with consideration to the environment of spaceflight. In a usual medical setting, asymptomatic, small stones less than 7 mm are often observed over time. Given the constraints of schedule, and the risks to crew health and mission, this approach is too liberal. An upper limit of 3 mm stone diameter was adopted before requiring intervention, because this is the largest size that has a significant chance of spontaneous passage on its own. Other specific guidelines were also created. Discussion The spaceflight environment requires more aggressive treatment than would otherwise be found with the usual practice of medicine. A small stone can become a major problem because it may ultimately require medical evacuation from orbit. Thus renal stones are a significant mission threat and should be managed in a systematic way to mitigate risks to crew health and mission success.

Ureteroscopy for the management of stone disease.

PubMed

Eisner, Brian H; Kurtz, Michael P; Dretler, Stephen P

2010-01-01

Ureteroscopy is the first-line treatment for urinary stone disease at many institutions. Techniques and indications continue to evolve. This Review covers the most current trends, controversies, and issues in ureteroscopic stone management. We present a summary of the most recent evidence regarding ureteroscopic treatment of ureteral and renal stones, current standard indications, adjunct devices and instruments used during ureteroscopy, and future directions.

29. DETAIL OF A STONE USED IN THE CONSTRUCTION OF ...

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

29. DETAIL OF A STONE USED IN THE CONSTRUCTION OF A RECTANGULAR COKE OVEN, SHOWING THE MAKER'S MARK. STONE FROM THE GARFIELD COMPANY WERE USED IN THE CONSTRUCTION OF BOTH THE BEEHIVE AND RECTANGULAR OVENS. - Tower Hill No. 2 Mine, Approximately 0.47 mile Southwest of intersection of Stone Church Road & Township Route 561, Hibbs, Fayette County, PA

Natural Abundance 43Ca NMR as a Tool for Exploring Calcium Biomineralization: Renal Stone Formation and Growth

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bowers, Geoffrey M.; Kirkpatrick, Robert J.

2011-12-07

Renal stone diseases are a global health issue with little effective therapeutic recourse aside from surgery and shock-wave lithotripsy, primarily because the fundamental chemical mechanisms behind calcium biomineralization are poorly understood. In this work, we show that natural abundance 43Ca NMR at 21.1 T is an effective means to probe the molecular-level Ca2+ structure in oxalate-based kidney stones. We find that the 43Ca NMR resonance of an authentic oxalate-based kidney stone cannot be explained by a single pure phase of any common Ca2+-bearing stone mineral. Combined with XRD results, our findings suggest an altered calcium oxalate monohydrate-like Ca2+ coordination environmentmore » for some fraction of Ca2+ in our sample. The evidence is consistent with existing literature hypothesizing that nonoxalate organic material interacts directly with Ca2+ at stone surfaces and is the primary driver of renal stone aggregation and growth. Our findings show that 43Ca NMR spectroscopy may provide unique and crucial insight into the fundamental chemistry of kidney stone formation, growth, and the role organic molecules play in these processes.« less

Reproducing stone monument photosynthetic-based colonization under laboratory conditions.

PubMed

Miller, Ana Zélia; Laiz, Leonila; Gonzalez, Juan Miguel; Dionísio, Amélia; Macedo, Maria Filomena; Saiz-Jimenez, Cesareo

2008-11-01

In order to understand the biodeterioration process occurring on stone monuments, we analyzed the microbial communities involved in these processes and studied their ability to colonize stones under controlled laboratory experiments. In this study, a natural green biofilm from a limestone monument was cultivated, inoculated on stone probes of the same lithotype and incubated in a laboratory chamber. This incubation system, which exposes stone samples to intermittently sprinkling water, allowed the development of photosynthetic biofilms similar to those occurring on stone monuments. Denaturing gradient gel electrophoresis (DGGE) analysis was used to evaluate the major microbial components of the laboratory biofilms. Cyanobacteria, green microalgae, bacteria and fungi were identified by DNA-based molecular analysis targeting the 16S and 18S ribosomal RNA genes. The natural green biofilm was mainly composed by the Chlorophyta Chlorella, Stichococcus, and Trebouxia, and by Cyanobacteria belonging to the genera Leptolyngbya and Pleurocapsa. A number of bacteria belonging to Alphaproteobacteria, Bacteroidetes and Verrucomicrobia were identified, as well as fungi from the Ascomycota. The laboratory colonization experiment on stone probes showed a colonization pattern similar to that occurring on stone monuments. The methodology described in this paper allowed to reproduce a colonization equivalent to the natural biodeteriorating process.

Protection and consolidation of stone heritage by self-inoculation with indigenous carbonatogenic bacterial communities.

PubMed

Jroundi, Fadwa; Schiro, Mara; Ruiz-Agudo, Encarnación; Elert, Kerstin; Martín-Sánchez, Inés; González-Muñoz, María Teresa; Rodriguez-Navarro, Carlos

2017-08-17

Enhanced salt weathering resulting from global warming and increasing environmental pollution is endangering the survival of stone monuments and artworks. To mitigate the effects of these deleterious processes, numerous conservation treatments have been applied that, however, show limited efficacy. Here we present a novel, environmentally friendly, bacterial self-inoculation approach for the conservation of stone, based on the isolation of an indigenous community of carbonatogenic bacteria from salt damaged stone, followed by their culture and re-application back onto the same stone. This method results in an effective consolidation and protection due to the formation of an abundant and exceptionally strong hybrid cement consisting of nanostructured bacterial CaCO 3 and bacterially derived organics, and the passivating effect of bacterial exopolymeric substances (EPS) covering the substrate. The fact that the isolated and identified bacterial community is common to many stone artworks may enable worldwide application of this novel conservation methodology.Salt weathering enhanced by global warming and environmental pollution is increasingly threatening stone monuments and artworks. Here, the authors present a bacterial self-inoculation approach with indigenous carbonatogenic bacteria and find that this technique consolidates and protects salt damaged stone.

The incidence and clinical features of acute kidney injury secondary to ureteral calculi.

PubMed

Wang, Si-Jun; Mu, Xiao-Nan; Zhang, Long-Yang; Liu, Qing-Yong; Jin, Xun-Bo

2012-08-01

The aim of this study is to evaluate the incidence and clinical features of acute kidney injury (AKI) secondary to ureteral calculi. Between February 2002 and December 2009, the prevalence of AKI was 0.72% in our series of 2,073 cases of ureteral stones. The AKI patients received ureteroscopy or percutaneous nephrostomy as the primary treatment. The most popular symptom was significant decrease in urine output (75%, 12/16). Five cases (33.3%) were caused by bilateral ureteral stones, and 76.19% of the stones were located in the upper ureter, the mean size of single stone was 1.35 ± 0.38 cm. The serum creatinine before treatment was 514.34 ± 267.04 μmol/L and the blood urea nitrogen before treatment was 21.31 ± 10.24 mmol/L. 46.67% of the patients had a functional or anatomical solitary kidney unit. Our study suggests that risk factors for developing AKI in ureteral stone patients are bigger sized stones, ureteral stones in patients with only one functioning kidney or pre-existing kidney disease, and bilateral ureteral stones. Early effective drainage in these cases could decrease the risk developing AKI secondary to ureteral calculi.

Urinary calculi: microbiological and crystallographic studies.

PubMed

Rosenstein, I J

1986-01-01

Although referred to as "urinary calculus disease", the formation of stone in the urinary tract is not caused by a single etiological agent. As such, diverse clinical investigations to diagnose the cause of stone formation must be carried out and the course of management after diagnosis must inevitably be different in each case. This review will cover all aspects of calculus formation, but will give particular attention to calculi caused by infection of the urinary tract with urease-producing bacteria. This is a recurrent, potentially life-threatening disease which has led clinicians to refer to the condition as "stone cancer". Because the etiology of infection stones is so different from stones caused by metabolic disorders, the two disease patterns should be considered separately, a fact often overlooked in epidemiological studies of stone formation. The importance of analysis of calculi as an aid to management is thus emphasized; identification of stone type will help to indicate appropriate therapy. A review of methods of analysis will be covered, particularly crystallographic analysis. Inhibition of bacterial urease as a means of management of infection stones will be discussed together with problems encountered and brighter hopes for the future.

Assessment of Stone Complexity for PCNL: A Systematic Review of the Literature, How Best Can We Record Stone Complexity in PCNL?

PubMed

Withington, John; Armitage, James; Finch, William; Wiseman, Oliver; Glass, Jonathan; Burgess, Neil

2016-01-01

This study aims to systematically review the literature reporting tools for scoring stone complexity and the stratification of outcomes by stone complexity. In doing so, we aim to determine whether the evidence favors uniform adoption of any one scoring system. PubMed and Embase databases were systematically searched for relevant studies from 2004 to 2014. Reports selected according to predetermined inclusion and exclusion criteria were appraised in terms of methodologic quality and their findings summarized in structured tables. After review, 15 studies were considered suitable for inclusion. Four distinct scoring systems were identified and a further five studies that aimed to validate aspects of those scoring systems. Six studies reported the stratification of outcomes by stone complexity, without specifically defining a scoring system. All studies reported some correlation between stone complexity and stone clearance. Correlation with complications was less clearly established, where investigated. This review does not allow us to firmly recommend one scoring system over the other. However, the quality of evidence supporting validation of the Guy's Stone Score is marginally superior, according to the criteria applied in this study. Further evaluation of the interobserver reliability of this scoring system is required.

Percutaneous nephrolithotomy for the treatment of radiolucent renal stones in children: is it different opaque stone treatment?

PubMed

Adanur, Şenol; Ziypak, Tevfik; Sancaktutar, Ahmet Ali; Tepeler, Abdülkadir; Reşorlu, Berkan; Söylemez, Haluk; Dağgülli, Mansur; Özbey, İsa; Unsal, Ali

2014-02-01

We aimed to evaluate the effectiveness of percutaneous nephrolithotomy (PNL), stone-free rates, and related complications in children with radiolucent renal stones. A total of 56 patients aged <16 years from four institutions were enrolled in our study. Asymptomatic, clinically insignificant residual fragments measuring <4 mm or a complete stone-free status was accepted as the criterion for clinical success. Complications were evaluated according to the modified Clavien classification. The mean age of the patients was 7.8 ± 4.5 years. The mean stone size was calculated as 24.07 ± 10.4 mm. The median operative and fluoroscopy times were 53.2 min (15-170 min) and 172.4 s (5-520 s), respectively. The success rate after PNL monotherapy was 87.4%; the total success rate with shock wave lithotripsy used as an auxillary treatment method was detected as 94.6%. The total complication rate was 19.6% (11 patients). No adjacent organ injury was observed. All of the complications that occurred were minor according to the Clavien classification (Clavien Grades I-II). PNL can be applied to radiolucent pediatric renal stones in children with similar success, and complication rates as noted for radiopaque stones.

A novel technique of percutaneous stone extraction in choledocholithiasis after cholecystostomy.

PubMed

Lim, Kyoung Hoon; Kim, Yong Joo

2013-05-01

To evaluate the technical feasibility and clinical efficacy of percutaneous common bile duct stone extraction via cystic duct after percutaneous cholecystostomy. Twenty-five consecutive patients with choledocholithiasis underwent percutaneous stone extraction under conscious sedation. The stones were extracted through the 12-Fr sheath using Wittich nitinol stone basket under fluoroscopic guidance via cystic duct after percutaneous trnas-hepatic cholecystostomy. Common bile duct stones were successfully removed in 22 of the 25 patients (88%) by this new technique. The causes of failure in three patients were bile leakage, hematoma of the gallbladder and failure of cystic duct cannulation. Cystic duct injury during this procedure did not occur and there was no post-procedure mortality. The mean period of indwelling catheter was 8.7±4.6 days and the mean duration of hospitalization was 13.4±5.9 days. Percutaneous commmon bile duct stone extraction via the cystic duct through percutaneous cholecystostomy route is effective and feasible for treating choledocholithiasis.

Microscopic Examination of Gallbladder Stones Improves Rate of Detection of Clonorchis sinensis Infection

PubMed Central

Ma, Rui-hong; Luo, Xiao-bing; Zheng, Pei-ming; Luo, Zhen-liang; Yang, Liu-qing

2013-01-01

To improve the rate of detection of Clonorchis sinensis infection, we compared different specimens from patients with cholecystolithiasis. Feces, gallbladder bile, and gallbladder stones collected from 179 consecutive patients with cholecystolithiasis underwent microscopic examination, and according to the results, 30 egg-positive and 30 egg-negative fecal, gallbladder bile, and gallbladder stone specimens, respectively, underwent real-time fluorescent PCR. The detection rates of eggs in feces, bile, and gallbladder stones were 30.7%, 44.7%, and 69.8%, respectively, and the differences were statistically significant (P < 0.01). The PCR results confirmed that the eggs in the specimens were C. sinensis eggs. Eggs in the feces were “fresh” and in the gallbladder stones were “old.” Microscopic examination of gallbladder stones may improve the detection rates of C. sinensis infection, which is important for developing individualized treatments to prevent the recurrence of gallbladder stones and to prevent the occurrence of severe liver damage and cholangiocarcinoma. PMID:23698535

Stone tool analysis and human origins research: some advice from Uncle Screwtape.

PubMed

Shea, John J

2011-01-01

The production of purposefully fractured stone tools with functional, sharp cutting edges is a uniquely derived hominin adaptation. In the long history of life on earth, only hominins have adopted this remarkably expedient and broadly effective technological strategy. In the paleontological record, flaked stone tools are irrefutable proof that hominins were present at a particular place and time. Flaked stone tools are found in contexts ranging from the Arctic to equatorial rainforests and on every continent except Antarctica. Paleolithic stone tools show complex patterns of variability, suggesting that they have been subject to the variable selective pressures that have shaped so many other aspects of hominin behavior and morphology. There is every reason to expect that insights gained from studying stone tools should provide vital and important information about the course of human evolution. And yet, one senses that archeological analyses of Paleolithic stone tools are not making as much of a contribution as they could to the major issues in human origins research. Copyright © 2011 Wiley Periodicals, Inc.

The effect of carbon dioxide on the twinkling artifact in ultrasound imaging of kidney stones: A pilot study

PubMed Central

Simon, Julianna C.; Wang, Yak-Nam; Cunitz, Bryan W.; Thiel, Jeffrey; Starr, Frank; Liu, Ziyue; Bailey, Michael R.

2016-01-01

Bone demineralization, dehydration, and stasis put astronauts at an increased risk of forming kidney stones in space. The color-Doppler ultrasound “twinkling artifact”, which highlights kidney stones with color, can make stones readily detectable with ultrasound; however our previous results suggest twinkling is caused by microbubbles on the stone surface which could be affected by the elevated levels of carbon dioxide found on space vehicles. Four pigs were implanted with kidney stones and imaged with ultrasound while the anesthetic carrier gas oscillated between oxygen and air containing 0.8% carbon dioxide. Upon exposing pigs to 0.8% carbon dioxide, twinkling was significantly reduced after 9–25 minutes and recovered when the carrier gas returned to oxygen. These trends repeated when pigs were again exposed to 0.8% carbon dioxide followed by oxygen. The reduction of twinkling from exposure to elevated carbon dioxide may make kidney stone detection with twinkling difficult in current space vehicles. PMID:28190622

Acoustic and mechanical properties of renal calculi: implications in shock wave lithotripsy.

PubMed

Chuong, C J; Zhong, P; Preminger, G M

1993-12-01

The acoustic and mechanical properties of renal calculi dictate how a stone interacts with the mechanical forces produced by shock wave lithotripsy; thus, these properties are directly related to the success of the treatment. Using an ultrasound pulse transmission technique, we measured both longitudinal and transverse (or shear) wave propagation speeds in nine groups of renal calculi with different chemical compositions. We also measured stone density using a pycnometer based on Archimedes' principle. From these measurements, we calculated wave impedance and dynamic mechanical properties of the renal stones. Calcium oxalate monohydrate and cystine stones had higher longitudinal and transverse wave speeds, wave impedances, and dynamic moduli (bulk modulus, Young's modulus, and shear modulus), suggesting that these stones are more difficult to fragment. Phosphate stones (carbonate apatite and magnesium ammonium phosphate hydrogen) were found to have lower values of these properties, suggesting they are more amenable to shock wave fragmentation. These data provide a physical explanation for the significant differences in stone fragility observed clinically.

Relationship between the incidence infection stones and the magnesium-calcium ratio of tap water.

PubMed

Kohri, K; Ishikawa, Y; Iguchi, M; Kurita, T; Okada, Y; Yoshida, O

1993-01-01

In a previous study we showed that the magnesium-calcium ratio of tap water is negatively correlated with the incidence of calcium-containing urinary stones. In this study we examined the relationship between the incidence of struvite stones, water hardness and the regional geological features on the basis of our previous study and an epidemiological study of urolithiasis performed in Japan. The magnesium-calcium ratio of tap water was found to correlate positively with the incidence of struvite stones. The tap water magnesium-calcium ratio was high in regions of basalt and sedimentary rock and was low in granite and limestone areas. The incidence of struvite stones in the regions of basalt and sedimentary rock was higher than that in the granite and limestone areas. Thus, this study suggested that the incidence of struvite stones is related to the magnesium-calcium ratio of tap water and to the regional geology, as is the case for calcium-containing stones.

[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. © Georg Thieme Verlag KG Stuttgart · New York.

The building stones of ancient Egypt a gift of its geology

NASA Astrophysics Data System (ADS)

Klemm, Dietrich D.; Klemm, Rosemarie

2001-08-01

Building stones and clay-rich Nile mud were ancient Egypt's main raw construction materials. While the mud was easily accessible along the Nile river valley, the immense quantities of the different stone materials used for construction of the famous pyramids, precious temples and tombs needed a systematic quarrying organization, well arranged transport logistics over extreme distances and a high standard of stone masonry. The petrography, occurrence, and main applications of the 11 most popular stone types used in ancient Egypt are described in this contribution. Rough estimates of the scale of this mining activity, based on the volume of many different ancient quarry sites, all over Egypt, reveal that the monuments known today represent only a small fraction of the amount of building stones mined during the long, ancient Egyptian history.

Extracorporeal shock wave lithotripsy as first line treatment for urinary tract stones in children: outcome of 500 cases.

PubMed

Badawy, Abdelbasset A; Saleem, Mohamed D; Abolyosr, Ahmad; Aldahshoury, Mohamed; Elbadry, Mohamed S B; Abdalla, Medhat A; Abuzeid, Abdelmoneim M

2012-06-01

The continued evolution of stone treatment modalities, such as endourologic procedures, open surgery and shock wave lithotripsy, makes the assessment of continuous outcomes are essential. Pediatric urolithiasis are an important health problem allover the world, especially in Middle East region. We evaluate the safety, efficacy and factors affecting success rate and clearance of stones in children treated with shock wave lithotripsy. Between 2005 and 2010, a total of 500 children with stones in the upper urinary tract at different locations were treated by Extracorporeal shock wave lithotripsy (ESWL) in our department, Sohag University, Egypt. We have used the Siemn's Lithostar Modularis machine, Germany. A total of 371 boys and 129 girls with the average age of 8.63 ± 5 years, and a range from 9 months to 17 years were included in this study. Diagnosis of their urinary calculi was established either by the use of abdominal ultrasound, plain X-ray, intravenous urography, or CT scan. The stones were located in the kidney in 450 (90%) patients; 298 (66%) pelvic, 26 (5.7%) upper calices, 57 (12.6%) mid calices, and lower calices in 69 (15.3%) patients. The average of their stone sizes was 12.5 ± 7.2 mm. The other 50 children their stone were located in the proximal ureteral stones in 35 patients (70%); middle third in 5 (10%) patients and in the distal ureter in 10 (20%) patients. The average ureteral stone size was 7.5 ± 3.2 mm. All children were treated under general anesthesia with adequate lung and testes shielding using air foam. We treated the distal ureteral stones of young children in the supine position through greater sciatic foramen and lesser sciatic foramen as the path of shockwave instead of prone position, which is not a comfortable or natural position and could adversely affect cardiopulmonary function especially under general anesthesia. Localization was mainly done by ultrasound, and X-ray was only used to localize ureteral calculi. For follow-up, we have used abdominal ultrasound, plain X-ray, and CT scan if needed to confirm stone disintegration and clearance. The overall success rate for renal and ureteral calculi was 83.4 and 58.46%, respectively. The re-treatment rate was 4% in renal group and 28% for the ureteral group. No serious complications were recorded in our patients. Minor complications occurred in 15% of our patients; renal colic was reported in 10% of our treated patients, and repeated vomiting was reported in 5% that respond to antiemetics. In the renal group; children with history of pervious urologic surgical procedures had low success rate of stone clearance after ESWL. In the ureteral group stone burden, stone location, had a significant impact on stone clearance outcome. This study showed that SWL in pediatric age group for both renal and ureteral stone is cost effective, safe with an acceptable re-treatment rate; however children with large stone burden or previous urologic surgery have low success rate.

Choledochoscopic Holmium Laser Lithotripsy for Difficult Bile Duct Stones.

PubMed

Lv, Shangdong; Fang, Zheping; Wang, Aidong; Yang, Jian; Zhang, Wenlong

2017-01-01

The aim of this study was to evaluate the feasibility and efficacy of choledochoscopic holmium laser lithotripsy as a means of removing resistant extrahepatic and intrahepatic bile duct stones. Clinical data on 28 patients who had undergone choledochoscopic holmium laser lithotripsy were analyzed. Complete stone clearance was obtained in 24 patients; small numbers of residual stones in the left or right hepatic duct were found in 4 patients. No severe complications such as hemobilia and bile duct injuries occurred. Choledochoscopic holmium laser lithotripsy is a simple, safe, and effective treatment method for patients with resistant bile duct stones.

Bath Stone - a Possible Global Heritage Stone from England

NASA Astrophysics Data System (ADS)

Marker, Brian

2014-05-01

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

Surgical outcomes of percutaneous nephrolithotomy in 3402 patients and results of stone analysis in 1559 patients.

PubMed

Rizvi, Syed Adibul Hasan; Hussain, Manzoor; Askari, Syed Hassan; Hashmi, Altaf; Lal, Murli; Zafar, Mirza Naqi

2017-11-01

To report our experience of a series of percutaneous nephrolithotomy (PCNL) procedures in a single centre over 18 years in terms of patient and stone characteristics, indications, stone clearance and complications, along with the results of chemical analysis of stones in a subgroup. We retrospectively analysed the outcomes of PCNL in 3402 patients, who underwent the procedure between 1997 and 2014, obtained from a prospectively maintained database. Data analysis included patients' age and sex, laboratory investigations, imaging, punctured calyx, duration of operation, volume of irrigation fluid, radiation exposure time, blood transfusion, complications and stone-free status at 1-month follow-up. For the present analysis, outcomes in relation to complications and success were divided in two eras, 1997-2005 and 2006-2014, to study the differences. Of the 3402 patients, 2501 (73.5%) were male and 901 (26.5%) were female, giving a male:female ratio of 2.8:1. Staghorn (partial or complete) calculi were found in 27.5% of patients, while 72.5% had non-staghorn calculi. Intracorporeal energy sources used for stone fragmentation included ultrasonography in 917 patients (26.9%), pneumatic lithoclast in 1820 (53.5%), holmium laser in 141 (4.1%) and Lithoclast ® master in 524 (15.4%). In the majority of patients (97.4%) a 18-22-F nephrostomy tube was placed after the procedure, while 69 patients (2.03%) underwent tubeless PCNL. The volume of the irrigation fluid used ranged from 7 to 37 L, with a mean of 28.4 L. The stone-free rate after PCNL in the first era studied was 78%, vs 83.2% in the second era, as assessed by combination of ultrasonography and plain abdominal film of the kidney, ureter and bladder. The complication rate in the first era was 21.3% as compared with 10.3% in the second era, and this difference was statistically significant. Stone analysis showed pure stones in 41% and mixed stones in 58% of patients. The majority of stones consisted of calcium oxalate. This is the largest series of PCNL reported from any single centre in Pakistan, where there is a high prevalence of stone disease associated with infective and obstructive complications, including renal failure. PCNL as a treatment method offers an economic and effective option in the management of renal stone disease with acceptable stone clearance rates in a resource-constrained healthcare system. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

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 primary economic outcome is a reduction in the incremental cost per quality-adjusted life years, determined at 12 weeks. The analysis will be based on all participants as randomized (intention to treat). The trial has 90% power with a type I error rate of 5% to detect a 10% increase in primary outcome between the tamsulosin and nifedipine treatment groups. Trial registration ISRCTN69423238; EudraCT number: 2010-019469-26 PMID:24947817

TISU: Extracorporeal shockwave lithotripsy, as first treatment option, compared with direct progression to ureteroscopic treatment, for ureteric stones: study protocol for a randomised controlled trial.

PubMed

McClinton, Samuel; Cameron, Sarah; Starr, Kathryn; Thomas, Ruth; MacLennan, Graeme; McDonald, Alison; Lam, Thomas; N'Dow, James; Kilonzo, Mary; Pickard, Robert; Anson, Ken; Keeley, Frank; Burgess, Neil; Clark, Charles Terry; MacLennan, Sara; Norrie, John

2018-05-22

Urinary stone disease is very common with an estimated prevalence among the general population of 2-3%. Ureteric stones are associated with severe pain as they pass through the urinary tract and have significant impact on patients' quality of life due to the detrimental effect on their ability to work and need for hospitalisation. Most ureteric stones can be expected to pass spontaneously with supportive care. However, between one-fifth and one-third of cases require an intervention. The two standard active intervention options are extracorporeal shockwave lithotripsy (ESWL) and ureteroscopic stone retrieval. ESWL and ureteroscopy are effective in terms of stone clearance; however, they differ in terms of invasiveness, anaesthetic requirement, treatment setting, complications, patient-reported outcomes (e.g. pain after intervention, time off work) and cost. There is uncertainty around which is the most clinically effective in terms of stone clearance and the true cost to the NHS and to society (in terms of impact on patient-reported health and economic burden). The aim of this trial is to determine whether, in adults with ureteric stones, judged to require active intervention, ESWL is not inferior and is more cost-effective compared to ureteroscopic treatment as the initial management option. The TISU study is a pragmatic multicentre non-inferiority randomised controlled trial of ESWL as the first treatment option compared with direct progression to ureteroscopic treatment for ureteric stones. Patients aged over 16 years with a ureteric stone confirmed by non-contrast computed tomography of the kidney, ureter and bladder (CTKUB) will be randomised to either ESWL or ureteroscopy. The primary clinical outcome is resolution of the stone episode (no further intervention required to facilitate stone clearance) up to six months from randomisation. The primary economic outcome is the incremental cost per quality-adjusted life years (QALYs) gained at six months from randomisation. Determining whether ESWL is not inferior clinically and is cost-effective compared to ureteroscopic treatment as the initial management in adults with ureteric stones who are judged to require active treatment is relevant not only to patients and clinicians but also to healthcare providers, both in the UK and globally. ISRCTN registry, ISRCTN92289221 . Registered on 21 February 2013.

"Piedra Franca": the same name for many different natural stones.

NASA Astrophysics Data System (ADS)

Pereira, Dolores; Navarro, Rafael; Baltuille, Jose Manuel

2014-05-01

The Spanish name "Piedra Franca" refers to all the stones of sedimentary origin that have uniform coloration and easeof cutting/carving in order to obtain dimensional blocks for construction. The first references to this denomination occurred during medieval times, when builders had to choose the best materials to construct magnificent cathedrals. The largest volume of such natural stones were extracted from Caen, northern France, and historic records use the English term, "freestone", ie stone easy to cut, and to work by the masons dedicated to build cathedrals ("freemasons") in contrast to the "roughstone", hard stones worked by the hard hewers or "rough masons". The original French name referred to the limestones extracted at Caen, but over time, the original meaning expanded to include other natural stones with similar coloration and ease to carve. Notably this included many sandstones that were used in adjacent countries such as Spain. In the latter, although the most popular for its importance in architectural heritage is the Villamayor sandstone from Salamanca, other historically important natural stones are also known as "Piedra Franca" including the calcarenite from Santa Pudia (Granada), the limestone from Alava, the sandstone from Jaen and the sandstone from Cádiz. All of them were used in the construction of Spanish architectonic heritage and share similar exterior characteristics. In fact, several are known as golden stones. However when conservation and restoration of architectonic heritage is involved, the correct and original material should be used. The existence of national networks (e.g. CONSTRUROCK) and international task groups (e.g. IUGS Heritage Stone Task Group) can help to properly characterize, document, and differentiate between the varieties of "Piedra Franca" and they should be consulted by builders, architects and any other stone professsionals involved in such activities. An error in choosing the natural stone can result in significant damage to the architectonic heritage. The same issue that occurs with "Piedra Franca" also extends to other natural stones in Spain and around the world. This explains the importance of these networks and task groups. This work was sponsored by the ERASMUS Intensive Programme 2012-1-ES1-ERA10-54375 and it was done within the framework of the Heritage Stone Task Group and CONSTRUROCK activities.

How practical is the application of percutaneous nephrolithotomy scoring systems? Prospective study comparing Guy's Stone Score, S.T.O.N.E. score and the Clinical Research Office of the Endourological Society (CROES) nomogram.

PubMed

Singla, Anurag; Khattar, Nikhil; Nayyar, Rishi; Mehra, Shibani; Goel, Hemant; Sood, Rajeev

2017-03-01

To prospectively compare the Guy's Stone Score (GSS), S.T.O.N.E. [stone size (S), tract length (T), obstruction (O), number of involved calices (N), and essence or stone density (E)] score and the Clinical Research Office of the Endourological Society (CROES) nephrolithometric nomogram to predict percutaneous nephrolithotomy (PCNL) success rate and assess the correlation with perioperative complications. We prospectively evaluated all consecutive PCNL patients at our institute between 1 November 2013 and 31 May 2015. The above scoring systems were applied to preoperative non-contrast computed tomography and the practical difficulties in such applications were noted. Perioperative complications and the stone-free rate (SFR) were also recorded. Receiver operating characteristic curves were drawn and the areas under curves were compared and appropriate statistical analysis done. In all, 48 renal units were included in the study. The overall SFR was 62.2%. The presence of staghorn stones ( β  = 27.285, 95% confidence interval 1.19-625.35; P  = 0.039) was the only significant variable associated with the residual stones on multivariate analysis. Stone-free patients had significantly lower median GSS (2 vs 4) and S.T.O.N.E. scores (6 vs 10) and higher median CROES scores (83% vs 63%) (all P  < 0.001) compared to residual-stone patients. All scoring systems were significantly associated with SFR (all P  < 0.001). There was no significant difference in the areas under curves of the scoring systems (0.858, 0.923, and 0.931, respectively). Furthermore, all scoring systems had weak correlations with Clavien-Dindo classified complications ( r  = 0.29, P  = 0.045; r  = 0.40, P  = 0.005 and r  = -0.295, P  = 0.04, respectively). We found no standardisation for the measurement of stone dimensions, tract length, Hounsfield units, and staghorn definition. All scoring systems equally predicted SFR and had a weak correlation with Clavien-Dindo complications. Standardisation is needed for the variables in which they have been found deficient.

Kidney stones and kidney function loss: a cohort study.

PubMed

Alexander, R Todd; Hemmelgarn, Brenda R; Wiebe, Natasha; Bello, Aminu; Morgan, Catherine; Samuel, Susan; Klarenbach, Scott W; Curhan, Gary C; Tonelli, Marcello

2012-08-29

To investigate whether the presence of kidney stones increase the risk of end stage renal disease (ESRD) or other adverse renal outcomes. A registry cohort study using validated algorithms based on claims and facility utilisation data. Median follow-up of 11 years. Alberta, Canada, between 1997 and 2009. 3,089,194 adult patients without ESRD at baseline or a history of pyelonephritis. Of these, 1,954,836 had outpatient serum creatinine measurements and were included in analyses of chronic kidney disease and doubling of serum creatinine level. One or more kidney stones during follow-up. Incident ESRD, development of stage 3b-5 chronic kidney disease (estimated glomerular filtration rate <45 mL/min/1.73 m(2)), and sustained doubling of serum creatinine concentration from baseline. 23,706 (0.8%) patients had at least one kidney stone, 5333 (0.2%) developed ESRD, 68,525 (4%) developed stage 3b-5 chronic kidney disease, and 6581 (0.3%) experienced sustained doubling of serum creatinine. Overall, one or more stone episodes during follow-up was associated with increased risk of ESRD (adjusted hazard ratio 2.16 (95% CI 1.79 to 2.62)), new stage 3b-5 chronic kidney disease (hazard ratio 1.74 (1.61 to 1.88)), and doubling of serum creatinine (hazard ratio 1.94 (1.56 to 2.43)), all compared with those without kidney stones during follow-up. The excess risk of adverse outcomes associated with at least one episode of stones seemed greater in women than in men, and in people aged <50 years than in those aged ≥ 50. However, the risks of all three adverse outcomes in those with at least one episode of stones were significantly higher than in those without stones in both sexes and age strata. The absolute increase in the rate of adverse renal outcomes associated with stones was small: the unadjusted rate of ESRD was 2.48 per million person days in people with one or more episodes of stones versus 0.52 per million person days in people without stones. Even a single kidney stone episode during follow-up was associated with a significant increase in the likelihood of adverse renal outcomes including ESRD. However, the increases were small in absolute terms.

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

McClinton, Sam; Starr, Kathryn; Thomas, Ruth; McLennan, Graeme; McPherson, Gladys; McDonald, Alison; Lam, Thomas; N'Dow, James; Kilonzo, Mary; Pickard, Robert; Anson, Ken; Burr, Jennifer

2014-06-20

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. 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 primary economic outcome is a reduction in the incremental cost per quality-adjusted life years, determined at 12 weeks. The analysis will be based on all participants as randomized (intention to treat). The trial has 90% power with a type I error rate of 5% to detect a 10% increase in primary outcome between the tamsulosin and nifedipine treatment groups. ISRCTN69423238; EudraCT number: 2010-019469-26.

An Item Fit Statistic Based on Pseudocounts from the Generalized Graded Unfolding Model: A Preliminary Report.

ERIC Educational Resources Information Center

Roberts, James S.

Stone and colleagues (C. Stone, R. Ankenman, S. Lane, and M. Liu, 1993; C. Stone, R. Mislevy and J. Mazzeo, 1994; C. Stone, 2000) have proposed a fit index that explicitly accounts for the measurement error inherent in an estimated theta value, here called chi squared superscript 2, subscript i*. The elements of this statistic are natural…

Ultrasound Based Method and Apparatus for Stone Detection and to Facilitate Clearance Thereof

NASA Technical Reports Server (NTRS)

Bailey, Michael (Inventor); Kaczkowski, Peter (Inventor); Illian, Paul (Inventor); Kucewicz, John (Inventor); Sapozhnikov, Oleg (Inventor); Shah, Anup (Inventor); Dunmire, Barbrina (Inventor); Lu, Wei (Inventor); Owen, Neil (Inventor); Cunitz, Bryan (Inventor)

2015-01-01

Described herein are methods and apparatus for detecting stones by ultrasound, in which the ultrasound reflections from a stone are preferentially selected and accentuated relative to the ultrasound reflections from blood or tissue. Also described herein are methods and apparatus for applying pushing ultrasound to in vivo stones or other objects, to facilitate the removal of such in vivo objects.