Accuracy of ultrasound versus computed tomography urogram in detecting urinary tract calculi.

PubMed

Salinawati, B; Hing, E Y; Fam, X I; Zulfiqar, M A

2015-08-01

To determine the (i) sensitivity and specificity of ultrasound (USG) in the detection of urinary tract calculi, (ii) size of renal calculi detected on USG, and (iii) size of renal calculi not seen on USG but detected on computed tomography urogram (CTU). A total of 201 patients' USG and CTU were compared retrospectively for the presence of calculi. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of USG were calculated with CTU as the gold standard. From the 201 sets of data collected, 59 calculi were detected on both USG and CTU. The sensitivity and specificity of renal calculi detection on USG were 53% and 85% respectively. The mean size of the renal calculus detected on USG was 7.6 mm ± 4.1 mm and the mean size of the renal calculus not visualised on USG but detected on CTU was 4 mm ± 2.4 mm. The sensitivity and specificity of ureteric calculi detection on USG were 12% and 97% respectively. The sensitivity and specificity of urinary bladder calculi detection on USG were 20% and 100% respectively. This study showed that the accuracy of US in detecting renal, ureteric and urinary bladder calculi were 67%, 80% and 98% respectively.

Melamine-contaminated milk products induced urinary tract calculi in children.

PubMed

Zhang, Li; Wu, Ling-Ling; Wang, Ya-Ping; Liu, Ai-Min; Zou, Chao-Chun; Zhao, Zheng-Yan

2009-02-01

Melamine is an industrial chemical used primarily as plastics stabilizer and fire retardant. On September 11, 2008, melamine-contaminated milk products were reported to be responsible for urinary tract calculi in infants and children in China. This study aimed to investigate the prevalence, lesions, risk factors, clinical features, and management of children fed with the melamine-contaminated milk products. A total of 15 577 infants and children fed with the milk products were screened at our hospital. Ultrasonography was performed in all the infants and children. For those found with urinary tract calculion ultrasonography, urnalysis was done. Among them, 846 with detailed data screened from September 17 to 25 were enrolled for further analysis in this study. They were divided into calculus group (326 children) and non-calculus group (520 children) according to the results of ultrasonography. They included 429 boys and 417 girls, aged from 1 month to 5 years (median, 18 months). Their clinical and laboratory data, ultrasonograms, and treatment results were analyzed. Of the 15 577 children screened, 562 (3.61%) had urinary tract calculi. The rate was closely related to the melamine concentration in patients fed with formula. In 846 children with detailed data enrolled in this analysis, weight and head circumference Z scores in the calculus group were lower than those in the non-calculus group (P=0.048, P=0.046). Long duration of formula feeding, high melamine contained formula, and minimal water intake were the risk factors for calculi (P<0.05, respectively). Of 326 children with calculi, 281 had small calculiless than 0.5 cm in diameter, 227 had multiple calculi, and 34 had urinary tract distention. Moreover, diffuse renal lesions, renal failure and ascites were noted in 4, 3 and 2 patients, respectively. After 1-month treatment with sodium bicarbonate and Chinese traditional medicine, calculi disappeared in 49 of 54 outpatients. In 41 inpatients, 5 had calculi removed operatively and 36 had calculi minimized. Melamine-contaminated milk products induced urinary tract calculi, which have a good response to conservative therapy. Long-term follow-up of infants and children fed with melamine-contaminated milk products is required, and food safety should be supervised increasingly for the health of children.

Composition and characteristics of urinary calculi from guinea pigs.

PubMed

Hawkins, Michelle G; Ruby, Annette L; Drazenovich, Tracy L; Westropp, Jodi L

2009-01-15

To determine the mineral composition of calculi, anatomic locations of the calculi, and findings of urinalysis and bacteriologic culture of urine and calculi in guinea pigs with urolithiasis. Cross-sectional study. 127 guinea pigs. Records of urinary calculi that had been submitted to the University of California Stone Laboratory from 1985 through 2003 were reviewed. In addition, submissions of urinary calculi for evaluation by the laboratory were prospectively solicited from 2004 through 2007. Prospectively obtained calculi were accompanied by a urine sample for urinalysis and bacteriologic culture and a completed questionnaire. All calculi were analyzed by use of polarized light microscopy and infrared spectroscopy. A subset of calculi was examined by means of x-ray diffractometry (XRD). 83% (43/52) of calculi from the laboratory database and 93% (70/75) of calculi that were prospectively solicited were composed of 100% calcium carbonate. Analysis via XRD confirmed that 5 of 6 calculi from a subset that had the greatest gross morphologic variation were composed of 100% calcite. Although many guinea pigs had received anti-microbials before bacteriologic cultures of urine were performed, Corynebacterium renale was isolated from 5 urine samples. Contrary to findings of other studies, urinary calculi analyzed for the present study were most commonly composed of 100% calcium carbonate, and infrared spectroscopy or XRD was necessary to differentiate this mineral from others. Treatments, including diet and husbandry practices, should be developed to help prevent development of calcium carbonate calculi in guinea pigs.

Management of upper urinary tract calculi with ureteroscopic techniques.

PubMed

Tawfiek, E R; Bagley, D H

1999-01-01

To evaluate our experience in treating 155 patients with upper urinary tract calculi ureteroscopically. The treatment of urinary calculi has remained the most frequent application of ureteroscopy. Miniaturization of semirigid and flexible ureteroscopes has permitted easier access to calculi throughout the urinary tract. Ureteroscopic stone treatment was attempted in 155 patients with upper urinary tract calculi between November 1995 and March 1997. Fifty-nine (38.1%) patients had renal calculi, 82 (52.9%) ureteral, and 14 (9%) had both renal and ureteral calculi. Both semirigid and flexible ureteroscopes were used for treatment (rigid alone in 21 [13.5%], flexible in 64 [41.3%], and both rigid and flexible in 70 [45.2%] patients). Lithotripsy was required in 122 (79%) of the patients. The holmium:yttrium-aluminum-garnet laser was used in 113 (92.6%) of these patients. All patients with ureteral calculi (29 proximal, 19 mid, and 34 distal) were successfully cleared after one endoscopic procedure except for 1 patient with a proximal ureteral calculus who had a 4-mm residual fragment in the kidney. Of the 59 patients with renal calculi, 47 (79.7%) were totally clear of stones 1 month after treatment. The remaining 12 (20.3%) patients had evidence of residual calculi 3 to 4 mm or less in diameter. In patients with combined renal and ureteral calculi, 1 1 of 14 (78.6%) were rendered stone free. The remaining 3 (21.4%) patients had evidence of residual calculi 4 mm in diameter. Overall, 95% of the patients were treated in an outpatient setting. Morbidity was low, with no evidence of stricture. Ureteroscopy and laser lithotripsy in experienced hands are a safe and reliable method for the treatment of ureteral and even intrarenal calculi.

Comparison of 0.625-mm source computed tomographic images versus 5-mm thick reconstructed images in the evaluation for renal calculi in at-risk patients.

PubMed

Berkenblit, Robert; Hoenig, David; Lerer, Daniel; Moses, Melanie; Minsky, Lloyd

2013-02-01

CT has become a well-established modality in the evaluation of urinary calculi. The advent of multidetector CT (MDCT) scanners and submillimeter thick slice acquisitions has yielded CT images with even greater resolution. MDCT scanners allow for source data slice acquisition with submillimeter slice thickness. These source images can then be reconstructed to thicker slices for more convenient interpretation of the CT scan. Previous authors have looked at the effect of slice thickness on detection of urinary calculi. We investigated whether the thin slice source images yielded detection of additional stones and the potential significance of detecting these additional stones. Ninety-five consecutive patients who were referred to our outpatient imaging center for CT, with a clinical history placing them at risk for urinary calculi, were included in the study. In 49 (52%) of the 95 patients, more calculi were visualized using the 0.625-mm thick images than with the 5-mm thick images. In 34 (69%) of these 49 patients, the additional findings were thought to be "clinically significant," while in the remaining 15 (31%) patients, the additional findings were not thought to be clinically significant. In 46 (48%) of the 95 patients, there were no additional urinary calculi identified on the 0.625-mm thick images compared with that observed on 5-mm thick images. The results from this study encourage reviewing the thin slice source images of MDCTs in patients at risk for urinary calculi, because important clinical decisions may hinge on the additional findings made on these images.

The association between urinary calculi and increased risk of future cardiovascular events: A nationwide population-based study.

PubMed

Hsu, Chien-Yi; Chen, Yung-Tai; Huang, Po-Hsun; Leu, Hsin-Bang; Su, Yu-Wen; Chiang, Chia-Hung; Chen, Jaw-Wen; Chen, Tzeng-Ji; Lin, Shing-Jong; Chan, Wan-Leong

2016-05-01

Although accumulating evidence suggests urinary calculi may be associated with an increased risk of cardiovascular disease (CVD), the number of longitudinal studies linking urolithiasis to CVD events is limited. We investigated the association between urinary calculi and the risk of development of myocardial infarction (MI) and/or stroke in a nationwide, population-based cohort database in Taiwan. Our analyses were conducted using information from a random sample of 1 million people enrolled in the nationally representative Taiwan National Health Insurance Research Database. A total of 81,546 subjects aged 18 years or above, including 40,773 subjects diagnosed with urinary calculi during the study period and a propensity score-matched 40,773 subjects without urinary calculi were enrolled in our study. During a 10-year follow-up period, 501 MI events and 1295 stroke events were identified. By comparison, the urinary calculi group had a higher incidence rate of MI occurrence (11.79 vs 8.94 per 10,000 person-years) and stroke (31.41 vs 22.45 per 10,000 person-years). Cox proportional hazard regression model analysis showed that development of urinary calculi was independently associated with higher risk of developing future MI (HR, 1.31; 95% CI, 1.09-1.56, p=0.003), stroke (HR, 1.39; 95% CI, 1.24-1.55, p<0.001), and total cardiovascular events (HR, 1.38; 95% CI, 1.25-1.51, p<0.001). Urinary calculi were associated with an increased risk of future cardiovascular events in the Asian population, which was consistent with the recent epidemiologic evidence in Western countries. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

The association of benign prostatic hyperplasia with lower urinary tract stones in adult men: A retrospective multicenter study.

PubMed

Jung, Jae Hung; Park, Jinsung; Kim, Won Tae; Kim, Hong Wook; Kim, Hyung Joon; Hong, Sungwoo; Yang, Hee Jo; Chung, Hong

2018-04-01

To examine the relationship between benign prostatic hyperplasia (BPH) and the presence of lower urinary tract stones. We retrospectively reviewed the records of men with lower urinary tract stones who presented to three clinical centers in Korea over a 4-year period. We divided the patients into two groups based on the location of urinary stones: Group 1 (bladder calculi) and Group 2 (urethral calculi). We compared the characteristics of both groups and performed univariate and multivariate analyses with a logistic regression model to investigate the relationship between BPH and lower urinary tract stones. Of 221 patients, 194 (87.8%) had bladder calculi and 27 (12.2%) had urethral calculi. The mean age of Group 1 was higher than that of Group 2 (68.96 ± 12.11 years vs. 55.74 ± 14.20 years, p  < 0.001). The mean prostate volume of Group 1 was higher than that of Group 2 (44.47 ± 27.14 mL vs. 24.70 ± 6.41 mL, respectively, p  < 0.001). Multivariate logistic regression showed that age (OR = 1.075, 95%CI: 1.023-1.129) and prostate volume (OR = 1.069, 95%CI: 1.017-1.123) were independently associated with increased risk for bladder calculi. Upper urinary tract stones and/or hydronephrosis conferred a 3-fold risk for urethral calculi (OR = 3.468, 95%CI: 1.093-10.999). Age and prostate volume are independent risk factors for bladder calculi. In addition, men with upper urinary tract disease are at greater risk for urethral calculi, which may migrate from the upper urinary tract rather than from the bladder.

Source of a micro-nutrient in a semi-synthetic basal diet as a causative factor in inducing urinary calculi in rats and its inhibition by PSC 833, a potent inhibitor of P-glycoprotein.

PubMed

Kankesan, Janarthanan; Vanama, Ramesh; Renlund, Richard; Thiessen, Jake J; Ling, Victor; Rao, Prema M; Rajalakshmi, Srinivasan; Sarma, Dittakavi S R

2003-08-01

We report a serendipitous finding of urinary calculi in rats fed a semi-synthetic basal diet. This observation was made during ongoing studies to evaluate the inhibitory effect of PSC 833, a potent inhibitor of P-glycoprotein, on development of tumors in rodent tumor model systems. A large number of specific-pathogen-free (SPF) female Sprague-Dawley and SPF male Fischer 344 rats being fed the diet were euthanized when it became evident clinically that they were uremic. At necropsy, the renal pelvis, ureters, and urinary bladder contained numerous calculi. The presence of urinary calculi was determined to be related to the source of a Food Chemical Codex grade of choline bitartrate. Rats being fed the same basal diet containing the United States Pharmacopia grade of choline bitartrate failed to develop urinary calculi. Interestingly, rats treated with the P-glycoprotein inhibitor were at significantly reduced risk of developing urinary calculi. This finding highlights how something seemingly innocuous as a minor dietary constituent can have a profound impact and, thereby, affect experimental outcome.

Endoscopic-assisted disruption of urinary calculi using a holmium:YAG laser in standing horses.

PubMed

Judy, Carter E; Galuppo, Larry D

2002-01-01

To describe a technique for endoscope-assisted disruption and removal of urinary calculi using a holmium:YAG laser in sedated, standing horses. Retrospective study. Six horses with urinary calculi. A holmium:YAG laser was used to disrupt naturally occurring urinary calculi in horses (4 geldings, 1 stallion, 1 mare). Ischial urethrotomy was performed in male horses to provide a portal for the endoscope and laser fiber. Calculus fragments were removed by a combination of lavage, transendoscopic basket snare removal, forceps, and digital manipulation. Ischial urethrotomies healed by second intention. Follow-up was obtained by recheck examination and telephone interview of owners. No major operative or postoperative complications occurred. Two calculi (1 stallion and 1 mare) were fragmented by a combination of laser ablation and manual disruption with a lithotrite. Postoperative dysuria occurred in the mare, but resolved after 1 month. Mean (+/- SD) follow-up was 306 +/- 149 days; no other complications were reported. Calcium carbonate urinary calculi (up to 15 cm in diameter) in horses can be effectively fragmented with a holmium:YAG laser. It is not known if this technique would be completely effective for larger calculi or extremely dense calculi. Calculus disruption by an endoscopically assisted holmium:YAG laser offers a minimally invasive method that can be performed in standing horses and that minimizes patient risk. Copyright 2002 by The American College of Veterinary Surgeons

Cystine-containing urinary calculi in dogs: 102 cases (1981-1989).

PubMed

Case, L C; Ling, G V; Franti, C E; Ruby, A L; Stevens, F; Johnson, D L

1992-07-01

One hundred and seven cystine-containing urinary calculi from 1 female and 101 male dogs were analyzed. Cystine-containing calculi accounted for 2% (107 of 5,375) of all canine urinary calculi submitted to the urinary stone analysis laboratory from July 1981 through December 1989. Male dogs that formed cystine calculi were compared with 3 other canine populations to determine whether certain breeds were apparently at increased or decreased risk for cystine calculus formation. In one or more of 3 population comparisons, significantly increased risk of cystine calculus formation was found in Mastiffs, Australian Cattle Dogs, English Bulldogs, Chihuahuas, Bullmastiffs, Newfoundlands, Dachshunds, Basenjis, Australian Shepherd Dogs, Scottish Deerhounds, Staffordshire Terriers, Miniature Pinschers, pitbull terriers, Welsh Corgis, Silky Terriers, and Bichon Frises. Significantly low risk of cystine calculus formation was found in German Shepherd Dogs, Poodles, Schnauzers, and mixed-breed dogs.

[Analysis of development, safety and efficacy of percutaneous nephrolithotomy for management of upper urinary tract calculi in pediatric patients].

PubMed

Yu, L P; Xu, T

2017-08-18

To evaluate the development, safety and efficacy of percutaneous nephrolithotomy(PNL) for management of upper urinary tract calculi in pediatric patients. In the study, 77 pediatric patients undergoing 87 PNLs through mini or standard tract for upper urinary tract calculi between January 2005 and December 2016 in Peking University People's hospital were reviewed, including 69 renal calculi, 6 upper ureteral calculi, 12 renal and upper ureteral calculi, 35 single calculi, 43 multiple calculi and 9 staghorn calculi. The development and efficacy of PNL in pediatric patients were studied by analyzing the characteristics and clinical indexes, and by reviewing the associated literature. The Clavien classification system was used to evaluate the complications after PNL. A total of 87 PNLs were performed in 77 pediatric patients. Eighty-one upper urinary tract calculi were managed through a single tract(93.1%), 5 pediatric patients were managed through 2 tracts(5.7%), and 1 pediatric patient was managed through 3 tracts(1.2%). The mean operating time was (77.0±29.8) min. The stone-free rate after one session was 100% for single calculi and 71.2% for multiple or staghorn calculi, 5(5.8%) children underwent auxiliary procedure to remove the residual calculi and the final stone-free rate of PNL was 88.5%. One of the main complications of pediatric PNL was fever. Sixteen (18.4%) had moderate fever(38-39 °C), 5 (5.7%) had high fever (39-40 °C) and there were no severe complications of infection, such as sepsis or septic shock. The mean hemoglobin loss was (10.3±16.1) g/L and the serum creatinine rise was (7.0±13.3) μmol/L. One(1.2%) pediatric patient suffered ureteroscopic lithotripsy because of the obstruction by the residual stone in ureter. No injury of organs or retroperitoneal urinary extravasation occurred. General assessment of the complications showed Clavien grade I complications in 14 (16.1%) pediatric patients, grade II in 7(8.0%) children and grade III in 1(1.2%) children. There was no grade IV or V complications. The overall complication rate was 25.3%. PNL for management of upper urinary tract calculi in pediatric patients is effective. Complications after PNL, as assessed with Clavien classification system, are mild and PNL in pediatric patients is safe.

Ultrastructure of selected struvite-containing urinary calculi from cats.

PubMed

Neumann, R D; Ruby, A L; Ling, G V; Schiffman, P S; Johnson, D L

1996-01-01

To elucidate the ultrastructural details of struvite-containing urinary calculi from cats. Specimens studied were inclusive of the range of textures visible during preliminary analysis by use of a stereoscopic dissecting microscope. Textural types, which were used to infer crystal growth conditions, were differentiated with regard to crystal habit, crystal size, growth orientation, and primary porosity. Thirty specimens were selected from a collection of approximately 1,600 feline urinary calculi: 20 of these were composed entirely of struvite, and 10 consisted of struvite and calcium phosphate (apatite). Qualitative and quantitative analyses of specimens included use of plain and polarized light microscopy, x-ray diffractometry, scanning electron microscopy with backscattered electron imagery, x-ray fluorescence scans, and electron probe microanalysis. Four textural types were recognized among struvite calculi, whereas 2 textural types of struvite-apatite calculi were described. The presence of minute, well interconnected primary pores in struvite-containing urinary calculi from cats is an important feature, which may promote possible interaction of calculi with changes in urine composition. Primary porosity, which can facilitate interaction between the calculus and changing urine composition, may explain the efficacy of dietary or medicinal manipulations to promote the dissolution of struvite-containing uroliths from this species.

Evaluation of low-dose dual energy computed tomography for in vivo assessment of renal/ureteric calculus composition

PubMed Central

Mahalingam, Harshavardhan; Mandal, Arup K; Singh, Shrawan Kumar; Bhattacharyya, Shalmoli; Khandelwal, Niranjan

2015-01-01

Purpose This study aimed to assess the accuracy of low-dose dual-energy computed tomography (DECT) in predicting the composition of urinary calculi. Materials and Methods A total of 52 patients with urinary calculi were scanned with a 128-slice dual-source DECT scanner by use of a low-dose protocol. Dual-energy (DE) ratio, weighted average Hounsfield unit (HU) of calculi, radiation dose, and image noise levels were recorded. Two radiologists independently rated study quality. Stone composition was assessed after extraction by Fourier transform infrared spectroscopy (FTIRS). Analysis of variance was used to determine if the differences in HU values and DE ratios between the various calculus groups were significant. Threshold cutoff values to classify the calculi into separate groups were identified by receiver operating characteristic curve analysis. Results A total of 137 calculi were detected. FTIRS analysis differentiated the calculi into five groups: uric acid (n=17), struvite (n=3), calcium oxalate monohydrate and dihydrate (COM-COD, n=84), calcium oxalate monohydrate (COM, n=28), and carbonate apatite (n=5). The HU value could differentiate only uric acid calculi from calcified calculi (p<0.001). The DE ratio could confidently differentiate uric acid, struvite, calcium oxalate, and carbonate apatite calculi (p<0.001) with cutoff values of 1.12, 1.34, and 1.66, respectively, giving >80% sensitivity and specificity to differentiate them. The DE ratio could not differentiate COM from COM-COD calculi. No study was rated poor in quality by either of the observers. The mean radiation dose was 1.8 mSv. Conclusions Low-dose DECT accurately predicts urinary calculus composition in vivo while simultaneously reducing radiation exposure without compromising study quality. PMID:26279828

Increased risk of urinary calculi in patients with migraine: a nationwide cohort study.

PubMed

Tsai, Min-Juei; Chen, Yung-Tai; Ou, Shuo-Ming; Shin, Chia-Jen; Peng, Kuan-Po; Tang, Chao-Hsiun; Wang, Shuu-Jiun

2015-07-01

Whether migraine is associated with urinary calculi is an unresolved issue, although topiramate, a migraine-preventive agent, is known to contribute to this complication. This study investigates the association between migraine and the risk of urinary calculi. We identified a total of 147,399 patients aged ≥18 years with migraine diagnoses recorded in the Taiwan National Health Insurance Research Database between 2005 and 2009. Each patient was randomly matched with one individual without headache using propensity scores. All participants were followed from the date of enrollment until urinary calculi development, death, or the end of 2010. The risk of urinary calculi was greater in the migraine than the control cohort (adjusted hazard ratio (aHR), 1.58; 95% confidence interval (CI), 1.52-1.63; p < 0.001, irrespective of the influence of topiramate. The risk was higher in younger and female patients. The magnitude of the risk was proportional to the annual frequency of clinic visits for headache (≥6 vs. <3, aHR = 1.11; 95% CI, 1.04-1.17; p = 0.002), but did not differ between migraine patients with and without aura. Our study showed migraine was associated with an increased risk of urinary calculi, independent of topiramate use. A higher frequency of clinic visits was associated with a greater risk. © International Headache Society 2014.

Prospective evaluation of Doppler sonography to detect the twinkling artifact versus unenhanced computed tomography for identifying urinary tract calculi.

PubMed

Kielar, Ania Z; Shabana, Wael; Vakili, Maryam; Rubin, Jonathan

2012-10-01

The twinkling artifact is an emerging tool for identifying urinary tract calculi. The purpose of this prospective study was to evaluate the diagnostic accuracy of the twinkling artifact compared to unenhanced computed tomography in detecting urolithasis. After Research Ethics Board approval, 51 patients with flank pain from the emergency department were enrolled between November 2009 and September 2010. Patients received an unenhanced computed tomographic scan with 1.25-mm raw data and reformatted 5-mm axial and 2-mm coronal images. Blinded assessment of the urinary tract was performed with gray-scale and color Doppler interrogation. The number of calculi, location, size, kidney distance from the skin, body mass index of the patient, and sonographic image parameters were recorded. There were 35 right-sided and 38 left-sided renal calculi, 14 right-sided and 21 left-sided ureteric calculi, and 6 bladder calculi (total, 114 calculi). Thirteen patients had no calculi. The average calculus size was 2.6 mm (range, 1-9 mm). There were 6 false-positive and 22 false-negative instances of twinkling artifacts. On gray-scale evaluation looking for an echogenic focus with shadowing, there were 8 false-positive and 40 false-negative findings. The positive predictive value (PPV) of the twinkling artifact for identifying calculi was 94%, and the sensitivity was 83%. The PPV of gray-scale sonographic shadowing was only 64.9%, and the sensitivity was 80.2%. The twinkling artifact has a high PPV for detecting renal and urinary tract calculi. Evaluation for the twinkling artifact is a complementary technique to standard gray-scale shadowing of calculi and improves detection of urolithiasis on sonography.

In vivo characterization of urinary calculi on dual-energy CT: going a step ahead with sub-differentiation of calcium stones.

PubMed

Acharya, Sudeep; Goyal, Ankur; Bhalla, Ashu Seith; Sharma, Raju; Seth, Amlesh; Gupta, Arun Kumar

2015-07-01

The role of dual-energy computed tomography (DECT) in characterization of urinary calculi is evolving and literature regarding differentiation of calcium calculi is sparse and confounding. To evaluate the capability of DECT in assessing the urinary calculi composition in vivo, especially in differentiating various types of calcium calculi. One hundred and twenty patients underwent DECT for characterization of urinary calculi. Seventy patients with 114 calculi, including 93 calcium stones, were retrospectively analyzed. DE ratios and attenuation differences were compared using ANOVA and receiver-operating-characteristic (ROC) analysis was done to predict cut-off values, in particular for detecting calcium-oxalate-monohydrate (COM) stones. DE ratio ≤1.14 accurately detected uric acid calculi, ≥1.29 was definitive for calcium and intermediate values were characteristic of cystine stones. DE ratios were significantly different between group 1 (COM [n = 32]; mean 1.376 ± 0.041), group 2 ([calcium oxalate dihydrate (COD) + COM] [n = 51]; 1.416 ± 0.048), and group 3 ([carbonate apatite (CaP) + COD + COM] [n = 10]; 1.468 ± 0.038) (group 1 vs. 2, P = 0.001; 1 vs. 3, P = 0.000; 2 vs. 3, P = 0.004). More importantly, pure COM calculi (group 1) had significantly lower DE ratio compared with mixed calcium calculi (groups 2 and 3) (P = 0.000). Attenuation differences (between low and high kV images) could not distinguish between COM and mixed calculi. ROC analysis for detection of COM calculi yielded AUC of 0.770 with cut-off DE ratio 1.385 (sensitivity 65.6%, specificity 82%) and value <1.335 was seen only with COM calculi (100% specificity). DECT can be employed for in vivo differentiation of various types of calculi and for detection of relatively lithotripsy-resistant COM calculi. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Bladder stones

MedlinePlus

Stones - bladder; Urinary tract stones; Bladder calculi ... Benway BM, Bhayani SB. Lower urinary tract calculi. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, PA: Elsevier; 2016:chap 55. Sharma R, ...

A combined qualitative and quantitative procedure for the chemical analysis of urinary calculi

PubMed Central

Hodgkinson, A.

1971-01-01

A better understanding of the physico-chemical principles underlying the formation of calculus has led to a need for more precise information on the chemical composition of stones. A combined qualitative and quantitative procedure for the chemical analysis of urinary calculi which is suitable for routine use is presented. The procedure involves five simple qualitative tests followed by the quantitative determination of calcium, magnesium, inorganic phosphate, and oxalate. These data are used to calculate the composition of the stone in terms of calcium oxalate, apatite, and magnesium ammonium phosphate. Analytical results and derived values for five representative types of calculi are presented. PMID:5551382

[Renal staghorn calculi in small children - presentation of two cases].

PubMed

Krzemień, Grażyna; Szmigielska, Agnieszka; Jankowska-Dziadak, Katarzyna; Pańczyk-Tomaszewska, Małgorzata

2016-01-01

Urolithiasis in children occurs with the incidence of 0.1-5%. Risk factors such as metabolic disorders, recurrent urinary tract infections and/or congenital abnormalities of urinary tract are detected in 75-85% of children with urolithiasis. Staghorn calculi is associated with delayed diagnosis and treatment of urinary tract infection caused by specific organisms, which produce the enzyme urease, promoting generation of ammonia and hydroxide from urea. We present two boys with staghorn calculi recognized in 8th and 31st month of age. The reason for performing ultrasonography was urinary tract infection in both boys. The younger child was previously healthy, with no symptoms of urolithiasis, the older one had recurrent urinary tract infections caused by Proteus mirabilis, episodes of anxiety and abdominal pain. Laboratory test and imaging studies excluded congenital abnormalities in the urinary tract and typical metabolic causes of urolithiasis in both boys. Treatment of infection-related stones in the younger child included two extracorporeal shock-wave lithotripsy (ESWL). In the older child, both ESWL and operation were performed. Staghorn calculi were composed of mixtures of magnesium ammonium phosphate (struvite) and calcium carbonate (apatite) and confirmed to be identified as infection-related stones. During follow-up in a nephrology outpatient clinic, values of blood pressure, renal ultrasonography, kidney function test were normal and no symptoms of urinary tract infections were clinically present. In patients with recurrent urinary tract infections, urolithiasis should be taken into consideration. The majority of staghorn calculi is often asymptomatic and can be diagnosed with an ultrasonography study performed routine or during urinary tract infection.

Renal calculi in primary hyperaldosteronism.

PubMed Central

Kabadi, U. M.

1995-01-01

Increased urinary calcium (Ca++) excretion and the presence of negative Ca++ balance is well documented in primary hyperaldosteronism. However, renal calculi as a major manifestation of this disorder has not previously been described. This report describes a patient who presented with renal calculi in association with primary hyperaldosteronism. We believe that primary hyperaldosteronism was a major pathogenetic factor in the formation of renal calculi since the increased urinary excretion of Ca++ and uric acid noted at onset declined following a short-term spironolactone administration and remission from renal calculi has persisted following initial nephrolithotomy and continued spironolactone therapy, which also corrected hypertension and hypokalemia, a hallmark of this disorder. Images Figure PMID:7479473

An Additional Potential Factor for Kidney Stone Formation during Space Flights: Calcifying Nanoparticles (Nanobacteria): A Case Report

NASA Technical Reports Server (NTRS)

Jones, Jeffrey A.; Ciftcioglu, Neva; Schmid, Joseph; Griffith, Donald

2007-01-01

Spaceflight-induced microgravity appears to be a risk factor for the development of urinary calculi due to skeletal calcium liberation and other undefined factors, resulting in stone disease in crewmembers during and after spaceflight. Calcifying nanoparticles, or nanobacteria, reproduce at a more rapid rate in simulated microgravity conditions and create external shells of calcium phosphate in the form of apatite. The questions arises whether calcifying nanoparticles are niduses for calculi and contribute to the development of clinical stone disease in humans, who possess environmental factors predisposing to the development of urinary calculi and potentially impaired immunological defenses during spaceflight. A case of a urinary calculus passed from an astronaut post-flight with morphological characteristics of calcifying nanoparticles and staining positive for a calcifying nanoparticle unique antigen, is presented.

Unenhanced CT findings can predict the development of urinary calculi in stone-free patients.

PubMed

Ciudin, Alexandru; Luque Galvez, Maria Pilar; Salvador Izquierdo, Rafael; Franco de Castro, Agustin; Garcia-Cruz, Eduardo; Alcover García, Juan; Alvarez-Vijande García, Jose Ricardo; Nicolau, Carlos; Alcaraz Asensio, Antonio

2012-09-01

To determine if calcium deposits in the papillae can be identified by unenhanced computed tomography (uCT) even before renal stones develop. A retrospective review of 413 patients with calculi identified 31 patients (stone-forming group) with a history of urinary tract calculi with a calculus demonstrated by uCT and a stone-free uCT before calculi had developed. The control group (n = 31) was composed of live kidney donors with no history of calculi and a stone-free uCT. CT attenuation was measured in all CTs using two regions of interest of 0.05 cm(2) and 0.1 cm(2) over the tip and the neighbouring area of the papillae. Student's and Wilcoxon t-tests were used for comparing results in the two groups. The attenuation of the tip of the papilla was higher in the stone-forming group when compared to the controls after (45.2 HU versus 32.1 HU, P = 0.001) and even before frank calculi had developed (44.2 HU versus 32.1 HU, P = 0.003). There was no significant difference in papillary attenuation in the stone group before and after calculi had developed (45.2 HU versus 44.2 HU, P = 0.82). Stone-forming patients exhibit higher papillary density even before calculi develop. This could define a population at risk of developing calculi.

Urolithiasis in dogs. IV: Survey of interrelations among breed, mineral composition, and anatomic location of calculi, and presence of urinary tract infection.

PubMed

Ling, G V; Franti, C E; Johnson, D L; Ruby, A L

1998-05-01

To compile and analyze selected data from a large number of canine urinary calculus specimens that were subjected to quantitative, layer-by-layer mineral analysis. 11,000 canine urinary calculus specimens: 5,781 from female dogs, 5,215 from male dogs, and 4 from dogs of unrecorded sex. Records of the Urinary Stone Analysis Laboratory, School of Veterinary Medicine, University of California were used to compile information regarding urinary calculus specimens from dogs. Records surveyed were of all canine calculi submitted for analysis between July 1981 and January 1994. Results analyzed included those of a mixed-breed group and 26 common breeds of stone-forming dogs. Interrelations of breed, sex, and age of the affected dogs, mineral composition of the specimens, and associated urinary tract infections were analyzed statistically. Proportions of culture-positive specimens were significantly correlated between the sexes (r = 0.494, P = 0.008). Staphylococcus intermedius was isolated most often from either sex, ranging from 36.1% (Basset Hounds) to 67.9% (Pekingese) of cultured specimens from females and 8.7% (Chihuahuas) to 71.4% (Scottish Terriers) of specimens from males. The second most frequently isolated bacterial species, Escherichia coli, ranged from 0% in males of 2 breeds and females of 4 breeds to 25% in Cairn Terrier males and 19.4% in Basset Hound females. Streptococcus spp were the third most frequently isolated bacterial species. Significant correlations between the sexes were found for percentages of calculi located in the urinary bladder (r = 0.490, P = 0.008), and for calculi voided in the urine (r = 0.503, P = 0.006). Breed and sex differences in prevalence of urolithiasis- and mineral-associated bacterial infections are numerous. Staphylococcus intermedius was the most common isolate from specimens from all but 3 of 54 breed/sex groupings. For either sex, streptococcal infections were significantly related to proportions of calculi passed in the urine.

Outcomes of urethral calculi patients in an endemic region and an undiagnosed primary fossa navicularis calculus.

PubMed

Verit, Ayhan; Savas, Murat; Ciftci, Halil; Unal, Dogan; Yeni, Ercan; Kaya, Mete

2006-02-01

Urethral calculus is a rare form of urolithiasis with an incidence lower than 0.3%. We determined the outcomes of 15 patients with urethral stone, of which 8 were pediatric, including an undiagnosed primary fossa navicularis calculus. Fifteen consecutive male patients, of whom eight were children, with urethral calculi were assessed between 2000 and 2005 with a mean of 19 months' follow-up. All stones were fusiform in shape and solitary. Acute urinary retention, interrupted or weak stream, pain (penile, urethral, perineal) and gross hematuria were the main presenting symptoms in 7 (46.7%), 4 (26.7%), 3 (20%) and 1 (6.6%) patient, respectively. Six of them had accompanying urethral pathologies such as stenosis (primary or with hypospadias) and diverticulum. Two patients were associated with upper urinary tract calculi but none of them secondary to bladder calculi. A 50-year-old patient with a primary urethral stone disease had urethral meatal stenosis accompanied by lifelong lower urinary tract symptoms. Unlike the past reports, urethral stones secondary to bladder calculi were decreasing, especially in the pediatric population. However, the pediatric patients in their first decade are still under risk secondary to the upper urinary tract calculi or the primary ones.

Acute urinary retention in women due to urethral calculi: A rare case

PubMed Central

Turo, Rafal; Smolski, Michal; Kujawa, Magda; Brown, Stephen C.W.; Brough, Richard; Collins, Gerald N.

2014-01-01

We present a case of a 51-year-old woman with acute urinary retention caused by a urethral calculus. Urethral calculi in women are extremely rare and are usually formed in association with underlying genitourinary pathology. In this case, however, no pathology was detected via thorough urological evaluation. We discuss the pathogenesis, clinical presentation and treatment of urethral calculi. To our knowledge, this is the second reported case of a primary urethral calculus in a female with an anatomically normal urinary tract and the first in a middle-aged Caucasian female. PMID:24554984

Holmium:YAG laser lithotripsy: A dominant photothermal ablative mechanism with chemical decomposition of urinary calculi.

PubMed

Chan, K F; Vassar, G J; Pfefer, T J; Teichman, J M; Glickman, R D; Weintraub, S T; Welch, A J

1999-01-01

Evidence is presented that the fragmentation process of long-pulse Holmium:YAG (Ho:YAG) lithotripsy is governed by photothermal decomposition of the calculi rather than photomechanical or photoacoustical mechanisms as is widely thought. The clinical Ho:YAG laser lithotriptor (2.12 microm, 250 micros) operates in the free-running mode, producing pulse durations much longer than the time required for a sound wave to propagate beyond the optical penetration depth of this wavelength in water. Hence, it is unlikely that shock waves are produced during bubble formation. In addition, the vapor bubble induced by this laser is not spherical. Thus the magnitude of the pressure wave produced at cavitation collapse does not contribute significantly to lithotripsy. A fast-flash photography setup was used to capture the dynamics of urinary calculus fragmentation at various delay times following the onset of the Ho:YAG laser pulse. These images were concurrently correlated with pressure measurements obtained with a piezoelectric polyvinylidene-fluoride needle-hydrophone. Stone mass-loss measurements for ablation of urinary calculi (1) in air (dehydrated and hydrated) and in water, and (2) at pre-cooled and at room temperatures were compared. Chemical and composition analyses were performed on the ablation products of several types of Ho:YAG laser irradiated urinary calculi, including calcium oxalate monohydrate (COM), calcium hydrogen phosphate dihydrate (CHPD), magnesium ammonium phosphate hexahydrate (MAPH), cystine, and uric acid calculi. When the optical fiber was placed perpendicularly in contact with the surface of the target, fast-flash photography provided visual evidence that ablation occurred approximately 50 micros after the initiation of the Ho:YAG laser pulse (250-350 micros duration; 375-400 mJ per pulse), long before the collapse of the cavitation bubble. The measured peak acoustical pressure upon cavitation collapse was negligible (< 2 bars), indicating that photomechanical forces were not responsible for the observed fragmentation process. When the fiber was placed in parallel to the calculus surface, the pressure peaks occurring at the collapse of the cavitation were on the order of 20 bars, but no fragmentation occurred. Regardless of fiber orientation, no shock waves were recorded at the beginning of bubble formation. Ablation of COM calculi (a total of 150 J; 0.5 J per pulse at an 8-Hz repetition rate) revealed different Ho:YAG efficiencies for dehydrated calculus, hydrated calculus, and submerged calculus. COM and cystine calculi, pre-cooled at -80 degrees C and then placed in water, yielded lower mass-loss during ablation (20 J, 1.0 J per pulse) compared to the mass-loss of calculi at room temperature. Chemical analyses of the ablated calculi revealed products resulting from thermal decomposition. Calcium carbonate was found in samples composed of COM calculi; calcium pyrophosphate was found in CHPD samples; free sulfur and cysteine were discovered in samples composed of cystine samples; and cyanide was found in samples of uric acid calculi. These experimental results provide convincing evidence that long-pulse Ho:YAG laser lithotripsy causes chemical decomposition of urinary calculi as a consequence of a dominant photothermal mechanism. Copyright 1999 Wiley-Liss, Inc.

Renal Calculi

PubMed Central

Yendt, E. R.

1970-01-01

The pathogenesis of renal calculi is reviewed in general terms followed by the results of investigation of 439 patients with renal calculi studied by the author at Toronto General Hospital over a 13-year period. Abnormalities of probable pathogenetic significance were encountered in 76% of patients. Idiopathic hypercalciuria was encountered in 42% of patients, primary hyperparathyroidism in 11%, urinary infection in 8% and miscellaneous disorders in 8%. The incidence of uric acid stones and cystinuria was 5% and 2% respectively. In the remaining 24% of patients in whom no definite abnormalities were encountered the mean urinary magnesium excretion was less than normal. Of 180 patients with idiopathic hypercalciuria, only 24 were females. In the diagnosis of hyperparathyroidism, the importance of detecting minimal degrees of hypercalcemia is stressed; attention is also drawn to the new observation that the upper limit of normal for serum calcium is slightly lower in females than in males. The efficacy of various measures advocated for the prevention of renal calculi is also reviewed. In the author's experience the administration of thiazides has been particularly effective in the prevention of calcium stones. Thiazides cause a sustained reduction in urinary calcium excretion and increase in urinary magnesium excretion. These agents also appear to affect the skeleton by diminishing bone resorption and slowing down bone turnover. PMID:5438766

Metabolic factors associated with urinary calculi in children.

PubMed

Naseri, Mitra; Varasteh, Abdol Reza; Alamdaran, Seied Ali

2010-01-01

We aimed to identify metabolic and anatomical abnormalities present in children with urinary calculi. Metabolic evaluation was done in 142 pediatric calculus formers. Evaluation included serum biochemistry; measurement of daily excretion of urinary calcium, uric acid, oxalate, citrate, and magnesium (in older children); and measurement of calcium, uric acid, oxalate, and creatinine in random urine samples in nontoilet-trained patients. Urinary tests for cystinuria were also performed. All of the patients underwent renal ultrasonography. Sixty-one patients (42.7%) had metabolic abnormalities. Anatomical abnormalities were found in 12 patients (8.4%). Three children (2.1%) had infectious calculi, and 3(2.1%) had a combination of metabolic and anatomic abnormalities. In 66 children (46.2 %) we did not find any reasons for calculus formation (idiopathic). Urinalysis revealed hypercalciuria in 25 (17.6%), hyperuricosuria in 23 (16.1%), hyperoxaluria in 17 (11.9%), cystinuria in 9 (6.3%), hypocitraturia in 3 (2.1%), and low urinary magnesium level in 1 (0.7%) patients. Sixteen patients (11.2%) had mixed metabolic abnormalities. Metabolic abnormalities are common in pediatric patients with urinary calculi. In our study, calcium and uric acid abnormalities were the most common, and vesicoureteral reflux seemed to be the most common urological abnormality which led to urinary stasis and calculus formation.

Hydronephrosis of one kidney

MedlinePlus

... Acute hydronephrosis; Urinary obstruction; Unilateral hydronephrosis; Nephrolithiasis - hydronephrosis; Kidney stone - hydronephrosis; Renal calculi - hydronephrosis; Ureteral calculi - hydronephrosis; ...

Percutaneous nephrolithotomy in patients with a solitary kidney.

PubMed

Süelözgen, Tufan; Budak, Salih; Celik, Orcun; Yalbuzdag, Okan; Mertoglu, Oguz; Isoglu, Selcuk; Yoldas, Mehmet; Ilbey, Yusuf Ozlem

2014-12-30

The results of percutaneous nephrolithotomy applied to 716 patients in our clinic between January 2008 and January 2014 were retrospectively evaluated. Age, gender, urinary calculi size (mm(2)), urinary calculi localization, ESWL history, operation duration (min), fluoroscopy duration (sec), access type, reason of solitary kidney, hemoglobin drawdown (g/dl) and operation success of the patients with a solitary kidney were recorded. The patients having no preoperative and postoperative non contrast abdominal tomography were excluded from the study. Fifteen of nineteen patients (79%) were men and 4 of them (21%) were women. The average age of the patients was 42.52 ± 16.72 (14-72). Ten patients had anatomical solitary kidney and nine patients had physiological solitary kidney. In fact counter kidney was non functional in 9 patients (47%) whereas there was agenesis in 2 (11%) and outcome of nephrectomy in 8 (42%) patients. In our study, presence of residual stone less than 4 mm at 1st month postoperative non contrast abdominal tomography was accepted as a successful result and accordingly our success rate was detected as 84%. Mean urinary calculi size was 405 ± 252.9 mm(2); urinary calculi localization was pelvic, lower pole, upper-middle pole, middle-lower pole and staghorn in 11 (58%), 4 (21%), 1 (5%), 1 (5%) and 1 (5%) patients, respectively; previous ESWL history was 16%; operation duration was 55.47-± 28.1 min and fluoroscopy duration 131.10 ± 87.6 sec; access type was subcostal in 79%, supracostal in 10.5% and multiple in 10.5%; hemoglobin drawdown was 1.75 ± 0.97 mg/dl. PNL can be effectively and safely administered for the treatment of solitary kidney. In the treatment of large urinary calculi in patients with a solitary kidney, PNL has some advantages such as short surgery duration, less complication, acceptable hemoglobin drawdown and high success rates. According to our study, PNL operation in patients with a solitary kidney is a good option for carefully and poisedly selected cases.

New potential solutions for the chemolysis of urinary phosphate calculi determined by an in vitro study.

PubMed

Zhang, Jinqing; Wang, Shuo; Hong, Jingfan; Liu, Chunxiao; Jiang, Yanbin

2015-04-01

To find a more efficient solution for chemolysis of urinary calculi, several organic acids were chosen to form solutions by consulting the composition of a classic solution, Suby G. The solutions together with Renacidin, another classic solution, were designed to react with the 4 phosphate components of urinary stone. The processes were real-time measured and analysed by a focused beam reflectance measurement, and the efficiency factors were investigated and discussed in detail. The results show that several organic acids, e.g. hydroxyacetic acid, lactic acid and α-ketoglutaric acid, are more efficient than citric acid in dissolving urinary phosphate calculus. The new solutions containing the organic acids are promising for improving chemolysis treatment.

Are prostatic calculi independent predictive factors of lower urinary tract symptoms?

PubMed

Park, Sung-Woo; Nam, Jong-Kil; Lee, Sang-Don; Chung, Moon-Kee

2010-03-01

We determined the correlation between prostatic calculi and lower urinary tract symptoms (LUTS), as well as the predisposing factors of prostatic calculi. Of the 1 527 patients who presented at our clinic for LUTS, 802 underwent complete evaluations, including transrectal ultrasonography, voided bladder-3 specimen and international prostatic symptoms score (IPSS). A total of 335 patients with prostatic calculi and 467 patients without prostatic calculi were divided into calculi and no calculi groups, respectively. Predictive factors of severe LUTS and prostatic calculi were determined using uni/multivariate analysis. The overall IPSS score was 15.7 +/- 9.2 and 14.1 +/- 9.2 in the calculi and no calculi group, respectively (P = 0.013). The maximum flow rate was 12.1 +/- 6.9 and 14.2 +/- 8.2 mL s(-1) in the calculi and no calculi group, respectively (P = 0.003). On univariate analysis for predicting factors of severe LUTS, differences on age (P = 0.042), prostatic calculi (P = 0.048) and prostatitis (P = 0.018) were statistically significant. However, on multivariate analysis, no factor was significant. On multivariate analysis for predisposing factors of prostatic calculi, differences on age (P < 0.001) and prostate volume (P = 0.001) were significant. To our knowledge, patients who have prostatic calculi complain of more severe LUTS. However, prostatic calculi are not an independent predictive factor of severe LUTS. Therefore, men with prostatic calculi have more severe LUTS not only because of prostatic calculi but also because of age and other factors. In addition, old age and large prostate volume are independent predisposing factors for prostatic calculi.

Minimally invasive management with holmium laser in total urinary tract calculi.

PubMed

Zhang, Xiao; Yu, Jianjun; Yang, Ranxing

2013-05-01

The purpose of this article was to study the management of total urinary tract calculi using holmium laser minimally invasive techniques. It is rare for patients to present kidney stones, ureteral stones, and bladder stones simultaneously, and their treatment is considered to be complicated and difficult, specifically by minimally invasive techniques. We collected seven cases of total urinary tract calculi from May 2007 to September 2012. Three cases were unilateral, and the others were bilateral. All of the cases presented calculus in the bladder, ureter, and kidney, which were secondary to the long-term indwelling double J stent or lower urinary obstruction. Extracorporeal shock-wave lithotripsy (SWL) was administered first, followed by the operation. For patients with bilateral calculi, at one stage, ureteroscopic lithotripsy (URL) with holmium laser was performed in all four cases to remove the bladder and bilateral ureter stones. Then, all patients underwent percutaneous nephrolithotomy (PCNL) with holmium procedures to address the bilateral kidney and upper ureter stones at the second stage. The indwelling double J stents were removed at the same time. For the patients with unilateral calculi, we performed a single operation, but it was conducted using the same treatment sequence as the bilateral procedure. The related symptoms in all cases disappeared after the operation. Re-examination showed that the stones were nearly dissolved and that renal function was recovered. URL with holmium laser for the bladder and ureters combined with PCNL to dissolve kidney and upper ureteral stones could be the ideal choice for the treatment of total urinary tract calculi.

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

Silicate calculi, a rare cause of kidney stones in children.

PubMed

Taşdemir, Mehmet; Fuçucuoğlu, Dilara; Özman, Oktay; Sever, Lale; Önal, Bülent; Bilge, Ilmay

2017-02-01

Urinary silicate calculi in humans are extremely rare. Reported cases of silicate calculi are mostly documented in adults and are commonly related to an excessive intake of magnesium trisilicate in food or drugs. Published studies on the presence of silicate calculi in children are scarce. Three cases of silicate kidney stones without prior silicate intake are reported. Two patients underwent surgical treatment, and the third patient was treated using conservative methods. Urinalysis revealed no underlying metabolic abnormalities. Analyses revealed that silicate was the major component of the stones. Siliceous deposits in urinary stones may be more common than anticipated, and the underlying pathophysiology remains to be clarified.

Extracorporeal shockwave lithotripsy, endourology and open surgery: the management and follow-up of 200 patients with urinary calculi.

PubMed Central

Webb, D. R.; McNicholas, T. A.; Whitfield, H. N.; Wickham, J. E.

1985-01-01

The management and follow up of 200 consecutive patients with renal and ureteric calculi are presented. The primary treatment of 185 (92.5%) was by extracorporeal shockwave lithotripsy (ESWL), of whom three (1.6)%) with large calculi underwent percutaneous nephrolithotripsy (PCNL) prior to ESWL as a planned combined procedure. Twelve (6%) were treated by PCNL or ureterorenoscopy (URS) as their definitive treatment and three (1.5%) by conventional open renal and ureteric surgery. The average in-patient stay was 3.8 days and most returned to normal activity within one day of discharge. Of the 185 patients 102 (55%) required no analgesia after treatment by ESWL, 29 (15.6%) required parenteral analgesia and the rest were comfortable with oral non-narcotic medication. Thirty (16%) required auxillary treatment by percutaneous nephrostomy (PCN), PCNL and URS following ESWL for obstructive complications from stone particles. Two required further ESWL and one PCNL at three months for large fragments. Overall, open surgery was required for only 1% of renal calculi and 13% of ureteric stones. These results are consistant with the extensive West German experience confirming that most urinary calculi are now best managed by ESWL and endoscopic techniques. Where these facilities are available open surgery should only be necessary for less than 5% of upper urinary tract stones. PMID:4073760

Evaluation of low-dose dual energy computed tomography for in vivo assessment of renal/ureteric calculus composition.

PubMed

Mahalingam, Harshavardhan; Lal, Anupam; Mandal, Arup K; Singh, Shrawan Kumar; Bhattacharyya, Shalmoli; Khandelwal, Niranjan

2015-08-01

This study aimed to assess the accuracy of low-dose dual-energy computed tomography (DECT) in predicting the composition of urinary calculi. A total of 52 patients with urinary calculi were scanned with a 128-slice dual-source DECT scanner by use of a low-dose protocol. Dual-energy (DE) ratio, weighted average Hounsfield unit (HU) of calculi, radiation dose, and image noise levels were recorded. Two radiologists independently rated study quality. Stone composition was assessed after extraction by Fourier transform infrared spectroscopy (FTIRS). Analysis of variance was used to determine if the differences in HU values and DE ratios between the various calculus groups were significant. Threshold cutoff values to classify the calculi into separate groups were identified by receiver operating characteristic curve analysis. A total of 137 calculi were detected. FTIRS analysis differentiated the calculi into five groups: uric acid (n=17), struvite (n=3), calcium oxalate monohydrate and dihydrate (COM-COD, n=84), calcium oxalate monohydrate (COM, n=28), and carbonate apatite (n=5). The HU value could differentiate only uric acid calculi from calcified calculi (p<0.001). The DE ratio could confidently differentiate uric acid, struvite, calcium oxalate, and carbonate apatite calculi (p<0.001) with cutoff values of 1.12, 1.34, and 1.66, respectively, giving >80% sensitivity and specificity to differentiate them. The DE ratio could not differentiate COM from COM-COD calculi. No study was rated poor in quality by either of the observers. The mean radiation dose was 1.8 mSv. Low-dose DECT accurately predicts urinary calculus composition in vivo while simultaneously reducing radiation exposure without compromising study quality.

[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.

Are prostatic calculi independent predictive factors of lower urinary tract symptoms?

PubMed Central

Park, Sung-Woo; Nam, Jong-Kil; Lee, Sang-Don; Chung, Moon-Kee

2010-01-01

We determined the correlation between prostatic calculi and lower urinary tract symptoms (LUTS), as well as the predisposing factors of prostatic calculi. Of the 1 527 patients who presented at our clinic for LUTS, 802 underwent complete evaluations, including transrectal ultrasonography, voided bladder-3 specimen and international prostatic symptoms score (IPSS). A total of 335 patients with prostatic calculi and 467 patients without prostatic calculi were divided into calculi and no calculi groups, respectively. Predictive factors of severe LUTS and prostatic calculi were determined using uni/multivariate analysis. The overall IPSS score was 15.7 ± 9.2 and 14.1 ± 9.2 in the calculi and no calculi group, respectively (P = 0.013). The maximum flow rate was 12.1 ± 6.9 and 14.2 ± 8.2 mL s−1 in the calculi and no calculi group, respectively (P = 0.003). On univariate analysis for predicting factors of severe LUTS, differences on age (P = 0.042), prostatic calculi (P = 0.048) and prostatitis (P = 0.018) were statistically significant. However, on multivariate analysis, no factor was significant. On multivariate analysis for predisposing factors of prostatic calculi, differences on age (P < 0.001) and prostate volume (P = 0.001) were significant. To our knowledge, patients who have prostatic calculi complain of more severe LUTS. However, prostatic calculi are not an independent predictive factor of severe LUTS. Therefore, men with prostatic calculi have more severe LUTS not only because of prostatic calculi but also because of age and other factors. In addition, old age and large prostate volume are independent predisposing factors for prostatic calculi. PMID:19966831

Cystine calculi: challenging group of stones.

PubMed

Ahmed, Kamran; Dasgupta, Prokar; Khan, Mohammad Shamim

2006-12-01

Cystinuria is an autosomal recessive disorder in renal tubular and intestinal transport of dibasic amino acids, which results in increased urinary excretion of cystine, ornithine, lysine and arginine. It affects 1 in 20 000 people and is caused by a defect in the rBAT gene on chromosome 2. Development of urinary tract cystine calculi is the only clinical manifestation of this disease. Owing to recurrent episodes of stone formation, these patients require a multi-modal approach to management. The role of medical management and minimally invasive surgery was reviewed for the treatment of cystinuria.

Investigation of the microstructure and mineralogical composition of urinary calculi fragments by synchrotron radiation X-ray microtomography: a feasibility study.

PubMed

Kaiser, Jozef; Holá, Markéta; Galiová, Michaela; Novotný, Karel; Kanický, Viktor; Martinec, Petr; Sčučka, Jiří; Brun, Francesco; Sodini, Nicola; Tromba, Giuliana; Mancini, Lucia; Kořistková, Tamara

2011-08-01

The outcomes from the feasibility study on utilization of synchrotron radiation X-ray microtomography (SR-μCT) to investigate the texture and the quantitative mineralogical composition of selected calcium oxalate-based urinary calculi fragments are presented. The comparison of the results obtained by SR-μCT analysis with those derived from current standard analytical approaches is provided. SR-μCT is proved as a potential effective technique for determination of texture, 3D microstructure, and composition of kidney stones.

Urethral calculi in young-adult Nigerian males: a case series.

PubMed

Gali, B M; Ali, N; Agbese, G O; Garba, I I; Musa, K

2011-01-01

Urethral calculi are rare and usually encountered in males with urethral pathology. To present our experience managing urethral calculi in a resource limited centre and review the literature. We did a chart review of management of patients with urethral calculi between January and April 2009, at Federal Medical Centre (FMC) Azare, Nigeria. We also reviewed the literature on this rare condition. Four young adult male Nigerians between the ages of 17 and 27 years presented with varying degrees of urethral pain and palpable calculi in the anterior urethra. Two presented with acute retention of urine, but none had haematuria. The calculi were radio-opaque, located in the anterior urethra with no associated urethral pathology. Three were solitary and one multiple. The composition of the urethral calculi was a mixture of calcium oxalate calcium carbonate, magnesium phosphate, one has additional cystine but none had struvite or uric acid. Their sizes ranged between 1cm ×1.5cm and 1.5cm × 5.5cm. External urethrotomy was the method of treatment. Urethral calculi are rare in our setting, with no clear identifiable aetiological factors which suggests urinary schistosomiasisbeing associsted. The occurrence of urethral calculi appears to have a relationship with childhood urinary schistosomasis.

Extensive prostatic calculi in alkaptonuria: An unusual manifestation of rare disease.

PubMed

Sali, Gaurav; Thomas, Appu; Kumar, Ginil; Nair, Balagopalan; Sanjeevan, Kalvampara; Mathew, Georgie; Nair, Kannan

2015-07-01

Extensive prostatic calculi in a young man should always elicit the suspicion of alkaptonuria. Although prostatic calculi are seen in chronic prostatitis, chronic pelvic pain syndrome and benign prostate hyperplasia, none of these have prostatic calculi or calcification as extensive as in alkaptonuria. A 36 years young man who had severed obstructive lower urinary tract symptoms with extensive prostatic calculi was found to be alkaptonuric on further evaluation.

Lithotripsy

MedlinePlus

... Laser lithotripsy; Percutaneous lithotripsy; Endoscopic lithotripsy; ESWL; Renal calculi-lithotripsy ... Lingeman JE. Surgical management of upper urinary tract calculi. In: Wein AJ, Kavoussi LR, Partin AW, Peters ...

Urinary calculi composed of uric acid, cystine, and mineral salts: differentiation with dual-energy CT at a radiation dose comparable to that of intravenous pyelography.

PubMed

Thomas, Christoph; Heuschmid, Martin; Schilling, David; Ketelsen, Dominik; Tsiflikas, Ilias; Stenzl, Arnulf; Claussen, Claus D; Schlemmer, Heinz-Peter

2010-11-01

To retrospectively evaluate radiation dose, image quality, and the ability to differentiate urinary calculi of differing compositions by using low-dose dual-energy computed tomography (CT). The institutional review board approved this retrospective study; informed consent was waived. A low-dose dual-energy CT protocol (tube voltage and reference effective tube current-time product, 140 kV and 23 mAs and 80 kV and 105 mAs; collimation, 64 × 0.6 mm; pitch, 0.7) for the detection of urinary calculi was implemented into routine clinical care. All patients (n = 112) who were examined with this protocol from July 2008 to August 2009 were included. The composition of urinary calculi was assessed by using commercially available postprocessing software and was compared with results of the reference standard (ex vivo infrared spectroscopy) in 40 patients for whom the reference standard was available. Effective doses were calculated. Image quality was rated subjectively and objectively and was correlated with patient size expressed as body cross-sectional area at the level of acquisition by using Spearman correlation coefficients. One calcified concrement in the distal ureter of an obese patient was mistakenly interpreted as mixed calcified and uric acid. One struvite calculus was falsely interpreted as cystine. All other uric acid, cystine, and calcium-containing calculi were correctly identified by using dual-energy CT. The mean radiation dose was 2.7 mSv. The average image quality was rated as acceptable, with a decrease in image quality in larger patients. Low-dose unenhanced dual-source dual-energy CT can help differentiate between calcified, uric acid, and cystine calculi at a radiation dose comparable to that of conventional intravenous pyelography. Because of decreased image quality in obese patients, only nonobese patients should be examined with this protocol. © RSNA, 2010.

Influence of prostatic calculi on lower urinary tract symptoms in middle-aged men.

PubMed

Kim, Woong Bin; Doo, Seung Whan; Yang, Won Jae; Song, Yun Seob

2011-08-01

To investigate the incidence and echographic patterns of prostatic calculi, and to determine whether the presence of prostatic calculi is an associated factor for moderate lower urinary tract symptom (LUTS) in middle-aged men. Between October 2007 and June 2010, 1575 consecutive ostensibly healthy Korean men aged 40-59 years visited the health promotion center for a routine check-up and were enrolled. All men had a complete history, physical examination, and an international prostate symptom score (IPSS) questionnaire. Based on the echo patterns of the prostatic calculi by transrectal ultrasound, the men were divided in 3 groups-no calculi; type A calculi (discrete, small echoes); and type B calculi (large masses of multiple echoes, much coarser). In total, 1563 men were included. Measurable calcifications in the prostate gland were found in 799 men (51.1%). Small calculi (type A) were found in 615 men (39.3%) and large calculi (type B) were found in 184 men (11.8%). In the multivariate analysis, old age (>50 years), obesity (body mass index >25 kg/m(2)), and large calculi (type B) were significant associated factors for higher IPSS ≥8. The likelihood of IPSS being ≥8 was related to large calculi group with a 1.784-fold increase in risk over no and small calculi (P <.001). The presence of large prostatic calculi is a significant associated factor of moderate LUTS, whereas there was no statistical difference in IPSS analyzed between the no calculi and small calculi group. Copyright © 2011 Elsevier Inc. All rights reserved.

Material decomposition images generated from spectral CT: detectability of urinary calculi and influencing factors.

PubMed

Lv, Peijie; Zhang, Yonggao; Liu, Jie; Ji, Lijuan; Chen, Yan; Gao, Jianbo

2014-01-01

To evaluate the detectability of urinary calculi on material decomposition (MD) images generated from spectral computed tomography (CT) and identify the influencing factors. Forty-six patients were examined with true nonenhanced (TNE) CT and spectral CT urography in the excretory phase. The contrast medium was removed from excretory phase images using water-based (WB) and calcium-based (CaB) MD analysis. The sensitivity for detection on WB and CaB images was evaluated using TNE results as the reference standard. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) on MD images were evaluated. Using logistic regression, the influences of image noise, attenuation, stone size, and patient's body mass index (BMI) were assessed. Threshold values with maximal sensitivity and specificity were calculated by means of receiver operating characteristic analyses. One hundred thirty-six calculi were detected on TNE images; 98 calculi were identified on WB images (sensitivity, 72.06%) and 101 calculi on CaB images (sensitivity, 74.26%). Sensitivities were 76.92% for the 3-5-mm stones and 84.51% for the 5-mm or larger stones on both WB and CaB images but reduced to 46.15% on WB images and 53.85% on CaB images for small calculi (<3 mm). Compared to WB images, CaB images showed lower image noise, higher SNR but similar CNR. Larger stone sizes (both >2.71 mm on WB and CaB) and greater CT attenuation (>280 Hounsfield units [HU] on WB, >215 HU on CaB) of the urinary stones were significantly associated with higher stone visibility rates on WB and CaB images (P ≤ .003). Image noise and BMI showed no impact on the stone detection. MD images generated from spectral CT showed good reliability for the detection of large (>2.71 mm) and hyperattenuating (>280 HU on WB, >215 HU on CaB) urinary calculi. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

A Giant Urethral Calculus.

PubMed

Sigdel, G; Agarwal, A; Keshaw, B W

2014-01-01

Urethral calculi are rare forms of urolithiasis. Majority of the calculi are migratory from urinary bladder or upper urinary tract. Primary urethral calculi usually occur in presence of urethral stricture or diverticulum. In this article we report a case of a giant posterior urethral calculus measuring 7x3x2 cm in a 47 years old male. Patient presented with acute retention of urine which was preceded by burning micturition and dribbling of urine for one week. The calculus was pushed in to the bladder through the cystoscope and was removed by suprapubic cystolithotomy.

Plasma shield lasertripsy: in vitro studies.

PubMed

Bhatta, K M; Rosen, D I; Dretler, S P

1989-10-01

A technique for safer and more effective pulsed laser lithotripsy of urinary and biliary calculi was investigated in vitro. The technique involves enclosing the distal end of the laser delivery fiber in a "plasma shield." The plasma shield is a specially designed metal cap that serves to transfer the laser-induced mechanical impulse to the calculus while shielding surrounding tissue from direct laser exposure and thermal radiation. The metal cap also offers the advantage of effectively blunting the sharp fiber tip and improving its visualization under fluoroscopy. Plasma shield lithotripsy using a 200 micron quartz fiber inserted into a section of a modified 0.034 in. diameter stainless steel guide wire was tested in vitro on a variety of calculi and compared with results obtained using a 200 micron laser fiber applied directly. Calculi tested included cystine, struvite and calcium oxalate dihydrate urinary stones and pigmented cholesterol gallstones. The laser source was a flashlamp-pumped dye laser producing pulses of 1.2 microsecond duration and operated at a wavelength of 504 nm and pulse repetition frequency of 5 Hz. The results show that plasma shield lasertripsy is as effective as direct lasertripsy for fragmenting gallstones, struvite and calcium oxalate dihydrate calculi, is potentially safer, and can fragment cystine calculi which the pulsed dye laser applied directly cannot.

Fourier Transform Infrared Analysis of Urinary Calculi and Metabolic Studies in a Group of Sicilian Children.

PubMed

D'Alessandro, Maria Michela; Gennaro, Giuseppe; Tralongo, Pietro; Maringhini, Silvio

2017-05-01

Prevalence of urinary calculi in children has been increasing in the past years. We performed an analysis of the chemical composition of stones formers of the pediatric population in our geographical area over the years 2005 to 2013. Fourier transform infrared spectroscopy was employed for the determination of the calculus composition of a group of Sicilian children, and metabolic studies were performed to formulate the correct diagnosis and establish therapy. The prevalence of stone formation was much higher for boys than for girls, with a sex ratio of 1.9:1. The single most frequent component was found to be calcium oxalate monohydrate, and calcium oxalates (pure or mixed calculi) were the overall most frequent components. Calcium phosphates ranked 2nd for frequency, most often in mixed calculi, while urates ranked 3rd. The metabolic disorder most often associated with pure calcium oxalate monohydrate calculi was hypocitraturia, while hyperoxaluria was predominantly associated with calcium oxalate dihydrate calculi. Mixed calculi had the highest prevalence in our pediatric population. Our data showed that Fourier transform infrared spectroscopy was a useful tool for the determination of the calculi composition.

[Bacterial culture and drug sensitivity analysis of upper urinary tract calculi complicating with infection].

PubMed

Wang, Shu; Shi, Yong-kang; Huang, Xiao-bo; Ma, Kai; Xu, Qing-quan; Xiong, Lin-lin; Li, Jian-xing; Wang, Xia-feng

2014-10-18

To investigate the bacteriology and drug sensitivity of upper urinary tract calculi patients, and to provide information for choosing suitable antibiotics. In the study, 21 patients who suffered from lithiasis in upper urinary tract and required an emergency drainage for acute obstruction and infection were the "acute group"; 64 patients with calculi in upper urinary tract and accompanied with no infectious symptoms were the "common group". The bacteriology and drug sensitivity of the two groups were investigated. Gram-negative bacteria infected the most common of upper urinary tract calculi patients with infection, accounting for 71.4% in the acute group and 65.7% in the common group, among which Escherichia coli were the predominant ones (35.7% in the acute group and 32.9% in the common group). No difference was found between these two groups in bacterial distribution (P>0.05). Although the average drug resistance rate of Gram-negative bacteria in the acute group was higher than that in the common group, it revealed no significant difference (P>0.05). The drug resistance rate to semisynthetic penicillin, cefuroxime and ceftriaxone were more than 50%, 60%, and 50%, respectively. Quinolones, such as ciprofloxacin and levofloxacin, got a 45% drug resistance. Aminoglycoside, carbapenema were sensitive to Gram-negative bacteria. Cefoperazone/sulbactam and piperacillin/tazobactam were more effective than ceftriaxone and piperacillin, respectively. There was no significant difference between upper urinary tract calculi patients with acute infection and common infection in bacteriology and drug sensitivity. Semisynthetic penicillin, the second generation of cephalosporin and quinolone were no longer the good choices of empirical use. Antibiotics combined with β-lactamase inhibitors would be an ideal empirical therapeutic choice.

The incidence and location of prostatic calculi on noncontrast computed tomography images in patients with renal calculi.

PubMed

Balasar, Mehmet; Poyraz, Necdet; Göğer, Yunus Emre; Unal, Yunus; Pişkin, Mehmet Mesut

2015-08-01

In this study, the incidence and location of prostatic calculi on noncontrast abdominal computed tomography (NCACT) images of patients with and without renal stones were investigated. Between 2006 and 2013, NCACT images were taken of 133 patients treated for renal stones (Group I) and of 100 age-matched control patients with putative urinary stone disease (Group II) in our clinic. The incidence and location of prostatic calculi on these images were determined. The location of prostatic calculus was classified as type A if they were located in the main prostatic ducts, and type B if they were located outside the ducts. Prostatic calculi were present in 44.4% of patients in Group I and 21.0% of patients in Group II. The incidence of prostatic calculi was significantly higher in patients with urinary stones compared with those without (P<0.001). The location of prostatic calculi in Group I included 74.6% type A and 25.4% type B while in Group II the locations were 76.2% type A and 23.8% type B. The incidence of prostatic calculi is more prevalent in patients with renal stones. On NCACT images, prostatic calculi were mostly detected in the main prostatic ducts, which were defined as type A.

Flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants

PubMed Central

Li, Jun; Han, Tiandong; Tian, Ye; Wang, Wenying; Du, Yuan

2016-01-01

We evaluated the clinical value of flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants. Fifty-five infants with upper urinary tract calculi were included in this study: 41 males and 14 females. Retrograde intrarenal surgery was performed by an 8 Fr/30 cm flexible ureterorenoscope (POLY®) combined with a holmium laser. CT scanning or radiography of the kidneys, ureters, and bladder region was performed one month after the operation to confirm the clearance of calculi. All the 55 infants with calculi in 74 sides underwent 66 flexible ureteroscopic lithotripsy procedures. The median operation time was 30 min. The median amount of flushing fluid was 500 mL. The stone-free rate after a single session treatment was 94.6%, within which 10 infants underwent simultaneous bilateral flexible ureteroscopy lithotripsy. Catheters were retained in 45 infants for 24–48 h after the operation. Continuous high fever due to reflux was present in two cases. Flushing fluid extravasation was found in one infant. Some patients with minor complications, such as mild hematuria, irritation symptoms, and low fever, recovered without treatment. The duration of hospitalization time after the operation was approximately 1–5 days. Flexible ureteroscopic lithotripsy is a safe, highly efficient, minimally invasive, and reproducible operation for removal of upper urinary tract calculi in infants. This technique is a convenient method for postoperative management of patients that enhances their rapid recovery. It is a promising option for therapy of infants ineffectively treated by extracorporeal shockwave lithotripsy. PMID:27633576

Flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants.

PubMed

Li, Jun; Xiao, Jing; Han, Tiandong; Tian, Ye; Wang, Wenying; Du, Yuan

2017-01-01

We evaluated the clinical value of flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants. Fifty-five infants with upper urinary tract calculi were included in this study: 41 males and 14 females. Retrograde intrarenal surgery was performed by an 8 Fr/30 cm flexible ureterorenoscope (POLY®) combined with a holmium laser. CT scanning or radiography of the kidneys, ureters, and bladder region was performed one month after the operation to confirm the clearance of calculi. All the 55 infants with calculi in 74 sides underwent 66 flexible ureteroscopic lithotripsy procedures. The median operation time was 30 min. The median amount of flushing fluid was 500 mL. The stone-free rate after a single session treatment was 94.6%, within which 10 infants underwent simultaneous bilateral flexible ureteroscopy lithotripsy. Catheters were retained in 45 infants for 24-48 h after the operation. Continuous high fever due to reflux was present in two cases. Flushing fluid extravasation was found in one infant. Some patients with minor complications, such as mild hematuria, irritation symptoms, and low fever, recovered without treatment. The duration of hospitalization time after the operation was approximately 1-5 days. Flexible ureteroscopic lithotripsy is a safe, highly efficient, minimally invasive, and reproducible operation for removal of upper urinary tract calculi in infants. This technique is a convenient method for postoperative management of patients that enhances their rapid recovery. It is a promising option for therapy of infants ineffectively treated by extracorporeal shockwave lithotripsy.

Cystine calculi: challenging group of stones

PubMed Central

Ahmed, Kamran; Dasgupta, Prokar; Khan, Mohammad Shamim

2006-01-01

Cystinuria is an autosomal recessive disorder in renal tubular and intestinal transport of dibasic amino acids, which results in increased urinary excretion of cystine, ornithine, lysine and arginine. It affects 1 in 20 000 people and is caused by a defect in the rBAT gene on chromosome 2. Development of urinary tract cystine calculi is the only clinical manifestation of this disease. Owing to recurrent episodes of stone formation, these patients require a multi‐modal approach to management. The role of medical management and minimally invasive surgery was reviewed for the treatment of cystinuria. PMID:17148700

[Does carbonate originate from carbonate-calcium crystal component of the human urinary calculus?].

PubMed

Yuzawa, Masayuki; Nakano, Kazuhiko; Kumamaru, Takatoshi; Nukui, Akinori; Ikeda, Hitoshi; Suzuki, Kazumi; Kobayashi, Minoru; Sugaya, Yasuhiro; Morita, Tatsuo

2008-09-01

It gives important information in selecting the appropriate treatment for urolithiasis to confirm the component of urinary calculus. Presently component analysis of the urinary calculus is generally performed by infrared spectroscopy which is employed by companies providing laboratory testing services in Japan. The infrared spectroscopy determines the molecular components from the absorption spectra in consequence of atomic vibrations. It has the drawback that an accurate crystal structure cannot be analyzed compared with the X-ray diffraction method which analyzes the crystal constituent based on the diffraction of X-rays on crystal lattice. The components of the urinary calculus including carbonate are carbonate apatite and calcium carbonate such as calcite. Although the latter is reported to be very rare component in human urinary calculus, the results by infrared spectroscopy often show that calcium carbonate is included in calculus. The infrared spectroscopy can confirm the existence of carbonate but cannot determine whether carbonate is originated from carbonate apatite or calcium carbonate. Thus, it is not clear whether calcium carbonate is included in human urinary calculus component in Japan. In this study, we examined human urinary calculus including carbonate by use of X-ray structural analysis in order to elucidate the origin of carbonate in human urinary calculus. We examined 17 human calculi which were reported to contain calcium carbonate by infrared spectroscopy performed in the clinical laboratory. Fifteen calculi were obtained from urinary tract, and two were from gall bladder. The stones were analyzed by X-ray powder method after crushed finely. The reports from the clinical laboratory showed that all urinary culculi consisted of calcium carbonate and calcium phosphate, while the gallstones consisted of calcium carbonate. But the components of all urinary calculi were revealed to be carbonate apatite by X-ray diffraction. The components of gallstones were shown to be calcium carbonate (one calcite and the other aragonite) not only by infrared spectroscopy but by X-ray diffraction. It was shown that component analysis of the calculus could be more accurately performed by adding X-ray diffraction method to infrared spectroscopy. It was shown that calcium carbonate existed in a gallstone. As for the carbonate in human urinary calculi, present study showed that it was not calcium carbonate origin but carbonate apatite origin.

Effectiveness of early ureteric stenting for urosepsis associated with urinary tract calculi.

PubMed

Nishiguchi, Sho; Branch, Joel; Suganami, Yu; Kitagawa, Izumi; Tokuda, Yasuharu

2014-01-01

Patients with urosepsis associated with urinary tract calculi occasionally require drainage, primarily via ureteric stenting. Such patients require longer hospitalization. However, the indications for early ureteric stenting for this condition have not been clearly defined. To compare the length of stay (LOS) in the hospital between patients treated with earlier ureteric stenting versus those with delayed ureteric stenting. Design: Retrospective cohort study. Setting: An acute care teaching hospital in Japan. Length of hospital stay in days. Patients Patients with urosepsis associated with urinary tract calculi. Among a total of 30 patients (mean age, 72; 13 men), the mean number of days from emergency room admission to ureteric stenting was 3.5 days (range, 1-14 days), and the overall mean LOS was 36 days (range, 8-102 days). The early stenting group (mean LOS, 21 days) had a significantly shorter LOS than the delayed stenting group (mean LOS, 50 days), with an adjusted beta coefficient of -26 days [95% confidence interval (CI), -46, -6]. In patients with urosepsis associated with urinary tract calculi, performing early stenting within two days of admission may reduce the LOS in the hospital.

[Identification and quantitation of purine derivatives in urinary calculi as markers of abnormal purine metabolism by using high-performance liquid chromatography (HPLC)].

PubMed

Safranow, K

2000-01-01

The objective of this study was to develop a practical method for the analysis of purine derivatives in urinary calculi using high-performance liquid chromatography (HPLC). The method presented herein includes extraction of purine derivatives from urinary stones, followed by chromatography on a reversed-phase column with UV detection. A simpler isocratic method was applied to quantitate 6 purines known to be components of urinary stones, namely uric acid, xanthine, hypoxanthine, 2,8-dihydroxyadenine, oxypurinol and allopurinol. Gradient method separated 10 additional peaks representing methyl derivatives of uric acid or xanthine (1-, 3-, 7-, and 9-methyluric acid, 1,3-,1,7-, and 3,7-dimethyluric acid, and 1-, 3-, and 7-methylxanthine) (Fig. 1). Detection limits for individual compounds ranged from 25 to 140 micrograms purine per g stone weight and precision (RSD%) was 0.5-2.4%. Both methods were next used to analyze purine derivatives in urinary calculi from 48 residents of Western Pomerania. Uric acid was the main component of 9 stones. All of the uric acid stones showed admixtures of 9 other purine derivatives: natural metabolites (hypoxanthine, xanthine, 2,8-dihydroxyadenine) and methyl derivatives of uric acid (1-,3-, and 7-methyluric acid, 1,3-dimethyluric acid, 3-, and 7-methylxanthine) originating from the metabolism of exogenous methylxanthines (caffeine, theophylline and theobromine) (Tab. 1,2). Methyl derivatives of uric acid and xanthine, with a maximal content in stones of 1.7%, have hitherto not been considered constituents of urinary calculi. Statistical analysis of the results revealed strong positive correlations between the level of uric acid and of other purine derivatives in stones (Fig. 2). Correlations were also found between levels of some purines and inorganic compounds (Tab. 3). The sensitivity and specificity of HPLC with UV detection satisfy the requirements of a reference method for the analysis of purines in urinary stones. Isocratic separation is simpler in terms of technique and equipment, and therefore more suitable for hospital laboratories. Examination of purine derivatives in stones may be very helpful for the diagnosis of abnormal purine metabolism and urolithiasis, particularly in dihydroxyadeninuria, xanthinuria and during treatment with allopurinol. Gradient separation requiring more sophisticated instrument seems useful for research purposes when the content of methyl derivatives of purines must be known. The present results indicate that urinary purines at concentrations lower than saturation point may nevertheless coprecipitate with oversaturated uric acid and appear as admixtures in urinary stones. The content of a purine derivative in stone depends on its average urinary excretion in the general population, similarity to the chemical structure of uric acid, and content of the latter in stone. These findings suggest that purines in stones represent a solid solution with uric acid as solvent. It is also plausible that methylxanthines, ubiquitous components of the diet and drugs, are involved in the pathogenesis of urolithiasis. Interpretation of results and practical significance of the determination of purine derivatives in stones is discussed, and future studies to assess the clinical importance of endo- and exogenous purine derivatives in urinary calculi are suggested.

Bilateral renal calculi

PubMed Central

Sreenevasan, G

1974-01-01

Bilateral renal calculi were present in 114 (10.7%) of 1,070 cases of proved urinary calculus admitted to the Urological Department of the General Hospital, Kuala Lumpur, during the period November 1968—May 1973. The management of bilateral renal calculi is discussed with reference to the first 100 cases in this series. The introduction of renography has greatly facilitated the decision as to which kidney should be operated on first. The management of patients with and without uraemia is discussed and the use of the modified V and V—Y incisions for the removal of staghorn calculi is described. Complications and results are briefly reviewed. ImagesFig. 1Fig. 4Fig. 6Fig. 7 PMID:4845653

A new method for computer-assisted detection, definition and differentiation of the urinary calculi.

PubMed

Yildirim, Duzgun; Ozturk, Ovunc; Tutar, Onur; Nurili, Fuad; Bozkurt, Halil; Kayadibi, Huseyin; Karaarslan, Ercan; Bakan, Selim

2014-09-01

Urinary stones are common and can be diagnosed with computed tomography (CT) easily. In this study, we aimed to specify the opacity characteristics of various types of calcified foci that develop through the urinary system by using an image analysis program. With this method, we try to differentiate the calculi from the non-calculous opacities and also we aimed to present how to identify the characteristic features of renal and ureteral calcules. We obtained the CT studies of the subjects (n = 48, mean age = 41 years) by using a dual source CT imaging system. We grouped the calculi detected in the dual-energy CT sections as renal (n = 40) or ureteric (n = 45) based on their locations. Other radio-opaque structures that were identified outside but within close proximity of the urinary tract were recorded as calculi "mimickers". We used ImageJ program for morphological analysis. All the acquired data were analyzed statistically. According to thorough morphological parameters, there were statistically significant differences in the angle and Feret angle values between calculi and mimickers (p < 0.001). Multivariate logistical regression analysis showed that Minor Axis and Feret angle parameters can be used to distinguish between ureteric (p = 0.003) and kidney (p = 0.001) stones. Computer-based morphologic parameters can be used simply to differentiate between calcular and noncalcular densities on CT and also between renal and ureteric stones.

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.

Recent Developments in Computed Tomography for Urolithiasis: Diagnosis and Characterization

PubMed Central

Mc Laughlin, P. D.; Crush, L.; Maher, M. M.; O'Connor, O. J.

2012-01-01

Objective. To critically evaluate the current literature in an effort to establish the current role of radiologic imaging, advances in computed tomography (CT) and standard film radiography in the diagnosis, and characterization of urinary tract calculi. Conclusion. CT has a valuable role when utilized prudently during surveillance of patients following endourological therapy. In this paper, we outline the basic principles relating to the effects of exposure to ionizing radiation as a result of CT scanning. We discuss the current developments in low-dose CT technology, which have resulted in significant reductions in CT radiation doses (to approximately one-third of what they were a decade ago) while preserving image quality. Finally, we will discuss an important recent development now commercially available on the latest generation of CT scanners, namely, dual energy imaging, which is showing promise in urinary tract imaging as a means of characterizing the composition of urinary tract calculi. PMID:22952473

The burden of prostatic calculi is more important than the presence

PubMed Central

Park, Bumsoo; Choo, Seol Ho

2017-01-01

Prostatic calculi are a common finding on transrectal prostate ultrasound. However, it remains unclear whether they are significantly associated with lower urinary tract symptoms (LUTS). Our objective was to evaluate the association between prostatic calculi and LUTS with a focus on “calculi burden” because no studies have investigated prostatic calculi using “calculi burden” as an indicator. A total of 606 participants who received transrectal prostate ultrasound were divided into two groups according to the presence of prostatic calculi. “Calculi burden” was defined as the sum of the transverse diameters of all visible calculi within the prostate. The International Prostatic Symptom Score (IPSS) and a quality of life (QoL) score were collected. Both groups were compared, and a multivariate analysis was performed to predict moderate/severe LUTS. Linear correlation was evaluated between calculi burden and IPSS in the calculi group. No differences in total IPSS, voiding IPSS, or QoL score were detected between the two groups, but storage IPSS was significantly higher in the calculi group than that of controls. The multivariate analysis showed that the presence of prostatic calculi was not an independent predictor of moderate/severe LUTS. A positive linear correlation was detected between calculi burden and storage IPSS in calculi group (r = 0.148). However, no correlation was found between calculi burden and total IPSS, voiding IPSS, or QoL score. Our results showed that the presence of prostatic calculi was not a significant factor predicting moderate/severe LUTS. However, an increased calculi burden may be associated with aggravating storage symptoms. PMID:27184549

The burden of prostatic calculi is more important than the presence.

PubMed

Park, Bumsoo; Choo, Seol Ho

2017-01-01

Prostatic calculi are a common finding on transrectal prostate ultrasound. However, it remains unclear whether they are significantly associated with lower urinary tract symptoms (LUTS). Our objective was to evaluate the association between prostatic calculi and LUTS with a focus on "calculi burden" because no studies have investigated prostatic calculi using "calculi burden" as an indicator. A total of 606 participants who received transrectal prostate ultrasound were divided into two groups according to the presence of prostatic calculi. "Calculi burden" was defined as the sum of the transverse diameters of all visible calculi within the prostate. The International Prostatic Symptom Score (IPSS) and a quality of life (QoL) score were collected. Both groups were compared, and a multivariate analysis was performed to predict moderate/severe LUTS. Linear correlation was evaluated between calculi burden and IPSS in the calculi group. No differences in total IPSS, voiding IPSS, or QoL score were detected between the two groups, but storage IPSS was significantly higher in the calculi group than that of controls. The multivariate analysis showed that the presence of prostatic calculi was not an independent predictor of moderate/severe LUTS. A positive linear correlation was detected between calculi burden and storage IPSS in calculi group (r = 0.148). However, no correlation was found between calculi burden and total IPSS, voiding IPSS, or QoL score. Our results showed that the presence of prostatic calculi was not a significant factor predicting moderate/severe LUTS. However, an increased calculi burden may be associated with aggravating storage symptoms.

Urolithiasis in dogs. II: Breed prevalence, and interrelations of breed, sex, age, and mineral composition.

PubMed

Ling, G V; Franti, C E; Ruby, A L; Johnson, D L

1998-05-01

To analyze selected breed-related data for canine urinary calculi. 11,000 specimens: 5,781 from female dogs, 5,215 from males, and 4 from dogs of unrecorded sex. Information was compiled for all canine urinary calculi submitted between July 1981 and January 1994. Results for a mixed-breed group and 26 of the most common breeds of stone-forming dogs were analyzed. Interrelations of breed, sex, and age of affected dogs and mineral composition of the specimens were determined. Prevalence of 5 specific mineral types was significantly correlated between the sexes of 27 common breed groups: struvite, calcium phosphate (apatite), calcium oxalate, brushite, and urate. Struvite-containing calculi were seen in high proportions in both sexes of 7 breeds, and in low proportions in both sexes of 7 other breeds. Male and female Lhasa Apsos, Cairn Terriers, and 5 other breeds had high proportions of oxalate-containing calculi; values in males were substantially higher. Low numbers of oxalate-containing calculi were seen in both sexes of 7 breeds; Dalmatians had the lowest numbers. Males and females of 6 breeds had high numbers of urate-containing calculi, Dalmatians and English Bulldogs had the highest numbers. Low amounts of urate were found in calculi from males and females of 6 breeds, Samoyeds had the lowest numbers. Highest proportions of cystine-containing calculi were seen in male Dachshunds, English Bulldogs, and Chihuahuas. Males of 8 breeds had no specimens that contained cystine; only 2 such specimens were obtained from females. Prevalence of uroliths differs among breed, age, and sex of affected dogs. Breed, sex, and age of dogs; mineral types of calculi in males versus females; and their anatomic location within the tract are important considerations for clinicians when evaluating risk in dogs with urolithiasis and in identifying areas that need further in-depth applied or clinical investigation, or both.

Kidney stones - what to ask your doctor

MedlinePlus

Nephrolithiasis - what to ask your doctor; Renal calculi - what to ask your doctor; What to ask your doctor about kidney stones ... Strategies for nonmedical management of upper urinary tract calculi. In: Wein AJ, Kavoussi LR, Partin AW, Peters ...

The feasibility of using microwave-induced thermoacoustic tomography for detection and evaluation of renal calculi.

PubMed

Cao, Caijun; Nie, Liming; Lou, Cunguang; Xing, Da

2010-09-07

Imaging of renal calculi is important for patients who suffered a urinary calculus prior to treatment. The available imaging techniques include plain x-ray, ultrasound scan, intravenous urogram, computed tomography, etc. However, the visualization of a uric acid calculus (radiolucent calculi) is difficult and often impossible by the above imaging methods. In this paper, a new detection method based on microwave-induced thermoacoustic tomography was developed to detect the renal calculi. Thermoacoustic images of calcium oxalate and uric acid calculus were compared with their x-ray images. The microwave absorption differences among the calcium oxalate calculus, uric acid calculus and normal kidney tissue could be evaluated by the amplitude of the thermoacoustic signals. The calculi hidden in the swine kidney were clearly imaged with excellent contrast and resolution in the three orthogonal thermoacoustic images. The results indicate that thermoacoustic imaging may be developed as a complementary method for detecting renal calculi, and its low cost and effective feature shows high potential for clinical applications.

Differentiation of urinary calculi with dual energy CT: effect of spectral shaping by high energy tin filtration.

PubMed

Thomas, Christoph; Krauss, Bernhard; Ketelsen, Dominik; Tsiflikas, Ilias; Reimann, Anja; Werner, Matthias; Schilling, David; Hennenlotter, Jörg; Claussen, Claus D; Schlemmer, Heinz-Peter; Heuschmid, Martin

2010-07-01

In dual energy (DE) computed tomography (CT), spectral shaping by additional filtration of the high energy spectrum can theoretically improve dual energy contrast. The aim of this in vitro study was to examine the influence of an additional tin filter for the differentiation of human urinary calculi by dual energy CT. A total of 36 pure human urinary calculi (uric acid, cystine, calciumoxalate monohydrate, calciumoxalate dihydrate, carbonatapatite, brushite, average diameter 10.5 mm) were placed in a phantom and imaged with 2 dual source CT scanners. One scanner was equipped with an additional tin (Sn) filter. Different combinations of tube voltages (140/80 kV, 140/100 kV, Sn140/100 kV, Sn140/80 kV, with Sn140 referring to 140 kV with the tin filter) were applied. Tube currents were adapted to yield comparable dose indices. Low- and high energy images were reconstructed. The calculi were segmented semiautomatically in the datasets and DE ratios (attenuation@low_kV/attenuation@high_kV) and were calculated for each calculus. DE contrasts (DE-ratio_material1/DE-ratio_material2) were computed for uric acid, cystine and calcified calculi and compared between the combinations of tube voltages. Using exclusively DE ratios, all uric acid, cystine and calcified calculi (as a group) could be differentiated in all protocols; the calcified calculi could not be differentiated among each other in any examination protocol. The highest DE ratios and DE contrasts were measured for the Sn140/80 protocol (53%-62% higher DE contrast than in the 140/80 kV protocol without additional filtration). The DE ratios and DE contrasts of the 80/140 kV and 100/Sn140 kV protocols were comparable. Uric acid, cystine and calcified calculi could be reliably differentiated by any of the protocols. A dose-neutral gain of DE contrast was found in the Sn-filter protocols, which might improve the differentiation of smaller calculi (Sn140/80 kV) and improve image quality and calculi differentiation in larger patients (Sn140/100 kV). However, even with the improved spectral separation of the Sn-filter protocols, the DE ratios of calcified calculi are not sufficiently distinct to allow a differentiation within this group.

Clinical experience with the Swiss lithoclast master in treatment of bladder calculi.

PubMed

Kingo, Pernille S; Ryhammer, Allan M; Fuglsig, Sven

2014-10-01

Bladder calculi account for 5% of urinary tract calculi in the Western world, and many different treatment modalities have been presented throughout the decades. We report our clinical experience using the Swiss LithoClast® Master (SLM). The SLM is a rigid, hand-held endourologic probe including a pneumatic lithotriptor and an ultrasonic lithotriptor. Attached to the ultrasonic modality is a suction system. The two lithotriptor modalities are controlled by a footswitch and can be activated separately or simultaneously. The SLM is used via a rigid endoscope. Indications for treatment were medical complaints such as hematuria, lower urinary tract symptoms, pain, recurrent urinary tract infections, recurrent bursts of balloon in indwelling catheters, and difficulties performing clean intermittent self-catheterization. From August 1, 2009, to August 1, 2011, 27 patients were treated for bladder calculi (24 men). Five had a neurogenic voiding dysfunction, 3 had prostate cancer, and 19 had benign prostatic enlargement or detrusor muscle insufficiency. Median age was 74 years (range 45-86 years). Stone clearance was obtained in 26 (96%) patients. Stone burden was one or multiple bladder calculi. Median stone size of the largest stone in each patient was 20 (5-40) mm. Under the same anesthesia, two patients underwent a transurethral resection of the prostate because of a very large prostate. Median lithotripsy time was 60 (range 20-144) minutes. All patients were discharged within 24 hours. The method described is a safe and quick method for endoscopic lithotripsy of bladder calculi rendering the patients stone free in the vast majority of cases. The procedure can be performed as day-case surgery.

Multibacterial Growth From a Surgical Renal Stone Culture: A Case Report and Literature Review

PubMed Central

Mufarrij, Patrick W; Lange, Jessica N; Assimos, Dean G; Mirzazadeh, Majid; Holmes, Ross P

2012-01-01

Urinary calculi may harbor bacteria, and this may lead to deleterious events during stone fragmentation and removal. The isolation of such bacteria from surgically extracted calculi allows for the specific tailoring of antimicrobial therapy. Here, we describe a case involving percutaneous stone removal from which the stone culture demonstrated growth of five different microorganisms. The results of this culture prompted a change in the antibiotic coverage, resulting in a more targeted treatment and improved patient care. PMID:23524537

Intravesical foreign body–induced bladder calculi resulting in obstructive renal failure

PubMed Central

Kamal, Fadi; Clark, Aaron T.D.; Lavallée, Luke Thomas; Roberts, Matthew; Watterson, James

2008-01-01

We report the case of a 30-year-old man who presented with obstructive renal failure and urosepsis due to bladder outlet–obstructing bladder calculi that formed around 3 copper wires that were self-inserted into his urinary bladder 15 years previously. We present the evaluation, imaging and management of the unique complications resulting from the self-insertion of an intra-vesical foreign body. Our patient’s case was unique for 2 reasons. First, the length of time (15 yr) from foreign body insertion to presentation is the longest interval reported in the literature. Second, this is the first report of bladder calculi induced by the insertion of a foreign body that resulted in obstructive renal failure. PMID:18953457

Evolution of post-ESWL residual lithiasis depending on the type of calculus and urine composition.

PubMed

Grases, Felix; Costa-Bauzá, Antonia; Isern, Bernat; Sanchis, Pilar; Perelló, Joan; Hierro, Fernando; Conte Visus, Antonio

2009-07-01

Extracorporeal shock wave lithotripsy (ESWL) is one of the most commonly used procedures for removal of renal calculi from the upper urinary tract, but complete expulsion of the fragments generated is not always achieved. This can lead to new lithiasic episodes, and it is considered that 10-26% of fragmented calculi can undergo regrowth. This in vitro study investigated the influence of fragment and urinary composition on post-ESWL growth of fragments, with the aims of establishing the effect and importance of these parameters, and identifying effective prophylactic measures. Fragments collected from patients immediately following expulsion after ESWL treatment were selected for regrowth experiments. The particles included 24 calcium oxalate monohydrate (COM) fragments, 48 calcium oxalate dihydrate (COD), 24 hydroxyapatite (HAP), and 16 uric acid. In all treatments, calculi fragments showed a considerable capacity to induce growth of calcium oxalate and calcium phosphate. Under normocalciuria conditions, new COM crystals formed; both COM and COD crystals developed under hypercalciuria conditions at a urinary pH < 6.0; and in hypercalciuric conditions and urinary pH > 6.0 both HAP and brushite (BRU) crystals were formed. The highest growth rates were observed for COD calculi fragments under hypercalciuria conditions and at a urinary pH of 6.5, followed by growth on COM and HAP fragments under the same conditions; growth rates under other conditions tested were similar but 10-fold lower. With regard to the role of crystallization inhibitors, phytate exhibited inhibitory effects under all assay conditions. However, citrate had little effect, even at the highest concentration tested (1,000 mg/L). This study demonstrates the importance of avoiding heterogeneous nucleant retention (pre-existing solid microparticles) in renal cavities, as these can act as very efficient inducers of the formation of new calculi, the composition of which is mainly dependant on the urine composition.

[May renal lithiasis be really prevented? New trends and therapeutic tools.

PubMed

Grases, Félix; Costa-Bauzá, Antonia; Prieto, Rafael M

2017-01-01

Renal calculi are generally formed as a result of the combination of certain factors, some related to urine composition (concentration of lithogenic substances, deficiency of crystallization inhibitors, presence of heterogeneous nucleants) and others with renal morphology and anatomy (urinary tract stasis, low urodynamic efficiency cavities, morpho-anatomic deformations, renal papillary tissue lesions). In fact, the composition, macrostructure and microstructure of the calculus will clearly depend on the factors that have induced it. For this reason, the appropriate study and classification of the renal calculi simplifies the diagnosis and allows a more effective therapeutic approach since it can be oriented to directly correct the etiological factors responsible for stone formation. In this article, we review the main etiological factors involved in the formation of each type of calculus and the prophylactic measures that can be adopted for proper correction. The most frequent kidney stones have been classified into the following types: calcium oxalate monohydrate papillary calculi, calcium oxalate monohydrate non-papillary calculi, calcium oxalate dihydrate calculi, mixed hydroxyapatite/ calcium oxalate calculi, carboxyapatite/hydroxyapatite calculi, brushite calculi, struvite/carboxyapatite calculi, uric acid calculi, uric acid/calcium oxalate monohydrate calculi, and cystine calculi. Occasionally, however, the calculus is not available for study, in which case the only way forward is to use all available information (clinical history, life habits, radiological data), together with basic biochemical information, to identify and correct all etiological factors related to renal lithiasis that have been identified.

Massive Pulmonary Calculi Embolism: A Novel Complication of Pneumatic Lithotripsy: A Case Report.

PubMed

Zhang, Lin; Zhou, Yiwu

2015-07-01

Pneumatic lithotripsy is a minimally invasive technique mainly for the treatment of urinary staghorn stones. Previous literatures have reported some therapeutic complications during or after this procedure, but calculi embolism has not been mentioned before.We report here a fatal case of calculi-induced pulmonary embolism in an adult woman who underwent pneumatic lithotripsy. An autopsy did not reveal any evidence of pulmonary embolism. However, light microscopy revealed noticeable presence of calculi in pulmonary arterioles and capillaries, as evidenced by environmental scanning electron microscope and energy dispersive X-ray analysis. The primary determinants of calculi embolism include intrarenal pressure, and volume and viscosity of the calculi fragments formation. Vascular intravasation of smashed calculi might increase pulmonary vascular resistance and hypoxemia and decrease cardiac output.This case report intends to provide information for clinicians to consider the probability of intraoperative calculi embolism during lithotripsies when patients develop typical symptoms of acute pulmonary embolism.

Trends in surgery for upper urinary tract calculi in the USA using the Nationwide Inpatient Sample: 1999-2009.

PubMed

Ghani, Khurshid R; Sammon, Jesse D; Karakiewicz, Pierre I; Sun, Maxine; Bhojani, Naeem; Sukumar, Shyam; Peabody, James O; Menon, Mani; Trinh, Quoc-Dien

2013-07-01

To determine trends in demographics and treatment for inpatient upper urinary tract calculi in the USA using a population-based cohort. All patients with a primary or secondary diagnosis of kidney or ureteric calculus between 1999 and 2009 in the US Nationwide Inpatient Sample were extracted and weighted. Temporal trend analyses were used to determine trends in gender, race and age presentation, as well as utilization rates of interventions. Temporal trends were quantified using the estimated annual percent change (EAPC) using least squares linear regression analysis. Overall, 2 109 455 patients were hospitalized with upper urinary tract calculi over the 11-year period. The majority of admissions were for ureteric calculi (63.4%). Admissions for renal calculus increased by 12.1% during the study period (EAPC + 0.92%, P = 0.039, 95% CI: 0.17-1.66), whilst discharges for ureteric calculus remained stable. A significant increase (25.4%) in hospitalizations for women was found (EAPC + 2.21%, P < 0.001, 95% CI: 1.40-3.03); by 2006, more women than men were admitted to hospital (95 953 vs. 94 556, respectively). There were significant increases in hospitalization for black, Hispanic and older patients. Significant changes in the use of all studied interventions were found except for ureteroscopy, extracorporeal shockwave lithotripsy and nephrectomy. In this nationally representative sample of inpatient discharges, significant increases were found in admissions for renal compared with ureteric calculi, and for black, Hispanic and older patients. With regard to surgical intervention, the largest increase was found in the use of procedures for kidney calculi. Women now comprise the majority in the inpatient management of stone disease. © 2013 BJU International.

Risk factors for bladder calculi in patients with benign prostatic hyperplasia.

PubMed

Huang, Wei; Cao, Jun-Jie; Cao, Min; Wu, Hong-Shen; Yang, Yong-Yi; Xu, Zi-Meng; Jin, Xiao-Dong

2017-08-01

We aim to find the risk factors that influence the formation of bladder calculi in patients with benign prostate hyperplasia (BPH) and to reduce the surgical intervention related to bladder calculi.Between January 2015 and October 2016, 332 patients with BPH underwent surgical therapy were retrospectively evaluated. Patients with BPH were categorized into 2 groups: 94 patients with bladder calculi in group 1 and 238 patients without bladder calculi in group 2. Medical history, age, body mass index (BMI), total prostate specific antigen, total prostate volume (TPV), International Prostate Symptom Score (IPSS), intravesical prostatic protrusion (IPP), urodynamic parameters, and urine culture were compared between groups.There was no significant difference in the age, BMI, peak flow rate, and total IPSS between groups. TPV, total prostate specific antigen, and duration of BPH were significantly lower in group 1 than those in group 2. In addition, IPP was significantly higher in group 1 than group 2 (P < .001). Besides, after exclusion of patients with urinary retention and indwelling catheter, group 1 associated with a significantly higher preoperative positive rate of urine culture than that of group 2 (P = .046). Multivariate analysis indicated that IPP was a significant independent risk factor for the presence of bladder calculi.The incidence of bladder calculi in patients with BPH was proved to be closely associated with preoperative positive urine culture and longer IPP in our study. Furthermore, the IPP was presented to be an independent risk factor for the formation of bladder calculi. And early antibacterial therapy of urinary tract infection (UTI) may help to prevent the presence of bladder calculi in patients with BPH.

[Revisiting the chemical diversity in prostatic calculi: a SEM and FT-IR investigation].

PubMed

Dessombz, A; Méria, P; Bazin, D; Foy, E; Rouzière, S; Weil, R; Daudon, M

2011-12-01

Revisiting the chemical diversity of the crystalline phases of prostatic calculi by means of SEM and FT-IR analysis. A set of 32 prostatic calculi has been studied by FT-IR and SEM. FT-IR analysis has determined the chemical composition of each prostatic calculus and the SEM observation has described the morphology of the calculi surfaces and layers. Infrared analysis revealed that 90.7% of the stones were mainly composed of calcium phosphates. However, several mineral phases previously not reported in prostatic calculi were observed, as brushite or octocalcium phosphate pentahydrate. Prostatic calculi exhibited a diversity of crystalline composition and morphology. As previously reported for urinary calculi, relationships between composition and morphology of prostatic stones and étiopathogenic conditions could be of interest in clinical practice. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Two- and three-dimensional CT measurements of urinary calculi length and width: a comparative study.

PubMed

Lidén, Mats; Thunberg, Per; Broxvall, Mathias; Geijer, Håkan

2015-04-01

The standard imaging procedure for a patient presenting with renal colic is unenhanced computed tomography (CT). The CT measured size has a close correlation to the estimated prognosis for spontaneous passage of a ureteral calculus. Size estimations of urinary calculi in CT images are still based on two-dimensional (2D) reformats. To develop and validate a calculus oriented three-dimensional (3D) method for measuring the length and width of urinary calculi and to compare the calculus oriented measurements of the length and width with corresponding 2D measurements obtained in axial and coronal reformats. Fifty unenhanced CT examinations demonstrating urinary calculi were included. A 3D symmetric segmentation algorithm was validated against reader size estimations. The calculus oriented size from the segmentation was then compared to the estimated size in axial and coronal 2D reformats. The validation showed 0.1 ± 0.7 mm agreement against reference measure. There was a 0.4 mm median bias for 3D estimated calculus length compared to 2D (P < 0.001), but no significant bias for 3D width compared to 2D. The length of a calculus in axial and coronal reformats becomes underestimated compared to 3D if its orientation is not aligned to the image planes. Future studies aiming to correlate calculus size with patient outcome should use a calculus oriented size estimation. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

In vitro study concerning the efficiency of the frequency-doubled double-pulse Neodymium:YAG laser (FREDDY) for lithotripsy of calculi in the urinary tract.

PubMed

Zörcher, T; Hochberger, J; Schrott, K M; Kühn, R; Schafhauser, W

1999-01-01

In a preclinical study we have tested both in vitro and in vivo, a new type of pulsed solid-state laser system that has not been applied in urology so far and has been developed for optimized intracorporal lithotripsy of biliary, salivary, and urinary calculi. Sixty one calculi from the human urinary tract were split in vitro into fragments with a remaining particle size of

Transurethral lithotripsy with holmium-YAG laser of a large exogenous prostatic calculus.

PubMed

Hasegawa, Masanori; Ohara, Rei; Kanao, Kent; Nakajima, Yosuke

2011-04-01

Prostatic calculi are classified into two types, endogenous and exogenous calculi, based on their origin. Endogenous calculi are commonly observed in elderly men; however, exogenous prostatic calculi are extremely rare. We report here the case of a 51-year-old man who suffered incontinence and pollakiuria with a giant exogenous prostatic calculus almost completely replacing the prostatic tissue. X-rays and computed tomography demonstrated a large calculus of 65 × 58 mm in the small pelvic cavity. The patient underwent a transurethral lithotripsy with a holmium-YAG laser and a total of 85 g of disintegrated stones was retrieved and chemical stone analysis revealed the presence of magnesium ammonium phosphate. The incontinence improved and the voiding volume increased dramatically, and no stone recurrence in the prostatic fossa occurred at the 2 years follow-up. The etiology of this stone formation seemed to be based on some exogenous pathways combined with urinary stasis and chronic urinary infection due to compression fracture of the lumbar vertebra.

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.

Treatment of Renal Calculi with Extracorporeal Shock Wave Lithotripsy

PubMed Central

Eberwein, P. M.; Denstedt, J. D.

1992-01-01

In 12 years, extracorporeal shock wave lithotripsy has replaced other treatment techniques for most surgical calculi in the upper urinary tract. Worldwide clinical series have documented its efficacy. Technological advances and modifications have significantly expanded the clinical applications of this technique. Imagesp1673-aFigure 3 PMID:21221368

National Profiles of Urinary Calculi: a Comparison Between Developing and Developed Worlds.

PubMed

Alatab, Sudabeh; Pourmand, Gholamreza; El Howairis, Mohammed El Fatih; Buchholz, Noor; Najafi, Iraj; Pourmand, Mohammad Reza; Mashhadi, Rahil; Pourmand, Naghmeh

2016-03-01

The incidence of urolithiasis has increased in both the developed and the developing countries during the past decades. Economically, the increase of urolithiasis contributes to the rise of the healthcare burden everywhere. Moreover, this increase has been associated with a change in the epidemiology of urolithiasis in terms of age and sex distribution, and also the location and type of calculi. We searched the MEDLINE for relevant literature dating back to 1980. This review compared the trends in epidemiological factors affecting urolithiasis in the developed and the developing countries during the past decades. People in the developing countries are more likely to contract kidney calculi at a younger age than in the developed countries. Although calculus disease is still more prevalent in men than in women, the latter are increasingly affected in both worlds. Uric acid calculi are more prevalent in the developing than in industrialized countries. There is a progressive increase in the frequency of calcium oxalate and calcium phosphate calculi in the developing countries where these used to be less frequent. The incidence and prevalence of urinary calculi is increasing globally. Many factors including aging of the population, changes in diet, global warming, and employment of more accurate diagnostic tools seem to be involved in this increase. An increasing affluence and adaptation of Western diet habits in many developing countries seem likely to contribute to the changes.

Combined electrohydraulic and holmium: YAG laser ureteroscopic nephrolithotripsy of large (>2 cm) renal calculi

PubMed Central

Mariani, Albert J.

2008-01-01

Percutaneous nephrolithotripsy (PCL) is a standard treatment for renal calculi >2 cm. Modern flexible ureteroscopes and accessories employing the complementary effects of electrohydraulic lithotripsy (EHL) and Ho:YAG laser lithotrites can treat these renal calculi in a minimally invasive fashion with similar or superior results. Objective: To assess the safety and efficacy of ureteroscopic nephrolithotripsy monotherapy for the management of >2 cm renal calculi in the community setting. Materials and Methods: Fifty nine patients with 63 renal calculi ranging from 20 to 97 mm (mean 44 mm) in length and 175 to 3300 mm2 (mean 728 mm2) area underwent staged ureteroscopic nephrolithotripsy monotherapy. Obesity (BMI > 30) was present in 54% and 19% were morbidly obese (BMI > 40). An infectious etiology was present in 49% and hard stone components in 89%. All patients presented with hematuria, pain, and/or recurrent urinary tract infection (UTI). Lithotripsy was performed with a single deflection flexible ureteroscope and predominantly EHL. Laser drilling was employed (n = 6) to weaken very hard stones prior to EHL. Low intrarenal pressure was maintained by continuous bladder drainage and placement of a stiff safety wire. Visibility was maintained using manual pulsatile irrigation. Results: All patients were rendered pain and infection-free. No patient required a blood transfusion and there was no change in serum creatinine. Mobile stone-free status was achieved in 60/63 (95%) with a mean of 1.7 nephrolithotripsy stages and 0.38 secondary or ancillary procedures. Outpatient management was sufficient for 121/131 (92%) of the procedures. Operative time averaged 46 min/stage and 79 min/calculus. Complications included endotoxic shock (3), fever (5), ureteral fragments requiring treatment (11), delayed extubation (2), delayed pneumonia (1), and urinary retention (1). Conclusion: Staged ureteroscopic nephrolithotripsy of large renal calculi is feasible with low morbidity and stone clearance rates that compare favorably with PCL. It has largely replaced PCL at this institution. PMID:19468511

[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.

Prevalence, pathophysiological mechanisms and factors affecting urolithiasis.

PubMed

Khan, Aslam

2018-05-01

The formation of urinary stone, urolithiasis, is one the oldest known disease affecting human throughout different civilizations and times. The exact pathophysiological mechanism of urolithiasis is not yet clear, as these calculi are of various types and too complex for simple understanding. A single theory cannot explain its formation; therefore, different theories are presented in various times for its explanation like free particle, fixed particle, Randall's plaque theory. In addition, various factors and components are identified that play an important role in the formation of these urinary calculi. In this review, composition of kidney stones, its prevalence/incidence, explanation of pathophysiological mechanisms and role of various factors; urinary pH, uric acid, parathyroid hormone, citrate, oxalate, calcium and macromolecules; osteopontin, matrix Gla protein, kidney injury molecules, urinary prothrombin fragment-1, Tamm-Horsfall protein, inter-α-inhibitors, have been discussed in detail.

Urolithiasis and Genitourinary Systems Issues for Spaceflight

NASA Astrophysics Data System (ADS)

Jones, Jeffrey A.; Sargsyan, Ashot; Pietryzk, Robert; Sams, C.; Stepaniak, Phillip; Whitson, P.

2008-09-01

Genitourinary medical events have shown to be an issue for both short duration and long duration spaceflight, and are anticipated to also be a potential issue for future exploration missions as well. This is based on actual historical pre-, in- and post-flight medical events, as well as assessment of what future flight challenges lay ahead. For this study, retrospective record review, as well as prospective studies of ultrasound and contingency management procedure development, and oral urinary stone prophylaxis were conducted. Results showed that the incidence of prior urinary calculi in- and post-flight was a risk driver for development of on-orbit countermeasures, as well as diagnostic and therapeutic methods for a possible in-flight calculus contingency. Oral potassium citrate and bisphosphonate preparations show promise for prophylaxis in spaceflight risk reduction. We conclude that a properly developed approach of selection, monitoring, and preventive medicine with effective countermeasures, along with early imaging diagnosis and minimally-invasive contingency intervention, should prevent issues such as urinary calculi from having a significant mission impact for exploration-class spaceflight.

Biomineralogy of human urinary calculi (kidney stones) from some geographic regions of Sri Lanka.

PubMed

Chandrajith, Rohana; Wijewardana, Geethika; Dissanayake, C B; Abeygunasekara, Anurudha

2006-08-01

Kidney stones (urinary calculi) have become a global scourge since it has been recognized as one of the most painful medical problems. Primary causative factors for the formation of these stones are not clearly understood, though they are suspected to have a direct relationship to the composition of urine, which is mainly governed by diet and drinking water. Sixty nine urinary calculi samples which were collected from stone removal surgeries were analyzed chemically for their Na, K, Ca, Mg, Cu, Zn, Pb, Fe and phosphate contents. Structural and mineralogical properties of stones were studied by XRD and FT-IR methods. The mean contents of trace elements were 1348 mg kg(-1) (Na); 294 mg kg(-1) (K); 32% (Ca); 1426 mg kg(-1) (Mg); 8.39 mg kg(-1) (Mn); 258 mg kg(-1) (Fe); 67 mg kg(-1) (Cu); 675 mg kg(-1) (Zn); 69 mg kg(-1) (Pb); and 1.93% (PO (4) (3-) ). The major crystalline constituent in the calculi of Sri Lanka is calcium oxalate monohydrate. Principal component analysis was used to identify the multi element relationships in kidney stones. Three components were extracted and the first component represents positively correlated Na-K-Mg-PO (4) (3-) whereas the second components represent the larger positively weighted Fe-Cu-Pb. Ca-Zn correlated positively in the third component in which Mn-Cu correlated negatively. This study indicates that during the crystallization of human urinary stones, Ca shows more affinity towards oxalates whereas other alkali and alkaline earths precipitate with phosphates.

Virtual nonenhanced dual-energy CT urography with tin-filter technology: determinants of detection of urinary calculi in the renal collecting system.

PubMed

Mangold, Stefanie; Thomas, Christoph; Fenchel, Michael; Vuust, Morten; Krauss, Bernhard; Ketelsen, Dominik; Tsiflikas, Ilias; Claussen, Claus D; Heuschmid, Martin

2012-07-01

To retrospectively determine which features of urinary calculi are associated with their detection after virtual elimination of contrast medium at dual-energy computed tomographic (CT) urography by using a novel tin filter. The institutional ethics committee approved this retrospective study, with waiver of informed consent. A total of 152 patients were examined with single-energy nonenhanced CT and dual-energy CT urography in the excretory phase (either 140 and 80 kV [n=44] or 140 and 100 kV [n=108], with tin filtration at 140 kV). The contrast medium in the renal pelvis and ureters was virtually removed from excretory phase images by using postprocessing software, resulting in virtual nonenhanced (VNE) images. The sensitivity regarding the detection of calculi on VNE images compared with true nonenhanced (TNE) images was determined, and interrater agreement was evaluated by using the Cohen k test. By using logistic regression, the influences of image noise, attenuation, and stone size, as well as attenuation of the contrast medium, on the stone detection rate were assessed. Threshold values with maximal sensitivity and specificity were calculated by means of receiver operating characteristic analyses. Eighty-seven stones were detected on TNE images; 46 calculi were identified on VNE images (sensitivity, 52.9%). Interrater agreement revealed a κ value of 0.95 with TNE images and 0.91 with VNE data. Size (long-axis diameter, P=.005; short-axis diameter, P=.041) and attenuation (P=.0005) of the calculi and image noise (P=.0031) were significantly associated with the detection rate on VNE images. As threshold values, size larger than 2.9 mm, maximum attenuation of the calculi greater than 387 HU, and image noise less than 20 HU were found. After virtual elimination of contrast medium, large (>2.9 mm) and high-attenuation (>387 HU) calculi can be detected with good reliability; smaller and lower attenuation calculi might be erased from images, especially with increased image noise. © RSNA, 2012.

A multiple technique approach to the analysis of urinary calculi.

PubMed

Rodgers, A L; Nassimbeni, L R; Mulder, K J

1982-01-01

10 urinary calculi have been qualitatively and quantitatively analysed using X-ray diffraction, infra-red, scanning electron microscopy, X-ray fluorescence, atomic absorption and density gradient procedures. Constituents and compositional features which often go undetected due to limitations in the particular analytical procedure being used, have been identified and a detailed picture of each stone's composition and structure has been obtained. In all cases at least two components were detected suggesting that the multiple technique approach might cast some doubt as to the existence of "pure" stones. Evidence for a continuous, non-sequential deposition mechanism has been detected. In addition, the usefulness of each technique in the analysis of urinary stones has been assessed and the multiple technique approach has been evaluated as a whole.

Mass spectrometry and renal calculi

PubMed Central

Purcarea, VL; Sisu, I; Sisu, E

2010-01-01

The present review represents a concise and complete survey of the literature covering 2004–2009, concerning the mass spectrometric techniques involved in the structural investigation of renal calculi. After a short presentation of the fundamental mass spectrometric techniques (MALDI–TOF, QTOF, MS–MS) as well as hyphenated methods (GC–MS, LC–MS, CE–MS), an extensive study of the urinary proteome analysis as well as the detection and quantification by mass spectrometry of toxins, drugs and metabolites from renal calculi is presented. PMID:20968197

Ambulatory Medical Visits among Anthrax-Vaccinated and Unvaccinated Personnel after Return from Southwest Asia

DTIC Science & Technology

2001-07-01

Diseases (001-139): candidiasis , dermatophytosis, herpes simplex, helminthosis, infectious mononucleosls. molluscom contaglosum, pityriasis. scabies...epididymitis. pelvic inflammatory disease, prostatitis, pyelonephritis, urinary tract calculi, urethritis, urinary tract infection, vaginitis

Factors affecting calcium oxalate dihydrate fragmented calculi regrowth

PubMed Central

Costa-Bauzá, A; Perelló, J; Isern, B; Sanchis, P; Grases, F

2006-01-01

Background The use of extracorporeal shock wave lithotripsy (ESWL) to treat calcium oxalate dihydrate (COD) renal calculi gives excellent fragmentation results. However, the retention of post-ESWL fragments within the kidney remains an important health problem. This study examined the effect of various urinary conditions and crystallization inhibitors on the regrowth of spontaneously-passed post-ESWL COD calculi fragments. Methods Post-ESWL COD calculi fragments were incubated in chambers containing synthetic urine varying in pH and calcium concentration: pH = 5.5 normocalciuria (3.75 mM), pH = 5.5 hypercalciuria (6.25 mM), pH = 6.5 normocalciuria (3.75 mM) or pH = 6.5 hypercalciuria (6.25 mM). Fragment growth was evaluated by measuring increases in weight. Fragment growth was standardized by calculating the relative mass increase. Results Calcium oxalate monohydrate (COM) crystals formed on COD renal calculi fragments under all conditions. Under pH = 5.5 normocalciuria conditions, only COM crystals formed (growth rate = 0.22 ± 0.04 μg/mg·h). Under pH = 5.5 hypercalciuria and under pH = 6.5 normocalciuria conditions, COM crystals and a small number of new COD crystals formed (growth rate = 0.32 ± 0.03 μg/mg·h and 0.35 ± 0.05 μg/mg·h, respectively). Under pH = 6.5 hypercalciuria conditions, large amounts of COD, COM, hydroxyapatite and brushite crystals formed (growth rate = 3.87 ± 0. 34 μg/mg·h). A study of three crystallization inhibitors demonstrated that phytate completely inhibited fragment growth (2.27 μM at pH = 5.5 and 4.55 μM at pH = 6.5, both under hypercalciuria conditions), while 69.0 μM pyrophosphate caused an 87% reduction in mass under pH = 6.5 hypercalciuria conditions. In contrast, 5.29 mM citrate did not inhibit fragment mass increase under pH = 6.5 hypercalciuria conditions. Conclusion The growth rate of COD calculi fragments under pH = 6.5 hypercalciuria conditions was approximately ten times that observed under the other three conditions. This observation suggests COD calculi residual fragments in the kidneys together with hypercalciuria and high urinary pH values may be a risk factor for stone growth. The study also showed the effectiveness of specific crystallization inhibitors in slowing calculi fragment growth. PMID:16822299

Don’t get caught out! A rare case of a calcified urachal remnant mimicking a bladder calculus

PubMed Central

Rodrigues, Jonathan Carl Luis; Gandhi, Sanjay

2013-01-01

Computer tomography through the kidneys, ureters and bladder (CT KUB) is the mainstay investigation of suspected renal tract calculi. However, several pathologies other than renal tract calculi can cause apparent urinary bladder calcification. We describe the case of a 45 year old man who presented with left sided renal colic. Prone CT KUB performed on admission revealed a calcified urachal remnant mimicking a urinary bladder calculus in the dependent portion of the urinary bladder, confirmed by reviewing the multi-planar reformatted images. This is the first reported case in the literature of this phenomenon. We discuss the importance of using multi-planar reformatted images (MPR) and maximum intensity projection images (MIP), as well as careful review of previous imaging, in making the correct diagnosis. We also discuss the differential diagnoses that should be considered when presented with urinary bladder calcification. PMID:23705044

FT-Raman spectral analysis of human urinary stones.

PubMed

Selvaraju, R; Raja, A; Thiruppathi, G

2012-12-01

FT-Raman spectroscopy is the most useful tool for the purpose of bio-medical diagnostics. In the present study, FT-Raman spectral method is used to investigate the chemical composition of urinary calculi. Urinary calculi multi-components such as calcium oxalate, hydroxyl apatite, struvite and uric acid are studied. FT-Raman spectrum has been recorded in the range of 3500-400 cm(-1). Chemical compounds are identified by Raman spectroscopic technique. The quantitative estimations of calcium oxalate monohydrate (COM) 1463 cm(-1), calcium oxalate dehydrate (COD) 1478 cm(-1), hydroxyl apatite 959 cm(-1), struvite 575 cm(-1), uric acid 1283 cm(-1) and oxammite (ammonium oxalate monohydrate) 2129 cm(-1) are calculated using particular peaks of FT-Raman spectrum. The quantitative estimation of human urinary stones suitable for the single calibration curve was performed. Copyright © 2012 Elsevier B.V. All rights reserved.

Diagnosis and surgical management of ureteral calculi in dogs: 16 cases (1990-2003).

PubMed

Snyder, D M; Steffey, M A; Mehler, S J; Drobatz, K J; Aronson, L R

2005-02-01

To examine the clinical signs, laboratory and radiographic findings, surgical technique, ureterolith composition, and post-operative outcomes in dogs managed surgically for ureterolithiasis to determine whether surgical removal of ureteroliths in dogs resulted in a positive clinical outcome. The medical record database of a university veterinary hospital in Pennsylvania, USA, was searched for dogs that underwent surgery to remove obstructive ureteral calculi between 1990 and 2003. Records were reviewed for signalment, clinical history and examination findings, radiographic and laboratory test results, surgical technique, and ureterolith analysis. Follow-up information was obtained from telephone interviews with owners or referring veterinarians, or by reviewing the medical record of subsequent hospital visits. Sixteen dogs were included in this study; ten were neutered females, two intact females and four castrated males. Abdominal radiography revealed ureteral calculi in 14/16 dogs, renal calculi in 8/16, cystic calculi in 8/16, urethral calculi in 1/16, renomegaly in 6/16 and renal mineralisation in 5/16. Ureterolith type included struvite in six dogs, calcium oxalate in five, calcium phosphate in one, and a mix of struvite, calcium phosphate and calcium oxalate in another. Compared to dogs with non-struvite ureteroliths, those with struvite ureteroliths had a higher pre-operative white blood cell (WBC) count (25.6, SD 7 vs 17.6, SD 6 x 103 cells/mul; p=0.046), and were more likely to have a purulent discharge from the ureteral incision noted at the time of surgery (p=0.015). Following discharge, 14/16 dogs were re-evaluated. Median survival time was 904 days (range 2-1,876). Two dogs required additional surgery on the urinary tract. Four dogs died or were euthanised because of azotaemia and clinical signs related to the urinary system or non-specific signs of illness (vomiting, lethargy) at 8, 90, 333 and 904 days post-operatively. Surgical management of ureteroliths was successful and resulted in good long-term survival in the majority of dogs examined in this small study population. Similar proportions of calcium oxalate and struvite ureteroliths were identified. The use of the ureteral surgery may increase as the frequency of diagnosis of ureteroliths in dogs increases.

Vaginal Calculus in a Woman With Mixed Urinary Incontinence and Vaginal Mesh Exposure.

PubMed

Winkelman, William D; Rabban, Joseph T; Korn, Abner P

2016-01-01

Vaginal calculi are extremely rare and are most commonly encountered in the setting of an urethrovaginal or vesicovaginal fistula. We present a case of a 72-year-old woman with mixed urinary incontinence and vaginal mesh exposure incidentally found to have a large vaginal calculus. We removed the calculus surgically and analyzed the components. Results demonstrated the presence of ammonium-magnesium phosphate hexahydrate and carbonate apatite.

Struvite urolithiasis in a litter of miniature Schnauzer dogs.

PubMed

Klausner, J S; Osborne, C A; O'Leary, T P; Gebhart, R N; Griffith, D P

1980-05-01

Magnesium ammonium phosphate calculi developed in the urinary bladders and urethras of four of five offspring of Miniature Schnauzer parents with recurrent struvite urolithiasis. Calculi were detected by radiograhy when the dogs were 12 to 15 months old. Males and females were affected. A significant number of urease-producing staphylococci were identified in the urine of three of four dogs before urolith formation, and in one dog after urolith formation. The dogs were evaluated until they were 26 months old. Serum concentrations of calcium, phosphorus, and magnesium were inside usual limits throughout the study. Abnormalities that might predispose to urinary tract infection were not identified by radiography or necropsy studies. In one dog, bladder calculi recurred after surgical removal of multiple cystoliths. In another, urethral obstruction and acute generalized pyelonephritis induced a lethal uremic crisis. Gross and microscopic lesions, detected after necropsy of all dogs with uroliths, were typical of bacterial infection.

Kidney Calculi: Pathophysiology and as a Systemic Disorder.

PubMed

Shadman, Arash; Bastani, Bahar

2017-05-01

The pathophysiology of urinary stone formation is complex, involving a combination of metabolic, genetic, and environmental factors. Over the past decades, remarkable advances have been emerged in the understanding of the pathogenesis, diagnosis, and treatment of calcium kidney calculi. For this review, both original and review articles were found via PubMed search on pathophysiology, diagnosis, and management of urinary calculi. These resources were integrated with the authors' knowledge of the field. Nephrolithiasis is suggested to be associated with systemic disorders, including chronic kidney insufficiency, hematologic malignancies, endocrine disorders, autoimmune diseases, inflammatory bowel diseases, bone loss and fractures, hypertension, type 2 diabetes mellitus, metabolic syndrome, and vascular diseases like coronary heart diseases and most recently ischemic strokes. This is changing the perspective of nephrolithiasis from an isolated disorder to a systemic disease that justifies further research in understanding the underlying mechanisms and elaborating diagnostic-therapeutic options.

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.

Elemental analysis of urinary calculi by laser induced plasma spectroscopy.

PubMed

Fang, Xiao; Ahmad, S Rafi; Mayo, Mike; Iqbal, Syed

2005-12-01

Laser induced plasma spectroscopy (LIPS) has been applied to analyse and identify elemental constituents of urinary calculi. Measurements on seven different urinary stone samples were conducted and the concentrations of some key elemental species were estimated. The elements detected with the present system were: Calcium, Magnesium, Sodium, Samarium, Potassium and Lead. Absolute concentrations of the species were derived from pre-calibration of the system for each element. Their concentrations were found to be widely different in different samples. It was observed that the samples containing a significant amount of lead have large proportion of calcium. It has been established that LIPS would allow real time clinic measurements of elemental contents and the concentrations in the biomaterials without sample preparation. The technique has the potential for routine clinic applications in urological disorder diagnosis.

Correlation of metabolic syndrome with urinary stone composition.

PubMed

Cho, Sung Tae; Jung, Seung Il; Myung, Soon Chul; Kim, Tae Hyoung

2013-02-01

To determine the correlation between metabolic syndrome and the distribution of stone components in patients with urolithiasis. Between January 2007 and December 2010, renal or ureteral stones were collected from 712 patients (432 males, 280 females) who underwent surgical intervention at three hospitals in South Korea. Metabolic syndrome was defined according to the latest definition of the International Diabetes Federation, using ethnicity- and sex-specific cut-off values for central obesity. Patients were assessed by factors used in metabolic syndrome. All urinary stones were analyzed using infrared spectrophotometry and categorized according to their main component. The patients' mean age was 55.9 years (range 19-93 years). Of the 712 patients, 347 (48.7%; 205 males, 142 females) had a diagnosis of metabolic syndrome. Calcium oxalate (71.5%), uric acid (15.3%), carbonate apatite (8.0%) and struvite (4.1%) calculi were found as the main stone components. Overall, the proportion of uric acid calculi was markedly higher in patients with rather than without metabolic syndrome (19.6 vs 11.2%; P=0.002). However, the proportion of calcium oxalate, carbonate apatite and struvite calculi did not differ between the two groups. The multivariable-adjusted odds ratio for uric acid calculi according to the metabolic syndrome components indicated that the presence of metabolic syndrome was associated with a 93% increased odds ratio of uric acid calculi compared with the absence of metabolic syndrome. Impaired fasting glucose and hypertriglyceridemia were independent risk factors for uric acid calculi. Metabolic syndrome is associated with a significantly increased risk of uric acid calculi development, especially those with impaired fasting glucose and hypertriglyceridemia. © 2012 The Japanese Urological Association.

Acute inflammatory proteins constitute the organic matrix of prostatic corpora amylacea and calculi in men with prostate cancer

PubMed Central

Sfanos, Karen S.; Wilson, Brice A.; De Marzo, Angelo M.; Isaacs, William B.

2009-01-01

Corpora amylacea (CA) are a frequent microscopic finding in radical prostatectomy specimens from men undergoing treatment for prostate cancer. Although often observed histologically to be associated with inflammation, the contribution of CA to prostatitis-related symptoms of unknown etiology or to prostate carcinogenesis remains unclear. Prostatic calculi (PC), which potentially represent calcified forms of CA, are less common but can cause urological disease including urinary retention and prostatitis. We conducted a comprehensive compositional analysis of CA/PC to gain insight into their biogenesis. Infrared spectroscopy analysis of calculi collected from 23 patients confirmed a prevalence of calcium phosphate in the form of hydroxyapatite. This result sets PC apart from most urinary stones, which largely are composed of calcium oxalate. Tandem mass spectrometry-based proteomic analysis of CA/PC revealed that lactoferrin is the predominant protein component, a result that was confirmed by Western blot analysis. Other proteins identified, including calprotectin, myeloperoxidase, and α-defensins, are proteins contained in neutrophil granules. Immunohistochemistry (IHC) suggested the source of lactoferrin to be prostate-infiltrating neutrophils as well as inflamed prostate epithelium; however, IHC for calprotectin suggested prostate-infiltrating neutrophils as a major source of the protein, because it was absent from other prostate compartments. This study represents a definitive analysis of the protein composition of prostatic CA and calculi and suggests that acute inflammation has a role in their biogenesis—an intriguing finding, given the prevalence of CA in prostatectomy specimens and the hypothesized role for inflammation in prostate carcinogenesis. PMID:19202053

The History of Kidney Stone Dissolution Therapy: 50 Years of Optimism and Frustration With Renacidin

PubMed Central

Gonzalez, Ricardo D.; Whiting, Bryant M.

2012-01-01

Abstract Background and Purpose Over the last 50 years, chemolysis as a primary or adjuvant treatment for urinary stones has fallen in and out of favor. We review the literature for a historical perspective on the origins and chronology of Renacidin therapy, focusing on landmark studies and impracticalities that have seemingly condemned it to history. Materials and Methods A MEDLINE search was performed on the topic of chemolysis of urinary calculi. Historical literature was reviewed with regard to stone composition, treatment modalities, outcomes, and complications. Results A total of 61 articles were reviewed, 40 of which were case series, representing a total of 817 patients studied. Mulvaney first introduced Renacidin in 1959 as a modification of Suby and Albright's 1943 solution. Because of an overabundance of nonstandardized irrigation protocols, six deaths were reported in the early 1960s resulting in a Food and Drug Administration ban on the practice of upper urinary tract stone dissolution. Over time, Renacidin returned to the urologist's arsenal, appearing first as an adjunct to dissolve catheter and bladder calculi and later (1990) as an approved agent for renal pelvis and ureter use. This feat was almost single-handedly the result of a successful hemiacidrin case series published in 1971 by Nemoy and Stamey. By using daily urine cultures, prophylactic antibiotics, and meticulous intrarenal pressure monitoring, Nemoy and Stamey virtually eliminated all major irrigation complications, paving the way for a flurry of studies. More importantly, they established the link between residual struvite stones, persistent infection, and recurrent staghorn stone formation. Conclusions Dissolution of urinary calculi by chemolysis has been shown to be safe and effective if performed with sterile urine cultures, prophylactic antibiotics, and low intrapelvic pressures. The pioneers of this therapy are remembered for their attempts to develop an alternative to open surgery, and, in the process, solidified the “stone-free” concept for infection-based stones. PMID:21999455

How accurate is unenhanced multidetector-row CT (MDCT) for localization of renal calculi?

PubMed

Goetschi, Stefan; Umbehr, Martin; Ullrich, Stephan; Glenck, Michael; Suter, Stefan; Weishaupt, Dominik

2012-11-01

To investigate the correlation between unenhanced MDCT and intraoperative findings with regard to the exact anatomical location of renal calculi. Fifty-nine patients who underwent unenhanced MDCT for suspected urinary stone disease, and who underwent subsequent flexible ureterorenoscopy (URS) as treatment of nephrolithiasis were included in this retrospective study. All MDCT data sets were independently reviewed by three observers with different degrees of experience in reading CT. Each observer was asked to indicate presence and exact anatomical location of any calcification within pyelocaliceal system, renal papilla or renal cortex. Results were compared to intraoperative findings which have been defined as standard of reference. Calculi not described at surgery, but present on MDCT data were counted as renal cortex calcifications. Overall 166 calculi in 59 kidneys have been detected on MDCT, 100 (60.2%) were located in the pyelocaliceal system and 66 (39.8%) in the renal parenchyma. Of the 100 pyelocaliceal calculi, 84 (84%) were correctly located on CT data sets by observer 1, 62 (62%) by observer 2, and 71 (71%) by observer 3. Sensitivity/specificity was 90-94% and 50-100% if only pyelocaliceal calculi measuring >4 mm in size were considered. For pyelocaliceal calculi≤4 mm in size diagnostic performance of MDCT was inferior. Compared to flexible URS, unenhanced MDCT is accurate for distinction between pyelocaliceal calculi and renal parenchyma calcifications if renal calculi are >4 mm in size. For smaller renal calculi, unenhanced MDCT is less accurate and distinction between a pyelocaliceal calculus and renal parenchyma calcification is difficult. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Perioperative patient radiation exposure in the endoscopic removal of upper urinary tract calculi.

PubMed

Jamal, Joseph E; Armenakas, Noel A; Sosa, R Ernest; Fracchia, John A

2011-11-01

The efficacy of computed tomography (CT) in detailing upper urinary tract calculi is well established. There is no established acceptable annual recommended limit for medical exposure, yet the global accepted upper limit for occupational radiation exposure is <50 millisieverts (mSv) in any one year. We sought to appreciate the CT and fluoroscopic radiation exposure to our patients undergoing endoscopic removal of upper tract calculi during the periprocedure period. All patients undergoing upper urinary endoscopic stone removal between 2005 and 2009 were identified. To calculate the cumulative radiation exposure, we included all ionizing radiation imaging performed during a periprocedure period, which we defined as ≤90 days pre- and post-therapeutic procedure. A total of 233 upper urinary tract therapeutic patient stone procedures were identified; 127 patients underwent ureteroscopy (URS) and 106 patients underwent percutaneous nephrolithotomy (PCNL). A mean 1.58 CTs were performed per patient. Ninety (38.6%) patients underwent ≥2 CTs in the periprocedure period, with an average number in this group of 2.49 CT/patient, resulting in approximately 49.8 mSv of CT radiation exposure. Patients who were undergoing URS were significantly more likely to have multiple CTs (P=0.003) than those undergoing PCNL. Median fluoroscopic procedure exposures were 43.3 mGy for patients who were undergoing PCNL and 27.6 mGy for those patients undergoing URS. CT radiation exposure in the periprocedure period for patients who were undergoing endoscopic upper tract stone removal is considerable. Added to this is the procedure-related fluoroscopic radiation exposure. Urologic surgeons should be aware of the cumulative amount of ionizing radiation received by their patients from multiple sources.

Novel Methods of Determining Urinary Calculi Composition: Petrographic Thin Sectioning of Calculi and Nanoscale Flow Cytometry Urinalysis

PubMed Central

Gavin, Carson T; Ali, Sohrab N; Tailly, Thomas; Olvera-Posada, Daniel; Alenezi, Husain; Power, Nicholas E; Hou, Jinqiang; St. Amant, Andre H; Luyt, Leonard G; Wood, Stephen; Wu, Charles; Razvi, Hassan; Leong, Hon S

2016-01-01

Accurate determination of urinary stone composition has significant bearing on understanding pathophysiology, choosing treatment modalities and preventing recurrence. A need exists for improved methods to determine stone composition. Urine of 31 patients with known renal calculi was examined with nanoscale flow cytometry and the calculi collected during surgery subsequently underwent petrographic thin sectioning with polarized and fluorescent microscopy. Fluorescently labeled bisphosphonate probes (Alendronate-fluorescein/Alendronate-Cy5) were developed for nanoscale flow cytometry to enumerate nanocrystals that bound the fluorescent probes. Petrographic sections of stones were also imaged by fluorescent and polarized light microscopy with composition analysis correlated to alendronate +ve nanocrystal counts in corresponding urine samples. Urine samples from patients with Ca2+ and Mg2+ based calculi exhibited the highest alendronate +ve nanocrystal counts, ranging from 100–1000 nm in diameter. This novel urine based assay was in agreement with composition determined by petrographic thin sections with Alendronate probes. In some cases, high alendronate +ve nanocrystal counts indicated a Ca2+ or Mg2+ composition, as confirmed by petrographic analysis, overturning initial spectrophotometric diagnosis of stone composition. The combination of nanoscale flow cytometry and petrographic thin sections offer an alternative means for determining stone composition. Nanoscale flow cytometry of alendronate +ve nanocrystals alone may provide a high-throughput means of evaluating stone burden. PMID:26771074

Retroperitoneoscopic pyelolithotomy: a good alternative treatment for renal pelvic calculi in children.

PubMed

Cezarino, Bruno Nicolino; Park, Rubens; Moscardi, Paulo Renato Marcelo; Lopes, Roberto Iglesias; Denes, Francisco T; Srougi, Miguel

2016-01-01

Nephrolitiasis, once considered an adult disease, has become increasingly prevalent in children, with na increase from 6% to 10 % annually in past 25 years. Kidney stones in pediatric population can result from metabolic diseases in up to 50% of children affected. Other factors associated with litiasis are infection, dietary factors, and anatomic malformations of urinary tract. Standard treatment procedures for pediatric population are similar to adult population. Extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS), percutaneous nepfrolithotomy (PCNL), as well as laparoscopic and retroperitoneoscopic approaches can be indicated in selected cases. The advantages of laparoscopic or retroperitoneoscopic approaches are shorter mean operation time, no trauma of renal parenchyma, lower bleeding risk, and higher stone-free rates, especially in pelvic calculi with extrarenal pelvis, where the stone is removed intact. A 10 year-old girl presented with right abdominal flank pain, macroscopic hematuria,with previous history of urinary infections.. Further investigation showed an 1,5 centimeter calculi in right kidney pelvis. A previous ureterorenoscopy was tried with no success, and a double J catheter was placed. After discussing options, a retroperitoneoscopic pielolithotomy was performed. The procedure occurred with no complications, and the calculi was completely removed. The foley catheter was removed in first postoperative day and she was discharged 2 days after surgery. Double J stent was removed after 2 weeks. Retroperitoneoscopic pielolithotomy is a feasible and safe procedure in children, with same outcomes of the procedure for adult population. Copyright® by the International Brazilian Journal of Urology.

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.

Bladder calculi in the augmented bladder: a follow-up study of 160 children and adolescents.

PubMed

Kisku, S; Sen, S; Karl, S; Mathai, J; Thomas, R J; Barla, R

2015-04-01

Bladder augmentation (BA) has been used for various congenital and acquired conditions to create a low pressure, continent catheterizable reservoir. The prevalence of calculi within the BA have been reported to be from 3 to 52.5%. The present study reports the prevalence and risk factors of bladder calculi in patients with BA. A retrospective review of 160 patients was performed from January 1997 through December 2012. The various risk factors for the formation of bladder calculi such as the nature of the anatomical defect, presence of preoperative urinary calculi, type of bowel augmentation, addition of a mitrofanoff and/or bladder neck procedure, prevalence of post-operative urinary tract infections (UTIs), need for mitrofanoff revision due to stenosis/difficulty catheterization, postoperative significant hydronephrosis and bladder calculi were recorded for analysis. The children underwent open removal or endoscopic cystolithotripsy. One hundred and eight males and 52 females (average age 6.3 years) were followed up for a median of 70.5 months. All patients performed daily bladder irrigation with tap or drinking water. Post-operative bladder calculi were noted in 14 (8.8%) of 160 patients following BA. Median time to stone formation was 37.5 months (11-120 months). Recurrent febrile UTIs were noted in 16 of the 160 patients following BA. The various risk factors and their outcomes are summarized in table. Eight patients underwent open cystolithotomy and four patients were treated by cystolithotripsy. Post-operative recurrent bladder calculi were noted in 2 patients. Multivariate analysis revealed that exstrophy/epispadias (OR 17.2) and recurrent UTI (OR 55.4) were independent risk factors for developing postoperative calculi in bladder augmentations. All other risk factors did not achieve statistical significance. There seemed to be no difference in the prevalence of calculi in the ileal or colonic augmentations. Mucus secreted by the bowel segment blocks catheters leading to incomplete drainage, stagnation and UTIs. Our protocol consists of daily bladder irrigation till the effluents are clear of mucus. This is probably the key to the low prevalence of postoperative calculi (8.8%) in our patients. Bladder exstrophy/epispadias and UTIs are independent statistically significant risk factors for the formation of bladder calculi in BA patients. Other risk factors such as preoperative calculi, bladder neck procedures and the use of mitrofanoff though not statistically significant, may contribute to the overall risk. The performance of daily bladder irrigation is an important part of our management of mucus. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

A giant dumbbell shaped vesico-prostatic urethral calculus: a case report and review of literature.

PubMed

Prabhuswamy, Vinod Kumar; Tiwari, Rahul; Krishnamoorthy, Ramakrishnan

2013-01-01

Calculi in the urethra are an uncommon entity. Giant calculi in prostatic urethra are extremely rare. The decision about treatment strategy of calculi depends upon the size, shape, and position of the calculus and the status of the urethra. If the stone is large and immovable, it may be extracted via the perineal or the suprapubic approach. In most of the previous reported cases, giant calculi were extracted via the transvesical approach and external urethrotomy. A 38-year-old male patient presented with complaints of lower urinary tract symptoms. Further investigations showed a giant urethral calculus secondary to stricture of bulbo-membranous part of the urethra. Surgical removal of calculus was done via transvesical approach. Two calculi were found and extracted. One was a huge dumbbell calculus and the other was a smaller round calculus. This case was reported because of the rare size and the dumbbell nature of the stone. Giant urethral calculi are better managed by open surgery.

A Giant Dumbbell Shaped Vesico-Prostatic Urethral Calculus: A Case Report and Review of Literature

PubMed Central

Prabhuswamy, Vinod Kumar; Tiwari, Rahul; Krishnamoorthy, Ramakrishnan

2013-01-01

Calculi in the urethra are an uncommon entity. Giant calculi in prostatic urethra are extremely rare. The decision about treatment strategy of calculi depends upon the size, shape, and position of the calculus and the status of the urethra. If the stone is large and immovable, it may be extracted via the perineal or the suprapubic approach. In most of the previous reported cases, giant calculi were extracted via the transvesical approach and external urethrotomy. A 38-year-old male patient presented with complaints of lower urinary tract symptoms. Further investigations showed a giant urethral calculus secondary to stricture of bulbo-membranous part of the urethra. Surgical removal of calculus was done via transvesical approach. Two calculi were found and extracted. One was a huge dumbbell calculus and the other was a smaller round calculus. This case was reported because of the rare size and the dumbbell nature of the stone. Giant urethral calculi are better managed by open surgery. PMID:23762742

Predisposing factors for infantile urinary calculus in south-west of Iran.

PubMed

Alemzadeh-Ansari, Mohammad Hasan; Valavi, Ehsan; Ahmadzadeh, Ali

2014-01-01

Urinary calculi in infants are relatively infrequent, but their incidence has increased in the recent decades. The aim of this study was to investigate the clinical presentation, metabolic risk factors, and urinary tract abnormalities in infants suffering from kidney calculus. A total of 152 infants were admitted between 2009 and 2012 with ultrasonography-proven urolithiasis. A Foley catheter was fixed and 24-hour urine samples were analyzed for calcium, citrate, oxalate, uric acid, and magnesium. For detecting cystinuria, qualitative measurement of urinary cystine was done by nitroprusside test. Urinary tract structural abnormalities were also evaluated. The mean age at the diagnosis of kidney calculus was 5.46 months (range, 15 days to 12 months). The most common clinical findings were restlessness and urinary tract infection. A family history of calculi was found in 67.1% of the patients and 68.4% were born to consanguineous marriages. Metabolic abnormalities and urinary tract abnormalities were found in 96.1% and 15.1% of children, respectively. Urinary tract abnormalities were more common in girls. The most common metabolic risk factors were hypercalciuria (79.6%) and hypocitraturia (40.9%). Hyperoxaluria and hypomagnesuria were found in about 28% of patients, both of which were associated with bilateral urolithiasis. These findings show that urinary metabolic abnormalities are very common in infants with urolithiasis. Appropriate evaluation of urinary metabolic parameters can lead us to proper diagnosis and treatment.

In Vivo Differentiation of Uric Acid Versus Non-Uric Acid Urinary Calculi With Third-Generation Dual-Source Dual-Energy CT at Reduced Radiation Dose.

PubMed

Franken, Axelle; Gevenois, Pierre Alain; Muylem, Alain Van; Howarth, Nigel; Keyzer, Caroline

2018-02-01

The objective of our study was to evaluate in vivo urinary calculus characterization with third-generation dual-source dual-energy CT (DECT) at reduced versus standard radiation dose. One hundred fifty-three patients requiring unenhanced CT for suspected or known urolithiasis were prospectively included in our study. They underwent two acquisitions at reduced-dose CT (90 kV and 50 mAs ref ; Sn150 kV and 31 mAs ref , where Sn denotes the interposition of a tin filter in the high-energy beam) and standard-dose CT (90 kV and 50 mAs ref ; Sn150 kV and 94 mAs ref ). One radiologist interpreted the reduced-dose examinations before the standard-dose examinations during the same session. Among 103 patients (23 women, 80 men; mean age ± SD, 50 ± 15 years; age range, 18-82 years) with urolithiasis, dedicated DECT software measured the maximal diameter and CT numbers, calculated the DECT number ratio, and labeled with a color code each calculus visualized by the radiologist as uric acid (UA) or non-UA. Volume CT dose index (CTDI vol ) and dose-length product (DLP) were recorded. The radiologist visualized 279 calculi on standard-dose CT and 262 on reduced-dose CT; 17 calculi were missed on reduced-dose CT, all of which were ≤ 3 mm. Among the 262 calculi visualized at both doses, the CT number ratio was obtained with the software for 227 calculi and was not different between the doses (p = 0.093). Among these 262 calculi, 197 were labeled at both doses; 194 of the 197 labeled calculi were labeled with the same color code. Among the 65 remaining calculi, 48 and 61 (all ≤ 5 mm) were not labeled at standard-dose and reduced-dose CT (p = 0.005), respectively. At reduced-dose CT, the mean CTDI vol was 2.67 mGy and the mean DLP was 102.2 mGy × cm. With third-generation dual-source DECT, a larger proportion of calculi ≤ 5 mm are not characterized as UA or non-UA at a reduced dose.

FT-IR spectroscopic, thermal analysis of human urinary stones and their characterization

NASA Astrophysics Data System (ADS)

Selvaraju, R.; Raja, A.; Thiruppathi, G.

2015-02-01

In the present study, FT-IR, XRD, TGA-DTA spectral methods have been used to investigate the chemical compositions of urinary calculi. Multi-components of urinary calculi such as calcium oxalate, hydroxyl apatite, struvite and uric acid have been studied. The chemical compounds are identified by FT-IR spectroscopic technique. The mineral identification was confirmed by powder X-ray diffraction patterns as compared with JCPDS reported values. Thermal analysis techniques are considered the best techniques for the characterization and detection of endothermic and exothermic behaviors of the urinary stones. The percentages of each hydrate (COM and COD) are present together, in the presences of MAPH or UA. Finally, the present study suggests that the Urolithiasis is significant health problem in children, and is very common in some parts of the world, especially in India. So that present study is so useful and helpful to the scientific community for identification of latest human health problems and their remedies using spectroscopic techniques.

The history of kidney stone dissolution therapy: 50 years of optimism and frustration with renacidin.

PubMed

Gonzalez, Ricardo D; Whiting, Bryant M; Canales, Benjamin K

2012-02-01

Over the last 50 years, chemolysis as a primary or adjuvant treatment for urinary stones has fallen in and out of favor. We review the literature for a historical perspective on the origins and chronology of Renacidin therapy, focusing on landmark studies and impracticalities that have seemingly condemned it to history. A MEDLINE search was performed on the topic of chemolysis of urinary calculi. Historical literature was reviewed with regard to stone composition, treatment modalities, outcomes, and complications. A total of 61 articles were reviewed, 40 of which were case series, representing a total of 817 patients studied. Mulvaney first introduced Renacidin in 1959 as a modification of Suby and Albright's 1943 solution. Because of an overabundance of nonstandardized irrigation protocols, six deaths were reported in the early 1960s resulting in a Food and Drug Administration ban on the practice of upper urinary tract stone dissolution. Over time, Renacidin returned to the urologist's arsenal, appearing first as an adjunct to dissolve catheter and bladder calculi and later (1990) as an approved agent for renal pelvis and ureter use. This feat was almost single-handedly the result of a successful hemiacidrin case series published in 1971 by Nemoy and Stamey. By using daily urine cultures, prophylactic antibiotics, and meticulous intrarenal pressure monitoring, Nemoy and Stamey virtually eliminated all major irrigation complications, paving the way for a flurry of studies. More importantly, they established the link between residual struvite stones, persistent infection, and recurrent staghorn stone formation. Dissolution of urinary calculi by chemolysis has been shown to be safe and effective if performed with sterile urine cultures, prophylactic antibiotics, and low intrapelvic pressures. The pioneers of this therapy are remembered for their attempts to develop an alternative to open surgery, and, in the process, solidified the "stone-free" concept for infection-based stones.

Do stones still kill? An analysis of death from stone disease 1999-2013 in England and Wales.

PubMed

Kum, Francesca; Mahmalji, Wasim; Hale, Jemma; Thomas, Kay; Bultitude, Matthew; Glass, Jonathan

2016-07-01

To analyse the trends in the number of deaths attributable to urolithiasis in England and Wales over the past 15 years (1999-2013). Urolithiasis has an estimated lifetime risk of 12% in males and 6% in females and is not perceived as a life-threatening pathology. Admissions with urinary calculi contribute to 0.5% of all inpatient hospital stays, and the number of deaths attributable to stone disease has yet to be identified and presented. Office of National Statistics data relating to causes of death from urolithiasis, coded as International Classification of Diseases (ICD)-10 N20-N23, was collated and analysed for the 15-year period from 1999 to 2013 in England and Wales. These data were sub-categorised into anatomical location of calculi, age, and gender. In all, 1954 deaths were attributed to urolithiasis from 1999 to 2013 (mean 130.3 deaths/year). Of which, 141 were attributed to ureteric stones (mean 9.4 deaths/year). Calculi of the kidney and ureter accounted for 91% of all deaths secondary to urolithiasis; lower urinary tract (bladder or urethra) calculi contributed to only 7.9% of deaths. The data revealed an overall increasing trend in mortality from urolithiasis over this 15-year period, with an increase of 3.8 deaths/year based on a linear trend (R(2) = 0.65). Overall, the number of deaths in females was significantly higher than in males (ratio 1.5:1, P < 0.001); kidney and ureteric calculi causing death had a female preponderance (1.7:1, female:male); whereas calculi of the lower urinary tract was more common in males (1:2.2, female:male). Stone disease still causes death in the 21st century in England and Wales. This trend of increasing deaths must be placed in the context of the concurrent rising incidence of urolithiasis in the UK and the number of stone-related hospital episodes. The primary cause of death relating to complications of stone disease for each individual case should be further investigated to facilitate prevention of complications of urolithiasis. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

Ureteroscopic treatment of larger renal calculi (>2 cm)

PubMed Central

Bagley, Demetrius H.; Healy, Kelly A.; Kleinmann, Nir

2012-01-01

Objectives To evaluate the current status of ureteroscopic lithotripsy (UL) for treating renal calculi of >2 cm, as advances in flexible ureteroscope design, accessory instrumentation and lithotrites have revolutionised the treatment of urinary calculi. While previously reserved for ureteric and small renal calculi, UL has gained an increasing role in the selective management of larger renal stone burdens. Methods We searched the available databases, including PubMed, Google Scholar, and Scopus, for relevant reports in English, and the article bibliographies to identify additional relevant articles. Keywords included ureteroscopy, lithotripsy, renal calculi, and calculi >2 cm. Retrieved articles were reviewed to consider the number of patients, mean stone size, success rates, indications and complications. Results In all, nine studies (417 patients) were eligible for inclusion. After one, two or three procedures the mean (range) success rates were 68.2 (23–84)%, 87.1 (79–91)% and 94.4 (90.1–96.7)%, respectively. Overall, the success rate was >90% with a mean of 1.2–2.3 procedures per patient. The overall complication rate was 10.3%, including six (1.4%) intraoperative and 37 (8.9%) postoperative complications, most of which were minor. The most common indications for UL were a failed previous treatment (46%), comorbidities (18.2%), and technical and anatomical factors (12.3%). Conclusions UL is safe and effective for treating large renal calculi. While several procedures might be required for total stone clearance, UL should be considered a standard approach in the urologist’s options treating renal calculi of >2 cm. PMID:26558040

Endoscopically guided removal of cloacal calculi in three African spurred tortoises (Geochelone sulcata).

PubMed

Mans, Christoph; Sladky, Kurt K

2012-04-01

3 female African spurred tortoises (Geochelone sulcata) of various body weights (0.22, 0.77, and 2.86 kg [0.48, 1.69, and 6.29 lb]) were examined because of reduced food intake and lack of fecal output. Owners reported intermittent tenesmus in 2 of the tortoises. Physical examinations revealed no clinically important abnormalities in the tortoises. Cloacal calculi were diagnosed on the basis of radiography and cloacoscopy in all 3 tortoises. One tortoise had another calculus in the urinary bladder. Tortoises were anesthetized, and cloacal calculi were removed by use of a cutting burr (plain-fissure cutting burr and a soft tissue protector mounted to a dental handpiece that had a low-speed motor and a straight nose cone) and warm water irrigation with endoscopic guidance. Complete removal of calculus fragments was achieved by use of forceps and irrigation. In 1 tortoise, removal of the cloacal calculus was staged (2 separate procedures). In another tortoise, a second cloacal calculus (which had been located in the urinary bladder during the first examination) was successfully removed 25 days after removal of the first calculus. All 3 tortoises recovered uneventfully, and serious complications secondary to removal of the cloacal calculi were not detected. Cloacoscopy combined with the use of a low-speed dental drill and warm water irrigation should be considered a simple, safe, and nontraumatic treatment option for removal of obstructive cloacal calculi in tortoises.

THE METABOLISM OF SILICON IN THE RAT AND ITS RELATION TO THE FORMATION OF ARTIFICIAL SILICEOUS CALCULI

PubMed Central

Keeler, Richard F.; Lovelace, Stuart A.

1959-01-01

The urinary excretion of silicon in the rat was found to be enhanced beyond normal levels by the administration of various chemical forms of silicon. The excretion was enhanced to a much greater degree by the administration of ethyl silicate than by magnesium trisilicate, sodium metasilicate, or water glass. The tolerance level of rats to sustained daily doses of ethyl silicate fed via stomach tube was approximately 15 to 30 mg. of silicon per rat per day. Urinary silicon excretion was found to be a straight line function of the concentration of ethyl silicate administered, via stomach tube, with approximately 18 per cent of the administered silicon appearing in the urine at all levels tested. Using sustained dietary additions of ethyl silicate as a means of enhancing urine silicon levels, artificial siliceous urinary calculi were consistently produced on zinc pellets implanted in the bladders of rats. PMID:13654631

Management of upper urinary tract calculi in crossed fused renal ectopic anomaly

PubMed Central

Huang, Liang; Lin, Yong; Tang, Zhengyan; Lie, Dongjie; Wang, Zhao; Chen, Hequn; Wang, Guilin

2018-01-01

The aim of the present study was to summarize the management of upper urinary tract calculi in crossed fused renal ectopia (CFRE). Two patients were retrospectively studied in Xiangya Hospital (Changsha, China) and all relevant literature published in English between 1996 and 2016 was reviewed. All patients, including those reported in the literature, were characterized by age, sex, manifestation, therapy history, ectopic side, stone location, surgery and outcome. The patients had a mean age of 42.3±18.5 years, a male: Female ratio of 5:4 and the ratio of renal ectopic side was 9:8 (left:right). All patients suffered from different degrees of pain on the affected side, with or without hematuria. Up to 89% of patients presented with renal stones. These patients received treatments including conservative management in 2, extracorporeal shock wave lithotripsy (ESWL) in 2, percutaneous nephrolithotomy (PCNL) in 11, laparoscope nephrolithotomy in 1 and retrograde intrarenal surgery (RIRS) in 3. Complete stone clearance was achieved in 14 patients (73.7%). In addition, 3 patients had a history of failed ESWL. No obvious intraoperative or postoperative complications occurred. The results suggested that, for the treatment of CFRE with upper urinary tract calculi, conservative treatment and ESWL are insufficient. PCNL is a safe and effective treatment for renal calculus, and laparoscopic nephrolithotomy is an alternative choice for treating large or staghorn renal stones. RIRS may become the first line of treatment for renal stones (≤3.5 cm) due to its multiple merits, including higher stone-free rates, minimal invasion and fewer complications. PMID:29375692

Management of upper urinary tract calculi in crossed fused renal ectopic anomaly.

PubMed

Huang, Liang; Lin, Yong; Tang, Zhengyan; Lie, Dongjie; Wang, Zhao; Chen, Hequn; Wang, Guilin

2018-01-01

The aim of the present study was to summarize the management of upper urinary tract calculi in crossed fused renal ectopia (CFRE). Two patients were retrospectively studied in Xiangya Hospital (Changsha, China) and all relevant literature published in English between 1996 and 2016 was reviewed. All patients, including those reported in the literature, were characterized by age, sex, manifestation, therapy history, ectopic side, stone location, surgery and outcome. The patients had a mean age of 42.3±18.5 years, a male: Female ratio of 5:4 and the ratio of renal ectopic side was 9:8 (left:right). All patients suffered from different degrees of pain on the affected side, with or without hematuria. Up to 89% of patients presented with renal stones. These patients received treatments including conservative management in 2, extracorporeal shock wave lithotripsy (ESWL) in 2, percutaneous nephrolithotomy (PCNL) in 11, laparoscope nephrolithotomy in 1 and retrograde intrarenal surgery (RIRS) in 3. Complete stone clearance was achieved in 14 patients (73.7%). In addition, 3 patients had a history of failed ESWL. No obvious intraoperative or postoperative complications occurred. The results suggested that, for the treatment of CFRE with upper urinary tract calculi, conservative treatment and ESWL are insufficient. PCNL is a safe and effective treatment for renal calculus, and laparoscopic nephrolithotomy is an alternative choice for treating large or staghorn renal stones. RIRS may become the first line of treatment for renal stones (≤3.5 cm) due to its multiple merits, including higher stone-free rates, minimal invasion and fewer complications.

Lower urinary tract symptoms in benign prostatic hyperplasia patients: orchestrated by chronic prostatic inflammation and prostatic calculi?.

PubMed

Kim, Sang Hoon; Jung, Kyu In; Koh, Jun Sung; Min, Ki Ouk; Cho, Su Yeon; Kim, Hyun Woo

2013-01-01

This study aims to examine the relationship between chronic prostatic inflammation and prostatic calculi, and clinical parameters of benign prostatic hyperplasia (BPH). This study was based on 225 patients who underwent transurethral resection of the prostate for BPH. Chronic inflammation was graded as 0 (n = 44), I (n = 54), II (n = 88) or III (n = 39) according to severity. Prostatic calculi were classified into types A (n = 66), B (n = 44), M (n = 77) and N (n = 38). The relationship between inflammation and calculus type was analyzed, and clinical parameters of BPH were compared for each group. There was no correlation between severity of inflammation and calculus type. Prostatic volume increased with the severity of inflammation and showed significant differences between G2, G3 and G0. The International Prostate Symptom Score also increased with increasing inflammation. There was no significant difference between each clinical parameter according to calculus type. Prostatic calculi had no significant association with chronic inflammation and clinical parameters of BPH. Chronic inflammation was associated with the volume of the prostate and storage symptoms; thus, it is not only presumed to be related to the progression of BPH, but may also be one of the causes of lower urinary tract symptoms. Copyright © 2012 S. Karger AG, Basel.

Melamine-induced urinary calculi in infants--sonographic manifestations and outcomes 1 year after exposure.

PubMed

Nie, Fang; Li, Xin-jie; Shang, Pan-feng; Wang, Ying

2013-04-01

In 2008, the melamine-tainted-milk incident started with reports of increased incidence of urolithiasis in infants in China. Affected children were screened for urolithiasis. The purpose of this study was to analyze sonographic characterization of infant melamine-induced urolithiasis. Transabdominal US examination was done in 603 infants with melamine-induced calculi. The imaging characteristics of calculi and hydronephrosis were analyzed. Follow-up US imaging was performed. Comet-tail sign was seen behind the calculus of <4 mm. Calculi of ≥ 4 mm were found in 299 inpatients with clear posterior border and with or without light shadowing. Solitary and multiple stones had similar incidence. Incidence of calculi in the inferior renal calyx was the highest (55.2%) in inpatients. Calculus size in inpatients age 2-3 years was smaller than that of children younger than 2 years old (P < 0.05). Inpatients age 2-3 years had the highest incidence rate (48.0%) of hydronephrosis. Calculi of <4 mm manifested as hyperechoic foci near the renal papillae, while calculi of ≥ 4 mm usually manifested as echogenic foci with visible inferior edge in the renal calyx. Hydronephrosis was a common imaging finding in inpatients ages 2-3 years.

Extracorporeal shockwave lithotripsy in infants.

PubMed

Ramakrishnan, Prem A; Medhat, Mohammed; Al-Bulushi, Younis H; Nair, Priti; Al-Kindy, Ahmed

2007-10-01

Pediatric urolithiasis is relatively uncommon and limited information is available on the application of minimally invasive management modalities in young children. We present a single centre experience with extracorporeal shockwave lithotripsy (ESWL) for infants with upper urinary tract calculi. A total of 74 infants aged 3 months to 24 months with upper urinary tract calculi were treated with ESWL under general anesthesia using the Wolf 2500 and the 2501 Piezolith lithotriptors over a 14 and a half-year period. Patient and stone characteristics, risk factors for urolithiasis, treatment parameters, clinical outcomes and long-term follow-up were assessed and recorded. The mean patient age was 14.5 (range 3 to 24) months. The mean renal stone size was 18.2 (range 7 to 32) mm while the mean ureteral stone size was 9.4 (range 5 to 14) mm. Metabolic abnormalities, structural anomalies and urinary tract infections were identified as contributory factors for stone formation in 34% of the infants. At the 3-month follow-up there was an overall successful outcome in 72 infants (97%) that included 65 (88%) who were rendered stone-free and 7 (9%) who had clinically insignificant stone fragments. Retreatment was required in 27 (35%) patients, auxiliary procedures after ESWL were needed in 5 (7%) and secondary operative procedures were required in 2 (3%). Major complications were encountered in 5 (7%) patients that included complete ureteral obstruction with sepsis in 2, partial ureteral obstruction in 1 and febrile urinary tract infection in 2 other children. Long-term follow-up was recorded in 39 infants: 8 developed recurrent stones, 2 had stone regrowth and 1 developed mild hypertension but none had significant deterioration of renal function. ESWL is an effective treatment for upper urinary tract calculi in infants. In the short-term, complications are minimal but long-term follow-up is important.

Perspective on Lithotripsy Adverse Effects

NASA Astrophysics Data System (ADS)

Knoll, Thomas; Wendt-Nordahl, Gunnar

2008-09-01

Shock wave lithotripsy (SWL) is an effective and without any doubt the least invasive procedure to treat upper urinary tract calculi. Acute complications are rarely reported and do not require specific treatment in most cases. However, one should be aware that energy levels sufficient for stone breakage are capable of damaging tissue as well, and significant hematoma—not only in the kidney but as well in surrounding organs—has been observed. Furthermore, only little is known about the long-term effects of SWL. Some authors have reported an increased incidence of hypertension and possibly also diabetes mellitus. Such chronic diseases—if indeed related to prior SWL—may be a late result of acute SWL-related trauma but the discussion on the underlying pathogenesis is controversial. Many factors have to be considered, such as the natural history of recurrent stone formers, technical principles of SWL, and differences in treatment protocols. Promising studies are currently underway to optimize stone breakage while limiting potential collateral damage. With this progress, SWL remains a safe treatment option for most urinary calculi.

[Epidemiological study on urinary stones in the region of Fez and the risk of recurrence].

PubMed

El Habbani, R; Chaqroune, A; Sqalli Houssaini, T; Arrayhani, M; El Ammari, J; Dami, F; Chouhani, B A; Lahrichi, A

2016-04-01

In Morocco, few works on morpho-constitutional analysis of urinary calculi have been published, especially for patients in the region of Fez. This work aims to make a retrospective epidemiological study on the nature of urinary calculi with patients from the region of Fez and control the urine of the same patients after a period of three months to report on the risk of recurrence. Urinary stones were collected mostly in the nephrology service and urology service at the Hassan II Hospital in Fez. These calculations after being dried for 24 hours at room temperature underwent a morphological analysis, followed by infrared spectroscopic analysis Fourier transform. After a period of about three months, morning urine of the same patients was analyzed by crystalluria to control the presence of crystals that reflect a risk of recurrence. In our series of 123 samples, the age of patients ranges from 2-79 years. The prevalence was higher for men with a sex ratio of 1.3. The results of the analysis calculations showed that 61% were formed of calcium oxalate and 15% of uric acid and 25% of stones were carbapatite, struvite, cystine… The study by crystalluria urine revealed the presence of the crystals in 69% of patients' nephrolithiasis. The results of our study are conformed to the series of results in other regions of Morocco regarding the predominance of calcium oxalate stones. The presence of crystals in the urine of 69% of patients may indicate other recurrences. 4. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Predictive value of low tube voltage and dual-energy CT for successful shock wave lithotripsy: an in vitro study.

PubMed

Largo, Remo; Stolzmann, Paul; Fankhauser, Christian D; Poyet, Cédric; Wolfsgruber, Pirmin; Sulser, Tullio; Alkadhi, Hatem; Winklhofer, Sebastian

2016-06-01

This study investigates the capabilities of low tube voltage computed tomography (CT) and dual-energy CT (DECT) for predicting successful shock wave lithotripsy (SWL) of urinary stones in vitro. A total of 33 urinary calculi (six different chemical compositions; mean size 6 ± 3 mm) were scanned using a dual-source CT machine with single- (120 kVp) and dual-energy settings (80/150, 100/150 Sn kVp) resulting in six different datasets. The attenuation (Hounsfield Units) of calculi was measured on single-energy CT images and the dual-energy indices (DEIs) were calculated from DECT acquisitions. Calculi underwent SWL and the number of shock waves for successful disintegration was recorded. The prediction of required shock waves regarding stone attenuation/DEI was calculated using regression analysis (adjusted for stone size and composition) and the correlation between CT attenuation/DEI and the number of shock waves was assessed for all datasets. The median number of shock waves for successful stone disintegration was 72 (interquartile range 30-361). CT attenuation/DEI of stones was a significant, independent predictor (P < 0.01) for the number of required shock waves with the best prediction at 80 kVp (β estimate 0.576) (P < 0.05). Correlation coefficients between attenuation/DEI and the number of required shock waves ranged between ρ = 0.31 and 0.68 showing the best correlation at 80 kVp (P < 0.001). The attenuation of urinary stones at low tube voltage CT is the best predictor for successful stone disintegration, being independent of stone composition and size. DECT shows no added value for predicting the success of SWL.

Holmium:YAG laser lithotripsy for upper urinary tract calculi in 598 patients.

PubMed

Sofer, Mario; Watterson, James D; Wollin, Timothy A; Nott, Linda; Razvi, Hassan; Denstedt, John D

2002-01-01

We assessed the effectiveness and safety of holmium:YAG laser lithotripsy for managing upper urinary tract calculi in a prospective cohort of 598 patients. Ureteroscopic holmium:YAG laser lithotripsy was performed in 598 patients between 1993 and 1999. Calculi were located in the distal ureter in 39.6% of cases, mid ureter in 18.6%, proximal ureter in 32.4% and kidney in 9.4%. Patients were treated on an outpatient basis with various flexible and semirigid endoscopes. Of the cases 59% were referred as previous treatment failures. Patients were assessed 6 to 12 weeks postoperatively with repeat plain x-ray and ultrasound or excretory urography for late obstructive complications. The overall stone-free rate was 97%. As stratified by location, the stone-free rate was 98% in the distal ureter, 100% in the mid ureter, 97% in the proximal ureter and 84% in the kidney. Fragmentation was incomplete in 6% of cases and secondary intervention was required in 6%. The overall complication rate was 4%. New onset ureteral stricture developed postoperatively in 0.35% of patients. Holmium:YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral and a proportion of intrarenal calculi on an outpatient basis. The effectiveness and versatility of the holmium laser combined with small rigid or flexible endoscopes make it our modality of choice for ureteroscopic lithotripsy.

Minimally invasive treatment of urinary tract calculi in children.

PubMed

Fraser, M; Joyce, A D; Thomas, D F; Eardley, I; Clark, P B

1999-08-01

To report experience of a broad multimodality approach to the treatment of calculi in children using extracorporeal shock wave lithotripsy (ESWL), ureteroscopy/laser lithotripsy, lithoclast and percutaneous nephrolithotomy (PCNL). The treatment and outcome were reviewed in 43 children managed by a range of minimally invasive modalities, either singly or in combination, between 1990 and 1997. These patients represent a selected group deemed suitable for minimally invasive management during a period of developing experience with these techniques. Of this cohort, six children had previously undergone open stone surgery and contributory metabolic abnormalities were identified in seven. ESWL was the sole treatment modality in 24 children (56%). In five children (12%) ureteroscopy/laser lithotripsy was combined with ESWL, eight (18%) underwent ureteroscopy/laser lithotripsy alone, whilst three with bladder stones were treated with the lithoclast. Combined therapy including PCNL was required in three patients. Of the 43 children treated, 38 (88%) were rendered stone-free. Metabolic disorders accounted for three of the five cases of residual calculi. Complications requiring intervention occurred in two children (7%) and three subsequently underwent open pyelolithotomy or ureterolithotomy after unsuccessful minimally invasive treatment. Used selectively, the range of minimally invasive procedures available for adults, including ureteroscopy and PCNL, can be safely and effectively extended to the treatment of urinary tract calculi in children. The role of open surgery will diminish further with the availability of specialized instruments for paediatric PCNL.

PA01.01. A clinical study on the effect of paneeya kshara in the management of asmari w.s.r. to urinary calculi

PubMed Central

Chakradhar, K V

2012-01-01

Purpose: In Ayurveda, the diseases asmari was described under asta maha gada by Susrutha. This shows how difficult this disease to treat medically or surgically. According to modern science, various deposits of urological salts precipitate and form the calculi. The prevalence of these disease urinary calculi is about 3% of population with 1% of highly exploitable with severe agony and complications. The management in contemporary modern science is toughest approach because it may solve the problem temporarily but cannot render preventing or recurrence. Hence there is need to evaluate a better remedy. Here the kshara described by susrutha is selected and the yava kshara is chosen for study. Method: Total of 10 patients was selected from the SV ayurvedic college, Tirupati after subjecting to selection criteria based on inclusion and exclusion criteria. These 10 patients are given with yava kshara as paneeya kshara with the dose of 250 mg once in week for 4 weeks. The observations are noted and results were assessed on the basis of subjective (scoring prepared for symptomatology for pain, burning micturition, dysuria, tenderness in renal angle, haematuria, microscopic analysis of urine) and objective (kub usg) parameters. And then they are subjected for statistical validity. Result: It is found to be the yava kshara (paneeya kshara) is effective reducing the symptoms and producing remarkable benefit to patient. Conclusion: Even though it is difficult to treat the disease asmari, the yava kshara shown significant result and definitely be simple to use and cost effective management.

Effect of Hygrophila spinosa in ethylene glycol induced nephrolithiasis in rats.

PubMed

Ingale, Kundan G; Thakurdesai, Prasad A; Vyawahare, Neeraj S

2012-01-01

Hygrophila spinosa (Acanthaceae) is traditionally used to treat urinary calculi. The present study aimed to evaluate the antiurolithiatic activity of methanolic extract of Hygrophila spinosa (Acanthaceae) in ethylene glycol induced nephrolithiasic rats. Methanolic extract of Hygrophila spinosa (HSME) (250 and 500 mg/ kg body weight) was administered orally to male Wistar albino rats. Ethylene glycol (EG) was used to induce nephrolithiasis. The parameters studied included water intake, urinary volume, urinary pH, urinary and kidney oxalate and calcium, urinary magnesium and serum uric acid. Ethylene glycol feeding resulted in hyperoxaluria as well as increased renal excretion of calcium and serum uric acid along with decreased excretion of urinary magnesium. Treatment with HSME significantly reduced the elevated urinary oxalate, urinary calcium and serum uric acid with increase in reduced urinary magnesium. Ethylene glycol feeding also resulted in increased levels of calcium and oxalate in kidney which was decreased after the treatment with HSME. The increased deposition of stone forming constituents in the kidneys of ethylene glycol treated rats was significantly lowered by treatment with HSME. The results indicate that the aerial parts of Hygrophila spinosa are endowed with antiurolithiatic activity, thereby justifying its traditional claim.

Herbal extracts of Tribulus terrestris and Bergenia ligulata inhibit growth of calcium oxalate monohydrate crystals in vitro

NASA Astrophysics Data System (ADS)

Joshi, V. S.; Parekh, B. B.; Joshi, M. J.; Vaidya, A. B.

2005-02-01

A large number of people in this world are suffering from urinary stone problem. Calcium oxalate monohydrate (COM) and calcium oxalate dihydrate (COD) containing stones (calculi) are commonly found. In the present study, COM crystals were grown by a double diffusion gel growth technique using U-tubes. The gel was prepared from hydrated sodium metasilicate solution. The gel framework acts like a three-dimensional crucible in which the crystal nuclei are delicately held in the position of their formation, and nutrients are supplied for the growth. This technique can be utilized as a simplified screening static model to study the growth, inhibition and dissolution of urinary stones in vitro. The action of putative litholytic medicinal plants, Tribulus terrestris Linn. ( T.t) and Bergenia ligulata Linn. ( B.l.), has been studied in the growth of COM crystals. Tribulus terrestris and Bergenia ligulata are commonly used as herbal medicines for urinary calculi in India. To verify the inhibitive effect, aqueous extracts of Tribulus terrestris and Bergenia ligulata were added along with the supernatant solutions. The growth was measured and compared, with and without the aqueous extracts. Inhibition of COM crystal growth was observed in the herbal extracts. Maximum inhibition was observed in Bergenia ligulata followed by Tribulus terrestris. The results are discussed.

21 CFR 876.5990 - Extracorporeal shock wave lithotripter.

Code of Federal Regulations, 2011 CFR

2011-04-01

... focuses ultrasonic shock waves into the body to noninvasively fragment urinary calculi within the kidney... Notifications (510(k)'s) for Extracorporeal Shock Wave Lithotripters Indicated for the Fragmentation of Kidney...

21 CFR 876.5990 - Extracorporeal shock wave lithotripter.

Code of Federal Regulations, 2010 CFR

2010-04-01

... focuses ultrasonic shock waves into the body to noninvasively fragment urinary calculi within the kidney... Notifications (510(k)'s) for Extracorporeal Shock Wave Lithotripters Indicated for the Fragmentation of Kidney...

Urethral calculi with a urethral fistula: a case report and review of the literature.

PubMed

Zeng, Mingqiang; Zeng, Fanchang; Wang, Zhao; Xue, Ruizhi; Huang, Liang; Xiang, Xuyu; Chen, Zhi; Tang, Zhengyan

2017-09-06

To explore and summarize the reasons why urethral calculi cause a urethral fistula. We retrospectively studied 1 patient in Xiangya hospital and all relevant literature published in English between 1989 and 2015. The patients (including those reported in the literature) were characterized by age, origin, location of calculus, size of calculus, fistulous track, and etiological factors. Most of urethral calculi associated with a urethral fistula were native generated. Urethral calculi can be formed in various locations of the urethra, and the size of the calculus ranged from small (multiple) calculi to giant stones. The fistula external orifice located at the root of the penis was relatively common, and there were various etiological factors, such as urethral strictures, urethral trauma induced by long-term catheterization, lumbar fractures, and congenital anomaly factors. They were managed by the excision of the fistulous tract, retrieval of the urethral stones, and/or debridement and pus drainage operations. Some elements, such as trauma, recurrent urinary tract infections, abscess formation induced by long-term catheterization, and urethral calculus, may be the risk factors for a urethral fistula.

Ureteroscopic treatment of larger renal calculi (>2 cm).

PubMed

Bagley, Demetrius H; Healy, Kelly A; Kleinmann, Nir

2012-09-01

To evaluate the current status of ureteroscopic lithotripsy (UL) for treating renal calculi of >2 cm, as advances in flexible ureteroscope design, accessory instrumentation and lithotrites have revolutionised the treatment of urinary calculi. While previously reserved for ureteric and small renal calculi, UL has gained an increasing role in the selective management of larger renal stone burdens. We searched the available databases, including PubMed, Google Scholar, and Scopus, for relevant reports in English, and the article bibliographies to identify additional relevant articles. Keywords included ureteroscopy, lithotripsy, renal calculi, and calculi >2 cm. Retrieved articles were reviewed to consider the number of patients, mean stone size, success rates, indications and complications. In all, nine studies (417 patients) were eligible for inclusion. After one, two or three procedures the mean (range) success rates were 68.2 (23-84)%, 87.1 (79-91)% and 94.4 (90.1-96.7)%, respectively. Overall, the success rate was >90% with a mean of 1.2-2.3 procedures per patient. The overall complication rate was 10.3%, including six (1.4%) intraoperative and 37 (8.9%) postoperative complications, most of which were minor. The most common indications for UL were a failed previous treatment (46%), comorbidities (18.2%), and technical and anatomical factors (12.3%). UL is safe and effective for treating large renal calculi. While several procedures might be required for total stone clearance, UL should be considered a standard approach in the urologist's options treating renal calculi of >2 cm.

Urinary calculi increase the risk for adverse pregnancy outcomes: a nationwide study.

PubMed

Chung, Shiu-Dong; Chen, Yi-Hua; Keller, Jospeh J; Lin, Ching-Chun; Lin, Herng-Ching

2013-01-01

Using two large-scale nationwide population-based data sets, this study aimed to assess the risk of adverse pregnancy outcomes between mothers with and without urinary calculi. Cross-sectional study. Taiwan. This study included 3694 women who had live singleton births and received a diagnosis of urinary calculi (UC) in the year prior to their delivery, as well as 18 470 matched women without UC, who were used as a comparison group. Conditional logistic regression analyses were performed. Low birthweight, preterm birth, small for gestational age, cesarean section, lower Apgar score and pre-eclampsia/eclampsia. Women with UC had a higher prevalence of low-birthweight neonates (7.4 vs. 6.0%, p = 0.003), preterm births (9.5 vs. 7.3%, p < 0.001) and cesarean sections (43.1 vs. 35.4%, p < 0.001) than women without UC. After adjusting for potential confounding factors, women with UC were more likely than women without UC to have low-birthweight neonates (odds ratio 1.21, 95% confidence interval 1.05-1.39), preterm birth (odds ratio 1.28, 95% confidence interval 1.13-1.43) and cesarean sections (odds ratio 1.37, 95% confidence interval 1.28-1.48). There were increased risks for having low-birthweight, preterm infants and for experiencing cesarean section among women with UC in comparison to women without UC. © 2012 The Authors © 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

Experimental induction of struvite uroliths in miniature schnauzer and beagle dogs.

PubMed

Klausner, J S; Osborne, C A; O'Leary, T P; Muscoplat, C M; Griffith, D P

1980-09-01

Urease positive staphylococcal urinary tract infection was experimentally induced in 13 dogs. Eight dogs developed cystic and/or urethral struvite calculi in 2 to 8 weeks. No abnormalities in systemic cell mediated immunity were detected in dogs before or after the establishment of the urinary tract infection. Miniature schnauzers whose ancestors had developed stones seemed to be no more susceptible to experimental urinary tract infection and stone formation than miniature schnauzers or beagles whose ancestors did not develop stones.

Proteus mirabilis viability after lithotripsy of struvite calculi

NASA Astrophysics Data System (ADS)

Prabakharan, Sabitha; Teichman, Joel M. H.; Spore, Scott S.; Sabanegh, Edmund; Glickman, Randolph D.; McLean, Robert J. C.

2000-05-01

Urinary calculi composed of struvite harbor urease-producing bacteria within the stone. The photothermal mechanism of holmium:YAG lithotripsy is uniquely different than other lithotripsy devices. We postulated that bacterial viability of struvite calculi would be less for calculi fragmented with holmium:YAG irradiation compared to other lithotripsy devices. Human calculi of known struvite composition (greater than 90% magnesium ammonium phosphate hexahydrate) were incubated with Proteus mirabilis. Calculi were fragmented with no lithotripsy (controls), or shock wave, intracorporeal ultrasonic, electrohydraulic, pneumatic, holmium:YAG or pulsed dye laser lithotripsy. After lithotripsy, stone fragments were sonicated and specimens were serially plated for 48 hours at 38 C. Bacterial counts and the rate of bacterial sterilization were compared. Median bacterial counts (colony forming units per ml) were 8 X 106 in controls and 3 X 106 in shock wave, 3 X 107 in ultrasonic, 4 X 105 in electrohydraulic, 8 X 106 in pneumatic, 5 X 104 in holmium:YAG and 1 X 106 in pulsed dye laser lithotripsy, p less than 0.001. The rate of bacterial sterilization was 50% for holmium:YAG lithotripsy treated stones versus 0% for each of the other cohorts, p less than 0.01. P. mirabilis viability is less after holmium:YAG irradiation compared to other lithotripsy devices.

Calcium - urine

MedlinePlus

Urinary Ca+2; Kidney stones - calcium in urine; Renal calculi - calcium in your urine; Parathyroid - calcium in urine ... A 24-hour urine sample is most often needed: On day 1, urinate into the toilet when you wake up in the morning. ...

Urinary calculi in hypercalcemic states.

PubMed

Thomas, W C

1990-12-01

In this brief review of various hypercalcemic disorders and the likelihood of renal calculus formation, it is clearly evident that renal calculi occur much more often in hyperparathyroidism than in the other hypercalcemic states. Dystrophic calcification and nephrocalcinosis are common to all of the hypercalcemic disorders, including hyperparathyroidism, when the hypercalcemia is marked and the limit of solubility of calcium and phosphate in serum is approached. Interestingly, in sarcoidosis there are calcium oxalate crystals in variously distributed sarcoid granuloma, and the renal calculi are composed of calcium oxalate. By contrast, in hyperparathyroidism, the calculi composed of calcium phosphate predominate. This indicates a subtle and as yet undefined alteration in oxalate metabolism in sarcoidosis. An increase in urine pH occurs in hyperparathyroidism, and this enhances formation of crystalline calcium phosphate. However, the striking disparity between the frequency of calculus formation in hyperparathyroidism and that in other hypercalcemic disorders, several of which may be of relatively long duration, suggests that there indeed may be increased promoters of crystal formation in the urine of hyperparathyroid patients.

[Mini-percutaneous nephrolithotomy in the treatment of un-hydronephrotic cata-staghorn renal calculi].

PubMed

Gao, Ning; Chen, He-Qun; Qi, Lin; Yang, Zhong-Qing; Qi, Fan; Zhang, Xiang-Yang

2007-08-01

To evaluate the surgical techniques and clinical effects of mini-percutaneous nephrolithotomy (mini-PCNL) in the treatment of un-hydronephrotic cata-staghorn renal calculi. The clinical data of 46 cases (31 males and 15 females) treated by mini-PCNL were retrospectively analyzed. There were mono-renal calculi in 38 patients (3 patients were the isolated renal calculi) while the other 8 combined opposite side upper urinary tract calculi. The diameter of calculi ranged from 4.2 to 6.4 (mean=5.2) cm. Puncturation was guided by B-type ultrasound. Lithotripsy by air pressure path lithotripter and/or holmium laser was done when the pervium was established. The pervium in the 46 patients was successfully established by one-session puncturation with B-type ultrasonography guidance. The operative time ranged from 140 to 280 (mean=190) min. The amount of blood ranged from 50 to 200 (mean=100) mL and no one needed blood transfusion. Calculus was completely removed in 18 patients (39.1%). Calculi in 10 patients (21.7%) were completely removed among the 20 patients who underwent second-look mini-PCNL. Calculi in 1 of the 3 cases were completely removed by third-look mini-PCNL. Left-over calculi in 17 patients (8 patients after the first time mini-PCNL, 7 patients after second-look, and 2 patients after third-look) were treated by extracorporeal shock-wave lithotripsy (ESWL) and 8 were removed completely. All the 46 patients were followed up for 4 to 48 months. None of them had nephro-hydrops or stenosis. Renal function re-investigation showed that 8 patients recovered and 2 improved in the 10 patients who had azotemia before. Two (5.4%, 2/37) had calculus recurrence in 37 cases which calculi were completely removed before. The size and amount of left-over calculi in 3 patients (33.3%, 3/9) were increasing. Mini-PCNL is effective and causes less trauma for un-hydronephrotic cata-staghorn renal calculi. Mini-PCNL combined ESWL may substitute the open operation and is the preferred method for un-hydronephrotic renal cata-staghorn calculi.

Impact of reduced-radiation dual-energy protocols using 320-detector row computed tomography for analyzing urinary calculus components: initial in vitro evaluation.

PubMed

Cai, Xiangran; Zhou, Qingchun; Yu, Juan; Xian, Zhaohui; Feng, Youzhen; Yang, Wencai; Mo, Xukai

2014-10-01

To evaluate the impact of reduced-radiation dual-energy (DE) protocols using 320-detector row computed tomography on the differentiation of urinary calculus components. A total of 58 urinary calculi were placed into the same phantom and underwent DE scanning with 320-detector row computed tomography. Each calculus was scanned 4 times with the DE protocols using 135 kV and 80 kV tube voltage and different tube current combinations, including 100 mA and 570 mA (group A), 50 mA and 290 mA (group B), 30 mA and 170 mA (group C), and 10 mA and 60 mA (group D). The acquisition data of all 4 groups were then analyzed by stone DE analysis software, and the results were compared with x-ray diffraction analysis. Noise, contrast-to-noise ratio, and radiation dose were compared. Calculi were correctly identified in 56 of 58 stones (96.6%) using group A and B protocols. However, only 35 stones (60.3%) and 16 stones (27.6%) were correctly diagnosed using group C and D protocols, respectively. Mean noise increased significantly and mean contrast-to-noise ratio decreased significantly from groups A to D (P <.05). In addition, the effective dose decreased markedly from groups A to D at 3.78, 1.81, 1.07, and 0.37 mSv, respectively. Decreasing the DE tube currents from 100 mA and 570 mA to 50 mA and 290 mA resulted in 96.6% accuracy for urinary calculus component analysis while reducing patient radiation exposure to 1.81 mSv. Further reduction of tube currents may compromise diagnostic accuracy. Copyright © 2014 Elsevier Inc. All rights reserved.

Hounsfield unit density accurately predicts ESWL success.

PubMed

Magnuson, William J; Tomera, Kevin M; Lance, Raymond S

2005-01-01

Extracorporeal shockwave lithotripsy (ESWL) is a commonly used non-invasive treatment for urolithiasis. Helical CT scans provide much better and detailed imaging of the patient with urolithiasis including the ability to measure density of urinary stones. In this study we tested the hypothesis that density of urinary calculi as measured by CT can predict successful ESWL treatment. 198 patients were treated at Alaska Urological Associates with ESWL between January 2002 and April 2004. Of these 101 met study inclusion with accessible CT scans and stones ranging from 5-15 mm. Follow-up imaging demonstrated stone freedom in 74.2%. The overall mean Houndsfield density value for stone-free compared to residual stone groups were significantly different ( 93.61 vs 122.80 p < 0.0001). We determined by receiver operator curve (ROC) that HDV of 93 or less carries a 90% or better chance of stone freedom following ESWL for upper tract calculi between 5-15mm.

Diagnostic value of 64-slice spiral computed tomography imaging of the urinary tract during the excretory phase for urinary tract obstruction.

PubMed

Zhao, De-Li; Jia, Guang-Sheng; Chen, Peng; Liu, Xin-Ding; Shu, Sheng-Jie; Ling, Zai-Sheng; Fan, Ting-Ting; Shen, Xiu-Fen; Zhang, Jin-Ling

2017-11-01

The present study aimed to assess the diagnostic value of 64-slice spiral computed tomography (CT) imaging of the urinary tract during the excretory phase for urinary tract obstruction. CT imaging of the urinary tract during the excretory phase was performed in 46 patients that had been diagnosed with urinary tract obstruction by B-mode ultrasound imaging or clinical manifestations. It was demonstrated that out of the 46 patients, 18 had pelvic and ureteral calculi, 12 cases had congenital malformations, 3 had ureteral stricture caused by urinary tract infection and 13 cases had malignant tumors of the urinary tract. The average X-ray dose planned for the standard CT scan of the urinary tract group 1 was 14.11±5.45 mSv, while the actual X-ray dose administered for the CT scan during the excretory phase group 2 was 9.01±4.56 mSv. The difference between the two groups was statistically significant (t=15.36; P<0.01). The results of the present study indicate that CT scanning of the urinary tract during the excretory phase has a high diagnostic value for urinary tract obstruction.

Complete staghorn calculus in polycystic kidney disease: infection is still the cause

PubMed Central

2013-01-01

Background Kidney stones in patients with autosomal dominant polycystic kidney disease are common, regarded as the consequence of the combination of anatomic abnormality and metabolic risk factors. However, complete staghorn calculus is rare in polycystic kidney disease and predicts a gloomy prognosis of kidney. For general population, recent data showed metabolic factors were the dominant causes for staghorn calculus, but for polycystic kidney disease patients, the cause for staghorn calculus remained elusive. Case presentation We report a case of complete staghorm calculus in a polycystic kidney disease patient induced by repeatedly urinary tract infections. This 37-year-old autosomal dominant polycystic kidney disease female with positive family history was admitted in this hospital for repeatedly upper urinary tract infection for 3 years. CT scan revealed the existence of a complete staghorn calculus in her right kidney, while there was no kidney stone 3 years before, and the urinary stone component analysis showed the composition of calculus was magnesium ammonium phosphate. Conclusion UTI is an important complication for polycystic kidney disease and will facilitate the formation of staghorn calculi. As staghorn calculi are associated with kidney fibrosis and high long-term renal deterioration rate, prompt control of urinary tract infection in polycystic kidney disease patient will be beneficial in preventing staghorn calculus formation. PMID:24070202

Complete staghorn calculus in polycystic kidney disease: infection is still the cause.

PubMed

Mao, Zhiguo; Xu, Jing; Ye, Chaoyang; Chen, Dongping; Mei, Changlin

2013-08-01

Kidney stones in patients with autosomal dominant polycystic kidney disease are common, regarded as the consequence of the combination of anatomic abnormality and metabolic risk factors. However, complete staghorn calculus is rare in polycystic kidney disease and predicts a gloomy prognosis of kidney. For general population, recent data showed metabolic factors were the dominant causes for staghorn calculus, but for polycystic kidney disease patients, the cause for staghorn calculus remained elusive. We report a case of complete staghorm calculus in a polycystic kidney disease patient induced by repeatedly urinary tract infections. This 37-year-old autosomal dominant polycystic kidney disease female with positive family history was admitted in this hospital for repeatedly upper urinary tract infection for 3 years. CT scan revealed the existence of a complete staghorn calculus in her right kidney, while there was no kidney stone 3 years before, and the urinary stone component analysis showed the composition of calculus was magnesium ammonium phosphate. UTI is an important complication for polycystic kidney disease and will facilitate the formation of staghorn calculi. As staghorn calculi are associated with kidney fibrosis and high long-term renal deterioration rate, prompt control of urinary tract infection in polycystic kidney disease patient will be beneficial in preventing staghorn calculus formation.

Medullary Sponge Kidney and Urinary Calculi Aeromedical Concerns

NASA Technical Reports Server (NTRS)

Jones, Jeffrey A.; Cherian, Sebastian F.; Barr, Yael R.; Stocco, Amber

2008-01-01

Medullary Sponge Kidney (MSK) is a benign disorder associated with renal stones in 60% of patients. Patients frequently have episodic painless hematuria but are otherwise asymptomatic unless renal calculi or infections complicate the disease. Nephrolithiasis is a relative, but frequently enforced, contraindication to space or other high performance flight. Two case reports of asymptomatic NASA flight crew with MSK and three cases of military aviators diagnosed with MSK are reviewed, all cases resulted in waiver and return to flight status after treatment and a vigorous follow up and prophylaxis protocol. MSK in aviation and space flight necessitates a highly case-by-case dependent evaluation and treatment process to rule out other potential confounding factors that might also contribute to stone formation and in order to re-qualify the aviator for flight duties.

[Calculus formation in the prostatic cavity after transurethral resection of the prostate: causes, treatment and prevention].

PubMed

Wei, Zhi-Feng; Xu, Xiao-Feng; Cheng, Wen; Zhou, Wen-Quan; Ge, Jing-Ping; Zhang, Zheng-Yu; Gao, Jian-Ping

2012-05-01

To study the causes, clinical manifestations, treatment and prevention of calculus that develops in the prostatic cavity after transurethral resection of the prostate. We reported 11 cases of calculus that developed in the prostatic cavity after transurethral resection or transurethral plasmakinetic resection of prostate. The patients complained of repeated symptoms of frequent micturition, urgent micturition and urodynia after operation, accompanied with urinary tract infection and some with urinary obstruction, which failed to respond to anti-infective therapies. Cystoscopy revealed calculi in the prostatic cavity, with eschar, sphacelus, uneven wound surface and small diverticula in some cases. After diagnosis, 1 case was treated by holmium laser lithotripsy and a second transurethral resection of the prostate, while the other 10 had the calculi removed under the cystoscope, followed by 1 -2 weeks of anti-infective therapy. After treatment, all the 11 cases showed normal results of routine urinalysis, and no more symptoms of frequent micturition, urgent micturition and urodynia. Three- to six-month follow-up found no bladder irritation symptoms and urinary tract infection. Repeated symptoms of frequent micturition, urgent micturition, urodynia and urinary tract infection after transurethral resection of the prostate should be considered as the indicators of calculus in the prostatic cavity, which can be confirmed by cystoscopy. It can be treated by lithotripsy or removal of the calculus under the cystoscope, or even a second transurethral resection of the prostate. For its prevention, excessive electric coagulation and uneven wound surface should be avoided and anti-infection treatment is needed.

Predictors of septic shock in obstructive acute pyelonephritis.

PubMed

Tambo, Mitsuhiro; Okegawa, Takatsugu; Shishido, Toshihide; Higashihara, Eiji; Nutahara, Kikuo

2014-06-01

Acute pyelonephritis (APN) with obstructive uropathy is not uncommon and often causes serious conditions including sepsis and septic shock. We assessed the risk factors for septic shock in patients with obstructive APN associated with upper urinary tract calculi. We retrospectively studied 69 patients with obstructive APN associated with upper urinary tract calculi who were admitted to our hospital. Emergency drainage for decompression of the renal collecting system was performed for empirical treatment in cases of failure of initial treatment and for severe cases. We assessed the risk factors for septic shock by multivariate logistic regression analysis. Overall, 45 patients (65.2 %) underwent emergency drainage and 23 (33.3 %) patients showed septic shock. Poor performance status and the presence of diabetes mellitus (DM) in the septic shock group were more common than in the non-septic shock group (p = 0.012 and p = 0.011, respectively). The platelet count and serum albumin level in the septic shock group were significantly lower than in the non-septic shock group (p = 0.002 and p = 0.003, respectively). Positive rates of midstream urine culture and blood culture in the septic shock group were significantly higher than in the non-septic shock group (p = 0.022 and p = 0.001, respectively). Multivariate analysis showed that decreases in the platelet count (OR 5.43, p = 0.014) and serum albumin level (OR 5.88, p = 0.023) were independent risk factors for septic shock. Patients with obstructive APN associated with upper urinary tract calculi who have decreases in platelet count and serum albumin level should be treated with caution against the development of septic shock.

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

Femtosecond laser lithotripsy: feasibility and ablation mechanism.

PubMed

Qiu, Jinze; Teichman, Joel M H; Wang, Tianyi; Neev, Joseph; Glickman, Randolph D; Chan, Kin Foong; Milner, Thomas E

2010-01-01

Light emitted from a femtosecond laser is capable of plasma-induced ablation of various materials. We tested the feasibility of utilizing femtosecond-pulsed laser radiation (lambda=800 nm, 140 fs, 0.9 mJ/pulse) for ablation of urinary calculi. Ablation craters were observed in human calculi of greater than 90% calcium oxalate monohydrate (COM), cystine (CYST), or magnesium ammonium phosphate hexahydrate (MAPH). Largest crater volumes were achieved on CYST stones, among the most difficult stones to fragment using Holmium:YAG (Ho:YAG) lithotripsy. Diameter of debris was characterized using optical microscopy and found to be less than 20 microm, substantially smaller than that produced by long-pulsed Ho:YAG ablation. Stone retropulsion, monitored by a high-speed camera system with a spatial resolution of 15 microm, was negligible for stones with mass as small as 0.06 g. Peak shock wave pressures were less than 2 bars, measured by a polyvinylidene fluoride (PVDF) needle hydrophone. Ablation dynamics were visualized and characterized with pump-probe imaging and fast flash photography and correlated to shock wave pressures. Because femtosecond-pulsed laser ablates urinary calculi of soft and hard compositions, with micron-sized debris, negligible stone retropulsion, and small shock wave pressures, we conclude that the approach is a promising candidate technique for lithotripsy.

Performance of Quick Sequential (Sepsis Related) and Sequential (Sepsis Related) Organ Failure Assessment to Predict Mortality in Patients with Acute Pyelonephritis Associated with Upper Urinary Tract Calculi.

PubMed

Fukushima, Hiroshi; Kobayashi, Masaki; Kawano, Keizo; Morimoto, Shinji

2018-06-01

The Third International Consensus Definitions for Sepsis and Septic Shock Task Force proposed a new definition of sepsis based on the SOFA (Sequential [Sepsis-related] Organ Failure Assessment) score and introduced a novel scoring system, quickSOFA, to screen patients at high risk for sepsis. However, the clinical usefulness of these systems is unclear. Therefore, we investigated predictive performance for mortality in patients with acute pyelonephritis associated with upper urinary tract calculi. This retrospective study included 141 consecutive patients who were clinically diagnosed with acute pyelonephritis associated with upper urinary tract calculi outside the intensive care unit. We evaluated the performance of the quickSOFA, SOFA and SIRS (systemic inflammatory response syndrome) scores to predict in-hospital mortality and intensive care unit admission using the AUC of the ROC curve, net reclassification, integrated discrimination improvements and decision curve analysis. A total of 11 patients (8%) died in the hospital and 26 (18%) were admitted to the intensive care unit. The AUC of quickSOFA to predict in-hospital mortality and intensive care unit admission was significantly greater than that of SIRS (each p <0.001) and comparable to that of SOFA (p = 0.47 and 0.57, respectively). When incorporated into the baseline model consisting of patient age, gender and the Charlson Comorbidity Index, quickSOFA and SOFA provided a greater change in AUC, and in net classification and integrated discrimination improvements than SIRS for each outcome. Decision curve analyses revealed that the quickSOFA and SOFA incorporated models showed a superior net benefit compared to the SIRS incorporated model for most examined probabilities of the 2 outcomes. The in-hospital mortality rate of patients with a quickSOFA score of 2 or greater and a SOFA score of 7 or greater, which were the optimal cutoffs determined by the Youden index, was 18% and 28%, respectively. SOFA and quickSOFA are more clinically useful scoring systems than SIRS to predict mortality in patients with acute pyelonephritis associated with upper urinary tract calculi. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Prostatic calculi influence the antimicrobial efficacy in men with chronic bacterial prostatitis

PubMed Central

Zhao, Wei-Ping; Li, Yong-Tao; Chen, Jun; Zhang, Zhi-Gen; Jiang, Hai; Xia, Dan; Wang, Shuo; Wang, Ping

2012-01-01

We studied the efficacy of culture-specific antibiotic therapy for chronic bacterial prostatitis (CBP) patients with or without prostatic calculi. This study included 101 patients (21–62 years old) who met the consensus criteria for CBP (National Institutes of Health category II). According to the results of transrectal ultrasonography (TRUS), all patients were divided into two groups: Group 1, CBP with prostatic calculi, n=39; Group 2, CBP without prostatic calculi, n=62. All patients received optimal antimicrobial therapy for 4 weeks and followed up for a minimum of 3 months (range: 3–8 months). In addition to expressed prostatic secretions (EPS) and urine culture, all patients were asked to complete the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the subjective global assessment (SGA). The microbiological eradication rate at the end of treatment were 32/39 (82.1%) and 54/62 (87.1%), while the rates for continued eradication at the end of study were 17/39 (43.6%) and 45/62 (72.6%) in Group 1 and Group 2 (P<0.01), respectively. We observed a decrease in the total NIH-CPSI score median values from 24 to 19 in Group 1 and from 24 to 11 in Group 2. The pain subscore (P<0.01), urinary sunscore (P<0.05) and quality of life (QoL; P<0.05) as well as the total NIH-CPSI score (P<0.01) were significantly improved after antimicrobial treatment in Group 2 compared to Group 1. Response, defined as a decrease of the NIH-CPSI total score by at least 50%, was seen in Group 1 versus Group 2 in 38.5% and 58.1% (P<0.01), respectively. Our results showed that prostatic calculi influence the antimicrobial efficacy in men with CBP. There was a noticeable decrease in the cure rate of CBP patients with prostatic calculi due to relapse after antimicrobial therapy. PMID:22796735

Prostatic calculi influence the antimicrobial efficacy in men with chronic bacterial prostatitis.

PubMed

Zhao, Wei-Ping; Li, Yong-Tao; Chen, Jun; Zhang, Zhi-Gen; Jiang, Hai; Xia, Dan; Wang, Shuo; Wang, Ping

2012-09-01

We studied the efficacy of culture-specific antibiotic therapy for chronic bacterial prostatitis (CBP) patients with or without prostatic calculi. This study included 101 patients (21-62 years old) who met the consensus criteria for CBP (National Institutes of Health category II). According to the results of transrectal ultrasonography (TRUS), all patients were divided into two groups: Group 1, CBP with prostatic calculi, n=39; Group 2, CBP without prostatic calculi, n=62. All patients received optimal antimicrobial therapy for 4 weeks and followed up for a minimum of 3 months (range: 3-8 months). In addition to expressed prostatic secretions (EPS) and urine culture, all patients were asked to complete the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the subjective global assessment (SGA). The microbiological eradication rate at the end of treatment were 32/39 (82.1%) and 54/62 (87.1%), while the rates for continued eradication at the end of study were 17/39 (43.6%) and 45/62 (72.6%) in Group 1 and Group 2 (P<0.01), respectively. We observed a decrease in the total NIH-CPSI score median values from 24 to 19 in Group 1 and from 24 to 11 in Group 2. The pain subscore (P<0.01), urinary sunscore (P<0.05) and quality of life (QoL; P<0.05) as well as the total NIH-CPSI score (P<0.01) were significantly improved after antimicrobial treatment in Group 2 compared to Group 1. Response, defined as a decrease of the NIH-CPSI total score by at least 50%, was seen in Group 1 versus Group 2 in 38.5% and 58.1% (P<0.01), respectively. Our results showed that prostatic calculi influence the antimicrobial efficacy in men with CBP. There was a noticeable decrease in the cure rate of CBP patients with prostatic calculi due to relapse after antimicrobial therapy.

Changing composition of renal calculi in patients with musculoskeletal anomalies.

PubMed

Gnessin, Ehud; Mandeville, Jessica A; Handa, Shelly E; Lingeman, James E

2011-09-01

Calculi from patients with musculoskeletal (MS) anomalies who are largely immobile and prone to urinary infections have been traditionally composed primarily of struvite and carbonate apatite. Because of substantial improvements in the care of these patients in recent decades, stone etiology may have shifted from infectious to metabolic. We assessed the composition of renal calculi and metabolic characteristics in a contemporary cohort of patients with MS anomalies who underwent percutaneous nephrolithotomy (PCNL). Retrospective analysis of patients who underwent PCNL between April 1999 and June 2009 and had follow-up 24-hour urine studies was performed. Patients with MS anomalies included spinal cord injury, myelomeningocele, muscular dystrophy, multiple sclerosis, cerebral palsy, or other clinical syndromes causing kyphoscoliosis and contractures. Our cohort included 33 patients with MS anomalies and 334 consecutive patients as a control group who underwent PCNL and had metabolic workup. Stones were infectious in etiology in 18.4% and 6.2% in MS and control groups, respectively. Thus, most patients harbored stones of metabolic origin. Metabolic stones in the MS group were composed of 52.7% hydroxyapatite, 10.5% calcium oxalate, 7.9% brushite, 2.6% uric acid, 0% cystine, and 7.9% other. Metabolic stones in the control group were 50.5% calcium oxalate, 16.4% hydroxyapatite, 11.5% brushite, 10.8% uric acid, 4.3% cystine, and 0.3% other. Mean 24-hour urine values for patients with metabolic stones in MS/control groups were volume 2.18/1.87 L/d, pH 6.78/6.05, calcium to creatinine ratio 220/151 mg/g, and oxalate 44.8/39.5 mg/d. Although patients with MS anomalies are traditionally thought to harbor infection-related calculi, most will be found to have calculi of metabolic etiology. The incidence of calcium phosphate stones is high in this group of patients, perhaps reflecting their high urinary pH.

A fragment of Foley catheter balloon as a cause of Bladder stone in woman

PubMed Central

Aziz, El Majdoub; Amrani, Mouad; Abdelhak, Khallouk; Hassan, Farih Moulay

2015-01-01

Urinary bladder calculi are rarely seen in women and any history of previous pelvic surgery must, therefore, raise suspicion of an iatrogenic etiology. According to the literature, fewer than 2% of all bladder calculi occur in female subjects and, thus, their presence should provoke careful assessment of the etiology. We report one case of a fragment of Foley catheter balloon as a cause of Bladder stone in 28 years old woman. Weanalyzed the diagnosis, aspect and therapeutic management of this case which is the first described in literature to our knowledge. PMID:26587134

Bilateral kidney matrix stones: a rare case

PubMed Central

Lahyani, Mounir; Rhannam, Yassine; Slaoui, Amine; Touzani, Alae; Karmouni, Tarik; Elkhader, Khalid; Koutani, Abdellatif; Andaloussi, Ahmed Ibn attya

2016-01-01

Kedney matrix stones are a rare form of calculi. Flank pain and urinary tract infections (UTI) are the most common presentations of matrix calculi. The diagnosis is usually made at surgery, but some preoperative radiographic findings might be suggestive. Open surgery was the method of choice for treatment. However, combination of ureterorenoscopy and percutaneous nephrolithotomy (PCNL) was found to be safe and effective. We report a rare case of renal and ureteral matrix stones that were diagnosed and treated by open surgery. We also describe its clinical, radiological and therapeutic features through a review of the literature. PMID:28292065

Bilateral kidney matrix stones: a rare case.

PubMed

Lahyani, Mounir; Rhannam, Yassine; Slaoui, Amine; Touzani, Alae; Karmouni, Tarik; Elkhader, Khalid; Koutani, Abdellatif; Andaloussi, Ahmed Ibn Attya

2016-01-01

Kedney matrix stones are a rare form of calculi. Flank pain and urinary tract infections (UTI) are the most common presentations of matrix calculi. The diagnosis is usually made at surgery, but some preoperative radiographic findings might be suggestive. Open surgery was the method of choice for treatment. However, combination of ureterorenoscopy and percutaneous nephrolithotomy (PCNL) was found to be safe and effective. We report a rare case of renal and ureteral matrix stones that were diagnosed and treated by open surgery. We also describe its clinical, radiological and therapeutic features through a review of the literature.

Uric acid lithiasis in the Sudan.

PubMed

Ibrahim, A; Zein, M; Beleil, O

1977-08-01

Fifty-seven per cent of Urinary Calculi in the Sudan contain Uric Acid, 20 per cent in the pure form and 37 per cent mixed with other constituents mainly calcium oxalate. The peak age presentation of urolithiasis is 30-40 years with more prediliction to males than females. An earlier study documented a high incidence of hyperuricaemia in Sudanese people. It is probable that "voluntary dehydration" and hyperuricaemia acting together may help in the formation of uric acid stones on the surface of which other crystals mainly calcium oxalate may be deposited to form the bigger calculi which are commonly encountered in this country.

Effect of Ramadan fasting on urinary risk factors for calculus formation.

PubMed

Miladipour, Amir Hossein; Shakhssalim, Nasser; Parvin, Mahmoud; Azadvari, Mohaddeseh

2012-01-01

Even though dehydration could aggravate formation of urinary calculi, the effects of fluid and food restriction on calculus formation is not thoroughly defined. The purpose of this study is to evaluate the effects of fluid and food restriction in Ramadan fasting on urinary factors in kidney and urinary calculus formation. Fifty-seven men aged 30 to 55 years old, including 37 recurrent calcium calculus formers and 20 with no history of kidney calculi were evaluated for blood tests, ultrasonography investigations, urinalysis, urine culture, and also 24-hour urine collection test. Metabolites including calcium, oxalate, citrate, uric acid, magnesium, phosphate, potassium, sodium, and creatinine were measured before and during Ramadan fasting. The values of calculus-precipitating solutes as well as inhibitory factors were documented thoroughly. Total excretion of calcium, phosphate, and magnesium in 24-hour urine and also urine volume during fasting were significantly lower than those in the nonfasting period. Urine concentration of calcium during fasting was significantly lower than nonfasting (P < .001). Urine concentrations of uric acid, citrate, phosphate, sodium, and potassium during fasting were significantly higher than nonfasting. Uric acid supersaturation was accentuated, and calcium phosphate supersaturation was decreased significantly during fasting. There was no significant increase in calcium oxalate supersaturation during the fasting period. Fasting during Ramadan has different effects on total excretion and concentrations of urinary precipitate and inhibitory factors contributing to calculus formation. We did not find enough evidence in favor of increased risks of calculus formation during Ramadan fasting.

Transurethral holmium-YAG laser lithotripsy for large symptomatic prostatic calculi: initial experience.

PubMed

Goyal, Neeraj Kumar; Goel, Apul; Sankhwar, Satyanarayan

2013-08-01

Symptomatic prostatic calculi are a rare clinical entity with wide range of management options, however, there is no agreement about the preferred method for treating these symptomatic calculi. In this study we describe our experience of transurethral management of symptomatic prostatic calculi using holmium-YAG laser lithotripsy. Patients with large, symptomatic prostatic stones managed by transurethral lithotripsy using holmium-YAG laser over 3-year duration were included in this retrospective study. Patients were evaluated for any underlying pathological condition and calculus load was determined by preoperative X-ray KUB film/CT scan. Urethrocystoscopy was performed using 30° cystoscope in lithotomy position under spinal anesthesia, followed by transurethral lithotripsy of prostatic calculi using a 550 μm laser fiber. Stone fragments were disintegrated using 100 W laser generators (VersaPulse PowerSuite 100 W, LUMENIS Surgical, CA). Larger stone fragments were retreived using Ellik's evacuator while smaller fragments got flushed under continuous irrigation. Five patients (median age 42 years) with large symptomatic prostatic calculi were operated using the described technique. Three patients had idiopathic stones while rest two had bulbar urethral stricture and neurogenic bladder, respectively. Median operative time was 62 min. All the patients were stone free at the end of procedure. Median duration of catheterization was 2 days. Significant improvement was observed in symptoms score and peak urinary flow and none of the patient had any complication. Transurethral management using holmium-YAG laser lithotripsy is a safe and highly effective, minimally invasive technique for managing symptomatic prostatic calculi of all sizes with no associated morbidity.

Urinary stones in Malaysia--its incidence and management.

PubMed

Sreenevasan, G

1990-06-01

The life of Lord Moynihan is briefly reviewed. Incidence of stones in Peninsular Malaysia appears to show the same trend as in other industrialised countries. Management of urinary calculi both prior to and after the introduction of ESWL in a personal series is discussed. More than 90% of urinary stones are now treated by ESWL threatening the place of surgery in Urology. The pattern of incorporating renal transplantation into the urological training programme as practised in the Institute of Urology and Nephrology in Malaysia is suggested as a way to assure a place for surgery in Urology.

Validity of administrative coding in identifying patients with upper urinary tract calculi.

PubMed

Semins, Michelle J; Trock, Bruce J; Matlaga, Brian R

2010-07-01

Administrative databases are increasingly used for epidemiological investigations. We performed a study to assess the validity of ICD-9 codes for upper urinary tract stone disease in an administrative database. We retrieved the records of all inpatients and outpatients at Johns Hopkins Hospital between November 2007 and October 2008 with an ICD-9 code of 592, 592.0, 592.1 or 592.9 as one of the first 3 diagnosis codes. A random number generator selected 100 encounters for further review. We considered a patient to have a true diagnosis of an upper tract stone if the medical records specifically referenced a kidney stone event, or included current or past treatment for a kidney stone. Descriptive and comparative analyses were performed. A total of 8,245 encounters coded as upper tract calculus were identified and 100 were randomly selected for review. Two patients could not be identified within the electronic medical record and were excluded from the study. The positive predictive value of using all ICD-9 codes for an upper tract calculus (592, 592.0, 592.1) to identify subjects with renal or ureteral stones was 95.9%. For 592.0 only the positive predictive value was 85%. However, although the positive predictive value for 592.1 only was 100%, 26 subjects (76%) with a ureteral stone were not appropriately billed with this code. ICD-9 coding for urinary calculi is likely to be sufficiently valid to be useful in studies using administrative data to analyze stone disease. However, ICD-9 coding is not a reliable means to distinguish between subjects with renal and ureteral calculi. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Concave Urinary Crystallines: Direct Evidence of Calcium Oxalate Crystals Dissolution by Citrate In Vivo

PubMed Central

Shang, Yun-Feng; Xu, Meng; Zhang, Guang-Na; Ouyang, Jian-Ming

2013-01-01

The changes in urinary crystal properties in patients with calcium oxalate (CaOx) calculi after oral administration of potassium citrate (K3cit) were investigated via atomic force microscopy (AFM), scanning electron microscopy (SEM), X-ray powder diffractometry (XRD), and zeta potential analyzer. The AFM and SEM results showed that the surface of urinary crystals became concave, the edges and corners of crystals became blunt, the average size of urinary crystallines decreased significantly, and aggregation of urinary crystals was reduced. These changes were attributed to the significant increase in concentration of excreted citrate to 492 ± 118 mg/L after K3cit intake from 289 ± 83 mg/L before K3cit intake. After the amount of urinary citrate was increased, it complexed with Ca2+ ions on urinary crystals, which dissolved these crystals. Thus, the appearance of concave urinary crystals was a direct evidence of CaOx dissolution by citrate in vivo. The XRD results showed that the quantities and species of urinary crystals decreased after K3cit intake. The mechanism of inhibition of formation of CaOx stones by K3cit was possibly due to the complexation of Ca2+ with citrate, increase in urine pH, concentration of urinary inhibitor glycosaminoglycans (GAGs), and the absolute value of zeta potential after K3cit intake. PMID:24363634

Stone heterogeneity index on single-energy noncontrast computed tomography can be a positive predictor of urinary stone composition

PubMed Central

Lee, Jong Soo; Cho, Kang Su; Lee, Seung Hwan; Yoon, Young Eun; Kang, Dong Hyuk; Jeong, Won Sik; Jung, Hae Do; Kwon, Jong Kyou

2018-01-01

The aim of this study was to investigate the correlation between stone composition and single-energy noncontrast computed tomography (NCCT) parameters, including stone heterogeneity index (SHI) and mean stone density (MSD), in patients with urinary calculi. We retrospectively reviewed medical records of 255 patients who underwent operations or procedures for urinary stones or had spontaneous stone passage between December 2014 and October 2015. Among these, 214 patients with urinary calculi who underwent NCCT and stone composition analyses were included in the study. Maximal stone length (MSL), mean stone density (MSD), and stone heterogeneity index (SHI) were determined on pretreatment NCCT. The mean MSD (454.68±177.80 HU) and SHI (115.82±96.31 HU) of uric acid stones were lower than those of all other types. Based on post hoc tests, MSD was lower for uric acid stones than for the other types (vs. CaOx: P<0.001; vs. infection stones: P<0.001). SHI was lower for uric acid stones than for the other types (vs. CaOx: P<0.001; vs. infection stones: P<0.001) Receiver operating characteristic curves of uric acid stones for MSD and SHI demonstrated that SHI (cut-off value: 140.4 HU) was superior to MSD (cut-off value: 572.3 HU) in predicting uric acid stones (P<0.001). PMID:29649219

Spectroscopic study of the inhibition of calcium oxalate calculi by Larrea tridentata

NASA Astrophysics Data System (ADS)

Pinales, Luis Alonso

The causes of urolithiasis include such influences as diet, metabolic disorders, and genetic factors which have been documented as sources that aggravate urinary calculi depositions and aggregations, and, implicitly, as causes of urolithiasis. This study endeavors to detail the scientific mechanisms involved in calcium oxalate calculi formation, and, more importantly, their inhibition under growth conditions imposed by the traditional medicinal approach using the herbal extract, Larrea tridentata. The calculi were synthesized without and with Larrea tridentata infusion by employing the single diffusion gel technique. A visible decrease in calcium oxalate crystal growth with increasing amounts of Larrea tridentata herbal infusion was observed in photomicrographs, as well as a color change from white-transparent for pure crystals to light orange-brown for crystals with inhibitor. Analysis of the samples, which includes Raman, infrared absorption, scanning electron microscopy (SEM), and X-ray powder diffraction (XRD) techniques, demonstrate an overall transition in morphology of the crystals from monohydrate without herbal extract to dihydrate with inhibitor. Furthermore, the resulting data from Raman and infrared absorption support the possibilities of the influences, in this complex process, of NDGA and its derivative compounds from Larrea tridentata, and of the bonding of the magnesium of the inhibitor with the oxalate ion on the surface of the calculi crystals. This assumption corroborates well with the micrographs obtained under higher magnification, which show that the separated small crystallites consist of darker brownish cores, which we attribute to the dominance of growth inhibition by NDGA, surrounded by light transparent thin shells, which possibly correspond to passivation of the crystals by magnesium oxalate. The SEM results reveal the transformation from the dominant monoclinic structure of the calcium oxalate crystals grown alone to the tetragonal dipyramidal crystal structure of the calcium oxalate crystals grown with Larrea tridentata. Comparison between XRD experimental and simulated data, besides corroborating with our previous results, show that each sample is a combination of different structures.

Is computed tomography-defined obstruction a predictor of urological intervention in emergency department patients presenting with renal colic?

PubMed Central

Massaro, Peter Alexander; Kanji, Avinash; Atkinson, Paul; Pawsey, Ryan; Whelan, Tom

2017-01-01

Introduction Our objective was to determine whether unilateral calculus-induced ureteric obstruction on computed tomography (CT) was independently associated with the need for urological intervention and 30-day return to the emergency department (ED). Methods We performed a retrospective cohort study of patients with symptomatic urinary calculi diagnosed by unenhanced helical CT. Stepwise regression analysis was used to determine the predictors of urological intervention and 30-day return to the ED. Potential predictors assessed included: patient demographics, calculus size, calculus location, degree of obstruction, analgesic doses, signs and symptoms of infection, serum creatinine, cumulative intravenous fluid administered, and the prescription of medical expulsive therapy. Results Of 195 patients, 81 (41.5%) underwent urological intervention. The size of the calculus, its location, and the cumulative opioid dose were all independent predictors for urological intervention. Every 1 mm increase in calculus size increased the likelihood of intervention 2.2 times (odds ratio [OR] 2.17; 95% confidence interval [CI] 1.67–2.85). Proximal stones were 4.7 times more likely to require intervention than distal calculi (OR 0.21; 95% CI 0.09–0.49). Every 10 mg increase in morphine was associated with a 30% increase in the odds of intervention (OR 1.30; 95% CI 1.07–1.58). Degree of obstruction was not associated with the need for urological intervention. Finally, none of the variables were predictors for 30-day return to the ED. Conclusions Although stone size, proximal location, and severe pain, as indicated by higher opioid doses, were associated with the need for intervention, the degree of obstruction did not influence the management of patients with CT-defined urinary calculi. PMID:28515805

[EFFECTIVENESS OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN PATIENTS WITH UROLITHIASIS OF A SOLITARY KIDNEY].

PubMed

Parshenkova, I G; Dutov, V V; Rumjancev, A A; Mamedov, E A

2015-01-01

The article presents results of extracorporeal shock wave lithotripsy (ESWL) in 62 patients with urolithiasis of a solitary kidney. In 50 (80.6%) patients calculi were located in the kidney and in 12 (19.4%) patients in the ureter. Effectiveness of ESWL at 3 month follow-up was 85.5%, which is somewhat lower than in patients with two healthy kidneys due to the choice of sparing low-energy modes of lithotripsy. The effectiveness of ESWL depended on the size of the original calculi (p<0.0001), and the baseline urodynamics of the upper urinary tract (p<0.0001). The rates of complications (32.3%) and auxiliary procedures (16.1%) were relatively low, due to the usage of pre-drainage of the kidney before a session of ESWL in patients with large and multiple calculi. There was no correlation between the occurrence of complications during treatment and the clinical form of a solitary kidney (p>0.05). In patients with stones larger than 1 cm and a moderate baseline abnormalities of the upper urinary tract urodynamics ESWL was less effective (p<0.0001), they had increased time of lithotripsy (p=0.013), more sessions (p<0.0001), complications (19.4%, p=0.043) and auxiliary manipulation (9.7%). Nevertheless, the duration of stay in hospital in the postoperative period did not correlate with the size of calculus (p=0.504). Extracorporeal shock wave lithotripsy is a highly effective and safe treatment of stones of a solitary kidney. Rational choice of indications and contraindications for the use of ESWL in a specific clinical situation is of great importance.

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.

21 CFR 876.5990 - Extracorporeal shock wave lithotripter.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Extracorporeal shock wave lithotripter. 876.5990... shock wave lithotripter. (a) Identification. An extracorporeal shock wave lithotripter is a device that focuses ultrasonic shock waves into the body to noninvasively fragment urinary calculi within the kidney...

21 CFR 876.5990 - Extracorporeal shock wave lithotripter.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Extracorporeal shock wave lithotripter. 876.5990... shock wave lithotripter. (a) Identification. An extracorporeal shock wave lithotripter is a device that focuses ultrasonic shock waves into the body to noninvasively fragment urinary calculi within the kidney...

21 CFR 876.5990 - Extracorporeal shock wave lithotripter.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Extracorporeal shock wave lithotripter. 876.5990... shock wave lithotripter. (a) Identification. An extracorporeal shock wave lithotripter is a device that focuses ultrasonic shock waves into the body to noninvasively fragment urinary calculi within the kidney...

A unique complication of urethral catheterization: pubic hair associated with struvite bladder calculi.

PubMed

Perz, Sarah; Ellimoottil, Chandy; Rao, Manoj; Bresler, Larissa

2013-01-01

Bladder stones account for 5% of all urinary stone disease and can develop on a foreign body, such as a misplaced suture, eroded surgical mesh, or ureteral stent. In this case study, the authors present a patient with bladder stones associated with pubic hairs introduced during a monthly indwelling Foley catheter change. Clinicians have an important role in instructing patients on the use of proper technique and hygiene practices during urethral catheterization to minimize the potential for urinary complications.

Conservative management of staghorn calculi: a single-centre experience.

PubMed

Deutsch, Peter G; Subramonian, Kesavapilla

2016-09-01

To evaluate the outcomes of conservatively managed staghorn calculi, specifically looking at morbidity and mortality, incidence of infections and progressive changes in renal function. A total of 22 patients with unilateral or bilateral staghorn calculi, who were treated conservatively, were included in the study. Patients were reviewed yearly with symptom assessment, urine culture and measurement of estimated glomerular filtration rate. The presentations to the urology department of staghorn calculi were incidental (41%), haematuria (36%), abdominal discomfort (5%) and recurrent urinary tract infections (UTIs; 18%). The reasons for conservative management in the cohort were comorbidities (59%), patient choice (36%) or poor access/anatomy (5%). In the whole cohort the rate of recurrent UTIs was 50%, the progressive renal failure rate was 14%, the disease-specific mortality rate was 9%, the dialysis dependence rate was 9% and the rate of hospital attendances attributable to stone-related morbidity was 27%. Comparison of outcome measures between the unilateral and bilateral staghorn stones showed statistically significant differences in disease-specific mortality (0 vs 40%) and morbidity (12 vs 80%) in favour of the unilateral group. Although there was a lower incidence of UTIs (41 vs 80%), renal deterioration (6 vs 40%) and dialysis requirement (6 vs 20%) in the unilateral group, these findings were not statistically significant. From the results, we conclude that conservative management of staghorn calculi is not as unsafe as previously thought. Careful patient selection to include unilateral asymptomatic stones with minimal infection, and thorough counselling with regard to the risks, could make conservative management a suitable option for specific patient groups. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

Methylated purines in urinary stones.

PubMed

Safranow, Krzysztof; Machoy, Zygmunt

2005-08-01

The aim of the study was to measure the content of methylated purines that appear as admixtures in uric acid stones. We analyzed urinary calculi from 48 residents of Western Pomerania who underwent surgery at the urology ward in Szczecin. Stone samples were dissolved in 0.1 mol/L NaOH. Extracts were diluted in 50 mmol/L KH(2)PO(4) and analyzed by reversed-phase HPLC with ultraviolet detection and use of a gradient of methanol concentration and pH. Uric acid was the main component of 9 stones. All 9 showed admixtures of 9 other purine derivatives: endogenous purine breakdown products (xanthine, hypoxanthine, and 2,8-dihydroxyadenine) and exogenous methyl derivatives of uric acid and xanthine (1-, 3-, and 7-methyluric acid; 1,3-dimethyluric acid; and 3- and 7-methylxanthine). Amounts of these purine derivatives ranged from the limit of detection to 12 mg/g of stone weight and showed a strong positive correlation (Spearman rank correlation coefficients, 0.63-0.94) with the uric acid content of the samples. The main methylated purine in the stones was 1-methyluric acid. Urinary purines at concentrations below their saturation limits may coprecipitate in samples supersaturated with uric acid and appear as admixtures in urinary stones. The amount of each purine depends on its average urinary excretion, similarity to the chemical structure of uric acid, and concentration of the latter in the stone. These findings suggest that purines in stones represent a substitutional solid solution with uric acid as solvent. Methylxanthines, which are ubiquitous components of the diet, drugs, and uric acid calculi, may be involved in the pathogenesis of urolithiasis.

Protective effect of Urtica dioica methanol extract against experimentally induced urinary calculi in rats.

PubMed

Zhang, Haiying; Li, Ning; Li, Kun; Li, Peng

2014-12-01

Renal calculi formation is one of the most common urological disorders. Urinary stone disease is a common disease, which affects 10‑12% of the population in industrialized countries. In males, the highest prevalence of the disease occurs between the age of 20 and 40 years, while in females, the highest incidence of the disease occurs later. Previous studies have shown that long‑term exposure to oxalate is toxic to renal epithelial cells and results in oxidative stress. In the present study, a methanolic extract of aerial parts of Urtica dioica was screened for antiurolithiatic activity against ethylene glycol and ammonium chloride‑induced calcium oxalate renal stones in male rats. In the control rats, ethylene glycol and ammonium chloride administration was observed to cause an increase in urinary calcium, oxalate and creatinine levels, as well as an increase in renal calcium and oxalate deposition. Histopathological observations revealed calcium oxalate microcrystal deposits in the kidney sections of the rats treated with ethylene glycol and ammonium chloride, indicating the induction of lithiasis. In the test rats, treatment with the methanolic extract of Urtica dioica was found to decrease the elevated levels of urinary calcium, oxalate and creatinine, and significantly decrease the renal deposition of calcium and oxalate. Furthermore, renal histological observations revealed a significant reduction in calcium oxalate crystal deposition in the test rats. Phytochemical analysis of the Urtica dioica extract was also performed using liquid chromatography‑electrospray ionization tandem mass spectrometry and high-performance liquid chromatography with photodiode array detection, to determine the chemical composition of the extract. The eight chemical constituents identified in the extract were protocatechuic acid, salicylic acid, luteolin, gossypetin, rutin, kaempferol‑3‑O‑rutinoside, kaempferol‑3‑O‑glucoside and chlorogenic acid. In conclusion, the results of the present study suggest that Urtica dioica has strong antiurolithiatic activity and may have potential as a natural therapeutic agent for various urological disorders.

Accuracy of radiological features for predicting extracorporeal shock wave lithotripsy success for treatment of kidney calculi.

PubMed

Arshadi, Hamid; Dianat, Seyed Saied; Ganjehei, Leila

2009-01-01

Our aim was to assess the accuracy of radiological characteristics observed by the urologist in estimating the success rate of extracorporeal shock wave lithotripsy (SWL) in patients with kidney calculi. Patients with kidney calculi sized 10 mm to 15 mm who underwent SWL in our center were enrolled. One urologist estimated the success chance of SWL based on plain abdominal radiography. Accordingly, the patients were categorized into 2 groups with more than 75% chance of fragmentation (group 1) and with 50% to 75% estimated chance of fragmentation (group 2). Factors used for estimation included calculus shape, homogeneity, and density as compared with the adjacent 12th rib. The estimations were compared with the resulted stone-free rate after a 3-month follow-up. A total of 137 patients were studied, of whom, 92 (67.2%) were categorized in group 1 and 45 (32.8%) in group 2, before the lithotripsy. Successful treatment was recorded in 101 patients (73.7%). Eighty-five patients with favorable estimated chance of successful lithotripsy (92.4%) had successful SWL, and 29 with less favorable estimate (64.4%) did not have successful fragmentation following 2 sessions of SWL (P < .001). The sensitivity and specificity of radiological parameters for prediction of treatment success were 84.2% and 80.6%, respectively. We found that certain radiographic features of urinary calculi such as calculus density, as compared with the adjacent bone, and calculus shape could have predictive impression for the success rate of SWL.

Use of plain radiography in the diagnosis, surgical management, and postoperative treatment of obstructive urolithiasis in 25 goats and 2 sheep.

PubMed

Kinsley, Marc A; Semevolos, Stacy; Parker, Jill E; Duesterdieck-Zellmer, Katja; Huber, Michael

2013-08-01

To describe use of plain radiography for diagnosis, surgical management, and postoperative treatment of obstructive urolithiasis in small ruminants. Retrospective case series. Small ruminants (n = 27; 25 goats, 2 sheep). Medical records (January 2002-November 2011) and radiographs for all small ruminants diagnosed with obstructive urolithiasis and having plain abdominal radiographs were reviewed. Signalment, surgical procedures, radiographic findings, ultrasonographic findings, position of calculi, and how plain radiography influenced surgical management and postoperative treatment were recorded. Radiopaque urinary calculi were detected in 23 (85%) plain radiographic studies. Location of uroliths determined by plain radiography included: cystic only (n = 5), distal to the sigmoid flexure and cystic (5), subischial (5), distal to the sigmoid flexure only (3), sigmoid flexure (3), and subischial and cystic (2). In 8 of these animals, postoperative radiographs revealed residual calculi in the urethra and were essential for their targeted removal by urethrotomy in 7 animals. In regions where radiopaque calculi (calcium carbonate, calcium oxalate, silica) are commonly encountered in small ruminants, plain radiographs are recommended to determine the appropriate surgical approach(es) and to confirm resolution of the obstruction. © Copyright 2013 by The American College of Veterinary Surgeons.

Simultaneous determination of 16 purine derivatives in urinary calculi by gradient reversed-phase high-performance liquid chromatography with UV detection.

PubMed

Safranow, Krzysztof; Machoy, Zygmunt

2005-05-25

A reversed-phase high-performance liquid chromatography (HPLC) method with ultraviolet detection has been developed for the analysis of purines in urinary calculi. The method using gradient of methanol concentration and pH was able to separate 16 compounds: uric acid, 2,8-dihydroxyadenine, xanthine, hypoxanthine, allopurinol and oxypurinol as well as 10 methyl derivatives of uric acid or xanthine (1-, 3-, 7- and 9-methyluric acid, 1,3-, 1,7- and 3,7-dimethyluric acid, 1-, 3- and 7-methylxanthine). Limits of detection for individual compounds ranged from 0.006 to 0.035 mg purine/g of the stone weight and precision (CV%) was 0.5-2.4%. The method enabled us to detect in human uric acid stones admixtures of nine other purine derivatives: natural metabolites (hypoxanthine, xanthine, 2,8-dihydroxyadenine) and methylated purines (1-, 3- and 7-methyluric acid, 1,3-dimethyluric acid, 3- and 7-methylxanthine) originating from the metabolism of methylxanthines (caffeine, theophylline and theobromine). The method allows simultaneous quantitation of all known purine constituents of urinary stones, including methylated purines, and may be used as a reference one for diagnosing disorders of purine metabolism and research on the pathogenesis of urolithiasis.

Non-contrast CT at comparable dose to an abdominal radiograph in patients with acute renal colic; impact of iterative reconstruction on image quality and diagnostic performance.

PubMed

McLaughlin, P D; Murphy, K P; Hayes, S A; Carey, K; Sammon, J; Crush, L; O'Neill, F; Normoyle, B; McGarrigle, A M; Barry, J E; Maher, M M

2014-04-01

The aim was to assess the performance of low-dose non-contrast CT of the urinary tract (LD-CT) acquired at radiation exposures close to that of abdominal radiography using adaptive statistical iterative reconstruction (ASiR). Thirty-three patients with clinically suspected renal colic were prospectively included. Conventional dose (CD-CT) and LD-CT data sets were contemporaneously acquired. LD-CT images were reconstructed with 40 %, 70 % and 90 % ASiR. Image quality was subjectively and objectively measured. Images were also clinically interpreted. Mean ED was 0.48 ± 0.07 mSv for LD-CT compared with 4.43 ± 3.14 mSv for CD-CT. Increasing the percentage ASiR resulted in a step-wise reduction in mean objective noise (p < 0.001 for all comparisons). Seventy % ASiR LD-CT images had higher diagnostic acceptability and spatial resolution than 90 % ASiR LD-CT images (p < 0.001). Twenty-seven calculi (diameter = 5.5 ± 1.7 mm), including all ureteric stones, were correctly identified using 70 % ASiR LD-CT with two false positives and 16 false negatives (diameter = 2.3 ± 0.7 mm) equating to a sensitivity and specificity of 72 % and 94 %. Seventy % ASiR LD-CT had a sensitivity and specificity of 87 % and 100 % for detection of calculi >3 mm. Reconstruction of LD-CT images with 70 % ASiR resulted in superior image quality than FBP, 40 % ASIR and 90 % ASIR. LD-CT with ASIR demonstrates high sensitivity and specificity for detection of calculi >3 mm. • Low-dose CT studies for urinary calculus detection were performed with a mean dose of 0.48 ± 0.07 mSv • Low-dose CT with 70 % ASiR detected calculi >3 mm with a sensitivity and specificity of 87 % and 100 % • Reconstruction with 70 % ASiR was superior to filtered back projection, 40 % ASiR and 90 % ASiR images.

Acute urinary retention secondary to a urethral calculus in a bladder-drained kidney pancreas transplant patient - a metallic clip nidus.

PubMed

Smith, J B K; Sairam, K; Olsburgh, J

2009-01-01

Urological expertise is usually required for the management of any urological complications of bladder-drained pancreatic allografts whether they are the result of simultaneous pancreas-kidney transplants, pancreas after kidney transplants, or pancreas transplants alone. This study presents a case of urinary retention secondary to prostatic urethra calculus impaction, the nidus of which was found to be metallic staples from the donor duodenal segment of a pancreatic allograft. Knowledge of the pre-transplant benchwork gave a high index of suspicion to the urological sequelae of this case and, in particular, the presence of calculi should suggest a metal clip nidus. We examine the methods of exocrine pancreatic drainage, donor duodenum preparation and case management.

Complications employing the holmium:YAG laser.

PubMed

Beaghler, M; Poon, M; Ruckle, H; Stewart, S; Weil, D

1998-12-01

We report the operative and early postoperative complications and limitations in 133 patients treated with the holmium laser. Complications included urinary tract infection (N = 3), postoperative bradycardia (1), inverted T-waves (1), intractable flank pain (1), urinary retention (1), inability to access a lower-pole calix with a 365-microm fiber (9), stone migration (5), and termination of procedure because of poor visibility (2). No ureteral perforations or strictures occurred, and no complications were directly attributable to the laser. The holmium laser was capable of fragmenting all urinary calculi in this study. In our initial experience, the holmium laser is safe and effective in the treatment of urinary pathology. Use of laser fibers larger than 200 microm occasionally limits deflection of the endoscope into a lower-pole or dependent calix.

Evaluation of Sesbania grandiflora for antiurolithiatic and antioxidant properties.

PubMed

Doddola, Sujatha; Pasupulati, Haritha; Koganti, Bharathi; Prasad, Koganti V S R G

2008-07-01

In the indigenous system of medicine in India, the plant Sesbania grandiflora is claimed to be useful for various ailments, and one such use is for the treatment of renal calculi. The major purpose of this study is to investigate the potential of S. grandiflora in the treatment of renal calculi. The leaf juice of S. grandiflora was evaluated for median lethal dose, gross behavioral changes, antiurolithiatic and antioxidant activities. The antiurolithiatic activity was evaluated by a calculi-producing diet model, using gentamicin (subcutaneously) and 5% ammonium oxalate in rat feed to induce calcium oxalate-type stones. The parameters monitored in the present study are calcium and oxalate deposition in the kidney, kidney weights, urinary excretion of calcium and oxalate. The in vivo antioxidant parameters lipid peroxidation, glutathione reductase and catalase were monitored. The plant juice was also evaluated for scavenging of nitric oxide and 2-diphenyl-2-picryl hydrazyl free radicals. The leaf juice of S. grandiflora was safe orally and exhibited no gross behavioral changes except for an increase in urination. The leaf juice of S. grandiflora showed significant antiurolithiatic activity against calcium oxalate-type stones and also exhibited antioxidant properties. The results obtained in this study provide evidence for the efficacy of the leaf juice of S. grandiflora as antiurolithiatic agent.

Transrectal ultrasound-guided extraction of impacted prostatic urethral calculi: a simple alternative to endoscopy

PubMed Central

Amend, Gregory; Gandhi, Jason; Smith, Noel L.; Weissbart, Steven J.; Schulsinger, David A.; Joshi, Gargi

2017-01-01

Urethral stones can become impacted in the posterior urethra, typically presenting with varying degrees of acute urinary retention and lower urinary tract symptoms. These are traditionally treated in the inpatient setting, with external urethrotomy or endoscopic push-back of the calculus into the urinary bladder followed by cystolitholapaxy or cystolithotripsy. However, these methods are invasive, involve general anesthesia, and require radiation. In this report, we describe a simple, minimally invasive, and safe alternative technique to visualize and remove impacted prostatic urethral stones under the real-time guidance of transrectal ultrasonography (TRUS). The urologist can accomplish this procedure in the office, avoiding radiation exposure to the patient and hospital admission. PMID:28725602

The risk of bladder cancer in patients with urinary calculi: a meta-analysis.

PubMed

Yu, Zhang; Yue, Wu; Jiuzhi, Li; Youtao, Jiang; Guofei, Zhang; Wenbin, Guo

2018-01-05

The objective of this meta-analysis was to evaluate the association between a history of urinary calculi (UC) and the risk of bladder cancer (BC). A literature search was performed from inception until July 2017. Studies that reported odds ratios (OR), relative risks or hazard ratios comparing the risk of BC in patients with the history of UC vs those without the history of UC were included. Pooled odds ratios and 95% confidence interval (CI) were calculated using a random-effect or fixed-effect method. Thirteen studies were included in our analysis to assess the association between a history of UC and risk of BC. The pooled OR of BC in patients with UC was 1.87 (95% CI, 1.45-2.41). Bladder calculi [OR, 2.17 (95% CI, 1.52-3.08)] had a higher risk of BC than kidney calculi [OR, 1.39 (95% CI, 1.06-1.82)]. The subjects had a history of UC that was associated with increased BC risk both in males [OR, 2.04 (95% CI, 1.41-2.96)] and in females [OR, 2.99 (95% CI, 2.37-3.76)]. The subgroup analysis demonstrated that UC increasing risk of BC both in case-control studies [OR, 1.75 (95% CI, 1.25-2.45)] and cohort studies [OR, 2.27 (95% CI, 1.55-3.32)]. The pooled OR of BC risk in patients with UC were 1.60 (95% CI, 1.15-2.24) in America, 1.36 (95% CI, 1.14-1.64) in Europe and 3.05 (95% CI, 2.21-4.21) in Asia, respectively. Our study demonstrates a significant increased risk of BC in patients with prior UC. This finding suggests that a history of UC is associated with BC and may impact clinical management and cancer surveillance. Further studies still needed to confirm the findings.

Effect of feeding sweet-potato condensed distillers solubles on intake and urinary excretion of minerals in Japanese Black steers.

PubMed

Kamiya, Yuko; Kamiya, Misturu; Hattori, Ikuo; Hayashi, Yoshiro; Funaba, Masayuki; Matsui, Tohru

2017-01-01

Four Japanese Black steers (16 months of age) were assigned to a 4 × 4 Latin square design to investigate the effect of graded levels of sweet-potato condensed distillers solubles (SCDS) in their diets on intake and urinary excretion of minerals. The four diets consisted of 0%, 10%, 20% and 30% (dry matter (DM) basis) SCDS, with SCDS replacing commercial concentrate (CC). Intake of K, Cl, S, P and Mg increased linearly with increasing SCDS content. Urinary pH increased linearly with increasing dietary SCDS content. SCDS feeding increased urinary K concentrations (linear and quadratic effects). Urinary concentrations of Cl increased linearly with increasing SCDS content. In contrast, urinary concentrations of Mg decreased with increasing SCDS content. Feeding of SCDS did not apparently affect urinary NH 3 ,P, Na or Ca concentrations. These results suggest that high SCDS feeding is not a risk for crystallization of minerals leading to the formation of magnesium-phosphate type calculi: although SCDS contains large amounts of P and Mg, high SCDS feeding decreased the Mg concentration and did not affect the P concentration in urine. Additionally, high SCDS feeding had no apparent effects on plasma concentrations of Na, K, Cl, Ca or inorganic P. © 2016 Japanese Society of Animal Science.

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.

Large bilateral seminal vesicle calculi presenting with spermolithiasis.

PubMed

Williams, Sarah Anne; Christodoulidou, Michelle; Nigam, Raj

2017-06-02

A 34-year-old male presented with an 8-month history of passing increasingly painful 'grit' in his ejaculate. Semen analysis was normal as were urinary and blood tests. T1-weighted MRI revealed several bilateral high-signal areas measuring up to 1 cm in diameter, located in the seminal vesicles. These were confirmed as calculi on T2-weighted imaging and a seminal vesiculogram, with no drainage from the left ejaculatory duct and only minimal from the right duct. He is currently awaiting a robot-assisted laparoscopic vesiculotomy after completion of family. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The giant calculus within the prostatic urethra.

PubMed

Demir, Omer; Kefi, Aykut; Cahangirov, Asif; Cihan, Ahmet; Obuz, Funda; Esen, Adil Ahmet; Celebi, Ilhan

2011-08-01

The giant calculus within the prostatic urethra is a rare clinical entity in the young population. Most of the calculi within the urethra migrate from the urinary bladder and obliterate the urethra. These stones are often composed of calcium phosphate or calcium oxalate. The decision of treatment strategy is affected by the size, shape and position of the calculus and by the status of the urethra. If the stone is large and immovable, it may be extracted via the perineal or the suprapubic approach. In most cases, the giant calculi were extracted via the transvesical approach and external urethrotomy. Our case is the biggest prostatic calculus, known in the literature so far, which was treated endoscopically by the combination of laser and the pneumatic lithotriptor.

Pseudoephedrine and guaifenesin urolithiasis: widening the differential diagnosis of radiolucent calculi on abdominal radiograph.

PubMed

Song, G Y; Lockhart, M E; Smith, J K; Burns, J R; Kenney, P J

2005-01-01

Unenhanced helical computed tomography has played an increasingly important role in the management of urinary tract stones, guiding diagnosis and control of calculus disease. We report computed tomographic and radiographic appearances of a renal calculus composed of pseudoephedrine and guaifenesin in a patient who abused over-the-counter allergy medication.

[Urinary catheter biofilm infections].

PubMed

Holá, V; Růzicka, F

2008-04-01

Urinary tract infections, most of which are biofilm infections in catheterized patients, account for more than 40% of hospital infections. Bacterial colonization of the urinary tract and catheters causes not only infection but also other complications such as catheter blockage by bacterial encrustation, urolithiasis and pyelonephritis. About 50% of long-term catheterized patients face urinary flow obstruction due to catheter encrustation, but no measure is currently available to prevent it. Encrustation has been known either to result from metabolic dysfunction or to be of microbial origin, with urease positive bacterial species implicated most often. Infectious calculi account for about 15-20% of all cases of urolithiasis and are often associated with biofilm colonization of a long-term indwelling urinary catheter or urethral stent. The use of closed catheter systems is helpful in reducing such problems; nevertheless, such a system only delays the inevitable, with infections emerging a little later. Various coatings intended to prevent the bacterial adhesion to the surface of catheters and implants and thus also the emergence of biofilm infections, unfortunately, do not inhibit the microbial adhesion completely and permanently and the only reliable method for biofilm eradication remains the removal of the foreign body from the patient.

The influence of maternal and paternal history on stone composition and clinical course of calcium nephrolithiasis in subjects aged between 15 and 25.

PubMed

Guerra, Angela; Ticinesi, Andrea; Allegri, Franca; Nouvenne, Antonio; Pinelli, Silvana; Folesani, Giuseppina; Lauretani, Fulvio; Maggio, Marcello; Borghi, Loris; Meschi, Tiziana

2016-11-01

Our aim was to compare the influence of maternal history of stones (MHS) and paternal history of stones (PHS) on composition of calculi and disease course in a group of patients with calcium nephrolithiasis (CN) aged between 15 and 25, the age range with the maximal influence of family history on disease expression. One-hundred thirty-five patients (68 F) with CN and one stone-forming parent were retrospectively selected from the database of our outpatient stone clinic, and categorized according to MHS or PHS. Data about stone disease course and composition of passed calculi, determined by chemical analysis or Fourier-transformed infrared spectrophotometry, were collected together with information on blood chemistry and 24-h urinary profile of lithogenic risk. The characteristics of disease course and stone composition were compared using logistic regression tests adjusted for age, sex, and BMI or analysis of covariance where appropriate. Patients with MHS (n = 46) had significantly higher urinary calcium/creatinine ratio and ammonium, a higher prevalence of urological treatments (57 vs 27 %, p < 0.001) and mixed calcium oxalate/calcium phosphate stone composition (69 vs 35 %, p = 0.002) than those with PHS. At multivariate logistic regression models, MHS was independently associated with urological treatments (OR 4.5, 95 %CI 1.9-10.7, p < 0.001) and the formation of calculi with mixed calcium oxalate/calcium phosphate composition (OR 5.8, 95 %CI 1.9-17.9, p = 0.002). The method of stone analysis did not affect this result. In conclusion, in subjects aged 15-25, MHS is associated with mixed calcium stones and with a higher risk for urological procedures, and should be, therefore, considered in the management of urolithiasis.

[In vitro study with techniques of imaging of the composition of urinary calculi].

PubMed

Tellez Martínez-Fornés, M; Burgos Revilla, F J; Sáez Garrido, J C; Soria Descalzo, J; Barbero González, J; Sánchez Corral, J; Minaya Minaya, A; Vallejo Herrador, J

1997-02-01

Pre-treatment knowledge of the lithiasic composition can be useful to design the most appropriate therapeutic scheme for each kind of stone. The relationship between the stone's densitometry information provided by the different imaging techniques, conventional radiology (RX), computerized axial tomography (CAT) and dual energy radiographic densitometry (DO) is analyzed, as well as the elemental composition determined by the microanalysis of fragments obtained post-lithotrity using a scanning electronic microscope (SEM) associated to X-ray dispersion energy (XDE). 60 stones, 12 for each pure composition selected (calcium oxalate mono and dihydro, phosphocarbonate, magnesium ammonium phosphate and uric acid), were studied with XR, CAT and DO and were later subjected to lithofragmentation in vitro. Fragments analysis was carried out post-lithotrity with SEM associated to XDE. The X-ray does not allow to establish the composition of some calculi. CAT quantifies the mineral contents of the oxalocalcic and infective calculi and differentiates the uric acid from the other compositions because the mean density values are under 500 Hounsfield Units. DO evaluates the lithiasic content in phosphocarbonate salts which are structurally similar to bone hydroxyapatite.

Long-term complications following bladder augmentations in patients with spina bifida: bladder calculi, perforation of the augmented bladder and upper tract deterioration.

PubMed

Husmann, Douglas A

2016-02-01

We desire to review our experience with bladder augmentation in spina bifida patients followed in a transitional and adult urologic practice. This paper will specifically focus on three major complications: bladder calculi, the most frequent complication found following bladder augmentation, perforation of the augmentation, its most lethal complication and finally we will address loss of renal function as a direct result of our surgical reconstructive procedures. We reviewed a prospective data base maintained on patients with spina bifida followed in our transitional and adult urology clinic from 1986 to date. Specific attention was given to patients who had developed bladder calculi, sustained a spontaneous perforation of the augmented bladder or had developed new onset of renal scarring or renal insufficiency (≥ stage 3 renal failure) during prolonged follow-up. The development of renal stones (P<0.05) and symptomatic urinary tract infections (P<0.0001) were found to be significantly reduced by the use of high volume (≥240 mL) daily bladder wash outs. Individuals who still developed bladder calculi recalcitrant to high volume wash outs were not benefited by the correction of underlying metabolic abnormalities or mucolytic agents. Spontaneous bladder perforations in the adult patient population with spina bifida were found to be directly correlated to substance abuse and noncompliance with intermittent catheterization, P<0.005. Deterioration of the upper tracts as defined by the new onset of renal scars occurred in 40% (32/80) of the patients managed by a ileocystoplasty and simultaneous bladder neck outlet procedure during a median follow-up interval 14 years (range, 8-45 years). Development of ≥ stage 3 chronic renal failure occurred within 38% (12/32) of the patients with scarring i.e., 15% (12/80) of the total patient population. Prior to the development of the renal scarring, 69% (22/32) of the patients had been noncompliant with intermittent catheterization. The onset of upper tract deterioration (i.e., new scar formation, hydronephrosis, calculus development, decrease in renal function) was silent, that is, clinically asymptomatic in one third (10/32 pts). This paper documents the need for high volume bladder irrigations to both prevent the most common complication following bladder augmentation, which is the development of bladder calculi and to reduce the incidence of symptomatic urinary tract infections. It provides a unique perspective regarding the impact of substance abuse and patient non-compliance with medical directives as being both the most common cause for both spontaneous bladder rupture following augmentation cystoplasty and for deterioration of the upper tracts. These findings should cause the surgeon to reflect on his/her assessment of a patient prior to performing a bladder augmentation procedure and stress the need for close follow-up.

Single-center North American experience with wolf Piezolith 3000 in management of urinary calculi.

PubMed

Wang, Rou; Faerber, Gary J; Roberts, William W; Morris, David S; Wolf, J Stuart

2009-05-01

To review our experience with the newest generation piezoelectric lithotripter, the Piezolith 3000, in adult patients undergoing extracorporeal shock wave lithotripsy for solitary urinary calculi. We identified 139 shock wave lithotripsy procedures that had used the Piezolith 3000 from February 2005 to July 2007. All procedures were performed under intravenous sedation. Retrospective chart review was used to obtain the pertinent information. Stone-free status was defined as the absence of any fragments, and success as the absence of stone fragments >4 mm, on follow-up imaging after a single treatment. The stone-free and success rate 1 month after a single shock wave lithotripsy session was 45% and 64%, respectively. Only stone size correlated with the overall success rate (P = .004). The overall complication rate was 15% and included a 5.8% major complication rate requiring intervention or admission. The median time in the procedure room was 33 minutes. The adjunctive procedure rate was 1.4%, and the secondary retreatment rate was 10%. The Piezolith 3000 provides modest, but acceptable, single-treatment stone-free and success rates, with a reasonable safety profile, and offers rapid and convenient lithotripsy requiring only intravenous sedation.

Long-term complications following bladder augmentations in patients with spina bifida: bladder calculi, perforation of the augmented bladder and upper tract deterioration

PubMed Central

2016-01-01

Background We desire to review our experience with bladder augmentation in spina bifida patients followed in a transitional and adult urologic practice. This paper will specifically focus on three major complications: bladder calculi, the most frequent complication found following bladder augmentation, perforation of the augmentation, its most lethal complication and finally we will address loss of renal function as a direct result of our surgical reconstructive procedures. Methods We reviewed a prospective data base maintained on patients with spina bifida followed in our transitional and adult urology clinic from 1986 to date. Specific attention was given to patients who had developed bladder calculi, sustained a spontaneous perforation of the augmented bladder or had developed new onset of renal scarring or renal insufficiency (≥ stage 3 renal failure) during prolonged follow-up. Results The development of renal stones (P<0.05) and symptomatic urinary tract infections (P<0.0001) were found to be significantly reduced by the use of high volume (≥240 mL) daily bladder wash outs. Individuals who still developed bladder calculi recalcitrant to high volume wash outs were not benefited by the correction of underlying metabolic abnormalities or mucolytic agents. Spontaneous bladder perforations in the adult patient population with spina bifida were found to be directly correlated to substance abuse and noncompliance with intermittent catheterization, P<0.005. Deterioration of the upper tracts as defined by the new onset of renal scars occurred in 40% (32/80) of the patients managed by a ileocystoplasty and simultaneous bladder neck outlet procedure during a median follow-up interval 14 years (range, 8–45 years). Development of ≥ stage 3 chronic renal failure occurred within 38% (12/32) of the patients with scarring i.e., 15% (12/80) of the total patient population. Prior to the development of the renal scarring, 69% (22/32) of the patients had been noncompliant with intermittent catheterization. The onset of upper tract deterioration (i.e., new scar formation, hydronephrosis, calculus development, decrease in renal function) was silent, that is, clinically asymptomatic in one third (10/32 pts). Conclusions This paper documents the need for high volume bladder irrigations to both prevent the most common complication following bladder augmentation, which is the development of bladder calculi and to reduce the incidence of symptomatic urinary tract infections. It provides a unique perspective regarding the impact of substance abuse and patient non-compliance with medical directives as being both the most common cause for both spontaneous bladder rupture following augmentation cystoplasty and for deterioration of the upper tracts. These findings should cause the surgeon to reflect on his/her assessment of a patient prior to performing a bladder augmentation procedure and stress the need for close follow-up. PMID:26904407

Giant ureteric and staghorn calculi in a young adult Nigerian male: a case report.

PubMed

Gali, B M; Ali, A; Ibrahim, A G; Bakari, A; Minoza, K

2010-01-01

Ureteric calculi are usually small and solitary.The term giant has been applied to ureteric calculi that aremore than five cms in length and/or 50g or more in weight. These are uncommon and may present with few or no urological symptoms and might be ignored or be missed. To present a rare case of a giant left ureteric calculus associated with an ipsilateral staghorn calculus. A 31-year-old Nigerian male presented with recurrent left abdominal pain, dysuria, urinary frequency, and fever which had been on for 10 years. Patient was clinically evaluated. He had plain abdominal X-rays, abdominal ultrasonography and intravenous urography. He had to undergo nephrouterorectomy. Patient took analgesics and antibiotics purchased from patent chemist shops for relief of symptoms by himself. He was fit except for a hard cylindrical mass felt arising from the pelvis. Abdomino-pelvic ultrasound scan, plain abdominal X-ray and Intravenous urogram showed a giant ureteric calculus with an ipsilateral staghorn calculus in a nonfunctioning hydronephrotic left kidney. There was no evidence of underlying anatomic or metabolic abnormalities. He had left nephroureterectomy. The ureteric calculus measured 10.5 x 3.0cm and weighed 20.1gm. Giant ureteric calculi are rare. The association giant ureteric calculus with an ipsilateral staghorn renal calculus without underlying anatomic abnormalities appear not have been reported earlier.

How Do Urinary Calculi Influence Health-Related Quality of Life and Patient Treatment Preference: A Systematic Review.

PubMed

Raja, Aditya; Hekmati, Zara; Joshi, Hrishi B

2016-07-01

Urinary stone disease is a common and often recurrent condition that can affect kidney function and requires a range of medical and surgical treatments, all of which can have a significant impact on patients' health-related quality of life (HRQoL) and treatment preferences. To review the literature systematically for all studies that include HRQoL measurement or patient preferences in the context of urinary stone disease. Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process, EMBASE, SCOPUS, EconLit, and Web of Science were searched from inception to January 2016. All study designs with adult participants were included. Narrative synthesis was performed. Thirty-five studies met the inclusion criteria (six randomized controlled trials and 29 observational studies) from 15 countries, including 5472 patients. Eleven studies showed that stone formers had worse HRQoL than the general population; it was noted that stone formers were more likely to suffer from depression. Women have significantly lower HRQoL than men. Twenty-six studies used a generic HRQoL measure and six were nonvalidated disease specific. Studies concerning patient preference were heterogeneous and showed that extracorporeal shock wave lithotripsy is still favored above other interventions and that a large number of patients would prefer the treatment pathway to be decided upon by their clinician. Urinary calculi and its treatment can have significant negative patient impact and influence patient preferences. Patients with stone disease tend to have worse physical and mental HRQoL, quantified using generic measures. Structured research with disease-specific measures underpinned by sound methodology would be beneficial and aid in development of patient-centric management. This review was prospectively registered with the international prospective register of systematic reviews-PROSPERO 2013:CRD42013006084.

[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.

Urinary calculi in aviation pilots: what is the best therapeutic approach?

PubMed

Zheng, Wei; Beiko, Darren T; Segura, Joseph W; Preminger, Glenn M; Albala, David M; Denstedt, John D

2002-10-01

We reviewed treatment outcomes in a series of aviation pilots treated in the era of modern surgical techniques and provide recommendations regarding treatment in this unique group. We retrospectively analyzed the records of all aviation pilots surgically treated for urinary calculi at our 4 tertiary stone centers from January 1988 to June 2000. Preoperative data and postoperative results were evaluated. Primary outcome measures included stone-free status after initial therapy, time lost from work and overall stone-free rates. Secondary outcome measures included the need for secondary procedures and complications. Of the 36 patients 17 had renal and 19 had ureteral stones. In 4 patients the stones passed spontaneously, while 17 were initially treated with extracorporeal shock wave lithotripsy (ESWL) (Dornier Medical Systems, Marietta, Georgia), 9 were initially treated with ureteroscopy and 6 were treated with percutaneous nephrolithotripsy. There was 1 complication. The stone-free rate for ESWL, percutaneous nephrolithotripsy and ureteroscopy after initial therapy was 35%, 100% and 100%, respectively. All patients were rendered stone-free after secondary therapy. Mean time lost from work for ESWL, percutaneous nephrolithotripsy and ureteroscopy was 4.7, 2.6 and 1.6 weeks, respectively. Aviation pilots with surgical urolithiasis are best treated with an initial endoscopic procedure. Stone-free rates can be maximized, while time lost from work can be minimized when an endoscopic approach is used initially. All pilots with urolithiasis should undergo mandatory metabolic evaluations to institute medical therapy when indicated.

Medical and Surgical Treatment Modalities for Lower Urinary Tract Symptoms in the Male Patient Secondary to Benign Prostatic Hyperplasia: A Review

PubMed Central

Macey, Matthew Ryan; Raynor, Mathew C.

2016-01-01

Benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS) is one of the most common ailments affecting aging men. Symptoms typically associated with BPH include weak stream, hesitancy, urgency, frequency, and nocturia. More serious complications of BPH include urinary retention, gross hematuria, bladder calculi, recurrent urinary tract infection, obstructive uropathy, and renal failure. Evaluation of BPH includes a detailed history, objective assessment of urinary symptoms with validated questionnaires, and measurement of bladder function parameters, including uroflowmetry and postvoid residual. In general, treatment of LUTS associated with BPH is based on the effect of the symptoms on quality of life (QOL) and include medical therapy aimed at reducing outlet obstruction or decreasing the size of the prostate. If medical therapy fails or is contraindicated, various surgical options exist. As the elderly population continues to grow, the management of BPH will become more common and important in maintaining patient's QOL. PMID:27582609

Prediction of renal crystalline size distributions in space using a PBE analytic model. 2. Effect of dietary countermeasures.

PubMed

Kassemi, Mohammad; Thompson, David

2016-09-01

An analytic Population Balance Equation model is used to assess the efficacy of citrate, pyrophosphate, and augmented fluid intake as dietary countermeasures aimed at reducing the risk of renal stone formation for astronauts. The model uses the measured biochemical profile of the astronauts as input and predicts the steady-state size distribution of the nucleating, growing, and agglomerating renal calculi subject to biochemical changes brought about by administration of these dietary countermeasures. Numerical predictions indicate that an increase in citrate levels beyond its average normal ground-based urinary values is beneficial but only to a limited extent. Unfortunately, results also indicate that any decline in the citrate levels during space travel below its normal urinary values on Earth can easily move the astronaut into the stone-forming risk category. Pyrophosphate is found to be an effective inhibitor since numerical predictions indicate that even at quite small urinary concentrations, it has the potential of shifting the maximum crystal aggregate size to a much smaller and plausibly safer range. Finally, our numerical results predict a decline in urinary volume below 1.5 liters/day can act as a dangerous promoter of renal stone development in microgravity while urinary volume levels of 2.5-3 liters/day can serve as effective space countermeasures. Copyright © 2016 the American Physiological Society.

Imaging-based assessment of the mineral composition of urinary stones: an in vitro study of the combination of hounsfield unit measurement in noncontrast helical computerized tomography and the twinkling artifact in color Doppler ultrasound.

PubMed

Hassani, Hakim; Raynal, Gauthier; Spie, Romain; Daudon, Michel; Vallée, Jean-Noël

2012-05-01

We evaluated the value of combining noncontrast helical computerized tomography (NCHCT) and color Doppler ultrasound in the assessment of the composition of urinary stones. In vitro, we studied 120 stones of known composition, that separate into the five main types: 18 calcium oxalate monohydrate (COM) stones, 41 calcium oxalate dihydrate (COD) stones, 24 uric acid stones, 25 calcium phosphate stones and 12 cystine calculi. Stones were characterized in terms of their Hounsfield density (HU) in NCHCT and the presence of a twinkling artifact (TA) in color Doppler ultrasound. There were statistically significant HU differences between calcium and non-calcium stones (p < 0.001), calcium oxalate stones and calcium phosphate stones (p < 0.001) and uric acid stones and cystine calculi (p < 0.001) but not between COM and COD stones (p = 0.786). Hence, the HU was a predictive factor of the composition of all types of stones, other than for COM and COD stones within the calcium oxalate class (p > 0.05). We found that the TA does not enable differentiation between calcium and non-calcium stones (p > 0.999), calcium oxalate stones and calcium phosphate stones (p = 0.15), or uric acid stones and cystine calculi (p = 0.079). However, it did reveal a significant difference between COM and COD stones (p = 0.002). The absence of a TA is a predictive factor for the presence of COM stones (p = 0.008). Hence, the association of NCHCT and Doppler enables the accurate classification of the five types of stones in vitro. Copyright © 2012 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Effect of hydroalcoholic extract from Copaifera langsdorffii leaves on urolithiasis induced in rats.

PubMed

Brancalion, Ana Paula S; Oliveira, Rejane B; Sousa, João Paulo B; Groppo, Milton; Berretta, Andresa A; Barros, Marcio E; Boim, Mirian A; Bastos, Jairo K

2012-10-01

Copaifera langsdorffii Desf. commonly known as "copaíba", produce a commercially valuable oil-resin that is extensively used in folk medicine for anti-inflammatory, antimicrobial and antiseptic purposes. We have found the hydroalcoholic extract of this plant leaf has the potential to treat urolithiasis, a problem affecting ~7% of the population. To isolate the functional compounds C. langsdorffii leaves were dried, ground, and macerated in a hydroalcoholic solution 7:3 to produce a 16.8% crude extract after solvent elimination. Urolithiasis was induced by introduction of a calcium oxalate pellet (CaOx) into the bladders of adult male Wistar rats. The treated groups received the crude extract by oral gavage at 20 mg/kg body weight daily for 18 days. Extract treatment started 30 days after CaOx seed implantation. To monitor renal function sodium, potassium and creatinine concentrations were analyzed in urine and plasma, and were found to be in the normal range. Analyses of pH, magnesium, phosphate, calcium, uric acid, oxalate and citrate levels were evaluated to determine whether the C. langsdorffii extract may function as a stone formation prevention agent. The HPLC analysis of the extract identified flavonoids quercitrin and afzelin as the major components. Animals treated with C. langsdorffii have increased levels of magnesium and decreased levels of uric acid in urinary excretions. Treated animals have a significant decrease in the mean number of calculi and a reduction in calculi mass. Calculi taken from extract treated animals were more brittle and fragile than calculi from untreated animals. Moreover, breaking calculi from untreated animals required twice the amount of pressure as calculi from treated animals (6.90 ± 3.45 vs. 3.00 ± 1.51). The extract is rich in flavonoid heterosides and other phenolic compounds. Therefore, we hypothesize this class of compounds might contribute significantly to the observed activity.

Early complications with the holmium laser

NASA Astrophysics Data System (ADS)

Beaghler, Marc A.; Stewart, Steven C.; Ruckle, Herbert C.; Poon, Michael W.

1997-05-01

The purpose of this study is to report early complications in our initial experience with the holmium laser in 133 patients. A retrospective study of patients undergoing endourological procedures with the holmium laser was performed. Complications included urinary tract infection (3), post-operative bradycardia (1), inverted T-waves (1), intractable flank pain (1), urinary retention (1), inability to access a lower pole calyx with a 365 micron fiber (9), stone migration (5), termination of procedure due to poor visualization (2). No ureteral perforations or strictures occurred. The holmium laser was capable of fragmenting all urinary calculi in this study. In our initial experience, the holmium laser is safe and effective in the treatment of genitourinary pathology. Use of laser fibers larger than 200 microns occasionally limit deflection into a lower pole or dependent calyx.

[Investigation of typical melamine urinary stones using infrared spectra].

PubMed

Si, Min-Zhen; Li, Qing-Yun; Liu, Ren-Ming; Kang, Yi-Pu; Wang, Kun-Hua; Zhang, Zhi-Guo

2010-02-01

A typical melamine kidney stone confirmed by some medicine expert was collected from the first people's hospital of Yunnan. The kidney stone was adequately determined by PE corporation spectra 100(with resolution of 1 cm(-1)). The stone samples for FTIR analysis were prepared using the KBr pellet technique, where 2 mg of the pretreated stone powder was mixed with 200 mg of analytical grade KBr using an agate pestle and mortar. The digital spectrum was then scanned in the mid-infrared region from 4 000 to 400 cm(-1) at room temperature. The appearing bands between 4 000 and 2 000 cm(-1) were 3 487, 3 325, 3 162 and 2 788 cm(-1), those between 1 700 and 1 000 cm(-1) were 1 694, 1 555, 1 383, 1 340, 1 189 and 1 122 cm(-1), and those between 1 000 and 400 cm(-1) were 993, 782, 748, 709, 624, 585, 565 and 476 cm(-1). It was found that the main constituent of calculi showed few comparability with cat kidney stone, which was from cats that died after consuming the contaminated food, and confirmed that these deposits were primarily composed of melamine and cyanuric acid compared to the IR spectra of calculi in literature. It was also found that the main constituent of calculi showed few comparability with popular kidney stone by comparison with the IR spectra of calculi in literature. The spectrum of calculi was 50% respectively similar with melamine and uric acid as compared with the IR spectrum. It was found that the main constituent of calculi was melamine itself and uric acid as compared with the IR spectra of calculi and melamine: (1 : 1), because the spectrum of calculi was 83. 3% similar to melamine and uric acid (1 : 1). The appearing bands of melamine and uric acid (1 : 1) between 4 000 and 2 000 cm(-1) were 3 469, 3 419, 3 333, 3 132, 3 026, 2 827 cm(-1), those between 1 700 and 1 000 cm(-1) were 1 696, 1 656, 1 555, 1 489, 1 439, 1 350, 1 311, 1 198, 1 124 and 1 028 cm(-1), and those between 1 000 and 400 cm(-1) were 993, 878, 814, 784, 745, 708, 619, 577 and 475 cm(-1).

The usefulness of densitometry in predicting the composition and fragility of urolithiasis.

PubMed

Argüelles-Salido, Enrique; Lozano-Blasco, Jose Maria; Subira-Rios, Jorge; Bernardo-Villar, Pastora; Podio-Lora, Virtudes; Campoy-Martínez, Pedro; Vazquez-Albertino, Ricardo; Medina-Lopez, Rafael

2014-04-01

The choice of ideal treatment for a given lithiasis is a crucial factor for its success, minimizing the number of interventions and complications. Previous determination of stone composition and its fragility is desirable, to predict its behavior during extracorporeal shock wave lithotripsy and for evaluation of its appropriateness, or to set the indication for other techniques. To determine the role of densitometry in the prediction of composition and fragility of urinary lithiasis undergoing SWL. Experimental prospective, blinded, in vitro study using 193 urinary calculi of known composition : monohydrated calcium oxalate, mixed calcium oxalate, uric acid, and calcium carbonate, obtained from spontaneous passage or surgery. Densitometry and SWL were performed on them. We compare the mineral composition of the stone and mineral density of each composition group to check if they are characteristic of each type and correlate these parameters with the energy dose required to fragment them down to a given fragment size. Only 53 out of 193 stones showed valuable data. Calcium carbonate was the composition showing grater mineral content and density (1,24 gr and 0,47 gr/cm2), followed by mixed oxalate (0,51/0,26) and uric acid (0,52/ 0,15), finishing with the monohydrate calcium oxalate group (0,32/0,05).Only the comparison between calcium carbonate and monohydrated calcium oxalate showed statistically significant results (p<0,05). Correlation coefficients between mineral content (0,347) and density (0,424) and the energy used for stone fragmentation to a given fragment size were statistically significant (p<0,05) CONCLUSIONS: In our study, the use of densitometry to determine stone composition and lithiasic fragility did not show conclusive results due to the limited number of calculi tested. Nevertheless, there are signs that, with a different study design , more practically useful results could be achieved.

Combining ultrasonography and noncontrast helical computerized tomography to evaluate Holmium laser lithotripsy

PubMed Central

Mi, Jia; Li, Jie; Zhang, Qinglu; Wang, Xing; Liu, Hongyu; Cao, Yanlu; Liu, Xiaoyan; Sun, Xiao; Shang, Mengmeng; Liu, Qing

2016-01-01

Abstract The purpose of the study was to establish a mathematical model for correlating the combination of ultrasonography and noncontrast helical computerized tomography (NCHCT) with the total energy of Holmium laser lithotripsy. In this study, from March 2013 to February 2014, 180 patients with single urinary calculus were examined using ultrasonography and NCHCT before Holmium laser lithotripsy. The calculus location and size, acoustic shadowing (AS) level, twinkling artifact intensity (TAI), and CT value were all documented. The total energy of lithotripsy (TEL) and the calculus composition were also recorded postoperatively. Data were analyzed using Spearman's rank correlation coefficient, with the SPSS 17.0 software package. Multiple linear regression was also used for further statistical analysis. A significant difference in the TEL was observed between renal calculi and ureteral calculi (r = –0.565, P < 0.001), and there was a strong correlation between the calculus size and the TEL (r = 0.675, P < 0.001). The difference in the TEL between the calculi with and without AS was highly significant (r = 0.325, P < 0.001). The CT value of the calculi was significantly correlated with the TEL (r = 0.386, P < 0.001). A correlation between the TAI and TEL was also observed (r = 0.391, P < 0.001). Multiple linear regression analysis revealed that the location, size, and TAI of the calculi were related to the TEL, and the location and size were statistically significant predictors (adjusted r2 = 0.498, P < 0.001). A mathematical model correlating the combination of ultrasonography and NCHCT with TEL was established; this model may provide a foundation to guide the use of energy in Holmium laser lithotripsy. The TEL can be estimated by the location, size, and TAI of the calculus. PMID:27930563

Urolithiasis, Urinary Cancer, and Home Drinking Water Source in the United States Territory of Guam, 2006-2010.

PubMed

Haddock, Robert L; Olson, David R; Backer, Lorraine; Malilay, Josephine

2016-05-24

We reviewed patient records with a first-listed diagnosis of urolithiasis-also known as urinary tract or kidney stone disease, nephrolithiasis-upon discharge from Guam's sole civilian hospital during 2006 to 2010 and urinary cancer mortality records from the Guam Cancer Registry for 1970 to 2009 to determine the source of municipal water supplied to the patients' residence. The objective was to investigate a possible relationship between the sources of municipal water supplied to Guam villages and the incidence of urolithiasis and urinary cancer. We analyzed hospital discharge diagnoses of urolithiasis or renal calculi by calculating the incidence of first-mentioned discharge for urolithiasis or renal calculi and comparing rates across demographic or geographic categories while adjusting by age, sex, and ethnicity/race. We reviewed cancer registry records of urinary cancer deaths by patient residence. The annual incidence of hospitalization for urolithiasis was 5.22 per 10,000. Rates adjusted for sex or age exhibited almost no change. The rate of 9.83 per 10,000 among Chamorros was significantly higher (p < 0.05) than the rates among any other ethnic group or race. When villages were grouped by water source, rates of patients discharged with a first-listed diagnosis of urolithiasis, adjusted for ethnicity/race, were similar for villages using either well water (5.44 per 10,000) or mixed source water (5.39 per 10,000), and significantly greater than the rate for villages using exclusively reservoir water (1.35 per 10,000). No statistically significant differences were found between the water source or village of residence and urinary cancer mortality. Some Guam residents living in villages served completely or partly by deep well water high in calcium carbonate may be at increased risk for urolithiasis compared with residents living in villages served by surface waters. Although the risk appears to be highest in villagers of Chamorro ethnicity, residents should be aware of other contributing risk factors and steps to take to avoid developing this health problem.

Urolithiasis, Urinary Cancer, and Home Drinking Water Source in the United States Territory of Guam, 2006–2010

PubMed Central

Haddock, Robert L.; Olson, David R.; Backer, Lorraine; Malilay, Josephine

2016-01-01

We reviewed patient records with a first-listed diagnosis of urolithiasis—also known as urinary tract or kidney stone disease, nephrolithiasis—upon discharge from Guam’s sole civilian hospital during 2006 to 2010 and urinary cancer mortality records from the Guam Cancer Registry for 1970 to 2009 to determine the source of municipal water supplied to the patients’ residence. The objective was to investigate a possible relationship between the sources of municipal water supplied to Guam villages and the incidence of urolithiasis and urinary cancer. We analyzed hospital discharge diagnoses of urolithiasis or renal calculi by calculating the incidence of first-mentioned discharge for urolithiasis or renal calculi and comparing rates across demographic or geographic categories while adjusting by age, sex, and ethnicity/race. We reviewed cancer registry records of urinary cancer deaths by patient residence. The annual incidence of hospitalization for urolithiasis was 5.22 per 10,000. Rates adjusted for sex or age exhibited almost no change. The rate of 9.83 per 10,000 among Chamorros was significantly higher (p < 0.05) than the rates among any other ethnic group or race. When villages were grouped by water source, rates of patients discharged with a first-listed diagnosis of urolithiasis, adjusted for ethnicity/race, were similar for villages using either well water (5.44 per 10,000) or mixed source water (5.39 per 10,000), and significantly greater than the rate for villages using exclusively reservoir water (1.35 per 10,000). No statistically significant differences were found between the water source or village of residence and urinary cancer mortality. Some Guam residents living in villages served completely or partly by deep well water high in calcium carbonate may be at increased risk for urolithiasis compared with residents living in villages served by surface waters. Although the risk appears to be highest in villagers of Chamorro ethnicity, residents should be aware of other contributing risk factors and steps to take to avoid developing this health problem. PMID:27231922

Evaluation of anti-urolithiatic activity of Pashanabhedadi Ghrita against experimentally induced renal calculi in rats

PubMed Central

Gupta, Sanjay Kumar; Baghel, Madhav Singh; Bhuyan, Chaturbhuja; Ravishankar, B.; Ashok, B. K.; Patil, Panchakshari D.

2012-01-01

Population in an industrialized world is afflicted by urinary stone disease. Kidney stones are common in all kinds of urolithiasis. One distinguished formulation mentioned by Sushruta for management of Ashmari (urolithiasis) is Pashanabhedadi Ghrita (PBG), which is in clinical practice since centuries. Validation of drug is the requirement of time through the experimental study. In this study, trial of PBG has been made against ammonium oxalate rich diet and gentamicin injection induced renal calculi in albino rats. The calculi were induced by gentamicin injection and ammonium oxalate rich diet. Test drug was administered concomitantly in the dose of 900 mg/kg for 15 consecutive days. Rats were sacrificed on the 16th day. Parameters like kidney weight, serum biochemical, kidney tissue and histopathology of kidney were studied. Concomitant treatment of PBG attenuates blood biochemical parameters non-significantly, where as it significantly attenuated lipid peroxidation and enhanced glutathione and glutathione peroxidase activities. It also decreased crystal deposition markedly into the renal tubules in number as well as size and prevented damage to the renal tubules. The findings showed that PBG is having significant anti-urolithiatic activities against ammonium oxalate rich diet plus gentamicine injection induced urolithiasis in rats. PMID:23723654

Evaluation of anti-urolithiatic activity of Pashanabhedadi Ghrita against experimentally induced renal calculi in rats.

PubMed

Gupta, Sanjay Kumar; Baghel, Madhav Singh; Bhuyan, Chaturbhuja; Ravishankar, B; Ashok, B K; Patil, Panchakshari D

2012-07-01

Population in an industrialized world is afflicted by urinary stone disease. Kidney stones are common in all kinds of urolithiasis. One distinguished formulation mentioned by Sushruta for management of Ashmari (urolithiasis) is Pashanabhedadi Ghrita (PBG), which is in clinical practice since centuries. Validation of drug is the requirement of time through the experimental study. In this study, trial of PBG has been made against ammonium oxalate rich diet and gentamicin injection induced renal calculi in albino rats. The calculi were induced by gentamicin injection and ammonium oxalate rich diet. Test drug was administered concomitantly in the dose of 900 mg/kg for 15 consecutive days. Rats were sacrificed on the 16(th) day. Parameters like kidney weight, serum biochemical, kidney tissue and histopathology of kidney were studied. Concomitant treatment of PBG attenuates blood biochemical parameters non-significantly, where as it significantly attenuated lipid peroxidation and enhanced glutathione and glutathione peroxidase activities. It also decreased crystal deposition markedly into the renal tubules in number as well as size and prevented damage to the renal tubules. The findings showed that PBG is having significant anti-urolithiatic activities against ammonium oxalate rich diet plus gentamicine injection induced urolithiasis in rats.

Rhazes, a genius physician in diagnosis and treatment of kidney calculi in medical history.

PubMed

Changizi Ashtiyani, Saeed; Cyrus, Ali

2010-04-01

Abu Bakr Mohammad Ibn Zakariya Razi, known in the west as Rhazes (865 to 925 AD), was born in the ancient city of Rayy, near Tehran, Iran. He was a renowned physician in medical history and not only followed Hippocrates and Galen, but also greatly extended the analytical approach of his predecessors. Based on the existing documents, he was known as the most distinguished character in the world of medicine up to the 17th century. A great number of innovations and pioneering works in the medical science have been recorded in the name of Rhazes. His fundamental works in urology as part of his research in the realm of medicine have remained unknown. Pathophysiology of the urinary tract, venereal diseases, and kidney and bladder calculi are among his main interests in this field. He also purposed and developed methods for diagnosis and treatment of kidney calculi for the first time in medical history. He also presented a very exact and precise description of neuropathic bladder followed by vertebral fracture. He advanced urine analysis and studied function and diseases of the kidneys. Rhazes recommendations for the prevention of calculi are quite scientific and practical and in accordance with current recommendations to avoid hypercalciuria and increased saturation of urine. Rhazes was not only one of the most important Persian physician-philosophers of his era, but for centuries, his writings became fundamental teaching texts in European medical schools. Some important aspects of his contributions to medicine are reviewed.

The use of a fully integrated electronic medical record to minimize cumulative lifetime radiation exposure from CT scanning to detect urinary tract calculi.

PubMed

Kohler, Steven W; Chen, Richard; Kagan, Alex; Helvey, Dustin W; Buccigrossi, David

2013-06-01

In order to determine the effects of implementation of an electronic medical record on rates of repeat computed tomography (CT) scanning in the emergency department (ED) setting, we analyzed the utilization of CT of the kidneys, ureters, and bladder (CT KUB) for the detection of urinary tract calculi for periods before and after the implementation of a hospital-wide electronic medical record system. Rates of repeat CT scanning within a 6-month period of previous scan were determined pre- and post-implementation and compared. Prior to implementation, there was a 6-month repeat rate of 6.2 % compared with the post-implementation period, which was associated with a 6-month repeat rate of 4.1 %. Statistical analysis using a two-sample, one-tailed t test for difference of means was associated with a p value of 0.00007. This indicates that the implementation of the electronic medical record system was associated with a 34 % decrease in 6-month repeat CT KUB scans. We conclude that the use of an electronic medical record can be associated with a decrease in utilization of unnecessary repeat CT imaging, leading to decreased cumulative lifetime risk for cancer in these patients and more efficient utilization of ED and radiologic resources.

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.

Clinical and metabolic evaluation of patients with history of renal calculi in Qazvin, Iran.

PubMed

Charkhchian, Maliheh; Samani, Simin; Merat, Ehsan

2015-12-01

Nephrolithiasis is a common clinical disorder with significant health and economic burden. We conducted this study to evaluate clinical and metabolic parameters in adult patients with history of renal calculi. A total of 213 patients with history of nephrolithiasis participated in this study. Evaluation included the measurement of serum calcium, uric acid, parathormone, renal function tests, urinalysis, and urinary tests for cystinuria. Also, parameters such as volume, creatinine, calcium, uric acid, citrate, and oxalate levels were measured on 24-h urine. All patients underwent urinary tract system sonography. Of total patients, 52% were males and 48% females. The mean age was 45.16 ± 13.16 years. Also, 51.2% of subjects had positive family history of nephrolithiasis. The mean body mass index was (26.8 ± 4.2) kg/m(2). The mean 24-h urine biochemical profiles were volume (1,748 ± 860 ml), Ca (183 ± 115), uric acid (544 ± 220), citrate (490 ± 351), and oxalate (17.1 ± 15.3) mg/day; urine calcium to creatinine ratio (0.15 ± 0.10) mg/mg, and urine calcium to weight ratio (2.4 ± 1.7) mg/kg. While there were weak positive correlations between the body mass index and urinary calcium (r = 0.101, P < 0.001) and uric acid (r = 0.200, P < 0.001), a weak negative correlation with urine pH (r = -0.104, P < 0.001) was found. Urine calcium, uric acid, and oxalate excretion were low in our patients while urine citrate was relatively high. Higher BMI maybe a risk factor for nephrolithiasis.

Unenhanced low-dose versus standard-dose CT localization in patients with upper urinary calculi for minimally invasive percutaneous nephrolithotomy (MPCNL)

PubMed Central

Licheng, Jiang; Yidong, Fan; Ping, Wang; Keqiang, Yan; Xueting, Wang; Yingchen, Zhang; Lei, Gao; Jiyang, Ding; Zhonghua, Xu

2014-01-01

Background & objectives: With the ethical concern about the dose of CT scan and wide use of CT in protocol of suspected renal colic, more attention has been paid to low dose CT. The aim of the present study was to make a comparison of unenhanced low-dose spiral CT localization with unenhanced standard-dose spiral CT in patients with upper urinary tract calculi for minimally invasive percutaneous nephrolithotomy (MPCNL) treatment. Methods: Twenty eight patients with ureter and renal calculus, preparing to take MPCNL, underwent both abdominal low-dose CT (25 mAs) and standard-dose CT (100 mAs). Low-dose CT and standard-dose CT were independently evaluated for the characterization of renal/ureteral calculi, perirenal adjacent organs, blood vessels, indirect signs of renal or ureteral calculus (renal enlargement, pyeloureteral dilatation), and the indices of localization (percutaneous puncture angulation and depth) used in the MPCNL procedure. Results: In all 28 patients, low-dose CT was 100 per cent coincidence 100 per cent sensitive and 100 per cent specific for depicting the location of the renal and ureteral calculus, renal enlargement, pyeloureteral dilatation, adjacent organs, and the presumptive puncture point and a 96.3 per cent coincidence 96 per cent sensitivity and 93 per cent specificity for blood vessel signs within the renal sinus, and with an obvious lower radiation exposure for patients when compared to standard-dose CT (P<0.05). The indices of puncture depth, puncture angulation, and maximum calculus transverse diameter on the axial surface showed no significant difference between the two doses of CT scans, with a significant variation in calculus visualization slice numbers (P<0.05). Interpretation & conclusions: Our findings show that unenhanced low-dose CT achieves a sensitivity and accuracy similar to that of standard-dose CT in assessing the localization of renal ureteral calculus and adjacent organs conditions and identifying the maximum calculus transverse diameter on the axial surface, percutaneous puncture depth, and angulation in patients, with a significant lower radiation exposure, who are to be treated by MPCNL, and can be used as an alternative localization method. PMID:24820832

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

A urethrorectal fistula due to prostatic abscess associated with urolithiasis in a dog.

PubMed

Agut, A; Lucas, X; Castro, A; De Membiela, F; Soler, M; Belda, E

2006-06-01

An 8-year-old, entire male crossbreed dog had a 2-day history of abdominal pain and straining to urinate and defecate. A diagnosis of urolithiasis with urinary retention, and probable prostatitis was made. The dog was treated with fluids and enrofloxacin. Five days later, ultrasonography of the prostate showed two hypoechoic areas compatible with abscesses. Twelve hours later, the patient started to urinate from the rectum during micturition and urethrorectal fistula was diagnosed. The omentalization of the prostatic abscesses and castration were performed and calculi were removed. The urethrorectal fistula was treated conservatively with an indwelling urinary catheter, a low residue diet and antibiotics. The dog recovered uneventfully without recurrence of the fistula.

National Practice Pattern and Time Trends in Treatment of Upper Urinary Tract Calculi in Korea: a Nationwide Population-Based Study.

PubMed

Park, Jinsung; Suh, Beomseok; Lee, Myung Shin; Woo, Seung Hyo; Shin, Dong Wook

2016-12-01

Despite high prevalence of upper urinary tract calculi (UUTC), there are few studies regarding patterns of care in Asian populations. We investigated treatment patterns and time trends in patients with newly diagnosed UUTC in Korea using the National Health Insurance database that includes de-identified claims from a random 2% sample of the entire population (> 1 million people). A total of 14,282 patients who received active treatments, including shock wave lithotripsy (SWL), ureteroscopic surgery (URS), percutaneous nephrolithotomy (PNL), and uretero/pyelolithotomy (UPL), for newly diagnosed UUTC between 2003 and 2013 were included. The number of primary and all treated cases of UUTC significantly (43% and 103.3%, respectively) increased over the 10-year period. While patients undergoing SWL, URS, PNL, and UPL as primary treatment increased by 43.7%, 31.9%, 87.5%, and 0%, respectively, the relative proportion undergoing each treatment remained constant over the 10 years (SWL > 90%, URS 4.5% to 7.8%, PNL 0.4% to 1.0%, and UPL < 0.4%, respectively). Multinomial logistic regression analysis showed that age > 40 years (compared to age < 30 years) was significantly associated with URS, PNL, and UPL, rather than SWL, while patients living in urban or suburban/rural areas (compared to metropolitan) were significantly less likely to undergo URS and PNL. In summary, the majority of Korean patients underwent SWL as primary treatment for UUTC, and the predominant use of SWL remained steady over a 10-year period in Korea. Our results will be valuable in examining treatment patterns and time trends in Korean UUTC patients.

Squamous cell carcinoma of the renal pelvis associated with kidney stones: a case report.

PubMed

Paonessa, J; Beck, H; Cook, S

2011-12-01

A 70-year-old female with a long-standing history of kidney calculi presented with vague abdominal pain. Work-up included a CT and MRI of the kidneys. A mass was demonstrated in the superior pole of the left kidney. The mass was biopsied percutaneously under CT guidance. Pathology revealed a poorly differentiated carcinoma, but was inconclusive for a definitive cell type. The patient subsequently underwent a nephrectomy that revealed squamous cell carcinoma of the renal collecting system. She had an uneventful postoperative recovery. Chronic renal calculi pose a risk for the development of squamous metaplasia that may lead to squamous cell carcinoma. Although this malignancy is rare in the upper urinary tracts, patients with long-standing nephrolithiasis should be monitored. This diagnosis should be included in one's differential when evaluating a renal mass that is associated with chronic inflammatory conditions.

Endoscopic placement of ureteral stents for treatment of congenital bilateral ureteral stenosis in a dog.

PubMed

Lam, Nathaniel K; Berent, Allyson C; Weisse, Chick W; Bryan, Christine; Mackin, Andrew J; Bagley, Demetrius H

2012-04-15

A 5-year-old 8.6-kg (18.9-lb) spayed female Pug was evaluated because of chronic hematuria and recurrent urinary tract infections. Excretory urography, ultrasonography, and excretory CT urography were performed. Results indicated that the dog had bilateral hydronephrosis and hydroureter and suspected proximal ureteral stenosis. Retrograde ureteropyelography confirmed the presence of stenosis at the ureteropelvic junction of each ureter, along with a large amount of endoluminal ureteral debris. Clinical findings suggested that the dog had a congenital bilateral anomaly of the upper urinary tract. The dog was anesthetized, and 2 double-pigtail ureteral stents were placed cystoscopically with fluoroscopic guidance for immediate relief of the ureteropelvic junction obstructions. Each stent extended from the left or right renal pelvis to the urinary bladder. The procedures and the patient's recovery from anesthesia were uncomplicated. Continuing improvements in severity of hydronephrosis, hydroureter, and dysuria were evident during routine follow-up examinations at 2, 4, 12, 16, and 45 weeks after stent placement. Over the subsequent 12 months, all clinical signs remained resolved other than a urinary tract infection that was successfully treated with antimicrobials. Ureteral stenosis should be considered as a differential diagnosis for hydronephrosis in dogs, particularly when urinary tract calculi or neoplasia is not present. Chronic hematuria and recurrent urinary tract infections can be associated with this condition. Placement of ureteral stents may be a successful treatment option for ameliorization of congenital ureteral obstructions.

The acutely affected abdomen in paraplegic spinal cord injury patients.

PubMed Central

Neumayer, L A; Bull, D A; Mohr, J D; Putnam, C W

1990-01-01

The records of 145 paraplegic or quadriplegic patients were reviewed to identify those factors useful in the correct diagnosis of the acute abdomen in this population. Twenty-one patients had 22 episodes of acute or subacute abdominal problems. Presenting complaints, physical findings, and laboratory results were useful in various ways. However appropriate radiographic studies led to the correct diagnosis in 77% of patients. Although paraplegic and quadriplegic patients are predisposed to a distinct constellation of medical problems, including urinary tract infection and calculi, they also may present with other abdominal conditions that cause significant morbidity and mortality if not promptly recognized. PMID:2241311

Validation of a Functional Pyelocalyceal Renal Model for the Evaluation of Renal Calculi Passage While Riding a Roller Coaster.

PubMed

Mitchell, Marc A; Wartinger, David D

2016-10-01

The identification and evaluation of activities capable of dislodging calyceal renal calculi require a patient surrogate or validated functional pyelocalyceal renal model. To evaluate roller coaster facilitation of calyceal renal calculi passage using a functional pyelocalyceal renal model. A previously described adult ureteroscopy and renoscopy simulator (Ideal Anatomic) was modified and remolded to function as a patient surrogate. Three renal calculi of different sizes from the patient who provided the original computed tomographic urograph on which the simulator was based were used. The renal calculi were suspended in urine in the model and taken for 20 rides on the Big Thunder Mountain Railroad roller coaster at Walt Disney World in Orlando, Florida. The roller coaster rides were analyzed using variables of renal calculi volume, calyceal location, model position on the roller coaster, and renal calculi passage. Sixty renal calculi rides were analyzed. Independent of renal calculi volume and calyceal location, front seating on the roller coaster resulted in a passage rate of 4 of 24. Independent of renal calculi volume and calyceal location, rear seating on the roller coaster resulted in a passage rate of 23 of 36. Independent of renal calculi volume in rear seating, calyceal location differed in passage rates, with an upper calyceal calculi passage rate of 100%; a middle calyceal passage rate of 55.6%; and a lower calyceal passage rate of 40.0%. The functional pyelocalyceal renal model serves as a functional patient surrogate to evaluate activities that facilitate calyceal renal calculi passage. The rear seating position on the roller coaster led to the most renal calculi passages.

Cystoman® and calculi: a good alternative to standard therapies in preventing stone recurrence.

PubMed

Proietti, S; Giannantoni, A; Luciani, L G; Sortino, G; Graziotti, P; Giusti, G

2014-08-01

To assess the efficacy and tolerability of D-mannose-containing product (Cystoman(®)) in preventing recurrence in patients who underwent surgical treatment for infection related urinary stones. From January 2011 to February 2013 we have enrolled all consecutive patients affected by staghorn calculi and recurrent urinary tract infections (UTIs). All patients recommended for surgery were scheduled for percutaneous nephrolithotomy. The study agent was administered daily for 5 months after surgical procedure. At baseline and 5-month follow-up all patients underwent abdominal Computed Tomography (CT) scan and they also completed Medical Outcomes Study short-form, 36-item questionnaire (SF-36). They performed urine and urine culture monthly. The primary endpoints were the assessment of the efficacy with regard to infection-related urinary stone recurrence and the tolerability of Cystoman(®). The secondary endpoint was the evaluation of quality-of-life symptoms. During the study period, a total of 27 patients were included in the study. The data from 25 patients were analyzable. Seventeen patients (68%) did not report UTIs during follow-up. Eight patients (32%) remained infected and the average number of UTIs was 2.6 ± 1.6 in 5 months. At 5-month follow-up 17 (68%) patients were free from stones recurrence; in 8 (32%) cases CT scan revealed stone recurrence with an average stone diameter of 1.1 ± 0.4 cm. In nonrecurring patients, 2 (11.7%) reported an average of 1.5 ± 0.7 UTIs episodes; in recurring patients, 6 (75%) showed 3 ± 1.67 of UTIs episodes. Statistically significant differences were seen in the occurrence of UTIs episodes were detected between nonrecurring stone patients and recurring patients (p < 0.05). Moreover, statistically significant changes were detected in SF-36 scores from baseline to month 5 in the categories of physical functioning and energy/fatigue (p < 0.05). Cystoman(®) is effective in preventing infection-related urinary stones.

The analysis of microbial spectrum and antibiotic resistance of uropathogens isolated from patients with urinary stones.

PubMed

Chen, Dong; Zhang, Yuyan; Huang, Jian; Liang, Xiongfa; Zeng, Tao; Lan, Chuangxin; Duan, Xiaolu; Zhao, Zhijian; Zeng, Guohua; Tiselius, Hans-Göran; Lu, Xiaogang; Wu, Wenqi

2018-06-01

The characteristics and resistance patterns of urine bacteriology in patients with urinary tract stones have not been extensively studied. This study aims to investigate the microbial spectrum and antibiotic resistance of uropathogens isolated from urinary tract infections in patients with urinary stones and provide a basis for appropriate antimicrobial treatments. The results of positive bladder midstream urine cultures and their antimicrobial susceptibility were retrospectively analysed from hospitalised patients with diagnosis of urinary calculi and urinary tract infections between January 2010 and December 2015. A total of 3892 samples were analysed during the study period: 2201 were female patients (56.6%) and 1691 were male patients (43.4%). The 4 most common uropathogens were Escherichia coli (48.7%), Klebsiella pneumoniae (10.4%), Enterococcus faecalis (8.7%) and Proteus mirabilis (5.2%). Both E. coli (60.8%) and Proteus mirabilis (7.5%) were higher in female patients than in male patients (32.8%; 2.3%; P < .05). ESBL-positive E. coli accounted for 59.5% of total number of E. coli, while ESBL-positive K. pneumoniae comprised 42.0% of total K. pneumoniae. The majority of uropathogens in patients with stones had high resistance to fluoroquinolones, ceftriaxone, ceftazidime, cefepime, penicillins, sulfonamides and monobactams (resistance >20%). The microbial spectrum in patients with urinary stones had a complex pattern. The uropathogens showed marked multidrug resistance and a large proportion of the uropathogens were able to produce β-lactamase. © 2018 John Wiley & Sons Ltd.

Surgical management of recurrent urinary tract infections: a review

PubMed Central

Bergamin, Paul A.

2017-01-01

There are many causes of recurrent urinary tract infections (rUTI) which are amenable to surgical management. This usually follows a lengthy trial of conservative management. Aetiological classification of rUTI requiring surgical management may be divided into congenital or acquired. Predisposing factors are classified into two groups; those providing a source for organisms, or by maintaining favourable conditions for the proliferation of organisms. Sources of infections include calculi, fistulae or abscesses. Conditions which predispose to bacterial proliferation include malignancies, foreign bodies, high post void residuals, and neuropathic bladders. Removal of identified sources, treating the obstruction, and improving urinary drainage, are all goals of surgical management. Surgical options for rUTI management can range from minimally invasive procedures such as endoscopic or percutaneous, through to more invasive requiring laparoscopic or an open approach. Surgery remains a very important and viable solution. PMID:28791234

Urinary lithiasis in civil construction workers as a management indicator for health and improvement in personnel.

PubMed

Ferraz, Renato Ribeiro Nogueira; Aquino, Simone

2014-12-01

Empirical information provided by health care professionals acting in the first line of care report a constant increase in the number of civil construction workers that present painful acute conditions, in most cases associated with the existence of urinary tract calculi. Evaluating the prevalence of urinary lithiasis in civil construction workers, as a means to identify indicators for the management of health and personnel. Observational study based on directed questionnaire. From the 94 participants, 18 (19%) were lithiasic, mostly due to overweight and reduced fluid intake. The observed prevalence appeared to be two times greater than that of the general population. Thus, prevention for such condition gains relevance, in order to avoid discomfort for the worker, and also reduce costs due to absenteeism, improving productivity, benefiting the workers by performance and creating the perspective of an improved quality of life.

Characterization of the Protein Components of Matrix Stones Sheds Light on S100-A8 and S100-A9 Relevance in the Inflammatory Pathogenesis of These Rare Renal Calculi.

PubMed

Martelli, Claudia; Marzano, Valeria; Iavarone, Federica; Huang, Liling; Vincenzoni, Federica; Desiderio, Claudia; Messana, Irene; Beltrami, Paolo; Zattoni, Filiberto; Ferraro, Pietro Manuel; Buchholz, Noor; Locci, Giorgia; Faa, Gavino; Castagnola, Massimo; Gambaro, Giovanni

2016-09-01

Among the different types of kidney stones, matrix stones are uncommon urinary calculi composed of a soft, pliable, amorphous substance with little crystalline content. To gain insight into the pathogenesis we investigated the protein component by analyzing the proteomic profiles of surgically removed matrix stones. A total of 5 stones were harvested from 4 patients who underwent surgery for medical reasons at 3 clinical centers during a 7-year period. Matrix stone proteome characterization was performed by mass spectrometry based techniques using an integrated top-down/bottom-up proteomic platform. We identified 142 nonredundant proteins and peptides across all samples. Neutrophil defensin 1, and proteins S100-A8 and S100-A9 were the main components of these renal calculi. The abundance of identified inflammatory molecules points to an inflammatory process as the event that initializes soft calculi formation rather than as a consequence of such formation. The post-translational oxidative changes in S100-A8 and A9, and the presence of thymosin β-4, granulins and ubiquitin also suggest the intervention of host defenses through a superimposed, vigorous counter inflammatory process. The post-translational changes seen in the proteins and peptides, and the known self-assembling capability of S100-A8 and S100-A9 probably explain the gelatinous consistency of these stones. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Use of medical expulsive therapy in children: An assessment of nationwide practice patterns and outcomes

PubMed Central

Ellison, Jonathan S.; Merguerian, Paul A.; Fu, Benjamin C.; Holt, Sarah K.; Lendvay, Thomas S.; Gore, John L.; Shnorhavorian, Margarett

2018-01-01

Summary Introduction Early data support the use of medical expulsive therapy (MET) in children. However, little is known regarding use or outcomes associated with MET outside of pediatric-specific practices. Using a national administrative dataset, we sought to characterize utilization patterns of MET as well as assess outcomes associated with MET exposure. Study design We interrogated the MarketScan Commercial Claims and Encounters database to identify children under the age of 18 presenting to the emergency department (ED) with any diagnosis of upper urinary tract calculi (UUTC, including renal and ureteral calculi). MET exposure was defined as having a prescription filled for a MET agent within 1 week of the ED encounter. Characteristics of children receiving MET were defined and outcomes compared between children with and without MET exposure. Results Of 1325 children included in the study, 13.2% received MET, including 15.4% of children with a diagnosis of “calculus of the ureter.” MET use increased significantly throughout the study period (p = 0.004), although only 30.4% of children considered potential MET candidates received MET in the final year of the study (2013). Among all patients, receipt of MET was associated with male gender, presence of comorbidity, provider-type (urologist), and year of diagnosis, although among those with a specific diagnosis of “calculus of the ureter,” only year of diagnosis remained a significant factor. Rates of unplanned physician visits and surgical interventions were similar between groups. Children receiving MET were more likely to receive follow-up imaging, although only 46% of children with ureteral calculi had appropriate follow-up imaging within 90 days, regardless of MET exposure. Odds ratios of factors and outcomes associated with MET exposure are shown in the Table. Discussion Although early data support safety and efficacy MET in children, nationwide use in children is low among potential candidates for MET. For children with ureteral calculi, only year of diagnosis was a significant factor associated with MET use. No difference in unplanned physician visits or surgical interventions was noted. Most notable, however, was the low rate of follow-up imaging within 90 days for children presenting acutely with UUTC. Conclusions Use of MET for children with ureteral calculi is increasing, although still fewer than a third of children considered potential candidates receive this treatment. Follow-up imaging is not obtained for many children with ureteral calculi. Future work is needed to standardize management and follow-up protocols for children with acute renal colic. PMID:28483465

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

Prediction of the energy required for extracorporeal shock wave lithotripsy of certain stones composition using simple radiology and computerized axial tomography.

PubMed

Argüelles-Salido, E; Campoy-Martínez, P; Aguilar-García, J; Podio-Lora, V; Medina-López, R

2014-03-01

To demonstrate that urinary lithiasis have a specific susceptibility to fracture through extracorporeal shock wave lithotripsy (ESWL), which is common for all calculi with the same composition and which can be estimated before treatment using CT or plain x-ray. We present an in vitro, prospective, randomized, blind and multi-centre study involving 308 urinary calculi. 193 of these met the inclusion criteria: whole calculi composed purely of calcium oxalate monohydrate (COM), uric acid (UA) or carbonate apatite (CA), or a mix of oxalate (COMix) and of a size greater than 0.5 cm. The samples were broken using lithotripsy until reaching a pre-established level of comminution. The variables employed were energy dose (Edose) per cm(3) of lithiasis and Edose adjusted to lithiasic surface (EdAJ) per cm(3). COM was the hardest, requiring an Edose of 119,624 mJ/cm(3) and an EdAJ of 36,983 mJ/cm(3), followed by COMix (75,501/36,983), CA (22,734/21,186) and UA (22,580/6,837) (P < .05). Gmax y Gmda were correlated with Edose (r = 0.434/r = 0.420) and EdAJ (r = 0.599/r = 0.545) (P < .01). UH were correlated, in bone window and soft tissue window, with Edose/cm(3) (r = 0.478/r = 0.539) y EdAJ/cm(3) (r = 0.745/r = 0.758) (P < .01). In our in vitro research lithiasis require, due to the specific nature of their composition, a given amount of energy in order to be broken by ESWL, which is inherent to all those sharing the same composition, and can be predicted using CT or plain x-ray. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

Clinical evaluation of double-pigtail stent in patients with upper urinary tract diseases: report of 2685 cases.

PubMed

Hao, Ping; Li, Weibing; Song, Caiping; Yan, Junan; Song, Bo; Li, Longkun

2008-01-01

To review the indications, procedures, complications, and related treatments of double pigtail stent (DPS) placement as an adjunct for some types of endoscopic and open urologic surgery. From July 1998 to December 2006, 2413 patients aged 8 to 81 years underwent stent placement (2685 total placements). The indications consisted of ureteroscopic lithotripsy (1984 cases), percutaneous nephrolithotomy (329 cases), ureteral incision to remove calculi (71 cases), extracorporeal shockwave lithotripsy for upper urinary tract calculi (145 cases), ureteropelvic junction obstruction (31 cases), ureterocystoneostomy (29 cases), benign ureteral stenosis (52 cases), extrinsic ureteral stenosis (16 cases), and iatrogenic ureteral trauma (28 cases). DPSs were inserted into the ureter by cystoscopy (115 stents), ureteroscopy (2052 stents), percutaneous nephrostomy (393 stents), or open surgery (125 stents), and were kept inside the body for 28 +/- 1.7 days (range 1-193 days). The mean follow-up period was 31 +/- 1.9 days (range 1-123 days). Three hundred sixty-five patients (19.6%) experienced one or more problems during the stenting procedure. The main complications were gross hematuria (385 cases), pain (101 cases), bladder irritation (105 cases), high fever (6 cases), encrustation (53 cases), stent migration (42 cases), and stenosis or restenosis (51 cases). Most of the complications were mild and tolerable, and all were immediately treated appropriately. However, 60 stents had to be removed: 29 for gross hematuria, 18 for pain, 7 for bladder irritation, and 6 for high fever. DPS is a safe and useful adjunct for both endoscopic and open procedures to treat upper urinary tract diseases. Most of the complications of DPS placement can be well managed.

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.

Cystic urolithiasis in captive waxy monkey frogs (Phyllomedusa sauvagii).

PubMed

Archibald, Kate E; Minter, Larry J; Dombrowski, Daniel S; O'Brien, Jodi L; Lewbart, Gregory A

2015-03-01

The waxy monkey frog (Phyllomedusa sauvagii) is an arboreal amphibian native to arid regions of South America, and it has developed behavioral and physiologic adaptations to permit survival in dry environments. These adaptations include a uricotelic nitrogen metabolism and unique cutaneous lipid excretions to prevent evaporative water loss. Uroliths are a rare finding in amphibians. Six adult, presumed wild-caught waxy monkey frogs housed in a museum animal collection were diagnosed with cystic urolithiasis over a 7-yr period, and a single animal was diagnosed with four recurrent cases. Six cases were identified incidentally at routine physical or postmortem examination and four cases were identified during veterinary evaluation for coelomic distension, lethargy, anorexia, and increased soaking behavior. Calculi were surgically removed from three frogs via cystotomy, and a single frog underwent three cystotomies and two cloacotomies for recurrent urolithiasis. Two frogs died within the 24-hr postoperative period. Two representative calculi from a single frog were submitted for component analysis and found to consist of 100% ammonium urate. In the present report, cystic calculi are proposed to be the result of a high-protein diet based on a single invertebrate source, coupled with uricotelism, dehydration, increased cutaneous water loss, body temperature fluctuations facilitating supersaturation of urine, and subsequent accumulation and precipitation of urogenous wastes within the urinary bladder. Surgical cystotomy represents a short-term treatment strategy for this condition. Preventative measures, such as supplying a diversified and balanced diet in addition to environmental manipulation aimed at promoting adequate hydration, are anticipated to be more-rewarding management tools for cystic urolithiasis in the waxy monkey frog.

Seasonal variation in the acute presentation of urinary calculi over 8 years in Auckland, New Zealand.

PubMed

Lo, Sum Sum; Johnston, Richard; Al Sameraaii, Ahmed; Metcalf, Patricia A; Rice, Michael L; Masters, Jonathan G

2010-07-01

Symptom prevalence (retrospective cohort) Level of Evidence 2b. To determine the incidence of acute presentation of urinary calculi (UC) in Auckland, New Zealand, during the period 1999-2007, and whether there was any significant seasonal variation. The details of all UC within the population presenting acutely to public hospitals in Auckland between 1999 and 2007 were collected using clinical coding searches International Classification of Disease 10th revision (Australian Modification) N132 and N20. Climatic variables for the Auckland region were obtained from the National Institute of Water and Atmospheric Research, New Zealand. The mean atmospheric temperature, hours of sunshine and humidity data were calculated monthly for this period. During the study there were 7668 acute presentations of UC in the Auckland region. A Poisson regression model showed that the number of presentations was significantly related to temperature (P < 0.001) and hours of sunshine (P = 0.004) but not humidity (P = 0.14). For each degree increase in temperature the number of presentations increased by 2.8% (95% confidence interval 1.3-4.3%). For each 1-h increase in sunshine, the number of presentations increased by 0.2% (0.06-0.33)%. The acute presentation of UC in Auckland, New Zealand, varies significantly with temperature and hours of sunshine. Humidity was not a significant factor.

[Physicochemical quality of drinking water in Southern Algeria: study of excess mineral salts].

PubMed

Djellouli, H M; Taleb, S; Harrache-Chettouh, D; Djaroud, S

2005-01-01

The aim of this study was to determine the physicochemical composition of water intended for human consumption in several regions of Southern Algeria. Excess minerals in drinking water, including magnesium, calcium, sulfates and fluorides play a fundamental role in the prevention of urinary calculi, which are formed mainly from calcium oxalate. The ever-increasingly prevalence of this disorder and its recurrence make it a real public health problem in Algeria. The most elementary preventive treatment, recommended to all subjects with lithiasis, is to drink 2 to 3 L water distributed throughout the (24-hour) day. This study began by conducting a physicochemical analysis of the principal components of water from several sources. We will subsequently test it to examine the effects of its mineral salts on the crystallization kinetics of the principal component of calculi (calcium oxalate). The results indicate that 77.5 % of the samples had magnesium concentrations ([Mg 2+] > 50 mg/L), 95 % were sulfated, with sulfate ion concentrations exceeding the standard recommended by WHO ([SO4 2-] > 250 mg/L). Moreover, 57.5 % had excess fluoride levels, [F-] > 1.5 mg/L, and 65 % excessive calcium concentrations, with Ca 2+ > 150 mg/L.

Ileal loop ureteroileostomy in patients with neurogenic bladder. Personal experience with 54 patients.

PubMed

Kambouris, A A; Allaben, R D; Carpenter, W S; Shumaker, E J

1976-02-01

(1) In a six year experience with ileal loops in patients with neurogenic bladder, 49% of the patients were paralyzed, 30% had multiple sclerosis, and 91% had recurrent or persistent urinary tract infection. Reflux, incontinence, retention, and bladder calculi were additional indications for supravesical urinary diversions. (2) All loops were performed in a similar manner, most of them placed retroperitoneally, and a vigorous program of postoperative care was followed. There were no postoperative deaths, and a moderate number of complications occurred in 51.8% of the patients. (3) The participation of the enterostomal therapist is the preparation of the patient and in the immediate and long-term stomal care has been invaluable and is strongly recommended.

[Comparative study of X-ray digital DTS imaging and kidney ureter bladder radiography in urinary calculi].

PubMed

Liu, Shifeng; Guo, Jian; Hu, Xiaokun; Zhang, Hao; Shang, Qingjun; Xu, Wenjian; Feng, Weihua

2015-07-07

To investigate the value of X-ray digital tomosynthesis (DTS) in the diagnosis of urinary stones compared with kidney ureter bladder radiography. Between February 2011 and February 2012, 80 consecutively enrolled patients with urinary stones proved by UMDCT, the total number of which was 138, underwent additional DTS and KUB (kidney, ureter and bladder) then the number of stones and the proportions (the sensitivity of detecting stones) were recorded under all kinds of circumstances. Any two cases were selected in comparison with each other among the following four cases (DTS and KUB before and after bowel preparation).The data from all cases were statistically processed by chi-square test of four-fold table. The diagnostic sensitivity of DTS before and after bowel preparation, KUB before and after preparation were 94.2%, 96.4%, 47.8% and 66.7%, respectively. No significant differences between DTS before bowel preparation and DTS after bowel preparation were found. Significant differences were observed in other five ways. DTS is hardly affected by intestinal gas, feces and bones compared with KUB. Use of DTS results in improved detection rate and definition of stones with the same positioning function as KUB.

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.

Association between prostate cancer and urinary calculi: a population-based study.

PubMed

Chung, Shiu-Dong; Liu, Shih-Ping; Lin, Herng-Ching

2013-01-01

Understanding the reasons underlying the emerging trend and the changing demographics of Asian prostate cancer (PC) has become an important field of study. This study set out to explore the possibility that urinary calculi (UC) and PC may share an association by conducting a case-control study on a population-based database in Taiwan. The cases of this study included 2,900 subjects ≥ 40 years-old who had received their first-time diagnosis of PC and 14,500 randomly selected controls without PC. Conditional logistic regressions were employed to explore the association between PC and having been previously diagnosed with UC. We found that prior UC was found among 608 (21.0%) cases and 2,037 (14.1%) controls (p<0.001). Conditional logistic regression analysis revealed that compared to controls, the odds ratio (OR) of prior UC for cases was 1.63 (95% CI = 1.47-1.80). Furthermore, we found that cases were more likely to have been previously diagnosed with kidney calculus (OR = 1.71; 95% CI = 1.42-2.05), bladder calculus (OR = 2.06; 95% CI = 1.32-3.23), unspecified calculus (OR = 1.66; 95% CI = 1.37-2.00), and ≥2 locations of UC (OR = 1.73; 1.47-2.02) than controls. However, there was no significant relationship between PC and prior ureter calculus. We also found that of the patients with UC, there was no significant difference between PC and treatment method. This investigation detected an association between PC and prior UC. These results highlight a potential target population for PC screening.

Drinking water composition and incidence of urinary calculus: introducing a new index.

PubMed

Basiri, Abbas; Shakhssalim, Nasser; Khoshdel, Ali Reza; Pakmanesh, Hamid; Radfar, Mohammad Hadi

2011-01-01

INTRODUCTION. We searched for a pathophysiologically based feature of major water electrolytes, which may define water quality better than the water hardness, respecting urinary calculus formation. MATERIALS AND METHODS. Utilizing a multistage stratified sampling, 2310 patients were diagnosed in the imaging centers of the provincial capitals in Iran between 2007 and 2008. These were composed of 1755 patients who were settled residents of 24 provincial capitals. Data on the regional drinking water composition, obtained from an accredited registry, and their relationships with the region's incidence of urinary calculi were evaluated by metaregression models. The stone risk index (defined as the ratio of calcium to magnesium-bicarbonate product in drinking water) was used to assess the risk of calculus formation. RESULTS. No correlation was found between the urinary calculus incidence and the amount of calcium, bicarbonate, or the total hardness of the drinking water. In contrast, water magnesium had a marginally significant nonlinear inverse relationship with the incidence of the disease in the capitals (R(2) = 26%, P = .05 for a power model). The stone risk index was associated nonlinearly with the calculus incidence (R(2) = 28.4%, P = .04). CONCLUSIONS. Urinary calculus incidence was inversely related with drinking water magnesium content. We introduced a new index constructed on the foundation of a pathophysiologically based formula; the stone risk index had a strong positive association with calculus incidence. This index can have therapeutic and preventive applications, yet to be confirmed by clinical trials.

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.

[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.

New chemolysis for urological calcium phosphate calculi – a study in vitro

PubMed Central

Xiang-bo, Zhang; Zhi-ping, Wang; Jian-min, Duan; Jian-zhong, Lu; Bao-liang, Ma

2005-01-01

Background Advances in techniques have left very few indications for open surgical extraction of urinary stones currently. These advances notwithstanding, the search continues for medical approaches to urinary stone management. In this study, we perform an in vitro study analyzing the efficiency and prospect of two new complex solutions in urological calcium phosphate calculi dissolution. Methods Eighteen stones composed mainly of calcium phosphates were taken from patients who underwent kidney stone surgery. These stones were large enough (weight range 0.514–0.928 g) to be fragmented and matched equally into six groups. Chemolysis of phosphate stones was done with six different solvents and was repeated 3 times with 6 stones for each solution. At 24, 48 and 72 h, reduction in weight, percentage weight change, and dissolution rate; the dissolution rates at pH 5.0, 7.0 and 8.5 for each solution, using different cations (Na+, K+ or Ca2+), according to different dilutions (1:1, 1:2, 1:3, 1:4) of S1 and S2 were simultaneously determined. Results Calcium phosphate calculi were poorly dissolved by Phys and Art, and they had a low dissolution rate in pH 8.5 EDTA. The most effective solutions were S1, S2 and R, with 72 h mean dissolution rates: 5.75 ± 0.44 mg/hr (S1), 5.2 ± 0.63 mg/hr (S2), 4.55 ± 0.46 mg/hr (R) ( ± s, p < 0.01 R, S1 and S2 vs Phys, Art and EDTA; p < 0.05, S1 vs R, LSD-test). The mean percentage weight loss at 72 h was: 52.1 ± 15.75 % (S1), 44.4 ± 7.37 % (S2) and 40.5 ± 3.67 % (R) ( ± s, p < 0.01 R, S1 and S2 vs Phys, Art and EDTA, LSD-test). Diluted twice, S1 and S2 had even better effectiveness than their initial solution. The additive of Na+, K+ or Ca2+ greatly reduced the dissolution rates of S1, S2. Conclusion Our data indicate that test solutions S1 and S2 are effective solvents in the chemolysis of calcium phosphate stones. At twice dilutions, these solutions are even more useful in the treatment of stone disease. PMID:15907215

Obstructing urethral calculus in a woman revealed to be the cause of chronic pelvic pain.

PubMed

Thomas, J S; Crew, J

2012-10-01

Urethral calculi are extremely rarely reported in Caucasian females and are usually associated with an anatomical abnormality such as a diverticulum or a stricture. Ureteric calculi can move to become lodged in the urethra, although this is rare in women because of their short urethral length. We present a case of a 55-year-old woman presenting with urinary retention secondary to an obstructing upper tract calculus that had moved into the urethra. Four years previously, the patient had been diagnosed with chronic pelvic pain following a primary posterior vaginal wall repair. Following treatment of the obstructing calculus, her symptoms of pelvic pain completely resolved. We report a very unusual case that highlights the importance of investigating chronic pelvic pain. This patient's symptom of vaginal pain, though highly localized, was caused by pathology elsewhere in the pelvis. Alternative diagnoses should be sought for such patients and investigation performed to detect any nonvisible hematuria.

Primary vaginal calculus in a middle-aged woman with mental and physical disabilities.

PubMed

Ikeda, Yuji; Oda, Katsutoshi; Matsuzawa, Naoki; Shimizu, Ken

2013-07-01

Vaginal calculi are rarely encountered and are often misdiagnosed as bladder calculi because of the difficulty in achieving an appropriate diagnosis. Most vaginal calculi result from the presence of a urethrovaginal fistula; those occurring in the absence of such fistulas are extremely rare. We present a case of a 42-year-old bedridden woman with mental and physical disabilities who had been misdiagnosed for a decade as having a bladder calculus. We removed the calculus nonsurgically and the analyzed the components. Results demonstrated the presence of a primary vaginal calculus. Vaginal calculi may occasionally occur in disabled women, but further investigation of the etiology of such calculi is required.

Urinary extracorporeal shock wave lithotripsy: equipment, techniques, and overview.

PubMed

Pfister, R C; Papanicolaou, N; Yoder, I C

1988-01-01

Second generation urinary lithotriptors are characterized by extensive technical alterations and significant equipment improvement in the functional, logistical, and medical aspects of shock wave lithotripsy (SWL). These newer devices feature a water bath-free environment, a reduced anesthesia requirement, improved imaging, functional uses in addition to lithotripsy, or combinations thereof. Shock wave generation by spark gap, electromagnetic, piezoelectric and microexplosive techniques are related to their peak energy, frequency, and total energy capabilities which impacts on both anesthesia needs and the length and number of treatment sessions required to pulverize calculi. A master table summarizes the types of SW energy, coupling, imaging systems, patient transport, functional features, cost, and treatment effectiveness of 12 worldwide lithotriptors in various stages of investigative and clinical trials as monitored by the Food and Drug Administration (FDA) of America.

Ureteric stents vs percutaneous nephrostomy for initial urinary drainage in children with obstructive anuria and acute renal failure due to ureteric calculi: a prospective, randomised study.

PubMed

ElSheemy, Mohammed S; Shouman, Ahmed M; Shoukry, Ahmed I; ElShenoufy, Ahmed; Aboulela, Waseem; Daw, Kareem; Hussein, Ahmed A; Morsi, Hany A; Badawy, Hesham

2015-03-01

To compare percutaneous nephrostomy (PCN) tube vs JJ ureteric stenting as the initial urinary drainage method in children with obstructive calcular anuria (OCA) and post-renal acute renal failure (ARF) due to bilateral ureteric calculi, to identify the selection criteria for the initial urinary drainage method that will improve urinary drainage, decrease complications and facilitate the subsequent definitive clearance of stones, as this comparison is lacking in the literature. A series of 90 children aged ≤12 years presenting with OCA and ARF due to bilateral ureteric calculi were included from March 2011 to September 2013 at Cairo University Pediatric Hospital in this randomised comparative study. Patients with grade 0-1 hydronephrosis, fever or pyonephrosis were excluded. No patient had any contraindication for either method of drainage. Stable patients (or patients stabilised by dialysis) were randomised (non-blinded, block randomisation, sealed envelope method) into PCN-tube or bilateral JJ-stent groups (45 patients for each group). Initial urinary drainage was performed under general anaesthesia and fluoroscopic guidance. We used 4.8-6 F JJ stents or 6-8 F PCN tubes. The primary outcomes were the safety and efficacy of both groups for the recovery of renal functions. Both groups were compared for operative and imaging times, complications, and the period required for a return to normal serum creatinine levels. The secondary outcomes included the number of subsequent interventions needed for clearance of stones. Additional analysis was done for factors affecting outcome within each group. All presented patients completed the study with intention-to-treat analysis. There was no significant difference between the PCN-tube and JJ-stent groups for the operative and imaging times, period for return to a normal creatinine level and failure of insertion. There were significantly more complications in the PCN-tube group. The stone size (>2 cm) was the only factor affecting the rates of mucosal complications, operative time and failure of insertion in the JJ-stent group. The degree of hydronephrosis significantly affected the operative time for PCN-tube insertion. Grade 2 hydronephrosis was associated with all cases of insertion failure in the PCN-tube group. The total number of subsequent interventions needed to clear stones was significantly higher in the PCN-tube group, especially in patients with bilateral stones destined for chemolytic dissolution (alkalinisation) or extracorporeal shockwave lithotripsy (ESWL). We recommend the use of JJ stents for initial urinary drainage for stones that will be subsequently treated with chemolytic dissolution or ESWL, as this will lower the total number of subsequent interventions needed to clear the stones. This is also true for stones destined for ureteroscopy (URS), as JJ-stent insertion will facilitate subsequent URS due to previous ureteric stenting. Mild hydronephrosis will prolong the operative time for PCN-tube insertion and may increase the incidence of insertion failure. We recommend the use of PCN tube if the stone size is >2 cm, as there was a greater risk of possible iatrogenic ureteric injury during stenting with these larger ureteric stones in addition to prolongation of operative time with an increased incidence of failure. © 2014 The Authors. BJU International © 2014 BJU International.

The chemical work of Alexander and Jane Marcet.

PubMed

Rosenfeld, L

2001-04-01

Alexander Marcet was an authority on urinary calculi and their analysis when few medical practitioners appreciated the usefulness of chemistry in the explanation and treatment of disease. In An Essay on The Chemical History and Medical Treatment of Calculous Disorders, he described the discovery of an xanthine stone. He drew line illustrations of simple chemical apparatus useful for bedside analysis. His microtechnique used drops of solution and pinhead pieces of calculi; reagents were acids and alkalies and the blowpipe in conjunction with a small alcohol lamp. He reported the earliest description of a disorder later named "alcaptonuria". Marcet's work and that of a few others, on the chemical composition of urine and calculi, laid the foundations of our present knowledge. Between 1807 and 1820, his lectures to the medical students at Guy's Hospital were illustrated by experiments. Jane Haldimand Marcet wrote the very popular CONVERSATIONS: on Chemistry (16 editions in Great Britain). Her book dominated elementary chemical instruction during the first half of the 19th century. She followed Lavoisier's scheme of classification and explained chemical reactions in terms of affinity, aggregation, gravitation, and repulsion. Her advocacy that experimentation accompany lecture was new. The availability of serious scientific education in the new women's academies set the stage for increasing women's involvement in science. She also published a series of CONVERSATIONS: The topics were Political Economy, Natural Philosophy, and Vegetable Physiology.

Calcium and vitamin D supplementation and risk of kidney stone formation in postmenopausal women.

PubMed

Haghighi, Anousheh; Samimagham, Hamidreza; Gohardehi, Golnar

2013-05-21

Calcium and vitamin D are essential structural components of the skeletal system, which prevent osteoporosis after menopause. However, there is a controversial debate on the association between the intake of calcium and vitamin D supplements and the increased risk of formation of kidney calculi in postmenopausal women. which yet have to be confirmed. This study aimed to compare the metabolic changes after supplementation of calcium and vitamin D and examine the risk of stone formation. Fifty-three postmenopausal women referred to rheumatology clinic who had no history of kidney calculi, bone diseases (apart from osteoporosis), metabolic, and rheumatic disorders and had not been receiving calcium, diuretics and calcitonin were investigated. Renal ultrasonography and blood tests were performed and the urine calcium levels were measured for a period of 24 hours for all patients. The examinations were repeated after a 1- year period of treatment with supplemental calcium (100 mg/d) and vitamin D (400 IU/d) and compared with the data before the treatment. After 1 year, asymptomatic lithiasis was confirmed in 1 of 53 patients (1.9%) using ultrasonographic examination. No significant differences were found between the 24-hour urine and blood calcium levels before and after the treatment. Our findings showed that oral intake of calcium and vitamin D after 1 year has no effect on the urinary calcium excretion rate and the formation of kidney calculi in postmenopausal women.

Role of ultrasonography in percutaneous renal access in patients with renal anatomic abnormalities.

PubMed

Penbegul, Necmettin; Hatipoglu, Namik Kemal; Bodakci, Mehmet Nuri; Atar, Murat; Bozkurt, Yasar; Sancaktutar, Ahmet Ali; Tepeler, Abdulkadir

2013-05-01

To present our experience regarding the feasibility, safety, and efficacy of ultrasound (US)-guided percutaneous nephrolithotomy in anatomically abnormal kidneys. We performed US-guided percutaneous nephrolithotomy in 15 patients with anatomically abnormal kidneys and renal calculi. Of the 15 patients, 5 had horseshoe kidneys, 5 had rotation anomalies, 2 had kyphoscoliosis, and 3 had scoliosis. The stone size, number of access tracts, operative time, hospitalization duration, rate of stone clearance, and complication rate were recorded. Percutaneous access was achieved with US guidance in the operating room by the urologist. Successful renal access was obtained by the surgeon using US guidance in all patients, and a single access was obtained in all cases. Of the 15 patients, 8 were females, and 7 were males; 8 patients had solitary stones, and 7 had multiple calculi. The renal calculi were on the right in 7 patients and on the left in 8. Three patients had previously undergone unsuccessful shock wave lithotripsy. Complete stone clearance was achieved in 13 patients. The mean operative time was 54.2 minutes. No patient required a blood transfusion because of bleeding. Urinary tract infections occurred in 2 patients, who were treated with antibiotics. A double-J catheter was not inserted in any patient; however, a ureteral catheter was used in 3 patients for 1 day. None of the patients had any major complications during the postoperative period. The stone-free rate was 87%, and 2 patients had clinically insignificant residual fragments. Our results have demonstrated that US-guided percutaneous nephrolithotomy can be performed feasibly, safely, and effectively in anatomically abnormal kidneys. Copyright © 2013 Elsevier Inc. All rights reserved.

Hereditary xanthinuria and urolithiasis in a domestic shorthair cat

PubMed Central

Furman, E.; Hooijberg, E.H.; Leidinger, E.; Zedinger, C.; Giger, U.; Leidinger, J.

2015-01-01

A 2-year-old domestic shorthair cat was presented with a history of hematuria, stranguria and intermittent urethral obstruction. Urine sediment showed hematuria, pyuria, and yellow-brown, amorphous and spherical crystals. Upon surgical correction of the obstructed urethra by perineal urethrostomy, many dark yellow to grey, irregular, gravel-like to millet grain-sized uroliths, consisting of 100% xanthine by crystallography were found. The urinary xanthine concentration was high. The cat subsequently developed bilateral nephroliths, recurrent urinary tract infection, and chronic kidney failure. Dietary management with a low-purine diet failed in part due to poor compliance, and the cat was euthanized at 6 years of age. Xanthinuria is rare inborn error of metabolism in cats and other species but should be considered as a differential diagnosis in cases of feline urolithiasis. No associated molecular genetic defect has been elucidated, and management of these cases is difficult. In the absence of calculi for analysis, measuring urinary xanthine concentration can help in diagnosing this metabolic defect. PMID:26478726

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

Advanced non-contrasted computed tomography post-processing by CT-Calculometry (CT-CM) outperforms established predictors for the outcome of shock wave lithotripsy.

PubMed

Langenauer, J; Betschart, P; Hechelhammer, L; Güsewell, S; Schmid, H P; Engeler, D S; Abt, D; Zumstein, V

2018-05-29

To evaluate the predictive value of advanced non-contrasted computed tomography (NCCT) post-processing using novel CT-calculometry (CT-CM) parameters compared to established predictors of success of shock wave lithotripsy (SWL) for urinary calculi. NCCT post-processing was retrospectively performed in 312 patients suffering from upper tract urinary calculi who were treated by SWL. Established predictors such as skin to stone distance, body mass index, stone diameter or mean stone attenuation values were assessed. Precise stone size and shape metrics, 3-D greyscale measurements and homogeneity parameters such as skewness and kurtosis, were analysed using CT-CM. Predictive values for SWL outcome were analysed using logistic regression and receiver operating characteristics (ROC) statistics. Overall success rate (stone disintegration and no re-intervention needed) of SWL was 59% (184 patients). CT-CM metrics mainly outperformed established predictors. According to ROC analyses, stone volume and surface area performed better than established stone diameter, mean 3D attenuation value was a stronger predictor than established mean attenuation value, and parameters skewness and kurtosis performed better than recently emerged variation coefficient of stone density. Moreover, prediction of SWL outcome with 80% probability to be correct would be possible in a clearly higher number of patients (up to fivefold) using CT-CM-derived parameters. Advanced NCCT post-processing by CT-CM provides novel parameters that seem to outperform established predictors of SWL response. Implementation of these parameters into clinical routine might reduce SWL failure rates.

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.

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

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.

Computer-aided detection of renal calculi from noncontrast CT images using TV-flow and MSER features

PubMed Central

Liu, Jianfei; Wang, Shijun; Turkbey, Evrim B.; Linguraru, Marius George; Yao, Jianhua; Summers, Ronald M.

2015-01-01

Purpose: Renal calculi are common extracolonic incidental findings on computed tomographic colonography (CTC). This work aims to develop a fully automated computer-aided diagnosis system to accurately detect renal calculi on CTC images. Methods: The authors developed a total variation (TV) flow method to reduce image noise within the kidneys while maintaining the characteristic appearance of renal calculi. Maximally stable extremal region (MSER) features were then calculated to robustly identify calculi candidates. Finally, the authors computed texture and shape features that were imported to support vector machines for calculus classification. The method was validated on a dataset of 192 patients and compared to a baseline approach that detects calculi by thresholding. The authors also compared their method with the detection approaches using anisotropic diffusion and nonsmoothing. Results: At a false positive rate of 8 per patient, the sensitivities of the new method and the baseline thresholding approach were 69% and 35% (p < 1e − 3) on all calculi from 1 to 433 mm3 in the testing dataset. The sensitivities of the detection methods using anisotropic diffusion and nonsmoothing were 36% and 0%, respectively. The sensitivity of the new method increased to 90% if only larger and more clinically relevant calculi were considered. Conclusions: Experimental results demonstrated that TV-flow and MSER features are efficient means to robustly and accurately detect renal calculi on low-dose, high noise CTC images. Thus, the proposed method can potentially improve diagnosis. PMID:25563255

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

Renal papillary calcification and the development of calcium oxalate monohydrate papillary renal calculi: a case series study

PubMed Central

2013-01-01

Background The objective of this study is to determine in a case series (four patients) how calcified deposits in renal papillae are associated with the development of calcium oxalate monohydrate (COM) papillary calculi. Methods From the recently collected papillary calculi, we evaluated retrospectively patients, subjected to retrograde ureteroscopy, with COM papillary lithiasis. Results The COM papillary calculi were found to result from subepithelial injury. Many of these lesions underwent calcification by hydroxyapatite (HAP), with calculus morphology and the amount of HAP in the concave zone dependent on the location of the calcified injury. Most of these HAP deposits grew, eroding the epithelium covering the renal papillae, coming into contact with urine and starting the development of COM calculi. Subepithelial HAP plaques may alter the epithelium covering the papillae, resulting in the deposit of COM crystals directly onto the epithelium. Tissue calcification depends on a pre-existing injury, the continuation of this process is due to modulators and/or crystallization inhibitors deficiency. Conclusions Since calculus morphology and the amount of detected HAP are dependent on the location and widespread of calcified injury, all types of papillary COM calculi can be found in the same patient. All patients had subepithelial calcifications, with fewer papillary calculi, demonstrating that some subepithelial calcifications did not further evolve and were reabsorbed. A high number of subepithelial calcifications increases the likelihood that some will be transformed into COM papillary calculi. PMID:23497010

Multimodality approach to renal and ureteric calculi.

PubMed

Ahlawat, R K; Tewari, A; Bhandari, M; Kumar, A; Kapoor, R

1991-01-01

Minimal or non-invasivemethods for treating renal or ureteric calculi have reduced the incidence of open surgery in the West to less than 1%. Before using these methods routinely in India we need to take into account the social and economic needs of our patients and the cost-effectiveness of the therapy. Over a period of 16 months we analysed the results of 596 renal units with renal and ureteric calculi managed by (a) extracorporeal shock wave lithotripsy, (b) percutaneous litholapaxy, (c) ureteroscopy, (d) open surgery and (e) various combinations of a, b, c and d. Out-patient lithotripsy achieved a satisfactory outcome in pelvic (69% complete clearance, 21% minor residue), middle calyceal (84% complete clearance, 5% minor residue) and non-impacted ureteric calculi (93% complete clearance) with limited stone bulk. Percutaneous procedures had a better and quicker outcome than lithotripsy when the stone bulk was greater than 400 mm 2 because it required a larger number of shock waves, repeated sittings and pre-lithotripsy stenting. Primary percutaneous debulking with adjunct lithotripsy for staghom calculi had a satisfactory outcome in 80% cases, while lithotripsy monotherapy usually failed. Percutaneous extraction resulted in a 95% success rate for large impacted upper ureteric calculi. Seventy-sixper cent of ureteric calculi below the pelvic brim were retrieved using ureteroscopy alone. Open surgery either primarily or after failure of other modalities was offered to 6.4% of the patients. It was the procedure of choice for large staghorn calculi with major stone bulk spread over various calyces, for multiple large pelvicalyceal calculi, and for calculi associated with congenital anomalies. In India lithotripsy should only be used when a quick and satisfactory outcome is expected, otherwise an appropriate minimally invasive method or surgical stone removal should be advised.

Urinary lithogenesis risk tests: comparison of a commercial kit and a laboratory prototype test.

PubMed

Grases, Félix; Costa-Bauzá, Antonia; Prieto, Rafel M; Arrabal, Miguel; De Haro, Tomás; Lancina, Juan A; Barbuzano, Carmen; Colom, Sergi; Riera, Joaquín; Perelló, Joan; Isern, Bernat; Sanchis, Pilar; Conte, Antonio; Barragan, Fernando; Gomila, Isabel

2011-11-01

Renal stone formation is a multifactorial process depending in part on urine composition. Other parameters relate to structural or pathological features of the kidney. To date, routine laboratory estimation of urolithiasis risk has been based on determination of urinary composition. This process requires collection of at least two 24 h urine samples, which is tedious for patients. The most important feature of urinary lithogenic risk is the balance between various urinary parameters, although unknown factors may be involved. The objective of this study was to compare data obtained using a commercial kit with those of a laboratory prototype, using a multicentre approach, to validate the utility of these methods in routine clinical practice. A simple new commercial test (NefroPlus®; Sarstedt AG & Co., Nümbrecht, Germany) evaluating the capacity of urine to crystallize calcium salts, and thus permitting detection of patients at risk for stone development, was compared with a prototype test previously described by this group. Urine of 64 volunteers produced during the night was used in these comparisons. The commercial test was also used to evaluate urine samples of 83 subjects in one of three hospitals. Both methods were essentially in complete agreement (98%) with respect to test results. The multicentre data were: sensitivity 94.7%; specificity 76.9%; positive predictive value (lithogenic urine) 90.0%; negative predictive value (non-lithogenic urine) 87.0%; test efficacy 89.2%. The new commercial NefroPlus test offers fast and cheap evaluation of the overall risk of development of urinary calcium-containing calculi.

Ureolytic Biomineralization Reduces Proteus mirabilis Biofilm Susceptibility to Ciprofloxacin

PubMed Central

Li, Xiaobao; Lu, Nanxi; Brady, Hannah R.

2016-01-01

Ureolytic biomineralization induced by urease-producing bacteria, particularly Proteus mirabilis, is responsible for the formation of urinary tract calculi and the encrustation of indwelling urinary catheters. Such microbial biofilms are challenging to eradicate and contribute to the persistence of catheter-associated urinary tract infections, but the mechanisms responsible for this recalcitrance remain obscure. In this study, we characterized the susceptibility of wild-type (ure+) and urease-negative (ure−) P. mirabilis biofilms to killing by ciprofloxacin. Ure+ biofilms produced fine biomineral precipitates that were homogeneously distributed within the biofilm biomass in artificial urine, while ure− biofilms did not produce biomineral deposits under identical growth conditions. Following exposure to ciprofloxacin, ure+ biofilms showed greater survival (less killing) than ure− biofilms, indicating that biomineralization protected biofilm-resident cells against the antimicrobial. To evaluate the mechanism responsible for this recalcitrance, we observed and quantified the transport of Cy5-conjugated ciprofloxacin into the biofilm by video confocal microscopy. These observations revealed that the reduced susceptibility of ure+ biofilms resulted from hindered delivery of ciprofloxacin into biomineralized regions of the biofilm. Further, biomineralization enhanced retention of viable cells on the surface following antimicrobial exposure. These findings together show that ureolytic biomineralization induced by P. mirabilis metabolism strongly regulates antimicrobial susceptibility by reducing internal solute transport and increasing biofilm stability. PMID:26953206

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.

Unenhanced low-dose versus standard-dose CT localization in patients with upper urinary calculi for minimally invasive percutaneous nephrolithotomy (MPCNL).

PubMed

Licheng, Jiang; Yidong, Fan; Ping, Wang; Keqiang, Yan; Xueting, Wang; Yingchen, Zhang; Lei, Gao; Jiyang, Ding; Zhonghua, Xu

2014-03-01

With the ethical concern about the dose of CT scan and wide use of CT in protocol of suspected renal colic, more attention has been paid to low dose CT. The aim of the present study was to make a comparison of unenhanced low-dose spiral CT localization with unenhanced standard-dose spiral CT in patients with upper urinary tract calculi for minimally invasive percutaneous nephrolithotomy (MPCNL) treatment. Twenty eight patients with ureter and renal calculus, preparing to take MPCNL, underwent both abdominal low-dose CT (25 mAs) and standard-dose CT (100 mAs). Low-dose CT and standard-dose CT were independently evaluated for the characterization of renal/ureteral calculi, perirenal adjacent organs, blood vessels, indirect signs of renal or ureteral calculus (renal enlargement, pyeloureteral dilatation), and the indices of localization (percutaneous puncture angulation and depth) used in the MPCNL procedure. In all 28 patients, low-dose CT was 100 per cent coincidence 100 per cent sensitive and 100 per cent specific for depicting the location of the renal and ureteral calculus, renal enlargement, pyeloureteral dilatation, adjacent organs, and the presumptive puncture point and a 96.3 per cent coincidence 96 per cent sensitivity and 93 per cent specificity for blood vessel signs within the renal sinus, and with an obvious lower radiation exposure for patients when compared to standard-dose CT (P<0.05). The indices of puncture depth, puncture angulation, and maximum calculus transverse diameter on the axial surface showed no significant difference between the two doses of CT scans, with a significant variation in calculus visualization slice numbers (P<0.05). Our findings show that unenhanced low-dose CT achieves a sensitivity and accuracy similar to that of standard-dose CT in assessing the localization of renal ureteral calculus and adjacent organs conditions and identifying the maximum calculus transverse diameter on the axial surface, percutaneous puncture depth, and angulation in patients, with a significant lower radiation exposure, who are to be treated by MPCNL, and can be used as an alternative localization method.

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

PubMed

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

2016-07-01

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

THE CORE OF THE PSEUDOSTEM OF MUSA IN THE TREATMENT OF URINARY STONES

PubMed Central

Pillai, R. Gopakumara

1995-01-01

Ayurveda recommends many simple herbs in the treatment of urological afflictions like urolithiasis. Seventyone patients diagnosed to be suffering from urolithiasis were treated with juice of the core of the pseudostem of Musa Paradisiaca and Musa sapientum. A significant segment of them passed out calculi of varying size after consuming the drug for two weeks. Recurrence of stone formation was also prevented by the treatment, The author concludes that the plant material is quite effective in curing urolithiasis, especially of the calcium oxalate variety. PMID:22556713

[Effects of percutaneous nephrolithotomy in the treatment of medullary sponge kidney with calculi].

PubMed

Hong, Y; Xu, Q Q; Huang, X B; Zhu, Z J; Ye, H Y; Zhang, F S; Yang, Q Y; An, L Z; Xu, T

2017-10-01

Objective: To evaluate the effects of percutaneous nephrolithotomy (PNL) in the treatment of medullary sponge kidney with calculi. Methods: A total of 77 patients (91 renal units) of medullary sponge kidney with calculi (MSK group) and 77 patients (77 renal units) with common kidney stone (control group) received PNL at Department of Urology in Peking University People's Hospital from September 2006 to February 2016 were analyzed retrospectively. The MSK group included 33 males and 44 females with a mean age of (42.1±13.2) years, the mean stone burden was (3.9±1.8) cm. The control group included 36 males and 41 females with a mean age of (45.3±13.0) years, the mean stone burden was (3.6±1.5) cm. The numbers of tracts, the time of operation, the drop of hemoglobin, the change of creatine, the time of hospitalization, the stone free rate and major complications were compared between the two groups. The measurement data and numeration data were compared with t test and χ(2) test. Results: There were no significant differences in sex, age, preoperative urinary tract infection, stone type, and stone burden between the two groups (all P >0.05). The proportion of bilateral renal calculus in MSK group was higher (18.2% vs . 0, χ(2)=15.400, P =0.000). There were 159 percutaneous channels were established in MSK group while 90 percutaneous channels were established in control group. Compared with the control group, the operation time ((88.1±37.5) minutes vs . (68.5±30.1) minutes, t =3.543, P =0.000) and hospitalization time ((15.1±8.3) days vs . (10.1±3.6) days, t =4.816, P =0.000) were longer, the creatinine level increased ((101.2±62.6) μmol/L vs . (71.3±23.6) μmol/L, t =3.777, P =0.000), the rate of stone free decreased (27.5% vs . 83.1%, χ(2)=51.840, P =0.000) and the rate of complications increased (29.9% vs . 11.7%, χ(2)=8.114, P =0.004) in MSK group. There was no statistically difference in hemoglobin drop ((12.5±13.2) g/L vs . (13.0±10.9) g/L, t =-0.260, P =0.795). Conclusions: Using PNL for patients of MSK with calculi has a lower stone free rate and a higher complications. It is an effective method for patients of MSK with large and complex calculi.

Treatment efficacy and outcomes using a third generation shockwave lithotripter.

PubMed

Neisius, Andreas; Wöllner, Jens; Thomas, Christian; Roos, Frederik C; Brenner, Walburgis; Hampel, Christian; Preminger, Glenn M; Thüroff, Joachim W; Gillitzer, Rolf

2013-11-01

To evaluate the clinical efficiency of a third generation electromagnetic shock wave lithotripter, the Lithoskop(®) (Siemens, Erlangen, Germany), regarding outcomes, stone disintegration, retreatment and complication rates. To compare the results of the Lithoskop with other currently available systems and the reference standard lithotripter, the HM-3 (Dornier MedTech Europe GmbH, Wessling, Germany). We analysed the data from 183 patients, including 13 children, undergoing extracorporeal shock wave lithotripsy (ESWL) for renal and ureteric calculi collected from a prospectively populated database. Outcomes were assessed by plain abdominal film of kidney, ureter and bladder and renal ultrasonography for radiopaque and computerized tomography for radiolucent stones 1 day after treatment and after 3 months. We analysed stone size and location before and after treatment, stone disintegration rate, retreatment rate, stone-free and residual fragment rates after 3 months, along with auxiliary procedures and complications. The mean (range) patient age was 48.6 (1.3-81.4) years, including 13 children with a mean (range) age of 8.4 (1.3-16.7) years, and 77% of the patients were male. In all, 46% of the calculi were localized in the kidney and 54% in the ureter. Renal stones were localized in the upper, middle and lower calyx and in the renal pelvis in 9, 29, 30 and 32% of patients, respectively. Ureteric stones were localized in the upper, mid- and distal ureter in 29, 19 and 52% of patients, respectively. The median (range) stone size before ESWL was 10 (4-25) mm in the kidney and 8 (4-28) mm in the ureteric calculi. The overall stone-free rate after 3 months was 91% (88% for renal and 93% for ureteric calculi); the mean number of sessions to achieve these rates was 1.3. Stone-free rates and the required number of sessions were determined only by stone size. In 7.1% of the patients (n = 13) post-interventional auxiliary procedures were necessary. We observed one perirenal haematoma as a major complication (0.5%), but this did not require any further therapy. Clinical stone-free rates with the Lithoskop are high and similar to those of other available systems, including the reference standard HM-3 lithotripter. Retreatment and complication rates are low, supporting the use of ESWL as first-line therapy for urinary calculi <10 mm, independent of stone location. © 2013 The Authors. BJU International © 2013 BJU International.

Renal papillary calcification and the development of calcium oxalate monohydrate papillary renal calculi: a case series study.

PubMed

Grases, Fèlix; Costa-Bauzá, Antonia; Prieto, Rafel M; Conte, Antonio; Servera, Antonio

2013-03-11

The objective of this study is to determine in a case series (four patients) how calcified deposits in renal papillae are associated with the development of calcium oxalate monohydrate (COM) papillary calculi. From the recently collected papillary calculi, we evaluated retrospectively patients, subjected to retrograde ureteroscopy, with COM papillary lithiasis. The COM papillary calculi were found to result from subepithelial injury. Many of these lesions underwent calcification by hydroxyapatite (HAP), with calculus morphology and the amount of HAP in the concave zone dependent on the location of the calcified injury. Most of these HAP deposits grew, eroding the epithelium covering the renal papillae, coming into contact with urine and starting the development of COM calculi. Subepithelial HAP plaques may alter the epithelium covering the papillae, resulting in the deposit of COM crystals directly onto the epithelium. Tissue calcification depends on a pre-existing injury, the continuation of this process is due to modulators and/or crystallization inhibitors deficiency. Since calculus morphology and the amount of detected HAP are dependent on the location and widespread of calcified injury, all types of papillary COM calculi can be found in the same patient. All patients had subepithelial calcifications, with fewer papillary calculi, demonstrating that some subepithelial calcifications did not further evolve and were reabsorbed. A high number of subepithelial calcifications increases the likelihood that some will be transformed into COM papillary calculi.

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

Liu, Jianfei; Wang, Shijun; Turkbey, Evrim B.

Purpose: Renal calculi are common extracolonic incidental findings on computed tomographic colonography (CTC). This work aims to develop a fully automated computer-aided diagnosis system to accurately detect renal calculi on CTC images. Methods: The authors developed a total variation (TV) flow method to reduce image noise within the kidneys while maintaining the characteristic appearance of renal calculi. Maximally stable extremal region (MSER) features were then calculated to robustly identify calculi candidates. Finally, the authors computed texture and shape features that were imported to support vector machines for calculus classification. The method was validated on a dataset of 192 patients andmore » compared to a baseline approach that detects calculi by thresholding. The authors also compared their method with the detection approaches using anisotropic diffusion and nonsmoothing. Results: At a false positive rate of 8 per patient, the sensitivities of the new method and the baseline thresholding approach were 69% and 35% (p < 1e − 3) on all calculi from 1 to 433 mm{sup 3} in the testing dataset. The sensitivities of the detection methods using anisotropic diffusion and nonsmoothing were 36% and 0%, respectively. The sensitivity of the new method increased to 90% if only larger and more clinically relevant calculi were considered. Conclusions: Experimental results demonstrated that TV-flow and MSER features are efficient means to robustly and accurately detect renal calculi on low-dose, high noise CTC images. Thus, the proposed method can potentially improve diagnosis.« less

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.

Ephedrine- and guaifenesin-induced nephrolithiasis.

PubMed

Bennett, Stephen; Hoffman, Nathan; Monga, Manoj

2004-12-01

Ephedrine and guaifenesin are herbal supplements that have experienced increased use over the past decade. Ephedrine has been used as a stimulant and weight-loss product, guaifenesin as an expectorant and cough suppressant; both are found in combination in many antitussives and expectorants. This paper reviews the reported cases of ephedrine- and guaifenesin-induced nephrolithiasis, as well as the diagnostic techniques and treatments that have been successfully used for these stones. A systematic review of the literature pertaining to nephrolithiasis and the compounds ephedrine and guaifenesin was conducted. Ephedrine and guaifenesin use results in over 35% of urinary stones that are related to pharmaceutical metabolites, and collectively are present in 0.1% of all urinary stones. These calculi are radiolucent, requiring the use of computerized tomography (CT scan) for diagnosis. Alkalinization therapy offers an alternative to surgical intervention and may have a role in prevention of recurrence. Ephedrine and guaifenesin have been shown to cause nephrolithiasis in cases of abuse when taken individually or in combination. It is important for the clinician to be aware of the potential for these compounds to cause nephrolithiasis.

[Giant prostatic calculus with neurogenic bladder disease and prostate diverticulum: a case report and review of the literature].

PubMed

Li, Xiao-Shi; Quan, Chang-Yi; Li, Gang; Cai, Qi-Liang; Hu, Bin; Wang, Jiu-Wei; Niu, Yuan-Jie

2013-02-01

To study the etiology, clinical manifestation, diagnosis and treatment of giant prostatic calculus with neurogenic bladder disease and prostate diverticulum. We retrospectively analyzed the clinical data of a case of giant prostatic calculus with neurogenic bladder disease and prostate diverticulum and reviewed the relevant literature. The patient was a 37-year-old man, with urinary incontinence for 22 years and intermittent dysuria with frequent micturition for 9 years, aggravated in the past 3 months. He had received surgery for spina bifida and giant vesico-prostatic calculus. The results of preoperative routine urinary examination were as follows: WBC 17 -20/HPF, RBC 12 - 15/HPF. KUB, IVU and pelvic CT revealed spina bifida occulta, neurogenic bladder and giant prostatic calculus. The patient underwent TURP and transurethral lithotripsy with holmium-YAG laser. The prostatic calculus was carbonate apatite in composition. Urinary dynamic images at 2 weeks after surgery exhibited significant improvement in the highest urine flow rate and residual urine volume. Seventeen months of postoperative follow-up showed dramatically improved urinary incontinence and thicker urine stream. Prostate diverticulum with prostatic giant calculus is very rare, and neurogenic bladder may play a role in its etiology. Cystoscopy is an accurate screening method for its diagnosis. For the young patients and those who wish to retain sexual function, TURP combined with holmium laser lithotripsy can be employed, and intraoperative rectal examination should be taken to ensure complete removal of calculi.

Phase composition and morphological characterization of human kidney stones using IR spectroscopy, scanning electron microscopy and X-ray Rietveld analysis.

PubMed

Chatterjee, Paramita; Chakraborty, Arup; Mukherjee, Alok K

2018-07-05

Pathological calcification in human urinary tract (kidney stones) is a common problem affecting an increasing number of people around the world. Analysis of such minerals or compounds is of fundamental importance for understanding their etiology and for the development of prophylactic measures. In the present study, structural characterization, phase quantification and morphological behaviour of thirty three (33) human kidney stones from eastern India have been carried out using IR spectroscopy (FT-IR), powder X-ray diffraction (PXRD) and scanning electron microscopy (SEM). Quantitative phase composition of kidney stones has been analyzed following the Rietveld method. Based on the quantitative estimates of constituent phases, the calculi samples have been classified into oxalate (OX), uric acid (UA), phosphate (PH) and mixed (MX) groups. Rietveld analysis of PXRD patterns showed that twelve (36%) of the renal calculi were composed exclusively of whewellite (calcium oxalate monohydrate, COM). The remaining twenty one (64%) stones were mixture of phases with oxalate as the major constituent in fourteen (67%) of these stones. The average crystallite size of whewellite in oxalate stones, as determined from the PXRD analysis, varies between 93 (1) nm and 202 (3) nm, whereas the corresponding sizes for the uric acid and struvite crystallites in UA and PH stones are 79 (1)-155 (4) nm and 69 (1)-123(1) nm, respectively. The size of hydroxyapatite crystallites, 10 (1)-21 (1) nm, is smaller by about one order of magnitude compared to other minerals in the kidney stones. A statistical analysis using fifty (50) kidney stones (33 calculi from the present study and 17 calculi reported earlier from our laboratory) revealed that the oxalate group (whewellite, weddellite or mixture of whewellite and weddellite as the major constituent) is the most prevalent (82%) kidney stone type in eastern India. Copyright © 2018 Elsevier B.V. All rights reserved.

Emphysematous pyelonephritis with calculus: Management strategies

PubMed Central

Goel, Tanmaya; Reddy, Sreedhar; Thomas, Joseph

2007-01-01

Objective: Emphysematous pyelonephritis (EPN) with calculus is well recognized but with very few reports on its treatment. Our aim is to elucidate our experience in its successful management. Materials and Methods: Over four years, we diagnosed seven cases (eight renal units) of EPN, out of which two patients (three renal units) had EPN with urinary calculi. After the initial conservative management of EPN, the stones were tackled appropriately. Results: EPN was initially managed effectively with antibiotics and supportive care. Once the patient was stable, the stones were cleared in a step-wise fashion. The associated postoperative complications were also tackled efficiently with preservation of renal function. Conclusion: In EPN with stones, nephrectomy is not the sole option available and they can be effectively managed with open / endoscopic measures. PMID:19718324

The increased risk of urinary stone disease in betel quid chewers.

PubMed

Allen, Siân E; Singh, Sadmeet; Robertson, William G

2006-08-01

The chewing of betel quid is a common practice in many countries of the world, particularly in Southeast Asia. The quid consists of a preparation of areca nut, betel leaf and calcium hydroxide "lime" paste ("chuna"). For the first time, we present a study that links its use to urinary stone disease. Eight patients (seven male and one female) who presented to our Stone Unit with recurrent urinary stones were included in the study. All were from the Indian subcontinent and were found to regularly chew betel. The patients underwent metabolic screening including blood, random urine and 24-h urine tests, quantitative chemical analysis of their calculi (where possible) and each completed a 7-day Diet Diary on his/her free, home diet. The study demonstrated a high incidence of hypercalciuria, a tendency to pass an alkaline urine and low urinary citrate excretion among the patients. Together these urinary risk factors increase the probability of developing both calcium phosphate-containing and calcium oxalate-containing stones. In support of this hypothesis, the patients were found to form stones consisting mainly of calcium phosphate but mixed with calcium oxalate. It is concluded that the use of calcium hydroxide "chuna" in the betel quid is the major contributor to the cause of urinary stones in its users. Moreover, the development of urinary lithiasis in such patients may be a precursor to milk-alkali syndrome in those individuals whose chewing habit is more extensive than in the patients in this study and who do not seek to decrease their habit over the long term.

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.

Computer-aided detection of renal calculi from noncontrast CT images using TV-flow and MSER features.

PubMed

Liu, Jianfei; Wang, Shijun; Turkbey, Evrim B; Linguraru, Marius George; Yao, Jianhua; Summers, Ronald M

2015-01-01

Renal calculi are common extracolonic incidental findings on computed tomographic colonography (CTC). This work aims to develop a fully automated computer-aided diagnosis system to accurately detect renal calculi on CTC images. The authors developed a total variation (TV) flow method to reduce image noise within the kidneys while maintaining the characteristic appearance of renal calculi. Maximally stable extremal region (MSER) features were then calculated to robustly identify calculi candidates. Finally, the authors computed texture and shape features that were imported to support vector machines for calculus classification. The method was validated on a dataset of 192 patients and compared to a baseline approach that detects calculi by thresholding. The authors also compared their method with the detection approaches using anisotropic diffusion and nonsmoothing. At a false positive rate of 8 per patient, the sensitivities of the new method and the baseline thresholding approach were 69% and 35% (p < 1e - 3) on all calculi from 1 to 433 mm(3) in the testing dataset. The sensitivities of the detection methods using anisotropic diffusion and nonsmoothing were 36% and 0%, respectively. The sensitivity of the new method increased to 90% if only larger and more clinically relevant calculi were considered. Experimental results demonstrated that TV-flow and MSER features are efficient means to robustly and accurately detect renal calculi on low-dose, high noise CTC images. Thus, the proposed method can potentially improve diagnosis.

Genitourinary issues during spaceflight: a review.

PubMed

Jones, J A; Jennings, R; Pietryzk, R; Ciftcioglu, N; Stepaniak, P

2005-12-01

The genitourinary (GU) system is not uncommonly affected during previous spaceflights. GU issues that have been observed during spaceflight include urinary calculi, infections, retention, waste management, and reproductive. In-flight countermeasures for each of these issues are being developed to reduce the likelihood of adverse sequelae, due to GU issues during exploration-class spaceflight, to begin in 2018 with flights back to the Moon and on to Mars, according to the February 2004 Presendent's Vision for US Space Exploration. With implementation of a robust countermeasures program, GU issues should not have a significant threat for mission impact during future spaceflights.

Cystinuria in the maned wolf of South America.

PubMed

Bovée, K C; Bush, M; Dietz, J; Jezyk, P; Segal, S

1981-05-22

Of 42 maned wolves in zoos or live-trapped in Brazil, 34 had excessive cystine in their urine. Renal clearance studies of five of the affected wolves revealed a variable defect for the reabsorption of cystine and dibasic amino acids. The renal tubular handling of other solutes including glucose, phosphate, sodium, potassium, and uric acid was considered normal. Urinary calculi composed of cystine were found in four wolves and proved fatal in three of them. With the exception of the high incidence in this species, this hereditary disease resembles the disorder described in dogs and humans.

Rare complication of needleless mini-sling procedure: Case report.

PubMed

Karalar, Mustafa; Keles, Ibrahim; Unlu, Serdar; Sarici, Hasmet; Kose, Mesut; Ay, Cemil

2017-01-01

The mini-sling procedure is a widely used, minimally invasive treatment for stress urinary incontinence. While bladder perforation and stone formation over the mesh is not an expected complication of the mini-sling procedure, in this case, we report on the management of bladder calculi formed over the mesh, which was passed through the bladder while applying the mini-sling procedure, and was eventually removed using holmium laser. Performing cystoscopy in patients with irritative and obstructive symptoms after the sling procedure will help confirm bladder perforation, and an endoscopic approach using holmium laser is an effective treatment.

Insights of the dental calculi microbiome of pre-Columbian inhabitants from Puerto Rico

PubMed Central

Narganes-Storde, Yvonne; Toranzos, Gary A.; Cano, Raul J.

2017-01-01

Background The study of ancient microorganisms in mineralized dental plaque or calculi is providing insights into microbial evolution, as well as lifestyles and disease states of extinct cultures; yet, little is still known about the oral microbial community structure and function of pre-Columbian Caribbean cultures. In the present study, we investigated the dental calculi microbiome and predicted function of one of these cultures, known as the Saladoid. The Saladoids were horticulturalists that emphasized root-crop production. Fruits, as well as small marine and terrestrial animals were also part of the Saladoid diet. Methods Dental calculi samples were recovered from the archaeological site of Sorcé, in the municipal island of Vieques, Puerto Rico, characterized using 16S rRNA gene high-throughput sequencing, and compared to the microbiome of previously characterized coprolites of the same culture, as well modern plaque, saliva and stool microbiomes available from the Human Microbiome Project. Results Actinobacteria, Proteobacteria and Firmicutes comprised the majority of the Saladoid dental calculi microbiome. The Saladoid dental calculi microbiome was distinct when compared to those of modern saliva and dental plaque, but showed the presence of common inhabitants of modern oral cavities including Streptococcus sp., Veillonella dispar and Rothia mucilaginosa. Cell motility, signal transduction and biosynthesis of other secondary metabolites may be unique features of the Saladoid microbiome. Discussion Results suggest that the Saladoid dental calculi microbiome structure and function may possibly reflect a horticulturalist lifestyle and distinct dietary habits. Results also open the opportunity to further elucidate oral disease states in extinct Caribbean cultures and extinct indigenous cultures with similar lifestyles. PMID:28480145

Effect of Dietary Countermeasures and Impact of Gravity on Renal Calculi Size Distributions Predicted by PBE-System and PBE-CFD Models

NASA Technical Reports Server (NTRS)

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

2016-01-01

Renal stone disease is not only a concern on earth but can conceivably pose a serious risk to the astronauts health and safety in Space. In this work, two different deterministic models based on a Population Balance Equation (PBE) analysis of renal stone formation are developed to assess the risks of critical renal stone incidence for astronauts during space travel. In the first model, the nephron is treated as a continuous mixed suspension mixed product removal crystallizer and the PBE for the nucleating, growing and agglomerating renal calculi is coupled to speciation calculations performed by JESS. Predictions of stone size distributions in the kidney using this model indicate that the astronaut in microgravity is at noticeably greater but still subcritical risk and recommend administration of citrate and augmented hydration as effective means of minimizing and containing this risk. In the second model, the PBE analysis is coupled to a Computational Fluid Dynamics (CFD) model for flow of urine and transport of Calcium and Oxalate in the nephron to predict the impact of gravity on the stone size distributions. Results presented for realistic 3D tubule and collecting duct geometries, clearly indicate that agglomeration is the primary mode of size enhancement in both 1g and microgravity. 3D numerical simulations seem to further indicate that there will be an increased number of smaller stones developed in microgravity that will likely pass through the nephron in the absence of wall adhesion. However, upon reentry to a 1g (Earth) or 38g (Mars) partial gravitational fields, the renal calculi can lag behind the urinary flow in tubules that are adversely oriented with respect to the gravitational field and grow agglomerate to large sizes that are sedimented near the wall with increased propensity for wall adhesion, plaque formation, and risk to the astronauts.

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.

[Asymptomatic Renal Stones: Do they really Exist?].

PubMed

Seseke, S; Rudolph, R; Rebmann, U

2011-11-01

Asymptomatic renal calculi without any history of colic, hematuria or infection can be found as an incidental finding during preven-tive check-ups. The aim of our study was to eval-uate whether these stones provoke symptoms with the need for further treatment during the follow-up and whether they cause cortical defects which may consecutively affect the renal func-tion. In a prospective study we evaluated 104  patients with renal calculi. The -medical history, radiological findings and functional imaging as well as urine and blood analyses were recorded and evaluated. The influence of stone size and localisation on the development of acute stone-related symptoms, renal function and renal scarring were evaluated. Furthermore, we analysed whether localised pathological findings in radiographic or functional imaging may influence the creatinine level. The follow-up was be-tween 12 and 48  months (median: 25  months). During the study period 27 / 104 of our patients (26 %) developed symptomatic events (renal colic, hematuria, infection) in which patients with middle pole calculi with a mean -cumulative stone diameter of 9.8  mm had the -highest risk. A localised renal scarring could be found in 36.6 %. These patients had a significantly higher risk in presenting an increased creatinine level. Increasing stone size was diagnosed in 39  cases (37.5 %). Asymptomatic renal stones have to be controlled regularly in order to prevent the -patient from loss of renal function and hypertension caused by increasing stones or urinary tract infection. © Georg Thieme Verlag KG Stuttgart ˙ New York.

[Effects of modified three-step procedure for anatrophic nephrolithotomy in the treatment of complex staghorn renal calculi].

PubMed

Yang, C L; Wang, W; Zhou, W E; Xue, Y P; Wang, B Q; Nie, H B; Hu, W L

2017-10-01

Objective: To investigate the effects of modified three-step procedure for anatrophic nephrolithotomy in the treatment of complex staghorn renal calculi. Methods: A total of 22 patients with complex staghorn renal calculi between June 2013 and June 2016 at Department of Urology in Guangzhou General Hospital of Guangzhou Military Command were retrospective analyzed. There were 13 males and 9 females, ranging from 35 to 62 years old with mean age of 47 years. There were 17 patients with dull pain, and 5 patients who were found through physical examinations. Kidney calculi located in left kidney in 15 patients, right kidney in 7 patients. All patients were treated with modified three-step procedure for anatrophic nephrolithotomy. The operation time, blood loss, time of intraoperative renal ischemia, and postoperative complications were recorded. Serum creatinine (Scr), blood urea nitrogen(BUN), β(2)-microglobulin(β(2)-MG), diseased side glomerular filtration rate(GFR) , and renal cortical thickness of the diseased kidney in preoperative and postoperative were compared. The clinical data were compared by paired sample t test between pre-operation and post-operation. Results: The calculi were completely removed in 22 patients, the mean operation time was 84 minutes (50 to 126 minutes), the mean time of intraoperative renal ischemia was 31 minutes (20 to 56 minutes), the mean blood loss was 246 ml (150 to 360 ml). There were no secondary bleeding or urinary fistula happened, the perinephric drainage tub was removed in 3 to 7 days postoperative, the mean hospitalization time was 7 days.Compared with the preoperative, the Scr ((172.7±21.3)μmol/L vs . (146.4±22.8)μmol/L, t =7.197, P =0.000), BUN ((9.2±1.8)mmol/L vs . (8.0±0.5)mmol/L, t =3.798, P =0.001) and β(2)-MG ((203.0±32.0)μg/L vs . (175.6±23.8)μg/L, t =5.009, P =0.000) in postoperative decreased, the diseased side GFR increased ((28.6±4.0) ml/min(31.8±3.3) ml/min, t =-3.521, P =0.002). There were no significant difference of diseased renal cortical thickness between preoperative and postoperative( t =-1.323, P =0.200). There were 12 patients with postoperative pain, 2 patients with vomiting, 3 patients with fever, and 2 patients with wound infection. The follow-up time was 6 months, no residual stones in 22 patients. Conclusion: The modified three-step procedure for anatrophic nephrolithotomy has high stone free rates with less effects on renal function and fewer complications, the method could be widely applied.

Use of ureteral stent in extracorporeal shock wave lithotripsy for upper urinary calculi: a systematic review and meta-analysis.

PubMed

Shen, Pengfei; Jiang, Min; Yang, Jie; Li, Xiong; Li, Yutao; Wei, Wuran; Dai, Yi; Zeng, Hao; Wang, Jia

2011-10-01

This systematic review was performed to assess the necessity and complications of stenting before extracorporeal shock wave lithotripsy in the management of upper urinary stones. A systematic research of PubMed®, EMBASE® and the Cochrane Library was performed to identify all randomized controlled trials. The comparisons were about the outcomes and complications of extracorporeal shock wave lithotripsy in the management of upper urinary stones with or without Double-J stenting before extracorporeal shock wave lithotripsy, including stone-free rate, Steinstrasse, lower urinary tract symptoms, hematuria, fever, urinary tract infection, pain and analgesia, auxiliary treatment, and nausea and vomiting. We used the Cochrane Collaboration's Review Manager (RevMan) 5.0.2 software for statistical analysis. Eight randomized controlled trials were included in analysis that reported 876 patients in total, divided into the stented group of 453 and the stentless group of 423. All studies recorded the stone-free rate and the results of the meta-analysis showed no difference between the groups (RR 0.97, 95% CI 0.91-1.03, p = 0.27). The total incidence of Steinstrasse in the stented group was similar to that of the stentless group with the exception of 1 study. However, the incidence of lower urinary tract symptoms was significantly higher in the stented group than in the stentless group (RR 4.10, 95% CI 2.21-7.61, p <0.00001). Significant differences could not be found in hematuria, fever, urinary tract infection, pain and analgesia, auxiliary treatment, or nausea and vomiting between the groups. The systematic review suggested significant advantages of stenting before extracorporeal shock wave lithotripsy compared to in situ extracorporeal shock wave lithotripsy in terms of Steinstrasse. However, stenting did not benefit stone-free rate and auxiliary treatment after extracorporeal shock wave lithotripsy, and it induced more lower urinary tract symptoms. More high quality, randomized controlled trials are needed to address this issue. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Urine and serum fetuin-A levels in patients with urolithiasis.

PubMed

Arora, Rajat; Abrol, Nitin; Antonisamy, B; Vanitha, S; Chandrasingh, J; Kumar, Santosh; Kekre, Nitin; Devasia, Antony

2017-01-01

Fetuin-A is a glycoprotein secreted by liver and has been shown to inhibit extraosseous mineralization. Urolithiasis may be a manifestation in the urinary tract due to fetuin deficiency in urine. The objective of this study was to compare the 24-h urine and serum fetuin-A levels of patients with and without urolithiasis. Serum and 24-h urine fetuin-A levels were measured in 41 patients with bilateral, multiple, or recurrent urinary tract calculi (Group A) and 41 matched controls with no calculi (Group B). Fetuin levels were measured by enzyme linked immunosorbent assay. Serum and urine fetuin-A levels in the two groups were compared. The median (range) 24-h urine fetuin-A value in Group A was 11.9 (1.12-221) mg/day and in Group B was 37.7 (1.28-125) mg/day. This difference was statistically significant (Mann-Whitney test, P = 0.0169). The median (range) serum fetuin-A in Group A was 0.67 (0.05-2.68) g/L and in Group B was 0.99 (0.01-5.5) g/L. The difference between serum values in the two arms was not statistically significant (Mann-Whitney test, P = 0.1817). However, the serum creatinine-adjusted mean log serum fetuin and urine fetuin were significantly different in the two arms ( P = 0.003). The mean ± standard deviation (range) serum creatinine in Group A was 0.98 ± 0.25 (0.56-1.58) mg% and in Group B was 0.83 ± 0.16 (0.58-1.18) mg% (two sample t -test, P = 0.0031). Patients with urolithiasis have lower urine fetuin-A and creatinine-adjusted serum fetuin-A levels.

Geoenvironmental factors related to high incidence of human urinary calculi (kidney stones) in Central Highlands of Sri Lanka.

PubMed

Abeywickarama, Buddhika; Ralapanawa, Udaya; Chandrajith, Rohana

2016-10-01

An area with extremely high incidence of urinary calculi was investigated in the view of identifying the relationship between the disease prevalence and the drinking water geochemistry. The prevalence of the kidney stone disease in the selected Padiyapelella-Hanguranketa area in Central Highlands of Sri Lanka is significantly higher compared with neighboring regions. Drinking water samples were collected from water sources that used by clinically identified kidney stone patients and healthy people. A total of 83 samples were collected and analyzed for major anions and cations. The anions in the area varied in the order HCO3 (-) > Cl(-) > SO4 (2-) > NO3 (-) and cations varied in the order Ca(2+) > Mg(2+) > Na(+) > K(+) > Fe(2+). The dissolved silica that occurs as silicic acid (H4SiO4) in natural waters varied from 8.8 to 84 mg/L in prevalence samples, while it was between 9.7 and 65 mg/L for samples from non-prevalence locations. Hydrogeochemical data obtained from the two groups were compared using the Wilcoxon rank-sum test. It showed that pH, total hardness, Na(+), Ca(2+) and Fe(2+) had significant difference (p < 0.005) between water sources used by patients and non-patients. Elemental ratio plots, Gibbs' plot and factor analysis indicated that the chemical composition of water sources in this area is strongly influenced by rock-water interactions, particularly the weathering of carbonate and silicate minerals. This study reveals a kind of association between stone formation and drinking water geochemistry as evident by the high hardness/calcium contents in spring water used by patients.

Safety and efficacy of transurethral pneumatic lithotripsy for bladder calculi in children.

PubMed

Khosa, Ali Sher; Hussain, Muhammad; Hussain, Manzoor

2012-12-01

To determine the safety and efficacy of transurethral pneumatic lithotripsy for bladder calculi in children. The study included 100 children up to 15 years of age undergoing pneumatic cystolithoclast for bladder stones. The descriptive study was conducted from September 2006 to February 2007 at the Sindh Institute of Urology and Transplantation, Karachi. The inclusion criteria was children up to 15 years of age with a bladder stone of up to 3cm, pre-operative negative urine culture, no coagulopathy and fit for general anaesthesia. An X-ray and ultrasound of Kidney and Urinary Bladder (KUB) was mandatory. The procedure was done under general anaesthesia with a single dose of pre-operative antibiotic. A mini-scope of 4FR or a semi-rigid ureteroscope of 7/8.5 FR with pneumatic wolf lithoclast was used for the fragmentation of stones. Duration of procedure, any per-operative and post-operative complications and the duration of hospital stay were recorded. Post-operatively, the patient underwent ultrasound Kidney and Urinary Bladder at the first follow-up to assess stone clearance after one week. Mean patients age was 4.95 +/- 3.3 years. The male-to-female ratio was 11.5: 1 The mean hospital stay was 9.2 +/- 2.5 hours. The mean operating time was 25 (10 -65) minutes. Ten (10%) patients developed minor complications out of which 5 (5%) developed haematuria and 4 (4%) developed difficulty in passing urine. One (1%) of the patients developed post-operative retention of urine. All the patients were stone-free after the procedure. The transurethral pneumatic lithoclast is very effective and safe in children with bladder stones up to 3cm.

Can renal and bladder ultrasound replace CT urogram in patients investigated for microscopic hematuria?

PubMed

Tan, Wei Shen; Sarpong, Rachael; Khetrapal, Pramit; Rodney, Simon; Mostafid, Hugh; Cresswell, Joanne; Hicks, James; Rane, Abhay; Henderson, Alastair; Watson, Dawn; Cherian, Jacob; Williams, Norman; Brew-Graves, Chris; Feber, Andrew; Kelly, John D

2018-04-24

Computed tomography urogram (CTU) is recommended when investigating patients with hematuria. We determine the incidence of urinary tract cancer and compare the diagnostic accuracy of CTU and renal and bladder ultrasound (RBUS) at identifying urinary tract cancer. The DETECT I study (clinicaltrials.gov NCT02676180) is a prospective observational study recruiting patients ≥18 years following a presentation of macroscopic or microscopic haematuria at 40 hospitals. All patients had cystoscopy and upper tract imaging (CTU, RBUS or both). 3,556 patients with a median age of 68 years were recruited, of which 2166 had RBUS and 1692 had CTU in addition to cystoscopy. The incidence of bladder, renal and upper tract urothelial cancer (UTUC) were 11.0%, 1.4% and 0.8% respectively in macroscopic hematuria patients. Patients with microscopic hematuria had a 2.7%, 0.4% and 0% incidence of bladder, renal and UTUC respectively. The sensitivity and negative predictive value (NPV) of RBUS for the detection of renal cancer was 85.7% and 99.9% respectively but 14.3% and 99.7% for the detection of UTUC. RBUS was poor at identifying renal calculi. Sensitivity of RBUS was lower than CTU for the detection of bladder cancer (both <85%). Cystoscopy has a specificity and PPV of 98.3% and 83.9% respectively. CTU can be safely replaced with RBUS in patients with microscopic hematuria. The incidence of UTUC is 0.8% in patients with macroscopic hematuria and CTU is recommended. Patients with suspected renal calculi will require non-contrast renal tract CT. Imaging cannot replace cystoscopy to diagnose bladder cancer. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Laparoscopic Transcystic Treatment Biliary Calculi by Laser Lithotripsy

PubMed Central

Jin, Lan; Zhang, Zhongtao

2016-01-01

Background and Objectives: Laparoscopic transcystic common bile duct exploration (LTCBDE) is a complex procedure requiring expertise in laparoscopic and choledochoscopic skills. The purpose of this study was to investigate the safety and feasibility of treating biliary calculi through laparoscopic transcystic exploration of the CBD via an ultrathin choledochoscope combined with dual-frequency laser lithotripsy. Methods: From August 2011 through September 2014, 89 patients at our hospital were treated for cholecystolithiasis with biliary calculi. Patients underwent laparoscopic cholecystectomy and exploration of the CBD via the cystic duct and the choledochoscope instrument channel. A dual-band, dual-pulse laser lithotripsy system was used to destroy the calculi. Two intermittent laser emissions (intensity, 0.12 J; pulse width 1.2 μs; and pulse frequency, 10 Hz) were applied during each contact with the calculi. The stones were washed out by water injection or removed by a stone-retrieval basket. Results: Biliary calculi were removed in 1 treatment in all 89 patients. No biliary tract injury or bile leakage was observed. Follow-up examination with type-B ultrasonography or magnetic resonance cholangiopancreatography 3 months after surgery revealed no instances of retained-calculi–related biliary tract stenosis. Conclusion: The combined use of laparoscopic transcystic CBD exploration by ultrathin choledochoscopy and dual-frequency laser lithotripsy offers an accurate, convenient, safe, effective method of treating biliary calculi. PMID:27904308

An algorithm for calculi segmentation on ureteroscopic images.

PubMed

Rosa, Benoît; Mozer, Pierre; Szewczyk, Jérôme

2011-03-01

The purpose of the study is to develop an algorithm for the segmentation of renal calculi on ureteroscopic images. In fact, renal calculi are common source of urological obstruction, and laser lithotripsy during ureteroscopy is a possible therapy. A laser-based system to sweep the calculus surface and vaporize it was developed to automate a very tedious manual task. The distal tip of the ureteroscope is directed using image guidance, and this operation is not possible without an efficient segmentation of renal calculi on the ureteroscopic images. We proposed and developed a region growing algorithm to segment renal calculi on ureteroscopic images. Using real video images to compute ground truth and compare our segmentation with a reference segmentation, we computed statistics on different image metrics, such as Precision, Recall, and Yasnoff Measure, for comparison with ground truth. The algorithm and its parameters were established for the most likely clinical scenarii. The segmentation results are encouraging: the developed algorithm was able to correctly detect more than 90% of the surface of the calculi, according to an expert observer. Implementation of an algorithm for the segmentation of calculi on ureteroscopic images is feasible. The next step is the integration of our algorithm in the command scheme of a motorized system to build a complete operating prototype.

Management of Pancreatic Calculi: An Update.

PubMed

Tandan, Manu; Talukdar, Rupjyoti; Reddy, Duvvur Nageshwar

2016-11-15

Pancreatolithiasis, or pancreatic calculi (PC), is a sequel of chronic pancreatitis (CP) and may occur in the main ducts, side branches or parenchyma. Calculi are the end result, irrespective of the etiology of CP. PC contains an inner nidus surrounded by successive layers of calcium carbonate. These calculi obstruct the pancreatic ducts and produce ductal hypertension, which leads to pain, the cardinal feature of CP. Both endoscopic therapy and surgery aim to clear these calculi and decrease ductal hypertension. In small PC, endoscopic retrograde cholangiopancreatography (ERCP) followed by sphincterotomy and extraction is the treatment of choice. Large calculi require fragmentation by extracorporeal shock wave lithotripsy (ESWL) prior to their extraction or spontaneous expulsion. In properly selected cases, ESWL followed by ERCP is the standard of care for the management of large PC. Long-term outcomes following ESWL have demonstrated good pain relief in approximately 60% of patients. However, ESWL has limitations. Per oral pancreatoscopy and intraductal lithotripsy represent techniques in evolution, and in current practice their use is limited to centers with considerable expertise. Surgery should be offered to all patients with extensive PC, associated multiple ductal strictures or following failed endotherapy.

Combined calculi for photon orbital and spin angular momenta

NASA Astrophysics Data System (ADS)

Elias, N. M.

2014-08-01

Context. Wavelength, photon spin angular momentum (PSAM), and photon orbital angular momentum (POAM), completely describe the state of a photon or an electric field (an ensemble of photons). Wavelength relates directly to energy and linear momentum, the corresponding kinetic quantities. PSAM and POAM, themselves kinetic quantities, are colloquially known as polarization and optical vortices, respectively. Astrophysical sources emit photons that carry this information. Aims: PSAM characteristics of an electric field (intensity) are compactly described by the Jones (Stokes/Mueller) calculus. Similarly, I created calculi to represent POAM characteristics of electric fields and intensities in an astrophysical context. Adding wavelength dependence to all of these calculi is trivial. The next logical steps are to 1) form photon total angular momentum (PTAM = POAM + PSAM) calculi; 2) prove their validity using operators and expectation values; and 3) show that instrumental PSAM can affect measured POAM values for certain types of electric fields. Methods: I derive the PTAM calculi of electric fields and intensities by combining the POAM and PSAM calculi. I show how these quantities propagate from celestial sphere to image plane. I also form the PTAM operator (the sum of the POAM and PSAM operators), with and without instrumental PSAM, and calculate the corresponding expectation values. Results: Apart from the vector, matrix, dot product, and direct product symbols, the PTAM and POAM calculi appear superficially identical. I provide tables with all possible forms of PTAM calculi. I prove that PTAM expectation values are correct for instruments with and without instrumental PSAM. I also show that POAM measurements of "unfactored" PTAM electric fields passing through non-zero instrumental circular PSAM can be biased. Conclusions: The combined PTAM calculi provide insight into mathematically modeling PTAM sources and calibrating POAM- and PSAM-induced measurement errors.

Extracorporeal shockwave lithotripsy in the management of salivary calculi.

PubMed

Escudier, M P; Brown, J E; Drage, N A; McGurk, M

2003-04-01

The aim was to investigate the results of extracorporeal shockwave lithotripsy in the management of salivary calculi using a dedicated sialolithotriptor. Some 122 salivary calculi (84 submandibular and 38 parotid) were treated in an experimental study using a sialolithotriptor. Complete success was achieved in 40 procedures (33 per cent), 27 of 84 submandibular and 13 of 38 parotid calculi. A further 43 patients (35 per cent) were rendered asymptomatic although some stone debris remained in the duct (26 submandibular and 17 parotid). Failure (retention of stone debris and continued symptoms) occurred in 39 patients (32 per cent), 30 submandibular and eight parotid glands. The chance of failure increased with the size of the calculus and increasing duration of symptoms. Extracorporeal shockwave lithotripsy provides a useful option for the management of salivary calculi, particularly for stones less than 7 mm in diameter. Copyright 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

[Urinary calculi and infection].

PubMed

Trinchieri, Alberto

2014-01-01

Infection urinary stones resulting from urease-producing bacteria are composed by struvite and/or carbonate apatite. Bacterial urease splits urea and promotes the formation of ammonia and carbon dioxide leading to urine alkalinization and formation of phosphate salts. Proteus species are urease-producers, whereas a limited number of strains of other Gram negative and positive species may produce urease. Ureaplasma urealyticum and Corynebacterium urealyticum are urease-producers that are not isolated by conventional urine cultures, but require specific tests for identification. Primary treatment requires surgical removal of stones as complete as possible. Extracorporeal and endoscopic treatments are usually preferred, while open surgery is actually limited to few selected cases. Residual stones or fragments should be treated by chemolysis via ureteral catheter or nephrostomy or administration of citrate salts in order to achieve a stone-free renal unit. Postoperatively, recurrent urinary tract infection should be treated with appropriate antibiotic treatment although long-term antibiotic prophylaxis can cause resistance. Urinary acidification has been proposed for the prophylaxis of infection stones, but long-term acidification is difficult to achieve in urine infected by urease-producing bacteria. Urease inhibitors lead to prevention and/or dissolution of stones and encrustations in patients with infection by urea-splitting bacteria, but their use is limited by their toxicity. The administration of citrate salts involves an increase of the value of nucleation pH (pHn), that is the pH value at which calcium and magnesium phosphate crystallization occurs, in a greater way than the corresponding increase in the urinary pH due to its alkalinizing effect and resulting in a reduction of the risk of struvite crystallization. In conclusion prevention of the recurrence of infection stones can be achieved by an integrated approach tailored on the single patient. Complete clearance of the stone must be achieved by primary surgical procedure and residual fragments should be extensively treated. In the case of persistent infection, conservative measures, such as acidification and urease inhibitors or citrate administration, should be adopted to minimize its effect on urinary saturation with respect to struvite.

Foreign bodies in the urinary bladder and their management: a Pakistani experience.

PubMed

Mannan, A; Anwar, S; Qayyum, A; Tasneem, R A

2011-01-01

This was a retrospective study conducted to assess the nature, presentation, mode of insertion, diagnosis and management of foreign bodies in the urinary bladder. Between January 1998 and December 2007, 20 patients with foreign bodies in their urinary bladder were treated at our centre. The records of these patients were reviewed and analysed for their symptoms, mode of insertion, diagnosis, management and complications. A total of 20 foreign bodies were recovered from the urinary bladders during the study period. These included JJ stents with calculi, intrauterine contraceptive devices with stones, a rubber stick, ribbon gauze, encrusted pieces of Foley catheter, proline thread with calculus, a suture needle, broken cold knives, the ceramic beak of a paediatric resectoscope, a knotted suprapubic tube, a hair clip, a nail, an electrical wire and a hairpin. The common presenting features were dysuria and haematuria. The diagnosis was established radiologically in most of the cases. The circumstances of insertion were variable; iatrogenic in 16 (80.0 percent) cases, sexual stimulation in two (10.0 percent), accidental insertion by a child in one (5.0 percent) and physical torture in one (5.0 percent). 17 (85.0 percent) foreign bodies were recovered endoscopically, and cystolithotomy was required in three (15.0 percent) patients. The instances of foreign bodies in the urinary bladder are uncommon. A diagnosis is usually made radiologically. Iatrogenic foreign bodies were found to be the most frequent type of insertion encountered. Endoscopic retrieval is usually successful, with minimal morbidity.

Insights of the dental calculi microbiome of pre-Columbian inhabitants from Puerto Rico.

PubMed

Santiago-Rodriguez, Tasha M; Narganes-Storde, Yvonne; Chanlatte-Baik, Luis; Toranzos, Gary A; Cano, Raul J

2017-01-01

The study of ancient microorganisms in mineralized dental plaque or calculi is providing insights into microbial evolution, as well as lifestyles and disease states of extinct cultures; yet, little is still known about the oral microbial community structure and function of pre-Columbian Caribbean cultures. In the present study, we investigated the dental calculi microbiome and predicted function of one of these cultures, known as the Saladoid. The Saladoids were horticulturalists that emphasized root-crop production. Fruits, as well as small marine and terrestrial animals were also part of the Saladoid diet. Dental calculi samples were recovered from the archaeological site of Sorcé, in the municipal island of Vieques, Puerto Rico, characterized using 16S rRNA gene high-throughput sequencing, and compared to the microbiome of previously characterized coprolites of the same culture, as well modern plaque, saliva and stool microbiomes available from the Human Microbiome Project. Actinobacteria, Proteobacteria and Firmicutes comprised the majority of the Saladoid dental calculi microbiome. The Saladoid dental calculi microbiome was distinct when compared to those of modern saliva and dental plaque, but showed the presence of common inhabitants of modern oral cavities including Streptococcus sp., Veillonella dispar and Rothia mucilaginosa . Cell motility, signal transduction and biosynthesis of other secondary metabolites may be unique features of the Saladoid microbiome. Results suggest that the Saladoid dental calculi microbiome structure and function may possibly reflect a horticulturalist lifestyle and distinct dietary habits. Results also open the opportunity to further elucidate oral disease states in extinct Caribbean cultures and extinct indigenous cultures with similar lifestyles.

Urolithiasis analysis in a multiethnic population at a tertiary hospital in Nairobi, Kenya.

PubMed

Wathigo, Francis K; Hayombe, Alfred; Maina, Daniel

2017-04-20

Urolithiasis is a global problem whose incidence is reported to be on the rise across the world. Previously, urolithiasis was reported as being rare among the indigenous African population but recent data suggest otherwise. This study reviewed the demographic and clinical characteristics of patients with urolithiasis seen at the Aga Khan University hospital Nairobi (AKUHN) as well as the chemical composition of the stones and the modalities of therapy used. This was a retrospective study which utilized patients' clinical and laboratory records from 2013 to 2014. Sixty-seven symptomatic patients with confirmed urolithiasis formed the study. This study aimed to describe the clinical characteristics of patients, modalities of treatment as well as the chemical composition of renal stones from patients diagnosed and managed for urolithiasis during a duration spanning 17 months. Wet chemistry was utilized for analyzing the chemical composition of the urinary calculi. Data on age, sex, symptoms, radiological investigations done, location of the calculi, chemical composition of calculi and therapeutic procedures instituted were extracted and analyzed. Ages ranged from 3 to 87 years with a median of 42; males were the majority (79%) and the commonest presenting symptoms were flank pain (91%) and dysuria (19%). The majority of the stones were located in the ureters (46%) and at the pelvi-ureteric junction (25%). A statistically significant difference in frequency of lodgment at the pelvi-ureteric site between males and females was noted. However, the number of female patients in this study was small and studies with larger numbers of female participants are required to confirm this observation. All stones contained calcium and oxalate, often as the only constituents (72%). In the remainder of the stones, other constituents such bicarbonate, ammonium, phosphorous, magnesium, uric acid and cystine occurred in varying combinations with calcium oxalate. Laser lithotripsy was the most performed therapeutic procedure (77.6%). Males formed the majority of patient with urolithiasis. Overall, most of the calculi were located in the ureters except in women where the pelviureteric location was commoner. Stones containing calcium oxalate only were predominant across the age groups and in both sexes. Lithotripsy was the commonest mode of management.

Treatment of Distal Ureteral Calculi Using Extracorporeal Physical Vibrational Lithecbole Combined with Tamsulosin: A New Option to Speed Up Obstruction Relief.

PubMed

Liu, Guanlin; Cheng, Yue; Wu, Weijie; Jia, Xiaolong; Hu, Jiasheng; Xie, Guohai; Chen, Xueqin

2018-02-01

The obstruction of the urinary tract by calculi at the narrowest anatomical areas leads to impaired drainage and severe pain. The aim of this study was to evaluate a new technology, extracorporeal physical vibrational lithecbole (EPVL) combined with tamsulosin, as a treatment for distal ureteral calculi (DUC). Between July 2013 and July 2014, 672 patients diagnosed with DUC were randomly divided into three groups; a group receiving EPVL plus 0.4 mg oral tamsulosin daily (PO qd) (experimental group, n = 236), a group receiving 0.4 mg tamsulosin PO qd (n = 222), and a group receiving EPVL only (n = 214) (control groups). There were no significant differences in general characteristics between the three groups. Stone diameters ranged from 0.32 to 1 cm. In the EPVL plus tamsulosin group, 60.1% of patients showed detectable fragment expulsion at 48 hours, and 91.1% were stone free at 7 days. Compared with the two control groups, these rates were significantly higher (EPVL group was 0% and 50.5% and medical expulsive therapy group was 0% and 50.0%, p < 0.05). The stone-free rates were similar in the three groups 2 weeks later (94.5%, 93.6%, and 93.5%; p > 0.05). Patients in the EPVL plus tamsulosin group achieved similar stone-free rates compared with the other two groups, but the speed of the stone expulsion was quicker for both sexes and all age groups (about a week; p < 0.05). This indicates that EPVL plus tamsulosin could be used as an effective, but faster treatment option for patients with DUC, alleviating the symptoms of DUC in a shorter period of time.

Transvesicular percutaneous cystolithotomy for the retrieval of cystic and urethral calculi in dogs and cats: 27 cases (2006-2008).

PubMed

Runge, Jeffrey J; Berent, Allyson C; Mayhew, Philipp D; Weisse, Chick

2011-08-01

To describe the use of transvesicular percutaneous cystolithotomy for the retrieval of cystic and urethral calculi and to report the outcome in dogs and cats. Retrospective case series. 23 dogs and 4 cats. Medical records were reviewed for signalment, procedure time, stone number, stone location, pre- and postoperative radiographs, procedure-associated complications, and short-term outcome. A ventral midline approach was made into the abdomen over the urinary bladder apex. A screw cannula was inserted at the bladder apex for normograde rigid and flexible cystourethroscopy. All uroliths were removed via a stone basket device and retrograde flushing and suction. Long-term follow-up (1 year after surgery) information was obtained by telephone or e-mail contact with owners. 27 animals with cystic and urethral calculi were included. Median patient weight was 8.3 kg (18.3 lb; range, 1.8 to 42.6 kg [4.0 to 93.7 lb]). Urolith number ranged from 1 to > 35 (median, 7). Urolith size ranged from < 1 to 30 mm (median, 4.5 mm). Fifteen of the 27 animals had a previous cystotomy (range, 1 to 5 procedures). Median procedure time was 66 minutes (range, 50 to 80 minutes). All patients were discharged within 24 hours. No postoperative complications were reported at the time of suture removal. At the time of long-term follow-up, the 22 clients that could be contacted were satisfied with the procedure. Transvesicular percutaneous cystolithotomy may decrease the need for urethrotomy, serial transurethral endoscopic procedures, and abdominal insufflation associated with other minimally invasive interventions currently available. This procedure also provided excellent visualization for bladder and urethral luminal inspection.

Contemporary surgical trends in the management of upper tract calculi.

PubMed

Oberlin, Daniel T; Flum, Andrew S; Bachrach, Laurie; Matulewicz, Richard S; Flury, Sarah C

2015-03-01

Upper tract nephrolithiasis is a common surgical condition that is treated with multiple surgical techniques, including shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy. We analyzed case logs submitted to the ABU by candidates for initial certification and recertification to help elucidate the trends in management of upper tract urinary calculi. Annualized case logs from 2003 to 2012 were analyzed. We used logistic regression models to assess how surgeon specific attributes affected the way that upper tract stones were treated. Cases were identified by the CPT code of the corresponding procedure. A total of 6,620 urologists in 3 certification groups recorded case logs, including 2,275 for initial certification, 2,381 for first recertification and 1,964 for second recertification. A total of 441,162 procedures were logged, of which 54.2% were ureteroscopy, 41.3% were shock wave lithotripsy and 4.5% were percutaneous nephrolithotomy. From 2003 to 2013 there was an increase in ureteroscopy from 40.9% to 59.6% and a corresponding decrease in shock wave lithotripsy from 54% to 36.3%. For new urologists ureteroscopy increased from 47.6% to 70.9% of all stones cases logged and for senior clinicians ureteroscopy increased from 40% to 55%. Endourologists performed a significantly higher proportion of percutaneous nephrolithotomies than nonendourologists (10.6% vs 3.69%, p <0.0001) and a significantly smaller proportion of shock wave lithotripsies (34.2% vs 42.2%, p = 0.001). Junior and senior clinicians showed a dramatic adoption of endoscopic techniques. Treatment of upper tract calculi is an evolving field and provider specific attributes affect how these stones are treated. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Human Health Effects of Biphenyl: Key Findings and Scientific Issues.

PubMed

Li, Zheng; Hogan, Karen A; Cai, Christine; Rieth, Susan

2016-06-01

In support of the Integrated Risk Information System (IRIS), the U.S. Environmental Protection Agency (EPA) has evaluated the human health hazards of biphenyl exposure. We review key findings and scientific issues regarding expected human health effects of biphenyl. Scientific literature from 1926 through September 2012 was critically evaluated to identify potential human health hazards associated with biphenyl exposure. Key issues related to the carcinogenicity and noncancer health hazards of biphenyl were examined based on evidence from experimental animal bioassays and mechanistic studies. Systematic consideration of experimental animal studies of oral biphenyl exposure took into account the variety of study designs (e.g., study sizes, exposure levels, and exposure durations) to reconcile differing reported results. The available mechanistic and toxicokinetic evidence supports the hypothesis that male rat urinary bladder tumors arise through urinary bladder calculi formation but is insufficient to hypothesize a mode of action for liver tumors in female mice. Biphenyl and its metabolites may induce genetic damage, but a role for genotoxicity in biphenyl-induced carcinogenicity has not been established. The available health effects data for biphenyl provides suggestive evidence for carcinogenicity in humans, based on increased incidences of male rat urinary bladder tumors at high exposure levels and on female mouse liver tumors. Kidney toxicity is also a potential human health hazard of biphenyl exposure. Li Z, Hogan KA, Cai C, Rieth S. 2016. Human health effects of biphenyl: key findings and scientific issues. Environ Health Perspect 124:703-712; http://dx.doi.org/10.1289/ehp.1509730.

Flexible ureterorenoscopy and laser lithotripsy in children

PubMed Central

Yeow, When-Chan; Pemberton, Richard; Barker, Andrew

2009-01-01

Background: Flexible ureterorenoscopy (FUR) and laser lithotripsy (LL) are techniques used in the management of upper urinary tract disorders. These techniques, so far established in adults, are now being used in children as well. We report our experience with 26 cases of pediatric upper urinary tract disorders treated using these techniques. Methods: In the period from 1997 to 2006, FUR was performed in 26 children (14 males and 12 females) in the age group of three months to 15 years with a mean age of 8.2 years. Twenty five were stented prior to undergoing FUR and 24 presented with suspected upper tract stones (17 pelvicalyceal and seven midureteric). Two cases showed JJ stent migration post-pyeloplasty. Results: Eight cases involved diagnostic procedures. Six excluded the presence of renal calculi, one had focal medullary sponge kidney, and one had calcified papillae. There were 15 cases of therapeutic FUR. Of these, 12 had LL with only one had incomplete stone fragmentation which subsequently passed spontaneously. Other therapeutic procedures included removal of migrated JJ stents and FUR with the basket removal of a midureteric calculus. Three cases failed ureterorenoscopy due to technical difficulties. The overall success rate was 88.5% for FUR. Conclusion: FUR and LL are valuable minimally invasive techniques for the examination and treatment of pediatric upper urinary tract conditions. Preoperative stenting improves passage of the ureteroscope and with progressive miniaturization of instruments, the lower weight limit will decrease. PMID:20671848

Use of pneumatic lithotripsy for managing difficult CBD calculi.

PubMed

Farooq Qadri, Syed Javid; Khan, Muneer; Khan, Naveed

2011-01-01

About 7-12% of patients who harbor gallbladder calculi concomitant common bile duct (CBD) calculi are present. The treatment of gallbladder calculi has standardized in the form of laparoscopic cholecystectomy but management of CBD calculi is still evolving. Endoscopic removal of CBD calculi <2 cm in diameter is successful in 90-100% of cases but patients harboring stones >2 cm in diameter high failure rates can be seen. Traditionally, laparoscopically one can achieve success rate comparable to endoscopic surgery but large and impacted calculi may cause failures. If one uses pneumatic lithotripsy during laparoscopic management of CBD calculi one can achieve 100% stone clearance irrespective of size, degree of hardness and impaction. This study evaluates the feasibility of using pneumatic lithotripsy for CBD calculi. To our knowledge this is the 1st reported series of using pneumatic lithotripsy for CBD calculi. From June 2002 to June 2010 96 laparoscopic CBD explorations (LCBDE) were done for CBD calculi. Patients having choledocholithiasis with CBD diameter of >10 mm were taken for LCBDE while in patients with CBD diameter of <10 mm were referred for endoscopic clearance. Additionally ERCP failure cases were also subjected to LCBDE. Rigid nephroscope was used for LCBDE and usually calculi were removed by forceps only. In patients having large, hard &/or impacted calculi pneumatic lithotripsy were used for fragmentation. Out of the 96 patients in 12 (12.5%) cases pneumatic lithotripsy was used for stone fragmentation. Out of these 12 cases 5 (41.6%) were ERCP failure cases. At a mean hospital stay of 2.5 days 100% stone clearance was achieved in all cases with no perioperative complication. The present study shows how successfully pneumatic lithotripsy can be used to fragment large, hard &/or impacted CBD calculi. Pneumatic lithotripsy being user friendly easily available can reliably fragment CBD calculi in one session. Copyright © 2010 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

The management of staghorn calculi in children

PubMed Central

Horuz, Rahim; Sarica, Kemal

2012-01-01

Objectives To review reports focusing on the surgical treatment of staghorn stones in children, as despite all the improvements in the surgical treatment of paediatric urolithiasis the management of staghorn calculi still represents a challenging problem in urology practice. Methods To evaluate current knowledge about treating staghorn calculi in children, we searched PubMed for relevant articles published between 1991 and 2011, using a combination of related keywords, i.e. staghorn stone, child, kidney calculi, surgical treatment, electrohydraulic shockwave therapy (ESWL), percutaneous nephrolithotomy (PCNL), and open surgery. Reports relating to the treatment of paediatric stone disease in general (open surgery, PCNL, ESWL) were also searched with the same method. Additional references were obtained from the reference list of full-text reports. Results Although open surgery had been widely used in the past for treating such stones in children, currently it has only limited indications in highly selected patients. Current published data clearly indicate that, in experienced hands, both PCNL and ESWL are now effective methods for treating staghorn calculi in children. Conclusions Due to advanced techniques and instrumentation, it is now possible to successfully treat staghorn calculi in children, with very limited safety concerns. Currently, while PCNL is recommended as the first-line surgical treatment, ESWL, open surgery and/or combined methods are valuable but secondary options in the treatment of paediatric staghorn calculi. PMID:26558045

Ultrasonographic evaluation of abdominal distension in 52 camels (Camelus dromedarius).

PubMed

Tharwat, Mohamed; Al-Sobayil, Fahd; Ali, Ahmed; Buczinski, Sébastien

2012-08-01

The purpose of this study was to assess the diagnostic value of ultrasonography in the evaluation of abdominal distension in 52 camels (Camelus dromedarius). The conditions included trypanosomiasis (n=35), intestinal obstruction (n=12) and ruptured urinary bladder (n=5). Fifteen clinically normal camels were included as controls. Transabdominal and transrectal ultrasonography was carried out on all camels. In animals with trypanosomiasis, ultrasonographic findings included accumulation of massive amounts of hypoechoic abdominal fluids where liver, intestine, kidney, spleen and urinary bladder were imaged floating. Except in two cases of bile duct calcification and one of hepatic abscessation, no detectable abnormal sonographic lesions were detected while imaging the hepatic and renal parenchyma, and the heart and its valves and major blood vessels. In camels with intestinal obstruction, ultrasonographic findings included distended intestinal loops with markedly reduced or absent motility. In one camel, the intestinal lumen contained localised hyperechoic material that was consistent with a foreign body. Hypoechoic fluid with or without fibrin was seen between intestinal loops. In camels with ruptured urinary bladder, ultrasonographic findings included collapsed and perforated bladder, echogenic blood clots within the urinary bladder and peritoneal cavity, increased thickness of the bladder wall, floating intestines in hypoechogenic fluid and echogenic calculi within the urethra. Ultrasonography was considered a useful tool for the evaluation of dromedary camels with abdominal distension. Copyright © 2011 Elsevier Ltd. All rights reserved.

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.

Common questions about the diagnosis and management of benign prostatic hyperplasia.

PubMed

Pearson, Ryan; Williams, Pamela M

2014-12-01

Benign prostatic hyperplasia (BPH) is a common condition that increases in prevalence with age. A history should include onset, duration, and severity of lower urinary tract symptoms and medication use to rule out other causes of symptoms. Physical examination includes a digital rectal examination and assessment for bladder distention or neurologic impairment. Recommended tests include serum prostate-specific antigen measurement and urinalysis to help identify infection, genitourinary cancer, or calculi as an alternative cause of lower urinary tract symptoms. BPH severity is assessed using validated, self-administered symptom questionnaires such as the American Urological Association Symptom Index or International Prostate Symptom Score. Mild or nonbothersome symptoms do not require treatment. Bothersome symptoms are managed with lifestyle modifications, medications, and surgery. Alpha blockers are first-line medications for BPH. Surgical referral is indicated if BPH-related complications develop, medical therapy fails, or the patient chooses it. Dietary supplements, such as saw palmetto, pygeum, cernilton, and beta sitosterols, and acupuncture are not recommended for the management of BPH.

The impact of obesity in urology.

PubMed

Mydlo, Jack H

2004-05-01

The incidence and progression of urologic diseases, as well as several urologic cancers.depend on many interrelated factors, such as obesity, diet, genetics, environment, age, and the immune system. Obesity is a risk factor for stress urinary incontinence, ED, infertility, and renal calculi. Numerous publications have demonstrated that a high dietary intake of fat increases prostate cancer risk, although the mechanisms are not clear. Although some reports may demonstrate an association between obesity and prostate cancer, it may be hard to establish because, in general, men with obesity have a high-fat diet. Obesity, recurrent urinary tract infections, increased intake of protein and fried foods, and female sex seem to increase the risk of renal cancer. Environmental toxins seem to be the major factors affecting the incidence of bladder cancers. Thus, dietary modification and other public health measures directed at reducing weight may reduce the incidence of urologic illnesses. More studies are necessary to determine the therapeutic effects of weight loss and dietary modification on the incidence and progression of urologic tumors.

Bilateral epididymal sperm granulomas following urethrostomy in a German shepherd dog.

PubMed

Batista-Arteaga, M; Santana, M; Lozano, O; Niño, T; Alamo, D; Rodríguez, F

2011-08-01

Bilateral enlargement of both epididymes was observed in a 6-year-old German shepherd dog following a pre-scrotal urethrostomy. Testicular parenchyma showed regular structure, and the spermatogenesis and the steroidogenic functions were not modified. However, macroscopic examination of the tail and the body of both epididymes exhibited multiple white and well-delimited foci. Histopathological study of the epididymes confirmed the development of granulomas associated with extravasated spermatozoa. Urethrostomy caused a severe stenosis of the penile urethra, favouring the retention of urine at the urinary bladder. The retrograde pressure exerted by the distension of the urinary bladder could have allowed the urine to reach the prostatic urethra and the deferent ducts and, finally, the epididymes, causing irritation and rupture of the mucous layer of the epididymal duct, the consequent sperm extravasation and the development of sperm granulomas. We speculate that the inadequate surgical resolution of the urethral calculi caused the bladder distension, the subsequent retrograde flow of urine and the development of the lesions. © 2010 Blackwell Verlag GmbH.

Management of Pancreatic Calculi: An Update

PubMed Central

Tandan, Manu; Talukdar, Rupjyoti; Reddy, Duvvur Nageshwar

2016-01-01

Pancreatolithiasis, or pancreatic calculi (PC), is a sequel of chronic pancreatitis (CP) and may occur in the main ducts, side branches or parenchyma. Calculi are the end result, irrespective of the etiology of CP. PC contains an inner nidus surrounded by successive layers of calcium carbonate. These calculi obstruct the pancreatic ducts and produce ductal hypertension, which leads to pain, the cardinal feature of CP. Both endoscopic therapy and surgery aim to clear these calculi and decrease ductal hypertension. In small PC, endoscopic retrograde cholangiopancreatography (ERCP) followed by sphincterotomy and extraction is the treatment of choice. Large calculi require fragmentation by extracorporeal shock wave lithotripsy (ESWL) prior to their extraction or spontaneous expulsion. In properly selected cases, ESWL followed by ERCP is the standard of care for the management of large PC. Long-term outcomes following ESWL have demonstrated good pain relief in approximately 60% of patients. However, ESWL has limitations. Per oral pancreatoscopy and intraductal lithotripsy represent techniques in evolution, and in current practice their use is limited to centers with considerable expertise. Surgery should be offered to all patients with extensive PC, associated multiple ductal strictures or following failed endotherapy. PMID:27784844

Non-contrast MDCT for Ureteral Calculi and Alternative Diagnoses: Yield in Adult Women vs in Adult Men.

PubMed

Fani, Parisa; Patlas, Michael N; Monteiro, Sandra; Katz, Douglas S

2018-02-02

To determine the yield of non-contrast multi-detector computed tomography (MDCT) of the abdomen and pelvis in diagnosing ureteral calculi as well as other alternative acute conditions in male vs in female adult patients presenting to the emergency department with new onset of symptoms. Our institutional review board approved a retrospective review of the official reports of the non-contrast MDCT examinations of the abdomen and pelvis performed on adults (18 years and older) presenting to our emergency department with a suspected ureteral calculus from October 1, 2011 to October 30, 2013. Patients with recently documented ureteral calculi, known urinary tract infection, malignancy, and trauma were excluded from the study. From a total of 1097 non-contrast MDCT examinations of the abdomen and pelvis over the 2-year period, 400 randomly selected examinations were reviewed (approximately one-third of all the examinations). We compared the prevalence of ureteral calculi between the male and female population. P values and confidence intervals were determined using software Stata 14. Other acute intra-abdominal and intra-pelvic findings amenable to prompt medical care were also documented and analyzed separately. The mean patient age was 55.2 years, with a range of 19-90 years. This included 170 female (mean age 56.8 years) and 230 male patients (mean age 54.2 years). Ureteral calculi were detected in 170 (42.5%) of the patients [111 males (48%) and 59 females (34.7%)] with a prevalence which was statistically significantly higher in the male patients compared to in the female patients (P < 0.01, confidence level of 95% and CI of 13.2-13.4). An alternative diagnosis was made based on the MDCT findings in 49 patient cases (12.25 %), including 26 females (15.29%) and 23 males (10.00%). There was no statistically significant difference in alternative acute findings in male compared to in female patients (P > 0.05). This was with the exception of acute pyelonephritis, which was statistically significantly higher in the female patients (P < 0.01). The likelihood of making the diagnosis of a ureteral calculus on non-contrast MDCT of the abdomen and pelvis was statistically significantly higher in male patients compared with female patients presenting to our emergency department. However, there was no statistically significant difference in the alternative diagnoses, with the exception of pyelonephritis, which was more common in women. Copyright © 2018 Elsevier Inc. All rights reserved.

Dysfunction of the lower urinary and distal gastrointestinal tracts in pediatric patients with known spinal cord problems.

PubMed

Churchill, B M; Abramson, R P; Wahl, E F

2001-12-01

Destruction of the urinary tract in children with elimination, storage, and holding dysfunction of the lower urinary and the distal GI tracts is caused primarily by high intravesical pressure. UTI accelerates this process. The LPP and the status of the urethral control mechanism and its relationship to the detrusor are the primary determinants of intravesical pressure. Intravesical pressures of more than 40 cm H2O are dangerous because they cause a pressure gradient that is transmitted proximally to the renal papillae, which results in the cessation of renal blood flow and a loss of renal function over time. Hydroureteronephrosis, VUR, UTI, urinary incontinence, and calculi formation also may occur. If these dangerously high intravesical pressures remain untreated, renal failure is likely to occur over time. These children then require dialysis or renal transplantation to survive, which is tragic and represents an enormous economic cost to society. Renal failure and upper urinary tract damage is nearly 100% preventable with early and appropriate evaluation and treatment. CIC is a crucial part of the management of these children and has been shown to be safe and effective, even in newborn boys. The use of the Credé maneuver (i.e., manual compression) to empty the bladder is obsolete and should be abandoned. The distal GI tract is inseparable from the lower urinary tract and must be treated simultaneously. Failure to treat the distal GI tract yields poor clinical results and much patient dissatisfaction and makes it difficult or impossible to treat the child's urinary tract problem successfully. Bowel-management programs must include daily high water and fiber intake, together with digital perianal stimulation or fecal extraction. Neuropathic bladder and bowel problems that are intractable to conservative medical and mechanical (i.e., CIC and digital perianal stimulation or fecal extraction, respectively) management almost always can be corrected surgically with high success rates in cooperative patients. Finally, neuropathic bladder and bowel problems can be extremely isolating and debilitating problems. Psychologic counseling and emotional support must be provided as needed. The care that these patients receive must be organized, comprehensive, and correlated with these patients' lifestyles. If these children are evaluated and treated early, they have the potential to live long, healthy, and productive lives.

Clinical Significance of Prostatic Calculi: A Review

PubMed Central

2018-01-01

Prostatic calculi often occur in middle-aged and old men. Prostatic calculi are usually classified as primary/endogenous stones or secondary/extrinsic stones. Endogenous stones are commonly caused by obstruction of the prostatic ducts around the enlarged prostate by benign prostatic hyperplasia (BPH) or by chronic inflammation. Extrinsic stones occur mainly around the urethra, because they are caused by urine reflux. The exact prevalence of prostatic calculi is not known, and it has been reported to vary widely, from 7% to 70%. Most cases of prostatic calculi are not accompanied by symptoms. Therefore, most cases are found incidentally during the diagnosis of BPH using transrectal ultrasonography (TRUS). However, prostatic calculi associated with chronic prostatitis may be accompanied by chronic pelvic pain. Rare cases have been reported in which extrinsic prostatic calculi caused by urine reflux have led to voiding difficulty due to their size. More than 80% of prostatic calculi are composed of calcium phosphate. Prostatic calculi can be easily diagnosed using TRUS or computed tomography. Treatment is often unnecessary, but if an individual experiences difficulty in urination or chronic pain, prostatic calculi can be easily removed using a transurethral electroresection loop or holmium laser. PMID:29076299

Scrotal calculi in clinical practice and their role in scrotal pain: A prospective study.

PubMed

Aslan, Ahmet; Tan, Sinan; Yıldırım, Halil; Dönmez, Uğur; Çam, Ali; Gezer, Mehmet Can; Teber, Mehmet Akif; Arslan, Halil

2015-09-01

Scrotal calculi are rare, and their clinical significance is uncertain. Scrotal pain is a frequent, hard-to-manage problem in urology clinics. Our purpose in this study was to determine the relationship between the presence of scrotal calculi and scrotal pain in a prospective manner. Sonography and color Doppler ultrasound of the scrotum were performed in 758 consecutive patients referred with scrotal pain. The pain was rated by using an 11-point numeric rating scale; scores were compared among patients with scrotal calculi with and without additional scrotal pathology. Scrotal calculi were detected in 73 of the 758 patients (9.6%). Scrotal pain (n = 50 [61%]) and a palpable mass in the scrotum (n = 25 [30.5%]) were the most common complaints in patients with scrotal calculi. Hydrocele (n = 17 [29.8%]) and varicocele (n = 15 [26.3%]) were the most commonly associated abnormalities; there was a statistically significant association between the presence of scrotal calculi and hydrocele (p < 0.01). Scrotal pain was present in 61 (83.5%) patients with scrotal calculi, and this association was significant (p < 0.001). The presence of scrotal pain and the correlation between location of calculi and pain in patients without additional scrotal abnormalities were also significant (p = 0.04 and p < 0.004, respectively). The prevalence of scrotal calculi was 9.6%, and hydrocele was found to be associated with scrotal calculi. We also found a significant relationship between the presence of calculi and scrotal pain. Because the etiology of scrotal pain is essential for appropriate treatment, scrotal calculi should be kept in mind when making a differential diagnosis of scrotal pain. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:406-411, 2015. © 2014 Wiley Periodicals, Inc.

Differences in stone size and ureteral dilation between obstructing proximal and distal ureteral calculi.

PubMed

Eisner, Brian H; Pedro, Renato; Namasivayam, Saravanan; Kambadakone, Avinash; Sahani, Dushyant V; Dretler, Stephen P; Monga, Manoj

2008-09-01

To examine the differences in ureteral dilation and calculus size between obstructing proximal and distal ureteral stones. A retrospective review of computed tomography (CT) scans from 176 consecutive patients with obstructing ureteral calculi was performed. For the calculi, the axial diameter was defined as the largest stone diameter on the axial CT images, and the coronal length was defined as the cephalocaudal length of the stone measured on the coronal CT images. Univariate and multivariate statistical analyses were performed. A total of 65 proximal and 111 distal ureteral calculi were analyzed. On univariate analysis, the proximal calculi were associated with a greater degree of ureteral dilation (mean 6.1 mm vs 5.3 mm, P = .01) and had a greater coronal length (mean 9.9 mm vs 8.3 mm, P = .005) than distal calculi. This association was also true on the multivariate analysis, which controlled for age and sex (P = .0004). No statistically significant difference was found in the axial calculus diameter for the proximal and distal stones (mean 5.3 mm vs 5.0 mm, P = .29). In a subset of 50 patients whose contralateral ureters (without stones) were measured for control comparison, the ureteral dilation in the ureters with stones was significantly greater than in the control ureters (proximal ureter 6.2 mm vs 4.3 mm, P = .001; distal ureter 4.7 mm vs 3.8 mm, P = .004). For proximal calculi, 72.3% were associated with ureteral dilation of less than 7 mm, 23.1% with 7-10 mm, and 4.6% with greater than 10 mm. For the distal calculi, 90.1% were associated with ureteral dilation of less than 7 mm, 6.3% with 7-10 mm, and 3.6% with greater than 10 mm. The coronal length was the largest measured diameter in 94% of the calculi, and the mean calculus coronal length was significantly greater than the mean axial diameter (8.9 mm vs 5.1 mm, respectively, P < .001). The results of our study have shown that proximal ureteral calculi are associated with a significantly greater degree of ureteral dilation and larger coronal length than are distal calculi. These findings should guide the endoscopist in planning intracorporeal ureteroscopic lithotripsy. We suggest obtaining CT coronal images to more accurately characterize obstructing ureteral stones.

Subchronic toxicity studies of t-butyl alcohol in rats and mice.

PubMed

Lindamood, C; Farnell, D R; Giles, H D; Prejean, J D; Collins, J J; Takahashi, K; Maronpot, R R

1992-07-01

The purpose of this study was to evaluate the toxicity of t-butyl alcohol, an important commodity chemical, an additive to unleaded gasoline, and a contaminant of drinking water. Ninety-day toxicity studies were conducted in B6C3F1 mice and Fischer 344 (F344) rats of both sexes using dosed water. Dose levels of t-butyl alcohol were 0, 0.25, 0.5, 1, 2, and 4% (w/v). Lethality was observed at the 4% level of both sexes and species. Weight-gain depression was present in all dose levels of male rats; 4% female rats; 1, 2, and 4% male mice; and 2 and 4% female mice. Water consumption was increased at lower dose levels in male rats and decreased in the higher dose levels of both sexes of rats and female mice. Clinical signs in rats were ataxia in both sexes and hypoactivity in males. Clinical signs in mice were ataxia, abnormal posture, and hypoactivity. In rats, urine volumes were reduced, in association with crystalluria. Gross lesions at necropsy were urinary tract calculi, renal pelvic and ureteral dilatation, and thickening of the urinary bladder mucosa. Microscopic lesions were hyperplasia of transitional epithelia and inflammation of the urinary bladder. In male rats treated with t-butyl alcohol, microscopic renal changes were suggestive of alpha-2 mu-globulin nephropathy. No-effect levels for the urinary tract lesions were 1% in male rats and mice (803.7 mg/kg/day for the male rats and 1565.8 mg/kg/day for the male mice) and 2% in female rats and mice (1451.5 mg/kg/day for the female rats and 4362.9 mg/kg/day for the female mice). The results indicate that in rodents the urinary tract is the target organ for t-butyl alcohol toxicity, and males are more sensitive to t-butyl alcohol toxicity than females.

Nephrolithiasis as a presenting feature of chronic sarcoidosis.

PubMed Central

Rizzato, G.; Fraioli, P.; Montemurro, L.

1995-01-01

BACKGROUND--Renal calculi have been reported to occur in about 10% of patients with chronic sarcoidosis, but nephrolithiasis as a presentation of this disease has not been studied. METHODS--The charts of 618 patients with histologically proven sarcoidosis, seen in the period October 1978-1992, were reviewed in order to identify nephrolithiasis at presentation. RESULTS--Seventeen patients had renal calculi which preceded other manifestations of sarcoidosis. In six the occurrence of calculi suggested the diagnosis. Another eight patients had a previous history of recurrent colic with calculi. The time intervals between the first calculus and the appearance of other manifestations of sarcoidosis ranged from one to 25 years, but it was over four years in only two cases and all had at least one calculus in the year before the diagnosis was made. In the other three patients appearance of the calculus was distant in time and was probably unrelated to their sarcoidosis. In most cases the sarcoidosis was chronic and needed long term treatment with corticosteroids. Four patients had further calculi during follow up (one month to 16 years) due to an improper withdrawal of treatment decided by the patient in two cases, and to the reduction in the corticosteroid dose in the other two. CONCLUSIONS--Calculi were the presenting feature of sarcoidosis in six (1%) patients, and were the first manifestation of the disease in a total of 14 (2.2%). This frequency is over 20 times the likely incidence of calculi in the general population. Renal calculi may therefore be a rare primary manifestation of sarcoidosis. In such cases the disease is likely to be chronic and to require long term corticosteroid therapy. Sarcoidosis should always be suspected in cases of nephrolithiasis of unknown origin. PMID:7597671

Clinical evaluation of Apamarga-Ksharataila Uttarabasti in the management of urethral stricture

PubMed Central

Reddy, K. Rajeshwar

2013-01-01

Stricture urethra, though a rare condition, still is a rational and troublesome problem in the international society. Major complications caused by this disease are obstructed urine flow, urine stasis leading to urinary tract infection, calculi formation, etc. This condition can be correlated with Mutramarga Sankocha in Ayurveda. Modern medical science suggests urethral dilatation, which may cause bleeding, false passage and fistula formation in few cases. Surgical procedures have their own complications and limitations. Uttarabasti, a para-surgical procedure is the most effective available treatment in Ayurveda for the diseases of Mutravaha Strotas. In the present study, total 60 patients of urethral stricture were divided into two groups and treated with Uttarabasti (Group A) and urethral dilatation (Group B). The symptoms like obstructed urine flow, straining, dribbling and prolongation of micturation were assessed before and after treatment. The results of the study were significant on all the parameters. PMID:24250127

Histopathological studies on the cystic formation of the human urothelium.

PubMed

Noda, S; Eto, K

1990-01-01

Histopathological examination of pyeloureteritis cystica and cystitis cystica revealed the mechanisms for the cystic formation of the urothelium. Chronic stimulation with inflammation or physical stimulation with crystals or calculi causes the urothelium to form an inflammatory crypt. The crypt is isolated as a result of an adhesive occlusion of the urothelium at the orifice of the crypt. This crypt is an immature cyst that cannot be clinically detected. A von Brunn's cell nest represents a cut surface of the immature cyst. The inflammatory cyst isolated from the urinary tract, i.e., the immature cyst, gradually grows into a complete cyst, i.e., a clinically visible mature cyst, because of a hydrodynamic flow between the surrounding tissue and neogenetic capillaries, and inflammation. These findings indicate that von Brunn's cell nest, and glandular and cystic formation, occur during development from an inflammatory crypt to an immature cyst and then, a mature cyst.

Clinical evaluation of Apamarga-Ksharataila Uttarabasti in the management of urethral stricture.

PubMed

Reddy, K Rajeshwar

2013-04-01

Stricture urethra, though a rare condition, still is a rational and troublesome problem in the international society. Major complications caused by this disease are obstructed urine flow, urine stasis leading to urinary tract infection, calculi formation, etc. This condition can be correlated with Mutramarga Sankocha in Ayurveda. Modern medical science suggests urethral dilatation, which may cause bleeding, false passage and fistula formation in few cases. Surgical procedures have their own complications and limitations. Uttarabasti, a para-surgical procedure is the most effective available treatment in Ayurveda for the diseases of Mutravaha Strotas. In the present study, total 60 patients of urethral stricture were divided into two groups and treated with Uttarabasti (Group A) and urethral dilatation (Group B). The symptoms like obstructed urine flow, straining, dribbling and prolongation of micturation were assessed before and after treatment. The results of the study were significant on all the parameters.

Prostate calculi in cancer and BPH in a cohort of Korean men: presence of calculi did not correlate with cancer risk

PubMed Central

Hwang, Eu-Chang; Choi, Hyang-Sik; Im, Chang-Min; Jung, Seung-Il; Kim, Sun-Ouck; Kang, Taek-Won; Kwon, Dong-Deuk; Park, Kwang-Sung; Ryu, Soo-Bang

2010-01-01

Prostatic calculi are common and are associated with inflammation of the prostate. Recently, it has been suggested that this inflammation may be associated with prostate carcinogenesis. The aim of this study was to investigate the relationship between prostatic calculi and prostate cancer (PCa) in prostate biopsy specimens. We retrospectively analyzed 417 consecutive patients who underwent transrectal ultrasonography (TRUS) and prostate biopsies between January 2005 and January 2008. Based on the biopsy findings, patients were divided into benign prostatic hyperplasia and PCa groups. TRUS was used to detect prostatic calculi and to measure prostate volume. The correlations between PCa risk and age, serum total PSA levels, prostate volume, and prostatic calculi were analyzed. Patient age and PSA, as well as the frequency of prostatic calculi in the biopsy specimens, differed significantly between both the groups (P < 0.05). In the PCa group, the Gleason scores (GSs) were higher in patients with prostatic calculi than in patients without prostatic calculi (P = 0.023). Using multivariate logistic regression analysis, we found that patient age, serum total PSA and prostate volume were risk factors for PCa (P = 0.001), but that the presence of prostatic calculi was not associated with an increased risk of PCa (P = 0.13). In conclusion, although the presence of prostatic calculi was not shown to be a risk factor for PCa, prostatic calculi were more common in patients with PCa and were associated with a higher GS among these men. PMID:20037598

Molecular mechanisms involved in the protective effect of the chloroform extract of Selaginella lepidophylla (Hook. et Grev.) Spring in a lithiasic rat model.

PubMed

Mirian, Estévez-Carmona María; Juanita, Narvaéz-Morales; Christophe, Barbier Olivier; Estela, Meléndez-Camargo María

2013-06-01

Urolithiasis is a multifaceted process, progressing from urine supersaturation to the formation of mature renal calculi. Calcium oxalate, the main component of kidney stones, has toxicological effects on renal epithelial cells. Some medicinal plants have shown pharmacological effects against renal lithiasis, such as Selaginella lepidophylla (Hook. et Grev) Spring, a plant empirically used in Mexico for its diuretic and antilithiasic activity. The plant was identified and ground, and a chloroform extract (CE) was obtained. Urolithiasis was induced in Wistar female rats by administration of ethylene glycol and ammonium chloride for 21 days. Urolithiasis rats were treated with the CE (50 mg/kg) for 21 days. Osmolality, creatinine, sodium and potassium concentrations were measured in blood and urine. Glomerular filtration rate (GFR), and electrolytic and water balances were calculated. Urinary oxalic acid concentration was measured. Apoptosis, lipoperoxidation, ROS and p-amino hippuric acid were determined in cortical tissue. Urolithiasis rats showed a decrease of urinary flow, GFR, electrolytic balance, renal tubular secretion and ATP concentration and increase of urinary oxalic acid, lipoperoxidation, oxidative stress and apoptosis in cortical tissue. After treatment with the CE, urinary flow rate, GFR and renal tubular secretion levels were recovered; on the other hand, serum creatinine and urinary oxalic acid decreased on day 21. CE of Selaginella lepidophylla prevented the damage caused by lithiasic process by improving the active secretion in the proximal tubules, counteracting the ROS and lipoperoxidation effects by oxalate and decreased the OAT3 expression on kidney.

Urinary Tract Infection among Renal Transplant Recipients in Yemen

PubMed Central

Gondos, Adnan S.; Al-Moyed, Khaled A.; Al-Robasi, Abdul Baki A.; Al-Shamahy, Hassan A.; Alyousefi, Naelah A.

2015-01-01

Urinary tract infection (UTI) is the most common complication following kidney transplantation (KT), which could result in losing the graft. This study aims to identify the prevalence of bacterial UTI among KT recipients in Yemen and to determine the predisposing factors associated with post renal transplantation UTI. A cross sectional study included of 150 patients, who underwent KT was conducted between June 2010 and January 2011. A Morning mid-stream urine specimen was collected for culture and antibiotic susceptibility test from each recipient. Bacterial UTI was found in 50 patients (33.3%). The prevalence among females 40.3% was higher than males 29%. The UTI was higher in the age group between 41–50 years with a percentage of 28% and this result was statistically significant. Predisposing factors as diabetes mellitus, vesicoureteral reflux, neurogenic bladder and polycystic kidney showed significant association. High relative risks were found for polycystic kidney = 13.5 and neurogenic bladder = 13.5. The most prevalent bacteria to cause UTI was Escherichia coli represent 44%, followed by Staphylococcus saprophyticus 34%. Amikacin was the most effective antibiotic against gram-negative isolates while Ciprofloxacin was the most effective antibiotic against Staphylococcus saprophyticus. In conclusion, there is high prevalence of bacterial UTI among KT recipients in Yemen. Diabetes mellitus, vesicoureteral reflux, neurogenic bladder, polycystic kidney and calculi were the main predisposing factors. PMID:26657128

Impact of loop-tail ureteral stents on ureteral stent-related symptoms immediately after ureteroscopic lithotripsy: Comparison with pigtail ureteral stents

PubMed Central

Inoue, Takaaki; Muguruma, Kouei; Murota, Takashi; Kinoshita, Hidefumi; Matsuda, Tadashi

2017-01-01

Purpose To evaluate urination-related quality of life (QoL) in patients with an indwelling ureteral stent immediately after ureteroscopic lithotripsy (URSL) for upper urinary calculi. We compared the effects of loop-tail and pigtail ureteral stents on urination-related QoL. Materials and Methods Of 135 patients who underwent URSL between May 2014 and March 2015 at our hospital, we retrospectively analyzed the records of 70 patients (42 men, 28 women; median age, 63 years) in whom the stent tail was positioned inside the bladder without crossing the midline and who completed the core lower urinary tract symptoms score (CLSS) questionnaire pre- and postoperatively. Results There were significant differences in incomplete emptying (p=0.048) and bladder pain (p=0.041) between patients with loop-tail versus pigtail ureteral stents after URSL. In the multivariate analysis, stent type had a stronger association with incomplete emptying (p=0.022) and bladder pain (p=0.018) than age, sex, body mass index, stent side, operation time, diameter of ureteral access sheath, and stent type. Conclusions Patients with loop-tail ureteral stents had better urination-related QoL in the immediate post-URSL stage than patients with pigtail stents. PMID:29124244

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.

An alternative treatment modality in closing bladder exstrophy: use of rectus abdominus muscle flap--preliminary results in a rat model.

PubMed

Büyükünal, S N; Kaner, G; Celayir, S

1989-06-01

The aim of this study was to find a new alternate method for bladder exstrophies with small capacity and inelasticity, and to resolve complications of other bladder augmentation techniques. In 50 Wistar albino rats, a large bladder defect was created excising at least one half of their original bladder, keeping the peritrigonal zone intact. In each rat, a 2.5 x 1-cm inferiorly based rectus abdominus muscle flap was prepared from the lower abdominal quadrant. This flap was then rotated to cover the bladder defect. The inner layer formed by the peritoneum was sutured to the edges of the bladder defect by 6-0 separate sutures. The post-operative radiologic and scintigraphic examination of the urinary system done at different intervals showed no difference from that of normal rats. The only observed disadvantage of this technique was the formation of calculi in the bladder in 8/50 rats in the late post-operative period. Post-mortem histopathologic investigations performed at different intervals showed the inner layer of the flap to be completely covered by the transitional urinary epithelium of the bladder. We think this technique is easy to perform, non-time-consuming, and has a low complication rate. It may be useful in infants with small, noncompliant, inelastic bladder exstrophies.

Measurement of urinary cystine and cysteinyl-penicillamine in patients with cystinuria.

PubMed

Sampson, D C; Stewart, P M; Hammond, J W

1986-02-01

A high-performance liquid chromatographic method with electrochemical detection (LC/EC) was developed to measure cystine and cysteinyl-penicillamine disulfide in the urine of patients screened or treated for cystinuria. Urine was acidified, centrifuged to remove urinary protein, diluted and injected. The disulfides were separated on a reversed-phase column, reduced at the upstream electrode of a dual electrochemical detector with gold-mercury amalgam (Au/Hg) electrodes and the resultant thiols measured at the downstream electrode. The sample preparation is simple, the analysis rapid, specimens can be easily batched and the specificity of the method is better than those of two other separative procedures with which it was compared. The coefficient of variation for cystine in cystinuric urine is 6.7%, 5.5% and 3.2% for levels of 0.09, 0.52 and 1.02 mmol/l respectively, and for cysteinyl-penicillamine disulfide 2.6% and 7.5% for levels of 0.45 and 0.98 mmol/l respectively. Urine for analysis of these disulfides should not be collected within 24 hours of administration of the radiopaque agent diatrizoate but no other interference to the assay has been noted. This method is suitable as a screen for cystinuria in patients with renal tract calculi, for ongoing monitoring of cystinuric patients and to check patient compliance with d-penicillamine therapy.

Obstructive uropathy and severe acute kidney injury from renal calculi due to adenine phosphoribosyltransferase deficiency.

PubMed

Chong, Siew Le; Ng, Yong Hong

2016-05-01

Adenine phosphoribosyltransferase (APRT) deficiency is an uncommon genetic cause of chronic kidney disease due to crystalline nephropathy. A case of a Chinese boy with APRT deficiency presenting with severe acute kidney injury secondary to obstructive uropathy from multiple renal calculi was reviewed. The patient underwent staged removal of the calculi. Infrared spectrometry of the renal calculi showed 2,8-dihydroxyadenine. APRT deficiency was confirmed with abolished APRT enzyme activity in red blood cells. He was started on allopurinol and low purine diet with complete resolution of the residual calculi. APRT deficiency should be considered in patients with multiple radiolucent renal calculi.

Parsley! Mechanism as antiurolithiasis remedy.

PubMed

Al-Yousofy, Fayed; Gumaih, Hussein; Ibrahim, Hassan; Alasbahy, Afrah

2017-01-01

Parsley is a medicinal plant used widely in urolithiasis. The present study aimed to evaluate the antiurolithiatic effect of parsley and its mechanism. 24 rats divided into four groups: group A (negative control), group B (positive control), group C (cystone ® group) and group D (parsley group). Group B were treated with EG and Ammonium chloride (AC). Group C were treated as B plus cystone ® and group D was treated as B plus parsley. The period of experiment was 15 days. Urine samples were analysis on days 0 and 15 days. Kidneys of rats from all groups were removed, and histopathologically examined. The kidnies of parsley treated group appeared mostly to be calculi-free (less CaOx) even better than the cystone treated group. CaOx crystals was significantly lower both in histological sections and in urine samples in parsley treated group. We further investigated the mechanism of parsley by adding another 6 rats. The latter treated by parsley only after adaptation period. We found significant increase in urine volume and pH in parsley treated rats compared to negative control. We concluded that parsley acts as antiurolithiatic drug through decreasing urinary calcium excretion, increasing urinary pH, dieresis, decreasing urinary protein excretion and its nephroprtective activity. We recommended to use it in pharmaceutical forms as it is safe and effective as antiurolithiasis remedy.

The urological complications of renal transplantation: a series of 1535 patients.

PubMed

Streeter, E H; Little, D M; Cranston, D W; Morris, P J

2002-11-01

To determine the incidence of urological complications of renal transplantation at one institution, and relate this to donor and recipient factors. A consecutive series of 1535 renal transplants were audited, and a database of donor and recipient characteristics created for risk-factor analysis. An unstented Leadbetter-Politano anastomosis was the preferred method of ureteric reimplantation. There were 45 urinary leaks, 54 primary ureteric obstructions, nine cases of ureteric calculi, three bladder stones and 19 cases of bladder outlet obstruction at some time after transplantation. The overall incidence of urological complications was 9.2%, with that for urinary leak or primary ureteric obstruction being 6.5%. One graft was lost because of complications, and there were three deaths associated directly or indirectly with urological complications. There was no association with recipient age, cadaveric vs living-donor transplants, or cold ischaemic times before organ reimplantation, although the donor age was slightly higher in cases of urinary leak. There was no association with kidneys imported via the UK national organ-sharing scheme vs the use of local kidneys. The management of these complications is discussed. The incidence of urological complications in this series has remained essentially unchanged for 20 years. The causes of these complications and techniques for their prevention are discussed.

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.

[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.

Types of Renal Calculi and Management Regimen for Chinese Minimally Invasive Percutaneous Nephrolithotomy.

PubMed

Gu, Si-Ping; Zeng, Guo-Hua; You, Zhi-Yuan; Lu, Yi-Jin; Huang, Yun-Teng; Wang, Qing-Mao; He, Zhao-Hui

2015-12-01

Strict selection of patients for minimally invasive percutaneous nephrolithotomy could effectively improve the success rate of surgery. This study aimed to understand the required skills and the efficacy of mini-PCNL in the treatment of five types of upper ureteral calculi. Data collected after X-ray analysis and B mode ultrasound from 633 patients with upper ureteral and renal pelvis calculi who underwent B ultrasound-guided lithotomy was reviewed, including the following: type I, upper ureteral or renal pelvis calculi with moderate hydronephrosis (154 cases); type II, upper ureteral or renal pelvis calculi with severe hydronephrosis (157 cases); type III, upper ureteral or renal pelvis calculi without hydronephrosis (61 cases); type IV, renal pelvis calculi, one or two renal calyx calculi (206 cases); and type V, renal staghorn calculi (55 cases). Operations on 611 cases were successful. The treatment method for five patients was converted to open surgery. Twelve cases were treated by indwelling double-J tube retro-catheterization and extracorporeal shock wave lithotripsy. Five patients gave up the treatment. The rate of calculus clearance was 82.3 %, and the rate of residual calculus was 17.6 %. Selective renal artery embolization was performed in nine cases. Hydropneumothorax occurred in nine cases. No intestinal fistula occurred, and no patient had to undergo nephrectomy. The difficulty and the curative effect of the operation were different because the types of calculi varied. Selection of the procedure based on the different types of calculi could effectively improve the success rate of the procedure, reduce complications, and shorten the learning curve.

Is Tubeless Percutaneous Nephrolithotomy a Feasible Technique for the Treatment of Staghorn Calculi?

PubMed Central

Lee, Sang Cheol; Kim, Chang Hee; Kim, Kwang Taek; Kim, Tae Beom; Kim, Khae Hawn; Jung, Han; Yoon, Sang Jin

2013-01-01

Purpose Tubeless percutaneous nephrolithotomy (PNL) remains a challenging technique for the surgical treatment of staghorn renal calculi. Our study was designed to compare surgical outcomes between conventional and tubeless PNL. Materials and Methods We retrospectively enrolled consecutive patients who underwent conventional or tubeless PNL under general anesthesia performed by a single surgeon (H.J.) for the treatment of staghorn calculi between 2003 and 2012. All patients were divided into two groups: group 1 included patients who underwent conventional PNL and group 2 included patients who were managed by tubeless PNL for the treatment of staghorn calculi. Preoperative and postoperative parameters were analyzed between the two groups, including age, stone burden, complications, any interventions, and duration of hospital stay. Results A total of 165 patients (group 1, 106; group 2, 59) were enrolled in the study. No significant differences in age, sex, body mass index, or stone laterality were observed between the two groups. The mean stone burdens (±standard deviation) of group 1 and group 2 were 633.6 (±667.4) and 529.9 (±362.8), respectively (p=0.271). The postoperative stone-free clearance rate was higher in group 2 (78.0%) than in group 1 (69.8%); however, the difference was not clinically significant (p=0.127). In addition, no significant differences in postoperative complications, including fever, bleeding, infection, or additional interventions, were observed between the two groups. Conclusions Our results demonstrated that tubeless PNL has the same effectiveness and safety as conventional PNL in the treatment of staghorn calculi. Tubeless PNL may be feasible for managing renal staghorn calculi. PMID:24175044

Pulp stones can help in detection of calculus in the kidneys and/or in the bile--fact or fiction?

PubMed

Aleksova, Pavlina; Serafimoski, Vladimir; Popovska, Mira; Ristovski, Milčo

2013-01-01

Pulp stones or denticles are frequently found in the dental pulp; there is, however, scarce evidence about this phenomenon. Regardless of the obvious endodontic problem of inhibiting access to the canals and their further treatment, they have not been given great importance. The latest experiences of scientific and practical research, including examinations of dental calcifications and their association with calcifications/calculi in the organism, have not been included in the literature. To investigate the possible association between dental calcifications and calculi in the kidney and/or bile. The study group included 200 patients diagnosed with pulptits chronica. All patients underwent dental and systematic examinations. Dental examination included x-rays, which detected the presence of calcifications in the dental pulps. Histopathological analysis of extirpated pulps was also made. Clinical examination comprised ultrasound that detected calculi. The results of the histopathological analysis of the extirpated pulps from the group of patients without denticles, but with calculi in their kidneys, bile and/or other organs, showed a regular presence of "sand" in large quantities in dental pulps. The presence of "sand" was depicted as presence of dystrophic calcifications. There was a percentage difference between the two groups: calculi in the organism (kidney and bile) and denticles--70% and calculi in the organism without denticles--30%. The Student's t-test showed a statistically significant difference for P=0.0000. This study defines the association between the calculi in the organism and the presence of dental calcifications, as well as their possible bacterial association.

Retrograde intrarenal surgery for lower pole renal calculi smaller than one centimeter

PubMed Central

Shah, Hemendra Navinchandra

2008-01-01

Objectives: Recently there has been an increasing interest in the application of retrograde intrarenal surgery (RIRS) for managing renal calculi. In this review we discuss its application for the management of lower calyceal (LC) stones less than 10 mm in maximum dimension. Materials and Methods: Literature was reviewed to summarize the technical development in flexible ureterorenoscopy and its accessories. Further, the indications, outcome and limitations of RIRS for LC calculi < 1 cm were reviewed. Results: Use of access sheath and displacement of LC stone to a more favorable location is increasingly employed during RIRS. Patients who are anticoagulated or obese; those with adverse stone composition and those with concomitant ureteral calculi are ideally suited for RIRS. It is used as a salvage therapy for shock wave lithotripsy (SWL) refractory calculi but with a lower success rate (46-62%). It is also increasingly being used as a primary modality for treating LC calculi, with a stone-free rate ranging from 50-90.9%. However, the criteria for defining stone-free status are not uniform in the literature. The impact of intrarenal anatomy on stone-free rates after RIRS is unclear; however, unfavorable lower calyceal anatomy may hamper the efficacy of the procedure. The durability of flexible ureteroscopes remains an important issue. Conclusions: RIRS continues to undergo significant advancements and is emerging as a first-line procedure for challenging stone cases. The treatment of choice for LC calculi < 1 cm depends on patient's preference and the individual surgeon's preference and level of expertise. PMID:19468515

Human Health Effects of Biphenyl: Key Findings and Scientific Issues

PubMed Central

Li, Zheng; Hogan, Karen A.; Cai, Christine; Rieth, Susan

2015-01-01

Background: In support of the Integrated Risk Information System (IRIS), the U.S. Environmental Protection Agency (EPA) has evaluated the human health hazards of biphenyl exposure. Objectives: We review key findings and scientific issues regarding expected human health effects of biphenyl. Methods: Scientific literature from 1926 through September 2012 was critically evaluated to identify potential human health hazards associated with biphenyl exposure. Key issues related to the carcinogenicity and noncancer health hazards of biphenyl were examined based on evidence from experimental animal bioassays and mechanistic studies. Discussion: Systematic consideration of experimental animal studies of oral biphenyl exposure took into account the variety of study designs (e.g., study sizes, exposure levels, and exposure durations) to reconcile differing reported results. The available mechanistic and toxicokinetic evidence supports the hypothesis that male rat urinary bladder tumors arise through urinary bladder calculi formation but is insufficient to hypothesize a mode of action for liver tumors in female mice. Biphenyl and its metabolites may induce genetic damage, but a role for genotoxicity in biphenyl-induced carcinogenicity has not been established. Conclusions: The available health effects data for biphenyl provides suggestive evidence for carcinogenicity in humans, based on increased incidences of male rat urinary bladder tumors at high exposure levels and on female mouse liver tumors. Kidney toxicity is also a potential human health hazard of biphenyl exposure. Citation: Li Z, Hogan KA, Cai C, Rieth S. 2016. Human health effects of biphenyl: key findings and scientific issues. Environ Health Perspect 124:703–712; http://dx.doi.org/10.1289/ehp.1509730 PMID:26529796

Alcea rosea root extract as a preventive and curative agent in ethylene glycol-induced urolithiasis in rats

PubMed Central

Ahmadi, Marzieh; Rad, Abolfazl Khajavi; Rajaei, Ziba; Hadjzadeh, Mousa-Al-Reza; Mohammadian, Nema; Tabasi, Nafiseh Sadat

2012-01-01

Introduction: Alcea rosea L. is used in Asian folk medicine as a remedy for a wide range of ailments. The aim of the present study was to investigate the effect of hydroalcoholic extract of Alcea rosea roots on ethylene glycol-induced kidney calculi in rats. Materials and Methods: Male Wistar rats were randomly divided into control, ethylene glycol (EG), curative and preventive groups. Control group received tap drinking water for 28 days. Ethylene glycol (EG), curative and preventive groups received 1% ethylene glycol for induction of calcium oxalate (CaOx) calculus formation; preventive and curative subjects also received the hydroalcoholic extract of Alcea rosea roots in drinking water at dose of 170 mg/kg, since day 0 or day 14, respectively. Urinary oxalate concentration was measured by spectrophotometer on days 0, 14 and 28. On day 28, the kidneys were removed and examined histopathologically under light microscopy for counting the calcium oxalate deposits in 50 microscopic fields. Results: In both preventive and curative protocols, treatment of rats with hydroalcoholic extract of Alcea rosea roots significantly reduced the number of kidney calcium oxalate deposits compared to ethylene glycol group. Administration of Alcea rosea extract also reduced the elevated urinary oxalate due to ethylene glycol. Conclusion: Alcea rosea showed a beneficial effect in preventing and eliminating calcium oxalate deposition in the rat kidney. This effect is possibly due to diuretic and anti-inflammatory effects or presence of mucilaginous polysaccharides in the plant. It may also be related to lowering of urinary concentration of stone-forming constituents. PMID:22701236

[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.

Prevalence of scrotal calculi and their relationship with pain.

PubMed

Tan, Sinan; Özcan, Muhammet Fuat; Karaoğlanoğlu, Mustafa; Ipek, Ali; Özcan, Ayşenur Sirin; Arslan, Halil

2012-01-01

The purpose of this study was to determine the frequency of scrotal calculi in men referred for scrotal ultrasonography (US), to identify any associated pathologies, and to investigate if any relationship exists between scrotal lithiasis and pain. This was a retrospective study in which 4084 scrotal US examinations in 3435 men were evaluated. Scrotal US was performed using a high-frequency linear transducer. Forty patients were questioned as to whether scrotal pain was present. Patients were asked to grade their scrotal pain intensity using the Numerical Rating Scale. Sixty-seven of the 3435 patients with scrotal US examinations had scrotal calculi with a mean size of 3.7 ± 1.4 mm (range, 1.6-7 mm). Twenty patients with scrotal calculi had no scrotal pain. Nine patients with scrotal pain (22.5%) had no US or clinical abnormalities except scrotal calculi. The frequency of scrotal calculi was 1.95%. Approximately one-quarter of patients with scrotal calculi and pain had no additional abnormalities. Therefore, scrotal calculi should be considered in the differential diagnosis of scrotal pain.

Evaluation of the sensitivity of scout radiographs on unenhanced helical CT in identifying ureteric calculi: a large UK tertiary referral centre experience

PubMed Central

Yap, W W; Belfield, J C; Bhatnagar, P; Kennish, S; Wah, T M

2012-01-01

Objective Unenhanced helical CT for kidney, ureter and bladder (CT KUB) has become the standard investigation for renal colic. This study aims to determine the sensitivity of scout radiographs in detecting ureteric calculi using CT KUB as a standard reference. Methods A retrospective review of consecutive patients who presented with acute flank pain and were investigated using CT KUB. 201 patients with positive ureteric calculi were included. Two radiologists independently reviewed the scout radiographs with access to CT KUB images. Each observer recorded the presence or absence of calculi, location, size and mean Hounsfield units of each calculus. Results 203 ureteric calculi were analysed from 201 patients. The overall sensitivity of scout radiographs for Observer A was 42.3% and for Observer B 52.2%, with an interobserver reliability κ-value of 0.78. The significance of mean Hounsfield units and size between two groups of patients with visible stones and those not visible were tested; the p-value for both variables was <0.0001, which is statistically significant. The study found that calculi in the upper ureter and larger than 4 mm are more likely to be seen on the scout radiograph. Conclusions Usage of CT scout radiography should be encouraged and reported routinely in conjunction with CT KUB as a baseline for treatment follow-up. PMID:22665926

Diagnostic utility of attenuation measurement (Hounsfield units) in computed tomography stonogram in predicting the radio-opacity of urinary calculi in plain abdominal radiographs.

PubMed

Chua, Michael E; Gatchalian, Glenn T; Corsino, Michael Vincent; Reyes, Buenaventura B

2012-10-01

(1) To determine the best cut-off level of Hounsfield units (HU) in the CT stonogram that would predict the appearance of a urinary calculi in plain KUB X-ray; (2) to estimate the sensitivity and specificity of the best cut-off HU; and (3) to determine whether stone size and location affect the in vivo predictability. A prospective cross-sectional study of patients aged 18-85 diagnosed with urolithiases on CT stonogram with concurrent plain KUB radiograph was conducted. Appearance of stones was recorded, and significant difference between radiolucent and radio-opaque CT attenuation level was determined using ANOVA. Receiver operating characteristics (ROC) curve determined the best HU cut-off value. Stone size and location were used for factor variability analysis. A total of 184 cases were included in this study, and the average urolithiasis size on CT stonogram was 0.84 cm (0.3-4.9 cm). On KUB X-ray, 34.2 % of the urolithiases were radiolucent and 65.8 % were radio-opaque. Mean value of CT Hounsfield unit for radiolucent stones was 358.25 (±156), and that for radio-opaque stones was 816.51 (±274). ROC curve determined the best cut-off value of HU at 498.5, with the sensitivity of 89.3 % and specificity of 87.3 %. For >4 mm stones, the sensitivity was 91.3 % and the specificity was 81.8 %. On the other hand, for =<4 mm stones, the sensitivity was 60 % and the specificity was 89.5 %. Based on the constructed ROC curve, a threshold value of 498.5 HU in CT stonogram was established as cut-off in determining whether a calculus is radio-opaque or radiolucent. The determined overall sensitivity and specificity of the set cut-off HU value are optimal. Stone size but not location affects the sensitivity and specificity.

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.

Sensitivity of Noncontrast Computed Tomography for Small Renal Calculi With Endoscopy as the Gold Standard.

PubMed

Bhojani, Naeem; Paonessa, Jessica E; El Tayeb, Marawan M; Williams, James C; Hameed, Tariq A; Lingeman, James E

2018-04-03

To compare the sensitivity of noncontrast computed tomography (CT) with endoscopy for detection of renal calculi. Imaging modalities for detection of nephrolithiasis have centered on abdominal x-ray, ultrasound, and noncontrast CT. Sensitivities of 58%-62% (abdominal x-ray), 45% (ultrasound), and 95%-100% (CT) have been previously reported. However, these results have never been correlated with endoscopic findings. Idiopathic calcium oxalate stone formers with symptomatic calculi requiring ureteroscopy were studied. At the time of surgery, the number and the location of all calculi within the kidney were recorded followed by basket retrieval. Each calculus was measured and sent for micro-CT and infrared spectrophotometry. All CT scans were reviewed by the same genitourinary radiologist who was blinded to the endoscopic findings. The radiologist reported on the number, location, and size of each calculus. Eighteen renal units were studied in 11 patients. Average time from CT scan to ureteroscopy was 28.6 days. The mean number of calculi identified per kidney was 9.2 ± 6.1 for endoscopy and 5.9 ± 4.1 for CT (P <.004). The mean size of total renal calculi (sum of the longest stone diameters) per kidney was 22.4 ± 17.1 mm and 18.2 ± 13.2 mm for endoscopy and CT, respectively (P = .06). CT scan underreports the number of renal calculi, probably missing some small stones and being unable to distinguish those lying in close proximity to one another. However, the total stone burden seen by CT is, on average, accurate when compared with that found on endoscopic examination. Copyright © 2018 Elsevier Inc. All rights reserved.

Effects of shielded or unshielded laser and electrohydraulic lithotripsy on rabbit bladder.

PubMed

Bhatta, K M; Rosen, D I; Flotte, T J; Dretler, S P; Nishioka, N S

1990-04-01

The pulsed dye laser and electrohydraulic lithotriptor (EHL) are both effective devices for fragmenting urinary and biliary calculi. Both fragment stones by producing a plasma-mediated shockwave. Recently, a plasma shield consisting of a hollow spring and a metal end cap has been described for use with the laser and EHL devices in an attempt to minimize tissue damage without adversely affecting stone fragmentation rates. The tissue effects produced by a pulsed dye laser and an EHL device with and without plasma shields were examined and compared using rabbit urinary bladders. If blood was present, the unshielded laser perforated the bladder wall in two pulses. However, in the absence of blood, over 100 pulses were needed for the laser to perforate the bladder. A mean of six pulses were required to perforate the bladder wall with a shielded laser. The unshielded EHL perforated the bladder wall in two pulses, whereas, the shielded EHL required a mean of 35 pulses. Microscopically, areas of exposure revealed hemorrhage and tissue ablation. We conclude that all devices examined can produce significant tissue damage when discharged directly onto bladder epithelium.

Xanthine crystals induced by topiroxostat, a xanthine oxidoreductase inhibitor, in rats, cause transitional cell tumors.

PubMed

Shimo, Takeo; Moto, Mitsuyoshi; Ashizawa, Naoki; Matsumoto, Koji; Iwanaga, Takashi; Saito, Kazuhiro

2014-04-01

The present study was performed to elucidate the underlying mechanism of transitional cell tumors found in the carcinogenicity testing of topiroxostat, a xanthine oxidoreductase inhibitor, in which topiroxostat was orally given to F344 rats at 0.3, 1, and 3 mg/kg for 2 years. In the urinary bladder, transitional cell papillomas and/or carcinomas were seen in males receiving 0.3, 1, and 3 mg/kg (1/49, 3/49, and 10/50, respectively). In the kidney, transitional cell papillomas and/or carcinomas in the pelvis were seen in 2/50 males and 1/50 females receiving 3 mg/kg. In the mechanistic study by 52-week oral treatment with topiroxostat at 3 mg/kg to F344 male rats, with and without citrate, simple and papillary transitional cell hyperplasias of the urinary bladder epithelium were observed in 5/17 in the topiroxostat-alone treatment group, along with xanthine-induced nephropathy, in contrast to neither xanthine crystals nor lesions in urinary organs by co-treatment group with citrate. As for sex differences of urinary bladder tumors, the BrdU labeling index for epithelial cells of the urinary bladder by 5-week oral treatment with topiroxostat at 10 mg/kg to F344 rats was increased in males only, showing consistency with histopathological findings. Therefore, the present study indicates that transitional cell tumors induced by topiroxostat in rats were due to physical stimulation to transitional cells of xanthine crystals/calculi and provides that other factors were not implicated in this tumorigenesis. Furthermore, the present study suggests that such tumors do not predict for humans since topiroxostat-induced xanthine deposition is a rodent-specific event.

Does Stone Removal Help Patients with Recurrent Urinary Tract Infections?

PubMed

Omar, Mohamed; Abdulwahab-Ahmed, Abdullahi; Chaparala, Hemant; Monga, Manoj

2015-10-01

We evaluated the impact of surgical extraction of nonobstructing asymptomatic stones on recurrent urinary tract infections and identified predictors of patients who may be rendered infection-free. We retrospectively reviewed charts to identify patients with recurrent urinary tract infections who underwent surgical stone extraction and were rendered stone-free. Demographic variables as well as procedure, infectious etiology, stone composition and the systemic inflammatory response syndrome rate were also recorded. Patients were divided into 2 groups. Group 1 had no evidence of recurrent infection following surgery while recurrent infection developed in group 2. Univariate analysis was performed using the Wilcoxon signed rank and Fisher exact tests. Logistic regression was used for multivariate analysis. We identified 120 patients with recurrent urinary tract infections and a nonobstructive renal stone. Surgical management included shock wave lithotripsy in 32% of cases, ureteroscopy in 7% and percutaneous nephrolithotomy in 61%. Of the 120 patients 58 (48%) remained infection-free after surgery while 62 (52%) experienced recurrent infection. Factors associated with a higher risk of recurrent infections included type 2 diabetes mellitus (OR 1.73, p = 0.01), hypertension (OR 2.8, p = 0.007) and black ethnicity (OR 13.7, p = 0.009). Escherichia coli infections were more likely to resolve (OR 0.34, p = 0.01). In contrast, Enterococcus infections were more likely to persist (OR 2.5, p = 0.04). On multiple logistic regression analysis only race, hypertension and E. coli infections were significant predictors of infection clearance. Of patients with recurrent urinary tract infections and asymptomatic renal calculi 50% may be rendered infection-free following stone extraction. Patients with risk factors for recurrent infections after surgery should be counseled that stone extraction might not eradicate the infection. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Possible etiology of calculi formation in salivary glands: biophysical analysis of calculus.

PubMed

Mimura, Masafumi; Tanaka, Nobuyuki; Ichinose, Shizuko; Kimijima, Yutaka; Amagasa, Teruo

2005-09-01

Sialolithiasis is one of the common diseases of the salivary glands. It was speculated that, in the process of calculi formation, degenerative substances are emitted by saliva and calcification then occurs around these substances, and finally calculi are formed. However, the exact mechanism of the formation of calculi is still unclear. In this study, we identify some possible etiologies of calculi formation in salivary glands through biophysical analysis. Calculi from 13 patients with submandibular sialolithiasis were investigated by transmission electron microscopy, scanning electron microscopy, X-ray microanalyzer, and electron diffraction. Transmission electron microscopic observation of calculi was performed in the submandibular gland (n = 13). In 3 of the 13 cases, a number of mitochondria-like structures and lysosomes were found near calcified materials. Scanning electron microscopic examination of these materials revealed that there were lamellar and concentric structures and that the degree of calcification was different among the calculi. X-ray microanalysis disclosed the component elements in the calculi to be Ca, P, S, Na, etc., and the main constituents were Ca and P. The calcium-to-phosphorus ratio was 1.60-1.89. Analysis of the area including mitochondria-like structures, lysosomes, and the fibrous structures by electron diffraction revealed the presence of hydroxyapatite and calcified materials. It is speculated that mitochondria and lysosomal bodies from the ductal system of the submandibular gland are an etiological source for calcification in the salivary gland.

Salivary Calculi Removal by Minimally Invasive Techniques: A Decision Tree Based on the Diameter of the Calculi and Their Position in the Excretory Duct.

PubMed

Foletti, Jean Marc; Graillon, Nicolas; Avignon, Simon; Guyot, Laurent; Chossegros, Cyrille

2018-01-01

To suggest a decision tree for the choice of the best minimally invasive technique to treat submandibular and parotid calculi, according to the diameter of the calculi and their position in the excretory duct. Submandibular and parotid ducts can both be divided into thirds, delineated by easily recognizable landmarks. The diameter of calculi is schematically classified into 1 of these 3 categories: floating, slightly impacted, or largely impacted. Using 3 criteria, the type of gland involved (G), the topography (T) of the calculus and its diameter (D), a 3-stage GTD classification of calculi was established. Next, the best indication for each available minimally invasive technique (sialendoscopy, transmucosal approach, a combined approach, intra- or extracorporeal stone fragmentation) was determined for each calculus stage. The minimally invasive treatment options are numerous and have replaced invasive resection surgical approaches (submandibulectomy and parotidectomy) in the management of salivary calculi, significantly improving the prognosis of these diseases. We emphasize the need for flexibility in the surgical indications and challenge the dogma of "all endoscopic" management of salivary calculi. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Electromagnetic shock-wave lithotripsy of gallbladder calculi. Multicentered preliminary report on experience with 276 patients.

PubMed

Classen, M; Cremer, M; Faustini, S; Meiser, G; zum Büschenfelde, M; Neuhaus, H; Ott, R; Pizzi, P; Salvini, A; Staritz, M

1990-08-01

The Lithostar Working Group reports on the first 276 patients who underwent lithotripsy of biliary calculi by means of an electromagnetic Lithotriptor (Lithostar Plus from Siemens). Some 66% (183/276) and 27% (75/276) of the patients had solitary and two or three stones, respectively while 7% (18/276) had more than three gallbladder calculi. Calcified calculi were found in 11% of the patients. On an average the patients were treated in 1.6 (range 1.4-2.15) sessions; with the exception of one user the maximal energy (setting 9) was applied. The upper limit of shock waves per session was 1500-6000 (x = 2189 +/- 1058). 17% and 48% of the patients were free from calculi after 3 and 6 months, respectively. During the follow-up period 14% of the patients complained of severe biliary pain and 1.5% suffered from pancreatitis, which was controlled by conservative treatment. In three out of five patients with a transitory cholestatic jaundice endoscopic papillotomy was necessary. Four patients underwent an elective cholecystectomy. Considering the selection of the patients, the results obtained are comparable with those found in other studies.

Sialoendoscopically assisted open sialolithectomy for removal of large submandibular hilar calculi.

PubMed

Su, Yu-xiong; Liao, Gui-qing; Zheng, Guang-sen; Liu, Hai-chao; Liang, Yu-jie; Ou, De-ming

2010-01-01

The management of large hilar calculi is a technically challenging issue during sialoendoscopic surgery. The aim of the present study was to evaluate the clinical efficacy of sialoendoscopically assisted open sialolithectomy for the removal of large submandibular hilar calculi to avoid sialoadenectomy. The present study was undertaken among patients with sialolithiasis scheduled for sialoendoscopic surgery from August 2005 to October 2008. When we failed to remove large submandibular hilar stones intraductally, we performed sialoendoscopically assisted open sialolithectomy. The clinical characteristics, pre- and intraoperative data, and outcomes were documented in a prospective fashion. Of 78 consecutive patients with submandibular sialolithiasis, 18 were treated with sialoendoscopically assisted open sialolithectomy immediately after failure of intraductal removal of calculi by sialoendoscopy. For 17 patients, large hilar sialoliths were successfully removed using this surgical technique. The surgery failed in 1 patient with multiple sialoliths, and the procedure was converted to open sialoadenectomy. Temporary numbness of the tongue for 1 week postoperatively was documented in 3 patients. The patients were followed up for a median period of 18 months without any symptoms or signs of recurrence. Our results suggest that sialoendoscopically assisted open sialolithectomy is an effective and safe surgical technique to remove large submandibular hilar calculi.

Abdominal calcifications and diagnostic imaging decision making: a topic review

PubMed Central

Bassano, John M.

2006-01-01

Abstract Objective To review commonly encountered calcifications found within the abdomen as seen on the lumbar spine radiograph and to determine which advanced imaging modality is best to thoroughly assess the patient. Methods Searches of electronic databases and textbooks were conducted to construct this narrative overview. Discussion By categorizing the type of calcification and localizing it anatomically, most often a definitive diagnosis can be reached. Two commonly encountered conditions, abdominal aortic aneurysms and urinary calculi, are used to compare the main advanced imaging modalities (diagnostic ultrasound and computed tomography) used to further assess abdominal calcifications. Conclusion In most circumstances, either diagnostic ultrasound or computed tomography will establish a definitive diagnosis and offer thorough imaging assessment for abdominal calcifications. PMID:19674671

Emphysematous pyelonephritis with calculus: Management strategies.

PubMed

Goel, Tanmaya; Reddy, Sreedhar; Thomas, Joseph

2007-07-01

Emphysematous pyelonephritis (EPN) with calculus is well recognized but with very few reports on its treatment. Our aim is to elucidate our experience in its successful management. Over four years, we diagnosed seven cases (eight renal units) of EPN, out of which two patients (three renal units) had EPN with urinary calculi. After the initial conservative management of EPN, the stones were tackled appropriately. EPN was initially managed effectively with antibiotics and supportive care. Once the patient was stable, the stones were cleared in a step-wise fashion. The associated postoperative complications were also tackled efficiently with preservation of renal function. In EPN with stones, nephrectomy is not the sole option available and they can be effectively managed with open / endoscopic measures.

Abuse of guaifenesin-containing medications generates an excess of a carboxylate salt of beta-(2-methoxyphenoxy)-lactic acid, a guaifenesin metabolite, and results in urolithiasis.

PubMed

Pickens, C L; Milliron, A R; Fussner, A L; Dversdall, B C; Langenstroer, P; Ferguson, S; Fu, X; Schmitz, F J; Poole, E C

1999-07-01

Several urinary calculi were submitted to our institution for compositional analysis. The typical techniques of analysis, polarized light microscopy, electron microprobe analysis, and infrared spectroscopy proved inadequate for a definitive identification. As a result, a more detailed organic analysis was conducted to determine the exact chemical structure of the material. Infrared spectroscopy and mass spectrometric analysis were carried out on the solid material, providing information concerning the functional groups and the molecular mass of the organic constituent and its components. The stone was solubilized in deuterated solvents and analyzed by nuclear magnetic resonance spectroscopy, which resulted in a definitive chemical structure. The spectroscopic analysis indicated that the stones were composed of a calcium salt of beta-(2-methoxyphenoxy)-lactic acid, a metabolite of the pharmaceutical guaifenesin, which is used as an expectorant. Guaifenesin, an expectorant common in over-the-counter cold and allergy remedies, can cause urolithiasis if taken in excess. Discussions with physicians and their patients confirmed that most patients admitted to taking large doses of guaifenesin-containing medications.

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".

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.

Robotically assisted ureteroscopy for kidney exploration.

PubMed

Talari, Hadi F; Monfaredi, Reza; Wilson, Emmanuel; Blum, Emily; Bayne, Christopher; Peters, Craig; Zhang, Anlin; Cleary, Kevin

2017-02-01

Ureteroscopy is a minimally invasive procedure for diagnosis and treatment of a wide range of urinary tract pathologies. It is most commonly performed in the diagnostic work-up of hematuria and the diagnosis and treatment of upper urinary tract malignancies and calculi. Ergonomic and visualization challenges as well as radiation exposure are limitations to conventional ureteroscopy. For example, for diagnostic tumor inspection, the urologist has to maneuver the ureteroscope through each of the 6 to 12 calyces in the kidney under fluoroscopy to ensure complete surveillance. Therefore, we have been developing a robotic system to "power drive" a flexible fiber-optic ureteroscope with 3D tip tracking and pre-operative image overlay. Our goal is to provide the urologist precise control of the ureteroscope tip with less radiation exposure. Our prototype system allows control of the three degrees of freedom of the ureteroscope via brushless motors and a joystick interface. The robot provides a steady platform for controlling the ureteroscope. Furthermore, the robot design facilitates a quick "snap-in" of the ureteroscope, thus allowing the ureteroscope to be mounted midway through the procedure. We have completed the mechanical system and the controlling software and begun evaluation using a kidney phantom. We put MRI-compatible fiducials on the phantom and obtained MR images. We registered these images with the robot using an electromagnetic tracking system and paired-point registration. The system is described and initial evaluation results are given in this paper.

Pre-percutaneous nephrolithotomy opacification for caliceal diverticular calculi.

PubMed

Matlaga, Brian R; Kim, Samuel C; Watkins, Stephanie L; Munch, Larry C; Chan, Brandon W; Lingeman, James E

2006-03-01

Caliceal diverticula harbor calculi in as many as 50% of cases. Such stones rarely pass spontaneously. Various stone-removal techniques have been used, with percutaneous techniques generally having the best results. In patients with nonradiopaque stones or in whom the diverticulum does not opacify when contrast is instilled retrograde or by intravenous urogram, contrast can be instilled directly into the cavity with CT or ultrasound guidance. Three such cases are described, with good results.

A biological stone from a medieval cemetery in Poland.

PubMed

Gładykowska-Rzeczycka, Judyta J; Nowakowski, Dariusz

2014-01-01

A review of the literature shows that origination of biological stones as well as their pathogenesis mostly depend on the environmental factors. As a result, the structural spectrum of such calculi and their chemical composition are highly diversified. It is well known that biological stones are formed mostly in the digestive and urinary tracts. However, it has been demonstrated that this kind of stony structure can be also, though rarely, found in circulatory and reproductive systems, skin, mucosa, and tear ducts. Although in palaeopathology, the list of biological stones is enriched by stony tumours and/or discharges, it is very difficult to uncover the small size deposits in excavation material. In the literature such findings, originating from different countries and centuries, are few. The described stone was found among the bones of an adult individual in the medieval cemetery of Gdańsk (Poland). The SEM, X-ray spectrometer and chemical evaluation revealed that it was a bladder calculus.

A Biological Stone from a Medieval Cemetery in Poland

PubMed Central

Gładykowska-Rzeczycka, Judyta J.; Nowakowski, Dariusz

2014-01-01

A review of the literature shows that origination of biological stones as well as their pathogenesis mostly depend on the environmental factors. As a result, the structural spectrum of such calculi and their chemical composition are highly diversified. It is well known that biological stones are formed mostly in the digestive and urinary tracts. However, it has been demonstrated that this kind of stony structure can be also, though rarely, found in circulatory and reproductive systems, skin, mucosa, and tear ducts. Although in palaeopathology, the list of biological stones is enriched by stony tumours and/or discharges, it is very difficult to uncover the small size deposits in excavation material. In the literature such findings, originating from different countries and centuries, are few. The described stone was found among the bones of an adult individual in the medieval cemetery of Gdańsk (Poland). The SEM, X-ray spectrometer and chemical evaluation revealed that it was a bladder calculus. PMID:25275551

Compliance with American Urological Association Guidelines for Post-Percutaneous Nephrolithotomy Antibiotics Does Not Appear to Increase Rates of Infection.

PubMed

Deshmukh, Sameer; Sternberg, Kevan; Hernandez, Natalia; Eisner, Brian H

2015-10-01

We compared infection rates after percutaneous nephrolithotomy in a group of patients without a history of infection or struvite calculi who received 24 hours or less of antibiotics postoperatively (ie compliance with AUA guidelines) vs a group that received 5 to 7 days of antibiotics postoperatively. We retrospectively reviewed the records of consecutive percutaneous nephrolithotomy procedures in patients without a history of urinary tract infection. Group 1 received 24 hours or less of antibiotics postoperatively and group 2 received a mean of 6 days of antibiotics postoperatively. A total of 52 patients in group 1 (24 hours or less of antibiotics) and 30 in group 2 (mean 6 days of antibiotics) met study inclusion criteria. In 5 group 1 patients (9.6%) fever developed within 72 hours of percutaneous nephrolithotomy but none demonstrated bacteriuria or bacteremia on cultures. No patient in group 1 was treated for urinary tract infection on postoperative days 3 to 14. In 4 group 2 patients (13.3%) fever developed within 72 hours of percutaneous nephrolithotomy. A single patient showed bacteriuria (less than 10,000 cfu mixed gram-positive bacteria) on culture while no patient demonstrated bacteremia. No patient in group 2 was treated for urinary tract infection on postoperative days 3 to 14. There was no difference in stone-free rates or the need for additional procedures between the 2 groups. In this pilot series compliance with AUA guidelines for antibiotic prophylaxis did not result in higher rates of infection than in a comparable group of 30 patients who received approximately 6 days of antibiotics postoperatively. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

[Percentage of uric acid calculus and its metabolic character in Dongjiang River valley].

PubMed

Chong, Hong-Heng; An, Geng

2009-02-15

To study the percentage of uric acid calculus in uroliths and its metabolic character in Dongjiang River valley. To analyze the chemical composition of 290 urinary stones by infrared (IR) spectroscopy and study the ratio changes of uric acid calculus. Uric acid calculus patients and healthy people were studied. Personal characteristics, dietary habits were collected. Conditional logistic regression was used for data analysis and studied the dietary risk factors of uric acid calculus. Patients with uric acid calculus, calcium oxalate and those without urinary calculus were undergone metabolic evaluation analysis. The results of uric acid calculus patients compared to another two groups to analysis the relations between the formation of uric acid calculus and metabolism factors. Uric acid calculi were found in 53 cases (18.3%). The multiple logistic regression analysis suggested that low daily water intake, eating more salted and animal food, less vegetable were very closely associated with uric acid calculus. Comparing to calcium oxalate patients, the urine volume, the value of pH, urine calcium, urine oxalic acid were lower, but uric acid was higher than it. The value of pH, urine oxalic acid and citric acid were lower than them, but uric acid and urine calcium were higher than none urinary calculus peoples. Blood potassium and magnesium were lower than them. The percentage of uric acid stones had obvious advanced. Less daily water intake, eating salted food, eating more animal food, less vegetables and daily orange juice intake, eating sea food are the mainly dietary risk factors to the formation of uric acid calculus. Urine volume, the value of pH, citric acid, urine calcium, urine uric acid and the blood natrium, potassium, magnesium, calcium, uric acid have significant influence to the information of uric acid stones.

Preoperative Belladonna and Opium Suppository for Ureteral Stent Pain: A Randomized, Double-blinded, Placebo-controlled Study

PubMed Central

Lee, Franklin C.; Holt, Sarah K.; Hsi, Ryan S.; Haynes, Brandon M.; Harper, Jonathan D.

2017-01-01

OBJECTIVE To investigate whether the use of a belladonna and opium (B&O) rectal suppository administered immediately before ureteroscopy (URS) and stent placement could reduce stent-related discomfort. METHODS A randomized, double-blinded, placebo-controlled study was performed from August 2013 to December 2014. Seventy-one subjects were enrolled and randomized to receive a B&O (15 mg/30 mg) or a placebo suppository after induction of general anesthesia immediately before URS and stent placement. Baseline urinary symptoms were assessed using the American Urological Association Symptom Score (AUASS). The Ureteral Stent Symptom Questionnaire and AUASS were completed on postoperative days (POD) 1, 3, and after stent removal. Analgesic use intra-operatively, in the recovery unit, and at home was recorded. RESULTS Of the 71 subjects, 65 had treatment for ureteral (41%) and renal (61%) calculi, 4 for renal urothelial carcinoma, and 2 were excluded for no stent placed. By POD3, the B&O group reported a higher mean global quality of life (QOL) score (P = .04), a better mean quality of work score (P = .05), and less pain with urination (P = .03). The B&O group reported an improved AUASS QOL when comparing POD1 with post-stent removal (P = .04). There was no difference in analgesic use among groups (P = .67). There were no episodes of urinary retention. Age was associated with unplanned emergency visits (P <.00) and “high-pain” measure (P = .02) CONCLUSION B&O suppository administered preoperatively improved QOL measures and reduced urinary-related pain after URS with stent. Younger age was associated with severe stent pain and unplanned hospital visits. PMID:27658661

Significant differences in struvite and cystine stone frequency seen among Chinese nephrolithiasis patients living in North America compared to those living in China

PubMed Central

Chi, Thomas; Usawachintachit, Manint; Filippou, Pauline; Bayne, David; Hu, Weiguo; Chang, Helena; Xia, Lei; Chen, Qi; Xue, Wei; He, Hui; Long, Qingzhi; Arsovska, Olga; Taylor, Eric; Paterson, Ryan; Sur, Roger L.; Chew, Ben; Stoller, Marshall L.

2016-01-01

Background Interracial disparities in nephrolithiasis prevalence have been reported, but the interplay between genetics and the environment for urinary stone disease risk factors is poorly understood. To examine how environment may alter genetic predisposition for stone formation, we established the International Chinese Consortium on Nephrolithiasis (ICCON) as a multi-institutional collaboration to examine patterns of nephrolithiasis presentation between Chinese patients living in different countries. Methods Chinese patients undergoing percutaneous nephrolithotomy (PCNL) at six participating institutions in China and North America over 4 years were reviewed retrospectively. Patient demographics and clinical data were compared between Chinese patients living in China and North America. Results A total of 806 patients were included, encompassing 721 Chinese patients living in China and 85 living in North America. Nephrolithiasis patients living in China were more likely to be male (67% vs. 56%, P=0.02), present at a younger age (48.6±15.0 vs. 55.0±13.0 years, P<0.01), and have a lower BMI (24.6±4.0 vs. 25.9±5.7, P=0.04) but were less likely to form struvite stones (5.5% vs. 14.1%, P<0.01). No cystine stone patients were seen in North American Chinese patients, whereas 1.8% of nephrolithiasis patients living in China presented with cystine stones. Similar rates of calcium-based and uric acid calculi as well as urinary pH were seen among both groups. Conclusions Significant differences exist between Chinese nephrolithiasis patients living in China compared to those living in North America, highlighting the importance of environmental factors in addition to genetics in modulating risk for urinary stone disease. PMID:27298786

Half-dose non-contrast CT in the investigation of urolithiasis: image quality improvement with third-generation integrated circuit CT detectors.

PubMed

Wang, Jun; Kang, Tony; Arepalli, Chesnal; Barrett, Sarah; O'Connell, Tim; Louis, Luck; Nicolaou, Savvakis; McLaughlin, Patrick

2015-06-01

The objective of this study is to establish the effect of third-generation integrated circuit (IC) CT detector on objective image quality in full- and half-dose non-contrast CT of the urinary tract. 51 consecutive patients with acute renal colic underwent non-contrast CT of the urinary tract using a 128-slice dual-source CT before (n = 24) and after (n = 27) the installation of third-generation IC detectors. Half-dose images were generated using projections from detector A using the dual-source RAW data. Objective image noise in the liver, spleen, right renal cortex, and right psoas muscle was compared between DC and IC cohorts for full-dose and half-dose images reconstructed with FBP and IR algorithms using 1 cm(2) regions of interest. Presence and size of obstructing ureteric calculi were also compared for full-dose and half-dose reconstructions using DC and IC detectors. No statistical difference in age and lateral body size was found between patients in the IC and DC cohorts. Radiation dose, as measured by size-specific dose estimates, did not differ significantly either between the two cohorts (10.02 ± 4.54 mGy IC vs. 12.28 ± 7.03 mGy DC). At full dose, objective image noise was not significantly lower in the IC cohort as compared to the DC cohort for the liver, spleen, and right psoas muscle. At half dose, objective image noise was lower in the IC cohort as compared to DC cohort at the liver (21.32 IC vs. 24.99 DC, 14.7% decrease, p < 0.001), spleen (19.33 IC vs. 20.83 DC, 7.20% decrease, p = 0.02), and right renal cortex (20.28 IC vs. 22.98 DC, 11.7% decrease, p = 0.005). Mean obstructing ureteric calculi size was not significantly different when comparison was made between full-dose and half-dose images, regardless of detector type (p > 0.05 for all comparisons). Third-generation IC detectors result in lower objective image noise at full- and half-radiation dose levels as compared with traditional DC detectors. The magnitude of noise reduction was greater at half-radiation dose indicating that the benefits of using novel IC detectors are greater in low and ultra-low-dose CT imaging.

Changes in intrarenal resistive index following electromagnetic extracorporeal shock wave lithotripsy.

PubMed

Mohseni, Mohammad Ghasem; H Khazaeli, Mahziar; Aghamir, Seyed Mohammad Kazem; Biniaz, Farzad

2007-01-01

Our aim was to study the changes in resistive index (RI) of the ipsilateral and contralateral kidneys following electromagnetic extracorporeal shock wave lithotripsy (SWL) of the kidney calculi. Using color Doppler ultrasonography, the RI was determined in 21 patients with unilateral caliceal and pelvic kidney calculi. The RI of the interlobar renal arteries were measured for the regions near and far from the calculi (distance, less and more than 2 cm), before, 30 minutes after, and 1 week after SWL. The same measurements were carried out for the contralateral kidney. Changes in the RI values and their relation with age were evaluated. The RI near the calculi increased 30 minutes after SWL from 0.594 +/- 0.062 to 0.620 +/- 0.048 (P = .003; 95% confidence interval, 0.020 to 0.073), but returned to the pre-SWL values 1 week later. The RI values of the region remote from the calculus and in the contralateral kidney did not change significantly. There was a weak correlation between age and the RI far from the calculus before and 1 week after SWL. There were no relationships between the RI and age, sex, weight, blood pressure, and smoking. The results suggest that SWL of the kidney calculi changes the RI only near the calculus which is immediate, transient, and not age-related.

Renal calculi in pregnancy? The role of ultralow-dose CT

PubMed Central

Nash, Zachary; Mascarenhas, Lawrence

2013-01-01

Presented is a case of an acute, right flank, loin to groin pain in the third trimester of an otherwise uncomplicated pregnancy. Renal calculi was suspected clinically and supported by radiological evidence. Temporising treatment was undertaken successfully by retrograde ureteric stenting, which became blocked, secondarily resulting in a percutaneous nephrostomy. Good symptomatic control was achieved before the delivery at 38 weeks and 1 day gestation. Postpartum intravenous urogram and ureteroscopy did not reveal evidence of calculi. The patient does not recall passing a stone. With existing diagnostic modalities having poor sensitivity and specificity, the clinical role of ultralow-dose CT is explored, in light of recent new evidence. PMID:23729704

Content and Face Validation of a Curriculum for Ultrasonic Propulsion of Calculi in a Human Renal Model

PubMed Central

Dunmire, Barbrina; Cunitz, Bryan W.; He, Xuemei; Sorensen, Mathew D.; Harper, Jonathan D.; Bailey, Michael R.; Lendvay, Thomas S.

2014-01-01

Abstract Purpose: Ultrasonic propulsion to reposition urinary tract calculi requires knowledge about ultrasound image capture, device manipulation, and interpretation. The purpose of this study was to validate a cognitive and technical skills curriculum to teach urologists ultrasonic propulsion to reposition kidney stones in tissue phantoms. Materials and Methods: Ten board-certified urologists recruited from a single institution underwent a didactic session on renal ultrasound imaging. Subjects completed technical skills modules in tissue phantoms, including kidney imaging, pushing a stone through a translucent maze, and repositioning a lower pole calyceal stone. Objective cognitive and technical performance metrics were recorded. Subjects completed a questionnaire to ascertain face and content validity on a five-point Likert scale. Results: Eight urologists (80%) had never attended a previous ultrasound course, and nine (90%) performed renal ultrasounds less frequently than every 6 months. Mean cognitive skills scores improved from 55% to 91% (p<0.0001) on pre- and post-didactic tests. In the kidney phantom, 10 subjects (100%) repositioned the lower pole calyceal stone to at least the lower pole infundibulum, while 9 (90%) successfully repositioned the stone to the renal pelvis. A mean±SD (15.7±13.3) pushes were required to complete the task over an average of 4.6±2.2 minutes. Urologists rated the curriculum's effectiveness and realism as a training tool at a mean score of 4.6/5.0 and 4.1/5.0, respectively. Conclusions: The curriculum for ultrasonic propulsion is effective and useful for training urologists with limited ultrasound proficiency in stone repositioning technique. Further studies in animate and human models will be required to assess predictive validity. PMID:24228719

Extracorporeal shockwave lithotripsy of distal ureteral calculi.

PubMed

Miller, K; Bubeck, J R; Hautmann, R

1986-01-01

To date, the use of extracorporeal shockwave lithotripsy (ESWL) has been limited to renal calculi and ureteral calculi above the pelvic brim. Modifying the position of the patient on the support of the Dornier lithotripter HM3, we were able to localize and treat distal ureteral calculi. Until April 1986, 43 patients with stones in the lower ureter underwent contact-free lithotripsy. Treatment was successful in 39 patients (90%), 2 of these requiring 2 sessions. In 4 patients treatment failed and stone removal was accomplished using ureteroscopy or open surgery. No complications or adverse side effects were encountered in the whole series. ESWL is now the method of choice for the treatment of distal ureteral calculi in our department.

Is tubeless percutaneous nephrolithotomy a feasible technique for the treatment of staghorn calculi?

PubMed

Lee, Sang Cheol; Kim, Chang Hee; Kim, Kwang Taek; Kim, Tae Beom; Kim, Khae Hawn; Jung, Han; Yoon, Sang Jin; Oh, Jin Kyu

2013-10-01

Tubeless percutaneous nephrolithotomy (PNL) remains a challenging technique for the surgical treatment of staghorn renal calculi. Our study was designed to compare surgical outcomes between conventional and tubeless PNL. We retrospectively enrolled consecutive patients who underwent conventional or tubeless PNL under general anesthesia performed by a single surgeon (H.J.) for the treatment of staghorn calculi between 2003 and 2012. All patients were divided into two groups: group 1 included patients who underwent conventional PNL and group 2 included patients who were managed by tubeless PNL for the treatment of staghorn calculi. Preoperative and postoperative parameters were analyzed between the two groups, including age, stone burden, complications, any interventions, and duration of hospital stay. A total of 165 patients (group 1, 106; group 2, 59) were enrolled in the study. No significant differences in age, sex, body mass index, or stone laterality were observed between the two groups. The mean stone burdens (±standard deviation) of group 1 and group 2 were 633.6 (±667.4) and 529.9 (±362.8), respectively (p=0.271). The postoperative stone-free clearance rate was higher in group 2 (78.0%) than in group 1 (69.8%); however, the difference was not clinically significant (p=0.127). In addition, no significant differences in postoperative complications, including fever, bleeding, infection, or additional interventions, were observed between the two groups. Our results demonstrated that tubeless PNL has the same effectiveness and safety as conventional PNL in the treatment of staghorn calculi. Tubeless PNL may be feasible for managing renal staghorn calculi.

Extracorporeal shock wave lithotripsy for pancreatic and large common bile duct stones

PubMed Central

Tandan, Manu; Reddy, D Nageshwar

2011-01-01

Extraction of large pancreatic and common bile duct (CBD) calculi has always challenged the therapeutic endoscopist. Extracorporeal shockwave lithotripsy (ESWL) is an excellent tool for patients with large pancreatic and CBD calculi that are not amenable to routine endotherapy. Pancreatic calculi in the head and body are targeted by ESWL, with an aim to fragment them to < 3 mm diameter so that they can be extracted by subsequent endoscopic retrograde cholangiopancreatography (ERCP). In our experience, complete clearance of the pancreatic duct was achieved in 76% and partial clearance in 17% of 1006 patients. Short-term pain relief with reduction in the number of analgesics ingested was seen in 84% of these patients. For large CBD calculi, a nasobiliary tube is placed to help target the calculi, as well as bathe the calculi in saline - a simple maneuver which helps to facilitate fragmentation. The aim is to fragment calculi to < 5 mm size and clear the same during ERCP. Complete clearance of the CBD was achieved in 84.4% of and partial clearance in 12.3% of 283 patients. More than 90% of the patients with pancreatic and biliary calculi needed three or fewer sessions of ESWL with 5000 shocks being delivered at each session. The use of epidural anesthesia helped in reducing patient movement. This, together with the better focus achieved with newer third-generation lithotripters, prevents collateral tissue damage and minimizes the complications. Complications in our experience with nearly 1300 patients were minimal, and no extension of hospital stay was required. Similar rates of clearance of pancreatic and biliary calculi with minimal adverse effects have been reported from the centers where ESWL is performed regularly. In view of its high efficiency, non-invasive nature and low complication rates, ESWL can be offered as the first-line therapy for selected patients with large pancreatic and CBD calculi. PMID:22110261

[Fissures in biliary calculi. Personal contribution (author's transl)].

PubMed

Nano, M; Potenzoni, F; Camandona, M; Casalegno, P A

1979-04-01

In a series of 70 patients suffering from biliary lithiasis, the roentgenologic findings of fissures in the calculi was observed in 5 cases examined by means of cholecystography and in 7 cases who underwent cholangiocholecystography. Fissures were demonstrated 11 times in calculi after surgery. The "Mercedes-Benz" sign was never observed at the abdominal examination without contrast medium. The presence of fissures may be an additional sign in the radiologic diagnosis of biliary calculi, but its value is not determinant.

Efficacy of endoscopic combined intrarenal surgery in the prone split-leg position for staghorn calculi.

PubMed

Hamamoto, Shuzo; Yasui, Takahiro; Okada, Atsushi; Koiwa, Satoshi; Taguchi, Kazumi; Itoh, Yasunori; Kawai, Noriyasu; Hashimoto, Yoshihiro; Tozawa, Keiichi; Kohri, Kenjiro

2015-01-01

Abstract Purpose: To evaluate the efficacy of endoscopic combined intrarenal surgery (ECIRS) using retrograde flexible ureteroscopy and miniature percutaneous nephrolithotomy (PNL) for the treatment of patients with staghorn calculi in the prone split-leg position. We retrospectively reviewed the records of 42 patients with staghorn calculi (45.8±3.2 mm) who underwent ECIRS using retrograde flexible ureteroscopy and miniature PNL in the prone split-leg position for the treatment of staghorn calculi in our center between December 2010 and August 2013. A flexible ureteroscope with a laser fiber was inserted through a ureteral access sheath, and lithoclast lithotripsy was performed through a mini-percutaneous tract. Both procedures were performed simultaneously by two urologists. Surgical parameters, including surgical time, stone-free (SF) rates, modified Clavien complication grades, and risk factors for residual stones, were analyzed. Fifteen patients (35.7%) had complete staghorn calculi. Among the 42 staghorn calculi treated, 23 had 0 to 5 stone branches, 14 had 6 to 10 stone branches, and 5 had ≥11 stone branches. All procedures were performed successfully using a single lithotripsy tract with the patient in the prone split-leg position. The mean surgical time was 143.2±9.2 minutes. The initial SF rate was 71.4%, and the final SF rate was 83.3% after further treatment. One patient required a blood transfusion (2.4%), but no patient experienced a ≥3 Clavien grade complication. Risk factors for residual stones were stone size, stone surface area, complete staghorn calculi, and the number of stone branches. ECIRS for staghorn calculi in the prone split-leg position is a safe, efficient, and versatile method for the effective management of staghorn calculi without the creation of multiple percutaneous tracts.

Expanding role of ureteroscopy and laser lithotripsy for treatment of proximal ureteral and intrarenal calculi.

PubMed

Bagley, Demetrius H

2002-07-01

Ureteroscopy has assumed an expanded and important role in the treatment of proximal ureteral and intrarenal calculi with the development of new endoscopes, more effective grasping devices, and the holmium laser lithotriptor. The success rate for treating proximal ureteral stones with small rigid and flexible ureteroscopes and the holmium laser is well over 90%. Lower pole renal calculi can also be treated with a success rate of approximately 80%, which surpasses that of shock wave lithotripsy. Selected stones that are over 2 cm in diameter, along with branched stones, can also be treated successfully with ureteroscopy. Ureteroscopy is the most successful technique for the treatment of ureteral calculi (success rates >90%) and is an optional treatment for many renal calculi.

Rare Co-existence of Squamous Cell Carcinoma with Infiltration of Renal Vein and Xanthogranulomatous Pyelonephritis

PubMed Central

Vanikar, A.V.; Patel, R.D.; Nigam, L. K.; Trivedi, H. L.

2015-01-01

Primary renal squamous cell carcinoma is a very rare malignancy of the upper urinary tract. Most patients have history of chronic urolithiasis, analgesics abuse, radiotherapy or infection. Co-existence of SCC with xanthogranulomatous pyelonephritis is exceedingly rare with only few reports in the literature. We report a case of a 60-year-old male presented with right flank pain and mild tenderness of abdomen. Computed tomography of the abdomen revealed gross hydronephrosis with parenchymal thinning and irregular thick enhancing wall of pelvicalyceal system with multiple calculi in right kidney. Right renal vein appeared distended, filled with hypo dense material. Right nephrectomy was performed and sent for pathological examination. Histological evaluation revealed keratinizing squamous cell carcinoma with infiltration of renal vein and xanthogranulomatous pyelonephritis. PMID:26816904

The management of kidney stones as suggested by Goeury-Duvivier.

PubMed

Bellinghieri, Guido; Satta, Ersilia; Savica, Vincenzo; Gembillo, Guido; Salvo, Antonino; Buemi, Michele; Santoro, Domenico

2016-02-01

The management of kidney stones has always been a big problem for doctors of all time. Goeury Duvivier in his masterpiece "Guide des malades atteints daffections de voie urinaires ou des organes de la gnration chez lhomme et chez la femme shows us the different kind of diseases which affects the urinary tract and in particular highlights the list of the main methods that during the history characterized the treatment of renal calculi. Duvivier gives us the descriptions of invasive innovative techniques of the time, the Taille, the Lithotripsy and Lithotomy and their negative effects or limits for each technique. He also describes the different kind of palliative methods used in the 19th century to treat renal lithiasis and the clinical case reports of the time.

Zonisamide and renal calculi in patients with epilepsy: how big an issue?

PubMed

Wroe, Stephen

2007-08-01

To determine the prevalence of renal calculi in patients treated with zonisamide during randomized, controlled and open-label clinical trials, and from post-marketing surveillance data. Reports of renal calculi from four placebo-controlled double-blind trials of zonisamide, their long-term open-label treatment extension phases, and the US/European zonisamide clinical trial programme were reviewed. One double-blind study and its extension included routine ultrasound screening to identify asymptomatic calculi. Post-marketing surveillance data were also investigated, as was concomitant treatment with topiramate. No symptomatic renal calculi were reported during four randomized double-blind, placebo-controlled trials involving 848 subjects (including 498 zonisamide recipients) treated for up to 3 months. In long-term extension studies with treatment for up to 24 months, symptomatic renal calculi were reported in 9/626 (1.4%) patients. Pooled safety data from all US/European clinical trials identified 15/1296 (1.2%) patients with symptomatic renal calculi during treatment for up to 8.7 years. Post-marketing surveillance revealed nine cases from 59 667 patient-years of exposure in the USA, and 14 from 709 294 patient-years of exposure in Japan; only one case occurred during concomitant topiramate and zonisamide treatment. No imbalance in electrolyte levels was found from 35 patients receiving such co-treatment in clinical trials. The available data suggest that the risk of developing renal calculi during zonisamide treatment is low. Data are insufficient to determine whether concomitant treatment with topiramate increases the risk of renal stones.

Giant Submandibular Calculus Eroding Oral Cavity Mucosa.

PubMed

Lim, Eng Haw; Nadarajah, Sanjeevan; Mohamad, Irfan

2017-09-01

Sialolithiasis is the formation of calculi or sialoliths in the salivary gland. It is the most common benign condition of the salivary gland. Sialolithiasis can occur in all salivary glands. The submandibular gland is most commonly affected followed by the parotid gland. Calculi commonly measure less than 10 mm. Calculi of more than 15 mm are termed giant salivary gland calculi and are infrequently reported in the literature. Here, we report a case of unusually large submandibular gland calculus of 5 cm in greatest dimension which caused erosion of the oral cavity.

Giant Submandibular Calculus Eroding Oral Cavity Mucosa

PubMed Central

Lim, Eng Haw; Nadarajah, Sanjeevan; Mohamad, Irfan

2017-01-01

Sialolithiasis is the formation of calculi or sialoliths in the salivary gland. It is the most common benign condition of the salivary gland. Sialolithiasis can occur in all salivary glands. The submandibular gland is most commonly affected followed by the parotid gland. Calculi commonly measure less than 10 mm. Calculi of more than 15 mm are termed giant salivary gland calculi and are infrequently reported in the literature. Here, we report a case of unusually large submandibular gland calculus of 5 cm in greatest dimension which caused erosion of the oral cavity. PMID:29026477

Anatrophic nephrolithotomy for removal of staghorn or branched renal calculi.

PubMed

James, R; Novick, A C; Straffon, R A; Stewart, B H

1980-02-01

Forty anatrophic nephrolithotomies were performed in 38 patients between November, 1965, and December, 1977, to remove staghorn or branched renal calculi. Thirty-six (95 per cent) of the patients' preoperative urine cultures were infected, and postoperatively 35 of the cultures (88 per cent) were sterile. Magnesium ammonium phosphate calculi were present in the majority of patients (67 per cent). In 6 patients (15 per cent) transient nephrocutaneous fistulas developed. Thirty-six of the 40 renal units (90 per cent) had improved or stable intravenous pyelograms postoperatively. The patients had been followed for an average of twenty months (four to one hundred and twelve months). In 6 patients (15 per cent) recurrent renal calculi developed, and 3 patients (8 per cent) had residual calculi during this period.

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

Experimental removal of subgingival calculus with the Er:YAG laser

NASA Astrophysics Data System (ADS)

Keller, Ulrich; Hibst, Raimund

1996-01-01

The purpose of this study was to evaluate the effects of the Er:YAG laser removal of subgingival calculi in periodontal treatment and to describe laser-induced cementum surface alterations. Freshly extracted human teeth with adherent plaques and mineralized calculi were laser treated using modified quartz fiber tips in direct contact to the root surface. For the fiber tip tested, the ablation threshold was 6.5 mJ. An effective removal of calculi was possible with 50 mJ resp. 150 mJ for a triple fiber. For the latter, a mass loss with a mean of about 5.1. mg/min was achieved. Histologic examinations of the cementum surface showed smoothed appearance alternately with rough depressions of the fiber tips, which can be discussed as a good precondition for periodontal tissue regeneration. Maximum temperature increase of 1.4 K was reached in the pulp, if an additional water irrigation was applied to the root surface. From these results it can be concluded that with the Er:YAG laser an effective removal of subgingival calculi can be performed without thermal risk for the pulp.

Crystallization from Gels

NASA Astrophysics Data System (ADS)

Narayana Kalkura, S.; Natarajan, Subramanian

Among the various crystallization techniques, crystallization in gels has found wide applications in the fields of biomineralization and macromolecular crystallization in addition to crystallizing materials having nonlinear optical, ferroelectric, ferromagnetic, and other properties. Furthermore, by using this method it is possible to grow single crystals with very high perfection that are difficult to grow by other techniques. The gel method of crystallization provides an ideal technique to study crystal deposition diseases, which could lead to better understanding of their etiology. This chapter focuses on crystallization in gels of compounds that are responsible for crystal deposition diseases. The introduction is followed by a description of the various gels used, the mechanism of gelling, and the fascinating phenomenon of Liesegang ring formation, along with various gel growth techniques. The importance and scope of study on crystal deposition diseases and the need for crystal growth experiments using gel media are stressed. The various crystal deposition diseases, viz. (1) urolithiasis, (2) gout or arthritis, (3) cholelithiasis and atherosclerosis, and (4) pancreatitis and details regarding the constituents of the crystal deposits responsible for the pathological mineralization are discussed. Brief accounts of the theories of the formation of urinary stones and gallstones and the role of trace elements in urinary stone formation are also given. The crystallization in gels of (1) the urinary stone constituents, viz. calcium oxalate, calcium phosphates, uric acid, cystine, etc., (2) the constituents of the gallstones, viz. cholesterol, calcium carbonate, etc., (3) the major constituent of the pancreatic calculi, viz., calcium carbonate, and (4) cholic acid, a steroidal hormone are presented. The effect of various organic and inorganic ions, trace elements, and extracts from cereals, herbs, and fruits on the crystallization of major urinary stone and gallstone constituents are described. In addition, tables of gel-grown organic and inorganic crystals are provided.

Temporal Trends and Treatment Outcomes of Flexible Ureteroscopy for Lower Pole Stones in a Tertiary Referral Stone Center.

PubMed

Orywal, Ann Kathrin; Knipper, Ann Sophie; Tiburtius, Christian; Gross, Andreas J; Netsch, Christopher

2015-12-01

To evaluate trends in efficacy and safety of flexible ureteroscopy (fURS) for the treatment of lower pole stones (LPS) over a 6-year period and to compare the annual outcomes after one fURS procedure retrospectively. Four hundred nine patients were treated for pure LPS. An analysis of the annual outcomes regarding patient characteristics, operative parameters, stone-free rates (SFRs), and complication rates (CRs) was performed. The SFR was stratified according to stone size and number of stones per patient. Patient data are expressed as mean±standard deviation. There were no annual differences regarding age, body-mass index, stone size (7.09±4.31 mm), number of stones per patient (1.66±2.86), operative time (52.93±33.58 minutes), use of postoperative stents (59.2%), and the Ho:YAG laser lithotripsy rate (49.4%) during the 6-year period. Total primary SFR (annual range) of 97.6% (88.2%-100%), 89.1% (82.9%-96.3%), 71% (60%-78.6%) for urinary calculi <5 mm (3.43±0.78 mm), 5-9 mm (6.69±1.34 mm), and ≥10 mm (13.09±6.02 mm) could be demonstrated over the 6-year period. The total SFR differed significantly between urinary calculi <5 mm, 5-9 mm, and those ≥10 mm (p<0.0179). The SFR (annual range) decreased from 90% (86.2%-95.4%) in patients with 1 stone to 84.1% (60%-100%) in those with ≥3 stones. Perioperative complications (annual range) occurred in 9.7% (6%-13.6%) of the patients (Clavien I 5.1% [1.2%-8.6%], Clavien II 2% [0%-4.9%], Clavien IIIa 0.9% [0%-3.4%], Clavien IIIb 1.7% [1.2%-4.8%]) without differences in the annual CR. fURS is a safe and efficacious procedure for the treatment of LPS with high primary SFR and low CR. fURS in larger LPS (≥10 mm) is associated with the risk for staged procedures.

Electrokinetic lithotripsy: safety, efficacy and limitations of a new form of ballistic lithotripsy.

PubMed

Keeley, F X; Pillai, M; Smith, G; Chrisofos, M; Tolley, D A

1999-08-01

To investigate the safety and efficacy of electrokinetic lithotripsy (EKL), a ballistic lithotripter which uses high-energy magnetic fields to propel an impactor to fragment calculi. The records and radiographs of 121 patients who underwent ureteroscopy using the EKL for stones in the upper (26), mid (28) or lower (67) ureter were reviewed retrospectively. Ureteroscopy was performed with an 8.5 F semi-rigid ureteroscope, through which a 3 F EKL probe was passed. A total of 148 stones (mean stone size 11.5 mm, range 6-40) in 121 patients were treated using the EKL. One patient was lost to follow-up. Of 148 stones, 147 (99.3%) were fragmented, including five that had resisted fragmentation with either pulsed-dye laser or electrohydraulic lithotripsy. Despite this, only 45 of 56 patients (80%) with a single stone in the lower ureter were rendered stone-free after a single ureteroscopic procedure. Seven patients in this group (12%) required shock-wave lithotripsy for fragments that had been propelled into the kidney, while four patients (7%) required repeat ureteroscopy for retained ureteric fragments. Complications were limited to minor ureteric perforations in two patients, both of which were treated with a stent. EKL is an inexpensive and reliable endoscopic method which fragments nearly all urinary calculi. Its limitations include the propulsion of fragments and the need to use an offset, semi-rigid ureteroscope. We recommend the use of a basket or graspers to remove fragments of >/=4 mm after EKL.

Extracorporeal shock wave lithotripsy (ESWL) of a renal calculus in a liver transplant recipient: report of a severe complication--a case report.

PubMed

Friedersdorff, F; Buckendahl, J; Fuller, T F; Cash, H

2010-11-01

Extracorporeal shock wave lithotripsy (ESWL) has evolved as a standard treatment modality for calculi of the upper urinary tract. Noninvasive ESWL shows rare life-threatening complications. Herein we have reported the case of a liver transplant recipient who developed severe renal hemorrhage after ESWL of a renal calculus. Transfusion of erythrocytes and platelets led to anaphylactic shock with acute renal failure requiring intensive care. The patient fully recovered shortly thereafter and was discharged home with a residual left kidney stone measuring 8 mm. A 55-year-old man with a single left kidney underwent ESWL due to symptomatic left nephrolithiasis. He had undergone successful liver transplantation 11 years earlier. At the time of ESWL his liver functions were normal and his serum creatinine level was 1.3 mg/dL. Two weeks before the treatment a double pigtail ureteral stent was inserted because of a symptomatic left hydronephrosis. Several hours after ESWL treatment the patient complained of left-sided flank pain. An ultrasound revealed a large subcapsular hematoma of the left kidney, which was confirmed using abdominal computed tomography (CT). With the patient being hemodynamically stable, we opted for conservative management. Despite postinterventional complications, the patient made a fast recovery. ESWL is a noninvasive, safe, and efficient method to treat renal calculi. Patients who are at risk for hemorrhage should undergo close postinterventional monitoring, including red blood cell count and renal ultrasound. Copyright © 2010 Elsevier Inc. All rights reserved.

Clinical evaluation of cats with nonobstructive urinary tract diseases.

PubMed

Buffington, C A; Chew, D J; Kendall, M S; Scrivani, P V; Thompson, S B; Blaisdell, J L; Woodworth, B E

1997-01-01

To identify the underlying cause of clinical signs in cats with nonobstructive diseases of the bladder and urethra. Prospective case series. 109 cats examined by the urology service of The Ohio State University's veterinary teaching hospital because of stranguria, hematuria, pollakiuria, or urination in inappropriate locations. History was obtained and a CBC, serum biochemical analyses, serologic tests for FeLV and feline immunodeficiency virus, urinalysis, bacterial culture of urine, and contrast radiography or urethrocystoscopy (females only) were performed. 16 cats had cystic calculi: 8 had struvite uroliths, 7 had calcium oxalate uroliths, and 1 had a urolith of unknown composition in conjunction with an anatomic defect. Anatomic defects, including diverticulae, urethral strictures, and a malpositioned urethra, were identified in 12 cats. A urinary tract infection was identified in 1 cat, and neoplasia was diagnosed in 2. One of the cats with neoplasia also had a struvite urolith. The remaining 80 cats did not have an anatomic defect, urolith, or tumor. Ten of these cats also did not have radiographic or cystoscopic abnormalities and were presumed to have a behavioral disorder. The remaining 70 cats had radiographic or cystoscopic abnormalities, and idiopathic cystitis was diagnosed. In 14 of the cats with idiopathic cystitis, results of a urinalysis were normal. Cats with idiopathic cystitis were significantly more likely to eat dry food exclusively (59%) than were cats in the general population (19%). Results suggest that idiopathic cystitis occurs commonly in cats with stranguria, hematuria, pollakiuria, or inappropriate elimination and is associated with consumption of dry foods. Contrast radiography or cystoscopy is necessary for differentiating idiopathic cystitis from behavioral disorders in some cats.

When is prior ureteral stent placement necessary to access the upper urinary tract in prepubertal children?

PubMed

Corcoran, Anthony T; Smaldone, Marc C; Mally, Dev; Ost, Michael C; Bellinger, Mark F; Schneck, Francis X; Docimo, Steven G; Wu, Hsi-Yang

2008-10-01

We studied the possibility that age, height, weight and body mass index could be used to predict the likelihood of successful ureteroscopic access to the upper urinary tract without previous stent placement in prepubertal children. We retrospectively reviewed all ureteroscopic procedures for upper tract calculi in prepubertal children from 2003 to 2007. We compared age, height, weight and body mass index in patients who underwent successful primary flexible ureteroscopic access and in those who required initial stent placement to perform ureteroscopy. Successful primary ureteroscopic access to the upper tract was achieved in 18 of 30 patients (60%). There was no difference in mean age (9.9 vs 9.5 years, p = 0.8), height (132 vs 128 cm, p = 0.6), weight (37 vs 36 kg, p = 0.86) or body mass index (19.3 vs 20.5 kg/m(2), p = 0.55) between patients with successful vs unsuccessful upper tract access. Locations that prevented access to the upper urinary tract were evenly distributed among the ureteral orifice, iliac vessels and ureteropelvic junction. Age, height, weight and body mass index could not predict the likelihood of successful ureteroscopic access to the upper tract. Placement of a ureteral stent for passive ureteral dilation is not necessary for successful ureteroscopic access to the renal pelvis in prepubertal children. An initial attempt at ureteroscopy, with placement of a ureteral stent if upper tract access is unsuccessful, decreases the number of procedures while maintaining a low complication rate.

Retroperitoneal Laparoscopic Ureterolithotomy for Proximal Ureteral Calculi in Selected Patients

PubMed Central

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

2014-01-01

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

Spectroscopic characterizations of organic/inorganic nanocomposites

NASA Astrophysics Data System (ADS)

Govani, Jayesh R.

2009-12-01

In the present study, pure and 0.3 wt%, 0.4 wt%, as well as 0.5 wt% L-arginine doped potassium dihydrogen phosphate (KDP) crystals were grown using solution growth techniques and further subjected to infrared (IR) absorption and Raman studies for confirmation of chemical group functionalization for investigating the incorporation mechanism of the L-arginine organic material into the KDP crystal structure. Infrared spectroscopic analysis suggests that structural changes are occurring for the L-arginine molecule as a result of its interaction with the KPD crystal. Infrared spectroscopic technique confirms the disturbance of the N-H, C-H and C-N bonds of the amino acid, suggesting successful incorporation of L-arginine into the KDP crystals. Raman analysis also reveals modification of the N-H, C-H and C-N bonds of the amino acid, implying successful inclusion of L-arginine into the KDP crystals. With the help of Gaussian software, a prediction of possible incorporation mechanisms of the organic material was obtained from comparison of the simulated infrared and Raman vibrational spectra with the experimental results. Furthermore, we also studied the effect of L-arginine doping on the thermal stability of the grown KDP crystal by employing Thermo gravimetric analysis (TGA). TGA suggests that increasing the level of L-arginine doping speeds the decomposition process and it weakens the KDP crystal, which indicates successful doping of the KDP crystals with L-arginine amino acid. Urinary stones are one of the oldest and most widely spread diseases in humans, animals and birds. Many remedies have been employed through the ages for the treatment of urinary stones. Recent medicinal measures reflect the modern advances, which are based on surgical removal, percutaneous techniques and extracorporeal shock wave lithotripsy (ESWL). Although these procedures are valuable, they are quite expensive for most people. Furthermore, recurrence of these diseases is awfully frequent with these procedures and the patients have to be subjected to careful follow up for several years. In contrast, in traditional therapeutic systems, most of the remedies were taken from plants and they proved to be helpful. However, the rationale behind their use is not thoroughly established through systematic pharmacological and clinical studies. In this regard, in the present investigation, with a view towards acquiring more insights, we have performed a detailed study of kidney stone formation and growth inhibition based on a traditional medicine approach with herbal extracts. The intricacy of calculi formation (i.e. nucleation, transformation, and aggregation) in a natural system such as urine is replicated to a certain extent in the present study by using a simplified single diffusion gel growth technique. Crystals were synthesized in a static gel environment without and with the presence of 1% and 2% concentration of Rotula Aquatica Lour (RAL) herbal extracts and further subjected to Raman, infrared absorption, X-ray photoelectron spectroscopy (XPS), and photoluminescence to analyze the effects of RAL on the growth of manganese-based calculi. Raman spectroscopy clearly provided an indication of the newberyite type of crystal as well as information on the chemical interaction between crystal and inhibitor. It also indicates the presence of organic components due to the RAL plant material. Infrared absorption spectroscopy indicates the presence of a strong reflecting component in the inhibitor as well as the newberyite type of crystal. XPS results indicated the presence of metallic zinc in the crystal with inhibitor. Furthermore, a considerable increase in the intensity of the magnesium and oxygen lines are noticed with the addition of the herbal extract, which suggest that the inhibitor chemical composition includes a substantial quantity of Mg and O. XPS analysis also demonstrates the presence of modified phosphorus oxidation states and suggest that they might make a contribution, too. The photoluminescence spectra of the crystal with inhibitor indicate the presence of chlorophyll, and hence, confirm the presence of Mg. This study provides evidence of Mg- and Zn-related inhibition of urinary calculi formation with the addition of RAL herbal extract, contributing, from the spectroscopic point of view, to an intricate subject. Our present investigation might serve as an important source of information on this tantalizing and multifaceted problem, which is not yet completely understood. (Abstract shortened by UMI.)

Robotically assisted ureteroscopy for kidney exploration

PubMed Central

Talari, Hadi F.; Monfaredi, Reza; Wilson, Emmanuel; Blum, Emily; Bayne, Christopher; Peters, Craig; Zhang, Anlin; Cleary, Kevin

2018-01-01

Ureteroscopy is a minimally invasive procedure for diagnosis and treatment of a wide range of urinary tract pathologies. It is most commonly performed in the diagnostic work-up of hematuria and the diagnosis and treatment of upper urinary tract malignancies and calculi. Ergonomic and visualization challenges as well as radiation exposure are limitations to conventional ureteroscopy. For example, for diagnostic tumor inspection, the urologist has to maneuver the ureteroscope through each of the 6 to 12 calyces in the kidney under fluoroscopy to ensure complete surveillance. Therefore, we have been developing a robotic system to “power drive” a flexible fiber-optic ureteroscope with 3D tip tracking and pre-operative image overlay. Our goal is to provide the urologist precise control of the ureteroscope tip with less radiation exposure. Our prototype system allows control of the three degrees of freedom of the ureteroscope via brushless motors and a joystick interface. The robot provides a steady platform for controlling the ureteroscope. Furthermore, the robot design facilitates a quick “snap-in” of the ureteroscope, thus allowing the ureteroscope to be mounted midway through the procedure. We have completed the mechanical system and the controlling software and begun evaluation using a kidney phantom. We put MRI-compatible fiducials on the phantom and obtained MR images. We registered these images with the robot using an electromagnetic tracking system and paired-point registration. The system is described and initial evaluation results are given in this paper. PMID:29731536

Holmium laser lithotripsy of bladder calculi

NASA Astrophysics Data System (ADS)

Beaghler, Marc A.; Poon, Michael W.

1998-07-01

Although the overall incidence of bladder calculi has been decreasing, it is still a significant disease affecting adults and children. Prior treatment options have included open cystolitholapaxy, blind lithotripsy, extracorporeal shock wave lithotripsy, and visual lithotripsy with ultrasonic or electrohydraulic probes. The holmium laser has been found to be extremely effective in the treatment of upper tract calculi. This technology has also been applied to the treatment of bladder calculi. We report our experience with the holmium laser in the treatment of bladder calculi. Twenty- five patients over a year and a half had their bladder calculi treated with the Holmium laser. This study was retrospective in nature. Patient demographics, stone burden, and intraoperative and post-operative complications were noted. The mean stone burden was 31 mm with a range of 10 to 60 mm. Preoperative diagnosis was made with either an ultrasound, plain film of the abdomen or intravenous pyelogram. Cystoscopy was then performed to confirm the presence and determine the size of the stone. The patients were then taken to the operating room and given a regional or general anesthetic. A rigid cystoscope was placed into the bladder and the bladder stone was then vaporized using the holmium laser. Remaining fragments were washed out. Adjunctive procedures were performed on 10 patients. These included transurethral resection of the prostate, transurethral incision of the prostate, optic internal urethrotomy, and incision of ureteroceles. No major complications occurred and all patients were rendered stone free. We conclude that the Holmium laser is an effective and safe modality for the treatment of bladder calculi. It was able to vaporize all bladder calculi and provides a single modality of treating other associated genitourinary pathology.

Modern management of salivary calculi.

PubMed

McGurk, M; Escudier, M P; Brown, J E

2005-01-01

The aim was to investigate the results of a minimally invasive approach to the management of salivary calculi. Four hundred and fifty-five salivary calculi (323 submandibular and 132 parotid) were treated using extracorporeal shock-wave lithotripsy (ECSWL), fluoroscopically guided basket retrieval or intraoral stone removal under general anaesthesia. The techniques were used either alone or in combination. ECSWL achieved complete success (stone and symptom free) in 87 (39.4 percent) of 221 patients (84 of 218 primary and all of three secondary procedures; 43 of 131 submandibular, 44 of 90 parotid). Basket retrieval cured 124 (74.7 percent) of 166 patients (103 of 136 primary and 21 of 30 secondary procedures; 80 of 109 submandibular, 44 of 57 parotid). Intraoral surgical removal was successful in a further 137 (95.8 percent) of 143 patients with submandibular stones (99 of 101 primary, 36 of 38 secondary and two of four tertiary procedures). The overall success rate for the three techniques was 348 (76.5 percent) of 455. A minimally invasive approach to the management of salivary calculi is to be encouraged. All three techniques described have low morbidity and afford the possibility of retaining a functional gland.

Hair as the nidus for bladder calculi formation complicating suprapubic cystostomy catheterization: a case report.

PubMed

Ke, Hung-Lung; Lin, Hung-Yu; Jang, Mei-Yu; Wu, Wen-Jeng

2006-05-01

Neurogenic bladder is a familiar sequel to spinal cord injury, and bladder calculi is a common complication of neurogenic bladder. We report a case of a 25-year-old man with spinal cord injury resulting in neurogenic bladder. Permanent cystostomy was performed, and, for 4 years, the patient received periodic replacement of a cystostomy catheter. Bladder calculi were found on follow-up radiography. Cystoscopic lithotripsy was done, and it was noted that a hair was the nidus of a calculus. The hair could have been introduced into the bladder accidentally during the cystostomy catheter replacement. We suggest routine pubic hair care, even shaving, for patients suffering from neurogenic bladder with cystostomy. In addition, patients and caregivers should take care not to introduce pubic hair into the bladder while changing cystostomy catheters.

The efficacy of tamsulosin in lower ureteral calculi

PubMed Central

Griwan, M.S.; Singh, Santosh Kumar; Paul, Himanshu; Pawar, Devendra Singh; Verma, Manish

2010-01-01

Context: There has been a paradigm shift in the management of ureteral calculi in the last decade with the introduction of new less invasive methods, such as ureterorenoscopy and extracorporeal shock wave lithotripsy (ESWL). Aims: Recent studies have reported excellent results with medical expulsive therapy (MET) for distal ureteral calculi, both in terms of stone expulsion and control of ureteral colic pain. Settings and Design: We conducted a comparative study in between watchful waiting and MET with tamsulosin. Materials and Methods: We conducted a comparative study in between watchful waiting (Group I) and MET with tamsulosin (Group II) in 60 patients, with a follow up of 28 days. Statistical Analysis: Independent 't' test and chi-square test. Results: Group II showed a statistically significant advantage in terms of the stone expulsion rate. The mean number of episodes of pain, mean days to stone expulsion and mean amount of analgesic dosage used were statistically significantly lower in Group II (P value is 0.007, 0.01 and 0.007, respectively) as compared to Group I. Conclusions: It is concluded that MET should be considered for uncomplicated distal ureteral calculi before ureteroscopy or extracorporeal lithotripsy. Tamsulosin has been found to increase and hasten stone expulsion rates, decrease acute attacks by acting as a spasmolytic, reduces mean days to stone expulsion and decreases analgesic dose usage. PMID:20882156

Diagnosis and management of symptomatic seminal vesicle calculi.

PubMed

Christodoulidou, Michelle; Parnham, Arie; Nigam, Raj

2017-08-01

The aim of this study was to review the management of patients with symptomatic seminal vesicle calculi, from presentation and diagnosis to postoperative outcomes. A systematic review of the English literature in MEDLINE and Embase was performed, based on the following model: patients with a diagnosis of seminal vesicle calculi; all interventions considered with or without control groups with single and comparator interventions; outcomes considered were incidence, presentation, diagnostic methods and treatment. A narrative synthesis of the data was performed according to PRISMA 2009 guidelines. The study protocol was registered on PROSPERO (CRD42016032971). In total, 213 cases of seminal vesicle calculi from 37 studies were identified between 1928 and 2016. Published articles included cohort studies (16), case-control studies (two) and case reports (19). The most likely aetiology was stasis of ejaculate secondary to impaired drainage of secretions from the seminal vesicles. Transrectal ultrasound remains the primary investigation for haematospermia and painful ejaculation; however, magnetic resonance imaging seems to play an increasingly important role, especially when considering surgery. Transurethral seminal vesiculoscopy and lithotripsy is the ideal procedure for small calculi but requires surgical expertise. For larger calculi a transperitoneal laparoscopic approach is safe in the hands of experienced laparoscopic surgeons. Modern imaging techniques and cross-sectional imaging are leading to an increased number of diagnosed cases of seminal vesicle calculi. Optimal treatment depends on the stone size and burden, and centralization of services will assist in the development of specialized centres.

Retrograde intrarenal surgery for lower pole renal calculi smaller than one centimeter.

PubMed

Shah, Hemendra Navinchandra

2008-10-01

Recently there has been an increasing interest in the application of retrograde intrarenal surgery (RIRS) for managing renal calculi. In this review we discuss its application for the management of lower calyceal (LC) stones less than 10 mm in maximum dimension. Literature was reviewed to summarize the technical development in flexible ureterorenoscopy and its accessories. Further, the indications, outcome and limitations of RIRS for LC calculi < 1 cm were reviewed. Use of access sheath and displacement of LC stone to a more favorable location is increasingly employed during RIRS. Patients who are anticoagulated or obese; those with adverse stone composition and those with concomitant ureteral calculi are ideally suited for RIRS. It is used as a salvage therapy for shock wave lithotripsy (SWL) refractory calculi but with a lower success rate (46-62%). It is also increasingly being used as a primary modality for treating LC calculi, with a stone-free rate ranging from 50-90.9%. However, the criteria for defining stone-free status are not uniform in the literature. The impact of intrarenal anatomy on stone-free rates after RIRS is unclear; however, unfavorable lower calyceal anatomy may hamper the efficacy of the procedure. The durability of flexible ureteroscopes remains an important issue. RIRS continues to undergo significant advancements and is emerging as a first-line procedure for challenging stone cases. The treatment of choice for LC calculi < 1 cm depends on patient's preference and the individual surgeon's preference and level of expertise.

Site of impaction of ureteric calculi requiring surgical intervention.

PubMed

El-Barky, Ehab; Ali, Yusuf; Sahsah, Mohammed; Terra, Ali A; Kehinde, Elijah O

2014-02-01

Textbooks describe three narrowest anatomic sites in the ureter as the most likely places for ureteral calculi to lodge, these are: the pelvi-ureteric junction (PUJ), the point where the ureters cross over the iliac vessels and the ureterovesical junction (UVJ). The purpose of this study is to determine whether calculi causing ureteric obstruction and requiring surgical treatment are found mostly at these three narrowest anatomic points of the ureter. Three hundred consecutive patients with impacted ureteric calculi who required surgical intervention were studied. The location of the impacted calculus on the day of surgical intervention was categorized according to nine predetermined levels outlined in a designed diagram based on findings on non-contrast CT of kidneys, ureters and bladder. Two peaks in stone distribution in the ureters were encountered; the first was above the ischial spine in the proximal part of the lower third ureter (84 patients, 28%), while the second was at the level between L3 and L4 lumbar vertebrae (66 patients, 22%). Overall, the location of impacted calculi was as follows, 53, 34, 10 and 3% in the lower third ureter, upper third ureter, PUJ and mid ureter, respectively. This study demonstrates two peaks of calculi distribution in the ureter where ureteric calculi become impacted: the upper ureter below the PUJ and a second in the lower ureter, more proximal than the UVJ. There was an absence of the peak in stone location over the iliac vessels, that is, the mid ureter.

Missed signs of autonomic dysreflexia in a tetraplegic patient after incorrect placement of urethral Foley catheter: a case report.

PubMed

Vaidyanathan, Subramanian; Soni, Bakul M; Oo, Tun; Hughes, Peter L; Singh, Gurpreet

2014-01-01

Autonomic dysreflexia is poorly recognised outside of spinal cord injury centres, and may result in adverse outcomes including mortality from delayed diagnosis and treatment. We present a spinal cord injury patient, who developed autonomic dysreflexia following incorrect placement of urethral Foley catheter. Health professionals failed to recognise signs and symptoms of autonomic dysreflexia as well as its significance in this tetraplegic patient. A tetraplegic patient started sweating profusely following insertion of a Foley catheter per urethra. The catheter was draining urine; there was no bypassing, no bleeding per urethra, and no haematuria. Patient's wife, who had been looking after her tetraplegic husband for more than forty years, told the health professionals that the catheter might have been placed incorrectly but her concerns were ignored. Ultrasound scan of urinary tract revealed no urinary calculi, no hydronephrosis. The balloon of Foley catheter was not seen in urinary bladder but this finding was not recognised by radiologist and spinal cord physician. Patient continued to sweat profusely; therefore, CT of pelvis was performed, but there was a delay of ten days. CT revealed the balloon of Foley catheter in the over-stretched prostate-membranous urethra; the tip of catheter was not located within the urinary bladder but was lying distal to bladder neck. Flexible cystoscopy was performed and Foley catheter was inserted into the bladder over a guide wire. The intensity of sweating decreased; noxious stimuli arising from traumatised urethra might take a long while to settle. Inserting a catheter in a tetraplegic patient should be carried out by a senior health professional, who is familiar with spasm of bladder neck which occurs frequently in tetraplegic patients. Facilities for urgent CT scan should be available to check the position of Foley catheter in spinal cord injury patients when a patient manifests signs and symptoms of autonomic dysreflexia following insertion of a urethral catheter. When an isolated symptom such as flushing or sweating is noticed in a tetraplegic patient, doctors should seek out other signs/symptoms of autonomic dysreflexia.

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.

Explicit Substitutions and All That

NASA Technical Reports Server (NTRS)

Ayala-Rincon, Mauricio; Munoz, Cesar

2000-01-01

Explicit substitution calculi are extensions of the lambda-calculus where the substitution mechanism is internalized into the theory. This feature makes them suitable for implementation and theoretical study of logic-based tools such as strongly typed programming languages and proof assistant systems. In this paper we explore new developments on two of the most successful styles of explicit substitution calculi: the lambda sigma- and lambda S(e)-calculi.

Explicit Substitutions and All That

NASA Technical Reports Server (NTRS)

Ayala-Rincon, Mauricio; Munoz, Cesar; Busnell, Dennis M. (Technical Monitor)

2000-01-01

Explicit substitution calculi are extensions of the Lambda-calculus where the substitution mechanism is internalized into the theory. This feature makes them suitable for implementation and theoretical study of logic-based tools such as strongly typed programming languages and proof assistant systems. In this paper we explore new developments on two of the most successful styles of explicit substitution calculi: the lambda(sigma)- and lambda(s(e))-calculi.

Influence of denture surface roughness and host factors on dental calculi formation on dentures: a cross-sectional study.

PubMed

Matsumura, Keisuke; Sato, Yuji; Kitagawa, Noboru; Shichita, Toshiharu; Kawata, Daisuke; Ishikawa, Mariko

2018-05-04

Dental calculi formation on dentures can worsen the oral cavity environment by complicating oral hygiene. However, few studies have investigated the effect of how patients use and manage their dentures, denture surface roughness, and host factors such as oral cavity dryness and saliva properties on denture cleanliness and denture dental calculi formation. Accordingly, we conducted the present survey to evaluate these factors to clarify the strength of the influence of each factor. We enrolled 53 patients who had used dentures for at least 3 months and used a dental prosthesis that covered at least the six front teeth including the left and right mandibular canines. After staining the dentures, we divided the participants into a group that was positive for dental calculi (DCP group) and a group that was negative for dental calculi (DCN group). After removing all the stains, we evaluated the surface roughness of the dentures. A questionnaire was used to survey how the participants used and managed their dentures. Oral cavity dryness was evaluated, and resting saliva samples were collected to assess saliva properties. Correlations between the presence or absence of dental calculi and denture use and management were evaluated using a chi-square test. Correlations with denture surface roughness, oral cavity dryness, and saliva properties were evaluated using the Mann-Whitney U test. Correlations between the presence or absence of dental calculi and all factors were analyzed using multivariate analysis (quantification II). Surface roughness was significantly greater in the DCP group (p < 0.01), and the DCP group members wore their dentures during sleep significantly more often and used a denture cleaner when storing their dentures significantly less often (both p < 0.01). No significant differences were observed for oral cavity dryness or saliva properties. The multivariate analysis showed significant correlations of dental calculi formation with denture surface roughness and items related to denture use and management, but not for oral cavity dryness or saliva properties. Our findings indicate that dental calculi formation is influenced by how dentures are used and managed and by denture surface roughness, but not by oral cavity dryness and saliva properties.

Efficacy of percutaneous treatment of biliary tract calculi using the holmium:YAG laser.

PubMed

Hazey, J W; McCreary, M; Guy, G; Melvin, W S

2007-07-01

Few Western studies have focused on percutaneous techniques using percutaneous transhepatic choledochoscopy (PTHC) and holmium:yttrium-aluminum-garnet (YAG) laser to ablate biliary calculi in patients unable or unwilling to undergo endoscopic or surgical removal of the calculi. The authors report the efficacy of the holmium:YAG laser in clearing complex biliary calculi using percutaneous access techniques. This study retrospectively reviewed 13 non-Asian patients with complex secondary biliary calculi treated percutaneously using holmium:YAG laser. Percutaneous access was accomplished via left, right, or bilateral hepatic ducts and upsized for passage of a 7-Fr video choledochoscope. Lithotripsy was performed under choledochoscopic vision using a holmium:YAG laser with 200- or 365-microm fibers generating 0.6 to 1.0 joules at 8 to 15 Hz. Patients underwent treatment until stone clearance was confirmed by PTHC. Downsizing and subsequent removal of percutaneous catheters completed the treatment course. Seven men and six women with an average age of 69 years underwent treatment. All the patients had their biliary tract stones cleared successfully. Of the 13 patients, 3 were treated solely as outpatients. The average length of percutaneous access was 108 days. At this writing, one patient still has a catheter in place. The average number of holmium:YAG laser treatments required for stone clearance was 1.6, with no patients requiring more than 3 treatments. Of the 13 patients, 8 underwent a single holmium:YAG laser treatment to clear their calculi. Prior unsuccessful attempts at endoscopic removal of the calculi had been experienced by 7 of the 13 patients. Five patients underwent percutaneous access and subsequent stone removal as their sole therapy for biliary stones. Five patients were cleared of their calculi after percutaneous laser ablation of large stones and percutaneous basket retrieval of the remaining stone fragments. There was one complication of pain requiring admission, and no deaths. The use of PTHC with holmium:YAG laser ablation is safe and efficacious, but requires prolonged biliary access and often multiple procedures to ensure clearance of all calculi.

Laser-induced shock-wave lithotripsy of canine urocystoliths and nephroliths

NASA Astrophysics Data System (ADS)

Woods, J. P.; Bartels, Kenneth E.; Stair, Ernest L.; Schafer, Steven A.; Nordquist, Robert E.

1997-05-01

Urolithiasis is a common disease affecting dogs which can sometimes be treated with dietary and medical protocols. In many cases, however, medical management cannot be employed because the dietary restrictions are contraindicated, effective medical dissolution protocols for the calculi (uroliths) do not exist, or obstruction by the calculi may result in deterioration of renal function during the time required for medical dissolution. At present, the management of medically untreatable calculi has been surgical removal which may result in temporary but dramatic decrease in renal function, irreversible loss of damaged nephrons, and significant risk, particularly for bilateral or recurrent nephroliths. An innovative technique for the removal of these uroliths would involve laser lithotripsy which transforms light energy into acoustical energy generating a shock wave sufficient to fragment stones (photoacoustic ablation). The laser is transmitted via quartz fibers which are small and flexible and can be used under direct vision through endoscopes resulting in effective fragmentation with little surrounding tissue damage. Lasers are becoming increasingly more utilized in veterinary medicine, in contrast to the limited availability of other non-invasive methods of treatment of nephroliths (i.e. extracorporeal shock-wave lithotripsy).

Anatrophic Nephrolithotomy in the Management of Large Staghorn Calculi - A Single Centre Experience.

PubMed

Keshavamurthy, Ramaiah; Karthikeyan, Vilvapathy Senguttuvan; Mallya, Ashwin; Sreenivas, Jayaram; Nelivigi, Girish Gurubasappa; Kamath, Ananth Janarthan

2017-05-01

With advances in endourology, open stone surgery for staghorn calculi has markedly diminished. Anatrophic Nephrolithotomy (AN) is performed for complex staghorn stones which cannot be cleared by a reasonable number of Percutaneous Nephrolithotomy (PNL) attempts. To assess the indications and outcomes of AN in the modern era. Between April 2008 and July 2015, AN was done in 14 renal units in 13 patients. In this retrospective study, demography, stone characteristics, operative details, clearance and long term outcomes were assessed. AN was performed for complex staghorn calculi involving pelvis and all calyces in 10 patients, infundibular stenosis in two patients and failed PNL in one patient. Mean (SD) in situ cold ischemia time was 47.64 (5.27) minutes. Retroperitoneal drain and double J stent were placed in all 13 patients. Median (IQR) estimated blood loss was 130 (75) ml. There was no perioperative mortality. Surgical site infection was seen in 2 patients and urosepsis in 2 patients. Drain was removed at a mean (SD) of 9.11 (6.15) days. Mean (SD) postoperative length of hospitalization was 15.44 (7.14) days. Stent removal was done in all patients between 2-8 weeks. Median (IQR) clearance was 95 (7.5%). There was no renal failure or new calculi during the follow up period {median (IQR): 1(3) years}. AN is effective in management of large staghorn calculi failed minimally invasive approaches and achieves 80%-100% clearance without much need for secondary interventions. Renal function is preserved and with emergence of laparoscopy and robotics, postoperative stay is minimized with expedited recovery and comparable results with open surgery.

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.

Robotic extended pyelolithotomy for treatment of renal calculi: a feasibility study.

PubMed

Badani, Ketan K; Hemal, Ashok K; Fumo, Michael; Kaul, Sanjeev; Shrivastava, Alok; Rajendram, Arumuga Kumar; Yusoff, Noor Ashani; Sundram, Murali; Woo, Susan; Peabody, James O; Mohamed, Sahabudin Raja; Menon, Mani

2006-06-01

Percutaneous nephrolithotomy (PCNL) remains the treatment of choice for staghorn renal calculi. Many reports suggest that laparoscopy can be an alternative treatment for large renal stones. We wished to evaluate the role and feasibility of laparoscopic extended pyelolithotomy (REP) for treatment of staghorn calculi. Thirteen patients underwent REP for treatment of staghorn calculi over a 12-day period. Twelve patients had partial staghorn stones and one had a complete staghorn stone. All patients had pre-operative and post-operative imaging including KUB and computed tomography. All procedures were completed robotically without conversion to laparoscopy or open surgery. Mean operative time was 158 min and mean robotic console time was 108 min. Complete stone removal was accomplished in all patients except the one with a complete staghorn calculus. Estimated blood loss was 100 cc, and no patient required post-operative transfusion. REP is an effective treatment alternative to PCNL in some patients with staghorn calculi. However, patients with complete staghorn stones are not suitable candidates for this particular technique.

Treatment of small lower pole calculi--SWL vs. URS vs. PNL?

PubMed

Knoll, Thomas; Tasca, Andrea; Buchholz, Noor P

2011-03-01

According to current guideline recommendations extracorporeal shock wave lithotripsy (SWL) remains the first choice treatment for small and mid-sized renal calculi. However, the results of SWL treatment for lower pole stones can be disappointing whilst more invasive endoscopic modalities, such as flexible ureterorenoscopy (fURS) and percutaneous nephrolithotomy (PNL) are often considered more effective. This article summarizes a point-counterpoint discussion at the 9th eULIS symposium in Como, Italy, and discusses the potential advantages and disadvantages of the different therapeutic approaches.

Concomitant treatment of ureteropelvic junction obstruction and renal calculi with robotic laparoscopic surgery and rigid nephroscopy.

PubMed

Zheng, Ji; Yan, Junan; Zhou, Zhansong; Chen, Zhiwen; Li, Xin; Pan, Jinhong; Li, Weibing

2014-01-01

The treatment of ureteropelvic junction obstruction (UPJO) and concomitant calculus poses a technically challenging situation. We present our experience with using rigid nephroscopy for renal calculi removal during robot-assisted pyeloplasy (RAP) for UPJO. From December 2010 to November 2012, 25 patients with UPJO had RAP at our institution; 9 of those had concurrent renal calculi, which were simultaneously treated with rigid nephroscopy. For stone extraction, a rigid ureteroscope was passed through an assistant trocar under laparoscopic vision directly into a previously created pyelotomy. The stones were extracted using a rigid grasper or stone basket through the rigid ureteroscope. For the removal of the stones within the upper and lower calyces, the rigid ureteroscope was introduced into the incised renal pelvis through robotic trocars if the "assistant trocar" route failed. Complete stone clearance was achieved in 8 of 9 patients. Residual calculi in 1 patient were removed with a single session of extracorporeal shock wave lithotripsy. At the mean follow-up of 10.2 months, no patients had obstruction or recurrent stones. The mean operative time was 187.1 minutes, which was 40.9 minutes longer than the mean operative time in patients without renal calculi. There was no significant difference in blood loss, hospital stay, complications, and success rates between patients with and without renal calculi. Our data suggest that the use of a concomitant rigid nephroscope and RAP is a safe and feasible option for the treatment of UPJO complicated with renal calculi. Copyright © 2014 Elsevier Inc. All rights reserved.

Treatment for residual stones using flexible ureteroscopy and holmium laser lithotripsy after the management of complex calculi with single-tract percutaneous nephrolithotomy.

PubMed

Chen, L; Sha, M-L; Li, D; Zhuo, J; Jiang, C-Y; Zhu, Y-P; Xia, S-J; Lu, J; Shao, Y

2017-04-01

This study validated the effectiveness and safety of the treatment for residual stones using flexible ureteroscopy (fURS) and holmium laser (0.6-1.2 J, 20-30 Hz) lithotripsy via a fiber with a 200-μm core diameter and 0.22 numerical aperture (NA) after the management of complex calculi with single-tract percutaneous nephrolithotomy (PCNL). Between January 2014 and June 2016, 27 consecutive patients with complex calculi underwent fURS and holmium laser lithotripsy after a planned single-tract PCNL. Among the 27 patients with complex calculi, 9 had full staghorn calculi, 7 had partial staghorn calculi, and 11 had multiple calculi. After the first single-tract PCNL session, the mean stone size and mean stone surface area were 18.0 ± 10.7 mm and 181.9 ± 172.2 mm 2 , respectively. Treatment for residual stones with fURS and holmium laser lithotripsy was successfully completed and was performed without intraoperative complications. The mean operative time of the fURS procedure was 69.1 ± 23.6 min, and the mean hospital stay was 5.3 ± 2.4 days. The mean decrease in the hemoglobin level was 7.3 ± 6.5 g/l. After the fURS procedure, the overall stone-free rate was 88.9%. The overall postoperative complication rate was 14.8% (Clavien grade I 11.1%; Clavien grade II 3.7%). The current approach tested here combines the advantages of both PCNL and fURS and effectively manages complex calculi with a high stone-free rate (SFR) (88.9%). This approach also reduced the number of treatment sessions, the number of percutaneous access tracts, and the blood loss and potential morbidity associated with multiple tracts.

Top 50 Highly Cited Articles on Dual Energy Computed Tomography (DECT) in Abdominal Radiology: A Bibliometric Analysis.

PubMed

Gong, Bo; Wu, Yuhao; O'Keeffe, Michael E; Berger, Ferco H; McLaughlin, Patrick D; Nicolaou, Savvas; Khosa, Faisal

2017-01-01

This study aims to identify the 50 most highly cited articles on dual energy computed tomography (DECT) in abdominal radiology Thomson Reuters Web of Science All Databases was queried without year or language restriction. Only original research articles with a primary focus on abdominal radiology using DECT were selected. Review articles, meta-analyses, and studies without human subjects were excluded. Fifty articles with the highest average yearly citation were identified. These articles were published between 2007 and 2017 in 12 journals, with the most in Radiology (12 articles). Articles had a median of 7 authors, with all first authors but one primarily affiliated to radiology departments. The United States of America produced the most articles (16), followed by Germany (13 articles), and China (7 articles). Most studies used Dual Source DECT technology (35 articles), followed by Rapid Kilovoltage Switching (14 articles), and Sequential Scanning (1 article). The top three scanned organs were the liver (24%), kidney (16%), and urinary tract (15%). The most commonly studied pathology was urinary calculi (28%), renal lesion/tumor (23%), and hepatic lesion/tumor (20%). Our study identifies intellectual milestones in the applications of DECT in abdominal radiology. The diversity of the articles reflects on the characteristics and quality of the most influential publications related to DECT.

Top 50 Highly Cited Articles on Dual Energy Computed Tomography (DECT) in Abdominal Radiology: A Bibliometric Analysis

PubMed Central

Gong, Bo; Wu, Yuhao; O’Keeffe, Michael E; Berger, Ferco H; McLaughlin, Patrick D; Nicolaou, Savvas

2017-01-01

Summary This study aims to identify the 50 most highly cited articles on dual energy computed tomography (DECT) in abdominal radiology Thomson Reuters Web of Science All Databases was queried without year or language restriction. Only original research articles with a primary focus on abdominal radiology using DECT were selected. Review articles, meta-analyses, and studies without human subjects were excluded. Fifty articles with the highest average yearly citation were identified. These articles were published between 2007 and 2017 in 12 journals, with the most in Radiology (12 articles). Articles had a median of 7 authors, with all first authors but one primarily affiliated to radiology departments. The United States of America produced the most articles (16), followed by Germany (13 articles), and China (7 articles). Most studies used Dual Source DECT technology (35 articles), followed by Rapid Kilovoltage Switching (14 articles), and Sequential Scanning (1 article). The top three scanned organs were the liver (24%), kidney (16%), and urinary tract (15%). The most commonly studied pathology was urinary calculi (28%), renal lesion/tumor (23%), and hepatic lesion/tumor (20%). Our study identifies intellectual milestones in the applications of DECT in abdominal radiology. The diversity of the articles reflects on the characteristics and quality of the most influential publications related to DECT. PMID:29657641

Percutaneous Nephrolithotomy in Children

PubMed Central

DeMarco, Romano T.

2011-01-01

The surgical management of pediatric stone disease has evolved significantly over the last three decades. Prior to the introduction of shockwave lithotripsy (SWL) in the 1980s, open lithotomy was the lone therapy for children with upper tract calculi. Since then, SWL has been the procedure of choice in most pediatric centers for children with large renal calculi. While other therapies such as percutaneous nephrolithotomy (PNL) were also being advanced around the same time, PNL was generally seen as a suitable therapy in adults because of the concerns for damage in the developing kidney. However, recent advances in endoscopic instrumentation and renal access techniques have led to an increase in its use in the pediatric population, particularly in those children with large upper tract stones. This paper is a review of the literature focusing on the indications, techniques, results, and complications of PNL in children with renal calculi. PMID:22013438

Cryotherapy of the nephrostomy tract: a novel technique to decrease the risk of hemorrhage after tubeless percutaneous renal surgery.

PubMed

Okeke, Zeph; Andonian, Sero; Srinivasan, Arun; Shapiro, Edan; Vanderbrink, Brian A; Kavoussi, Louis R; Smith, Arthur D

2009-03-01

Delayed hemorrhage and significant postoperative pain are associated with complex percutaneous renal surgery. Cryoablation of the percutaneous nephrostomy tract after endoscopic procedures is a potential means of preventing delayed renal hemorrhage. In this study, we investigated the efficacy of this technique by comparing a group of patients who underwent this approach with another group who had nephrostomy tube insertion after percutaneous renal surgery. Sixty patients with complex renal calculi or ureteropelvic junction (UPJ) obstruction underwent percutaneous endoscopic management of their disease. At the conclusion of the procedure, 30 consecutive patients underwent a single 10-minute freeze-thaw cycle, in which a cryoprobe traversed the nephrostomy tract. These 30 patients were compared with the preceding 30 patients who had a nephrostomy tube inserted after complex percutaneous renal surgery. The two groups were well matched in terms of age, body mass index, total stone burden, number of patients with full staghorn calculi, and number of patients with concomitant UPJ obstruction. The cryotherapy group had a significantly shorter hospital stay (2.1 v 3.6 days, P < 0.001); decreased rates of delayed bleeding episodes (3% v 13%, P < 0.001), and urinary leak (0% v 10%, P < 0.001). Cryotherapy of the nephrostomy is a novel means of decreasing the risk of delayed postoperative hemorrhage after complex percutaneous renal surgery. It is associated with significantly decreased length of hospitalization postoperatively, as well as decreased risk of urine leakage compared with nephrostomy tubes in these groups of patients.

Can we identify men who will have complications from benign prostatic obstruction (BPO)? ICI-RS 2011.

PubMed

Oelke, Matthias; Kirschner-Hermanns, Ruth; Thiruchelvam, Nikesh; Heesakkers, John

2012-03-01

This ICI-RS report aims to analyze morphological or functional complications of the lower or upper urinary tract in elderly men, clarify the association between complications and benign prostatic obstruction (BPO) and define men who will develop these complications. Research proposals to further enlighten these associations were to be defined. A think-tank discussion was held on the annual ICI-RS meeting in 2011. The published literature between 1966 and 2011 was reviewed and research proposals were defined with all congress participants. Post-void residual, bladder diverticula or calculi, vesico-ureteral reflux, hydronephrosis, renal insufficiency, and urinary retention appear with greater prevalence in patients with symptoms or signs of benign prostatic hyperplasia. BPO may directly or indirectly be responsible for these complications but conclusive evidence for BPO as the primary cause does not exist. Many of the complications have a multifactorial etiology and BPO is only partially responsible. It is currently impossible to define men who will develop complications. In contrast to the widespread belief of urologist, there is only rudimentary data available showing no convincing association between urinary tract complications and BPO. The ICI-RS proposes that prospective trials are conducted to demonstrate the association between complications and BPO by using cystometry, pressure-flow (P/F) studies, and other commonly used BPO parameters in men with complications and comparing those with a cohort of age-matched men without complications. Non-invasive proxy parameters of BPO, for example, ultrasonic measurement of detrusor wall thickness, can be used instead of P/F studies especially in longitudinal trials. Copyright © 2012 Wiley Periodicals, Inc.

[Experience of use of prolit super septo in the rehabilitation of patients after endoscopic surgery].

PubMed

Martov, A G; Ergakov, D V

2014-01-01

Numerous publications on the successful application of prolit super septo ( Greenwood, RF) in metaphylaxis of urolithiasis after extracorporeal shockwave lithotripsy, and in infectiousand inflammatory diseases of the upper and lower urinary tract gave rise to research aimed at investigating the efficacy and safety of long-term use of prolit super septo in patients undergoing various transurethral and percutaneous interventions. From September 2012, to March 2013, 894 transurethral and percutaneous endoscopic interventions were performed. The main group (n=450) consisted of patients treating with prolit super septo at a dose of 2 capsules 2 times a day for a one month in addition to standard uroantiseptic therapy after endourological interventions. The control group (n=444) consisted of patients receiving standard therapy for the same period after same interventions. The evaluation of patients both main and control group was focused on pyuria, daily diuresis, symptoms and quality of life of patients. It was found that after transurethral surgery of the lower urinary tract, the use of prolit super septo reduces the severity of irritative symptoms, improves the quality of life, reduces the leucocyturia, and increases the diuresis. Application of prolit super septo after operations on the upper urinary tract leads to a decrease of leucocyturia, increase of dieresis, and improves the discharge of residual fragments. In patients with oxalate and urate calculi, persistent increase in the pH of urine was noteda, which may be a part of metaphylaxis of urolithiasis. Adverse effects associated with taking of prolit super septo were not observed.

Prophylactic role of phycocyanin: a study of oxalate mediated renal cell injury.

PubMed

Farooq, Shukkur Muhammed; Asokan, Devarajan; Kalaiselvi, Periandavan; Sakthivel, Ramasamy; Varalakshmi, Palaninathan

2004-08-10

Oxalate induced renal calculi formation and the associated renal injury is thought to be caused by free radical mediated mechanisms. An in vivo model was used to investigate the effect of phycocyanin (from Spirulina platensis), a known antioxidant, against calcium oxalate urolithiasis. Male Wistar rats were divided into four groups. Hyperoxaluria was induced in two of these groups by intraperitoneal infusion of sodium oxalate (70 mg/kg) and a pretreatment of phycocyanin (100 mg/kg) as a single oral dosage was given, 1h prior to sodium oxalate infusion. An untreated control and drug control (phycocyanin alone) were also included in the study. We observed that phycocyanin significantly controlled the early biochemical changes in calcium oxalate stone formation. The antiurolithic nature of the drug was evaluated by the assessment of urinary risk factors and light microscopic observation of urinary crystals. Renal tubular damage as divulged by urinary marker enzymes (alkaline phosphatase, acid phosphatase and gamma-glutamyl transferase) and histopathological observations such as decreased tubulointerstitial, tubular dilatation and mononuclear inflammatory cells, indicated that renal damage was minimised in drug-pretreated group. Oxalate levels (P < 0.001) and lipid peroxidation (P < 0.001) in kidney tissue were significantly controlled by drug pretreatment, suggesting the ability of phycocyanin to quench the free radicals, thereby preventing the lipid peroxidation mediated tissue damage and oxalate entry. This accounts for the prevention of CaOx stones. Thus, the present analysis revealed the antioxidant and antiurolithic potential of phycocyanin thereby projecting it as a promising therapeutic agent against renal cell injury associated kidney stone formation.

Association with meteo-climatological factors and daily emergency visits for renal colic and urinary calculi in Cuneo, Italy. A retrospective observational study, 2007-2010

NASA Astrophysics Data System (ADS)

Condemi, Vincenzo; Gestro, Massimo; Dozio, Elena; Tartaglino, Bruno; Corsi Romanelli, Massimiliano Marco; Solimene, Umberto; Meco, Roberto

2015-03-01

The incidence of nephrolithiasis is rising worldwide, especially in women and with increasing age. Incidence and prevalence of kidney stones are affected by genetic, nutritional, and environmental factors. The aim of this study is to investigate the link between various meteorological factors (independent variables) and the daily number of visits to the Emergency Department (ED of the S. Croce and Carle Hospital of Cuneo for renal colic (RC) and urinary stones (UC) as the dependent variable over the years 2007-2010. The Poisson generalized regression models (PGAMs) have been used in different progressive ways. The results of PGAMs (stage 1) adjusted for seasonal and calendar factors confirmed a significant correlation ( p < 0.03) with the thermal parameter. Evaluation of the dose-response effect [PGAMs combined with distributed lags nonlinear models (DLNMs)—stage 2], expressed in terms of relative risk (RR) and cumulative relative risk (RRC), indicated a relative significant effect up to 15 lag days of lag (RR > 1), with a first peak after 5 days (lag ranges 0-1, 0-3, and 0-5) and a second weak peak observed along the 5-15 lag range days. The estimated RR for females was significant, mainly in the second and fourth age group considered (19-44 and >65 years): RR for total ED visits 1.27, confidence interval (CI) 1.11-1.46 (lag 0-5 days); RR 1.42, CI 1.01-2.01 (lag 0-10 days); and RR 1.35, CI 1.09-1.68 (lag 0-15 days). The research also indicated a moderate involvement of the thermal factor in the onset of RC caused by UC, exclusively in the female sex. Further studies will be necessary to confirm these results.

Treatment of mid- and lower ureteric calculi: extracorporeal shock-wave lithotripsy vs laser ureteroscopy. A comparison of costs, morbidity and effectiveness.

PubMed

Bierkens, A F; Hendrikx, A J; De La Rosette, J J; Stultiens, G N; Beerlage, H P; Arends, A J; Debruyne, F M

1998-01-01

To determine the efficacy and costs of extracorporeal shock-wave lithotripsy (ESWL) compared with ureteroscopy (URS) in the treatment of mid- and lower ureteric calculi. The records of patients treated primarily by ESWL and URS were analysed retrospectively. Treatment with ESWL included 63 patients (42 men and 21 women, mean age 52 years, range 23-78, 19 mid- and 44 lower ureteric calculi). All patients received 4000 shock waves at a mean energy setting of 18.1 kV. URS was used in 105 patients, with a 7.2 F miniscope or the 7.1 F flexible scope. Stones were fragmented with a pulsed-dye laser lithotripter at 504 nm and a power of up to 130 mJ (mean 53 mJ) using a 200 or 320 microns fibre. All ureteroscopies were performed with the patient under general (n = 17) or spinal (n = 87) anaesthesia in a mean treatment duration of 34 min. Stones were located in the mid-ureter in 24 patients and in the lower ureter in 80. The outcome was assessed by stone-free rates, re-treatment rates, time to become stone-free, complication and costs. ESWL for mid- and lower ureteric calculi resulted in a success rate of 90% and 81%, respectively, compared with 96% and 99% for URS. However, patients treated with URS were stone-free within 2 days, whereas patients in the ESWL group required up to 4 months. The best results for ESWL were achieved with stones of < 50 mm2. The costs of URS were higher than those for ESWL. ESWL provides a noninvasive, simple and safe option for the management of mid- and lower ureteric calculi, provided that the stones are < 50 mm2; larger stones are best treated by URS.

An experimental model for calcium carbonate urolithiasis in goats

PubMed Central

Dominguez, Brandon J.; Deveau, Michael A.

2018-01-01

Background Calcium carbonate is a common urolith type in small ruminants with no high‐yield experimental model to evaluate animal susceptibility or preventative measure response. Hypothesis That novel plastic winged implants would allow accumulation and quantification of calcium carbonate calculus formation in goats on a high‐calcium diet and identify individual variation between goats in the mass of calculi produced. Animals Eight nonpregnant 3‐ and 4‐year‐old Boer‐cross does, weighing 22.3–39.5 kg, determined to be healthy based on physical examination, were used in these experiments. Methods Prospective cohort study for in vivo experimental model development. Implants were placed into the urinary bladder lumen in 8 goats over 2 evaluation periods. The alfalfa‐based ration had a total ration Ca : P of 3.29 and 3.84 : 1, respectively. Urine was collected at 0, 28, 56, and 84 days in the 1st experiment; blood and urine at those timepoints in the 2nd experiment. For each evaluation period, the implants were removed 84 days after implantation and weighed. Accumulated calculi mass was calculated and compared between goats and was analyzed for composition. Results Implant retention was 100% and 86% in the 2 studies. All goats with retained implants accumulated calcium carbonate at a mean implant gain per day across studies ranging from 0.44 to 57.45 mg. Two goats accumulated (0.44–7.65 mg/day and 33.64 & 57.45 mg/day) significantly more urolith material than the cohort across both studies (P = .047). No routine analytes on blood or urine were found to be explanatory for the difference observed. Conclusions and Clinical Importance These findings form a basis for implant and diet selection for use in future studies of urolithiasis development and for studies regarding individual susceptibility to urolithiasis. PMID:29524246

Percutaneous management of urolithiasis during pregnancy.

PubMed

Kavoussi, L R; Albala, D M; Basler, J W; Apte, S; Clayman, R V

1992-09-01

A total of 6 pregnant women with obstructing urinary calculi was managed by percutaneous nephrostomy drainage placed under ultrasound guidance with the patient under local anesthesia. All patients initially had relief of acute obstruction. However, occlusion of the percutaneous nephrostomy tubes with debris necessitated tube changes in 5 of 6 patients. In 2 patients recurrent nephrostomy tube obstruction, fever and pain led to percutaneous stone removal during pregnancy. In the remaining 4 patients the nephrostomy tubes were left indwelling through delivery. During the postpartum period 3 patients successfully underwent ureteroscopic stone extraction and 1 passed the stone spontaneously. Bacteriuria developed in each patient despite the use of preventive antibiotics. All 6 women had uncomplicated vaginal deliveries of healthy newborns and are currently asymptomatic with no evidence of obstruction. Percutaneous drainage of an acutely obstructed kidney in a pregnant woman is an effective temporizing alternative to ureteral stent placement until definitive treatment can be performed.

Evolving Guidance on Ureteric Calculi Management in the Acute Setting.

PubMed

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

2016-03-01

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

Onosma L.: A review of phytochemistry and ethnopharmacology

PubMed Central

Kumar, Neeraj; Kumar, Rajnish; Kishore, Kamal

2013-01-01

The genus Onosma L. (Boraginaceae) includes about 150 species distributed world-wide in which only about 75 plants has been described for its morphology and less than 10 plants for their chemical constituents and clinical potential. The phytochemical reports of this genus revels that it comprise mainly aliphatic ketones, lipids, naphthazarins, alkaloids, phenolic compounds, naphthoquinones, flavones while most important are shikonins and onosmins. The plants are traditionally used as laxative, anthelmintic and for alexipharmic effects. The plants are also equally use in eye, blood diseases, bronchitis, abdominal pain, stangury, thirst, itch, lecoderma, fever, wounds, burns, piles and urinary calculi. The flowers of various plants are prescribed as stimulants, cardiotonic, in body swelling while leaves are used as purgative and in cutaneous eruptions. The roots are used for coloring food stuffs, oils and dying wool and in medicinal preparations. This review emphasizes the distribution, morphology, phytochemical constituents, ethnopharmacology, which may help in future research. PMID:24347922

Particle motion in unsteady two-dimensional peristaltic flow with application to the ureter

NASA Astrophysics Data System (ADS)

Jiménez-Lozano, Joel; Sen, Mihir; Dunn, Patrick F.

2009-04-01

Particle motion in an unsteady peristaltic fluid flow is analyzed. The fluid is incompressible and Newtonian in a two-dimensional planar geometry. A perturbation method based on a small ratio of wave height to wavelength is used to obtain a closed-form solution for the fluid velocity field. This analytical solution is used in conjunction with an equation of motion for a small rigid sphere in nonuniform flow taking Stokes drag, virtual mass, Faxén, Basset, and gravity forces into account. Fluid streamlines and velocity profiles are calculated. Theoretical values for pumping rates are compared with available experimental data. An application to ureteral peristaltic flow is considered since fluid flow in the ureter is sometimes accompanied by particles such as stones or bacteriuria. Particle trajectories for parameters that correspond to calcium oxalates for calculosis and Escherichia coli type for bacteria are analyzed. The findings show that retrograde or reflux motion of the particles is possible and bacterial transport can occur in the upper urinary tract when there is a partial occlusion of the wave. Dilute particle mixing is also investigated, and it is found that some of the particles participate in the formation of a recirculating bolus, and some of them are delayed in transit and eventually reach the walls. This can explain the failure of clearing residuals from the upper urinary tract calculi after successful extracorporeal shock wave lithotripsy. The results may also be relevant to the transport of other physiological fluids and industrial applications in which peristaltic pumping is used.

Conspicuity of renal calculi at unenhanced CT: effects of calculus composition and size and CT technique.

PubMed

Tublin, Mitchell E; Murphy, Michael E; Delong, David M; Tessler, Franklin N; Kliewer, Mark A

2002-10-01

To determine the effects of calculus size, composition, and technique (kilovolt and milliampere settings) on the conspicuity of renal calculi at unenhanced helical computed tomography (CT). The authors performed unenhanced CT of a phantom containing 188 renal calculi of varying size and chemical composition (brushite, cystine, struvite, weddellite, whewellite, and uric acid) at 24 combinations of four kilovolt (80-140 kV) and six milliampere (200-300 mA) levels. Two radiologists, who were unaware of the location and number of calculi, reviewed the CT images and recorded where stones were detected. These observations were compared with the known positions of calculi to generate true-positive and false-positive rates. Logistic regression analysis was performed to investigate the effects of stone size, composition, and technique and to generate probability estimates of detection. Interobserver agreement was estimated with kappa statistics. Interobserver agreement was high: the mean kappa value for the two observers was 0.86. The conspicuity of stone fragments increased with increasing kilovolt and milliampere levels for all stone types. At the highest settings (140 kV and 300 mA), the detection threshold size (ie, the size of calculus that had a 50% probability of being detected) ranged from 0.81 mm + 0.03 (weddellite) to 1.3 mm + 0.1 (uric acid). Detection threshold size for each type of calculus increased up to 1.17-fold at lower kilovolt settings and up to 1.08-fold at lower milliampere settings. The conspicuity of small renal calculi at CT increases with higher kilovolt and milliampere settings, with higher kilovolts being particularly important. Small uric acid calculi may be imperceptible, even with maximal CT technique.

Salivary calculus diagnosis with 3-dimensional cone-beam computed tomography.

PubMed

Dreiseidler, Timo; Ritter, Lutz; Rothamel, Daniel; Neugebauer, Jörg; Scheer, Martin; Mischkowski, Robert A

2010-07-01

The objective of this study was to evaluate cone-beam CT (CBCT) diagnoses of sialoliths in the major salivary glands. Twenty-nine CBCT images containing salivary calculi were retrospectively evaluated for image quality and artifact influence. Additionally, the reproducibility of calculus measurement and the differences between CBCT measurements and ultrasonography (US) and histomorphometry (HM) measurements were determined. Diagnostic sensitivity and specificity calculations were based on the observations of 3 masked clinicians, who reviewed a total of 58 CBCT volumes. Salivary calculi were sufficiently visualized in all patients. Metal artifacts were detected in images of 7 patients, and movement artifacts in 2. CBCT calculi measurements were highly reproducible, with mean differences of less than 350 microm. Mean CBCT measurements of calculi diameters differed from mean US measurements by approximately 500 microm and differed from mean HM measurements by approximately 1 mm. For calculus diagnoses, the mean sensitivity and specificity were both 98.85%. Although poor image qualities and artifacts can reduce diagnostic information, salivary calculi can be evaluated adequately with CBCT. CBCT measurements of calculi are highly reproducible and differ little from measurements made with US and HM. Diagnostic sensitivity and specificity levels with CBCT are as high as or higher than those obtained with other diagnostic methods. Because of its high diagnostic-information-to-radiation-dose ratio, CBCT is the preferable imaging modality for salivary calculus diagnosis. Copyright (c) 2010 Mosby, Inc. All rights reserved.

Quantitative Mineralogical Composition of Calculi and Urine Abnormalities for Calcium Oxalate Stone Formers: A Single-Center Results.

PubMed

Kustov, Andrey V; Strelnikov, Alexander I

2018-05-03

The paper focuses on the relationship of risk factors and metabolic disorders with mineralogical composition of calculi, age and gender of calcium oxalate stone formers. Stone mineralogical composition, 24 hour biochemistry and pH-profile of urine were examined for sixty four stone formers using powder X-ray diffraction, spectrophotometric and potentiometric techniques. The analysis indicated that 44 % of calculi were composed of pure calcium oxalate monohydrate, whereas other 56 % contained both monohydrate and dihydrate or usually their mixtures with hydroxyl apatite. Hypocitraturia, hypercalciuria and hyperuricosuria were identified as the most frequent disorders. Patients with pure calcium oxalate stones and calcium oxalate mixed with apatite revealed different patterns including age, acid-base balance of urine, calcium, citrate excretion etc.Conclusions: Our results demonstrate that most patients simultaneously reveal several risk factors. The special attention should be paid to normalize the daily citrate, calcium and urate excretion. High risk patients, such as postmenopausal females or stone formers with a high apatite content require a specific metabolic evaluation towards in highlighting abnormalities associated with stone formation.

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.

Ultrasound detection of prostatic calculi as a parameter to predict the appearance of hematospermia after a prostate biopsy.

PubMed

Dell'Atti, Lucio

2017-01-01

We evaluated the correlation between prostate calculi and hematospermia in patients undergoing prostate biopsy, and its impact on sexual activity of patients. A single-center prospective randomized study of 212 patients referred for transrectal ultrasound-guided prostate biopsy (TRUSBx) was performed. All patients were divided into two groups: Group A (GA), 106 patients with moderate/marked presence of prostatic calculi visualized by TRUS; Group B (GB), 106 patients with absence/scarce of prostatic calcifications. Patients were handed questionnaires to obtain a validated data on the duration and impact of hematospermia on sexual activity. The anxiety scores were recorded using a visual analogue scale. No significant difference was noted between the two groups when comparing age, preoperative PSA level, prostate volume, and biopsy number, except for digital rectal examination (DRE) findings. Post-biopsy results of patients included in GA revealed that the complication of hematospermia was present in 65.1%, while in GB was present in 39.7% (p<0.001). On multivariate analysis for identifying significant preoperative predictors of hematospermia, which included variables of age, PSA, prostate volume, and prostate cancer were not shown to be significant predictors of hematospermia, except DRE and prostate calculi (p<0.001). The mean anxiety score was 3.7±2.8 in GA and 2.3±1.9 in GB, respectively (p<0.001). Prostatic calculi are an independent predictive factor of severe hematospermia after TRUSBx on the basis of multivariate analysis, but don't affect the positive rate of prostate cancer. Patients should be adequately counselled before TRUSBx to avoid undue anxiety and alterations in sexual activity. Copyright® by the International Brazilian Journal of Urology.

Percutaneous Transhepatic Endoscopic Holmium Laser Lithotripsy for Intrahepatic and Choledochal Biliary Stones

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

Rimon, Uri, E-mail: rimonu@sheba.health.gov.il; Kleinmann, Nir; Bensaid, Paul

2011-12-15

Purpose: To report our approach for treating complicated biliary calculi by percutaneous transhepatic endoscopic biliary holmium laser lithotripsy (PTBL). Patients and Methods: Twenty-two symptomatic patients (11 men and 11 women, age range 51 to 88 years) with intrahepatic or common bile duct calculi underwent PTBL. Nine patients had undergone previous gastrectomy and small-bowel anastomosis, thus precluding endoscopic retrograde cholangiopancreatography. In the other 13 patients, stone removal attempts by ERCP failed due to failed access or very large calculi. We used a 7.5F flexible ureteroscope and a 200-{mu}m holmium laser fiber by way of a percutaneous transhepatic tract, with graded fluoroscopy,more » to fragment the calculi with direct vision. Balloon dilatation was added when a stricture was seen. The procedure was performed with the patient under general anaesthesia. A biliary drainage tube was left at the end of the procedure. Results: All stones were completely fragmented and flushed into the small bowel under direct vision except for one patient in whom the procedure was aborted. In 18 patients, 1 session sufficed, and in 3 patients, 2 sessions were needed. In 7 patients, balloon dilatation was performed for benign stricture after Whipple operation (n = 3), for choledochalenteric anastomosis (n = 3), and for recurrent cholangitis (n = 1). Adjunctive 'balloon push' (n = 4) and 'rendezvous' (n = 1) procedures were needed to completely clean the biliary tree. None of these patients needed surgery. Conclusion: Complicated or large biliary calculi can be treated successfully using PTBL. We suggest that this approach should become the first choice of treatment before laparoscopic or open surgery is considered.« less

Extracorporeal shock wave lithotripsy for obstructing pancreatic duct calculi.

PubMed

Matthews, K; Correa, R J; Gibbons, R P; Weissman, R M; Kozarek, R A

1997-08-01

A review was done to determine the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in the treatment of impacted pancreatic duct calculi. A total of 19 patients, who were potential candidates for radical pancreatic surgery after unsuccessful endoscopic retrograde cholangiopancreatography, sphincterotomy and attempted stone extraction from the pancreatic ducts, underwent ESWL of the calculi. Followup ranged from 6 months to 6 years. Of the 19 patients 14 avoided a major operation and 6 have remained pain-free for the long term. Two patients died of causes not related to ESWL or endoscopic retrograde cholangiopancreatography. Five patients eventually underwent a Whipple or Puestow procedure for relief of symptoms or persistent obstruction. Complications were minimal. ESWL is a valuable adjunct in patients with impacted pancreatic duct calculi unretrievable by primary endoscopic retrograde cholangiopancreatography.

Retrospective Analysis of Ultrasound-guided Flexible Ureteroscopy in the Management of Calyceal Diverticular Calculi.

PubMed

Zhang, Ji-Qing; Wang, Yong; Zhang, Jun-Hui; Zhang, Xiao-Dong; Xing, Nian-Zeng

2016-09-05

Percutaneous nephrolithotomy (PCNL) is the most widely recommended treatment for calyceal diverticular calculi, providing excellent stone-free results. However, its invasiveness is not negligible considering its major complication rates. Flexible ureteroscopy (FURS) is currently used to treat calyceal diverticula. However, the greatest drawback of FURS is locating the diverticulum since its neck is narrow and concealed. In such a case, the FURS procedure must be converted to PCNL. The aim of this study was to evaluate ultrasound-guided flexible ureteroscopy (UFURS) identifying diverticulum and the management of calyceal diverticular calculi. A retrospective analysis was conducted on 24 patients who had calyceal diverticular calculi. In all 12 patients in the UFURS group, direct FURS failed to find evidence of calyceal diverticula but were confirmed with imaging. The other 12 patients in the PCNL group received PCNL plus fulguration of the diverticular walls. Puncture of calyceal diverticulum was successful in all 12 UFURS patients. Two patients in this group had postoperative residual calculi and two patients developed fever. In the PCNL group, percutaneous renal access and lithotomy were successful in all 12 patients. One patient in this group had residual calculi, one had perirenal hematoma, and two patients developed fever. No significant difference was found in the operating time (UFURS vs. PCNL, 91.8 ± 24.2 vs. 86.3 ± 18.7 min), stone-free rate (UFURS vs. PCNL, 9/12 vs. 10/12), and rate of successful lithotripsy (UFURS vs. PCNL, 10/12 vs. 11/12) between the two groups (all P> 0.05). Postoperative pain scores in the FURS group were significantly lower than that in the PCNL group (2.7 ± 1.2 vs. 6.2 ± 1.5, P< 0.05). Hospital stay in the UFURS group was significantly shorter than that in the PCNL group (3.4 ± 0.8 vs. 5.4 ± 1.0 days, P< 0.05). All patients were symptom-free following surgery (UFURS vs. PCNL, 10/10 vs. 12/12). Ultrasound-guided puncture facilitates identification of calyceal diverticula during FURS and improves the success rate of FURS surgery.

Fad diets and their effect on urinary stone formation.

PubMed

Nouvenne, Antonio; Ticinesi, Andrea; Morelli, Ilaria; Guida, Loredana; Borghi, Loris; Meschi, Tiziana

2014-09-01

The influence of unhealthy dietary habits on urinary stone formation has been widely recognized in literature. Dietary advice is indeed the cornerstone prescription for prevention of nephrolithiasis as well. However, only a small amount of medical literature has addressed the influence of popular or fad diets, often self-prescribed for the management of obesity and overweight or for cultural beliefs, on the risk of kidney stones. Thereby in this paper we analyze the current knowledge on the effects of some popular diets on overall lithogenic risk. High-protein diets, like Dukan diet, raise some concerns, since animal proteins are able to increase urinary calcium and to decrease urinary citrate excretion, thus leading to a high overall lithogenic risk. Low-carbohydrate diets, like Atkins diet or zone diet, may have a protective role against kidney stone formation, but there are also evidences stating that this dietary approach may rise calciuria and decrease citraturia, since it is generally associated to a relatively high intake of animal proteins. Vegan diet can be harmful for urinary stone disease, especially for the risk of hyperuricemia and micronutrient deficiencies, even if only few studies have addressed this specific matter. On the other side, the benefits of a lacto-ovo-vegetarian diet on kidney stone prevention have been largely emphasized, provided that the intake of calcium and oxalate is balanced. Traditional Mediterranean diet should exert a protective effect on nephrolithiasis as well, even if specific studies have not been carried out yet. High phytate and antioxidant content of this diet have however demonstrated to be beneficial in preventing the formation of new or recurrent calculi. Anyway, at the current state of knowledge, the most effective dietary approach to prevent kidney stone disease is a mild animal protein restriction, a balanced intake of carbohydrates and fats and a high intake of fruit and vegetables. Other fundamental aspects, which are often neglected in fad diets, are a normal intake of milk and dairy products and salt restriction. All these nutritional aspects should be greatly taken into account when patients who are willing to undergo fad or commercial diets ask for dietary advice.

Fad diets and their effect on urinary stone formation

PubMed Central

Nouvenne, Antonio; Ticinesi, Andrea; Morelli, Ilaria; Guida, Loredana; Meschi, Tiziana

2014-01-01

The influence of unhealthy dietary habits on urinary stone formation has been widely recognized in literature. Dietary advice is indeed the cornerstone prescription for prevention of nephrolithiasis as well. However, only a small amount of medical literature has addressed the influence of popular or fad diets, often self-prescribed for the management of obesity and overweight or for cultural beliefs, on the risk of kidney stones. Thereby in this paper we analyze the current knowledge on the effects of some popular diets on overall lithogenic risk. High-protein diets, like Dukan diet, raise some concerns, since animal proteins are able to increase urinary calcium and to decrease urinary citrate excretion, thus leading to a high overall lithogenic risk. Low-carbohydrate diets, like Atkins diet or zone diet, may have a protective role against kidney stone formation, but there are also evidences stating that this dietary approach may rise calciuria and decrease citraturia, since it is generally associated to a relatively high intake of animal proteins. Vegan diet can be harmful for urinary stone disease, especially for the risk of hyperuricemia and micronutrient deficiencies, even if only few studies have addressed this specific matter. On the other side, the benefits of a lacto-ovo-vegetarian diet on kidney stone prevention have been largely emphasized, provided that the intake of calcium and oxalate is balanced. Traditional Mediterranean diet should exert a protective effect on nephrolithiasis as well, even if specific studies have not been carried out yet. High phytate and antioxidant content of this diet have however demonstrated to be beneficial in preventing the formation of new or recurrent calculi. Anyway, at the current state of knowledge, the most effective dietary approach to prevent kidney stone disease is a mild animal protein restriction, a balanced intake of carbohydrates and fats and a high intake of fruit and vegetables. Other fundamental aspects, which are often neglected in fad diets, are a normal intake of milk and dairy products and salt restriction. All these nutritional aspects should be greatly taken into account when patients who are willing to undergo fad or commercial diets ask for dietary advice. PMID:26816783

Bilateral guaifenesin ureteral calculi.

PubMed

Whelan, Chris; Schwartz, Bradley F

2004-01-01

We report on a patient with bilateral ureteral calculi composed of guaifenesin metabolite as determined by infrared spectroscopy. These stones may be associated with excessive guaifenesin intake related to the current popularity of ephedrine preparations.

Impact of stone branch number on outcomes of percutaneous nephrolithotomy for treatment of staghorn calculi.

PubMed

Qi, Shiyong; Li, Li; Liu, Ranlu; Qiao, Baomin; Zhang, Zhihong; Xu, Yong

2014-02-01

To determine the impact of staghorn calculi branch number on outcomes of percutaneous nephrolithotomy (PNL). Retrospectively, we evaluated 371 patients (386 renal units) who underwent PNL for staghorn calculi. All calculi were showed with CT three-dimensional reconstruction (3DR) imaging preoperatively. From 3DR images, the number of stone branching into minor renal calices was recorded. According to the number, patients were divided into four groups. Group 1: the branch number 2-4; Group 2: the branch number 5-7; Group 3: the branch number 8-10; Group 4: the branch number >10. The number of percutaneous tract, operative time, staged PNL, intraoperative blood loss, postoperative hospital stay, complications, main stone composition, and stone clearance rate were compared. A significantly higher ratio of multitract (p<0.001) and staged PNL (p<0.001), a longer operative time (p<0.001) and postoperative hospital stay (p=0.043), and a lower rate of stone clearance (p<0.05) were found in PNL for calculi with a stone branch number ≥5. There was no statistical difference in intraoperative blood loss (p=0.101) and main stone composition (p=0.546). There was no statistically meaningful difference among the four groups based on the Clavien complication system (p=0.46). With the stone branch number more than five, the possibility of multitract and staged PNL, lower rate of stone clearance, and a longer postoperative hospital stay increases for staghorn calculi.

Photothermal laser lithotripsy of uric acid calculi: clinical assessment of the effects of cyanide production

NASA Astrophysics Data System (ADS)

Teichman, Joel M. H.; Champion, Paolo C.; Glickman, Randolph D.; Wollin, Timothy A.; Denstedt, John D.

1999-06-01

The mechanism of holmium:YAG lithotripsy is photothermal. Holmium:YAG lithotripsy of uric acid calculi produces cyanide, which is a known, thermal decomposition produce of uric acid. we review our experience with holmium:YAG lithotripsy of uric acid to determine if there is any clinical evidence of cyanide toxicity. A retrospective analysis of all of our cases of holmium:YAG lithotripsy of uric acid calculi was done. Anesthetic and postoperative data were reviewed. A total of 18 patients with uric acid calculi were tread with holmium:YAG lithotripsy by urethroscopy (5), retrograde nephroscopy (2), percutaneous nephrolithotomy (5) or cystolithotripsy (6). Total holmium:YAG irradiation ranged from 1.2 to 331 kJ. No patient had evidence of increased end-tidal carbon dioxide, change sin electrocardiogram or significant decrease in postoperative serum bicarbonate. An 84 year old woman had decreased diastolic pressure of 30 mm Hg while under general anesthesia. No cyanide related neurologic, cardiac or respiratory complications were noted. These data suggest no significant cyanide toxicity from holmium:YAG lithotripsy or uric acid calculi in typical clinical settings. More specific studies in animals are warranted to characterize the risk.

A Case of Acute Pancreatitis developing after Extracorporeal Shock Wave Lithotripsy.

PubMed

Goral, Vedat; Sahin, Erkan; Arslan, Murat

2015-01-01

Extracorporeal shock wave lithotripsy (ESWL) is a standard treatment method used for the treatment of renal calculi and upper ureteral calculi. Acute pancreatitis is a serious condition which develops due to multiple etiologic factors and is characterized by autodigestion of the pancreas. A case of acute pancreatitis which developed following ESWL performed for right renal calculi treatment is presented here. Goral V, Sahin E, Arslan M. A Case of Acute Pancreatitis developing after Extracorporeal Shock Wave Lithotripsy. Euroasian J Hepato-Gastroenterol 2015;5(1):52-54.

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

Vilches, J.; Lopez, A.; De Palacio, L.

Calculi removed from human prostates affected with nodular hyperplasia were analyzed with scanning electron microscopy and EDAX system. The general spectrum was made up of Na, Al, Mg, S, P, Ca and Zn. Two types of stone were identified morphostructurally and microanalytically: calculi type I of nodular surface with high peaks of S, and calculi type II polyfaceted with high peaks of P and Ca. Their formation from corpora amylacea and/or exogenous constituents is discussed. The superficial deposit of Zn suggests its incorporation from the prostatic liquid and does not seem to play an important role in the genesis.

Emergency extracorporeal shockwave lithotripsy for acute renal colic caused by upper urinary-tract stones.

PubMed

Kravchick, Sergey; Bunkin, Igor; Stepnov, Eugeny; Peled, Ronit; Agulansky, Leonid; Cytron, Shmuel

2005-01-01

To evaluate emergency SWL for the treatment of upper urinary-tract stones causing renal colic. Between January 1999 and June 2003, 53 patients with a mean age of 46.6 years (range 22-65 years) were enrolled. The inclusion criteria were acute renal colic, radiopaque 5-mm to 1.5-cm calculi in the ureteropelvic junction (N=10) or upper ureter (N=43), and no evidence of urinary-tract infection or acute renal failure. The mean stone size was 7.14 mm (range 5-13 mm). Patients were randomly assigned to the control (N=28) and study (N=25) groups using previously prepared cards in envelopes. Patients in the study group underwent emergency SWL, while patients in the control group underwent scheduled SWL within 30 days. Stone status was evaluated 4 weeks after lithotripsy. There was no significant difference between the control and study groups with respect to age, sex, stone location or volume, renal obstruction, or days spent in the hospital for pain control. Available fragments of stones were sent for infrared spectroscopy. Preoperative and postoperative data were compared in the two groups using SPSS 10.0 statistical software. The SWL treatment lasted 50+/-11 minutes. The stone-free rates were 72% and 64% and the efficiency quotients were 53% and 44% in study and control groups, respectively. Patients in the control group spent more time in the hospital (P=0.014) and in recovery at home (P=0.011). Emergency SWL for acute renal colic caused by upper-ureteral stones is a safe procedure and offers effective release from pain and obstruction. It also decreases hospitalization days and hastens return to normal activity.

Preoperative Belladonna and Opium Suppository for Ureteral Stent Pain: A Randomized, Double-blinded, Placebo-controlled Study.

PubMed

Lee, Franklin C; Holt, Sarah K; Hsi, Ryan S; Haynes, Brandon M; Harper, Jonathan D

2017-02-01

To investigate whether the use of a belladonna and opium (B&O) rectal suppository administered immediately before ureteroscopy (URS) and stent placement could reduce stent-related discomfort. A randomized, double-blinded, placebo-controlled study was performed from August 2013 to December 2014. Seventy-one subjects were enrolled and randomized to receive a B&O (15 mg/30 mg) or a placebo suppository after induction of general anesthesia immediately before URS and stent placement. Baseline urinary symptoms were assessed using the American Urological Association Symptom Score (AUASS). The Ureteral Stent Symptom Questionnaire and AUASS were completed on postoperative days (POD) 1, 3, and after stent removal. Analgesic use intraoperatively, in the recovery unit, and at home was recorded. Of the 71 subjects, 65 had treatment for ureteral (41%) and renal (61%) calculi, 4 for renal urothelial carcinoma, and 2 were excluded for no stent placed. By POD3, the B&O group reported a higher mean global quality of life (QOL) score (P = .04), a better mean quality of work score (P = .05), and less pain with urination (P = .03). The B&O group reported an improved AUASS QOL when comparing POD1 with post-stent removal (P = .04). There was no difference in analgesic use among groups (P = .67). There were no episodes of urinary retention. Age was associated with unplanned emergency visits (P <.00) and "high-pain" measure (P = .02) CONCLUSION: B&O suppository administered preoperatively improved QOL measures and reduced urinary-related pain after URS with stent. Younger age was associated with severe stent pain and unplanned hospital visits. Copyright © 2016 Elsevier Inc. All rights reserved.

Clinical value of crystalluria and quantitative morphoconstitutional analysis of urinary calculi.

PubMed

Frochot, Vincent; Daudon, Michel

2016-12-01

Crystalluria is a marker of urine supersaturation with substances deriving from metabolic disorders, inherited diseases or drugs. The investigation of crystalluria must be done according to a protocol which includes the delivery to the laboratory of a proper urine sample, the use of a microscope equipped with polarized light, the accurate knowledge of urine pH, and a comprehensive examination of the crystals, which is based on their identification, quantification and size measurement. For unusual crystals, infrared spectroscopy may also be needed. If the formation of stones is always preceded by crystalluria, the reverse is not true. In addition to the crystalline composition, stone morphology provides valuable information on stone activity and, for some crystalline species, major information regarding the underlying pathology. Fourier transform infrared spectroscopy (FTIR) reliably identify specific forms of nephrolithiasis, as common-type stones made of calcium oxalate (CaOx) and/or calcium phosphate that is combined with morphology classification; using this method, stones may be classified into 6 types subdivided in 22 subtypes. The investigation of crystalluria is an inexpensive and valuable tool for the detection and the monitoring of inherited and acquired diseases associated with urinary stone formation or acute or chronic renal function impairment from intrarenal crystal precipitation. Selective FTIR identification of the composition of core (or the umbilication), middle part, and surface of every stone allows identification of the initiating lithogenic process (in the nucleus or in the Randall's plaque) and the factors which subsequently contributed to stone growth. In conclusion, the proposed morpho-constitutional method of urinary stone analysis, which moreover is rapid and low cost, provides clinically relevant orientations for targeted etiologic evaluation. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Tailored minimally invasive management of complex calculi in horseshoe kidney.

PubMed

Ding, Jie; Zhang, Yuanyuan; Cao, Qifeng; Huang, Tao; Xu, Wei; Huang, Kai; Fang, Jing; Bai, Qiang; Qi, Jun; Huang, Yunteng

2015-01-01

Complex calculi in horseshoe kidney (HK) present a significant management challenge. Here, we report the clinical efficacy of extracorporeal shock wave lithotripsy (ESWL), minimally invasive percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy (FURS), combined with holmium laser lithotripsy, in the treatment of calculi in HK. From January 2005 to May 2014, 62 HK patients with renal calculi were reviewed in terms of medical history, treatment modality and therapeutic outcome in a single tertiary care hospital. Among the patients, 11 with a solitary stone ≤ 1.5 cm in diameter received ESWL, leading to overall stone-free rate of 72.7%; 18 with stone diameter ≤ 2-3 cm received retrograde flexible ureteroscopy, with a recorded mean digitized surface area (DSA) of 339.6 ± 103.9 mm2, mean operation time of 93.1 ± 11.5 minutes and overall stone-free rate of 88.9%; and 33 with staghorn or complex calculi (d ≥ 2 cm) had MPCNL or MPCNL-FURS, with a recorded mean DSA of 691.0 ± 329.9 vs. 802.9 ± 333.3 mm2, mean operation time of 106.4 ± 16.6 vs. 124.4 ± 15.1 min and overall stone-free rate of 89.5% vs. 92.9%. For complex calculi (d ≥ 2 cm), MPCNL combined with antegrade FURS was superior in terms of reducing number of tracts, controlling mean hemoglobin drop, but required longer operation time, comparing with MPCNL alone. As minimally invasive treatments, a combination of MPCNL and antegrade FURS provides a safe and effective modality in the management of staghorn or complex calculi (d ≥ 2 cm) in HK with significantly reduced blood loss comparing to MPCNL alone, and retrograde FURS alone is favorable for stones with a diameter ≤ 2-3 cm. ESWL is effective for viable small solitary stones (d ≤ 1.5 cm). Treatment modality should be tailored based on individual condition.

Role of combined use of potassium citrate and tamsulosin in the management of uric acid distal ureteral calculi.

PubMed

El-Gamal, Osama; El-Bendary, Mohamed; Ragab, Maged; Rasheed, Mohamed

2012-06-01

In this article, we investigated the effect of the combined use of tamsulosin and potassium citrate (Uralyt-U(®)) for the treatment of uric acid stones in the distal ureter. The study was designed as a prospective, double blind randomized controlled trial. A total of 191 adult patients with radiolucent distal ureteral calculi were recruited. We included patients with solitary stones ≥5 mm with mild or moderate hydronephrosis and a normal contralateral tract. The patients were randomized into four equal groups (the placebo, tamsulosin, Uralyt-U(®), and the combined treatment groups). The patients were treated for a maximum duration of 4 weeks or until stone expulsion. The stone size in all groups ranged from 5 to 11 mm (7.69 ± 1.7 mm). The total expulsion rate of the stones was significantly lower in the control group (26.1%) compared with that of any of the other three groups (68.8, 58.7, and 84.8% respectively) (P < 0.05). Meanwhile, the difference between the Uralyt-U(®) group and the combined treatment group was also statistically significant (P < 0.05). When we studied the patients with stones >8 mm as a separate subgroup to find the effect of the used drugs on the relatively large stones, we detected that the expulsion rate of these stones was significantly higher in the patients who received the combined treatment in comparison with any of the other three groups (P < 0.05). In conclusion, the use of urinary alkalization with tamsulosin can increase the frequency of spontaneous passage of distal ureteral uric acid stones especially those of 8-11 mm.

Content and face validation of a curriculum for ultrasonic propulsion of calculi in a human renal model.

PubMed

Hsi, Ryan S; Dunmire, Barbrina; Cunitz, Bryan W; He, Xuemei; Sorensen, Mathew D; Harper, Jonathan D; Bailey, Michael R; Lendvay, Thomas S

2014-04-01

Ultrasonic propulsion to reposition urinary tract calculi requires knowledge about ultrasound image capture, device manipulation, and interpretation. The purpose of this study was to validate a cognitive and technical skills curriculum to teach urologists ultrasonic propulsion to reposition kidney stones in tissue phantoms. Ten board-certified urologists recruited from a single institution underwent a didactic session on renal ultrasound imaging. Subjects completed technical skills modules in tissue phantoms, including kidney imaging, pushing a stone through a translucent maze, and repositioning a lower pole calyceal stone. Objective cognitive and technical performance metrics were recorded. Subjects completed a questionnaire to ascertain face and content validity on a five-point Likert scale. Eight urologists (80%) had never attended a previous ultrasound course, and nine (90%) performed renal ultrasounds less frequently than every 6 months. Mean cognitive skills scores improved from 55% to 91% (p<0.0001) on pre- and post-didactic tests. In the kidney phantom, 10 subjects (100%) repositioned the lower pole calyceal stone to at least the lower pole infundibulum, while 9 (90%) successfully repositioned the stone to the renal pelvis. A mean±SD (15.7±13.3) pushes were required to complete the task over an average of 4.6±2.2 minutes. Urologists rated the curriculum's effectiveness and realism as a training tool at a mean score of 4.6/5.0 and 4.1/5.0, respectively. The curriculum for ultrasonic propulsion is effective and useful for training urologists with limited ultrasound proficiency in stone repositioning technique. Further studies in animate and human models will be required to assess predictive validity.

Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters.

PubMed

Katsumi, H K; Kalisvaart, J F; Ronningen, L D; Hovey, R M

2010-04-01

Bladder management for male patients with spinal cord injury (SCI) challenges the urologist to work around physical and social restrictions set forth by each patient. The objective of this study was to compare the complications associated with urethral catheter (UC) versus suprapubic tube (SPT) in patients with SCI. A retrospective review of records at Long Beach Veterans Hospital was carried out to identify SCI patients managed with SPT or UC. Chart review identified morbidities including urinary tract infection (UTI), bladder stones, renal calculi, urethral complications, scrotal abscesses, epididymitis, gross hematuria and cancer. Serum creatinine measurements were evaluated to determine whether renal function was maintained. In all, 179 patients were identified. There was no significant difference between the two catheter groups in any areas in which they could be compared. There were catheter-specific complications specific to each group that could not be compared. These included erosion in the UC group and urethral leak, leakage from the SPT and SPT revision in the SPT group. Average serum creatinine for the UC and SPT groups was 0.74 and 0.67 mg per 100 ml, respectively. SCI patients with a chronic catheter have similar complication rates of UTIs, recurrent bladder/renal calculi and cancer. Urethral and scrotal complications may be higher with UC; however, morbidity from SPT-specific procedures may offset benefits from SPT. Serum creatinine was maintained in both groups. Overall, bladder management for patients with chronic indwelling catheters should be selected on the basis of long-term comfort for the patient and a physician mind-set that allows flexibility in managing these challenges.

Bilateral Same-Session Ureteroscopy for Treatment of Ureteral Calculi: A Systematic Review and Meta-Analysis.

PubMed

Ge, Hongwei; Zheng, Xiaoqing; Na, Yanqun; Hou, Xinzhi; Yu, Chengfan; Ding, Wenting; Wang, Yuyong; Yu, Zhijian; He, Huadong

2016-11-01

The traditional procedure for the management of bilateral ureteral stones is staged ureteroscopic lithotripsy (URS). However, in recent years particularly, some urologists advocate same-session bilateral URS on the ground of success rates and minimal morbidity. This systematic review is to evaluate the efficacy and safety of same-session bilateral ureteroscopy for the treatment of ureteral calculi. We conducted a bibliographic search using MEDLINE (1980 to August 2015) and EMBASE (1980 to August 2015). Review articles and abstract data were excluded and only studies in English reporting on outcomes of bilateral URS were included in this meta-analysis. Two reviewers independently assessed the quality of each included studies and extracted data. STATA 12.0 was used for meta-analysis. In 11 studies, 431 patients were reportedly treated with bilateral URS. Most of the stone sizes were not larger than 20 mm. The mean stone-free rate is 96% for the distal ureter, 85% for the middle ureter, and 72% for the proximal ureter. The mean operative time ranged from 45 to 100 minutes with an average hospital stay from 2 to 4 days. The overall complications rates were 17%, with the incidence of postoperative fever 4%, postoperative pain 20%, and gross hematuria 4%. Other complications, including urosepsis, urinary tract infection, small mucosal laceration, stone migration, and ureteral perforation, accounted for 6% of overall complications. This meta-analysis found that bilateral same-session ureteroscopy could achieve a high overall stone-free rate. There might be a relatively higher complication incidence, but most of the complications are minor. For selected cases, bilateral URS could be safe and effective.

Successful Diabetic Control as Measured by Hemoglobin A1c is Associated with Lower Urine Risk Factors for Uric Acid Calculi.

PubMed

Maciolek, Kimberly A; Penniston, Kristina L; Jhagroo, R Allan; Best, Sara L

2018-06-13

To examine the association of glycemic control, including strict glycemic control, with 24-hour (24-h) urine risk factors for uric acid and calcium calculi. With IRB approval, we identified 183 stone formers (SFs) with 459 24-h urine collections. Hemoglobin A1c (HgbA1c) measures were obtained within 3 months of the urine collection. Collections were separated into normoglycemic (NG, HgbA1c<6.5) and hyperglycemic (HG, HgbA1c≥6.5) cohorts; 24-h urine parameters were compared. The NG cohort was further divided into patients with and without a history of diabetes type 2 (DM). Variables were analyzed using chi squared, Welch's t-test and multivariate linear regression to adjust for clustering, BMI, age, gender, thiazide and potassium citrate use. Patients in the HG group were older with higher BMI. Multivariate analysis of the total study population revealed that hyperglycemia correlated with lower pH, higher uric acid relative saturation (RS), lower brushite RS and higher citrate. NG SFs with and without a history of DM had similar risk factors for uric acid stone formation. Among NG SFs, those with DM had higher urine calcium (UCa) and calcium oxalate RS than those without DM. However, this difference may be related to other factors since neither parameter correlated with DM on multivariate regression (p>0.05). Successful glycemic control may be associated with reduced urinary risk factors for uric acid stone formation. Patients with well controlled DM had equivalent risk factors to those without DM. Glycemic control should be considered a target of the multidisciplinary medical management of stone disease.

Recurrent pyogenic cholangitis in Asian immigrants: use of ultrasonography, computed tomography, and cholangiography

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

Federle, M.P.; Cello J.P.; Laing, F.C.

1982-04-01

Five cases of recurrent pyogenic cholangitis (RPC) were studied by ultrasonography, computed tomography (CT), and cholangiography. All patients were recent immigrants from the Orient or Indonesia and had had recurrent attacks of cholangitis for many years. The bile was infected by E. coli and the biliary ducts were dilated; in addition, extrahepatic bile-pigment calculi we represent in all 5 and intrahepatic calculi in 4. Abdominal ultrasound usually failed to demonstrate duct calculi and extrahepatic dilatation due to the soft, mud-like consistency of the stones. CT was successful in showing the calculi and the full extent of dilatation. The authors concludemore » that preoperative diagnosis of RPC is best achieved by awareness of the characteristic clinical presentation and the findings on abdominal CT. Preoperative cholangiography provides excellent detail, but poses the danger of biliary sepsis requiring antibiotics.« less

Toward the classification of differential calculi on κ-Minkowski space and related field theories

NASA Astrophysics Data System (ADS)

Jurić, Tajron; Meljanac, Stjepan; Pikutić, Danijel; Štrajn, Rina

2015-07-01

Classification of differential forms on κ-Minkowski space, particularly, the classification of all bicovariant differential calculi of classical dimension is presented. By imposing super-Jacobi identities we derive all possible differential algebras compatible with the κ-Minkowski algebra for time-like, space-like and light-like deformations. Embedding into the super-Heisenberg algebra is constructed using non-commutative (NC) coordinates and one-forms. Particularly, a class of differential calculi with an undeformed exterior derivative and one-forms is considered. Corresponding NC differential calculi are elaborated. Related class of new Drinfeld twists is proposed. It contains twist leading to κ-Poincaré Hopf algebra for light-like deformation. Corresponding super-algebra and deformed super-Hopf algebras, as well as the symmetries of differential algebras are presented and elaborated. Using the NC differential calculus, we analyze NC field theory, modified dispersion relations, and discuss further physical applications.

Local shock-wave lithotripsy of distal ureteral calculi.

PubMed

Voges, G E; Wilbert, D M; Stöckle, M; Hohenfellner, R

1988-01-01

Since the initiation of the clinical trial utilizing a second-generation lithotripor (Lithostar, Siemens, Erlangen, FRG), 96 patients with distal ureteral calculi (i.e. calculi below the pelvic brim) underwent local shock-wave lithotripsy. Routine treatment was conducted under intravenous sedation and light analgesia only. Complete stone disintegration was achieved in 84 patients (87.5%), 11 requiring two sessions and 1 patient, three. In 7 patients ureteroscopy became necessary after unsuccessful local shock-wave treatment. In 2 of these patients a 9-french flexible ureteroscope and the Storz Q-switched neodymium-YAG laser was used for stone disintegration. In 3 cases loop extraction and in 2 cases open surgery had to be performed for definitive stone removal. All pre- and postoperative manipulations (except open surgery) were done on the Lithostar. Local shock-wave lithotripsy is a highly successful, noninvasive, time-saving and easily applicable technique. It has become our primary approach in the treatment of distal ureteral calculi.

Sex prevalence of pediatric kidney stone disease in the United States: an epidemiologic investigation.

PubMed

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

2009-07-01

To define the sex prevalence of inpatient hospital discharges for pediatric patients diagnosed with upper urinary tract stone disease. The study examined inpatient admissions for pediatric urolithiasis in 2003, using the Healthcare Cost and Utilization Project Kids' Inpatient Database. We used the International Classification of Disease, 9th edition, Clinical Modification codes, to identify patients with a principal diagnosis of renal (592.0) or ureteral (592.1) calculi. Sex prevalence was assessed, and the results were stratified by age group. In the 2003 Kids' Inpatient Database, the sex distribution among pediatric patients with stone formation varied significantly by age. In the first decade of age, a male predominance was found that had shifted to a female predominance in the second decade. Overall, however, girls in the pediatric population were more commonly affected by stones than were boys. In this nationally representative sample, the sex distribution of pediatric urolithiasis varied with age, with boys more commonly affected in the first decade of age and girls in the second decade. Although the reason for this unique epidemiologic finding is not readily apparent, additional studies can build on this hypothesis-generating work.

Comparative spectroscopic analysis of urinary calculi inhibition by Larrea Tridentata infusion and NDGA chemical extract

NASA Astrophysics Data System (ADS)

Manciu, Felicia

2012-10-01

In the present comparative spectroscopic study we try to understand calcium oxalate kidney stone formation as well as its inhibition by using a traditional medicine approach with Larrea Tridentata (LT) herbal extracts and nordihydroguaiaretic acid (NDGA), which is a chemical extract of the LT bush. The samples were synthesized without and with LT or NDGA using a simplified single diffusion gel growth technique. While the use of infusion from LT decreases the sizes of calcium oxalate crystals and also changes their structure from monohydrate for pure crystals to dihydrate for crystals grown with different amounts of inhibitor, both Raman and infrared absorption spectroscopic techniques, which are the methods of analysis employed in this work, reveal that NDGA is not responsible for the change in the morphology of calcium oxalate crystals and does not contribute significantly to the inhibition process. The presence of NDGA slightly affects the structure of the crystals by modifying the strength of the C-C bonds as seen in the Raman data. Also, the current infrared absorption results demonstrate the presence of NDGA in the samples through a vibrational line that corresponds to the double bond between carbon atoms of the ester group of NDGA.

Application of ureterorenoscope and flexible ureterorenoscope lithotripsy in removing calculus from extracorporeal living donor renal graft: a single-center experience.

PubMed

Lin, Chun-Hua; Zhang, Zuo-Fu; Wang, Jiahui; Yu, Lu-Xin; Wang, Wen-Ting; Shi, Lei; Lin, Xiang-Nan

2017-11-01

Here, we reported our clinical application of ureterorenoscope (URS) and flexible URS lithotripsy in stone removal on 10 cases of excised living donor kidney graft. After the extraction of donor kidney by retroperitoneal laparoscopy, the donor graft was perfused with 4 °C HCA solution. Calculus between 2-4 mm were removed intact with lithotomy forceps under direct vision of URS. Larger calculi of >4 mm were fractured with flexible URS combining holmium laser lithotripsy. Fragments of the calculus were extracted with basket extractor and lithotomy forceps. All operations were successful. The operation time was 14-31 min (average 21.2 ± 6.3 min). The kidneys were then transplanted to the recipients using routine procedure. The transplanted kidneys functioned well after transplantation. Gross hematuria resolved 1-4 d after operation (average 2.6 ± 0.9 d). The transplanted kidneys functioned well without early complications such as functional recovery delay and acute graft rejection. The donors and recipients were followed for 12 months. The size of the transplanted kidneys was normal and new stones or urinary obstruction was not seen upon urinary color Doppler ultrasound examination. In conclusion, we believe it is feasible, safe and effective to use URS or flexible URS combining holmium laser lithotripsy on extracorporeal living donor kidney.

Nephrocalcinosis: re-defined in the era of endourology

PubMed Central

Miller, Nicole L.; Humphreys, Mitchell R.; Coe, Fredric L.; Evan, Andrew P.; Bledsoe, Sharon B.; Handa, Shelly E.; Lingeman, James E.

2013-01-01

Nephrocalcinosis generally refers to the presence of calcium salts within renal tissue, but this term is also used radiologically in diagnostic imaging in disease states that also produce renal stones, so that it is not always clear whether it is tissue calcifications or urinary calculi that give rise to the characteristic appearance of the kidney on x-ray or computed tomography (CT). Recent advances in endoscopic imaging now allow the visual distinction between stones and papillary nephrocalcinosis, and intrarenal endoscopy can also verify the complete removal of urinary stones, so that subsequent radiographic appearance can be confidently attributed to nephrocalcinosis. This report shows exemplary cases of primary hyperparathyroidism, type I distal renal tubular acidosis, medullary sponge kidney, and common calcium oxalate stone formation. In the first three cases—all being conditions commonly associated with nephrocalcinosis—it is shown that the majority of calcifications seen by radiograph may actually be stones. In common calcium oxalate stones formers, it is shown that Randall's plaque can appear as a small calculus on CT scan, even when calyces are known to be completely clear of stones. In the current era with the use of non-contrast CT for the diagnosis of nephrolithiasis, the finding of calcifications in close association with the renal papillae is common. Distinguishing nephrolithiasis from nephrocalcinosis requires direct visual inspection of the papillae and so the diagnosis of nephrocalcinosis is essentially an endoscopic, not radiologic, diagnosis. PMID:21057942

Asymptomatic Kidney Stones in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia

PubMed Central

Thomas, Nicole A.; Rai, Shesh N.; Cheon, Kyeongmi; McCammon, Elizabeth; Chesney, Russell; Jones, Deborah; Pui, Ching-Hon; Hudson, Melissa M.

2009-01-01

We hypothesized an association between renal calculi and bone mineral density (BMD) deficits, shown in adults, exists in survivors of childhood ALL. Thus, we analyzed associations between quantitative computed tomography (QCT)-determined renal calcifications and clinical parameters (gender, race, age at diagnosis, age at time of QCT), BMD, treatment exposures, Tanner stage. We investigated associations between stone formation and nutritional intake, serum and urinary calcium and creatinine levels, and urinary calcium/creatinine ratio. Exact Chi-square test was used to compare categorical patient characteristics and Wilcoxon-Mann-Whitney test to compare continuous measurements. Of 424 participants, 218 (51.4%) were male; 371 (87.5%) were non-black. Most (n=270; 63.7%) were ≥ 3.5 years at ALL diagnosis. Mean (SD) and median (range) BMD Z-scores of the entire cohort was -0.4 (1.2) and -0.5 (-3.9 to 5.1), respectively. Nineteen (10 males; 10 Caucasians) had kidney stones (observed prevalence of 4.5 %; 19/424) with significant negative association between stone formation and body habitus (BMI, p=0.003). Stone formation was associated with treatment protocol (p=0.009) and treatment group (0.007). Thus, kidney stones in childhood ALL survivors could herald future deterioration of renal function and development of hypertension. Long-term follow-up imaging may be warranted in these patients to monitor for progressive morbidity. PMID:18830261

Endoluminal Intervention in the Salivary Duct: Clinical Outcomes at a District General Hospital

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

Nagra, I.; Jones, C.; Dyer, J., E-mail: Jules.Dyer@rwh-tr.nhs.u

Our aim was to assess the preliminary clinical outcomes of interventional radiology for salivary duct obstruction in relation to salivary duct strictures or calculi. A retrospective analysis of consecutive patients referred for endoluminal procedures by ENT surgeons during a 4-year period were identified. The procedure was performed by a single interventional radiologist under fluoroscopic guidance using wire baskets and angioplasty balloons. Between June 2004 and October 2008, 50 sialoplasties were performed in 43 patients (30 female and 13 male). Twenty-six patients were prepared for 32 procedures for extraction of calculi (13 submandibular and 13 parotid), and 17 patients had 18more » procedures for strictures (16 parotid and 1 submandibular). One patient in the group with calculi was judged unsuitable for intervention because the stone had migrated outside the salivary duct. Information was collected regarding the clinical indication; duration and type of symptoms; technical factors; follow-up; and success or failure of reintervention. Complete stone removal was achieved in 18 of the 26 patients (69%), with success on the first attempt in 14 patients (54%). Redo procedures were required in 4 patients (15%), with subsequent complete clearance of calculi. In this cohort, 20 patients were symptomatically improved (77%). Of the 6 patients (26%) with continuing symptoms, 2 patients had mild symptoms; two had moderate symptoms; and two patients opted to have surgery for unremitting symptoms. In the stricture group, 18 procedures were performed in 17 patients, with a successful outcome in 16 patients after the initial sialoplasty. Only 1 patient required repeat intervention (6%) and later opted to have surgery for continuing symptoms. In this group, 14 patients (82%) were symptomatically improved, and 3 remained symptomatic despite a good immediate result due to restenosis. Two patients experienced early complications: One had a transient facial nerve palsy, and the other had sialadenitis treated with antibiotics. Preliminary results suggest that symptom resolution at first intervention is higher in patients with acalculous strictures. Patients with calculi are more likely to require a repeat procedure for complete clearance.« less

Computerized tomography magnified bone windows are superior to standard soft tissue windows for accurate measurement of stone size: an in vitro and clinical study.

PubMed

Eisner, Brian H; Kambadakone, Avinash; Monga, Manoj; Anderson, James K; Thoreson, Andrew A; Lee, Hang; Dretler, Stephen P; Sahani, Dushyant V

2009-04-01

We determined the most accurate method of measuring urinary stones on computerized tomography. For the in vitro portion of the study 24 calculi, including 12 calcium oxalate monohydrate and 12 uric acid stones, that had been previously collected at our clinic were measured manually with hand calipers as the gold standard measurement. The calculi were then embedded into human kidney-sized potatoes and scanned using 64-slice multidetector computerized tomography. Computerized tomography measurements were performed at 4 window settings, including standard soft tissue windows (window width-320 and window length-50), standard bone windows (window width-1120 and window length-300), 5.13x magnified soft tissue windows and 5.13x magnified bone windows. Maximum stone dimensions were recorded. For the in vivo portion of the study 41 patients with distal ureteral stones who underwent noncontrast computerized tomography and subsequently spontaneously passed the stones were analyzed. All analyzed stones were 100% calcium oxalate monohydrate or mixed, calcium based stones. Stones were prospectively collected at the clinic and the largest diameter was measured with digital calipers as the gold standard. This was compared to computerized tomography measurements using 4.0x magnified soft tissue windows and 4.0x magnified bone windows. Statistical comparisons were performed using Pearson's correlation and paired t test. In the in vitro portion of the study the most accurate measurements were obtained using 5.13x magnified bone windows with a mean 0.13 mm difference from caliper measurement (p = 0.6). Measurements performed in the soft tissue window with and without magnification, and in the bone window without magnification were significantly different from hand caliper measurements (mean difference 1.2, 1.9 and 1.4 mm, p = 0.003, <0.001 and 0.0002, respectively). When comparing measurement errors between stones of different composition in vitro, the error for calcium oxalate calculi was significantly different from the gold standard for all methods except bone window settings with magnification. For uric acid calculi the measurement error was observed only in standard soft tissue window settings. In vivo 4.0x magnified bone windows was superior to 4.0x magnified soft tissue windows in measurement accuracy. Magnified bone window measurements were not statistically different from digital caliper measurements (mean underestimation vs digital caliper 0.3 mm, p = 0.4), while magnified soft tissue windows were statistically distinct (mean underestimation 1.4 mm, p = 0.001). In this study magnified bone windows were the most accurate method of stone measurements in vitro and in vivo. Therefore, we recommend the routine use of magnified bone windows for computerized tomography measurement of stones. In vitro the measurement error in calcium oxalate stones was greater than that in uric acid stones, suggesting that stone composition may be responsible for measurement inaccuracies.

Water content contribution in calculus phantom ablation during Q-switched Tm:YAG laser lithotripsy.

PubMed

Zhang, Jian J; Rajabhandharaks, Danop; Xuan, Jason Rongwei; Wang, Hui; Chia, Ray W J; Hasenberg, Tom; Kang, Hyun Wook

2015-01-01

Q-switched (QS) Tm:YAG laser ablation mechanisms on urinary calculi are still unclear to researchers. Here, dependence of water content in calculus phantom on calculus ablation performance was investigated. White gypsum cement was used as a calculus phantom model. The calculus phantoms were ablated by a total 3-J laser pulse exposure (20 mJ, 100 Hz, 1.5 s) and contact mode with N=15 sample size. Ablation volume was obtained on average 0.079, 0.122, and 0.391  mm3 in dry calculus in air, wet calculus in air, and wet calculus in-water groups, respectively. There were three proposed ablation mechanisms that could explain the effect of water content in calculus phantom on calculus ablation performance, including shock wave due to laser pulse injection and bubble collapse, spallation, and microexplosion. Increased absorption coefficient of wet calculus can cause stronger spallation process compared with that caused by dry calculus; as a result, higher calculus ablation was observed in both wet calculus in air and wet calculus in water. The test result also indicates that the shock waves generated by short laser pulse under the in-water condition have great impact on the ablation volume by Tm:YAG QS laser.

X-ray diffraction and SEM study of kidney stones in Israel: quantitative analysis, crystallite size determination, and statistical characterization.

PubMed

Uvarov, Vladimir; Popov, Inna; Shapur, Nandakishore; Abdin, Tamer; Gofrit, Ofer N; Pode, Dov; Duvdevani, Mordechai

2011-12-01

Urinary calculi have been recognized as one of the most painful medical disorders. Tenable knowledge of the phase composition of the stones is very important to elucidate an underlying etiology of the stone disease. We report here the results of quantitative X-ray diffraction phase analysis performed on 278 kidney stones from the 275 patients treated at the Department of Urology of Hadassah Hebrew University Hospital (Jerusalem, Israel). Quantification of biominerals in multicomponent samples was performed using the normalized reference intensity ratio method. According to the observed phase compositions, all the tested stones were classified into five chemical groups: oxalates (43.2%), phosphates (7.7%), urates (10.3%), cystines (2.9%), and stones composed of a mixture of different minerals (35.9%). A detailed analysis of each allocated chemical group is presented along with the crystallite size calculations for all the observed crystalline phases. The obtained results have been compared with the published data originated from different geographical regions. Morphology and spatial distribution of the phases identified in the kidney stones were studied with scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). This type of detailed study of phase composition and structural characteristics of the kidney stones was performed in Israel for the first time.

SLC3A1 and SLC7A9 mutations in autosomal recessive or dominant canine cystinuria: a new classification system.

PubMed

Brons, A-K; Henthorn, P S; Raj, K; Fitzgerald, C A; Liu, J; Sewell, A C; Giger, U

2013-01-01

Cystinuria, one of the first recognized inborn errors of metabolism, has been reported in many dog breeds. To determine urinary cystine concentrations, inheritance, and mutations in the SLC3A1 and SLC7A9 genes associated with cystinuria in 3 breeds. Mixed and purebred Labrador Retrievers (n = 6), Australian Cattle Dogs (6), Miniature Pinschers (4), and 1 mixed breed dog with cystine urolithiasis, relatives and control dogs. Urinary cystinuria and aminoaciduria was assessed and exons of the SLC3A1 and SLC7A9 genes were sequenced from genomic DNA. In each breed, male and female dogs, independent of neuter status, were found to form calculi. A frameshift mutation in SLC3A1 (c.350delG) resulting in a premature stop codon was identified in autosomal-recessive (AR) cystinuria in Labrador Retrievers and mixed breed dogs. A 6 bp deletion (c.1095_1100del) removing 2 threonines in SLC3A1 was found in autosomal-dominant (AD) cystinuria with a more severe phenotype in homozygous than in heterozygous Australian Cattle Dogs. A missense mutation in SLC7A9 (c.964G>A) was discovered in AD cystinuria in Miniature Pinschers with only heterozygous affected dogs observed to date. Breed-specific DNA tests were developed, but the prevalence of each mutation remains unknown. These studies describe the first AD inheritance and the first putative SLC7A9 mutation to cause cystinuria in dogs and expand our understanding of this phenotypically and genetically heterogeneous disease, leading to a new classification system for canine cystinuria and better therapeutic management and genetic control in these breeds. Copyright © 2013 by the American College of Veterinary Internal Medicine.

Urogynaecological and obstetric issues in women with the exstrophy-epispadias complex.

PubMed

Mathews, R I; Gan, M; Gearhart, J P

2003-06-01

To review of the sexual and urogynaecological issues faced by a large cohort of women with the exstrophy-epispadias complex (EEC). The study comprised 83 women and girls with EEC; a confidential survey was mailed to identify their social and sexual concerns. Fifty-six women had classical bladder exstrophy (CBE), 13 had female epispadias (FE) and 14 had cloacal exstrophy (CE). Data on the initial method of reconstruction and urogynaecological problems were obtained from a review of the hospital records. Information on continence, infection and sexual function was obtained from 34 completed surveys. The bladder was closed in 51 patients with CBE and 13 with CE. Urinary calculi developed in 10 patients with CBE, two with FE and three with CE. Vaginal and uterine prolapse occurred an earlier age in patients with EEC. Eight women had 13 pregnancies, eight of which resulted in normal healthy children. Overall continence was achieved in 85% of the women surveyed. Urinary tract infections remained a frequent problem for women with EEC; only 27% of respondents indicated that they were infection-free. Women aged > 18 years (24) who responded indicated that they had appropriate sexual desire; 16 were sexually active and the mean age for commencing sexual activity was 19.9 years. Six patients had dyspareunia and 10 indicated that they had orgasms. However, five additional patients indicated that they had restricted intercourse, as they were dissatisfied with the cosmesis of their external genitalia. Sexual and gynaecological issues become increasingly important in patients with EEC as they become adults. Understanding these issues faced by patients with EEC as they mature will permit better counselling of future patients.

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.

Percutaneous Endoscopic Holmium Laser Lithotripsy for Management of Complicated Biliary Calculi

PubMed Central

Healy, Kelly; Chamsuddin, Abbas; Spivey, James; Martin, Louis; Nieh, Peter

2009-01-01

Background and Objectives: Advances in endoscopic techniques have transformed the management of urolithiasis. We sought to evaluate the role of such urological interventions for the treatment of complex biliary calculi. Methods: We conducted a retrospective review of all patients (n=9) undergoing percutaneous holmium laser lithotripsy for complicated biliary calculi over a 4-year period (12/2003 to 12/2007). All previously failed standard techniques include ERCP with sphincterotomy (n=6), PTHC (n=7), or both of these. Access to the biliary system was obtained via an existing percutaneous transhepatic catheter or T-tube tracts. Endoscopic holmium laser lithotripsy was performed via a flexible cystoscope or ureteroscope. Stone clearance was confirmed intra- and postoperatively. A percutaneous transhepatic drain was left indwelling for follow-up imaging. Results: Mean patient age was 65.6 years (range, 38 to 92). Total stone burden ranged from 1.7 cm to 5 cm. All 9 patients had stones located in the CBD, with 2 patients also having additional stones within the hepatic ducts. All 9 patients (100%) were visually stone-free after one endoscopic procedure. No major perioperative complications occurred. Mean length of stay was 2.4 days. At a mean radiological follow-up of 5.4 months (range, 0.5 to 21), no stone recurrence was noted. Conclusions: Percutaneous endoscopic holmium laser lithotripsy is a minimally invasive alternative to open salvage surgery for complex biliary calculi refractory to standard approaches. This treatment is both safe and efficacious. Success depends on a multidisciplinary approach. PMID:19660213

Incidence and management of dialysis patients with renal calculi.

PubMed

Viterbo, Rosalia; Mydlo, Jack H

2002-01-01

The incidence of renal stones in patients on dialysis, while lower in number compared to the general population because of decreased renal function, is nonetheless a clinical dilemma. We wanted to evaluate the incidence and management of stone disease in patients on hemodialysis. We reviewed the literature from 1966 to the present using Medline. Study inclusion criteria were detection and treatment of stone disease in both hemodialysis and peritoneal dialysis patients. It is estimated that between 5 and 13% of all dialysis patients will develop symptomatic renal calculi and many more asymptomatic calculi. Many of the stone-forming dialysis patients will have recurring stone disease with one study finding an 83.3% recurrence rate. Since dialysis patients have a wide range of urine output, the clinician should be alert to the possibility of stone formation. We recommend yearly ultrasound examinations on all dialysis patients as well as citrate and magnesium supplements with careful follow-up of laboratory results and urine electrolytes. We also recommend careful follow-up of all patients on aluminum-hydroxide phosphate binders as they are predisposed to form Al-Mg-urate stones. For those dialysis patients that form renal calculi, watchful waiting and symptomatic treatment is recommended since almost all patients will spontaneously pass their stones. However, ESWL and other current modalities may be used with no greater morbidity compared to nondialysis cohorts. We also suggest that patients with severe recurring intractable stone disease who are candidates for renal transplantation should be offered bilateral nephrectomies. Copyright 2002 S. Karger AG, Basel

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.

Body mass index and buttock circumference are independent predictors of disintegration failure in extracorporeal shock wave lithotripsy for ureteral calculi.

PubMed

Yang, Teng-Kai; Yang, Hung-Ju; Lee, Liang-Min; Liao, Chun-Hou

2013-07-01

Effective stone disintegration by extracorporeal shockwave lithotripsy (ESWL) may depend on patient- and stone-related factors. We investigated predictors of disintegration failure in ESWL for a solitary ureteral calculus. From July 2008 to May 2010, 203 patients who underwent ESWL for a solitary ureteral calculus were enrolled. Clinical and radiologic data were collected, and factors related to ESWL failure were analyzed. Fifty-two patients (25.6%) showed ESWL failure, with a mean follow-up of 41 days. Forty patients (19.7%) required retreatment, including 12 who underwent repeat ESWL and 28 who underwent curative ureteroscopy. Patients with ESWL failure had significantly higher body weight, body mass index (BMI), and buttock circumference (BC) than patients for whom ESWL was successful. Univariate analysis showed that stone burden (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.03-1.06) and BC (OR, 1.06; 95% CI, 1.01-1.11) were predictors of ESWL failure, while BMI was a potential predictor with borderline significance (OR, 1.09; 95% CI, 0.99-1.20). Multivariate analysis showed that stone burden (OR, 1.04; 95% CI, 1.03-1.06) was a significant predictor for all patients. On stratifying patients according to the level of ureteral calculi, BC was found to be an independent predictor (OR, 1.35; 95% CI, 1.02-1.80) for ESWL failure for middle/lower ureteral calculi and BMI (OR, 1.47; 95% CI, 1.13-1.91) for upper ureteral calculi. Stone burden is the main predictor of ESWL failure for all patients with ureteral calculi. BC and BMI are independent predictors for ESWL failure for middle/lower and upper ureteral calculi, respectively. Copyright © 2012. Published by Elsevier B.V.

Combined Endoscopic and Laparoscopic Management of Postcholecystectomy Mirizzi Syndrome from a Remnant Cystic Duct Stone: Case Report and Review of the Literature

PubMed Central

Amin, Arpit; Zhurov, Yuriy; Ibrahim, George; Maffei, Anthony; Giannone, Jonathan; Cerabona, Thomas; Kaul, Ashutosh

2016-01-01

Mirizzi syndrome has been defined in the literature as common bile duct obstruction resulting from calculi within Hartmann's pouch or cystic duct. We present a case of a 78-year-old female, who developed postcholecystectomy Mirizzi syndrome from a remnant cystic duct stone. Diagnosis of postcholecystectomy Mirizzi syndrome was made on endoscopic retrograde cholangiography (ERCP) performed postoperatively. The patient was treated with a novel strategy by combining advanced endoscopic and laparoscopic techniques in three stages as follows: Stage 1 (initial presentation): endoscopic sphincterotomy with common bile duct stent placement; Stage 2 (6 weeks after Stage 1): laparoscopic ultrasonography to locate the remnant cystic duct calculi followed by laparoscopic retrieval of the calculi and intracorporeal closure of cystic duct stump; Stage 3 (6 weeks after Stage 2): endoscopic removal of common bile duct stent along with performance of completion endoscopic retrograde cholangiogram. In addition, we have performed an extensive review of the various endoscopic and laparoscopic management techniques described in the literature for the treatment of postcholecystectomy syndrome occurring from retained cystic duct stones. PMID:27047698

Combined Endoscopic and Laparoscopic Management of Postcholecystectomy Mirizzi Syndrome from a Remnant Cystic Duct Stone: Case Report and Review of the Literature.

PubMed

Amin, Arpit; Zhurov, Yuriy; Ibrahim, George; Maffei, Anthony; Giannone, Jonathan; Cerabona, Thomas; Kaul, Ashutosh

2016-01-01

Mirizzi syndrome has been defined in the literature as common bile duct obstruction resulting from calculi within Hartmann's pouch or cystic duct. We present a case of a 78-year-old female, who developed postcholecystectomy Mirizzi syndrome from a remnant cystic duct stone. Diagnosis of postcholecystectomy Mirizzi syndrome was made on endoscopic retrograde cholangiography (ERCP) performed postoperatively. The patient was treated with a novel strategy by combining advanced endoscopic and laparoscopic techniques in three stages as follows: Stage 1 (initial presentation): endoscopic sphincterotomy with common bile duct stent placement; Stage 2 (6 weeks after Stage 1): laparoscopic ultrasonography to locate the remnant cystic duct calculi followed by laparoscopic retrieval of the calculi and intracorporeal closure of cystic duct stump; Stage 3 (6 weeks after Stage 2): endoscopic removal of common bile duct stent along with performance of completion endoscopic retrograde cholangiogram. In addition, we have performed an extensive review of the various endoscopic and laparoscopic management techniques described in the literature for the treatment of postcholecystectomy syndrome occurring from retained cystic duct stones.

Local anesthesia and hydro-distension to facilitate cystic calculus removal in horses.

PubMed

Russell, Tom; Pollock, Patrick J

2012-07-01

To report a technique for improving surgical access to the bladder for removal of cystic calculi in male horses. Retrospective case series. Geldings (8) with cystic calculi. After catheterization of the bladder through the penis, 100 mL 2% lidocaine hydrochloride solution was instilled. After 10 minutes, the bladder was distended with sterile, warmed Hartmann's solution to a pressure of ≈ 40 cm H(2) O, using gravity feed. This was left in place until abdominal access was gained at surgery, then the fluid siphoned off via the catheter. Calculi were 3-11 cm in diameter (median, 6 cm). Bladder capacity ranged from 1.4 to 2.5 L (median, 1.8 L). Exteriorization time from placing a hand in the abdomen to having the bladder in a surgically accessible position was <5 minutes. The described technique facilitates exteriorization of the bladder for removal of cystic calculi. Copyright 2012 by The American College of Veterinary Surgeons.

Percutaneous Removal of Retained Calculi from the Abdomen

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

O'Shea, S.J.; Martin, D.F.

With rising pressure placed on health service resources minimally invasive techniques requiring only short hospital admissions are increasing in importance. We describe the techniques used to remove calculi from the peritoneal cavity which had been retained after surgery and continued to cause clinical problems. In both cases described the calculi lay within abscess cavities associated with fistulous tracks to the skin. The fistulae were dilated to allow passage of therapeutic radiologic and endoscopic equipment enabling manipulation and subsequent extraction of the stones. In both cases removal of the calculi allowed complete resolution of the fistulae and the patients made amore » full clinical recovery. Removal of gallstones which have escaped into the peritoneum at laparoscopic cholecystectomy leading to sepsis has been described; we describe the novel management of a patient in whom extraction had already been attempted, at another hospital, without success. Removal of an appendicolith, described herein another patient, does not appear to have been reported previously.« less