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PubMedDate not supplied

[Current treatment of ureteral lithiasis].

The treatment of ureteral lithiasis has undergone a revolution since the arrival of new techniques offering different therapeutical choices for which time is gradually elucidating the indications for each of the new procedures; although, to a large extent, a degree of controversy still persists. This paper reviews the different methods for ureteral lithiasis; spontaneous ejection and medical treatment, surgery, early endoscopic manoeuvres, backward and forward urethroscopy and, finally, extracorporeal lithority. This therapeutical experience in 3 series of ureteral lithiasis addressed with different criteria are revised together with 182 obstructive calculi of the lumbar ureter. We believe that grading the ureteral calculi according to their anatomical and functional features improves the results, since improved adjustment can be achieved for the indications of the various methods. Also it is noted that support endourology for extracorporeal lithotrity does not improve the results of treatment in lumbar calculi under 2 cm, and therefore our current approach is towards "in situ" treatment without complementary manoeuvres. Finally we show the therapeutic algorithm we are following actually to manage ureteral litiasis.

Adolescent↗
PubMed1996

[Lithiasis of the transplanted kidney: therapeutical potential].

OBJECTIVES: The formation of calculus in the transplanted kidney is an uncommon complication. Metabolic derangements, infectious or obstructive processes, factors related with the surgical technique and the presence of ureteral catheters have been implicated in its etiopathogenesis. The therapeutic possibilities have changed in the last decade. The different factors related with stone formation in the transplanted kidney, the indications and treatment utilized in each case are analyzed. METHODS: We analyzed the cases of lithiasis following renal transplantation in our series of 800 renal transplants. The metabolic anomalies and other associated lithogenic factors in 5 cases that required treatment are described. RESULTS: All 5 patients were treated by ESWL. Complete resolution of the lithiasis was achieved in 4 cases whose kidney graft is currently stone free with preserved renal function, except one patient with hyperuricemia and hyperuricosuria who is again on hemodialysis for chronic rejection. In the fifth case fragmentation of the caliceal stone was not achieved after 4 sessions of ESWL. Subsequem ultrasound control evaluations have disclosed no changes in stone size or location. CONCLUSIONS: In our view, the approach to renal lithiasis in the transplanted kidney is similar to that of patients with solitary kidney, although stone size for treatment by ESWL should be limited to 2 cms. If stone size is between 1 and 2 cms, placement of a double-J catheter prior to ESWL is recommended, whenever possible. For stones larger than 2 cms, percutaneous nephrolithotomy is more effective and has less complications. Surgery is reserved for those patients in whom these techniques are unamenable or have failed.

Adolescent↗
PubMed1998

[Lithiasis in megacalyosis].

OBJECTIVE: To review our series of lithiasis associated with megacalyosis, a rare disease entity. METHODS/RESULTS: The clinical records of patients treated from 1976 to 1994 were reviewed. Of 39 cases of megacalyosis, 27 were associated with lithiasis and was slightly more prevalent in males (59.3%). Struvite and whewelite calculi were more prevalent and 40.7% also had urinary tract infection, E. coli, Pseudomonas and Proteus being the most frequent pathogens. ESWL with hyperhydration was the most frequently utilized treatment. CONCLUSIONS: Megacalyosis is an embryogenic anomaly of Malpighi's pyramids that is associated with lithiasis in 69.2% of our series, frequently localized to the left side. We have found no significant difference according to sex or a hereditary component. IVP is the principal diagnostic method for megacalyosis. The frequent association of urinary tract infection should be taken into account when instituting treatment.

Adolescent↗
PubMed1998

[Urethral diverticulum complicated with giant lithiasis].

Presentation of one case report of acquired urethral diverticulum in a male with giant urethral lithiasis. Urethral diverticulum are rare entities in males, the condition being more frequent in females. In general, they are acquired in up to 90% cases, the remaining 10% being hereditary Giant urethral lithiasis is also uncommon in our milieu, incidence being higher in Eastern Countries; 4-10% of urethral diverticulum are occupied by lithiasis. Diagnosis is mainly through clinical symptomatology involving the development of a perineal mass or phlegmon; however definite diagnosis is made through CUMS. Management of giant diverticulum in males is by open surgery, preferably a one-step diverticulectomy procedure; in cases such as the reported here, where urethral stenosis or a significant inflammatory involvement of the periurethral tissues is present, a two-step urethroplasty should be preferred.

Aged↗
PubMed1998

[Right ectopic hydronephrotic kidney with pelvic lithiasis. Report of a case].

OBJECTIVE: To report a case of hydronephrotic ectopic kidney with lithiasis and pelvic localization, its diagnostic aspects and surgical treatment. METHODS/RESULTS: A 39-year-old male consulted at the emergency services for low abdominal pain. Physical examination disclosed a hypogastric mass. Patient evaluation by ultrasound, intravenous urography and pyelography revealed a right hydronephrotic ectopic kidney with lithiasis and pelvic localization. Nephrectomy via a right infraumbilical incision was performed. CONCLUSION: Pelvic renal ectopy is uncommon, but not rare in our area. This anomaly is associated with a higher than normal incidence of hydronephrosis and lithiasis. The diagnostic techniques most frequently used to evaluate these patients are ultrasound, intravenous urography, cystography and pyelography. When a surgical procedure is performed, the anatomical features of this anomalous condition should be considered, such as abnormal vascularization, pyelourethral anomalies, kidney rotation and absence of perirenal fat tissue.

Adult↗
PubMed1996

[Lithiasis and ectopic pelvic kidney. Therapeutic aspects].

Kidney in ectopic position is dysplasic, and associated to other malformations. The advent of a lithiasis in these conditions rises questions about therapeutic options. We report on five observations of pelvic ectopic kidney with urinary lithiasis. Patients were aged from 16 to 42 years. Kidney was non functional in two cases, or with normal appearance sized 10 to 12 cm. We performed total nephrectomy in two cases, pyelolithotomy in the other cases. Surgical approach was subperitoneal via iliac route. A dismembered pyeloplasty was associated in one case. All patients did well. Radiologic control at 6 and 12 months showed no recurrence in a well functioning kidney. Surgical lithotomy is advocated as a treatment in urinary lithiasis affecting ectopic kidney. It is an easy procedure which permits correction of other associated malformations.

Adolescent↗
PubMedDate not supplied

Surgical treatment for biliary lithiasis in patients associated with chronic renal failure on hemodialysis.

BACKGROUND: Incidences of the variety of postoperative complications in surgical treatment for patients with chronic renal failure on hemodialysis is the clinically accepted opinion. The aim of this study was to ascertain the safety of surgical treatment for patients of biliary lithiasis with chronic renal failure on hemodialysis. METHODS: Eleven consecutive patients with biliary lithiasis, who had a history of chronic renal failure treated with hemodialysis, were selected. The peri-operative course in-each of these cases was investigated. RESULTS: There was no incidence of peri-operative problems and postoperative complications in cases treated with laparoscopic cholecystectomy. One case treated with cholecystectomy with laparotomy had a slight degree of postoperative pneumonia, which soon improved after administration of antibiotics. Only one case, treated with choledochotomy, resulted in operative death due to accidental septic shock from an unknown origin. CONCLUSIONS: Surgical treatment of patients with biliary lithiasis and chronic renal failure on hemodialysis can be safely performed with appropriate operative indications and noninvasive surgical techniques.

Aged↗
PubMed2004

[New techniques for the treatment of salivary lithiasis: sialoendoscopy and extracorporal lithotripsy: 1773 cases].

OBJECTIVES: Salivary lithiasis is a relatively common medical problem. Treatment by invasive endoscopy, intracorporeal lithotripsy, and extracorporeal lithotripsy has been developing worldwide as an alternative to open surgical procedures. We hypothesized that treatment of salivary gland duct stones with endoscopic ductal intervention and extracorporeal lithotripsy could eliminate ductal stones while exposing the patient to less morbidity. In the current study, we analyzed a large clinical series to determine the success of the new techniques and develop an algorithm for comprehensive treatment of salivary stones. STUDY DESIGN: Retrospective chart study of 1773 treated salivary ductal pathology cases. METHODS: Treatment of salivary lithiasis using either duct endoscopy with instrumentation and/or intracorporeal laser lithotripsy or electromagnetic extracorporeal shock wave lithotripsy was undertaken for 1773 lithitic glands between 1988 and 2002. A total of 1105 endoscopies were performed on pathologic glands. 668 therapeutic extracorporeal lithotripsies were conducted. RESULTS: Stones were eliminated endoscopically in 96% of patients. Lithotripsy completely destroyed the stones in 63% of the lithotriptor cases; and an additional 35% of these procedures resulted in stone fragmentation with spontaneous expulsion or ancillary endoscopic removal. There were no major complications such as nerve or tooth damage. Early in the endoscopic series, one patient required surgical removal of a lodged wire-basket snare. TIssue effects such as edema, swelling bleeding or infection were temporary and treated as necessary. Four percent of the endoscopic cases and 2% of the lithotriptor cases ultimately required gland excision to remove the stone. CONCLUSIONS: The treatment algorithm for salivary stones, which once contained only conventional open surgery, may now include endoscopic instrumentation and extracorporeal lithotripsy. Both techniques are particularly valuable for stones located in the major salivary ducts. This series demonstrates the efficacy of both endoscopic and lithotriptor techniques.

Aged↗
PubMed2001

[Submandibular lithiasis. Report of 48 cases].

This retrospective study concerned 48 patients treated surgically for sub mandibular lithiasis. Results of medical imaging (plain films, sialography, ultrasonography) are confronted with operative findings. The surgical indications are analysed according to lithiasis localisation.

Adult↗
PubMed2002

[Intra-scrotal lithiasis. Crystallographic analysis].

OBJECTIVE: To present two cases of intrascrotal lithiasis associated with hydrocele and the results of the crystallographic study. METHODS: Three intrascrotal calculi in two patients aged 72 and 75 years that underwent surgery for hydrocele were analyzed. Two 2-mm. calculi were incidentally discovered during surgery for a right hydrocele in one patient. An ultrasound scan of the other patient showed a left hydrocele with a free-floating, round, hyperechoic, 6-mm. calculus, with posterior acoustic shadow. None of the patients had a previous history of trauma. The 3 calculi were white and smooth, but turned yellow and rough after removal. Scanning electron microscopy and x-ray dispersion studies were performed. RESULTS: All 3 calculi had a center comprised of hydroxyapatite and white organic matter, and an exterior of yellow organic matter. The mineral portion of the center of the 6-mm. calculus and one of the 2-mm. calculi was composed of 33% phosphorus and 67% calcium, and the other 2-mm. calculus contained 32% phosphorus and 68% calcium by x-ray dispersion analysis. CONCLUSIONS: Intrascrotal lithiasis is rare. In the two cases described herein, we observed abundant organic matter, particularly on the stone surface, and hydroxyapatite, particularly in the center. Among the possible etiologic causes, the deposit of organic matter in the presence of high oversaturation of calcium phosphates and absence of crystallization inhibitors, can initiate calcification and the subsequent collection of organic matter makes the process irreversible.

Aged↗
PubMed2002

Epididymal lithiasis in roosters and efferent ductule and testicular damage.

Epididymal stones have been reported in roosters in the USA and Japan. The cause of this dysfunction, which is associated with low fertility, is not known. The hypothesis of the present study is that a potential cause is the aggressive selection of birds over many centuries based upon female egg laying traits, without concern for potential effects on the male. If this hypothesis is correct, one potential consequence would be the presence of epididymal stones only in domesticated fowl and this observation would be worldwide in distribution. The present study investigated epididymal lithiasis in Brazilian crossbreed roosters and two other fowl strains, in addition to several domestic and wild bird species. The efferent ductules contained stones in 94.3% of the roosters, but stones were absent in all other domestic and wild birds. The stones were irregular in shape, size and colour and consisted mainly of calcium. In affected roosters, the efferent ductules showed epithelial cell vacuolization and sloughing and peritubular mononuclear cell infiltration, culminating with atrophy. Signs of epithelial re-canalization were seen in ductules occluded by abnormal content, such as stones. In the testis, decrease in mass, sloughing of epithelium, mononuclear cell infiltration and tubular atrophy occurred. No correlation was found between the occurrence of stones and a positive test for ELISA IBV (infectious bronchitis virus), or between the number of stones and calcium concentration in water and food, indicating that IBV infection and calcium in the diet were not related to stones formation. This study confirms and extends information about the epididymal lithiasis, which appears to be unique for roosters but to occur around the world. The severity of the lesion points to potentially severe economical impact in the poultry industry.

Animals↗
PubMed2003

Extracorporeal shock wave lithotripsy for difficulty in withdrawal of double J ureteral stents due to ureteral lithiasis.

OBJECTIVE: To explore the efficacy of extracorporeal shock wave lithotripsy (ESWL) to coping with lithiasis-induced difficulty in withdrawing double J ureteral stents. METHODS: This study includes 6 patients with difficulty in withdrawing the stents due to lithiasis, who were in the anterior prone position or posterior oblique supine position to receive ESWL treatment. The stones were localized by double-band intersection X-ray system. The treatment voltage of shock wave was 11.2 kV initially, which was gradually increased to 18.1 kV, and the shock wave attack amounted to 1,000 to 3,000 times in total. RESULTS AND CONCLUSION: After ESWL treatment, the encrusted double J stents were successfully withdrawn in all the 6 cases, without causing any morbidity related to the use of ESWL. Among the various techniques available for removing encrusted double J stents, ESWL appears to be the most effective and the least invasive modality.

Adult↗
PubMedDate not supplied

[Appendiceal lithiasis: case report and review of literature].

Appendiceal calculi are found in a limited percentage of patients. They are in association to an elevated prevalence of necrotic appendicitis and perforation of the appendix. The Authors report a case of acute appendicitis associated to appendiceal lithiasis with perforation of the organ. They emphasize the possibility to perform a preventive appendectomy in case of incidental appendiceal lithiasis. Besides they consider the differential diagnosis of the calcified images located in the lower abdominal quadrants with the aid of the various imaging methods available today, particularity sonography and computerized tomography.

Adult↗
PubMed1995

Combined modality treatment of symptomatic pancreatic ductal lithiasis.

OBJECTIVE: To assess the efficacy and safety of the removal of pancreatic duct stones by a combined modality approach in patients with pancreatic ductal lithiasis and recurrent abdominal pain. DESIGN: Retrospective review with a mean follow-up of 19 months (range, 1 to 56 months). SETTING: A tertiary care, private community hospital with a university affiliation. PATIENTS: The records of patients who presented to the hospital or who were referred with recurrent abdominal pain and who were demonstrated to have pancreatic ductal lithiasis between 1989 and 1994 were reviewed. Patients were assessed by their clinical response to pancreatic duct stone extraction by a variety of therapeutic interventions. RESULTS: Fifteen patients were included in the study. One patient was excluded from analysis because of a concurrent choledochocele. Two patients required operative decompression and stone extraction for endoscopically inaccessible stones. Six patients were treated with endoscopic management alone, and six were treated with a combination of extracorporeal shock wave lithotripsy and endoscopic stone retrieval. Twelve patients had complete clearance of the pancreatic duct. One patient had a stone that was not removed, but adequate pancreatic ductal decompression was achieved. The remaining patient had incomplete clearance of pancreatic stone fragments following extracorporeal shock wave lithotripsy but had adequate ductal drainage. No patient has required further therapy or hospitalization for abdominal pain. No complications occurred as a result of any intervention in this study. CONCLUSIONS: A multidisciplinary combined modality approach is a safe and effective method for extracting pancreatic duct stones in symptomatic patients. Stone extraction and reestablishment of adequate ductal drainage appear to relieve symptoms in some patients.

Abdominal Pain↗
PubMed1987

Biliary lithiasis in the over seventy-five age group: a new therapeutic strategy.

Sixty-four gallstone patients aged 75 or more (mean age 83 +/- 5.1 years) were divided prospectively into two groups. They were mostly high-risk patients (average number of major risk factors, 2.2 +/- 0.9). Thirty-three showed one or several signs of lithiasis of the common bile duct and were treated with endoscopic sphincterotomy (ES) (31 successful cases, two technical problems) followed by early cholecystectomy (33 cases). Choledocholithiasis was present in 26 cases and stones were extracted in 25 cases. Two patients (6 per cent) died. ES caused no complications. Thirty-one other patients showed no sign of choledocholithiasis and were treated by cholecystectomy with operative cholangiography. Choledocholithiasis was found in two of these patients and treated by extraction and external drainage. Five of these patients (16 per cent) died. In 30 cases acute cholecystitis was found at operation, 15 in each group. ES is therefore an efficient procedure in high-risk patients, which facilitates operation, especially in cases of acute cholecystitis, and it is recommended in all cases of complicated biliary lithiasis. Early cholecystectomy is justified for these patients by the high frequency of associated acute cholecystitis.

Aged↗
PubMed1990

Glycose aminoglycane excretion and concentration in the urine of patients with frequently recurrent calcium-oxalate lithiasis prior to and following Diclofenac-Na therapy.

Excretion and concentration of glycose aminoglycans were measured in 19 patients with frequent relapses of calcium-oxalate lithiasis, prior to and two weeks after onset of Diclofenac-Na therapy. In most patients, markedly enhanced glycose aminoglycan concentration and excretion could be demonstrated. Elevation of the high-molecular inhibitor potential in the urine results in reduced risk of calcium-oxalate lithogenesis, which may explain the therapeutic success of nonsteroidal anti-inflammatory drugs in the treatment of therapy resistant calcium-oxalate lithiasis.

Calcium Oxalate↗
PubMed1994

Bronchobiliary fistula secondary to biliary lithiasis. Treatment by endoscopic sphincterotomy.

Bronchobiliary fistula is a rare condition, defined by the presence of a passage between the biliary tract and the bronchial tree. Many conditions can give rise to the development of such a communication. Biliary lithiasis is one of those and is perhaps the one most amenable to endoscopic management. We describe a case of bronchobiliary fistula secondary to the development of choledocholithiasis in a cholecystectomized patient. The clinical suspicion was raised by the presence of bilioptosis (bile-stained sputum), and the diagnosis established by endoscopic retrograde cholangiopancreatography. The patient was submitted to endoscopic sphincterotomy and stone extraction, achieving frank clinical alleviation. This case gives us the chance to review bronchobiliary fistulas secondary to biliary lithiasis, placing particular emphasis on the opportunities of endoscopic management.

Biliary Fistula↗
PubMed1989

Radiological treatment of common bile duct lithiasis in infancy.

The authors report a series of 10 infants aged from 20 days to 11 months, presenting with CBD lithiasis, explored and cured by radiological procedure. US showed BD dilatation in 9 cases, sludge in the GB in 5 and in the CBD in 2. Histological findings of cholangitis were present in 4 infants. PTC was performed by GB puncture in 6 and BD puncture in 4. There was evidence of a filling defect in CBD but no anatomical anomaly. Blackish concretions were removed through a side-holes catheter or pushed in the duodenum by washing with saline. An external drainage was left a few days to allow control cholangiogram. Three infants underwent subsequent surgery but no residual lithiasis was found. No recurrence has occurred with a follow-up ranging from 10 months to 7 years. Mechanisms of this entity are discussed.

Diagnosis, Differential↗