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PubMed1998

[Clinical study on cystinuria in children--the stone management and the prevention of calculi recurrence].

BACKGROUND: Cystinuria is an autosomal recessive disorder, and primary manifestation is the repeated formation of cystine calculi. Little information is available regarding clinical course of pediatric cystinuria having followed into adulthood. We report our experience with the management and the clinical course on cystinuria in children, who have been followed up for relatively long time. MATERIALS AND METHODS: We retrospectively reviewed the records of all pediatric patients with cystinuria in whom urolithiasis was treated from 1970 to 1996. RESULTS: A total of 15 pediatric patients with cystine calculi (9 boys, 6 girls) were treated in our hospital. Average age at diagnosis was 3 years 4 months old. Mean follow-up was 104 months. Stone location was upper urinary tract in 11 cases, bladder in 3 cases and both upper urinary tract and bladder in 1 case. Medical treatments including hydration, urine alkalization and dissolution therapy were performed in all patients. In three cases whose urinary cystine level ranged from 138 to 326 mg/gCr, cystine calculi were disappeared by medical therapy alone. In one of 3 cases vesicoureteral reflux was identified. Side effects were noticed in 30.0% of patients with tiopronin and in 85.7% of those with D-penicillamine, especially in 1 case with tiopronin nephrotic syndrome being noticed. Surgical procedures were performed in 13 patients (lithotomy: 17 calculi, endourology: 7 calculi and ESWL: 7 calculi). The stone free rate was 100% with lithotomy, 80 to 100% with endourology and 43% with ESWL at an average of 5.9 procedures. No complications were recognized after the surgical treatments. The stone events of 15 patients ranged from 0 to 1.5 (average 0.55). In all six patients followed up over the age of 20 years, stone recurrences were observed exclusively between 17 and 20 years of age. CONCLUSION: Dissolution therapy is more effective for cystinuric patients in whom urinary cystine excretion is less than 330 mg/gCr. For those cases with low urinary cystine level it is necessary to evaluate structural abnormalities of the urinary tract to avoid stone recurrence. ESWL and endourology should be tried for pediatric cystinuria except for neonates and infants, considering its safety. The patients and their parents must have adequate knowledge about the disease itself and its management. Prevention of cystine calculi recurrences depends on patient compliance to the therapeutic regimens necessitating close follow up according to the clinical conditions, especially for those in pubertic or postpubertic age.

Adolescent↗
PubMed2001

[Hydronephrosis caused spontaneous evacuation of many small calculi in a caliceal diverticulum: a case report].

We experienced a curious case that hydronephrosis had caused spontaneous evacuation of calculi in a caliceal diverticulum. A 50-year-old woman was visited to our department complaining of right lower abdominal pain. Several right ureteral stones, right hydronephrosis and a great numbers of small round-shaped calculi in a right caliceal diverticulum were diagnosed. Many of the calculi moved from the diverticulum to ureter, and were evacuated spontaneously. The month after, the right hydronephrosis had already subsided and almost all of the calculi had disappeared. It was supposed that a hydronephrosis had widened the narrow channel between the diverticulum and the calyx and enabled the small calculi to pass through. Recent reports show that effectiveness of ESWL for symptomatic caliceal diverticular calculi is doubtful, because the narrow channel hinders the passage of stone fragments. However, this case suggests that an artificial hydronephrosis created by retrograde occlusion ureteral balloon catheter may lead to good drainage of gravel and better stone-free rate of caliceal diverticular calculi treated by ESWL.

Diverticulum↗
PubMed2004

Prediction of upper urinary tract calculi using an artificial neural network.

OBJECTIVES: To evaluate the possibility of using an artificial neural network (ANN) in upper urinary tract calculi prediction. MATERIAL AND METHOD: Data of 168 upper urinary tract calculi patients treated in the Division of Urology, Department of Surgery, Songklanagarind Hospital from January 1997 to December 2000 were reviewed and classified into 6 catagories and 20 characteristics. 100 items were used in training and 68 in testing for an ANN designed with 3 layers: 20 nodes for an input layer, 5 nodes for a hidden layer and a node for the output. RESULTS: Output data between 0-0.38 indicate free of calculi, 0.65-1 indicate prone to have calculi, 0.38-0.65 indicate probable calculi and further need investigation. CONCLUSION: An ANN with error back-propagation training can be used in diagnosing the presence of upper urinary tract calculi. The accuracy of prediction depends on a previous history of calculi, nephrocalcinosis, 24 hour urine assay for citrate and urine culture.

Humans↗
PubMedDate not supplied

[Prostatic calculi: diagnostic and therapeutic aspects].

Strength properties of prostatic calculi (PC) were studied by microhardness HV. Fifteen calculi under study were divided into 3 groups by the size: 2-3 mm (group 1), 4-6 mm (group 2), > 6 mm (group 3). The surface of the thin sections of the calculi appeared as concentric, spherical layers of different size indicating formation of the calculus from the center. In the latter one could see a pigmented nucleus of organic nature. Some calculi had two nuclei under one cover--attached calculi. Correlations between the structure, morphology of prostatic calculi and their strength properties were established. These correlations allowed one to characterize destruction features of the calculi in different destructing impacts. We have designed and introduced into practice a complex of local physiotherapy in prostatolithiasis. This physiotherapy was conducted in combination with medicines for chronic prostatitis and included exposure of the prostate to ultrasound in impulse regime (4 mc, 0.4-1.0 W/cm2). The ultrasound was delivered through the rectum (insertion of the setting IUT 2.264-7-2.09u to the site of the concrements location) and alternated with laser therapy (insertion of the radiator P-2 into the rectum and radiator LO1 to the perineal area (5 W, 80 Hz, 64-128 s) and introduction of sulfide mud heated with the device PPK-01 Pra, electrostimulation for better passage of the prostatic section. The above therapy destructed the concrements which eliminated from the prostatic ducts as a result of which prostatic function recovered. The complex produced a good effect: 65% patients stated enhancement of the erectile function after 3 days of the treatment. After 5-6 procedures pain syndrome relieved in 40% patients, after 11-15 procedures in 87%. Ultrasonic investigation showed that posttreatment size of the prostate diminished from 0.8 to 0.2 cm. The absence of the calcinates's shadows were recorded in 87% patients, the symptoms of chronic prostatitis disappeared. The results of the combined physiotherapy demonstrate efficacy of the above method in true prostatoliths.

Adolescent↗
PubMed2005

Urinary tract calculi in southern Thailand.

OBJECTIVE: To study the epidemiology of urolithiasis in Southern Thailand. DESIGN: Descriptive study. MATERIAL AND METHOD: An overview of urolithiasis in the South of Thailand was derived from 10,344 urolithiasis patients seeking treatment in 14 hospitals in southern Thailand, from January to December 2000. An epidemiological study focused on 1,452 urolithiasis patients treated at Songklanagarind Hospital during the same period. Composition of calculi was analysed with infrared spectroscopy. RESULTS: The ratio of male to female was 1.6 : 1 and the most common age group was 41 - 50 years. Ureteric calculi were more frequently found than renal calculi. ESWL was the most common treatment for upper urinary tract (UUT) calculi, while surgery was the most common treatment for lower urinary tract (LUT) calculi. The body mass index (BMI) of 48.1% was between 18.5 - 24.9. The study of the calculi composition showed that oxalate was found in most UUT, and uric acid was found in most LUT CONCLUSION: Ureteric calculi were most common in the South of Thailand. The BMI of urolithiasis patients was higher than the population average.

Adult↗
PubMed1991

[The surgical and spontaneous elimination of kidney calculi--the type, incidence and treatment].

Results are reported of chemical (derivatographic and polarization microscopic) analysis of 2630 calculi removed by operation and 8607 spontaneously eliminated calculi. It was found that 82.7 per cent of the calculi removed by operation and 19.4 per cent of those eliminated spontaneously were mixed--composed of two or more components. The most common "pure" concrements were composed from oxalates and uric acid. The difference in the chemical types of the renal calculi of the two compared groups (removed by operation and spontaneously) is shown and followed up. Of interest is the different incidence of the two calcium oxalate hydrates in the two compared groups of renal calculi. Vevelite was more common in calculi removed by operation, while vedeline was the more common form in spontaneously eliminated calculi. Precision of the chemical form of the calculosis is recommended, with a view to including the genesis of stone formation for effective prophylaxis, treatment and metaphylaxis of the disease.

Adult↗
PubMed1990

ESWL for ureteral calculi. Using the Dornier HM 3, HM 3+ and Wolf Piezolith 2,200.

In a one year period from July 1985 to July 1986 226 upper and 62 distal ureteric calculi were treated. In situ ESWL represents the therapy of first choice for upper and distal ureteric calculi with a success rate of 81% and 76% respectively. Retrograde mobilization of the calculus was used only in cases where in situ ESWL was impossible because of localization difficulties (obesity, stone close to the spine, skeleton deformation). Although ESWL after successful mobilization succeeded in 95%, retrograde mobilization was possible only in 80%. Antegrade ureterorenoscopy via percutaneous nephrostomy was performed to avoid open surgery after impossible retrograde mobilization and succeeded in 90%. Two second generation lithotripters suitable for treatments without invasive forms of the anesthesia, the modified Dornier HM 3- and the Wolf Piezolith 2,200 were compared in terms of efficacy for ureteric calculi. In situ ESWL was successful with the Piezolith 2,200. In situ ESWL of middle ureteric calculi was successful 81.8% with modified HM 3+, while in situ treatment of middle ureteric calculi was impossible with the Piezolith 2,200 due to insufficient localization with ultrasound of middle ureteric calculi were treated successfully in 71.4% with the modified Dornier HM 3+ and in 64% with the Piezolith 2,200. First clinical experience of ESWL in prone position for iliac ureteric calculi was reported. 8 of 10 cases were treated successfully in situ.

Humans↗
PubMed1990

Epizootiologic evaluation and quantitative analysis of urinary calculi from 150 cats.

One hundred fifty specimens of urinary calculi from 150 cats were analyzed by at least 1 of 4 quantitative methods. Struvite (magnesium ammonium phosphate) was the predominant mineral substance encountered, with 104 (69%) of the calculi being composed entirely of struvite and 23 (15%) being composed partially of struvite. Most (93%) of the calculi were located in the urinary bladder. Growth of bacteria was observed in samples from calculi or urine from 30 (41%) of 74 cats. Coagulase-positive staphylococci were isolated from the urine or calculi from 17 cats (45% of bacteria isolated). Ten other bacterial species were isolated. Median and mean ages of the cats were 5.0 and 5.1 years, respectively. Domestic short-hair and domestic longhair breeds predominated. Fifty-seven percent of the calculi came from females, 43% from males. The distribution by gender did not differ significantly (P greater than 0.2) among the 3 groups (domestic shorthair, domestic longhair, and other). However, the distribution of struvite calculi differed significantly (chi 2 = 15.5, P less than 0.001) by age and gender; among cats less than or equal to 2 years of age, males predominated 2:1 over females, and among cats greater than 2 years of age, females predominated by nearly 3:1 over males. When compared with the general population, females greater than 2 years old were significantly (chi 2 = 15.4, P less than 0.001) overrepresented.

Age Factors↗
PubMed1989

[Epidemiologic study of complicated urinary calculi: an analysis of 164 cases].

We report a clinical and epidemiological study of 164 cases of complex urinary calculi which were seen in our hospital between 1984 and 1988. The highest incidence was found in patients aged between 40 and 50 years, with a female:male ratio of 1.27/1. In 37% of patients there were first degree relatives with calculi. The most common type were calculi with a calcium component, with a remarkably high proportion of struvite calculi and a low one of uric acid. Housewives had a high rate of struvite calculi associated with infections during pregnancy. Qualified professions have been associated with calcium oxalate and phosphate calculi. 13% has congenital renoureteral malformations, 4% had hyperuricemia and 1.2% had hyperparathyroidism. Pain was the most consistent symptom, followed by fever and urinary tract infection. 50% of patients had previously passed stones. 90% of calculi were visible in the plain abdomen X-ray film. 65% of patients required aggressive therapy.

Adolescent↗
PubMed1987

[Chemolysis of cystine calculi incarcerated in the ureter by the alkaline organic amine, tromethamine-E].

We dissolved the cystine calculi incarcerated in the ureter by irrigation with tromethamine-E via percutaneous nephrostomy. Case 1: A 25-year-old man with a past history of cystinuria and staghorn calculi in the right kidney, suffered from obstructive renal failure caused by the incarceration of a stone (18 x 15 mm) in the left middle ureter. After recovering promptly from renal failure by left percutaneous nephrostomy, he received continuous irrigation with tromethamine-E through an angiographic catheter percutaneously placed in the ureter. The ureteral calculus was reduced by 70% in size after the irrigation for 35 days, and then extracted percutaneously. Case 2: A 3-year-old child had multiple cystine calculi in the right renal pelvis and ureter. Although a calculus in the renal pelvis was extracted by the percutaneous ultrasound lithotripsy, two calculi incarcerated in the middle ureter were impossible to remove by a percutaneous approach. The irrigation with tromethamine-E was initiated through the catheter placed percutaneously in the right ureter. Both calculi completely dissolved 47 days later. The chemolysis by irrigation with tromethamine-E was greatly valuable in the treatment of cystine calculi. This dissolution could be an alternative to surgery especially in the treatment of ureteral cystine calculi, which might be difficult to be extracted by the percutaneous or transurethral approach.

Adult↗
PubMed1996

Ureteroscopic removal of mid and proximal ureteral calculi.

PURPOSE: Extracorporeal shock wave lithotripsy (ESWL) is considered standard therapy for most renal calculi as well as more than 80% of all upper urinary tract stones. The development of flexible and small diameter rigid ureteroscopes, and the increased availability of laser lithotriptors have made endoscopic treatment of ureteral calculi more successful and safe. This report represents our contemporary series of 80 single mid and proximal ureteral calculi treated endoscopically. MATERIALS AND METHODS: A total of 78 patients underwent 80 primary endoscopic procedures with 3 auxiliary ESWL and 2 endoscopic re-treatments for 41 mid and 39 proximal ureteral calculi. Lithotripsy was performed for 55 of the 80 stones. RESULTS: Of the 80 stones 75 (94%) successfully cleared 1 month after 1 endoscopic procedure. The success rate was 38 of 39 (97%) for proximal calculi and 37 of 41 (90%) for mid ureteral stones. With a single re-treatment overall success increased to 96%. If adjuvant ESWL was added, 100% success was attained. Currently all procedures are performed on an outpatient basis. Morbidity is low and there have been no major complications, such as stricture, renal loss or death. CONCLUSIONS: Our series demonstrates the high success rate that can be achieved with ureteroscopic removal of mid and proximal ureteral calculi. Thus, ureteroscopic treatment should be considered a treatment of choice for upper ureteral calculi.

Dilatation↗
PubMed1993

[Treatments of staghorn calculi].

The treatment of staghorn calculi is still difficult even though urolithiasis treatment can now be performed by endourology and extracorporeal shock-wave lithotripsy (ESWL) without open surgery. Because of the variety in volume and pattern of the staghorn calculi, especially with or without dilated renal pelvis and calyces, selection of treatment methods is important. The combined method of percutaneous nephrolithotomy (PNL) and ESWL has been highly effective in the complete removal of most staghorn calculi. Developments of the ESWL instrument and tools have increased the success of less invasive ESWL monotherapy with placing of stent or percutaneous nephrostomy for staghorn calculi with nondilated calyces. Also the treatment methods should be selected depending upon the components of the staghorn calculi. Dissolution and solidity, which are affected by the components, are also important factors. Complete removal of staghorn calculi is very difficult, and almost impossible to be performed in only one occasion including other surgical procedures as a series and this is the existing insurance provision. Therefore, we await the creation of a new insurance provision for the treatment of staghorn calculi.

Humans↗
PubMed1977

Relationship between the morphologic appearance of pancreatic calculi and pancreatic function in chronic calcifying pancreatitis.

The relationship between the two types of pancreatic calculi and their clinical pictures was studied in seven cases of diffuse minute calculi and 12 cases of large calculi. In the large calculi cases, the cause was often unknown, the calculi tended to be localized in the head and body and disturbances in pancreatic exocrine and endocrine functions were frequently found to be mild. In the diffuse minute calculi cases, alcohol ingestion was apparently responsible, the calculi tended to be distributed not only over the head and body but also over the tail and the pancreatic exocrine and endocrine function were markedly decreased with repetition of acute exacerbation. Consequently, the two types were clearly distinguished, indicating marked differences in pathophysiological process; they cannot be regarded as a single disease entity.

Adult↗
PubMed1997

[In vitro study of urinary calculi fragmentation with 4 different systems of lithofragmentation].

The results of shockwave lithofragmentation are conditioned by stone composition. Similarly, the different types of lithofragmenting energy can have different effects on the calculi. The purpose of this experimental study is to establish a relationship between calculi composition and type of energy used for fragmentation, with the results of the lithotriptsy treatment. 60 calculi, 12 for each pure composition selected (calcium oxalate mono and dihydrate, phosphocarbonate, ammonium magnesium phosphate and uric acid) underwent in vitro lithofragmentation with 4 different lithofragmenting sources (electrohydraulic, piezoelectric, ultrasound and pulsed laser). It was carried out a study of fragmentation in particles under 3 mm and pulverization in particles under 0.5 mm, analyzing post-lithotriptsy fragments with scanning electron microscopy associated to X-ray dispersion energy. No relationship was shown between calculi composition and amount of energy supplied for the fragmentation. The lithiasic composition correlates to the fragmentation pattern, so that oxalocalcium calculi undergoes good fragmentation and poor pulverization, infective calculi have poor fragmentation but good pulverization and uric acid calculi show poor fragmentation and pulverization.

Humans↗
PubMed1993

Limitations of extracorporeal shock wave lithotripsy for urinary tract calculi in young children.

Despite success rates with a variety of urinary tract calculi, there is growing concern that extracorporeal shock wave lithotripsy (ESWL) has limitations and that its role needs to be redefined. We report the outcome of 28 consecutive children (age range, 6.5 months to 7 years; mean, 3.6 years) with urinary calculus disease, treated over a 5-year period. Thirteen patients had ESWL monotherapy, and 8 achieved stone clearance. The other 5 children in the ESWL monotherapy group, all with multiple calculi, required surgery to render them stone free. A further 14 patients (6 staghorn calculi, 6 multiple calculi, 1 solitary renal, and 1 child with multiple bladder calculi) were considered unsuitable for ESWL and had primary surgery. Twelve of those 14 were cleared by open surgery, one had residual fragments successfully treated by ESWL, and one still awaits adjuvant ESWL. One child had a solitary renal calculus (5 mm) which passed spontaneously. This study demonstrates that ESWL monotherapy cleared stones in only 8 of 28 patients and clearance in a further 6 was achieved with surgery. Surgery will continue to play an important role in the management of paediatric urolithiasis for large staghorn, multiple urinary tract calculi and lithotripsy failures.

Child↗
PubMed1985

[Changing modality of the treatment in upper urinary tract calculi. Percutaneous nephrolithotripsy and transurethro-ureteral lithotripsy].

From March, 1984 to April, 1985, 70 cases of upper urinary tract calculi (73 renal units) were treated by percutaneous nephrolithotripsy or transurethro-ureteral lithotripsy, mainly utilizing ultrasonic lithotrite. While in the early period of treatment, two stage procedure of creation of nephrostomy tract and percutaneous nephrolithotripsy was performed for renal and upper or middle part of the ureteral calculi, one stage procedure, nephrostomy tract formation followed by ultrasonic nephrolithotripsy is commonly used in recent cases. During this period, conventional stone surgery was seen in 6 cases of pyelolithotomy and 2 of ureterolithotomy, while 52 cases of stone surgery were performed during the earlier period (from January, 1983 to February, 1984). Renal and upper or middle part of ureteral calculi were successfully removed in 49 out of 58 cases (84.5%). Most of the patients required 1 or 2 trials of percutaneous nephrolithotripsy. Middle or lower part of ureteral calculi were removed in transurethro-ureteral approach in 11 of the 12 cases. Hematuria and fever were most common complications after treatment and 3 patients required blood transfusion after 3 or 4 sessions of nephrolithotripsy. Percutaneous nephrolithotripsy and transurethro-ureteral lithotripsy are now widely used for treatment of upper urinary tract calculi, replacing the conventional surgical treatment. Moreover, very recently, extracorporeal shock wave lithotripsy is available in Japan. To the patients with renal calculi indicative of this treatment, both percutaneous nephrolithotripsy and extracorporeal shock wave lithotripsy are introduced and either way of treatment can be chosen by the patient himself.

Adult↗
PubMed1985

Chemical composition of biliary calculi in relation to the pattern of biliary disease in Singapore.

The chemical composition of biliary calculi from 25 Singapore patients operated upon over a three month period was determined by a microanalytical technique and equilibrium swelling tests. Twelve patients had biliary calculi confined to the gallbladder and the main component of six calculi was cholesterol. In the other 6 patients, the dark brown to black pigment calculi contained bilirubin and calcium and a small quantity of cholesterol, but the chief component was an insoluble pigment with the swelling characteristics of a bilirubin polymer. These cholesterol and pigment calculi have similarities in composition to gallstones of Western patients. In 13 patients with cholangitis, the brown, soft pigment calculi found in the dilated bile ducts (and also concurrently in the gallbladder in 5 patients) had bilirubin as the main component. Fatty acid was frequently present. The insoluble pigment component was considerably less but the lower swelling ratio suggested more cross linkage compared with black gallbladder stones. Differences in chemical composition between pigment gallbladder and bile duct calculi support the concept that Western type cholelithiasis and Oriental cholangitis occur as separate disease entities in Singapore patients.

Adolescent↗
PubMedDate not supplied

Long-term follow-up after endoscopic treatment of bile duct calculi in cholecystectomized patients.

Endoscopic sphincterotomy (EST) is an established method for treatment of retained or recurrent common bile duct (CBD) calculi after cholecystectomy. Present experience shows that few patients have recurrent biliary tract complications, but follow-up periods are most often short. EST was performed in 147 patients with bile duct calculi and remote cholecystectomy in our department from 1981 to 1992. In 8 of 147 patients (5.4%) complete removal of calculi failed. A total of 135 patients with a median age of 71 years (range 24-96 years) were eligible for a follow-up of 23 to 153 months (median 86 months). Thirty-seven patients have died without recurrent symptoms (a recurrent stone was revealed at postmortem examination in one patient), and four patients (two with calculi and two with cholangiocarcinoma) died with recurrent symptoms from the biliary tract. Ninety-four patients are alive; and with the exception of two who have had cholangitis without or with post-EST stenosis, respectively, they are all symptom-free. Jaundice, cholangitis, and biliary pancreatitis prior to EST were the only factors that significantly (p = 0.006, Fisher's exact test) predicted late biliary complications after EST in patients with recurrent calculi. These findings confirm that endoscopic treatment of CBD calculi in cholecystectomized patients has a low long-term rate (5 of 135; 3.7%) of recurrent nonmalignant bile duct disease (three patients with CBD calculi and two with cholangitis).

Adult↗