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PubMed1998

Experience with the Dornier lithotriptor MPL 9000-X for the treatment of vesical lithiasis.

Between February 1994 and March 1995, 52 patients (48 men and 4 women) with vesical lithiasis were treated by extracorporeal shock wave lithotripsy (ESWL), using the MPL 9000-X Dornier lithotriptor. Twenty-five patients showed bladder outlet obstruction. In 9 patients, there was evidence of associated bladder neuropathy. In 6 patients, calculi presented idiopathically in normal bladders. Two patients had silent migration of ureteral calculi and increase in bladder volume, 8 were high risk and 2 others refused other methods of up to date treatment. Vesical stone sizes ranged from 10 to 22 mm in greatest diameter (mean 15 mm). The treatments were performed without the use of anaesthesia and on an outpatient basis. Complete fragmentation was achieved after a single session in 46 patients and 3 required 2 sessions. Postoperative adjunctive endourological procedures included cystoscopy in 9 patients and urethroscopy in 1 patient for evacuation of stone fragments. The overall stone-free rate was 94.2% (49 out of 52 patients) with ESWL and adjunctive measures as needed. No major complications were noted. We find ESWL with the MPL 9000-X lithotriptor to be a simple, effective and safe modality for the treatment of most patients with vesical lithiasis, especially in high risk patients.

Adult↗
PubMed1989

Therapeutic strategy for intrahepatic lithiasis.

Among the various benign biliary tract diseases, intrahepatic lithiasis is the most refractory condition to treat surgically. Recently, endoscopic treatment (mainly cholangiofiberscopic lithotomy) has been more and more frequently employed. A nationwide survey by questionnaire was conducted in 1985 to clarify the exact status of the current therapies for intrahepatic lithiasis in Japan. A total of 143 institutions (33.4%) responded to our questionnaire, and 2614 cases over a 10-year-period were collected and analyzed. Operation alone was performed in 53.8%, operation plus endoscopic treatment in 38.6%, operation plus dissolution therapy in 5.5%, operation plus endoscopic treatment and dissolution therapy in 0.04% and endoscopic treatment alone in 2.1%. The most common treatment was surgery. This was employed in 97.9% of all the patients, but endoscopic treatment was added in 40.7% of the cases to extract stones mainly intra- and/or post-operatively. Dissolution therapy was carried out occasionally, but with poor results. Conducting both adequate surgical biliary drainage and cholangiofiberscopic lithotomy may result in a marked improvement in the treatment of this intractable disease.

Cholelithiasis↗
PubMed1989

Lithiasis inside a blind-ending branch of a trifid ureter.

A case of lithiasis inside a blind-ending branch of a trifid ureter is presented. This is a very uncommon anomaly and its association with lithiasis is not previously reported. The diagnosis was made by means of excretory urography followed by computed tomography (CT). The embryology, classification, and clinical aspects of such malformation are discussed.

Adult↗
PubMed2006

Bladder lithiasis: from open surgery to lithotripsy.

Bladder calculi account for 5% of urinary calculi and usually occur because of bladder outlet obstruction, neurogenic voiding dysfunction, infection, or foreign bodies. Children remain at high risk for developing bladder lithiasis in endemic areas. Males with prostate disease or relevant surgery and women who undergo anti-incontinence surgery are at a higher risk for developing vesical lithiasis. Open surgery remains the main treatment of bladder calculus in children. In adults, the classical treatment for bladder calculi is endoscopic transurethral disintegration with mechanical cystolithotripsy, ultrasound, electrohydraulic lithotripsy, Swiss Lithoclast, and holmium:YAG laser. Novel modifications of these treatment modalities have been used for large calculi. Open and endoscopic surgery requires anesthesia and hospitalization. Alternatively, extracorporeal shock wave lithotripsy has been demonstrated to be simple, effective, and well tolerated in high-risk patients. Recently, simultaneous percutaneous suprapubic and transurethral cystolithotripsy has been tested as well as percutaneous cystolithotomy by using a laparoscopic entrapment sac.

Humans↗
PubMed2003

Intrahepatic lithiasis as a late complication of hepaticojejunostomy.

The development of intrahepatic lithiasis proximal to a bilodigestive anastomosis is rare. We report a case of intrahepatic lithiasis of the right hepatic duct, which developed almost 6 years after a hepaticojejunostomy performed for an iatrogenic lesion of the common hepatic duct. The patient experienced repeated episodes of acute cholangitis and was treated with intracorporeal lithotripsy and dilation of the stenosis.

Aged↗
PubMed1991

Urinary infection, renal lithiasis and bladder cancer in Spain.

A case-control study on bladder cancer was carried out in 12 hospitals located in 4 regions of Spain. The study included 497 cases and 530 population controls, matched by sex, age and residence. The present paper reports the results regarding the risk for bladder cancer in relation to history of infections and lithiasis of the urinary tract. Increased risk was found for infections starting 4 years or less before diagnosis (OR = 15.00; 95% CL: 6.07-51.66) but no statistically significant increase in risk was observed for infections starting 5 or more years before (OR = 1.44; 95% CL: 0.86-2.47). Our data suggest that the association of urinary infections with bladder cancer is probably not causal and is more likely to be a consequence of cancer, although a weak causal association cannot be excluded. A small but not statistically significant increase in risk was found to be associated with a history of renal lithiasis.

Adolescent↗
PubMedDate not supplied

Effect of DL alpha-lipoic acid in glyoxylate-induced acute lithiasis.

Glyoxylic lithiasis by acute intoxication with sodium glyoxylate, significantly raised the levels of renal tissue calcium and oxalate which has been reflected simultaneously in their urinary levels. Administration of DL alpha-lipoic acid lowered the oxalate levels in the kidney and urine. Sodium glyoxylate administration resulted in enhanced liver glycollate oxidase activity, the major enzyme in endogenous oxalate synthesis. DL alpha-lipoic acid decreased glycollate oxidase activity but did not have any effect on lactate dehydrogenase. The possibility of regulating oxalate metabolism in glyoxylic lithiasis with the use of DL alpha-lipoic acid, by way of inhibiting liver glycollate oxidase, looks attractive.

Alcohol Oxidoreductases↗
PubMed1999

[Laparoscopic treatment of common bile duct lithiasis. Study of 56 cases].

AIM OF THE STUDY: The aim of this retrospective study was to report the results of the laparoscopic management of common bile duct stones in an unicentric series of 56 patients. PATIENTS AND METHOD: From January 1993 to April 1998, 56 patients, 38 women, 18 men (mean age: 59.2 years), underwent a common bile duct exploration for lithiasis through a laparoscopic approach. The patients were hospitalised for angiocholitis (n = 13), cholecystitis (n = 11), biliary pain (n = 29, nine with jaundice), pancreatitis (n = 3), abnormality of hepatic profile (n = 1). All the patients underwent an intraoperative cholangiography. Removal of the stones was tried in 50 cases through a choledochotomy, in four through the cystic duct, using Mirrizi forceps, or Dormia and Fogarty catheters in case of failure. External biliary drainage and postoperative cholangiography were done systematically. The average diameter of the common bile duct was 10.5 mm (6-20 mm). RESULTS: In 41 patients, removal of the stones was laparoscopically successful. In 11 patients, a conversion into laparotomy was necessary for several reasons. In three patients with common bile duct of small diameter, the stones were abandoned for a further endoscopic sphincterotomy. There was no mortality and the morbidity rate was 7%. The mean postoperative hospital stay was 8.6 days (4-20) for all the series and 7.8 days in case of successful laparoscopic management. CONCLUSION: In 73% of the patients, the treatment of the common bile duct lithiasis could be achieved laparoscopically, but conventional approach and endoscopic sphincterotomy are still useful in case of failure of the laparoscopic management.

Adult↗
PubMed1995

Predicting common bile duct lithiasis: determination and prospective validation of a model predicting low risk.

BACKGROUND: The aim of this two-part prospective study was: (1) to identify simple, noninvasive, preoperative factors associated with low or very low risk of common bile duct lithiasis (CBDL); and (2) to test the validity of the statistical model obtained during Part One by the postcholecystectomy follow-up of patients classified into a low-risk group. PATIENTS AND METHODS: In Part One of the study, preoperative clinical, biologic, and ultrasonographic data, and intraoperative cholangiographic findings were collected from 503 consecutive patients undergoing cholecystectomy for symptomatic lithiasis from 1985 to 1989. Using the data obtained in Part One, a linear logistic model was used prospectively in Part Two to determine the prediction of absence of CBDL in 279 consecutive patients. No jaundice, normal transaminase levels, common bile duct (CBD) diameter < 8 mm, and no intrahepatic duct enlargement defined the low-risk group of CBDL. RESULTS: In Part One, CBDL was present in 84 (17%) of all patients. Five parameters were used to classify 73% of all patients as low risk of CBDL and 27% as high risk. In the low-risk groups, CBDL was present in 1% of 116 cases with acute gallbladder complications, and 5% of 250 cases with no acute gallbladder complications. In Part Two, 171 (61%) patients were classified in the low-risk group (Group 1), and CBD stones were not sought by any additional preoperative investigations or intraoperative cholangiography (IOC). One hundred eight patients (39%) were considered at risk of CBDL (Group 2). Mean follow-up was 20.6 months (median 19); 2 patients (1%) in the low-risk group presented a symptomatic retained stone. CONCLUSIONS: This study validated this simple model for predicting risk of CBDL and avoiding invasive preoperative investigations--as well as IOC--in more than 60% of symptomatic cholelithiases. In addition, this model seemed useful for defining patients in whom further exploration for CBDL was justified, since 42 (39%) of the 108 Group 2 patients were proved to have CBDL.

Analysis of Variance↗
PubMed2003

[Possible role of vitamin A and E deficiency in human idiopathic lithiasis].

The purpose of our study is to compare the status of vitamin A and E enters a group of male patients aged 30-40 years and having idiopathic lithiasis in the other whose origin of the lithiasis is awarded to a hypercalciuria and/or hypercalciuria and/or hyperoxaluria. Reference values were established from a normal subjects aged 30-40 years and having no history of nephrolithiasis. Our results showed that the mean levels of vitamin A was significantly lower in idiopathic renal stone-formers than metabolic stone-formers (p < 0.001). Compared to control group, the status of vitamin A was found lower only in idiopathic renal stone patients (p < 0.05). On the contrary, the mean levels of vitamin E were found similar in the two patient groups, but significantly lower compared to control group. These results suggested that idiopathic renal stone genesis could be generated by vitamin A deficiency.

Adult↗
PubMed1982

Double-blind study with thiazide in recurrent calcium lithiasis.

The effect of 25 mg. hydrochlorothiazide twice daily on the meta-phylaxis of recurrent calcium lithiasis was compared to placebo in a double-blind study during 1 year in 51 patients. A distinct and continuous decrease in urinary calcium excretion occurred only in patients given hyrochlorothiazide. On the other hand, both groups showed a slight increase in total serum calcium levels, unchanged values for ionized and ultrafilterable calcium, and decreased urinary excretion of oxalate during the study. The activity products of calcium oxalate and calcium phosphate also were decreased in both groups but remained within the metastable range. Spontaneous passage of renal stones occurred during treatment in 6 patients given placebo and in 6 treated with hydrochlorothiazide despite decreased urinary calcium excretion in the latter group. The findings show the specific effect of hydrochlorothiazide treatment to be a decrease in urinary calcium excretion in patients with calcium lithiasis, while other changes appear to be nonspecific effects of treatment.

Adult↗
PubMed1982

Idiopathic uric acid lithiasis: epidemiologic and metabolic aspects.

Of 264 patients with urolithiasis those with pure uric acid or urate stones were compared to those with other types of calculi for differences in epidemiologic factors and uric acid, calcium and phosphate metabolism. Patients with uric acid stones were predominantly older men. These patients had comparatively lower incomes and spent less money on food but consumed more alcohol. The urinary pH was lower than in the other groups. The absence of abnormally elevated serum uric acid levels and elevated 24-hour urinary uric acid excretion suggests this variety of uric acid lithiasis to be idiopathic in nature. This finding is supported by the results of standardized oral purine loading, which showed no post-loading differences in serum levels and revealed urinary concentrations in 12 patients with pure uric acid stones and 10 normal subjects. However, there is evidence to suggest that this condition may be a precursor of primary gout. Hereditary mechanisms are absent and the relapse rate is the same as in patients with other stones. Therefore, our results suggest the existence of an idiopathic variety of uric acid lithiasis that, at least in central Europe, occurs more frequently than previously assumed. The condition is not inherited, alcohol consumption is a major etiologic factor and there is no evidence of a causative role of abnormalities in purine metabolism.

Age Factors↗
PubMed2003

CT evaluation of urinary lithiasis.

Unenhanced CT has been demonstrated to be the most accurate and efficient diagnostic imaging means to evaluate urinary lithiasis, with capability of directing management, and has become well accepted by radiologists, urologists, and emergency department physicians such that it is now the standard of practice. It is the duty of the radiologist to be aware of proper technique and the details of interpretation. The radiologist also has a duty to be aware of the limitations of unenhanced CT for detection and evaluation of various nonstone disorders, particularly with poor patient selection, and to extend the examination if appropriate. Controversies and future developments include cost containment with care for the selection of patients. Further attempts to reduce radiation exposure should be made. Optimal CT technique is not needed in general merely to detect urinary lithiasis. A consensus should be developed regarding use of CT in pregnant patients. Further improvements in the digital scout view would be useful for following patients.

Diagnosis, Differential↗
PubMed1995

Incidence of negative hematuria in patients with acute urinary lithiasis presenting to the emergency room with flank pain.

OBJECTIVES: To determine the incidence of negative hematuria in patients with acute urinary lithiasis presenting to the emergency room with flank pain. METHODS: We retrospectively reviewed all 140 patients who presented with flank pain to the Long Island Jewish Medical Center emergency department from January 1, 1992, through December 31, 1992, and underwent intravenous urogram (IVU). We then calculated the incidence of negative hematuria in patients with acute urinary lithiasis (AUL) diagnosed by IVU based on the complete urinalysis alone or in combination with the urine dipstick test for blood. RESULTS: We found a 14.5% incidence of negative hematuria in patients with AUL when looking at the urinalysis alone. To our knowledge, this has never been reported in the literature. We also found that by considering a negative combination (urinalysis plus urine dipstick test) as a new definition of negative hematuria, the incidence of negative hematuria in patients with AUL was only 5.5% (P < 0.031). CONCLUSIONS: This is the first report in the literature documenting the incidence of negative hematuria in patients with AUL to be 14.5%. With the addition of the combination of urinalysis and urine dipstick test for hematuria, the incidence is only 5.5% and, therefore, represents a low yield when evaluated by IVU.

Acute Disease↗
PubMed2000

[Renal colic and lithiasis in HIV(+)-patients treated with protease inhibitors].

INTRODUCTION: Protease inhibitors, mainly Indinavir, are widely used drugs for the treatment of patients infected by the human immunodeficiency virus (HIV) and are related to renal colic and urinary obstruction. These conditions are the result of urine excretion of these drugs which favours the formation of small calculi (crystalluria and lithiasis). MATERIAL AND METHODS: Five PI treated HIV(+) patients; four males, one female, have recently been seen for renal colic at the Lithiasis Unit, Fundación Jiménez Díaz (FJD). All five patients had renal colic, one bilateral and one renal obstruction and fever. Small lithiasic concretions of null or minor radiological calcium density were identified by urinary X-ray and UIV. The patients had haematuria, crystalluria and urinary pH 5.0-6.0. Treatment was symptomatic, pharmacologic, emergency in situ extracorporeal shock-wave lithotrity (ESWL), or ureteral catheterisation, as appropriate. RESULTS: Patients had been treated with these antiviral agents for several months. They all required urologic care: pharmacologic, ureteral catheterisation, or ESWL, with good results. No stones were obtained for mineralogic analysis, but crystalluria was identified as being due to Indinavir and calcium oxalate. CONCLUSIONS: Renal excretion and urinary elimination of PIs (or their metabolites) results in asymptomatic crystalluria in HIV(+) patients treated with this class of drugs. Other cases present genuine calcium oxalate calculi with sings of renal colic and urinary obstruction requiring urologic care.

Adult↗
PubMed2002

[Endoscopic treatment of ureteral lithiasis. Our experience with 360 retrograde uretero-renal endoscopies in the last ten years].

Presentation of results and complications obtained in 360 procedures of transuretral ureterorenoscopy (URS) in ureteral lithiasis performed in our unit from january 1990 to august 2000 in 354 patients: 55% female and 45% male. A rigid ureteroscopy Storz 10.5 Ch. was used and intracorporeal lithotripsy was necessary in 17.31% of cases. URS indications were always treatment of ureteral lithiasis, pelvic ureter localization in most cases (70.33%) being 93.05% the percentage of overall success and with a significant decrease when the calculus was located in the upper third of the ureter. Serious complications were only 3.05% of cases and endoscopic surgery was necessary in three cases of ureteral stenosis. In our experience, URS is our technique of choice for treatment of lower and medium third of the ureter where the percentage of success we have obtained were 98.99% and 95.83% respectively.

Adult↗
PubMed2003

[Pyeloureteral fungus ball in patients with urinary lithiasis. Treatment with ureterorenoscopy].

INTRODUCTION: C. albicans is the most frequent fungus causing opportunist infections of the urinary tract. Agglutination of necrotic tissue nucleus (papilary necrosis), mucosus debri and chirurgic or lithiasic debri, originates a fungus ball, which can obstruct the urinary tract at any level. CLINICAL DATA: We present 2 patients with obstructive urinary lithiasis developing fungus ball in the dilated upper urinary tract. Patient 1 was bilaterally affected and never had systemic symptoms. Treatment consisted of uretherorrenoscope for removal of fungus ball, bilateral urinary diversion and anphotericine B irrigations and systemic. Patient 2 developed a candidemia and was treated with systemic liposomal anphotericine B, uretherorrenoscopy with removal of ureteric calculus and fungus ball, and placement of a double J catheter and nephrostomy tube for anphotericine B irrigation. DISCUSSION: Urinary lithiasis is a risk factor for fungal infection of the upper urinary tract, provided there is no other predisponent factor for opportunistic fungal infections. Calculi facilitates fungal growth by means of obstruction and subsequent retrograde estasis and creating a nucleus for growth, aggregation and ramification of mycelium. The infection pathway is probably ascendent and may turn into fungemia and septicaemia. Systemic antimicotics, urinary diversion and local irrigations with antimicotics, and endourologic technics, are the three basic items in the treatment. Ureterorrenoscopy plays an important roll as a diagnostic and therapeutic tool as it may solve the obstruction and allows removal of fungus ball.

Aged↗
PubMed2005

[A comparative study of the renal damage produced after the extracorporeal shock wave lithotripsy according to the lithiasis location].

INTRODUCTION: The Extracorporeal shock waves lithotripsy (ESWL) is fundamental in the treatment of lithiasis. However, there are evidences that it can produce renal damage. The objective of our study is to determine the degree of affectation of the glomerular and tubular function after ESWL, and the influence of the lithiasis location on the type of renal damage. MATERIAL AND METHODS: A prospective longitudinal study was carried out in 14 patients with normal renal function subjected to ESWL. We determined the basal level, and the levels at the 24 hours, at the 4th and the 10th day post ESWL of: microalbuminuria (MA) (that values the glomerular function), and N-acetyl glucosamide (NAG) and alanine aminopeptidase (AAP), (that value the tubular function). RESULTS: The basal levels of of MA, NAG and AAP didn't show significant differences in connection with the localization of the stones. A significant increase was observed of the three parameters only 24 hours post ESWL. No significant differences were observed between the variation of the microalbuminuria levels, AAP and NAG and the treatment in relation to the localization of the stones. CONCLUSIONS: It exists a glomerular and tubular damage after ESWL. This damage is not related with the pelvic or calicial location of the stones. In patient with previous normal renal function, the renal damage recovers at the 4th day post ESWL.

Adult↗