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Zonisamide - induced urinary lithiasis in patients with intractable epilepsy.

We report here three patients with intractable epilepsy who developed urinary lithiasis during zonisamide (ZNS) treatment. Abdominal pain due to left-sided hydronephrosis was the initial symptom in the first patient, and it was resolved after the excretion of a stone. The second patient, who had no specific symptoms, was found to have a thick sludge of calcium phosphate in the bladder when he suffered from aspiration pneumonia and dehydration. The third patient, who had a history of recurrent urinary obstruction, was also found to have a thick sludge of calcium oxalate in the bladder. The urinalysis of the three patients revealed alkaline urine and hypercalciuria. Although their urinary lithiasis was resolved by discontinuation of ZNS and supportive therapy, routine examination of urine parameters such as pH and sediments, and daily urine-output checks are thought to be necessary during treatment with ZNS, especially for patients who are bedridden for a long time and receive multiple antiepileptic drugs.

Adolescent↗

Biliary lithiasis: combined endoscopic and surgical treatment.

A combined endoscopic and surgical procedure was performed in 69 patients suffering from gallbladder lithiasis with suspected associated lithiasis of the common bile duct (CBD). The procedure was spread over two days: Day 1 - Endoscopic retrograde cholangiopancreatography (ERCP) revealed choledocholithiasis in 50 cases and papillary sclerosis in 4 cases. In 15 patients, the common bile duct was found to be normal. Fifty-four endoscopic sphincterotomies were performed. Among the 50 cases of choledocholithiasis, endoscopic removal of the stones was judged complete in 44 cases and incomplete in the other 6. Day 2 - Cholecystectomy was carried out in all the patients. Peroperative cholangiography confirmed the results of the pre-operative ERCP with respect to the CBD in all the patients except one, and a choledochotomy was necessary in 6 patients. Results were as follows: The average length of hospitalization was 12.4 days. No residual choledocholithiasis was noted. The morbidity of the procedure was 7.2%, and the mortality 1.4% unrelated to the technique. The diagnostic and therapeutic significance of the procedure is discussed.

Adult↗

Rapid communication: first clinical experience with Doli S 220F-XP extracorporeal lithotripter for urinary lithiasis.

PURPOSE: To assess the initial results of the Dornier Doli S 220F-XP extracorporeal lithotripter for the management of solitary urinary calculi. PATIENTS AND METHODS: We prospectively examined the outcome of shockwave lithotripsy (SWL) in the first 140 patients with solitary renal and ureteral lithiasis treated by one urologist with the new power Doli S lithotripter. Ninety-one patients (group A) had renal stones, and 49 patients (group B) had ureteral stones. Data were collected with respect to stone size, location, and fragmentation. RESULTS: In group A, clinical success was documented in 77 patients (84%) at 1 month after lithotripsy. Three months after lithotripsy, 69 patients (75.2%) were stone free and 8 (8.8%) had fragments <4 mm. In group B, 41 patients (83%) achieved clinical success 1 month after lithotripsy. Thirty-eight patients (77%) were stone free 3 months after treatment, and 3 (6%) had fragments <4 mm. Seven patients (7%) in group A and three patients (6%) in group B required re-treatment. The overall efficiency quotient was 67%. No patient developed a perinephric hematoma. Ninety-four percent of the patients reported mild pain during lithotripsy. The majority (91%) mentioned that they were satisfied with this treatment modality for urinary lithiasis (mean visual analog scale satisfaction score 8). CONCLUSIONS: The Doli S 220 F-XP is a safe and effective device for managing calculi throughout the urinary tract.

Humans↗

Incidence of gallbladder lithiasis after ceftriaxone treatment.

Ceftriaxone has potent activity against a broad range of Gram-positive and Gram-negative bacteria. While it is eliminated mainly by the kidney, 10-20% of the drug is eliminated in the bile and ceftriaxone salt precipitates have been described in the gallbladder of animals dosed with ceftriaxone. The purpose of the present study was to investigate the incidence of biliary lithiasis 6 and 12 months after treatment with ceftriaxone and to compare it with that in patients treated with amoxycillin/clavulanate. Biliary ultrasonography was performed at the start of treatment, at 6 months and at 12 months after the beginning of the study. One hundred patients were randomized and 74 were evaluable: 34 were given amoxycillin/clavulanate, 40 ceftriaxone. Gallbladder lithiasis developed in one patient 12 months after the amoxycillin/clavulanate treatment and in none in the ceftriaxone treatment arm. Biliary precipitate during ceftriaxone treatment was not looked for because this phenomenon was not known at the beginning of the study, but gallbladder precipitation that was seen in two patients given ceftriaxone during and at the end of treatment, respectively, resolved spontaneously. In conclusion, ceftriaxone treatment does not appear to lead to gallstone formation more often than an antibiotic that is not eliminated through the bile.

Adolescent↗

Uterine lithiasis.

We report a case of uterine lithiasis in a 73-year-old Latin American woman. The patient underwent vaginal hysterectomy and colporrhaphy for complaints related to secondary uterine prolapse and cystocele. The 70-g, 8 x 5 x 3.5 cm uterus had a normal shape. Ten white, starlike, 0.5 x 0.5 x 0.2 cm, calcified structures were found within the endometrial cavity. Chemical analysis of one of these by x-ray diffraction showed it to be composed of calcite, one of the crystalline forms of calcium carbonate. To our knowledge, this is the first report of human uterine lithiasis in the literature.

Aged↗

Extracorporeal shock wave lithotripsy for vesical lithiasis: initial experience.

The classical treatment for vesical lithiasis consists of surgery or endoscopic transurethral disintegration. These procedures require anaesthesia and hospitalisation. We report our experience with the Siemens Lithostar in 18 male patients with bladder stones. Complete fragmentation was achieved after a single session in 14 patients and 4 required 2 sessions. A 3-way Foley catheter with saline irrigation was used during treatment. Patients were treated in the prone position followed by immediate evacuation of stone fragments in 9 cases. Morbidity was minimal. Two patients developed impacted fragments and required stone retrieval. Extracorporeal shock wave lithotripsy (ESWL) for vesical lithiasis appears to be a simple, well tolerated and effective form of treatment.

Adult↗

Ultrasonography of pancreatic lithiasis.

The ultrasonograms of 13 patients with pancreatic lithiasis associated with chronic alcoholic pancreatitis were reviewed and compared with the abdominal radiographs. Although plain radiographs were sufficient to establish the presence of pancreatic calcifications, in many cases ultrasound provided the additional information concerning duct dilatation and lithiasis in the main duct. The progressive formation of stones with extrusion into the duct of Wirsung was observed in one case. Ultrasound enabled assessment of pancreatic size and detection of focal enlargement or associated carcinoma. Ultrasound serves as a useful guide to appropriate clinical management in patients with this disease.

Adult↗

ESWL as the treatment for lithiasis in horseshoe kidney.

Thirteen patients with lithiasis and horseshoe kidney were evaluated (4 cases with bilateral stones). Fifteen kidney units were treated with extracorporeal shock wave lithotripsy (ESWL), and in 2 cases, percutaneous nephrolithotomy (PCN) was used. The excellent results achieved with ESWL (80%) and the low incidence of complications (2 cases of nephritic colics and 1 case of acute pyelonephritis), lead us to propose ESWL as the therapy of choice for lithiasis in patients with horseshoe kidneys. PCN alone or in association with ESWL would be used in cases with large lithiasic masses. Conventional surgery would only be indicated in those cases which due to their high degree of complexity or difficult endourological access prevent the use of the above-mentioned techniques.

Female↗

Allopurinol in the recurrence prevention of calcium oxalate lithiasis.

Since 1973 we have used allopurinol in the prevention and aftercare of recurrent urolithiasis. We give indications for the administration of allopurinol for patients with chronically recurring calcium oxalate lithiasis. Special attention is given to the urinary stone analysis as well as to metabolic disorders as for example hyperuricaemia, hyperuricuria or idiopathic hypercalciuria. In 15 patients with calcium oxalate lithiasis the stone/patient/year ratio could be decreased to 38%. In 19 patients with uric acid/calcium oxalate calculi or alternating stone formations from uric acid and calcium oxalate we succeeded in decreasing this ratio from 1.72 to 0.47 or 27%.

Allopurinol↗

Impact of allopurinol treatment on the prevention of hyperuricosuric calcium oxalate lithiasis.

The beneficial effect of allopurinol treatment in metaphylaxis of hyperuricosuric calcium oxalate lithiasis has been analyzed in a retrospective study covering 10 years. 83 patients with hyperuricosuric calcium oxalate lithiasis (48 recurrent stone formers, 35 patients with a single stone episode) were treated with 300 mg allopurinol for 33.1 +/- 11.5 months. Subsequently, each patient was controlled for 43.9 +/- 27 months without therapy. The overall relapse rate was 28.9% but there is no statistically significant difference between treatment with and without allopurinol (Mann-Whitney: p = 0.16). The only striking difference was the fact that, with one exception, stone relapses occurred only in the group of recurrent stone formers, whereas the group with single stone formation seemed to be at a clearly decreased risk for stone recurrence during follow-up. This would suggest that factors other than those investigated in this study are responsible for the phenomenon of recurrent stone formation.

Allopurinol↗

Urinary lithiasis in children. A review of 155 cases.

155 children presenting with lithiasis have been studied. The study confirms other recent analyses: (1) Urinary lithiasis in the child is far more frequent than was previously thought. It is not always easy to diagnose because of the limited opacity of the calculi. (2) Its secondary nature is shown in 25% of the cases. (3) Its cause is still debated in spite of the evident part played by Proteus infection. (4) The prognosis is generally favourable.

Adolescent↗

Metabolic assessment in patients with urinary lithiasis.

INTRODUCTION: Metabolic investigation in patients with urinary lithiasis is very important for preventing recurrence of disease. The objective of this work was to diagnose and to determine the prevalence of metabolic disorders, to assess the quality of the water consumed and volume of diuresis as potential risk factors for this pathology. PATIENTS AND METHODS: We studied 182 patients older than 12 years. We included patients with history and/or imaging tests confirming at least 2 stones, with creatinine clearance > or = 60 mL/min and negative urine culture. The protocol consisted in the collection of 2, 24-hour urine samples, for dosing Ca, P, uric acid, Na, K, Mg, Ox and Ci, glycemia and serum levels of Ca, P, Uric acid, Na, K, Cl, Mg, U and Cr, urinary pH and urinary acidification test. RESULTS: 158 patients fulfilled the inclusion criteria. Among these, 151 (95.5%) presented metabolic changes, with 94 (62.2%) presenting isolated metabolic change and 57 (37.8%) had mixed changes. The main disorders detected were hypercalciuria (74%), hypocitraturia (37.3%), hyperoxaluria (24.1%), hypomagnesuria (21%), hyperuricosuria (20.2%), primary hyperparathyroidism (1.8%), secondary hyperparathyroidism (0.6%) and renal tubular acidosis (0.6). CONCLUSION: Metabolic change was diagnosed in 95.5% of patients. These results warrant the metabolic study and follow-up in patients with recurrent lithiasis in order to decrease the recurrence rate through specific treatments, modification in alimentary and behavioral habits.

Acidosis, Renal Tubular↗

Sulfadiazine-related obstructive urinary tract lithiasis: an unusual cause of acute renal failure after kidney transplantation.

We report on the first case of acute renal failure related to obstructive urinary tract lithiasis involving sulfadiazine crystals in a kidney transplant recipient. This patient had disseminated toxoplasmosis which was treated by sulfadiazine (4 g/day) and pyrimethamine (50 mg/day). In the fourth week of anti-toxoplasmosis therapy, he presented with obstructive acute renal failure: the plasma creatinine level increased from 220 micromol/l to 547 micromol/l. Apercutaneous pyelography was conducted showing the presence of a lithiasis located at the junction between the graft ureter and the bladder. Six days later, he underwent surgery to retrieve an orange-colored, friable stone. Its spectrophotometric analysis confirmed that the stone consisted of N-acetyl sulfadiazine crystals.

Acute Kidney Injury↗

Urinary lithogen risk test: usefulness in the evaluation of renal lithiasis treatment using crystallization inhibitors (citrate and phytate).

OBJECTIVES: This paper presents the results of a test to globally determine the urinary risk factor of calcium stone formation in the evaluation of treatments using crystallization inhibitors, such as citrate and phytate. METHODS: Three groups of active calcium oxalate stone-formers have been selected. The lithogen urinary risk was determined using a specially designed disposable test before any medical treatment. After evaluation group I did not receive any treatment, group II was treated with potassium citrate and group III with a phytate-rich dietary complement. When 15 days had elapsed, the test to evaluate the risk of urinary calcium stone formation was applied again to the three groups. The main lithogenic biochemical parameters of each tested urine were also determined before and after treatment. RESULTS: An important number of calcium oxalate stone-formers with high urinary risk factor (positive test) became negative after medical treatment (52% of the citrate-treated patients and 50% of the phytate-treated patients), but only 7% of the untreated patients (1 patient) showed a decrease in their urinary risk factor for calcium stones (negative test) after 15 days had elapsed. When the treatment was not effective, in an important number of cases, the urine contained high levels of calcium or showed pH values greater than 6.5. CONCLUSION: From the obtained results it can be concluded that the test is useful to evaluate the efficacy of a given renal lithiasis medical treatment, and also the efficacy of the treatment of calcium oxalate renal lithiasis using crystallization inhibitors, such as citrate and phytate, in an important number of cases.

Calcium Oxalate↗

[Calcium-dependent calcium oxalate lithiasis (type IIa). The importance of urinary citrate and the calcium/citrate ratio].

BACKGROUND: Type IIa urinary lithiasis (calcium oxalate dihydrate, weddellite) has a calcium-dependent structure implicating hyper-calciuria for its formation. CASE REPORT: We observed a case of type IIa lithiasis in a patient without elevated urine calcium. Weddellite crystals with a hexagonal habit were found in the nocturnal urines. The only urinalysis anomaly was a low citrate level giving a calcium/citrate level > 3. Oral potassium citrate normalized urinary citrate and the calcium/citrate ratio. After 3 years follow-up, crystal formation has remained negative. DISCUSSION: As illustrated by this case, the calcium/citrate ratio, rather than total urine calcium, would be a good indicator of urinary calcium output and the potential risk for weddellite crystal formation in the presence of oxalates.

Adult↗

Urinary lithogen risk test: usefulness in the evaluation of renal lithiasis treatment using crystallization inhibitors (citrate and phytate).

OBJECTIVES: This paper presents the results of a test to globally determine the urinary risk factor of calcium stone formation in the evaluation of treatments using crystallization inhibitors, such as citrate and phytate. METHODS: Three groups of active calcium oxalate stone-formers have been selected. The lithogen urinary risk was determined using a specially designed disposable test before any medical treatment. After evaluation group I did not receive any treatment, group II was treated with potassium citrate and group III with a phytate-rich dietary complement. When 15 days had elapsed, the test to evaluate the risk of urinary calcium stone formation was applied again to the three groups. The main lithogenic biochemical parameters of each tested urine were also determined before and after treatment. RESULTS: An important number of calcium oxalate stone-formers with high urinary risk factor (positive test) became negative after medical treatment (52% of the citrate-treated patients and 50% of the phytate-treated patients), but only 7% of the untreated patients (1 patient) showed a decrease in their urinary risk factor for calcium stones (negative test) after 15 days had elapsed. When the treatment was not effective, in an important number of cases, the urine contained high levels of calcium or showed pH values greater than 6.5. CONCLUSION: From the obtained results it can be concluded that the test is useful to evaluate the efficacy of a given renal lithiasis medical treatment, and also the efficacy of the treatment of calcium oxalate renal lithiasis using crystallization inhibitors, such as citrate and phytate, in an important number of cases.

Citrates↗

[Epidemiologic data in renal lithiasis in adults].

The morpho-costitutional analysis of 574 urinary lithiasis emitted by tunisean adults permitted to define an épidemiology's profile. This resemble to the épidemiology's profile of under-developed conry: Amore raised frequency of the renal lithiasis at the man than at the woman with a sec ratio of 2.4. An average age of +14 years with a peak to 4th decade in 2 sexes. The upper localitation of the calculi is founded in 94% cases. The fréquency of the relapses, the mode of expulsion and the size of calculi are différent of those published in the litérature. Probably because the time of study which last 4 years is too short, so it don't enable us to find a result like the literature. The surgery is the mode of most fréquent élimination (51%). This s dû to the présence great size calculi in our popûlation and to the récent introduction of the lithotritie in our country.

Adolescent↗