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[Extracorporeal shock wave lithotripsy and recurrent urolithiasis].

Changes in concentrations of total thyroxine (T4) and triiodothyronine (T3) in blood plasma, blood coagulation and prothrombin index (PI) 9 days after exposure to extracorporeal shock-wave lithotripsy (ESWL) were studied in patients with urolithiasis. Urolithiasis patients with chronic pyelonephritis running with non-severe renal pain had often elevated concentrations of T3, T4 and blood coagulation. On day 9 after ESWL plasma concentration of T3 and coagulation decreased while T4 concentration and PI rose. The analysis of 4-year follow-up after ESWL demonstrates that high levels of T4 and PI on day 9 after ESWL may contribute to development of recurrent urolithiasis.

Blood Coagulation↗

[Urolithiasis induced by combined ACTH and zonisamide treatment in a patient with startle induced epilepsy].

A 5-year-old boy had periodic spasms and startle-induced drop attacks. Zonisamide (ZNS) was partially effective for the former seizures, and propranolol for the latter. An add-on therapy with ACTH resulted in a transient disappearance of seizures and an improvement of EEG. However, the patient developed urolithiasis with resultant hematuria and pyelectasis during ACTH therapy. ZNS can induce urolithiasis by increasing urinary pH and calcium (Ca) excretion, and ACTH may facilitate this rare adverse effect of ZNS by further increasing the urinary Ca. Hydrochlorothiazide could resolve the urolithiasis by decreasing the urinary Ca excretion.

Adrenocorticotropic Hormone↗

Urolithiasis in pregnancy. Diagnosis, management and pregnancy outcome.

OBJECTIVE: To review our experiences with ureterolithiasis and nephrolithiasis in pregnancy and compare their outcomes with those in the rest of the obstetric population. STUDY DESIGN: A database of obstetric deliveries was used to identify patients with (cases) and without (controls) urolithiasis and to compare demographics and pregnancy complications between the groups. Furthermore, retrospective chart review of the cases group was utilized to obtain additional pertinent information. RESULTS: Over a 3-year period, there were 21,010 deliveries, 86 of which had symptomatic urolithiasis, for an incidence of 1 in 244 pregnancies. Renal calculi occurred more commonly in Caucasians than African Americans. Patients were more likely to become symptomatic in the second or third trimester, and most stones passed spontaneously. Pregnancy complications were similar between the groups; however, there was a higher percentage of preterm premature rupture of membranes in the nephrolithiasis cases (7.0% vs. 2.9%, P < .05). CONCLUSION: Nephrolithiasis and ureterolithiasis occurred more commonly in Caucasians during pregnancy. The majority of patients became symptomatic in the last two-thirds of pregnancy and usually passed the calculus spontaneously. A higher incidence of preterm premature rupture of membranes was noted in pregnancies complicated by urolithiasis.

Adult↗

[Beneficial effect of angiotensin converting enzyme inhibitor treatment in severe cystine urolithiasis].

Cystinuria is an autosomal recessive defect in transepithelial transport of dibasic amino acids (e.g. cystine) which involves the proximal canaliculi, small intestine and central nervous system. It is the least common cause of nephrolithiasis, accounting for 1 to 3% of renal calculi. The natural course of the disease, characterised by recurrent stone formation, can frequently lead to renal failure, if left untreated. Until recently, treatment of cystinuria has been limited to symptomatic management including intensive hydration and urine alkalinisation. Different drugs that react with cystine to form soluble complexes have been used but their efficacy remains questionable. We present the case of a 6-year-old boy with severe, recurrent cystine urolithiasis treated with captopril. The diagnosis of cystine urolithiasis was established after a 3-year course of clinically apparent nephrolithiasis, characterised by stone passage. At the age of 5 years he underwent lithotripsy and nephrolithotomy for removal of staghorn calculi. Since then treatment with citrate and magnesium supplementation combined with captopril was introduced. After a follow-up of 12 months the patient remained stone-free. Urinary cystine decreased from 230 to 136 mg per gram creatinine. We conclude that captopril can be useful in the treatment of cystine urolithiasis in children.

Angiotensin-Converting Enzyme Inhibitors↗

Urolithiasis in pregnancy.

BACKGROUND: The aim of this study was to review our experience in the diagnosis and management of urolithiasis in pregnant women, and to discuss safety, appropriate diagnostic tools and treatment modalities with review of literatures. METHODS: Nine women with pregnancy proved to have urolithiasis were included in this study. The diagnosis was made according to their symptoms and signs, and ultrasonographic findings. Conservative treatment with hydration, analgesics and antibiotics was applied initially, followed by some minimally invasive procedures, including percutaneous nephrostomy (PCN), double J (DBJ) stenting and ureterorenoscopy (URS), if initial treatment failed. RESULTS: All patients received conservative treatment at first, and 4 patients got well till delivery, another 5 patients needed further minimally invasive procedures; 1 of them received DBJ stenting, another 1 received PCN first and changed to DBJ stenting. The remaining 3 patients were treated by ureterorenoscopy with stone manipulation. All these 5 patiens had full-term delivery without obstetric sequela, except 1 patient who received left salpingoophrectomy due to left ovarian abscess. CONCLUSIONS: During pregnancy, urolithiasis is a diagnostic and therapeutic challenge. Clinical symptoms and signs are most important in establishing diagnosis, and ultrasound examination adds accuracy. Minimally invasive procedures (such as PCN, DBJ stenting, URS) can facilitate the successful management of patients requiring further intervention due to failure of conservative treatment.

Adult↗

[Diagnosis and management of primary hyperparathyrodism with urolithiasis].

OBJECTIVE: To investigate the diagnosis and management of primary hyperparathyroidism with urolithiasis. METHODS: The clinical data of 12 patients who were diagnosed with primary hyperparathyroidism with urolithiasis from January 1998 to June 2004 were analyzed retrospectively. RESULTS: Four male and five female patients were demonstrated pathologically as parathyroid adenoma, with a mean age of 45.7 +/- 11.8 years (26 approximately 57) and a stone history of 8.3 +/- 6.4 years (0.5 approximately 22). Their serum calcium and PTH level were elevated obviously, while serum phosphate of 66% patients were lowered. The positive rate and accuracy of ultrasound, CT and (99m)TC-MIBI imaging were 67%, 100%, and 100% and 67%, 75%, 100% respectively. After resection of the parathyroid adenoma, the patients' serum calcium and PTH returned to normal. The other data of 3 cases without parathyroid adenoma. all males aged 45 approximately 54, were also investigated. CONCLUSIONS: Serum calcium level above 2.96 mmol/L and PTH 3.9 or more times as normal in patients with recurrent or bilateral urolithiasis should be suspected with primary hyperparathyroidism. (99m)TC-MIBI image functions best in preoperative localization of the abnormal gland. Parathyroidectomy is the curative approach for the disease. Stones should be followed up after operation and appropriate treatment should be employed when needed.

Adenoma↗

[A phytogenic drug kanefron H in patients with chronic cystitis and urolithiasis].

To evaluate efficacy of kanefron H (KH) in combined therapy of chronic cystitis and urolithiasis (after extracorporeal shock-wave lithotripsy-ESWL), we examined 48 women suffering from chronic cystitis. The patients were divided into two groups by the presence of pyuria: 20 patients of group 1 had pyuria, 28 patients of group 2 had no pyuria. Each group was subdivided into two groups in relation to KH. Subgroup 1a received phosphomycin as monotherapy, subgroup 1b--phosphomycin with KH (2 pellets 3 times a day for 30 days). Subgroup 2a was initially treated with anti-inflammatory drugs, local medication physiotherapy, circulation improving drugs for 10 days. Then the patients were followed up for a months without any treatment. Subgroup 2b received the same initial course but it was followed for 30 days with KH. 79 patients with urolithiasis (uroliths and ureteroliths) have undergone ESWL. 45 entered KH group (2 pellets 3 times a day), 34--the control group (spasmolytic and anti-inflammatory therapy). KH in combined treatment of chronic cystitis raises efficacy of the initial therapy (antibacterial or combined, made in the absence of pyuria), promotes achievement of longer disease remission, elimination of concrement fragments from the urinary tract. Long-term administration of KH induce no side effects. Thus, KH can be recommended in chronic cystitis and urolithiasis in patients exposed to ESWL as an effective and safe drug.

Adolescent↗

[Lipids content in renal tissue membranes in patients with urolithiasis and secondary pyelonephritis].

We studied cytomembranes of the interstitial tissue of renal medullary layer obtained by lifetime biopsy of renal tissue in the course of pyelolithotomy in 46 patients with urolithiasis and secondary pyelonephritis. Biopsy structure was controlled with histological methods using standard staining. Basic phospholipids and cholesterol fractions in renal tissue cytomembranes were assayed at thin layer chromatography. The findings show significant changes in a nephron cytomembrane lipid phase in patients with urolithiasis and secondary pyelonephritis. There was a structural rearrangement of lipid biolayer of renal tissue cell membranes in response to microbial inflammation. Thus, use of membrane-stabilising drugs are grounded in patients with secondary pyelonephritis and urolithiasis.

Humans↗

[Hydrochlorothiazide, allopurinol and magnesium oxide in the treatment of recurrent calcium urolithiasis].

The study aimed at presenting own experience in prevention of new urinary calculi in 18 patients with metabolically active calcium urolithiasis treated with hydrochlorothiazide in daily doses of 100 mg (group I) for 2 years, and in 6 patients with the same disease treated with magnesium oxide in daily doses 300 mg twice a day (group II) for average period of 10 months. In 9 patients a new calculus was formed during the treatment with hydrochlorothiazide, in 7 patients no recurrence was noted, and in 2 remaining patients the results were controversial (coral calculus). Therefore, patients were subdivided into group Ia (failure of hydrochlorothiazide therapy), and group Ib (no recurrence noted). Hydrochlorothiazide did not lead to the stable decrease in the saturation of the urine with calcium oxalate in group Ia whereas in group Ib (without recurrence of urolithiasis) the content of calcium oxalate in the urine was significantly lower than that in group Ia after a 2-year treatment with hydrochlorothiazide (p < 0.01) Recurrence of the disease was seen only in one patient of group II, i.e. treated with magnesium oxide. The treatment of the recurrent calcium urolithiasis is justified and efficient in those patients in whom therapy decreases the content of calcium oxalate in the urine.

Adult↗

[The indices of cell membrane destabilization in urolithiasis patients].

The paper gives the results of a clinical and biochemical study of 165 patients with urolithiasis and 46 healthy persons. Their urinary samples and renal biopsy specimens were analysed to assess the structural and functional status of nephron cell membranes. In urolithiasis patients, the urine was found to contain a great quantities of emulsified lipids enriched in toxic phospholipid and cholesterol metabolism products; renal tissue cytomembranes in the patients were depleted of phospholipids, free cholesterol and enriched in phospholipid lysoforms and cholesterol esters. Lipid phase destabilization of nephron epithelial membranes was shown to be pathogenetically associated with concrement formation. The examination of emulsified urinary lipids is an objective tool of renal tissue crystallization activity and may be recommended for the early diagnosis of urolithiasis, as well as an indicator of membrane-stabilizing therapy efficiency.

Adult↗

[Clinical application of EDAP LT-01 PLUS on extracorporeal shock wave lithotripsy for urolithiasis].

With EDAP LT-01 PLUS, a new extracorporeal shock wave lithotriptor which generates shock waves by 320 ceramic elements activated by the piezoelectric effect and which was produced to be used for the treatments of both urolithiasis and gall bladder stones, we performed extracorporeal shock wave lithotripsy (ESWL) on 37 patients with urolithiasis between November 22, 1989 and July 31, 1990. Thirty seven target stones of 37 patients were located in the renal calyx (11 cases), renal pelvis (3 cases), UPJ (6 cases), renal calyx and pelvis (1 case), renal calyx and UPJ (1 case), renal calyx and upper ureter (1 case), upper ureter (9 cases), middle ureter (1 case), and lower ureter (4 cases). None of the patients needed anesthesia. The average number of treatments per case was 2.9 and the average total times of treatment per case was 196 minutes. The overall stone-free rate one month after the last ESWL treatment was 54.1% (20/37), and no patients had any major side-effects. Judging from our present clinical application, we concluded that EDAP LT-01 PLUS is a useful extracorporeal shock wave lithotriptor for urolithiasis.

Adult↗

Immunohistochemical detection of renal carbonic anhydrase of patients with recurrent urolithiasis.

In renal exploratory excisions the isoenzyme C of the carbonic anhydrase was detected in 51 operative treated patients with recurrent urolithiasis and in 6 patients with ren mobilis or stenosis of the ureteral pelvic junction by using the immunohistochemical PAP-method. In the distal tubules and collecting ducts there is an alternating occurrence of cells with small and those with strong reactivity. This correlates with the distribution of mean or principal (P-, small reaction) and intercalated (I-, strong reaction) cells. The number of carbonic anhydrase rich cells and the degree of their cytoplasmic reaction to this enzyme seem to correlate with the ability of the urine to acidify. The patients were divided into four groups according to the mean urine pH estimated for a period of two weeks. The third group with predominantly acid urine (pH less than 5.8) showed a significantly increased number of carbonic anhydrase rich cells (mean = 63% +/- 6, n = 18) as compared to the first group (controls) without urolithiasis and normal urine (pH 5.8-6.8, mean = 46% +/- 8, n = 6) or the second group with urolithiasis and normal urine (pH 5.8-6.8, mean = 46% +/- 8, n = 28). The fourth group with predominant alkaline urine (pH greater than 6.8) showed a significantly decreased number of intercalated cells (mean = 42% +/- 16, n = 5) in comparison to the third group. Indeed, the difference with the control group is not significant but the cytoplasmic reaction of I-cells decreases distinctly in comparison to all other groups.

Biopsy↗

Metabolic evaluation of urolithiasis.

After detailed instruction, 62 patients with urolithiasis treated at Taichung Veterans General Hospital entered this program, which ran from September 1987 to November 1988. Based on Pak's classification, there were 13 cases (21.0%) of absorptive hypercalciuria, type I (AH-I); 12 cases (19.4%) of absorptive hypercalciuria, type II (AH-II); 16 cases (25.8%) of renal hypercalciuria (RH); 3 cases (4.8%) of hyperuricosuric calcium urolithiasis (HUCU); 11 cases (17.7%) of hypocitraturia (Hypocit); 3 cases (4.8%) of hyperoxluria (HO); one case (1.6%) of primary hyperparathyroidism (PHPT) and one case (1.6%) of infectious lithiasis. Two cases (3.2%) with no metabolic abnormalities were found. Hypocitraturia, HUCU, and HO can be the primary abnormal findings, but more often coexist with various forms of hypercalciuria as a second factor. If the coexistence is considered, hypocitraturia (33 cases, 53.2%) and HUCU (24 cases, 38.7%) were the most prevalent categories. Meanwhile, 24 cases (38.7%) had only one physiological derangement, 25 cases (40.3%) had two derangements, and 13 cases (21.0%) had three. This study indicates that metabolic evaluation can elucidate the physiological derangements of urolithiasis, so that further medical treatment can be administered selectively.

Adult↗

Childhood urolithiasis: experiences and advances.

Between June 1979 and June 1989, 54 children with urolithiasis were evaluated and treated at the Johns Hopkins Children's Center. The most common symptoms were flank or abdominal pain (58%) and gross hematuria (28%). In 46 children (86%), stones were secondary to a preexisting condition and in only 8 (14%) no apparent cause of stone formation could be found. Thirty-six patients (66%) had a solitary stone, most commonly found in the kidney. Urinary tract infections were present in 25 (47%) of the patients who had stones. Stones composed either of calcium oxalate or struvite were the most frequently recovered in these patients with infections. Twenty-one patients (39%) spontaneously passed their stones whereas 23 (43%) required either surgery or extracorporeal shock-wave lithotripsy to resolve stones. Ten (20%) showed recurrence of their urolithiasis, with follow-up examination periods ranging from 1 month to 10 years. Recent advances in the management of urolithiasis and their applicability to the pediatric population are discussed.

Adolescent↗

Promoters and inhibitors of calcium urolithiasis in children.

We have evaluated the urinary excretion of promoting (calcium, phosphorus, uric acid, oxalate) and inhibiting (citrate, magnesium, glycosaminoglycans) factors of crystallization in subjects with idiopathic hypercalciuria and calcium urolithiasis and in a control group. The examined children had a free diet and were drug free for the last 2 weeks. They were not affected by malabsorption, D-RTA, urinary tract infection, or urinary tract malformation (factors interfering with urinary excretion of citrate and oxalate). In the patients with calcium urolithiasis, the daily urinary excretion of oxalate was significantly higher (p less than 0.01), and the urinary excretion of citrate was significantly lower (p less than 0.001) than in the subjects with idiopathic hypercalciuria and in the control group. Among the subjects with idiopathic hypercalciuria, those aged 4-9 years had a significantly reduced, though in the normal range, urinary excretion of citrate as compared with those aged 10-15 years (362 +/- 189 and 503 +/- 198 mg/g creatinine/24 h, respectively; p less than 0.01). Our data show that hypocitruria may play an important role in the pathogenesis of urolithiasis in children with idiopathic hypercalciuria. In these cases, the urinary citrate excretion was not inversely related to age, as has been suggested by other authors.

Calcium↗

[The role of immunologic factors in the pathogenesis of urolithiasis].

The role of thrombin, fibrinogen, specific and unspecific immunological reactions in the pathogenesis of urolithiasis were evaluated. It was found in the urine of patients with urolithiasis and concomitant pyelonephritis that most bacteria, leucocytes and organic substances fixed on crystalloids contained on their surfaces immunoglobulins M, G and A. The mechanisms of the possible participation of immune reactions in the pathogenesis of urolithiasis are discussed.

Adult↗

[Urolithiasis--changes in its treatment in the traditional surgical management].

Surgical treatments for urolithiasis in the upper urinary tract are reviewed on the basis of operation statistics at the Department of Urology, Osaka University Hospital for the past 30 years from 1957 to 1986. Open surgery was applied for 1,624 patients with urolithiasis in the kidney and ureter during this period. These operations accounted for 14.4% of the 11,300 cases of urological surgery at our department. Types and frequency of operations for urolithiasis were as follows: ureterolithotomies 697 cases (6.2%), pyelolithotomies including extended pyelotomy 376 cases (3.3%), nephrolithotomies 294 cases (2.6%), partial nephrectomies 132 cases (1.2%) and nephrectomies 125 cases (1.1%).

Adolescent↗

Calcium oxalate urolithiasis in the rat: is it a model for human stone disease? A review of recent literature.

Calcium oxalate stone disease is the most common human urinary stone disease in the Western Hemisphere. To understand different aspects of the disease, calcium oxalate urolithiasis in the rat is used as a model. Spontaneous calcium oxalate urolithiasis is very rare in rats. Thus the disease is experimentally induced and the rats are generally made hyperoxaluric either by administration of excess oxalate, exposure to the toxin ethylene glycol, or various nutritional manipulations. All the experimental models show renal injury associated with crystal deposition. Calcium oxalate crystals are in most cases intraluminal in renal tubules and often attached to the basal lamina of the denuded epithelium. Rat renal papillary tips and fornices appear to be the preferential sites for the deposition of large calcium oxalate calculi. Where urinary supersaturation of calcium oxalate has been studied the crystal forming rat urines are shown to have higher urinary supersaturation of calcium oxalate than their controls. Oxalate metabolism in the rat is nearly identical to that in humans. Thus, in a number of respects, experimental calcium oxalate urolithiasis in the rat is similar to calcium oxalate stone disease in man.

Animals↗