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PubMedDate not supplied

[Current treatment of ureteral lithiasis. Review of our experience].

Retrospective analysis from June '89 to January '91 of 198 patients seen in our Hospital for ureteral lithiasis using 'in situ' ESWL as the first therapeutic choice. The number of sessions per calculus was 1.45, 68.7% cases receiving only one session. 84.2% calculi were resolved by ESWL, with associated instrumental manoeuvres in less than 15% cases. Our hospital's therapeutic algorithm for the 15.8% calculi where ESWL failed is presented. The conclusion is that 'in situ' shock wave extracorporeal lithotripsy represents a perfectly valid alternative for the treatment of ureteral lithiasis regardless its location.

Algorithms↗
PubMed1991

[Diagnostic and therapeutic strategy in extrahepatic biliary lithiasis. Our experience].

The paper describes the Authors' personal experience in the diagnosis and treatment of extrahepatic biliary lithiasis in 166 patients admitted to the Surgical Division of the International Evangelical Hospital. The basic tests for a correct diagnostic strategy are echotomography and ERCP in cases of jaundice and/or dilatation of the biliary tract with negative echographic results for lithiasis of the choledochus. The indications for surgery are also discussed and the new possibilities of pre- and post-operative PSTE are also taken into account.

Adult↗
PubMedDate not supplied

[Study, treatment and follow-up of 379 patients with urinary tract lithiasis].

Between May 1988 and December 1989, 369 patients were seen at our lithiasis unit. During that time the Unit had neither "percutaneous nephroscope" nor "ureterorenoscope". Twenty-three percent of the patients were not susceptible to therapy either due to spontaneous extrusion of their lithiasis or because it was not considered indicated. Of the remaining 77% (296 cases) 94.5% were referred for extracorporeal lithotrity with shock waves, of which 89.8 were monotherapy and 4.7% a combination with other strategies (medico-lithic, surgical, endoscopic extrusion). At the time of collecting the results, 216 patients had undergone some treatment. In those receiving shock waves, an EDAP piezoelectric lithotripter was used in 19.9% and a HM3-Dornier in 80% of the cases. Taking into consideration the overall resulted from last examination of each patient, 67% were free from lithiasic residues, 25% had residues under 4 mm, and 7.7% residues over 4 mm. 19.4% of the patients developed some kind of complication and 9 patients had to be admitted to hospital.

Adolescent↗
PubMed1990

[Response of vitamin D metabolites to calcium restriction in hypercalciuric renal lithiasis].

A group of patients with hypercalciuric renal lithiasis and a group of controls underwent dietary calcium restriction, reinforced by cellulose phosphate, during two weeks. Before and after that intervention, serum levels of 25 OH D, 1.25(OH)2D and PTH, and urinary excretion of cAMP and hydroxyproline were measured. Although the baseline 1.25(OH)2D level was higher in patients with stones, it did not increase with diet as it was the case with controls. Also, the urinary excretion of cAMP was increased in controls but not in patients. 25 OH D, PTH and hydroxyproline were not changed. We conclude that dietary calcium restriction in patients with hypercalciuric renal lithiasis does not appear to induce hormonal changes potentially damaging for the bone.

Adult↗
PubMed1990

[Cystinic lithiasis. Current aspects of the urologic treatment].

On the basis of a series of 9 patients (12 renal units) gathered over 19 years, the authors analyze the current possibilities of treatment of cystine lithiasis. They first describe the characteristics of this litiasis, which is rare but serious, being naturally prone to recurrence because it is caused by a genetic defect. The development of extracorporeal lithotripsy raised great hopes for the treatment of this lithiasis, but it was soon realized that cystine strones were hard to break. However, even the mere fragmentation of the stones improves the dissolving action of the various drugs proposed to modify the pH of urine. The authors consider that open surgery by means of posterior vertical lumbar section still is indicated for larger stones, and percutaneous nephrolithotomy seems to be a very useful technique, either exclusively or as a complement of extracorporeal lithotrity.

Adult↗
PubMed1990

[Intrahepatic biliary lithiasis: endoscopic transpapillary treatment].

Six cases of intrahepatic biliary lithiasis, condition rarely observed in western countries, are reported. Following a review of the literature and on the basis of personal experience, stress is laid on problems of classification, clinical and instrumental diagnosis and, in particular, the therapeutic approach to intrahepatic biliary lithiasis by the endoscopic transpapillary way.

Ampulla of Vater↗
PubMedDate not supplied

[Urinary lithiasis composed of silica].

We present a case of urinary silica (silicon dioxide) lithiasis in a patient without a background of medication use justifying the formation of this calculus. We review the literature on this type of lithiasis and comment on some aspects of the metabolism of silica connected with urolithiasis.

Adult↗
PubMedDate not supplied

[Lasertripsy in the treatment of ureteral lithiasis].

The pulsating colour laser generates a shock wave with a high energy power capable of shattering urinary calculi. Owing to their location and impaction, certain ureteral require intraureteral fragmentation, and ureteroscopy with a semi-rigid miniureteroscope permits the use of laser beams. We have treated 70 patients with ureteral lithiasis with this method and obtained complete fragmentation of the calculi in 61 patients, ascent of the calculus to caliceal cavities in 7, whilst no fragmentation was achieved in 2. No case required a surgical operation and no complications were observed. Laser therapy in the treatment of ureteral lithiasis.

Female↗
PubMed1989

[Treatment of renoureteral lithiasis using extracorporeal shockwave lithotripsy. Experience in Cuba].

Herein we present our experience in 5,000 cases of reno-ureteral lithiasis submitted to treatment at the Extracorporeal Lithotripsy Unit of Hermanos Ameijeiras Hospital in Havana, Cuba, from April 1986 and during a period spanning 30 months. Treatment was exclusively by extracorporeal shock wave lithotripsy (ESWL) in 85.5% of the patients and in combination with other procedures in 14.5% (endoscopic maneuvers in 5.9%, percutaneous nephrostomy 4.4%, open surgery 3.6%, and percutaneous nephrolithotripsy 0.6%). Complications were observed in 7% of the cases: ureteric obstruction (6.4%) with or without infection, perirenal hematoma (0.4%), and obstructive anuria (0.2%); acute urinary infection of different clinical types, some of which were very severe, were observed concomitantly in 2.6% of these patients. Two months following treatment, 86% of the cases were completely stone-free. At 6 months 96.2% were completely stone-free; the remaining 3.8% were classed as residual lithiasis. The pathologic conditions that put patients at high therapeutic risk and the possible complications that could arise were identified. The efficacy of the Dornier HM-3 lithotripter and the health care system that permits its extensive use are highlighted.

Adolescent↗
PubMed1989

[The importance of intraoperative diagnosis in biliary lithiasis].

Intraoperative cholangiography continues to be the principal investigation in the intraoperative diagnosis of biliary disease. Cholangiography and preoperative echography, the clinical aspect are not sufficient to exclude the possibility of choledochal lithiasis in operations carried out for straightforward cholelithiasis. Personal experience in a series of 248 bile lithiasis operations is examined: intraoperative diagnosis was based on 244 cholangiographies, 41 echographies and 22 choledochoscopies. Choledochoscopy proved decisive for evidencing residual choledochal calculi after seemingly accurate choledocholithotomy operations and also after trans-Kehr intraoperative cholangiography. Intraoperative echography, in the light of rather limited experience, would seem to add nothing to the two previous associated intraoperative instrumental investigations; it may prove useful in certain special cases.

Cholangiography↗
PubMedDate not supplied

[Our experience in the endoscopic treatment of ureteral lithiasis. 120 cases of transurethral ureterorenoscopy].

We present our experience over 3 years in the treatment of ureteral lithiasis by means of transurethral ureteroscopy. We analyze the results of our first 120 cases. The percentage of overall successes is 74%, which varies significantly according to whether the calculus is located in the upper or lower third of the ureter and according to the curve of apprenticeship. Iatrogenic problems drop considerably after 50 cases. Rigid transurethral ureteroscopy has become our preferential therapeutic procedure in practically every type of ureteral lithiasis and we have discarded flexible transurethral ureteroscopy for its useless results.

Adolescent↗
PubMed1988

[Treatment of lithiasis in horse-shoe kidney].

Between september 1985 and april 1987 the authors treated 16 patients with 27 calculi in horse-shoe kidneys. 14 patients were treated by extra-corporeal lithotrity with two failures from the outset because of impossibility of positioning the lithiasis at the second site of the ellipsoid. In the other twelve cases and 3 months after treatment there were four complete successes (no residual calculi) and eight partial successes with, in seven cases, residual calculi less than 4 mm in diameter and, in one case, a residual calculus of more than 10 mm. Of 4 percutaneous nephrolithotomies, including two from the outset, there were no post-operative complications and, only in one case, residual fragments in the inferior calyx. The authors then analyzed the special features and difficulties inherent to the unusual topography of the renal cavities of horse-shoe kidneys. Such topography leads to modifications which are described by the authors both in the technique of extra-corporeal lithotrity as well as in that of percutaneous nephrolithotomy. The study ends with an analysis of the respective indications of the two methods of extra-corporeal or endo-urological treatment of lithiasis affecting horse-shoe kidneys.

Adult↗
PubMed1978

[Urinary lithiasis after renal transplantation. 9 cases (author's transl)].

Nine cases of urinary lithiasis following renal transplantation are reported. They differ from 15 cases in the literature in their development late after transplantation and in that no relation with hyperparathyroidism could be clearly demonstrated. We emphasise the difficulty of the clinical and radiological diagnosis of this little-known complication. The course is essentially similar to that in non-transplant patients with lithiasis.

Adult↗
PubMed1986

[Urinary lithiasis after using mechanical suture procedures for Bricker's operation. Apropos of a case].

A further case is reported of urinary tract lithiasis developing around a metallic clip used to suture an ileal fragt during Bricker's operation. Although the calculus developed without provoking complications and was evacuated spontaneously through the stoma, the question is asked, after a literature review, whether it is justified to use mechanical suturing for transintestinal cutaneous anterostomies. The moderate gain in time (15 to 20 min) seems counterbalanced by the increased cost and definite risk (2 to 4%) of lithiasis on metallic clips.

Humans↗
PubMedDate not supplied

[The common channel syndrome associated with cystic dilatation of the common bile duct. Apropos of a case complicated by lithiasis of the common channel].

Perduodenoscopic retrograde cholangiography in a 15 year old boy with cystic dilatation of common bile duct demonstrated lithiasis of Vater's ampulla and collateral shunt for Wirsung's duct in the form of a functional Santorini duct. Cases of combined cystic dilatation of common bile and Vater's ducts reported in the literature are reviewed and a study conducted of frequency of cystic dilatation of common bile duct, its classification as described by Longmire and Hadat (enlarging that proposed by Alonso-Leij), and its diagnosis and complications. Routine retrograde cholangiography can delect lithiasis of Vater's ampulla and allow preoperative determination of therapy. Current investigatory procedures for these anomalies have allowed rediscussion of the etiopathogenicity of cystic dilatation of common bile duct and a tendency towards a duoalist hypothesis, without its definite confirmation at the present time.

Adolescent↗
PubMed1985

Technetium-99m HIDA hepatic lobar distribution and retention ratios in detection of intrahepatic lithiasis.

Technetium-99m HIDA hepatic lobar distribution and retention ratios were developed to evaluate patients with intrahepatic lithiasis. The data of 57 cases were analyzed. Results reveal a highly significant difference in these ratios between the patients and normal individuals. They are simple, objective, and easily obtainable. Thus, the determination of these ratios may replace [99mTc]HIDA sequential scintiphotography, which is qualitative and time consuming, for screening intrahepatic lithiasis.

Calculi↗
PubMed1979

[Biliary lithiasis in cystic fibrosis. Study of the bile salts in the serum and in the bile in one case (author's transl)].

Biliary lithiasis was discovered in a girl aged 11 suffering from Cystic Fibrosis and who underwent partial small bowel resection for meconium ileus. A cholecystectomy was performed at 15. Examination of the stones showed that they were composed of cholesterol and chemical examination of the bile showed an increase of phospholipids and a decrease in bile salts. There was also a modification of the ratio (Formula: see text) in the serum and the bile. All those factors contribute to the insolubility of cholesterol and to the formation of lithiasis. For all those reasons, the authors recommend a regular radiologic surveillance of the gallbladder in Cystic Fibrosis.

Adolescent↗
PubMed1983

[Urinary excretion of lithogenic substances in hospitalized patients with calcium lithiasis. Physiopathologic meaning and prognostic value].

The urinary excretion of various substances involved in kidney stone formation was evaluated in 67 patients with hypercalciuric lithiasis (HCl), 36 lithiasis patients with normal calciuria (NCl) and 21 controls without urinary stones. All subjects were hospitalized for 3 days and given a calcium, phosphorous and sodium-controlled diet. The 24-hour urine volume was significantly larger in the HCl and NCl groups than in controls. The 24-hour Ca, Na and uric acid excretion was significantly greater in the HCl group than in the NCl and control groups. Oxalate and pyrophosphate excretion was the same in all three groups. Urinary Ca correlated with urinary creatinine in the HCl and control groups, but the slope and ordinate of the regression line were significantly higher in the former group. Similarly, urinary Na correlated with urinary creatinine in the HCl and control groups with a significantly steeper slope in the HCl group. These data are suggestive of abnormalities in the tubular reabsorption of Ca and Na in HCl patients. Finally, there was no correlation between the values obtained and the activity of the disease, as evaluated by the finding of at least 3 urinary stones or one staghorn calculus during the 5 years preceding the study. It is concluded that measurements of Ca, Na, uric acid, creatine, oxalates and phosphates during a stay in hospital provide pathophysiological information but cannot be taken as indices of urolithiasis activity.

Calcium↗