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At least 289 records · Page 16Linked to original sources
PubMed2002

Clinical experience and results of ESWL treatment for 3,093 urinary calculi with the Storz Modulith SL 20 lithotripter at the Singapore general hospital.

We study the outcome of 2,700 patients treated for 3,093 urinary calculi over a period of 60 months. All patients underwent Extracorporeal Shock Wave Lithotripsy (ESWL) treatment using the Storz Modulith SL20, predominantly on an outpatient basis (99.9% using intravenous pethidine for analgesia). The treatment outcome of 1,666 renal calculi and 1,427 ureteric calculi were analysed and stratified according to size and site. Follow-up status at 3 months was available for 91.8% of patients. For renal calculi, the overall success rate was 81% (re-treatment rate 29.7%). The majority of failures were stones larger than 2 cm and those situated in the lower pole of the renal calyces. The overall success rate for ureteric calculi is 85% with similar clearance rates throughout the ureter (re-treatment rate 22.8%). Failures were predominantly with stones larger than 2 cm. For the entire series, the morbidity rate requiring hospital admission was 2.9%, there was no mortality. The commonest cause for admission was for pain control (1.8%). To our knowledge, our experience with this lithotriptor is the largest to date. We have demonstrated that ESWL with Storz Modulith SL20 is safe, well tolerated and highly effective for the treatment of urolithiasis.

Adolescent↗
PubMed1991

Extracorporeal shock wave lithotripsy of urinary calculi. Results from the first 306 patients treated at the Copenhagen Municipal Stone Center with a second generation lithotriptor.

The first Danish experience with Extracorporeal Shock Wave Lithotripsy (ESWL) using a second generation Lithotriptor (Siemens Lithostar) is reported. 306 patients underwent 392 treatments for 363 stones. There were 339 renal calculi including 5 staghorn calculi and 54 ureteral calculi. Treatments were performed under local analgesia (82%) or epidural or general anesthesia (18%) when invasive procedures had to be done in connection with the treatment. Stone fragmentation was achieved with 2487 +/- 1262 shocks. The first months stone clearance rate was 45%; 26% had fragments less than 6 mm; 29% had residual stones. Corresponding rates after 3 and 6 months were 58%, 24% and 18% and 70%, 21% and 9% respectively. Septicemia occurred in 4 patients and cardial arrhythmia in 34 patients (11%). No serious intra- or perirenal hematomas were registered. In 9% additional procedures were required and 11 patients had residual stones removed at open surgery. The used second generation lithotriptor with X-ray based stone localisation is effective for treatment of both renal calculi and ureteral calculi in situ in all three segments of the ureter.

Adolescent↗
PubMedDate not supplied

[Strategies for endoscopic and surgical treatment of biliary tract calculi].

INTRODUCTION: Common bile duct calculi represent a pathologic entity involving obstructive icterus, cholangitis, hepatic cirrhosis or pancreatitits. Common bile duct calculi mostly have a secondary origin (from gallbladder) in 95% of cases, while primary choledocholithiasis is rare. CLASSIFICATION: From surgical aspect, common bile duct calculi can be: 1. Asymptomatic, without manifested symptoms or signs, 2. Mobile, with intermittent biliar obstruction and disobstruction, 3. Fixed, with obstruction and signs of hepato-biliary and/or bilio-pancreatic duct, 4. Transitory, microcalculi which pass through Vater's Papilla by propulsion into duodenum with symptoms. DISCUSSION: Modern biliary surgery includes diagnosis of common bile duct calculi, and if possible preoperative endoscopic (endoluminal) surgery, which is less invasive for patients. If such approach is not possible, it is necessary to perform stone extraction and cholecystectomy. CONCLUSION: Common bile duct calculi represent a common disease of the digestive system. Endoscopic diagnostic procedure is very important in management of choledocholithiasis. Endoscopic treatment of common bile duct calculi prior to cholecystectomy is a method of choice and a strategy for associated cholecysto-choledocholithiasis.

Cholelithiasis↗
PubMed1990

[The endoscopic treatment of large calculi in the choledochus. The preliminary results with intracorporeal electrohydraulic shock-wave lithotripsy].

Results are reported of endoscopic treatment of: 236 patients with common bile duct calculi treated by endoscopic sphincterotomy with or without hydrostatic balloon extraction and extraction of the calculi, mechanical lithotripsy and endoprosthesis; preliminary results in 12 patients treated by intracorporeal electrohydraulic lithotripsy. Complete removal of calculi from the common bile duct was achieved in 171 of 236 sphincterotomized patients (72 per cent). Complications were observed in 11 per cent of the patients. Mechanical cracking of common bile duct calculi was realized in 60 of 65 patients (92 per cent) with complications observed in 3 per cent. Thus, with the use of mechanical lithotripsy the success of endoscopic treatment rose to 98 per cent, without increase in the incidence of complications. Seven patients had endoprostheses placed because of failure to extract the calculi. Intracorporeal electrohydraulic lithotripsy was performed in 12 patients with common bile duct lithiasis (4 with single and 8 with numerous stones with diameter 20-40 mm. In one patient transient acute pancreatitis was observed. A rise in serum amylase content was recorded in 9 patients. The stones in the common bile duct were effectively broken to pieces and removed in 8 patients. Lithotripsy was unsuccessful in 4 patients, two of whom had solid calcium depositions. In the common bile duct of the other two MTBE gas applied. The patients were subjected to repeated lithotripsy with positive effect. It is pointed out in conclusion that crushing stones in the common bile duct allows real improvement of the results of endoscopic sphincterotomy in common bile duct calculosis. Endoscopic treatment of larger calculi became also feasible which until a few years ago were contraindication for endoscopic treatment.

Aged↗
PubMed1988

Scanning electron microscopy and electron probe microanalyses of the crystalline components of human and animal dental calculi.

A review of the use of scanning electron microscopy (SEM) and electron probe microanalyses in the study of dental calculus showed that such studies provided confirmatory and supplementary data on the morphological features of human dental calculi but gave only limited information on the identity of the crystalline or inorganic components. This study aimed to explore the potential of combined SEM and microanalyses in the identification of the crystalline components of the human and animal dental calculi. Human and animal calculi were analyzed. Identification of the crystalline components were made based on the combined information of the morphology (SEM) and Ca/P molar ratios of the crystals with the morphology and Ca/P molar ratio of synthetic calcium phosphates (brushite or DCPD; octacalcium phosphate, OCP; Mg-substituted whitlockite, beta-TCMP; CO3-substituted apatite, (CHA); and calcite. SEM showed similarities in morphological features of human and animal dental calculi but differences in the forms of crystals present. Microanalyses and crystal morphology data suggested the presence of CaCO3 (calcite) and CHA in the animal (cat, dog, tiger) and of OCP, beta-TCMP and CHA in human dental calculi. X-ray diffraction and infrared (IR) absorption analyses confirmed these results. This exploratory study demonstrated that by taking into consideration what is known about the crystalline components of human and animal dental calculi, combined SEM and microanalyses can provide qualitative identification.

Adult↗
PubMed2003

Sialolithiasis: mechanism of calculi formation and etiologic factors.

BACKGROUND: Sialolithiasis is a common disease of salivary glands. The etiology of these calculi is little known and their exact mechanism of formation is unknown. METHODS: The composition and structure of 21 sialoliths were studied and the composition of the saliva of each corresponding patient was determined (pH, calcium, magnesium, phosphorus, citrate and phytate). RESULTS: Eighteen sialoliths exhibited similar macro and microstructure, being constituted by hydroxyapatite (HAP) and organic matter, normally arranged in a multilayer structure. The three remaining sialoliths were exclusively constituted by organic matter. The salivary Ca of patients with HAP calculi was significantly higher than that found in the saliva of the healthy group. The salivary phytate concentration of patients with HAP calculi was significantly inferior to that found in patients with calculi exclusively formed by organic matter, as well as to that found in saliva of healthy group. Significant differences between the salivary magnesium concentrations of patients with HAP calculi and the control group were also observed. No significant differences between pH and citrate concentrations of the three groups were found. CONCLUSIONS: It was concluded that the deficit of crystallization inhibitors such as myo-inositol hexaphosphate (phytate) was also an important etiologic factor implied in the sialolith development.

Adult↗
PubMed1993

Low energy lithotripsy with the Lithostar: treatment results with 19,962 renal and ureteral calculi.

Between November 1988 and January 1992, 19,962 renal and ureteral calculi were treated in the United States using 18 different mobile and 2 fixed base Lithostar lithotriptors. Lithotripsy was performed on 11,516 renal and 8,446 ureteral calculi by 750 urologists using the same technique. The success rate (asymptomatic with stone fragments of 4 mm. or less) for renal stones was 87.9%, the stone-free rate was 68.9% and the retreatment rate was 16.5%. Auxiliary procedures were performed in 32.2% of the renal calculi. The success rate for ureteral calculi was 89.5%, the stone-free rate was 83.5% and the retreatment rate was 10.7%. Auxiliary procedures were performed in 25.5% of the ureteral calculi. The overall success rate was 88.4% stone-free rate 75.5%, retreatment rate 14.0% and auxiliary procedure rate 29.4%. Anesthesia personnel were used in 1.9% of the cases. Low energy extracorporeal shock wave lithotripsy was found to be safe and effective.

Female↗
PubMed1990

Multimodality treatment of complex renal calculi.

More than 2,500 patients were treated for urolithiasis from 1984 to 1987. In an effort to define the relative role of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy with respect to size, location and composition of the calculus 912 of these patients (224 of whom underwent percutaneous nephrolithotomy and 688 of whom underwent extracorporeal shock wave lithotripsy) were reviewed. Size proved to be the only significant factor in the success and complication rates of extracorporeal shock wave lithotripsy but it did not affect the outcome of percutaneous nephrolithotomy. The roles of these 2 modalities were then examined with respect to the treatment of complex renal calculi. We reviewed 376 patients with complex renal calculi, including 40 percutaneous nephrolithotomy patients from the initial 912 patients studied. The initial therapy in 100 of these patients, treated consecutively, was extracorporeal shock wave lithotripsy. The remaining 276 patients were treated by percutaneous nephrolithotomy. The success rate of extracorporeal shock wave lithotripsy monotherapy in the treatment of complex renal calculi was 36%. The success rate of primary percutaneous nephrolithotomy was 83%. We conclude that percutaneous nephrolithotomy should be the primary therapy for patients with complex renal calculi. Extracorporeal shock wave lithotripsy is the preferred treatment for patients with smaller calculi and as an adjunct to percutaneous nephrolithotomy.

Combined Modality Therapy↗
PubMed1976

Urethral calculi.

The diagnosis and management of 34 men and 13 women with urethral calculi are reviewed. A majority of patients presented with dysuria, weak stream and perineal pain. Diagnosis was made radiographically in only 42 per cent but was confirmed in all patients who underwent cystourethroscopy. All patients had lower urinary tract lesions or previous prostatic operations and 47 per cent were infected. Migrant urethral calculi were encountered 10 times more often than were native stones and a metabolic cause was found in 10 of 18 patients studied. In men penile urethral calculi were removed transurethrally and all bulbous and most posterior urethral stones were guided endoscopically into the bladder. Most of these stones were irrigated out or removed by transurethral litholapaxy; the remaining few, together with vesical calculi, required cystolithotomy. In all 13 women calculi were removed at the time of urethral diverticulectomy. A majority of 17 men (76.5 per cent) and the 4 women who were followed for an average of 5.3 years have remained free of trouble.

Cystoscopy↗
PubMed1995

Paraureteral calculi caused by ureteroscopic perforation.

OBJECTIVES: Ureteroscopy has become an effective and safe procedure for treatment of ureteral calculi. Formation of strictures are considered long-term complications with a low incidence. This report focuses on the incidence of strictures in cases of calculi pushed or flushed retroperitoneally alongside the ureter because of iatrogenic ureteral perforation. METHODS: Fifteen consecutive patients with paraureteral calculi caused by ureteroscopic perforation were observed. An excretory urogram was performed after a mean of 22.5 months, with a range of 9 to 54 months. In all patients, a stent was placed for 3 to 41 days (mean, 13.5 days) and antibiotics were administered between 3 and 5 days postoperatively. RESULTS: Only 1 patient of 15 with a short stricture of the distal ureter was observed. The stricture was successfully treated by endoscopic ureterotomy, balloon dilation, and transient placement of a ureteral stent. CONCLUSIONS: Paraureteral calculi caused by ureteral perforation are a minor complication of ureteroscopy, which rarely lead to formation of strictures. Removal of paraureteral calculi by enhanced endoscopic procedures or open surgery is not required.

Adult↗
PubMed1997

Soft-tissue "rim" sign in the diagnosis of ureteral calculi with use of unenhanced helical CT.

PURPOSE: To determine the value of the ureteric soft-tissue "rim" sign for differentiation of ureteral calculi from phleboliths on unenhanced helical computed tomographic (CT) scans and to identify factors that are associated with the presence of the rim sign. MATERIALS AND METHODS: Of 442 patients with ureteral obstruction confirmed at CT, 200 had documented ureteral stone disease; 136 of these patients had ureteral calculi, excluding the ureterovesical or ureteropelvic junctions. Each calculus and phlebolith along the course of the ureter were evaluated retrospectively and blindly for the presence of the rim sign, stone location, and stone size; the duration of symptoms was documented when available. RESULTS: The rim sign was present in 105 of 136 ureteral calculi (77%) and in 20 of 259 phleboliths (8%) and yielded a sensitivity of 77% and a specificity of 92% for distinguishing a calculus from a phlebolith. Calculi associated with the rim sign had a mean size of 4.3 mm, and calculi without a rim sign had a mean size of 6.3 mm (P < .001). There was no difference in duration of symptoms among patients who did or did not exhibit a rim sign. CONCLUSION: In patients with flank pain, the presence of a rim sign is a strong indicator that a calcification along the course of the ureter is a stone. Absence of the rim sign indicates that a calcification remains indeterminate.

Calculi↗
PubMed1998

Unenhanced helical CT criteria to differentiate distal ureteral calculi from pelvic phleboliths.

PURPOSE: To identify imaging features at unenhanced helical computed tomography (CT) that help differentiate distal ureteral calculi from pelvic phleboliths. MATERIALS AND METHODS: Retrospective analysis was performed of 184 pelvic calcifications identified at unenhanced helical CT in 113 patients. The size, shape, and attenuation of each calcification were recorded in addition to the presence of a central lucency and the appearance of the adjacent soft tissues. With profile analysis, a graphic representation was generated of attenuation in each pixel along a line drawn through each calcification. RESULTS: Geometric configuration was seen in eight (21%) calculi but not in any phleboliths. Differences were significant (P < .0001) between the mean attenuation of calculi and that of phleboliths. Among phleboliths, none had a mean attenuation greater than 278 HU, 13 (9%) had a visible central lucency, 31 (21%) had a bifid peak at profile analysis, 30 (21%) had the "comet sign" (adjacent eccentric, tapering soft-tissue mass corresponding to the noncalcified portion of a pelvic vein), and three (2%) had the soft-tissue rim sign (edema of the ureteral wall). Among calculi, none had a central lucency, bifid peak, or comet sign, but 29 (76%) had the soft-tissue rim sign. CONCLUSION: Analysis of pelvic calcifications at unenhanced helical CT can help differentiate calculi from phleboliths.

Calculi↗
PubMed1988

Results in the use of extracorporeal piezoelectric lithotripsy (EPL) for treatment of urinary calculi.

The Piezolith 2200 as an extracorporeal shock wave lithotripter uses piezoelectrically generated, high-energy sonic impulses for treatment of urinary calculi; the shock wave generator is self-focussing. Localization of concrements is performed by means of ultrasound imaging. Treatment with the Piezolith 2200 is painless for the patient and thus possible without anesthesia and analgesia. We report on 806 cases of treatment involving a total of 572 kidneys in 567 patients (561 adults, 6 children) suffering from calculi of various sizes in the renal pelvis (n = 126), calculi in the calyces (n = 384), partial (n = 24) or full (n = 19) staghorn calculi, as well as calculi in the upper part of the ureter (n = 19). In 88% of these cases the concrements could be removed completely. Since cardiac activity is not influenced by piezoelectrically generated high-energy impulses, this procedure is particularly suited to the treatment of patients with heart problems.

Adult↗
PubMed1986

Effect of pH on the microhardness of renal calculi.

The effects of synthetic urine environments of pH 4, 6, and 9.5 on the microhardness of renal calculi have been investigated. Tests were made, using both Vickers and Knoop indenters, on three compositions of calculi: 100% calcium oxalate monohydrate (whewellite), 100% uric acid, and 98% magnesium ammonium phosphate hexahydrate (struvite) mixed with 2% carbonate apatite. Whewellite calculi hardness was lowered, relative to (dry) values by 45-55% when saturated with a solution of pH 9.5. Exposure to lower pH conditions was not as effective in lowering hardness in this case. Struvite calculi hardness was lowered by 41-52% compared to the dry hardness and uric acid calculi hardness decreased by 25-36%, compared to dry hardnesses. For uric acid stones the reduction in hardness did not depend on pH within the range of pH values investigated. For struvite stones, acid pH conditions appear to give an increased softening, compared to other pH values.

Biomechanical Phenomena↗
PubMed1995

Sex- and age-related composition of 10 617 calculi analyzed by infrared spectroscopy.

A series of 10 617 calculi were analyzed by stereomicroscopy and infrared spectroscopy. This first study of French calculi was compared with large series in the literature. That the frequency of pure calculi was the lowest ever observed can be related to the methodology routinely used in our laboratory, which includes microsampling. We described more than 70 components among the 10 617 calculi. The overall sex ratio male to female patients was high (2.27) and increased over the period 1981-1993. Calcium oxalate was the most frequent component (86.48%), followed by calcium phosphate (79.75%) and purines (18.64%). We found a low occurrence of "infection" stones. The sex ratio was related to stone composition and differed according to the main component. For instance, calcium oxalate dihydrate (COD) was more frequent in men than in women, with a sex ratio of 4.97 versus 2.57 for calcium oxalate monohydrate (COM). On the contrary, calcium phosphate was more frequent in female patients (sex ratio 0.72 versus overall ratio). The high frequency of COD calculi (23.17%) suggests that hypercalciuria is particularly frequent in French patients susceptible to stone formation. For each main component, a specific profile was observed in relation to the sex and age of the patients with stones.

Adult↗
PubMed1985

Bacteriological study of renal calculi.

The pre-operative urine, pelvic urine, removed calculi and calculus washings were examined bacteriologically in 24 patients undergoing removal of intrarenal calculi. Four of seven patients with struvite calculi had an infected pre-operative midstream urine specimen and six of the seven removed calculi demonstrated significant bacterial growth. Proteus mirabilis was the commonest organism isolated. Of 17 patients with oxalate calculi only one had an infected pre-operative urine culture, but in four cases the removed stones were infected. Quantitative bacteriological culture of the stones and their washings demonstrated that infection is within the stone itself. Pre-operative urine culture failed to predict infection within the stone in 60% of patients with infected stones. The results suggest that the presence of infected urine together with the presence of renal calculus is indication for removal of the calculus.

Adult↗
PubMed1989

Endoscopic treatment of urinary tract calculi.

Removal of urinary tract calculi by endourological techniques is now widely practised and has reduced the indications for open surgical removal to a minority of cases. A review of 270 consecutive patients who presented to the Meath Hospital Urology department with urinary tract calculi and were treated by percutaneous or transurethral endoscopy is herein reported. The rates of successful clearance of renal (95%) and ureteric (78%) calculi compare well with previous reports. The majority of complications were minor and a low overall complication rate was experienced at ureterorenoscopy. In our experience, endourological treatment of urinary tract calculi is successful, efficient and safe and is the recommended approach to urinary tract calculi that require surgical intervention.

Adult↗
PubMed2006

Outcomes of urethral calculi patients in an endemic region and an undiagnosed primary fossa navicularis calculus.

Urethral calculus is a rare form of urolithiasis with an incidence lower than 0.3%. We determined the outcomes of 15 patients with urethral stone, of which 8 were pediatric, including an undiagnosed primary fossa navicularis calculus. Fifteen consecutive male patients, of whom eight were children, with urethral calculi were assessed between 2000 and 2005 with a mean of 19 months' follow-up. All stones were fusiform in shape and solitary. Acute urinary retention, interrupted or weak stream, pain (penile, urethral, perineal) and gross hematuria were the main presenting symptoms in 7 (46.7%), 4 (26.7%), 3 (20%) and 1 (6.6%) patient, respectively. Six of them had accompanying urethral pathologies such as stenosis (primary or with hypospadias) and diverticulum. Two patients were associated with upper urinary tract calculi but none of them secondary to bladder calculi. A 50-year-old patient with a primary urethral stone disease had urethral meatal stenosis accompanied by lifelong lower urinary tract symptoms. Unlike the past reports, urethral stones secondary to bladder calculi were decreasing, especially in the pediatric population. However, the pediatric patients in their first decade are still under risk secondary to the upper urinary tract calculi or the primary ones.

Acute Disease↗