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PubMed2006

Effects of extracorporeal shock wave lithotripsy treatment on transient evoked otoacoustic emissions in patients with urinary lithiasis.

OBJECTIVE: The aim of this prospective study was to investigate the effects of electrohydraulic extracorporeal shock wave lithotripsy (ESWL) on the transient evoked otoacoustic emissions (TEOAEs) of the patients on whom ESWL was applied for urinary stones. METHODS: The study group consisted of 10 patients (7 male, 3 female) with unilateral urinary lithiasis on whom ESWL was applied in one course and 20 of their ears. The control group was chosen from patients who attended the Otolaryngology and Urology departments. Ten patients (7 male, 3 female) without urinary stones and ear problems and 20 of their ears constituted the control group. Only patients with normal hearing levels were included in the study. TEOAEs were recorded before the ESWL application (B-ESWL), on the first day (A-ESWL-1), and on day 15 (A-ESWL-15). RESULTS: At B-ESWL, the mean stimulus for the control group was significantly higher than that of the study group. Three kilohertz percentage values were significantly decreased on A-ESWL-1. The difference between A-ESWL-1 and A-ESWL-15 and between B-ESWL and A-ESWL-15 of the study group at 3.0 kHz% was not significant. CONCLUSION: It was thought that the reason for only temporary damage at 3.0 kHz was a result of the resonance effect of the external auditory canal. It was concluded that no damage on the other frequencies was due to protective earheadings and short exposure time to the noise. Since all of our patients had protective earheadings on both ears during the ESWL procedure, they may have been protected from any permanent damage of the inner ear and hairy cells of the cochlea.

Adult↗
PubMed1977

Regional hypothermia in renal surgery for severe lithiasis.

An active approach to severe renal lithiasis is advocated, though operative procedures often require interruption of the blood supply. Te evaluate the effect of ischemia on the kidney the literature has been searched and we have reached the following conclusions. A warm ischemic time of more than 20 minutes causes a brief and transitory reduction in renal function. If ischemia exceeds 30-40 minutes many kidneys will not regain their previous function. If the kidney's temperature is lowered to about 15 degrees C, ischemia can be tolerated for up to 12 hours. A priori these time limits applicable to normal kidneys are to broad for use in diseased kidneys. Cooling of the kidney can be achieved by either perfusion-cooling or by external parenchymatous cooling. We describe a method using the latter system for stone removal in 14 patients with staghorn calculi or multiple stones. Preoperatively 9 patients (64%) had persistent urinary tract infection, whereas infection persisted in only 2 patients following the operation (14%). Complete stone removal was achieved in 13 patients (93%). Renal function evaluated by creatinine clearance and renography generally improved following operation. There were no deaths, but in 9 patients severe complications were seen (transient oliguria and septicemia). At follow-up investigation 1.5 years after operation renewed stone formation was found in 1 patient, while the incidence of urinary tract infection had increased to 3 patients (21%). It is concluded that extensive surgery for stone removal with the use of external parenchymatous cooling is worthwhile and promising in patients with staghorn calculi or multiple stones in the kidneys.

Adult↗
PubMed1984

The surgical treatment of mixed phosphatic renal lithiasis. Long-term follow-up.

Of a total of 36 patients operated on for mixed phosphatic renal lithiasis without renal cooling, 26 were re-examined after a mean postoperative interval of 51 1/2 months. Pelvic and calyceal stones had been present in 17 of these patients and staghorn stones in 9. All the patients had presented with persistent urinary tract infection. The total of kidneys operated on was 41. Examination 1 to 3 months after the operation showed complete stone clearance in 85% of these kidneys nd freedom for urinary tract infection in 78% of the patients. At long-term follow-up 73% of the patients had no urinary tract infection. The follow-up investigation suggest that tiny fragments of stone may be left in difficult operations, since such fragments do not necessarily lead to formation of new stones and are not necessarily accompanied by persistent urinary tract infection.

Adult↗
PubMed2005

Predictors of common bile duct lithiasis in laparoscopic era.

AIM: To analyze retrospectively the records of 294 consecutive patients operated upon for gallbladder stones, to determine the predictive factors of synchronous common bile duct (CBD) stones and validate prospectively the generated model. METHODS: The prognostic estimation of a biochemical test and ultrasonography alone to differentiate between the absence and presence of choledocholithiasis was assessed using receiver operating characteristics curve analysis. Multivariate analysis was employed using discriminant analysis for establishment of a best model. Prospective validation of the model was made. RESULTS: Discriminant forward stepwise analysis disclosed that high values (> or = 2 x normal) of SGOT, ALP, conjugated bilirubin and CBD diameter on ultrasound > or = 10 mm were all prognostic factors of CBD lithiasis in univariate and multivariate analysis, P< 0.01. History was not included in the model. Prospective validation of the model was performed by multivariate analysis using Visual General Stepwise Regression. Positive predictive value, when considering all these predictors, was 93.3%, while the negative predictive value was 88.8%. Sensitivity of the model was 96.5% and specificity 80%. CONCLUSION: The above model can be objectively applied to predict the presence of CBD stones.

Adult↗
PubMed2005

[Multiple enterolithiasis, coexisting with bladder and gallbladder lithiasis, associated with colon adenocarcinoma].

Enteroliths are calculi primarily formed in the intestine. Enterolithiasis is a rare condition frequently associated with intestinal stasis. Usually it causes no symptoms in most cases, but it can be an important diagnostic clue in patients presenting intestinal occlusive symptoms. We report a case of multiple enterolithiasis, very infrequent pathology, coexisting with bladder and gall bladder lithiasis in a patient with colon adenocarcinoma. Diagnosis was made by X-rays and CT images. Calculi were analysed by several methods: chemical, infrared spectroscopy, stereoscopic microscopy and atomic emission spectroscopy; they showed that caluli are made up of organic material and whilokita (calcium and magnesium ortophosphate). No risk factors for lithogenesis were found in this patient excluding the intestinal stasis caused by intestinal narrowing as a result of adenocarcinoma. Genetic factors are suggested as main contributors to hyperlithogenesis observed in this patient. The physiopathological conditions were studied in depth and literature about this subject reviewed.

Abdominal Pain↗
PubMed1990

[Clinical study on recurrence of urinary tract lithiasis of ESWL].

During the 4 year period from September 1, 1984 through August 31, 1988, a total of 1,866 patients with calculi of the urinary tract (125 patients had bilateral calculi) were subjected to extracorporeal shock wave lithotripsy (ESWL) with a DORNIER HM3 ESWL apparatus. Follow-up was performed factor 1,056 cases 3 or more months after complete elimination of the calculi, and data were obtained for 343 of them. Lithiasis was found to have recurred after ESWL in 30 cases, with a recurrence rate of 11.1%. Recurrence was seen in 16.9% of cases with multiple calculi and 6.5% of cases with a single calculus. The difference was statistically significant. Surgical removed of calculi or spontaneous discharge of calculi had been experienced in 50.0% of the recurrent cases and 27.8% of the non recurrent cases. The difference was also statistically significant. Stone size, stone location and urinary tract infection were unrelated to the recurrence.

Adult↗
PubMed2002

[A pediatric case of ammonium acid urate lithiasis with ulcerative colitis].

A 13-year-old boy with ulcerative colitis was admitted to our hospital for the purpose of controlling diarrhea. He had received total colectomy and had been managed by intravenous hyper alimentation because of severe diarrhea (10 times/day). Oral intake had been prohibited except for fluid. Abdominal CT scan incidentally revealed two small calculi in the left kidney, which were left untreated. Two months later, one of them descended and was impacted into the urethra. Transurethral cystolitholapaxy showed the stone composition to be pure ammonium acid urate. Although ammonium acid urate lithiasis is rare in Japan, it should be reminded as a complication of chronic diarrhea secondary to inflammatory bowel disease in children.

Adolescent↗
PubMed1998

Unusual case of Munchausen's syndrome: factitious vesical lithiasis.

We report an uncommon case of a 38-year-old woman who admitted for bladder lithiasis undergoing repeated surgical management and being apparently recurrent. The intravenous pyelography and retrograde urethrocystography clear the urinary tract. Biologic evaluation eliminates any metabolic or endocrine cause. The confirmation of a factitious origin is given by fluorescence X analysis of the extracted stones which conclude to calcium carbonate structure and psychiatric care. The self-intromission of these calculi into the bladder is due to the personality disorder being in the frame of Munchausen's syndrome. Two years later, no recurrence is noted and an excellent psychiatric care is achieved.

Adult↗
PubMed1999

[The treatment of ureteral lithiasis with a pulsed dye laser].

PURPOSE: Pulsed dye laser lithotripsy has shown to be an effective and safe procedure for treatment of ureteral calculi. We report our experience. MATERIAL AND METHODS: A total of 1000 patients were treated with pulsed dye laser between January 1990 and February 1996. In 450 patients the procedure was performed under general or regional anaesthesia; the remaining 550 patients were treated with the aid of a mild sedation. RESULTS: In the mild sedation group a total of 417 out of 550 patients (75.8%) had their calculi completely cleared (85.6% of effectiveness in women with pelvic lithiasis). Different facts caused the treatment to fail in the remaining patients: severe pain, vagal reaction and technical difficulties. In the anesthesia group the procedure was effective in 346 cases (76.9%). Laser failed to clear calculi in 104 patients in this group due to technical impossibility and persistence of ureteral fragments. Additional treatment options in order to achieve resolution of the calculi were: ESWL, both ESWL and laser, Dormia basket, Zeiss stent, three-prong grasping forceps, ureterolithotomy and nephrectomy. Morbidity was higher in the group treated under anesthesia, being haematuria the most frequent adverse effect. CONCLUSIONS: We believe that ureteroscopy and laser lithotripsy is an effective, safe and low morbidity procedure for the treatment of ureteral calculi in women with distal calculi. It is often suitable to perform it with mild sedation with the subsequent benefit for both the patient and health care system regarding to cost-effectiveness balance.

Adolescent↗
PubMed1976

[Anatomo-surgical aspects of peroperative cholangiography in biliary lithiasis].

Biliary anomalies and volumetric changes in the ductal system often make it difficult to identify individual structures during the course of operations for biliary lithiasis. The Authors reviewed 406 peroperative cholangiographies during the course of 1250 operations, evidencing some statistical data regarding the anomalies of greatest interest for surgical practice and stressing the significance and limits of dilation of the V.B.P. On the basis of their personal experience and the relevant literature the Authors conclude that peroperative cholangiography constitutes a useful method not only for diagnostic purposes, but also for correct definition of certain aspects of the extrahepatic biliary ducts.

Cholangiography↗
PubMed1999

[ESWL-resistant lithiasis].

INTRODUCTION: To the extent in which the "lithotripter" improves technically. SWEL experts provide different explanations to the failures of this technique. It will depend on the type of "lithotripter" as well as the calculus and its features (size, number, location, composition, obstruction, impact, absence of expansion chamber, presence of ureteral catheter, ...). Not all facts in SWEL have a clear explanation today. Physically, the "cavitation" phenomena (shock, rebound, negative pressure, explosion, heat, ...) explain almost anything that takes place during SWEL. Certainly, the type of lithotripter has some influence, but the calculus fragility, determined by the chemical composition and the crystalline architecture, could be more determinant. MATERIAL AND METHOD: From a total series of 6,500 SWEL procedures performed in the Lithiasis-Lithotrity Unit at the "Jiménez Díaz" Foundation (JD) (January 1991-July 1998), 20 cases considered as failures after multiple SWELs were analyzed. Also the actual diagnostic tests (X-rays, helicoid CAT, densitometry, ...) were studied to establish a pre-SWEL chemical recognition of the calculi that may determine the behaviour of each case prior to treatment. RESULTS: After multiple SWELs (average 5 sessions) negative results were obtained in 65% cases. These cases were resolved with surgery (38%), ureterorenoscopy and ultrasound lithotrity (23%) or watchful wait in absence of signs and symptoms (39%). 57% were calcium phosphate calculi, 29% calcium oxalate monohydrate (COM) and 14% hypercalciuria calculi. CONCLUSIONS: SWEL resistant cases, either unresolved or undergoing multiple SWELs, demonstrate the existence of calculi that cannot be broken by SWEL, although no coincident or similar reasons can be established in all cases. Calcium phosphate dihydrate (brushite) and calcium oxalate monohydrate (COM) together with cystine are the most difficult to destroy with current shockwaves. Helicoid CAT could recognise chemically each case prior to SWEL, since it basically differentiates the most frequent ones, uric acid, struvite and calcium oxalate.

Adult↗
PubMed1999

[The historical setting of cystine lithiasis].

W. H. Wollaston, who first described cystine stones, as well as the most outstanding contemporary figures and their contribution to the understanding of this uncommon type of lithiasis are described.

Cystine↗
PubMed1999

[Urinary lithiasis: between metabolism and dietetics].

Prevalence and incidence of urinary lithiasis are increasing in western countries. Oxalocalcic stone is the major form of urinary calculi but other forms are not unusual. Caracteristics of the collected stone may improve the diagnosis investigations. Rationnal blood and urine examinations are essential for this medical managment. Most of the various metabolic abnormalities in cause can be corrected from specific dietary measures.

Calcium↗
PubMedDate not supplied

Phytate (IP6) is a powerful agent for preventing calcifications in biological fluids: usefulness in renal lithiasis treatment.

The extraordinary capacity of phytate (myo-inositol hexaphosphate), a substance present in blood, urine, interstitial and intracellular fluids, to inhibit crystallization of calcium salts (oxalate and phosphate) is discussed. Its role in preventing calcium renal stone formation is specifically presented and discussed. "In vitro" and "in vivo" experiments, as well as clinical studies clearly demonstrated that phytate plays an important role as a crystallization inhibitor of calcium salts in biological fluids and becomes a clear alternative in the treatment of calcium oxalate renal lithiasis.

Animals↗
PubMed1999

[Surgery of bladder lithiasis in the 19th century].

In the nineteenth century, in France, the vesical lithiasis, that as almost vanished today, was frequent. In the middle of the century, the ancient methods of surgical exeresis, by perineotomy or abdominal cystotomy, left one place to a new technique, the removal of the calculus by the natural ways: the lithotrity.

Adolescent↗
PubMed1999

Primary intrahepatic lithiasis: report of a case treated by laparoscopic bilioenteric anastomosis.

Recent advances in videolaparoscopic surgery have made this method the treatment of choice for many biliary diseases. However, it has not been used in certain cases, such as primary intrahepatic lithiasis. The authors report a case of a 62-year-old woman with a history of several episodes of cholangitis. Investigation revealed dilated intra- and extrahepatic bile ducts with intrahepatic stones. The patient underwent laparoscopy, and intraoperative cholangiography disclosed an enlarged common duct with absence of stones and the presence of multiple calculi in the intrahepatic biliary tree. A choledochotomy followed by choledochoscopy was performed, which revealed several intrahepatic pigmented stones that were completely retrieved, followed by a laterolateral choledochoduodenostomy to decompress the biliary tree and to allow the migration of residual or recurrent stones. The patient had an uneventful recovery and was discharged on the fourth postoperative day. After 15 months of follow-up the patient is asymptomatic with normal results of liver function tests. Late postoperative upper digestive endoscopy showed a patent choledochoduodenostomy.

Bile Ducts, Intrahepatic↗
PubMed2000

[Iatrogenic bladder lithiasis in the Burch technique. An infrequent complication].

OBJECTIVE: To describe an uncommon case of iatrogenic bladder lithiasis in a female patient who underwent colposuspension according to the Burch technique. METHODS/RESULTS: A female patient who had undergone colposuspension for urinary stress incontinence presented with irritative bladder symptoms and dyspareunia two years later. Patient evaluation revealed stone formation on the nonresorbable suture. Stone removal was achieved endoscopically using local anesthesia and without compromising continence. CONCLUSION: Removal of the calculus that had formed on the suture was achieved by endoscopy without compromising continence.

Female↗
PubMedDate not supplied

Lithotripsy in the treatment of urinary lithiasis.

Based on an extensive review of the literature and on our own clinical experience, this article attempts to present clear guidelines for the management of various kidney stones, particularly regarding the extracorporeal shock waves lithotripsy (ESWL) treatment nowadays. Few technical developments have changed medicine more within a short period of time than ESWL. Fifteen years after the first clinical application, ESWL has gained world-wide acceptance as first choice therapy for most forms of urolithiasis. Ninety-eight per cent of stones can be successfully fragmented by the application of shock-waves, but the ability of the kidney and ureter to clear the resulting fragments is far more important in terms of successful treatment outcome. Increasing experience with new ultrasound-guided lithotriptors has shown that there are some advantages: cost reduction, permanent monitoring and lack of exposure to ionising radiations. ESWL is a safe procedure for the treatment of urolithiasis; nevertheless some problems remain. In ureteric stones, ureteroscopy (rigid or flexible device) allows a rate of stone-free patients better than ESWL. For treatment of large staghorn calculi combined approach of PCNL and ESWL is preferred. For stones located at lower calyx, the stone-free rate in patients treated by ESWL fell to 50%, when unfavourable anatomy is present. The potential long-term renal damage, associated with ESWL in children, have delayed the acceptance of shock-waves into paediatric practice. Recent reports suggest that the renal damage, including the potential risk of hypertension induced by ESWL, is mild and transient. A subgroup of patients (e.g. solitary kidney, impaired renal function, children) required further attention. The fate of residual fragments is unclear. In some cases residual lithiasis tend to result in regrowth and further progression, although ESWL itself does not increase the recurrence rate of urolithiasis. Nevertheless follow-up of stone patients after ESWL is mandatory and the ultimate goal of treating stones by whatever means is to get the patient stone-free and prevent recurrence.

Humans↗