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PubMed1995

[Pulsed Neodimium-Yag laser in the management of ureteral calculi].

The authors report their experience with the laser smashing of 105 ureteral calculi between Sept. 1 1989 and Sept. 30 1992. Applying the pulsating Nd-Yag laser through an ureteroscope as a monotherapy, they have obtained good results in 83% of the cases. Using complementary methods in addition, the successful elimination of calculi was 95%. The possible complications are discussed and the advantages and disadvantages of the different energy sources used for smashing the calculi are compared. On the basis of their results, the authors consider that endoscopic treatment of ureteral calculi may be indicated even in the era of extracorporeal stonesmashing. They stress that endoscopic operations are only preferable compared to ESWL-treatment if all indispensable devices are available: energy sources and thin, flexible devices for energy conduction. Among them--literature confirms it--laser-energy is the most expedient and least invasive. Laser was first applied for smashing ureteral calculi in Hungary.

Aged↗
PubMed1993

[The treatment of staghorn calculi].

Between May 1989 and November 1991, 19 staghorn calculi were treated by extracorporeal shock-wave lithotripsy (ESWL) with a Dornier MFL 5000 or Northgate SD-3. The 19 calculi were evaluated. Treatment was with monotherapy by ESWL in 9, combination percutaneous nephrolithotomy (PNL)-ESWL in 9, and nephrostomy in 1. Of the patients, 14 had a cross stent catheter pre-ESWL treatment to improve fragment evacuation. Radiologic follow up in 19 kidneys revealed that 57.9% were stone free. We arbitrarily separated our cases into 3 groups: struvite renal calculi, calcium carbonate calculi and others. Result of stone-free rate was 100% for stones consisting of struvite, and 14. 3% for stones consisting of calcium carbonate. In our opinion, the best indication of monotherapy by ESWL is for staghorn calculi, which consists of struvite, without marked dilation of pelvis and calyces.

Adult↗
PubMed1995

Spontaneous resolution of retained renal calculi in USAF aviators.

USAF aviators may be granted medical waivers for continued flying duties when diagnosed as having retained renal calculi in parenchymal locations or in portions of the collecting system from which spontaneous passage is unlikely. The USAF Aircrew Medical Waiver File was reviewed in order to determine the proportion of USAF aviators with waivers for retained renal calculi whose calculi subsequently resolved. Of the 60 currently active aviators granted waivers between January 1976 and December 1990, 7 have had their retained calculi resolve following surgical intervention, and 13 (21.7%), 95% CI [11.2%, 32.1%], had "spontaneous" resolution of their retained calculi. Using the Armstrong Laboratory's Aeromedical Consultation Service clinical database, it was possible to determine how the diagnoses of retained stones were established and/or disestablished in 15 of the 60 aviators. Theories on stone formation and resolution, tools employed in diagnosis, and implications of these study findings on flight duties are discussed.

Aerospace Medicine↗
PubMedDate not supplied

Percutaneous ureterolitholapaxy: the best bet to clear large bulk impacted upper ureteral calculi.

OBJECTIVES: The outcome of treating impacted upper ureteral calculi by extra corporeal shock wave lithotripsy was less satisfactory than antegrade litholapaxy in our earlier experience. During a four year period (October 1988 to September 1992) 86 reno-ureteral units with impacted upper ureteral calculi were treated by percutaneous litholapaxy. We review our methods and results of this accumulated experience. METHODS: Moderate to severe proximal hydronephrosis on excretory urography or ultrasound was taken as evidence of impaction. Antegrade extraction was performed in a single stage, except in patients who presented with anuria, severe azotemia and urosepsis where the system was decompressed by initial nephrostomy drainage. RESULTS: 86 impacted upper ureteral calculi in 80 patients were treated by the percutaneous antegrade approach. Eleven were in a solitary functioning unit; 33% presented with moderate to severe renal failure. The average stone size was 256 sq mm. Associated renal calculous disease was present in 22 ipsilateral and 28 contralateral units. Total clearance was achieved in 74 units (86%) by antegrade litholapaxy alone. Adjunct ESWL (5) and ureteroscopy (4) rendered 96% of the units free; 3 units with recurrent calculi were salvaged by ESWL (2) and ureterolithotomy (1). Complications encountered in 17 (20%) patients were fewer in 13 (16%), ureteric perforation in 7 (9%), hematuria in 6 (7%) and ureteric stricture 1 (1%). Hospital stay was 5 days in uncomplicated cases; prolongation of stay (average 8.8 days) was necessitated in staged procedures (sepsis, renal failure), treatment of the contralateral unit or due to postoperative morbidity. The majority of the stones (80%) were of the calcium oxalate monohydrate variety. CONCLUSION: It is concluded that failing a retrograde manipulation, percutaneous ureterolitholapaxy offers the best bet to clear large bulk impacted upper ureteral calculi.

Adolescent↗
PubMed1996

Ureteroscopy with intravenous sedation for treatment of distal ureteral calculi: a safe and effective alternative to shock wave lithotripsy.

PURPOSE: We evaluated the safety, efficacy and patient tolerance of ureteroscopy with intravenous sedation for treatment of distal ureteral calculi. MATERIALS AND METHODS: Ureteroscopy with intravenous sedation was performed in 68 patients, with small distal ureteral calculi requiring treatment and in 2 with middle or upper third ureteral calculi. Intravenous sedation and analgesia were achieved with a combination of fentanyl and midazolam. Balloon dilation of the ureter was performed in 38 patients. Ureteroscopy was performed with a 6F rigid ureteroscope. RESULTS: Stone removal was successful in 66 patients (97%). There were no ureteral perforations in patients undergoing successful stone removal and no complications related to intravenous sedation. Tolerance of the procedure was good in 81% of the patients (including 72% of 36 men and 94% of 32 women undergoing ureteroscopy for distal ureteral calculi) and fair in 19%. CONCLUSIONS: In select patients with small distal ureteral calculi ureteroscopy offers a safe, effective and well tolerated alternative to shock wave lithotripsy.

Adult↗
PubMed1997

Use of intravenous contrast material during in situ extracorporeal shock wave lithotripsy of ureteral calculi.

PURPOSE: We prospectively studied the usefulness of contrast material to facilitate extracorporeal shock wave lithotripsy (ESWL) of ureteral calculi in situ. MATERIALS AND METHODS: Followup was available for 67 consecutive patients with ureteral calculi treated in situ (without ureteral catheterization) on an unmodified Dornier HM-3 lithotriptor. In 30 patients radiographic contrast material was administered to facilitate targeting of calculi. Intraoperative obstruction was determined by the lack of passage of contrast material beyond the calculus during treatment. Immediate postoperative obstruction was defined as prolonged retention of contrast material on a postoperative radiograph. RESULTS: Passage of contrast material beyond the calculus was not noted in 9 of 26 evaluable patients, 5 of whom appeared to have obstruction on postoperative radiography. Of these 5 patients 3 required immediate hospitalization for pain control, compared to none of those without intraoperative obstruction. The stone-free rates after ESWL, including success following adjunctive measures or repeat ESWL, were 83, 100 and 87% for calculi in the proximal, middle and distal ureter, respectively. Neither use of contrast material, nor intraoperative or postoperative obstruction altered the eventual success of ESWL. CONCLUSIONS: The administration of intravenous contrast material during ESWL allows for effective treatment of ureteral calculi that otherwise could not be imaged adequately without ureteral catheterization, and provides information valuable for short-term prognosis.

Contrast Media↗
PubMed1997

Long-term follow-up after primary extracorporeal shockwave lithotripsy monotherapy of staghorn calculi: results after more than 6 years.

OBJECTIVE: We retrospectively investigated 58 patients suffering from 60 staghorn calculi, who were treated with primary extracorporeal shockwave lithotripsy (ESWL) monotherapy, in order to determine long-term results and the fate of the residual stones. MATERIAL AND METHODS: Mean follow-up was 72.4 months. There were 49 partial staghorn calculi (C4) and 11 complete C5 stones according to Rocco's classification. The mean number of ESWL sessions needed for disintegration was 3.6. The mean amount of shockwaves was 10,244. ESWL monotherapy alone was performed in 26 staghorn calculi (43.3%). In treating the other 34 staghorn calculi 56 auxiliary procedures were necessary. RESULTS: At discharge 28.3% of the patients were free of stones. Fifty-five percent had small remnant particles (< 4 mm) and 16.7% had rest-fragments (> 4 mm). After a mean follow-up period of 72.4 months 36 patients were free of stones (60%). Twenty-four patients still have residual stones. The fragments in 2 patients did not change in size, in 14 patients fragments became bigger and 8 patients had a real recurrence (13.3%). CONCLUSIONS: Primary ESWL monotherapy of staghorn calculi is justified because of the comparable results with open surgery and percutaneous nephrolithotomy (PCNL). Prognostic good factors are small stone mass with most of the stone mass in the upper and middle calices, the absence of dilatation and the absence of anatomical anomalies.

Adult↗
PubMed1998

Surgical treatment of urate calculi in Dalmatians: 38 cases (1980-1995).

OBJECTIVE: To assess clinical signs and response to surgical treatment in Dalmatians with urate urolithiasis. DESIGN: Retrospective study. ANIMALS: 38 Dalmatians. PROCEDURE: Medical records from 1980 to 1995 of Dalmatians with urate urolithiasis were reviewed to obtain information on history, results of physical examination, hemogram, biochemical analysis, urinalysis, bacterial culture of urine, diagnostic imaging, analysis of calculi, treatment, and recurrence. RESULTS: 35 (92%) dogs were males. Mean age at admission was 4.9 years. Common clinical findings and initial complaints included dribbling of urine, stranguria, vomiting, tense abdomen with signs of pain, and a large bladder. Hematuria was found in 85% of dogs in which urinalysis was performed. Crystalluria was found in 54% of dogs. Bacteria were isolated from urine from 36% of dogs. Contrast radiography and abdominal ultrasonography were the most sensitive diagnostic tests for uroliths. Dogs that underwent scrotal urethrostomy and cystotomy had the fewest number of recurrent clinical signs that were attributable to urinary calculi. Clinical recurrence rate in dogs on a protein-restricted diet was 27%, compared with that (36%) for dogs on a commercial diet. CLINICAL IMPLICATIONS: Urate urolithiasis is more commonly recognized in male Dalmatians compared with females. Contrast radiography and ultrasonography appear to be the most useful techniques for detecting urate uroliths. Scrotal urethrostomy and cystotomy was the most effective surgical treatment for preventing recurrence of clinical signs associated with calculi. Complete removal of calculi and protein-restricted diets may have a beneficial effect in reducing recurrence of calculi.

Animals↗
PubMed1978

A relationship between the composition of the urine and that of urinary tract calculi in spinal patients.

Chemical analysis was carried out on 42 urinary phosphatic calculi obtained from 14 spinal cord patients (two to seven stones per patient) and on small samples taken from different sites in a further 17 large phosphatic calculi. In 'early' stones (removed up to 30 months after onset of the cord lesion) the ratio of calcium to magnesium was significantly higher than in 'late' stones. Samples taken from sites nearer to the centres of calculi contained more calcium and less magnesium than did those from more peripheral sites. This change in the composition of urinary calculi with time corresponds with the known alterations in urinary calcium and magnesium following spinal cord injury.

Calcium↗
PubMed1986

[Sonography of gallbladder calculi: possibilities and limits in the selection of gallstone patients suitable for conservative lysis].

The sonographic patterns of artificially produced pure cholesterol and pigment gallstones were evaluated in vitro. Cholesterol calculi exhibited a smooth echo with a relatively high beam penetration, whereas pigment calculi showed a sickle-like surface echo without beam penetration. Clinical evaluation of these criteria in 107 patients was based on correlating preoperative sonographic diagnosis with postoperative microchemical analysis of the calculi. Although small, smooth cholesterol calculi were detected via ultrasound with an accuracy of more than 90 percent, pigment calculi could not be separated and identified with satisfactory precision.

Adult↗
PubMed1984

Endoscopic sphincterotomy for common bile duct calculi.

A series of 74 patients having endoscopic sphincterotomy for common bile duct calculi is reported. Complete stone extraction was achieved in 53 cases (72%). Seventeen of 21 patients with retained calculi following recent biliary surgery had successful extractions (80%). Of 30 patients having had a cholecystectomy, 21 (70%) were successful, but only 15 of 23 patients with obstructive jaundice and no previous biliary surgery had the ducts cleared of calculi. Failure was due to multiple stones in the duct, or calculi too large to pass through the sphincterotomy. Endoscopic sphincterotomy is advocated in patients with obstructive jaundice due to stones, moving to early surgery should it prove unsuccessful. The results in patients with a T-tube in situ are comparable to extraction of the calculi along the T-tube tract.

Adult↗
PubMed2004

Percutaneous treatment of biliary stones: sphincteroplasty and occlusion balloon for the clearance of bile duct calculi.

OBJECTIVE: Our study describes the percutaneous expulsion of bile duct calculi into the duodenum by dilating the papilla with a balloon catheter. SUBJECTS AND METHODS. Patients (n = 212; 101 men and 111 women; mean age, 73 years; range, 31-95 years) had their calculi (single, 131; multiple, 81) percutaneously expelled into the duodenum in 73 patients via an indwelling T tube, and in 139 via transhepatic or transcystic duct route. Stone expulsion was facilitated with an occlusion balloon after balloon sphincteroplasty and with prior mechanical fragmentation in only 37 patients. After the expulsion of the calculi into the duodenum, drainage of the main bile duct to the exterior was maintained for 2-8 days. RESULTS: Technical success was initially 90.4%, increasing to 93% at the second attempt. There were 13 failures due to the large size of the calculi in nine patients, excessive tortuosity of the T tube (Kher tube) in one, and breaches of the established protocol in two. Residual lithiasis was resolved in 98.6% of cases, decreasing to 92% in the group of native, or nonresidual, lithiasis. There were 10 major complications (hemobilia) with three cases of poor clinical outcome: hepatic necrosis, multiorgan failure, or death. CONCLUSION: Percutaneous anterograde evacuation of bile duct stones with dilatation of the papilla using an angioplasty catheter and assisted with an occlusion balloon to expel the calculi is a cost-effective, nontraumatic, and safe procedure that retains the anatomic and functional integrity of the sphincter. It is a viable alternative procedure in the treatment of bile duct lithiasis.

Adult↗
PubMedDate not supplied

Rigid ureteroscopy for diagnosis and treatment of ureteral calculi during pregnancy.

OBJECTIVE: To evaluate ureteroscopy as a treatment option for women presenting ureteral calculi during pregnancy. MATERIALS AND METHODS: Eighteen pregnant patients presenting renal colic and indication of surgical treatment for ureteral calculi were analyzed. Patients were 20 to 34 years old (medium = 28), and the gestation period ranged from 12 to 34 weeks (medium = 18). Lumbar pain was present in 14 patients, and 4 had diffuse abdominal pain. Four patients were febrile in the occasion of the examination. Thirteen patients presented microscopic hematuria, 8 leucocituria, and 4 positive urine culture. The stone was detected by ultrasonography (US) in 12 patients. Magnetic resonance imaging (MRI) was performed in 2 cases, and did not demonstrate calculi. The stone location was: 1 in the superior ureter (pregnancy of 15 weeks), 4 in the medium ureter (pregnancy of 12, 15, 18 and 20 weeks), 12 in the inferior ureter, and 1 was not determined. The surgical indication was difficult pain control, fever, and presence of uterine contractions. RESULTS: Double-J insertion, as single treatment, was possible in 4 patients and it was kept in place for up to 2 weeks after delivery. Among the patients submitted to ureteroscopy, the calculi retrieval was always possible, except in 1 case where the calculus was not located by US, MRI or ureteroscopy. In 2 patients, the ultrasonic lithotriptor was used and in 11 the stone was removed intact with a basket. There were no complications due to the procedure and all pregnancies were carried to full term. CONCLUSION: Rigid ureteroscopy for extraction of ureteral calculi during pregnancy is efficient and safe.

Journal Article↗
PubMed2003

Drug-induced urinary calculi.

Urinary calculi may be induced by a number of medications used to treat a variety of conditions. These medications may lead to metabolic abnormalities that facilitate the formation of stones. Drugs that induce metabolic calculi include loop diuretics; carbonic anhydrase inhibitors; and laxatives, when abused. Correcting the metabolic abnormality may eliminate or dramatically attenuate stone activity. Urinary calculi can also be induced by medications when the drugs crystallize and become the primary component of the stones. In this case, urinary supersaturation of the agent may promote formation of the calculi. Drugs that induce calculi via this process include magnesium trisilicate; ciprofloxacin; sulfa medications; triamterene; indinavir; and ephedrine, alone or in combination with guaifenesin. When this situation occurs, discontinuation of the medication is usually necessary.

Journal Article↗
PubMed2006

Staghorn calculi in southern Thailand.

OBJECTIVE: To study the characteristics and components of staghorn calculi in southern Thailand. MATERIAL AND METHOD: 5,445 urolithiasis patients who underwent treatment in Songklanagarind Hospital between 1997 and 2000 were reviewed and 86 of them were included by the criteria of "complete staghorn" calculi. General data, laboratory data at presentation, and the component analysis was performed with infrared spectroscopy were analyzed. RESULTS: Forty-three men and 43 women were included in the present study, with a mean age of 55.5 years for men and 50.7 years for women. Uric acid was the most common component of staghorn calculi and 61.8% of the patients had hyperuricemia. Magnesium ammonium phosphate (MAP) was found in 11.6% of the calculi. A positive urine culture was found in 59.3% of the patients and the micro-organisms most frequently found were Corynebacterium sp and E. coli. CONCLUSION: There was a significant higher incidence of staghorn calculi in women in comparison with urolithiasis patients in southern Thailand, and the most common component was uric acid.

Adult↗
PubMedDate not supplied

[Comparison of the chemical composition of bile calculi in the gallbladder and in bile ducts].

After a brief survey of the literature and description of the methods of the study the results are presented of macroscopic, microscopic and chemical analysis of bile calculi obtained during operations from the gallbladder and bile ducts from patients with cholelithiasis. The results showed that cholesterol was the main component of the calculi and that age and sex had no effect on the chemical composition of the calculi: no significant differences were found in the composition of the gallbladder calculi as compared to the calculi from the bile ducts.

Adult↗
PubMedDate not supplied

Intrahepatic calculi: imaging by MR.

The magnetic resonance (MR) examinations of six patients with intrahepatic calculi were reviewed retrospectively to 1) determine the ability of MR to demonstrate intrahepatic calculi and 2) assess the MR appearance of the stones. In five out of six cases, MRI demonstrated intrahepatic calculi. In three cases, stones exhibited a low intensity signal on the different spin echo (SE) sequences, as previously described by in vitro and in vivo studies. However in two other cases, a significant signal with short T1 and relatively long T2 relaxation times was noticed. These different features are discussed in relation to chemical and physical differences in intrahepatic calculi and compared with variable CT attenuation values of stones. MRI seems to provide complementary information concerning intrahepatic calculi.

Adult↗
PubMed1996

[Non-surgical treatment of intrahepatic calculi].

It is obvious that the most favorable therapeutic results can be obtained by hepatic lobectomy in the patients with intrahepatic calculi. However the number of patients in which hepatic lobectomy can be indicated is limited because of localization of lesions and some others. Endoscopic stone-extraction technique is the only therapeutic tool available in those patients. In this paper, technical know-how of postoperative cholangioscopy (POCS) and percutaneous transhepatic cholangioscopy (PTCS) was introduced and their clinical significance for management of intrahepatic calculi were discussed. POC was safely carried out 3 weeks after surgery if the extra-ductal limb of T-tube, lager than 14 Fr size, in the common bile duct, was brought out through the abdominal wall as straight as possible to obviate a tortuous sinus tract. PTCS was carried out through the sinus tract dilated up to over 14 Fr size after percutaneous transhepatic biliary drainage. Advantages of these modalities are; 1) they can be safely and repeatedly carried out if the sinus tract is maintained open. 2) stones visible are readily removable with the use of basket forceps or stone-integrator under endoscopic guidance and 3) preoperative application of PTCS provides us the important informations necessary to decide an adequate surgical procedure by delineation of intrahepatic anatomy. For the period started from 1975 when we introduced the first model of cholangiofiberscope to the end of 1995, 134 cases with intrahepatic calculi have been encountered and stone extraction was successful in 119 cases, success rate being 88.8%. The prognosis of the patients in which stone-extraction was successful was generally good. Main causes of failure in 15 cases were attributable to difficult location of lesion to perform choplangioscopy and concomitant liver cirrhosis or pururent cholangitis. The 6 cases with concomitant liver cirrhosis and pururent cholangitis were passed away before stone-extraction was completed. Therefore it can be said that complete stone-extraction was POCS or PTCS is very important to obtain a better long term prognosis in the cases with intrahepatic calculi. The authors believe that therapeutic results of inrahepatic calculi will be improved with the use of POCS or PTCS.

Adult↗