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PubMed1995

Ultrastructural immunodetection of osteopontin and osteocalcin as major matrix components of renal calculi.

The organic matrix of renal calculi has long been considered to influence the crystal growth that occurs in these pathological mineral deposits. Recent advances in characterizing individual organic moieties from mineralized tissues in general and the combined use of antibodies raised against these molecules with different immunocytochemical approaches have allowed their precise distribution to be visualized in a variety of normal and pathological mineralized tissues. The present ultrastructural study reports on the epithelial expression and extracellular localization of several noncollagenous proteins in rat and human kidney stones using high-resolution colloidal-gold immunocytochemistry. To this end, we have examined in an ethylene glycol-induced calcium oxalate model of urolithiasis in the rat, and in human kidney stones, the distribution of certain noncollagenous and plasma proteins known to accumulate in bone and other mineralized tissues that include osteopontin, osteocalcin, bone sialoprotein, albumin, and alpha 2HS-glycoprotein. Of these proteins, osteopontin (uropontin) and osteocalcin (or osteocalcin-related gene/protein) were prominent constituents of the calcium oxalate-associated crystal "ghosts" found in the nuclei, lamellae, and striations of the organic matrix of lumenal renal calculi in the rat and of small crystal ghosts found within epithelial cells. Immunocytochemical labeling for both proteins of the content of secretory granules in tubular epithelial cells from treated rats, together with labeling of a similarly textured organic material in the tubular lumen, provides evidence for cosecretion of osteopontin and osteocalcin by epithelial cells, their transit through the urinary filtrate, and ultimately their incorporation into growing renal calculi. In normal rat kidney, osteopontin was localized to the Golgi apparatus of thin loop of Henle cells. In human calcium oxalate monohydrate stones, osteopontin was similarly detected in the lamellae and striations of the organic matrix. Based on these data, it is proposed that during urolithiasis, secretion of osteopontin (uropontin) and osteocalcin (or osteocalcin-related gene/protein), and the subsequent incorporation of these proteins into kidney stone matrix, may influence the nucleation, growth processes, aggregation, and/or tubular adhesion of renal calculi in mammalian kidneys.

Animals↗
PubMed1990

Follow-up of patients treated for urinary bladder calculi.

Fifty patients were followed-up for an average of 3 years after treatment for urinary bladder calculi. In 10 of these (20%) altogether 20 metabolic or endocrine diagnoses were revealed at follow-up: hypercalcaemia, 8; hyperuricosaemia, 4; high parathormone, 3; hyperuricosuria, 2; hypercalciuria, 2: hyperoxaluria, 1. About half of the patients also had other diagnoses, dominated by outflow obstruction at the prostatic level, followed by neurogenic bladder disorder. Fifteen had developed new bladder calculi. Urography revealed upper tract calculi in 12 patients, but 11 of these were free from metabolic disorder. Significant bacteriuria was common (24%). Our conclusion is that a follow-up is to be recommended after treatment of bladder calculi. It should include cystoscopy and screening for endocrine/metabolic disorders.

Adolescent↗
PubMed2004

Laparoscopically guided transperitoneal percutaneous nephrolithotomy for calculi in pelvic ectopic kidneys.

Although percutaneous nephrolithotomy is a well-established endourological modality for the management of calculi in the normally placed kidney, it is not easy to apply in the management of calculi in pelvic ectopic kidneys. We report the cases of three patients who were found to have large calculi in pelvic ectopic kidneys and subsequently underwent laparoscopically guided transperitoneal percutaneous nephrolithotomy, all with successful outcome. In all patients, complete stone clearance was achieved in a single operation with no intraoperative or postoperative morbidity. They remain asymptomatic and recurrence-free at a follow-up ranging from 2 to 38 months. Laparoscopic guidance allows the transperitoneal route to be used safely for percutaneous nephrolithotomy in patients with calculi in pelvic ectopic kidneys. We believe it to be a feasible, safe, and valid minimally invasive management option for this uncommon but challenging urological condition.

Abdominal Pain↗
PubMed2005

Ultrasound guided lithotripsy of salivary calculi using an electromagnetic lithotriptor.

Sialolithiasis is a common disease of the major salivary glands. A supplement to the traditional therapies is extracorporeal shock wave lithotripsy of the calculus. This method has been adopted from the therapy of renal or bladder calculi. Patients with a solitary calculus of parotid or submandibular gland were treated with a specially designed lithotriptor. In a retrospective study the results of this therapy were analysed. The success rate was far better for parotid gland calculi than for submandibular calculi. We could not find better results than those published in literature with other devices. In our therapeutic concept, sialolithotripsy is the therapy of first choice for single parotid gland calculi. For submandibular gland calculus this method is advisable in selected cases only.

Electromagnetic Phenomena↗
PubMed1986

Ultrasound and the diagnosis of renal and ureteral calculi.

We retrospectively compared ultrasound examination with plain film radiography of the abdomen (KUB) in the diagnosis of renal and ureteral calculi in 13 patients. Overall, ultrasound was more sensitive than KUB (84% versus 54%) in detecting calculi. However, KUB was superior for the diagnosis of ureteral stones. No calculi were detected by intravenous urography that were not first seen on either ultrasound or KUB. Our experience suggests that the combination of ultrasound and KUB is less invasive and more sensitive than intravenous urography for the diagnosis of calculi in patients with symptoms and signs suggestive of stone disease or who are at high risk for stone formation.

Adolescent↗
PubMed1999

Strategies for managing upper tract calculi in young children.

PURPOSE: Pediatric urolithiasis is relatively uncommon and there is little information on the application of modern surgical procedures in young children. We present a single center experience with the surgical management of upper tract calculi in this age group. MATERIALS AND METHODS: We reviewed presentation, co-morbidity, treatment, outcome and complications in all prepubertal patients who required surgical treatment for ureteral or renal calculi during a 4-year period. The series consists of 24 girls and 17 boys 17 months to 14 years old (mean age 7.5 years). A total of 26 children were anatomically normal, and 4 had myelomeningocele, 4 had ureteropelvic junction obstruction (in a pelvic kidney in 1), 2 had cloacal anomalies, 2 had vesicoureteral reflux, and 1 each had nonrefluxing megaureter, orthotopic ureterocele and a functioning renal transplant. RESULTS: Extracorporeal shock wave lithotripsy was performed in 24 patients. Stents or nephrostomy tubes were only used in the 4 patients who presented with pyonephrosis. Of the 41 cases 17 were rendered stone-free, 3 had a decreased stone burden and 4 were failures. Ureteroscopic extraction of distal ureteral calculi was successful in 11 of 12 children, of whom the youngest was 2.5 years old. No child had postoperative infection or evidence of ureteral obstruction. Stent placement facilitated stone passage or dissolution in 2 patients, a renal calculus was percutaneously extracted in 2 and 7 required open surgery, mostly for correcting simultaneous anatomical abnormalities or after minimally invasive surgery failed. Some metabolic abnormality was detected in 80% of the children tested. CONCLUSIONS: The surgical management of upper urinary tract calculi in young children parallels that in adults. Minimally invasive surgical methods may be safely used even in young infants. Most children do not need elective stenting before lithotripsy. Open procedures are still required in 17% of cases. The majority of children have definable metabolic abnormalities.

Adolescent↗
PubMed1989

Management of simultaneous renal and ureteral calculi: combined extracorporeal shock wave lithotripsy and ureteroscopy under a single anesthetic.

Simultaneously occurring renal and ureteral calculi were treated in 28 renal units combining extracorporeal shock wave lithotripsy and ureteroscopy during a single anesthetic session. Distributions of ureteral calculi removed or attempted to be removed by ureteroscopy were upper third in 3, middle third in 4 and lower third in 21. If ureteroscopy was successful a ureteral stent was placed and extracorporeal shock wave lithotripsy was applied to more proximal renal and upper ureteral calculi. Of 28 renal units 25 (89%) were rendered free of stones or had passable calculi of less than 3 mm. in diameter after a single combined treatment. This combined approach appears to be safe, effective and efficient.

Anesthesia↗
PubMed2001

Routine placement of ureteral stents is unnecessary after ureteroscopy for urinary calculi.

OBJECTIVES: To report a matched comparison of patients with and without stenting after ureteroscopy for calculi, including middle or proximal ureteral and renal calculi. The elimination of routine stenting after ureteroscopy would prevent stent pain, minimize the need for re-instrumentation, and reduce costs-as long as efficacy and safety are not diminished. METHODS: Of 318 patients who underwent ureteroscopy, 81 (25%) did not have a ureteral stent placed. Of those, 51 were suitable for analysis and included patients with distal ureteral (n = 22), middle or proximal ureteral (n = 11), and renal calculi (n = 18). This cohort was matched to a stented group by stone size and location. RESULTS: The preoperative characteristics of the groups were similar. A stone-free rate of 86% and 94% was achieved in the stented and nonstented groups, respectively (P = 0.32). Complications in the nonstented group were less frequent (flank pain in 3 and postoperative nausea in 1) than in the stented group (hospital visits for flank pain in 12, persistent nausea and vomiting in 1, sepsis in 1, perinephric hematoma in 1, and urinary retention in 1) (total of 4 versus 16, P = 0.025). CONCLUSIONS: Ureteroscopy for distal ureteral stones without ureteral stent placement has been previously described. Our experience expands to include the elimination of stent placement after ureteroscopy for middle or proximal ureteral (22%) and renal (35%) calculi. Our data suggest that after ureteroscopies with short operative times and minimal ureteral trauma, ureteral stents may not be necessary, even if proximal ureteral or renal ureteroscopy has been performed.

Follow-Up Studies↗
PubMed2000

The role of the plain radiograph and renal tract ultrasound in the management of children with renal tract calculi.

AIMS: The aim of this retrospective study was to assess the relative efficacy of plain abdominal radiographs and detailed renal tract ultrasound (US) examination in the diagnosis and follow-up of children with renal tract calculi. METHODS: The records and imaging studies of 28 paediatric patients who had presented with proven renal tract calculi over a period of 5 years were examined. RESULTS: In 23 (82%) patients, US was the first investigation. All these patients also had plain radiographs. Plain radiographs were the first investigation in five (18%) patients. All renal calculi (100%) visible on plain films were demonstrated on US. Furthermore, detailed US often provided other clinically significant findings that were not apparent on plain films. CONCLUSION: As a result of this study it is recommend that detailed US should be the investigation of choice in children with suspected renal tract calculi.

Adolescent↗
PubMed2002

Expanding role of ureteroscopy and laser lithotripsy for treatment of proximal ureteral and intrarenal calculi.

PURPOSE OF REVIEW: Ureteroscopy has assumed an expanded and important role in the treatment of proximal ureteral and intrarenal calculi with the development of new endoscopes, more effective grasping devices, and the holmium laser lithotriptor. RECENT FINDINGS: The success rate for treating proximal ureteral stones with small rigid and flexible ureteroscopes and the holmium laser is well over 90%. Lower pole renal calculi can also be treated with a success rate of approximately 80%, which surpasses that of shock wave lithotripsy. Selected stones that are over 2 cm in diameter, along with branched stones, can also be treated successfully with ureteroscopy. SUMMARY: Ureteroscopy is the most successful technique for the treatment of ureteral calculi (success rates >90%) and is an optional treatment for many renal calculi.

Humans↗
PubMed1990

[Extracorporeal lithotripsy of kidney and ureteral calculi after open operations].

Experience is recorded with the application of stroke-wave extracorporeal lithotripsy of calculi which have remained after open-technique operations for coral-shaped calculosis. Fifteen patients, 11 women and 4 men at mean age 43 years have been treated for the period 1.01.1989 through 7.02.1990. They all had nephrostoma placed by operation. Extracorporeal lithotripsy (ECL) was performed mean 14 days after the operation. The mean length of stay in hospital was 23 days. All patients were calculi-free 3 months after ECL. It is recommended to place nephrostoma when the kidney has not been fully freed from calculi during operation, to allow further performance of ECL. This helps to achieve quicker and complete removal of calculi from the urinary tract, which in turn contributes to successful of the urinary infection.

Adult↗
PubMed1990

[Rigid ureteroscopy and the pulsed laser. Apropos of 325 treated calculi].

A pulsed dye laser (Candela) was used in our lithiasis treatment center during the period 02/88-09/89 to remove 325 calculi in 278 patients, requiring 285 endoscopic instrumentations. The pulsed laser allowed to obtain fragmentation of 318 calculi, 238 of which were reduced to thin sand and 80 to coarser fragments. The latter were either cleared using a Dormia probe or further disintegrated by electrohydrolytic shock wave treatment or extracorporeal shock wave lithotripsy (ESWL). No complication imputable to laser stone fragmentation was noted. Failure of stone clearance was chiefly due to the nature and shape of the stone (black, smooth monohydrated calcium oxalate calculi). The thinness of the laser fiber has made it possible to use small caliber ureteroscopes, thereby increasing the reliability of ureteroscopy. Coupled with ESWL (EDAP LT01), this technique has caused the rate of open surgical removal of ureter confined calculi to fall from 11% to 1%.

Adolescent↗
PubMed1990

[Extracorporeal shock wave treatment of urinary calculi. Results after treatment of the first 207 patients at the Copenhagen City Stone Center with a second generation lithotriptor].

Early experience of extracorporeal shock wave lithotripsy (ESWL) using a second generation lithotriptor (Siemens Lithostar) is reported. Two hundred and seven patients underwent 272 treatments for 291 stones. There were 259 renal calculi, including three staghorn calculi and 32 ureteric calculi. Treatments were performed under local analgesia (78%) or epidural or general anaesthesia (22%) when invasive procedures had to be done in connection with the treatment. Stone fragmentation was achieved with 2,487 +/- 1,262 shocks. The first month stone clearance rate was 43%, 24% had fragments less than 6 mm and 33% had residual stones. The same figures after three and six months were 57%, 23% and 20% and 71%, 23% and 6%, respectively. Septicaemia occurred in four patients and cardiac arrhythmia in 24 patients (12%); no serious intra- or perirenal heamatomas were registered. In 7% additional procedures were required, seven patients had residual stones removed at an open operation. The Lithostar is an effective second generation lithotriptor which can be used for renal, staghorn and ureteric calculi in situ in all three segments without stone manipulation prior to ESWL.

Adolescent↗
PubMed1989

[Treatment of reno-ureteral calculi using ESWL and endourologic technics].

In recent years, there has been a complete change in the treatment of reno-ureteral lithiasis due to the availability of new endourological techniques (percutaneous nephrolithotomy, ureteroscopy) and particularly due to the development of extracorporeal shock wave lithotripsy (ESWL). The present study assessed the combination of endourological procedures and ESWL in the treatment of calculi localized in the kidney and lumbar ureter. A prospective study was undertaken to assess 1,500 renal units with calculi in the renal cavity and lumbar ureter that had been submitted to treatment by ESWL and endourological techniques. The results demonstrate that ESWL combined with percutaneous and endoscopic techniques affords effective treatment without major complications in 85.4% of calculi in the renal cavity and lumbar ureter. Treatment with ESWL as monotherapy was successful in 45.6% of the cases and endourological management prior to ESWL was successful in 39.8% of the cases. The most common complication of ESWL was colic and/or kidney referred discomfort (28.6%) and the most important complication was urinary tract obstruction following ESWL (9.67%). These required maneuvers to remove post-ESWL obstruction in 6.1% of the renal units treated. The number of shock waves employed and the kV utilized were associated to intense hematuria and perirenal hematoma. The combination of endourological techniques with extracorporeal shock wave lithotripsy completely eliminated calculi in 80.5% of the renal units at 3 months. 10.5% had remaining stone fragments that could be spontaneously passed, and 7.6% had larger residual fragments that could not be passed.

Adolescent↗
PubMed1989

[Treatment of distal ureteral calculi with extracorporeal shockwave lithotripsy: experiences with 310 cases].

Distal ureteral calculi are approached by ureterorenoscopy by most authors. With increasing experience ESWL of distal ureteral calculi gained in importance. The success rate of 96.2% in a large series of 310 consecutive patients treated in this manner, confirmed the results of other authors. Excluding women of child-bearing age and very large calculi (greater than 2 cm) the ESWL is a suitable treatment modality of distal ureteral calculi.

Adolescent↗
PubMed1988

[Electrohydraulic lithotripsy of upper urinary tract calculi].

Electrohydraulic lithotripsy (EHL) was employed for the treatment of 35 patients with upper urinary tract calculi. The stones in 14 patients with renal and upper ureteral calculi were disintegrated by a 9Fr probe and the rigid nephroscope. Twelve patients with upper or middle ureteral calculi were treated using a 5Fr probe and the fiberscope. The stones in 9 patients with lower ureteral calculi were removed by a 5Fr probe and the rigid ureteroscope. Although small residual stones were observed in 15 patients (43%), all the stones were fragmented satisfactorily except in two patients. The complications due to EHL were observed in eight patients (23%). The most frequent complication was the ureteral injury which was observed in 6 patients. In 2 of these patients the stone migrated out from the ureter. However, all the cases of ureteral injury were healed by the conservative therapy such as by indwelling the stent catheter without ureteral stricture.

Adult↗
PubMed1988

[Recurrence of upper urinary tract calculi].

Treatment of upper urinary tract stones has changed greatly. The recurrence of calculi after the discharge was studied in the 634 patients with urolithiasis admitted to our department during the 9 years up to the end of 1984. The recurrence rate in the 325 cases followed for more than 3 months after the disappearance of the original stones, was 15.6% after 2 years, 27.6% after 5 year and 51.4% after 8 years. In recurrent stone formers, the rate of recurrence thereafter was greater than that of primary stone formers. The growth of calculi was rapid in the renal stone former concomitant with urinary tract infection together with a past history of renal surgery. In relation to the composition of the stone, uric acid calculi tended to recur more often than calculi composed of other substances. In view of recurrence, pyelolithotomy is preferred to renal parenchymal incision.

Adolescent↗
PubMed1986

[Results of the percutaneous extraction of calculi of the kidney and ureter. Apropos of 124 cases].

In a series of 118 patients treated by percutaneous nephrolithotomy over a period of 18 months, 12 had staghorn calculi and 4 only one kidney. Punctures were made into the inferior calyx in 94% of cases. Two-plane control was by two brilliance amplifiers. The calculus had to be fragmented before removal in 53 patients. The nephrostomy catheter was left in situ for 3 days, 5 patients requiring a second operation. Results showed successful removal of calculi in 90% of cases, failure of puncture in 1.6%, the impossibility of removing calculi in 3.2% and the presence of residual calculi in 5.6%. Perforated colons in two patients healed spontaneously, two cases of secondary hemorrhage were treated by embolization and there was one death (a patient in a debilitated condition). Increasing experience in the use of the method and a more selective choice of patients should dramatically reduce the incidence of complications.

Adult↗