Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Calculi”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 415 records · Page 23Linked to original sources
PubMed1985

[Peroperative ultrasonics in excision of renal and ureteral calculi by the surgical approach. Apropos of 30 cases].

Ultrasound imaging was conducted in 30 patients during operation for removal of renal and ureteral stones, in most cases after contact radiography with small sterile films, and in all cases before opening the renal pelvis to avoid penetration of an air bubble into the intrarenal excretory tract. Each bubble may, because of its weak acoustic impedance, provoke total reflection of the waves simulating the image of a stone. Ultrasound provides data on cortical projection of calculi, the thickness of the parenchyma and the echoless avascular zones. All complex calculi (from Staghorn to caliceal types) should be investigated by ultrasound since it allows economy of time and reduced risks of excision of calculi. All stones greater than 1 mm give a hyperechogenic image with a cone shadow, the only differential diagnoses being air bubbles and intraparenchymatous calcification. Nonrecognition of calculi 1 mm in diameter is acceptable insofar as this type of caliceal or pyelic calculus may be excreted spontaneously. Ultrasound imaging during operation provides marked economy in time, of particular value during nephrotomy with pedicle clamping. Time is saved as a result of the three-dimensional detection of stones. Results in 30 cases showed a sensitivity of 97% for the method with excellent specificity, with only one false negative (residual microlithiasis) and one false positive (air bubble).

Humans↗
PubMed1985

Extracorporeal shockwave lithotripsy, endourology and open surgery: the management and follow-up of 200 patients with urinary calculi.

The management and follow up of 200 consecutive patients with renal and ureteric calculi are presented. The primary treatment of 185 (92.5%) was by extracorporeal shockwave lithotripsy (ESWL), of whom three (1.6)%) with large calculi underwent percutaneous nephrolithotripsy (PCNL) prior to ESWL as a planned combined procedure. Twelve (6%) were treated by PCNL or ureterorenoscopy (URS) as their definitive treatment and three (1.5%) by conventional open renal and ureteric surgery. The average in-patient stay was 3.8 days and most returned to normal activity within one day of discharge. Of the 185 patients 102 (55%) required no analgesia after treatment by ESWL, 29 (15.6%) required parenteral analgesia and the rest were comfortable with oral non-narcotic medication. Thirty (16%) required auxillary treatment by percutaneous nephrostomy (PCN), PCNL and URS following ESWL for obstructive complications from stone particles. Two required further ESWL and one PCNL at three months for large fragments. Overall, open surgery was required for only 1% of renal calculi and 13% of ureteric stones. These results are consistant with the extensive West German experience confirming that most urinary calculi are now best managed by ESWL and endoscopic techniques. Where these facilities are available open surgery should only be necessary for less than 5% of upper urinary tract stones.

Adolescent↗
PubMed1996

Intracorporeal electrohydraulic lithotripsy of ureteral and renal calculi using small caliber (1.9F) electrohydraulic lithotripsy probes.

PURPOSE: The development of 1.9F or smaller electrohydraulic lithotripsy probes has facilitated the use of this form of lithotripsy via miniature rigid and flexible ureteroscopes. We report our experience with ureteroscopic intracorporeal lithotripsy using 1.9F electrohydraulic lithotripsy probes. MATERIALS AND METHODS: A total of 45 patients (32 ureteral and 57 renal calculi) underwent retrograde rigid (microscopic to 6F short) or flexible (7.5 and 9.4F) ureteroscopy with electrohydraulic lithotripsy using 1.9F electrohydraulic lithotripsy probes. In 17 patients (38%) there were 37 lower pole caliceal calculi (41%). Stone size ranged from 3 to 30 mm. (mean 8.5). RESULTS: Electrohydraulic lithotripsy resulted in successful fragmentation (that is 2 mm. or smaller fragments) in 98% of patients overall. It was successful after failure of HM-3 extracorporeal shock wave lithotripsy in 10 patients and after failed lithotripsy with the 140 mJ. tunable dye laser in 7. Electrohydraulic lithotripsy resulted in successful fragmentation of 94% of lower pole caliceal stones. No intraoperative complications and no significant ureteral or renal mucosal damage were noted. Fever developed postoperatively in 2 patients (4.4%) with negative urine cultures. Postoperatively an indwelling stent was placed for 2 weeks or less in 71% of patients and no stents were placed due to preoperative stenting in 29%. Average hospital stay was 0.8 days (range 0 to 4). Followup imaging in 38 patients (84%) at a mean of 8.7 months (range 2 to 28) revealed stone-free rates of 92% overall and 87% in patients with lower pole renal calculi. No patient had a ureteral or infundibular stricture postoperatively. CONCLUSIONS: The development of 1.9F or smaller electrohydraulic lithotripsy probes provides the urologist with a safe, highly effective and inexpensive method for performing intracorporeal lithotripsy throughout the entire upper urinary tract via rigid or flexible ureteroscopes. Furthermore, for the ureteroscopic treatment of lower pole renal calculi electrohydraulic lithotripsy is the only form of intracorporeal lithotripsy sufficiently malleable to allow routine access.

Adolescent↗
PubMed1998

[Staghorn calculi of the kidney and ureter as a urologic complication ina child with cerebral palsy].

UNLABELLED: We present a child with cerebral palsy, treated for renal and ureteral staghorn calculi. Calculosis was associated with neurogenic voiding dysfunction. CASE REPORT: A 10 year boy was admitted to Pediatric Surgery Clinic in Poznań because of urolithiasis. In neurologic examination four-extremities spastic paresis and convergent strabismus was found. Intellectual contact with this child was very poor. Constant urine leakage from urethra was observed. In urine analysis pH < 7, leucocytes and erythrocytes, in urine culture Proteus vulgaris > 10(5). Ultrasonography revealed three staghorn calculi in right kidney. On the plain x-ray film three calculi in right kidney and two staghorn calculi in right ureter. In urodynamic evaluation in cystometry: low bladder compliance, no detrusor overactivity, no bladder sensation, "leak point" pressure 25-27 cm H2O. In profilometry incompetent urethral closure mechanism. All stones were evacuated during one operation. Postoperative course was uneventful. Risk factors in the treatment of patients with cerebral palsy are stressed. CONCLUSIONS: 1. Dysfunction of lower urinary tract is an important clinical problem in children with cerebral palsy. 2. Voiding dysfunction could be a risk factor in the development of urinary stones. 3. In the treatment of children with cerebral palsy multispecialistic team is needed.

Cerebral Palsy↗
PubMed1985

The risk of bladder calculi in patients with spinal cord injuries.

A nonconcurrent prospective study of bladder calculi included 500 persons treated at the University of Alabama in Birmingham Spinal Cord Injury Care System between 1973 and 1981. Risk factors suspected of contributing to the development of bladder calculi were identified. Logistic regression analysis was used to estimate each risk factor's adjusted odds ratio and to develop a predictive model for bladder stone formation. Bladder calculi were most likely to develop within one year of injury. Patients developing bladder calculi prior to first definitive discharge were most likely to be white and have neurologically complete lesions and Klebsiella infections at admission. Patients developing bladder stones within two years of hospital discharge were most likely to be young and white and have indwelling urethral catheters and either Proteus or multiple-organism infections at discharge. The predictive model was 82% sensitive and 83% specific when applied to a validation sample of patients.

Adult↗
PubMed1980

Radiological appearances of parotid duct calculi.

A total of 42 patients presenting with recurrent unilateral parotid gland swelling was studied. Plain radiology of 38 patients with proved calculi showed that the lateral view is valueless. The anteroposterior view was positive in 58 per cent, and when coupled with an intrabuccal view 71 per cent of the calculi were radio-opaque. The overwhelming majority of calculi were visible as filling defects on sialography, while in 4 patients an area of narrowing with dilatation of the parotid duct proximal to it represented the site of the calculus. In the remaining 4 patients with the latter sign, repeat sialography showed normal appearances in 2, suggesting that the calculi had passed.

Humans↗
PubMed2003

Extracorporeal shockwave lithotripsy in the management of salivary calculi.

BACKGROUND: The aim was to investigate the results of extracorporeal shockwave lithotripsy in the management of salivary calculi using a dedicated sialolithotriptor. METHODS: Some 122 salivary calculi (84 submandibular and 38 parotid) were treated in an experimental study using a sialolithotriptor. RESULTS: Complete success was achieved in 40 procedures (33 per cent), 27 of 84 submandibular and 13 of 38 parotid calculi. A further 43 patients (35 per cent) were rendered asymptomatic although some stone debris remained in the duct (26 submandibular and 17 parotid). Failure (retention of stone debris and continued symptoms) occurred in 39 patients (32 per cent), 30 submandibular and eight parotid glands. The chance of failure increased with the size of the calculus and increasing duration of symptoms. CONCLUSION: Extracorporeal shockwave lithotripsy provides a useful option for the management of salivary calculi, particularly for stones less than 7 mm in diameter.

Adolescent↗
PubMed2002

Fragmentation of uric acid calculi with the holmium: YAG laser produces cyanide.

BACKGROUND AND OBJECTIVES: To independently test previously reported findings of cyanide evolution under holmium:yttrium aluminum garnet (Ho:YAG) (holmium) lithotripsy of uric acid calculi, determine if this occurs with other forms of intracorporeal lithotripsy, and establish if this occurs due to a photothermal, photochemical, or photoacoustic reaction. STUDY DESIGN/MATERIALS AND METHODS: Human uric acid calculi were fragmented in vitro through exposure to holmium, ultrasound, and electrohydraulic (EHL) energy sources. The following parameters were varied: total laser energy, individual laser pulse energy, ultrasonic energies, and EHL energies. Uric acid powder was suspended in solution and exposed to holmium laser energy in vitro. Serum and irrigant samples from a human patient were collected following intrarenal holmium lithotripsy of a uric acid calculus. All samples were analyzed for hydrogen cyanide (HCN) content. RESULTS: Holmium lithotripsy of solid uric acid calculi produces cyanide. The yield is linearly dependent upon total laser energy delivered. Pulse energy does not affect cyanide yield. Photothermal mechanisms coupling laser energy to the solid crystal lattice are responsible for the production of cyanide. Ultrasound and EHL lithotripsy do not produce cyanide. A clinically insignificant level of cyanide was detected in the blood of a single patient following laser lithotripsy of a uric acid calculus. CONCLUSIONS: Our study confirms that cyanide is produced by a photothermal mechanism during holmium laser lithotripsy of uric acid calculi, and that the amount produced is clinically insignificant.

Holmium↗
PubMed2005

Transvaginal sonography in the assessment of distal ureteral calculi.

OBJECTIVES: To explore the morphological and functional findings of transvaginal sonography (TVS) in the diagnosis and management of distal ureteral calculi. METHODS: We retrospectively reviewed the imaging studies in seven cases of distal ureteral calculi (study group) and 20 cases of female volunteers without urinary tract infection (control group). All 27 patients had undergone TVS for assessment of the lower urinary tract. The variables measured on ultrasound included the presence or absence of distal ureteral calculi, the size and location of a calculus if present, the presence or absence of the ureter jet phenomenon, morphological changes of the ureteral papilla and adjoining tissue, and the height of the ureteral papilla, as well as vascular changes seen on Doppler imaging. RESULTS: In the controls, 80% of the ureteral papillae were triangular and 20% trapezoidal. The average (+/-SD) height of the ureteral papillae was 3.5 +/- 0.7 mm on the right and 3.6 +/- 0.9 mm on the left. There was no statistically significant difference between the heights of the right and left papillae (P = 0.619). In the study group, echogenic stones were identified in all seven patients and a hypoechogenic tubular structure connected to the involved papilla was identified in 6/7 patients. The average height of the involved papilla was 6.7 +/- 1.6 mm. Ureteric jets were visible in all patients in both the study and control groups. CONCLUSION: In patients with distal ureteral calculi, TVS provides a rapid, non-invasive and repeatable means of assessing the morphology and function of the distal ureter.

Adult↗
PubMed1998

Push and smash increases success rates in treatment of ureteric calculi by ESWL.

During a 3-year period 105 patients underwent attempted retrograde manipulation for ureteric calculi into the renal pelvis prior to extracorporeal shock wave lithotripsy (ESWL). The success rate of this group was compared to 93 patients receiving ESWL of ureteric calculi in situ. The method of retrograde manipulation was recorded prospectively. Retrograde flushing with a 5 F Tiemann ureteral catheter was performed after coating the proximal ureter and renal pelvis with a mixture of saline and lidocaine gel. Success rate of calculi push was 91.4%. Mean number of ESWL treatments in this group of patients was 1.4, compared to 2.1 in patients with in situ treatment. Reposition of ureteric calculi prior to ESWL treatment increases successful initial treatment and can be performed easily.

Anesthetics, Local↗
PubMed1993

A clinical prediction rule for the diagnosis of ureteral calculi in emergency departments.

OBJECTIVE: To determine: 1) whether a simple clinical prediction rule could identify emergency department patients with ureteral calculi; 2) whether the kidney, ureter, and bladder (KUB) radiograph provides diagnostic information beyond that obtained from the history and physical examination; and 3) whether ureteral calculi can be diagnosed accurately in the emergency department without emergency excretory urography, commonly known as intravenous pyelography (IVP). PATIENTS: Two hundred three patients who underwent emergency KUB and IVP studies for nontraumatic abdominal or flank pain (derivation group) were retrospectively identified from radiology department records; 72 patients were prospectively evaluated in the emergency department for suspected ureteral stones (validation group). MEASUREMENTS: Clinical information included age, gender, characteristics of pain, associated symptoms, presence of fever, history of ureteral calculi, whether a stone was passed, and results of urinalysis and KUB and IVP studies. All KUB and IVP radiographs were independently reviewed by a radiologist blinded to the patient's clinical information and urinalysis results. DESIGN: Stepwise linear discriminant analysis was used to derive a four-item prediction rule from the derivation group and the validation group; the areas under the receiver operating characteristic (ROC) curves and the misclassification rates were compared. RESULTS: The four-item rule (acute onset, flank pain, hematuria, and positive KUB radiograph) correctly classified 83% of patients in the derivation group and 90% in the validation group. The four-item rule had an ROC area of 0.86 in the derivation group and 0.89 in the validation group. The KUB radiograph significantly improved the discriminant ability of the two history items and the urinalysis result. Thirty-three percent of patients were identified to be in a subset with a 96% probability of having a stone. CONCLUSION: These findings, which should be confirmed in another emergency department, suggest that subsets of patients with suspected ureteral calculi may be managed without emergency IVP; this approach thereby reduces the time a patient spends in the emergency department, radiation exposure, expense, and morbidity.

Adolescent↗
PubMed2005

Dissolution of ureteral uric acid calculi with local litholytic irrigation.

This study was designed to evaluate the efficacy of local litholytic irrigation (LLI) in the treatment of ureteral uric acid calculi. Fourteen cases of ureteral uric acid calculi were diagnosed by abdominal plain radiography (KUB), retrograde urography, ultrasonography (B-mode ultrasound), spiral computerized tomography(CT) and blood biochemical examinations. A ureteral catheter was passed retrogradely across ureteral calculi by cystoscopy. LLI with tromethamine-E (THAM-E) was performed via the ureteral catheter after the improvement of renal function and general situation and the control of urinary tract infection under the condition of intravenous application of antibiotics. The irrigation rate varied from 1000 to 1500 ml per day. Retrograde pyelography demonstrated complete dissolution of all the stones, 13 cases within 10 days and 1 within 12 days. Mild hematuria was observed in the majority of the cases and temporary aggravated lumbago in 1 case, with no other side effects. It is concluded that LLI is a practical and effective method in the treatment of ureteral uric acid calculi for its advantages of shorter duration,lower cost, less physical suffering and no severe complications.

Adult↗
PubMed1979

Nonobstructing radiopaque ureteral calculi.

Twenty-two unilateral nonobstructing radiopaque ureteral calculi were found on excretory urography in 21 patients over a 6-year period. The calculi were frequently (12/22) not associated with pain at the time of urography. Of the 21 patients, 19 had intrarenal pelvis configuration which may limit the potential dilatation of the collecting system. Twelve calculi eventually passed spontaneously and two were removed surgically. Three remained in the ureter for prolonged periods (up to 18 months), still nonobstructing. The majority (13/22) of the calculi were in the distal third of the ureter.

Adult↗
PubMed2005

Determination of the chemical composition of urinary calculi by noncontrast spiral computerized tomography.

Various techniques for noncontrast spiral computerized tomography (NCCT) were utilized for the determination of the Hounsefield unit (HU) values of various types of urinary calculi with the aim of determining the best technique for distinguishing various stones compositions. A total of 130 urinary stones, obtained from patients who underwent open surgery, were scanned with a multidetector row scanner using 1.25 mm collimation at two energy levels of 100 and 120 kV at 240 mA. Two post-scanning protocols were used for the HU value assignment, tissue and bone windows, for both kV values. In both protocols, three transverse planes were defined in each stone, one near the top, one in the middle, and one near the bottom. Three regions of interest (ROI) were obtained in each plane. The absolute HU value was determined by three methods: the mean of the nine ROI, the mean of the central three ROI, and the central ROI in the middle plane. Determination of the stones' composition was performed using the absolute HU value measured at 120 kV, the dual CT values (HU values at 100 kV-HU values at 120 kV), and HU values/stone volume ratio (HU density). All stones were analyzed by x-ray diffraction to determine their chemical composition. After the exclusion of groups with few calculi, 47 pure stones [25 uric acid (UA), 15 calcium oxalate monohydrate (COM), seven struvite], and 60 mixed stones [15 COM 60-90%+hydroxyl apatite (HA), 14 COM 40-90%+UA, 21 UA+COM <40%, ten mixed struvite+COM+hydroxyl apatite] were included in the statistical analysis. From the least to the most dense, the pure stone types were UA, struvite, COM. Mixed UA+COM<40% calculi were less dense but insignificantly different from pure UA, while when the COM ratio was > or =40% their density became higher than and significantly different from pure UA, and less than but not significantly differentiated from pure COM. Mixed COM+HA were the most dense stones. Using the absolute HU values at 120 kV and HU density, we could distinguish, with statistical significance, all pure types from each other, pure UA from all mixed calculi except UA+COM <40%, pure COM from mixed UA+COM <40%, and pure struvite from all mixed stones except mixed struvite stones. Dual CT values were not as good as absolute HU values and HU density in the determination of stone composition. These results demonstrate that absolute HU values and HU density derived from CT scanning using a small collimation size could uncover statistically significant differences among all pure and most of the mixed urinary stones. This permits more accuracy in the prediction of stone composition. Moreover, this technique permits diagnostic conclusions on the basis of single CT evaluation.

Humans↗
PubMed2006

Treatment of calculi in kidneys with congenital anomalies: an assessment of the efficacy of lithotripsy.

We studied the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in the treatment of stones in kidneys with congenital anomalies to determine factors that may affect the results. Patients found to have renal calculi in kidneys with different types of congenital anomalies were treated using ESWL. All patients were investigated by intravenous urography (IVU) to confirm the diagnosis. J stents were inserted prior to therapy in renal units with calculi exceeding 1.5 cm in diameter. Complications encountered and factors affecting success using this treatment modality were analysed. Twenty-five patients (18 males, 7 females) were studied between August 1988 and July 2005. There were nine patients with horseshoe kidneys, eight with ectopic kidneys, three with malrotated kidneys, two with duplex renal system, and one patient each with polycystic kidneys and hypoplastic kidney. The IVU showed 31 isolated calyceal or renal pelvic stones with mean stone burden of 1.44cc. All 25 patients were treated by lithotripsy. Twenty-four (77.4%) renal units (in 19 patients) were completely cleared of stones, 2 (6.5%) renal units (2 patients) were partially cleared of calculi and the procedures failed in 5 (16.1%) renal units (4 patients). Out of five renal units in which the procedures failed, open surgery was performed in three renal units and percutaneous nephrolithotomy (PCNL) was performed in two. None of the 25 patients developed any major complications. No significant adverse changes in renal function tests were observed at 3-month follow-up. The stone-free rate was influenced and reduced by stone size and location in the pelvi-calyceal system. Calculi in kidneys with congenital anomalies may be treated successfully by ESWL as a first-line therapy in the majority of patients. With position modifications, localization of stones may be facilitated and disintegrated. The outcome in patients so treated does not differ significantly from that in those with normal kidneys.

Adolescent↗
PubMed2006

Deregulation of the p16-cyclin D1/cyclin-dependent kinase 4-retinoblastoma pathway involved in the rat bladder carcinogenesis induced by terephthalic acid-calculi.

Prolonged cell proliferation in response to irritation by calculi may itself evoke malignant transformation of the urothelium. However, the molecular mechanisms underlying this process are still unknown. The aim of the present study was to investigate cell cycle regulatory mechanisms in bladder carcinogenesis induced by bladder calculi. Six-week-old Wistar rats were consecutively fed a diet containing 5% terephthalic acid (TPA), 5% TPA plus 4% sodium bicarbonate (NaHCO(3)), 4% NaHCO(3), or basal diet for 48 weeks. Animals were killed at weeks 12, 24, and 48. Treatment with 5% TPA caused high incidences of bladder calculi, preneoplastic lesions, and neoplastic lesions. Immunohistochemical examination revealed overexpression of cyclin D1, cyclin-dependent kinase 4 (Cdk4), retinoblastoma (Rb), and proliferating cell nuclear antigen (PCNA) in bladder preneoplastic and neoplastic lesions. In contrast, p16 expression was reduced or absent. These results were confirmed by immunoblotting analysis. Quantitation of mRNA by real-time reverse transcription-polymerase chain reaction (RT-PCR) showed a significant increase in cyclin D1 and PCNA mRNA in tumor cells. None of the 16 transitional cell carcinomas (TCCs) had ras mutations as examined by PCR-single strand conformational polymorphism (PCR-SSCP) analysis. These results suggested that deregulation of p16-cyclin D1/Cdk4-Rb pathway, but not oncogenic activation of ras, plays a crucial role in bladder tumorigenesis induced by bladder calculi.

Animals↗
PubMed1998

Renal colic: comparison of spiral CT, US and IVU in the detection of ureteral calculi.

The aim of our study was to compare non-contrast spiral CT, US and intravenous urography (IVU) in the evaluation of patients with renal colic for the diagnosis of ureteral calculi. During a period of 17 months, 112 patients with renal colic were examined with spiral CT, US and IVU. Fifteen patients were lost to follow-up and excluded. The remaining 97 patients were defined to be either true positive or negative for ureterolithiasis based on the follow-up data. Sensitivity, specificity, positive and negative predictive value and accuracy of spiral CT, US and IVU were determined, and secondary signs of ureteral stones and other pathologies causing renal colic detected with these modalities were noted. Of 97 patients, 64 were confirmed to have ureteral calculi based on stone recovery or urological interventions. Thirty-three patients were proved not to have ureteral calculi based on failure to recover a stone and diagnoses unrelated to ureterolithiasis. Spiral CT was found to be the best modality for depicting ureteral stones with a sensitivity of 94 % and a specificity of 97 %. For US and IVU, these figures were 19, 97, 52, and 94 %, respectively. Spiral CT is superior to US and IVU in the demonstration of ureteral calculi in patients with renal colic, but because of its high cost, higher radiation dose and high workload, it should be reserved for cases where US and IVU do not show the cause of symptoms.

Adult↗
PubMed2006

Robotic extended pyelolithotomy for treatment of renal calculi: a feasibility study.

Percutaneous nephrolithotomy (PCNL) remains the treatment of choice for staghorn renal calculi. Many reports suggest that laparoscopy can be an alternative treatment for large renal stones. We wished to evaluate the role and feasibility of laparoscopic extended pyelolithotomy (REP) for treatment of staghorn calculi. Thirteen patients underwent REP for treatment of staghorn calculi over a 12-day period. Twelve patients had partial staghorn stones and one had a complete staghorn stone. All patients had pre-operative and post-operative imaging including KUB and computed tomography. All procedures were completed robotically without conversion to laparoscopy or open surgery. Mean operative time was 158 min and mean robotic console time was 108 min. Complete stone removal was accomplished in all patients except the one with a complete staghorn calculus. Estimated blood loss was 100 cc, and no patient required post-operative transfusion. REP is an effective treatment alternative to PCNL in some patients with staghorn calculi. However, patients with complete staghorn stones are not suitable candidates for this particular technique.

Adult↗