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PubMed1987

[Primary sonographic diagnosis of pancreatic duct calculi: the non-uniform aspect].

Four cases of sonographically visualised intraductal pancreatic calculi are reported. In three of these cases the calculi had been caused by chronic pancreatitis, and in one case by carcinoma of the head of the pancreas. The calculi did not present a uniform sonographic pattern, especially as regards echogenicity. A dorsal echo extinction was observed in three cases only. The non-uniform sonographic aspect of intraductal pancreatic calculi can probably be ascribed to differences in the lime content.

Adult↗
PubMed1985

[Sonography in salivary calculi--indications and status].

In 23 patients with sialolithiasis the value of real time sonography was investigated. The calculi were correctly diagnosed in 91% of the patients. 3 of 4 calculi could be localized in the main duct of the salivary gland. Because of the high accuracy and the possibility to detect non opaque stones, sonography should be performed, if on plain film the localisation of the calculi is questionable, before sialography is done. In sonolithotrypsy, sonography can be used to document the extraglandular localisation of intraductal calculi.

Humans↗
PubMed1993

Lasertripsy of upper urinary tract calculi after unsuccessful extracorporeal lithotripsy or ureteroscopy: comparison with primary lasertripsy.

Lasertripsy of upper urinary tract calculi after unsuccessful extracorporeal lithotripsy (SWL) or ureteroscopy (Group 1; N = 26 patients, 36 calculi) was compared with primary lasertripsy (Group 2; N = 56 patients, 79 calculi). Access to calculi was achieved by a Candela miniscope or flexible ureteroscope, and laser fragmentation was performed with the Candela pulsed-dye laser. Laser alone or laser plus 1.9F basket extraction produced a stone-free rate of 80.6% in Group 1 and 79.8% in Group 2. Additional treatment methods were needed in similar proportions of both groups and in most patients consisted of SWL of fragments displaced into the kidney. The laser fragmentation failures rates were 2.8% in Group 1 and 7.6% in Group 2. One-month stone-free rates and major complication rates were similar in the two groups. Lasertripsy after unsuccessful SWL or ureteroscopy was as effective as primary lasertripsy.

Endoscopy↗
PubMed1996

Electrohydraulic lithotripsy of upper ureteral calculi with semirigid ureteroscope.

Forty-three patients with single ureteral calculi located above the pelvic brim were treated by electrohydraulic lithotripsy (EHL) using a semirigid mini-ureteroscope. Of the 43 calculi, 36 (84%) were fragmented in one procedure. Six calculi (14%) were pushed back to the renal pelvis and treated successfully by complementary extracorporeal shockwave lithotripsy (SWL). The total success rate of ureteroscopic manipulation thus was 98%. The operation time (mean 26.4 minutes) and postoperative hospital stay (mean 2.53 days) were relatively short. Complications were limited to four (9%) minor perforations of the ureter managed by internal stenting. Among these patients with complications, there were no significant ureteral strictures noted on excretory urography or ureteroscopic examination 1 to 3 months after ureterolithotripsy. The costs of ureteroscopy with EHL are lower than that of SWL or ureteroscopic lasertripsy. The total fees for ureteroscopy with EHL are about two thirds those for SWL in Taiwan. Despite the longer learning curve required for ureteroscopy, ureteroscopy associated with EHL is a cost-effective alternative for the treatment of upper ureteral calculi, especially when SWL is not readily available.

Adult↗
PubMed1996

In situ extracorporeal shockwave lithotripsy for ureteral calculi: investigation of factors influencing stone fragmentation and appropriate number of sessions for changing treatment modality.

To determine the factors influencing stone fragmentation and to suggest when to change treatment modality for ureteral calculi refractory to repetitive in situ extracorporeal shockwave lithotripsy (SWL), we analyzed 369 patients treated primarily by the second-generation lithotripter, Siemens Lithostar, from March 1989 to December 1993. Three hundred forty-two (92.7%) of the patients were ultimately free of stones after repetitive in situ SWL. The cumulative stone-free rates of the first, second, and third session were 64%, 81%, and 88%, respectively, and the increment in the cumulative stone-free rate thereafter with further repeated in situ SWL was minimal (p < 0.01). The cumulative stone-free rate at the third session was 89%, 87%, and 86% for proximal, middle, and lower ureteral stones, respectively (p > 0.05). The cumulative stone-free rate at the third session was 100%, 90%, 87%, 70%, 67%, and 50% for stones <5 mm, 6 to 10 mm, 11 to 15 mm, 16 to 20 mm, 21 to 25 mm, and >25 mm, respectively (p < 0.001). According to the radiopacity of the stone, the cumulative stone-free rate at the third session was 96% for stones with minimal opacity, 94% for those with moderate opacity, and 70% for highly opaque stones (p < 0.001). The cumulative stone-free rate at the second session was 100% without ureteral obstruction; 80% with mild, 57% with moderate, and 67% with severe obstruction; and 50% in patients with nonappearance of the kidney (p < 0.05). From these observations, it could be concluded that the factors influencing fragmentation were the size and radiopacity of the calculi and the degree of ureteral obstruction, whereas the location of the calculi did not influence the cumulative stone-free rate of repetitive in situ SWL. It is preferable to restrict in situ SWL to three sessions in patients with ureteral calculi refractory to shockwaves. An early change of treatment modality either to ureteroscopic manipulation or to open surgery would be recommended if there were risk factors as listed above.

Adult↗
PubMed1998

Paraureteral extrusion of calculi after endoscopic pulsed-dye laser lithotripsy.

Laser lithotripsy has become an effective and low-morbidity procedure for the treatment of ureteral calculi. Nevertheless, ureteral endoscopy is not free of side effects and complications. Lithiasis extrusion is one of the early complications of this procedure, and usually, the diagnosis is carried out by means of urographic findings because it is not easily recognized during ureteroscopy. Between January 1990 and May 1996, a total of 1047 endoscopic lithotripsies with the pulsed-dye laser were performed in our department. The 3-month stone-free rate as a single treatment was 76.5%. We found 11 cases (1.05%) of calculi extrusion after ureteral endoscopic treatment. Only one case was diagnosed intraoperatively. The evolution after a mean follow-up period of 18 months (range 6-34 months) was satisfactory in all cases. No urinary extravasation, infection, or secondary ureteral strictures were found. According to the absence of side effects, it was considered unnecessary to remove the extruded calculi. Extrusion of noninfected calculi into the periureteral tissues after laser lithotripsy causes no significant consequences and can be successfully managed conservatively. Knowledge of this possible complication is the best way to avoid it. A careful technique and a low irrigant flow will be very helpful.

Adult↗
PubMed2000

Treatment of urinary calculi with ureteroscopy and Swiss lithoclast pneumatic lithotripter: report of 150 cases.

PURPOSE: To present our clinic experience with the Swiss Lithoclast pneumatic lithotripter in the endoscopic management of urinary calculi. PATIENTS AND METHODS: From August 1994 to December 1997, 145 patients with ureteral calculi and 5 patients with urethral calculi were treated with the Swiss Lithoclast. RESULTS: In the ureteral stone group, ureteroscopic addressing of the stones was successful in 133 patients. In 27 patients, the stones were partially fragmented and remained in situ or were pushed back to the calices. They were subsequently treated successfully with SWL. Stones were fragmented in a single session in 101 cases. Complications associated with the procedure included five perforations and four urinary tract infections. All of the five urethral stone patients were treated successfully with pneumatic lithotripsy. The overall successful fragmentation rate thus was 70.7% (106 of 150) and 88.7% (133 of 150) in combination with adjuvant SWL. CONCLUSIONS: We have found Swiss Lithoclast pneumatic lithotripsy to be a safe, effective, and economical treatment method for urinary calculi. If combined with other modalities such as SWL, this treatment will be even more effective.

Adolescent↗
PubMedDate not supplied

Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries.

PURPOSE: To assess the safety and efficacy of antegrade percutaneous nephrolithotomy (PCNL) of large impacted proximal-ureteral calculi. PATIENTS AND METHODS: Between July 1998 and October 2003, a total of 66 patients (43 male and 23 female; mean age 37.5 years) underwent PCNL for impacted proximal-ureteral calculi. The inclusion criteria were calculi >15 mm that were densely impacted and located between the ureteropelvic junction and the lower border of the 4th lumbar vertebra. The mean drop in hemoglobin, operating time, analgesic requirement, and hospital stay were assessed. RESULTS: Sixty-five patients (98.5%) had complete calculus clearance in a single session through a single tract. The mean operating time and hospital stay were 47 minutes and 46 hours, respectively. The mean analgesic requirement was 65 mg of pethidine (meperidine). The mean follow-up was 14 months. There were no significant postoperative complications. CONCLUSION: Antegrade PCNL is a safe and effective option for large, impacted proximal-ureteral calculi.

Adult↗
PubMedDate not supplied

Laparoscopy-assisted transperitoneal percutaneous nephrolithotomy for renal caliceal diverticular calculi.

BACKGROUND AND PURPOSE: There are a variety of options for the management of symptomatic calculi in caliceal diverticula, each with utility in particular situations. Herein, we describe a laparoscopy-assisted transperitoneal percutaneous nephrolithotomy (PCNL) technique to address the unusual combination of an anterior caliceal diverticulum together with multiple branched calculi having segments both within and proximal to the diverticulum. TECHNIQUE: With the patient in a modified lithotomy position, standard transperitoneal laparoscopy was performed utilizing three 10-mm trocars. After mobilization of the colon medially, the cystic diverticulum was opened. An additional 12-mm trocar was placed to allow transperitoneal PCNL within the diverticulum. Rigid nephroscopy, holmium laser lithotripsy, and stone extraction were performed, including laser enlargement of the diverticular neck and removal of the stone burden proximal to the neck. A double-pigtail ureteral stent and Jackson-Pratt drain were placed. RESULTS: This procedure was successful in the only patient in whom it has been used to date. As far as we know, this is the first report of laparoscopy-assisted transperitoneal PCNL for the management of caliceal diverticular calculi. CONCLUSION: Laparoscopy-assisted transperitoneal PCNL is a safe and effective alternative for the management of symptomatic stones in anterior cystic caliceal diverticula with a narrow neck and complex branched calculi.

Diverticulum↗
PubMed2005

Percutaneous nephrolithotomy for complete staghorn calculi in preschool children.

BACKGROUND AND PURPOSE: To evaluate the safety and efficacy of percutaneous nephrolithotomy (PCNL) for the management of complete staghorn calculi in children <or=5 years old. PATIENTS AND METHODS: The charts of 19 preschool children (15 boys, 4 girls) aged 20 months to 5 years (mean 4.2 years) with complete staghorn calculi who underwent PCNL at our center over a 3-year period were reviewed. The mean stone burden was 972 mm2 (range 870-1210 mm2). All procedures were performed with the patient in the prone position after retrograde catheterization with a 5F ureteral catheter. Fluoroscopyguided punctures were made by the urologist followed by track dilation to 24F. A 19F sheathless nephroscope passed through an Amplatz sheath was used in all cases. Flexible nephroscopy was used as an adjunct where necessary. Postoperative stone clearance was documented by plain film or, for radiolucent calculi, ultrasonography. RESULTS: The majority of children (68%; N = 13) required two tracts, while five children (26%) required only one tract and one child required three. Complete clearance with PCNL monotherapy was achieved in 17 patients (89%), which increased to 94.7% with adjunctive shockwave lithotripsy. Stone analysis revealed struvite in 1, uric acid in 3, and calcium oxalate monohydrate in 15 patients. CONCLUSION: In preschool children, PCNL for complete staghorn calculi is a safe and effective method for maximal stone clearance.

Calcium↗
PubMed2006

Success in treating renal calculi with single-access, single-event percutaneous nephrolithotomy: is a routine "second look" necessary?

BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy (PCNL) is an effective procedure for the treatment of large renal calculi. An important consideration for patients undergoing PCNL is the management of any residual stone burden, which may include "second-look" nephroscopy. The utility of this practice is unproven, and we present our data on a series of patients in which second-look procedures were not performed. PATIENTS AND METHODS: We retrospectively reviewed the records of 43 consecutive patients undergoing a total of 45 procedures by a single surgeon at a tertiary-care center. Patients were considered stone free if no calculi were evident by either plain film or noncontrast CT scan. Statistical analysis was used to look for correlations between radiographic stone clearance and various patient and stone characteristics. RESULTS: Of these procedures, 15% had immediate postoperative evidence of residual fragments. At a mean follow-up of 8 months, 32.5% had residual or recurrent stone. There were statistically significant correlations between both patient age and stone size and the risk of recurrent or residual stone. CONCLUSIONS: In our study, PCNL was effective for the single-stage treatment of large renal calculi. Aggressive stone clearance obviated the need for routine second-look nephroscopy. Factors leading to an increased risk of residual or recurrent calculi included the presence of a staghorn calculus and younger patient age. The excellent stone-free rates achieved suggest that routine second-look nephroscopy may not be necessary for the majority of patients undergoing PCNL.

Adolescent↗
PubMed2000

A new type of artificial urinary calculi: in vitro study by spiral CT.

RATIONALE AND OBJECTIVES: Artificial urinary calculi similar to natural stones have long been sought in urologic research. In an experimental study, the authors assessed the CT characteristics of a new type of artificially produced urinary calculus [BON(N)-STONE]. METHODS: Six different types of urinary calculi (uric acid, struvite, cystine, calcium oxalate, brushite, and apatite) were produced by a coating technique in which several layers of a suspension of pure substance were applied around a core and dried. A total of 60 stones (10 per group) were studied by spiral CT at two energy levels (100 and 120 kV, 250 mA) with 1-mm slice thickness. RESULTS: All calculi showed a small hyperdense core surrounded by a homogeneous matrix and a slightly hyperdense outer rim. From the least to the most dense, the stone types were uric acid, struvite, cystine, calcium oxalate, brushite, and apatite. Absolute CT values at 100 and 120 kV could differentiate between all groups of stones at a significance level of P < 0.001 or better. Attenuation values were in a comparable range to reported values for natural stones, with the exception of uric acid and struvite, which were notably lower. CONCLUSION: These artificially produced urinary calculi showed properties similar to those of natural stones. Thus, this seems to be a promising stone model for further investigations.

Humans↗
PubMed2003

Pediatric staghorn calculi: the role of extracorporeal shock wave lithotripsy monotherapy with special reference to ureteral stenting.

PURPOSE: Treatment for staghorn calculi in children represents a unique challenge. We assessed the efficacy of extracorporeal shock wave lithotripsy (ESWL) (Dornier Medical Systems, Inc., Marietta, Georgia) monotherapy for the management of staghorn calculi in children with special reference to ureteral stenting. MATERIALS AND METHODS: From June 1992 to January 2001 we treated 42 children 9 months to 12 years old with staghorn stones using the Piezolith 2501 (Richard Wolf GmBH, Knittlingen, Germany) lithotriptor. The initial group of 19 patients underwent ESWL without prophylactic ureteral stenting, while in the latter group of 23 a Double-J (Medical Engineering Corp., New York, New York) ureteral stent was inserted immediately before the first ESWL session. Mean patient age, stone size, number of shock waves and ESWL sessions, hospital stay, stone-free rate and major complications were compared in the 2 groups. RESULTS: Overall 33 children (79%) were stone-free after 3 months. The 2 groups were comparable in regard to patient age, stone size, number of shock waves and ESWL sessions, and stone-free rates. Major complications developed in 21% of the unstented group, whereas none were observed in stented cases. This difference was statistically significant (p = 0.035). Seven post-ESWL auxiliary procedures were required in the unstented group to manage complications. Hospital stay was significantly longer in the unstented compared with the stented group (p = 0.022). At a followup of 9 to 102 months (mean 47) stones recurred in 2 children, who were treated with further ESWL. CONCLUSIONS: ESWL monotherapy was an efficient and safe modality for the treatment of staghorn calculi in children. Stented patients had fewer major complications and a shorter hospital stay. Prophylactic ureteral stenting is advisable before ESWL for staghorn calculi in children.

Child↗
PubMed2003

Percutaneous management of calculi within horseshoe kidneys.

PURPOSE: Percutaneous treatment of patients with calculi in a horseshoe kidney can be challenging due to the altered anatomical relationship in the retroperitoneum. Therefore, we performed a multi-institutional review to assess the safety and efficacy of this minimally invasive technique. MATERIALS AND METHODS: Of 37 patients identified with calculi in a horseshoe kidney at 3 institutions 24 (65%) underwent percutaneous nephrolithotripsy as primary treatment. Average patient age was 48.4 years and 75% of the patients were male. In 3 patients with staghorn calculi mean stone size as measured by computed digitized stone surface area was 448 mm2. Mean followup was 5.8 months. The stone-free rate, complication rate, need for secondary intervention and stone composition were evaluated. RESULTS: Renal access was obtained through an upper pole calix in 63% of the cases, a lower calix in 25% and a middle calix in 4%. Access location was not documented in 1 patient (4%). Of the 24 patients 21 (87.5%) were rendered stone-free after primary or second look procedures. Flexible nephroscopy was used in 84% of cases. Minor complications occurred in 4 patients (16.7%), whereas 3 (12.5%) experienced major complications, including significant bleeding necessitating early cessation, nephropleural fistula and pneumothorax. No deaths occurred as a result of this treatment choice. Stone analysis was available for 21 cases (87.5%). Calcium stones predominated (87.5%), followed by uric acid (9.5%) and struvite (4.8%). CONCLUSIONS: Percutaneous treatment of patients with renal calculi in a horseshoe kidney is technically challenging, usually requiring upper pole access and flexible nephroscopy due to the altered anatomical relationships of the fused renal units. The success rate based on stone-free results and a relatively low incidence of major complications suggest that this minimally invasive management option is an effective means of stone management in this complex patient population.

Adult↗
PubMedDate not supplied

Radiological appearance of pancreatic calculi in tropical versus alcoholic chronic pancreatitis.

Tropical and alcoholic forms of chronic pancreatitis differ in their clinical, aetiological and epidemiological features. We compared the radiological appearances of pancreatic calculi seen on plain roentgenogram of the abdomen of 89 patients with tropical calcific pancreatitis (TCP) and 32 patients with alcoholic calcific pancreatitis (ACP) seen in Madras, Southern India. While TCP was characterized by the frequent occurrence of large, discrete, dense calculi, patients with ACP had typically small, speckled calculi with irregular, hazy margins. The calculi in TCP resembled those described for hereditary pancreatitis. This is the first report comparing the radiological appearances of TCP and ACP patients seen at the same centre.

Adult↗
PubMed2004

Characteristics of patients with staghorn calculi in our experience.

PURPOSE: To elucidate the factors contributing to staghorn stone formation in patients. MATERIALS AND METHODS: The records of 82 patients (44 men and 38 women) with complete staghorn calculi were reviewed retrospectively for clinical presentation, metabolic disturbances and anatomical abnormalities. RESULTS: There were 79 unilateral and three bilateral cases. The patient performance of the activities of daily life was assessed with the modified Rankin scale (MRS) and it was found that 69 patients were functionally independent (84.1%, MRS 0-1) and 10 patients had a severe disability (12.2%, MRS 4-5). Seven patients had chronic indwelling catheters (8.5%). A positive urine culture was found in 24.4% of patients. Analysis of stone composition revealed magnesium ammonium phosphate and mixed calcium oxalate-phosphate were the most frequently identified types of stone (32.1% and 22.2%, respectively). Urinary pH was low in patients with uric acid stones (mean 5.4). Hyperuricemia, cystinuria and hypercalciuria were found in 14.6%, 2.4% and 37.8%, respectively. Hypercalciuria was found more frequently in calcium-stone cases. Eleven patients (13.4%) showed structural abnormalities of the kidney. CONCLUSIONS: Our data show that the patients with severe disability, urinary tract infection and hypercalciuria could be recognized more frequently in staghorn calculi compared with common urolithiasis. However, in Western countries, the frequency of both urinary tract infection and struvite stones is much higher than in our data. Other Japanese authors have also reported the low frequency of struvite stones in staghorn calculi, suggesting that various factors other than urinary tract infection possibly contribute to the formation of staghorn calculi in Japan.

Activities of Daily Living↗
PubMed2005

A comparison of holmium:YAG laser with Lithoclast lithotripsy in ureteral calculi fragmentation.

PURPOSE: Among various intracorporeal lithotriptors, Lithoclast (EMS, Switzerland) has become the widely used tool for the treatment of urinary stones. Recently, the holmium:YAG laser has been used with a wide range of potential urological applications, including intracorporeal lithotripsy of urinary calculi. The purpose of the present study is to compare Lithoclast with holmium:YAG laser lithotripsy in ureteral calculi fragmentation. METHODS: Out of 51 patients with ureteral calculi, 26 underwent Lithoclast lithotripsy and 25 holmium:YAG lithotripsy using a 8/9.8F rigid ureteroscope. There were no changes to the ureteroscopes, video monitors, baskets or irrigation devices during the study period. RESULTS: There were no differences in patient age, sex, stone size and location of stones between these groups. The immediate stone-free rates were 96.0% in the holmium:YAG group and 73.1% in the Lithoclast group (P < 0.05). The 3-month stone-free rates were 96.0% and 84.6%, respectively (P = 0.350). The mean operation time and mean period of postoperative hospitalization in the holmium:YAG group (49.8 min and 1.0 days, respectively) were shorter than those of the Lithoclast counterpart (76.9 min and 2.5 days, respectively). Post-treatment complications, such as ureteral perforation, were encountered in only two patients who underwent Lithoclast. CONCLUSIONS: Holmium:YAG lithotripsy was associated with shorter operation time and postoperative hospitalization period. These data also suggest that holmium:YAG lithotripsy was safe and more effective than Lithoclast lithotripsy in the aspect of immediate stone free rate. We believe that holmium:YAG laser is an excellent treatment modality for managing ureteral calculi.

Adult↗
PubMed1987

Effect of changes in epidemiological factors on the composition and racial distribution of renal calculi.

One thousand and two calculi, which occurred in both black and white patients during a 15-year period, have been analysed by the X-ray diffraction technique. Calcium oxalate calculi were the most common irrespective of race. Whewellite calculi were equally distributed in both race groups, while weddelite stones appeared to be much less common amongst blacks; the opposite applied for struvite and the rare ammonium acid urate stones. The other calculi were approximately equally distributed between the two race groups. A statistically significant rising trend in the prevalence of renal stones in blacks, accompanied by changes in the ratios of the major stone forming constituents, have been a prominent feature of this survey. However, the aforementioned remained unchanged in white patients. Contrary to previous impressions, total urates exceed phosphates in whites as a major stone forming constituent. The composition of upper urinary tract stones in blacks, during the 3-year period 1981 to 1983, was very similar to the composition previously reported for the Sudanese. The profile of renal stones in blacks over the last 3 years, however, is now becoming substantially different from that of the other previously reported surveys and may be approaching that of their white compatriots. A change in the dietary patterns in blacks is occurring which is also reflected in an increasing incidence of ischaemic heart disease and which may also be responsible for the observed changes in renal stones.

Black or African American↗