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PubMed1979

[Experiences with instrumental methods for urinary calculi analysis].

To reduce the urinary calculi incidence by calculi formers, it is important to know the composition of these stones. Unfortunately the chemical analysis does not give very reliable results. Looking for a better method to analyse urinary calculi, three instrumental methods were tested: infared spectroscopy, thermal analysis and X-ray diffraction. The experimental results and economical considerations show that the X-ray diffraction analysis of urinary calculi would meet the goal of improved care of patients with stones.

Humans↗
PubMed1984

[Non-operative treatment of ureteral calculi using ureterorenoscopy].

Rigid transurethral ureteroscopy was used in the treatment of 31 patients with 32 ureteral calculi. The stones could be visualized in 90% of cases. The aim of treatment was immediate extraction under visual control for smaller calculi and retrograde advancement into the renal pelvis with subsequent extracorporeal shock wave lithotripsy for larger calculi. The aim of treatment was reached in 92% (11/12) of stones in the lower third of the ureter, in 67% (4/6) in the middle third and in 64% (9/14) in the upper third of the ureter leaving 12 calculi extracted and 12 pushed up into the renal pelvis. Electrohydraulic lithotripsy in the ureter was used in 3 cases before extraction. Ureterolithotomy had to be carried out in 3 patients only (9%) following the endoscopic procedure.

Catheterization↗
PubMed1984

[Comparative bacteriological and chemical analysis of kidney calculi. Apropos of 135 cases].

The formation of some urinary tract stones (struvite stones) is known to be related to infection by urease-possessing microorganisms, such as Proteus sp. and some other bacteria. Ureaplasma urealyticum, a genital mycoplasma, contains also urease and is predominantly located in the urogenital tract. Its significance in the production of human urinary stones has not yet been elucidated. In this study, 135 human calculi obtained by surgery were analysed chemically and were cultured for the presence of conventional bacteria and U. urealyticum, 51 were ammonium magnesium phosphate stones and contained Proteus (27), E. coli (4), Staphylococcus epidermidis (3), Streptococcus D (2), Pseudomonas aeruginosa (1), Staphylococcus aureus (1), Corynebacterium (1), Candida albicans (1). U. urealyticum was isolated in one patient, from two different calculi (left and right) taken after an interval of fifteen days. Different bacteria were isolated from other calculi (oxalate, uric acid). This findings suggest that Ureaplasma urealyticum should be looked for in struvite calculi.

Bacteria↗
PubMed1983

[Staghorn calculi in the child. Apropos of 17 cases representing 20 kidneys].

The authors report their experience involving 72 cases of lithiasis in the child, 17 involving staghorn calcuti. Of a total of 79 staghorn calculi, 17 affected children. Such staghorn calculi in the child were almost always infected (proteus), often extensive but not associated with any impairment of renal function for a long period. No metabolic disturbance which could explain the formation of these calculi was found, in particular no cases of hyperparathyroidism. Treatment is surgical. The operation is long, difficult and delicate, always requiring peroperative contact films and often clamping of the renal pedicle in the case of nephrotomy. Such clamping is much better tolerated with the use of contact refrigeration of the kidney. On the basis of the results of quantitative renal scintigraphy, nephrotomy seemed better tolerated by the kidneys of children than by the kidneys of adults. True recurrences were rare (3/20) and small "forgotten" calculi (2/20) were often well tolerated.

Child, Preschool↗
PubMed1981

Urinary calculi associated with portosystemic shunts in six dogs.

Portosystemic shunts were diagnosed in 6 dogs with urinary calculi and signs of neurologic disease. Five of the dogs were initially examined because of neurologic signs, and 1 was seen because of urinary tract problems. The composition of the calculi was variable, but in all 13 episodes of calculi formation, the calculi contained an ammonium or uric acid component. One dog is being controlled under medical management; 4 of the dogs died, and 1 was euthanatized. The interpretation of pathogenesis was that decreased delivery of blood to the liver due to shunting or decreased liver function can potentially result in high blood concentrations of ammonia and uric acid, both of which are metabolic end products cleared by the kidneys; thus, the urinary tract would be an excellent environment for the precipitation of their salts.

Ammonia↗
PubMedDate not supplied

[Newberyte in old calculi of the urinary system].

In 542 old calculi belonging to the collection complied by Dr. P. Cifuentes Díaz, we have found newberyte in 81 calculi (14.9%). Newberyte appears in the struvite and apatite calculi in the form of small crystals looking like a mosaic. This results from the transformation of the struvite when it loses NH3 and H2O which we have only found in old urinary calculi.

Humans↗
PubMed1975

The effects of thiazides on serum and urinary zinc in patients with renal calculi.

Urine zinc (Zn) excretion was significantly higher in 338 male patients with renal calculi than in 21 normal male subjects, but there was no significant difference between 102 female patients with renal calculi and 15 normal female subjects. In 33 patients with renal calculi urinary Zn was less than 50% of the mean normal value; in these patients there is a possibility that lower urine Zn excretion contributes to the formation of renal calculi. Hydrochlorothiazide produced a striking and sustained increase in urinary Zn excretion, which might contribute to the efficacy of this drug in the prevention of calcific renal stones. Serum Zn levels remained normal in the majority of subjects on long term thiazide therapy, but the occasional finding of subnormal levels suggests that long term thiazide therapy carries with it the hazard of Zn deficiency.

Female↗
PubMed1993

[Combination therapy of ESWL and PNL for the staghorn calculi].

We have been engaged in the treatment of urinary tract calculi using extracorporeal shockwave lithotripsy (ESWL) and endourology techniques for more than 8 years. In the treatment of thin staghorn calculi, ESWL monotherapy is the first choice. On the other hand, combination of percutaneous nephrolithotomy (PNL) and ESWL is important for the treatment of thick staghorn calculi in order to avoid the stone street and side effects of shock waves. When the stone is made of hard components such as calcium oxalate monohydrate and cystine, combination of both methods is also useful. In the case of complicated staghorn calculi with isolated branches, open surgery such as nephrolithotomy or partial nephrectomy might be the choice.

Combined Modality Therapy↗
PubMed1993

[Treatment of patients with staghorn calculi by means of extracorporeal shock wave lithotripsy (ESWL)].

Between August, 1987 and December, 1991, 84 patients with 87 staghorn calculi were treated mainly with extracorporeal shockwave lithotripsy (ESWL) using a Dornier HM-3 improved lithotriptor. Patients were 38 men (38 renal units, mean age 54.9 years) and 46 women (49 renal units, mean age 54.3 years). Staghorn calculi were divided into 2 types; 54 units of complete type (mean stone area 9.2 cm2) and 34 units of incomplete type (mean stone area 5.5 cm2). Patients with complete type were treated with 3.6 sessions and 7,779 shock waves on average and 31.6 days for hospitalization was required, while patients with incomplete type were treated with 2.4 sessions and 5,288 shock waves on average and 15.7 days for hospitalization was required. After treatment, the excellent rate was 47.2% for the complete type and 44.1% for the incomplete type. After the monotherapy of ESWL the excellent rate was 46.9% and after the combined therapy with percutaneous nephrolithotripsy (PNL) and/or percutaneous nephrostomy (PCN) it was 43.5%. We considered that the ESWL monotherapy for staghorn calculi was not feasible in patients with a large stone volume, with severe hydrocalices, with cystine stones and with so-called "complex staghorn calculi".

Adolescent↗
PubMed1993

[Treatment of ureteral calculi in bone coverage using in situ ESWL in prone position].

From January 1988 to February 1992, a total of 26 patients with calculi in the middle third of the ureter underwent primary in situ ESWL in the prone position. All treatments were performed in sedoanalgesia using the Dornier HM 3 lithotriptor. During and after ESWL in the prone position, severe complications did not occur. Of the 26 patients, 10 (38%) were treated by a single application of ESWL. No auxiliary measures were necessary, and they became stone-free within 3 months following treatment. In another 9 patients (35%) auxiliary measures were required for visualization of radiolucent calculi or to relieve a urinary tract obstruction with incipient septicemia. All these auxiliary measures could be performed in sedoanalgesia. In the remaining 7 patients (27%), in whom stone disintegration following ESWL was incomplete, ureteroscopic lithotripsy techniques had to be applied. One of these 7 patients had to undergo an additional open operative procedure. The results of the present study demonstrate that a majority of patients with calculi in the middle portion of the ureter can become stone-free without invasive lithotripsy techniques following ESWL in the prone position, if necessary plus auxiliary measures, in sedoanalgesia. From these results it can be concluded that primary ESWL in the prone position should be considered for patients with calculi in the middle third of the ureter before invasive lithotripsy techniques are applied.

Adult↗
PubMed1993

[Ureteral calculi: comparison of echographic and radiologic scanning].

The ureteral calculi can be treated, today in situ with extracorporeal shock wave lithotripsy. In our study we have used three different lithotriptors, two with fluoroscopic scanning, one with ultrasound scanning. The patients we have treated with ultrasound scanning lithotriptor Dornier MPL 9000 were 48 (22M-26F), while 210 patients were treated with fluoroscopic scanning lithotriptor, respectively 23 (15M-8F) with Direx Tripter XI and 187 with Dornier HM3. The ureteral calculi were so localized: among the patients treated with ultrasound scanning lithotriptor 16 presented calculi in the upper third ureter between GPU and L3, 9 in the middle third ureter between L3 and the superior border of sacroiliac articulation, 9 in pelvic tract above the spinoischiatic line, 6 between this line and juxtabladder ureter and 8 in juxtabladder ureter. Among the patients treated with fluoroscopic scanning lithotriptors all together 58 presented calculi in the upper third ureter between GPU and L3, 29 in the middle third ureter between L3 and the superior border of sacroiliac articulation, 13 in the iliac tract of the ureter, 41 in pelvic tract above the spino-ischiatic line, 27 between this line and juxtabladder ureter and 42 in juxtabladder ureter. For every treatment the number of shock waves was 2500 and the number of treatments for every patients was 1, 3. We report 82% of patients stone-free at a follow up of three months for the patients treated with the MPL 9000, 87% of patients stone-free for Direx Tripter XI and 85% of patients stone-free for Dornier HM3.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Ureteroscopy versus in situ extracorporeal shockwave lithotripsy in the treatment of calculi of the distal ureter].

In a retrospective study from a unique center (St. Luc Hospital, Montreal) stone clearance of 88 consecutive distal ureteral calculi (below pelvic brim) treated by extracorporeal shock wave lithotripsy in situ were compared to a group of 94 distal ureteral calculi treated by ureteroscopy during the same period. Our results show 84% success rate for ureteroscopy which is clearly superior than 58% stone clearance rate at 3 month follow-up for ESWL Success rate was influenced by stone size in the ESWL group but not in the ureteroscopy group. This study reveals similar success rate for calculi smaller than 6 mm but for larger calculi, success rate of ureteroscopy is significantly superior.

Adolescent↗
PubMed1977

[Various problems in urinary calculi].

After evaluation of the essential parameters concerning urinary calculi and patient with the help of adequate computer programmes in more than 30,000 persons some conspicious trends could be established. The necessity of operative removal of calculi is still relatively high in the most frequent species of calculi whewellite, weddellite, uric acid, struvite and carbonate apatite. Thus nearly 65% of all struvite and carbonate apatite calculi must be operatively removed in women. For individual species of stones with statistical certainty (alpha=0.01) the preference of the right kidney in women and of the left kidney in men is established. The summer months bring an increased risk of stone formation. The spontaneous passages show a highly significant increase from July to October (alpha=0.01), compared with the winter and spring months.

Carbonates↗
PubMed1998

Urolithiasis in dogs. IV: Survey of interrelations among breed, mineral composition, and anatomic location of calculi, and presence of urinary tract infection.

OBJECTIVE: To compile and analyze selected data from a large number of canine urinary calculus specimens that were subjected to quantitative, layer-by-layer mineral analysis. SAMPLE POPULATION: 11,000 canine urinary calculus specimens: 5,781 from female dogs, 5,215 from male dogs, and 4 from dogs of unrecorded sex. PROCEDURE: Records of the Urinary Stone Analysis Laboratory, School of Veterinary Medicine, University of California were used to compile information regarding urinary calculus specimens from dogs. Records surveyed were of all canine calculi submitted for analysis between July 1981 and January 1994. Results analyzed included those of a mixed-breed group and 26 common breeds of stone-forming dogs. Interrelations of breed, sex, and age of the affected dogs, mineral composition of the specimens, and associated urinary tract infections were analyzed statistically. RESULTS: Proportions of culture-positive specimens were significantly correlated between the sexes (r = 0.494, P = 0.008). Staphylococcus intermedius was isolated most often from either sex, ranging from 36.1% (Basset Hounds) to 67.9% (Pekingese) of cultured specimens from females and 8.7% (Chihuahuas) to 71.4% (Scottish Terriers) of specimens from males. The second most frequently isolated bacterial species, Escherichia coli, ranged from 0% in males of 2 breeds and females of 4 breeds to 25% in Cairn Terrier males and 19.4% in Basset Hound females. Streptococcus spp were the third most frequently isolated bacterial species. Significant correlations between the sexes were found for percentages of calculi located in the urinary bladder (r = 0.490, P = 0.008), and for calculi voided in the urine (r = 0.503, P = 0.006). CONCLUSIONS: Breed and sex differences in prevalence of urolithiasis- and mineral-associated bacterial infections are numerous. Staphylococcus intermedius was the most common isolate from specimens from all but 3 of 54 breed/sex groupings. For either sex, streptococcal infections were significantly related to proportions of calculi passed in the urine.

Age Distribution↗
PubMed1998

Medical management of urinary calculi in a stallion with breeding dysfunction.

A 9-year-old Thoroughbred stallion was examined because of breeding dysfunction and possible urethritis. The stallion had good libido and readily obtained an erection, mounted, and intromitted but did not thrust and ejaculate. After mounting the mare, the stallion would squeal and dismount. Endoscopic examination of the urethra and bladder revealed irregular, spiculate yellow crystals (< 1 cm in size) and sabulous deposits; numerous calculi were embedded in the mucosa of the bladder. Because the horse was at the start of a breeding season, the owner would not give permission for general anesthesia. Medical management was attempted, because postoperative convalescence after surgical removal of calculi might have curtailed breeding activities, and the calculi were small. Every 1 to 3 days, the bladder was lavaged with saline solution containing acetic acid, and anti-inflammatory and antimicrobial drugs were administered. The stallion was able to return to breeding mares, and sperm numbers and semen quality were good. However, urine contamination of the ejaculate was detected, suggesting that the stallion may have had a primary neurologic deficit affecting bladder control and function that was causing calculi to form secondarily because of delay in movement of urine through the urinary tract.

Animals↗
PubMed1998

Metabolic abnormalities in patients with caliceal diverticular calculi.

PURPOSE: We determined the incidence and spectrum of metabolic abnormalities in patients with caliceal diverticular calculi. MATERIALS AND METHODS: Five men and 9 women with caliceal diverticular calculi underwent metabolic evaluation, including determination of serum electrolytes, calcium, phosphate and uric acid, and 24-hour urinary volume, creatinine, calcium, oxalate, uric acid and citrate. RESULTS: Of the 14 patients 7 (50%) had urinary excretion abnormalities promoting stone formation, including hypercalciuria in 3, hyperoxaluria in 1, hypercalciuria combined with hyperuricosuria in 1 and hyperoxaluria combined with hyperuricosuria in 2. Two patients had a history of gout while another had radiographic evidence of medullary sponge kidney. Of the patients 9 (64.3%) had a history of synchronous or metachronous calculi distant from the involved caliceal diverticular stone and 5 (55.6%) of these 9 had definable metabolic disorders. However, there was no statistically significant difference in urinary excretion values between patients with or without a history of additional extra diverticular stones. CONCLUSIONS: Urinary stasis alone does not explain stone formation in a significant number of patients with caliceal diverticular calculi. Rather, the local physiological environment of the urine likely has a predisposing role and evaluation for metabolic abnormalities should be considered. In some patients cure may be effected by treating the stone and any associated metabolic disorders rather than the diverticulum.

Adult↗
PubMed1989

Vesicoureteric reflux and urinary calculi in children.

We present 5 patients with urinary calculi and vesicoureteric reflux (VUR). In 4 patients the VUR was probably primary and in 1 it was secondary to the calculus disease. The incidence of calculi with reflux is approximately 0.5% whereas the incidence of reflux with calculi is approximately 8%.

Child, Preschool↗
PubMed1958

The treatment of urinary tract calculi.

From review of recent information relative to calculus formation in the kidney, the conclusion reached that we do not yet understand, despite much effort, the basic physicochemical mechanisms involved. Since this is so, it has seemed best to the author for the present to rely, in treating patients with renal stones, on simple therapeutic concepts, which, if carefully and conscientiously applied, produce good results. The concepts are the elimination of known causes such as parathyroid adenomas and obstructive lesions, elimination or at least treatment of infections, diminution of urinary components which form the basis of calculi by limiting the oral intake or absorption from the gastrointestinal tract and maintenance of a dilute urine of desired pH.A plan for preoperative study is suggested to allow planned therapy. Indications for operative removal of calculi as well as some points of technique are discussed. It is emphasized that surgical removal of a calculus is but an incident in the care of patients with calculi and that treatment during the postoperative period and followup therapy is most important if success is to be achieved. Reports of cases to illustrate the application of these concepts are presented.

Biological Transport↗