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PubMed1980

[The value of radio-isotope investigations of the urinary tract for the diagnosis of urinary tract calculi during pregnancy (author's transl)].

According to the literature, urinary tract calculi are a rare complication of pregnancy. Because of the radiation effect of excretory urography on mother and fetus, intravenous pyelography can only rarely be used for the diagnosis of calculi in pregnancy. A sequential radio-isotope nephrogram and the simultaneous determination of the J 131 hippurate clearance equivalents were used in two pregnant patients. The cases are reported. The results are discussed and compared to reports in the literature. The exposure to radiation is about 50 mrem for radio-isotope nephrography compared to from 500 to 4000 mrem for excretory urography. Radio-isotope nephrography is therefore useful for the preliminary diagnosis of urinary tract calculi in pregnancy and the simultaneous clearance determination yields additional data on the function of the urinary tract.

Adult↗
PubMed2002

Effect of diuresis on extracorporeal shockwave lithotripsy treatment of ureteric calculi.

OBJECTIVE: To evaluate the effect of diuresis during extracorporeal shockwave lithotripsy (ESWL) treatment of ureteric calculi. The purpose is to improve stone fragmentation and clearance rates. MATERIALS AND METHODS: One hundred and six consecutive patients with ureteric calculi at different levels were treated by ESWL using Siemens Lithostar 2 machine. Patients have been randomized into two treatment groups. The first group was treated by standard ESWL and included 54 patients. The second group was treated by ESWL with diuresis during the ESWL session. Shock waves were given at a rate of 90 shocks/minute with energy starting from 10 up to 18 KV. During the ESWL session the patient belonging to the second group received i.v. infusion of 500 ml normal saline containing 40 mg furosemide as a diuretic. The stone fragmentation and clearance rates were the two end points for evaluation. RESULTS: The average number of sessions per stone was 1.92 and 1.5 and the average number of shocks per stone was 6295 and 5300 for the first and second treatment groups respectively. Stone fragmentation rate was 47/54 (87%) and 50/52 (96.2%) and the stone clearance (success) rate was 47/54 (87%) and 48/52 (92.3%) for the first and the second groups respectively. Analysis of the results in relation to stone location showed that the two treatment groups were comparable for upper and middle ureteric calculi. However for distal ureteric stones, the addition of diuresis during ESWL was associated with a lower mean number of ESWL sessions and shocks per stone compared with standard ESWL: 1.38 and 4950 for ESWL with diuresis compared with 2.9 and 8544 for standard ESWL respectively. The stone fragmentation and 3-month clearance (success) rates were clearly higher: 93.8% and 87.5% respectively for ESWL with diuresis compared with 70.6% (for both fragmentation and clearance) with standard ESWL. CONCLUSIONS: Diuresis is a useful, inexpensive and safe adjunct to ESWL of ureteric stones. It markedly improves the results of ESWL treatment of distal ureteric stones compared with standard ESWL.

Adolescent↗
PubMed1999

Crystalline phase differentiation in urinary calcium phosphate and magnesium phosphate calculi.

UNLABELLED: Phosphates are encountered as the main components in about 15% of urinary calculi. Except for struvite, no specific correlations have been found between the crystalline phase of the phosphates and the cause of nephrolithiasis. OBJECTIVE: The relationship between aetiological factors and crystalline phases or carbonate rate in calcium phosphate stones were assessed. MATERIAL AND METHODS: From a series of 1148 phosphate calculi, we investigated the relationship between composition and aetiological factors. RESULTS: Carbapatite was the most frequent crystalline phase (74.0%). It was associated with many possible causes, including hypercalciuria, hypocitraturia, primary hyperparathyroidism, tubular acidosis, medullary sponge kidney and chronic urinary tract infection. The carbonate rate of carbapatite may be of clinical interest because carbonate rates above 15% are frequently related to urinary tract infection with urea-splitting bacteria. Conversely, the carbonate rate was commonly less than 10% in cases of carbapatite induced by metabolic disorders. Among other phosphates, brushite was found in hypercalciuric states and primary hyperparathyroidism and whitlockite in cases of urinary tract infection by non-urease-producing bacteria. CONCLUSION: Identification of crystalline phases and measurement of carbonate rate in calcium phosphate calculi is of clinical interest for identifying stone aetiology.

Acidosis↗
PubMed2000

Therapeutic efficacy of Dornier MPL 9000 for prevesical calculi as judged by efficiency quotient.

PURPOSE: To study the efficacy and safety of the Dornier MPL 9000 lithotripter in the treatment of prevesical calculi using real-time ultrasound monitoring and to see if efficacy is adequately judged by the efficiency quotient (EQ). PATIENTS AND METHODS: Seventy-six patients underwent ultrasound-guided extracorporeal shockwave lithotripsy (SWL) for prevesical calculi over a period of 43 months. Their age ranged from 8 to 68 (mean 37.6) years, and the male:female ratio was 2.6:1. The size of the stones, measured in two dimensions, ranged from 4 to 25 mm (mean 9.3 mm) and 2 to 15 mm (mean 6.0 mm). No general or regional anesthesia or ureteral stents were used, and all patients were treated in the prone position. The EQ was calculated using the formula: Stone free (%) x 100/(100 + retreatment rate (%) + auxiliary procedures (%). RESULTS: Seventy patients were stone free in a mean time of 15 +/- 14.11 days. The average number of shockwaves used was 2,831 +/- 1,612, and the average number of sessions per patient was 1.7. About 92% of the patients were rendered stone free using in situ SWL alone. No major complication was encountered, and none of the patients required an inpatient stay after SWL. The EQ was 65. Five patients with failed SWL subsequently were rendered stone free, four with salvage ureteroscopy and pneumatic lithotripsy and one with cystolitholapaxy for a symptomatic fragment in the bladder. One patient was lost to follow-up. CONCLUSION: In situ SWL is a safe and effective treatment for prevesical calculi. It should be used as a first-line treatment for most such stones. Efficiency can be assessed objectively by the EQ.

Dose-Response Relationship, Radiation↗
PubMed2001

Extracorporeal shockwave lithotripsy in patients with distal ureteral calculi does not influence the prostate specific antigen value.

BACKGROUND AND PURPOSE: Distal ureteral calculi can be treated with extracorporeal shockwave lithotripsy (SWL) in situ, which has a high rate of success. As the prostate is in vicinity of this part of the ureter, it is possible that the shockwaves may pass through the prostate also. We evaluated the effect of SWL on the serum concentration of prostate specific antigen (PSA). PATIENTS AND METHODS: A total of 44 men with distal ureteral calculi located a maximum of 20 mm from the ureteral orifice and without any history of recent urinary tract infection, benign prostatic hyperplasia, or prostate cancer underwent SWL with the Dornier HM-4 lithotripter. Their serum PSA values were measured 5 minutes before SWL as well as 3 hours and 1, 7, and 30 days afterward. The differences of these PSA values were estimated. From a control group of 10 healthy donors, two consecutive PSA values were obtained 30 days apart. RESULTS: Of these patients, 93% (41/44) were stone free within 1 month according to plain radiographs and ultrasonography. No statistically significant difference was observed between the PSA concentration before and after treatment or between the patients who underwent SWL and the control group. CONCLUSION: Treatment of distal ureteral calculi with SWL does not affect the serum PSA concentration.

Adult↗
PubMed2001

Optimal treatment for distal ureteral calculi: extracorporeal shockwave lithotripsy versus ureteroscopy.

BACKGROUND: The optimal treatment for distal ureteral calculi remains controversial. We present data from our institution to compare the efficacy of extracorporeal shockwave lithotripsy (SWL) and ureteroscopy with different lithotripsy modalities (URSL). METHODS: From January 1994 to September 1997, 954 distal ureteral calculi were treated at our institution using in situ SWL (Siemens Lithostar) in 524 patients and ureteroscopy (Wolf 8.0F instrument and Swiss Lithoclast) in 430 patients. Stone sizes and patient ages were similar in these two groups. RESULTS: In the SWL group, the 3-month stone-free rate was 87%, and the effectiveness quotient (EQ) was 68.7%. In the URSL group, there was a 96% stone-free rate with an EQ of 92.1%. The SWL treatment was more expensive than URSL. CONCLUSION: At our institution, ureteroscopy is more efficacious than SWL for the treatment of distal ureteral calculi. In selected patients who had stones >10 mm with evidence of impaction and severe colic pain, we strongly suggest that URSL is the best choice.

Adult↗
PubMed2001

Pneumatic lithotripsy versus laser lithotripsy in the endoscopic treatment of ureteral calculi.

PURPOSE: To compare the efficacy, safety, and features of pneumatic lithotripsy (PL) with those of laser lithotripsy (LL) and present our clinical experience in the endoscopic management of ureteral calculi. PATIENTS AND METHODS: From August 1994 to February 2000, 285 consecutive patients underwent endoscopic lithotripsy with either the Swiss Lithoclast pneumatic lithotripter (145 patients) or the Ho:YAG laser lithotripter (140 patients) for the treatment of ureteral calculi. RESULTS: In one single session, the overall successful stone fragmentation rate of LL was higher than that of PL (95.7% v 69.7%; P < 0.01). The average time to stone-free status was shorter for LL than for PL (18 days v 31 days; P < 0.01). No major complications were observed in LL, while five ureteral perforations were encountered in PL. CONCLUSIONS: Laser lithotripsy has advantages over PL in high efficiency of stone fragmentation and a low complication rate. Laser lithotripsy is a powerful, effective, and safe treatment modality for ureteral calculi.

Adolescent↗
PubMed2001

Microscopic and biochemical fertility characteristics of semen after shockwave lithotripsy of distal ureteral calculi.

PURPOSE: To elucidate the frequency and adversity of the effects of shockwave lithotripsy (SWL) on the male reproductive system. We investigated the possible alterations in the quality of semen in patients treated by SWL for pelvic ureteral stones. PATIENTS AND METHODS: The semen of 10 men was examined 1 day before and 5 and 90 days after SWL for distal ureteral stones, in accordance with the World Health Organisation guidelines. The results were compared with those from the semen samples of 10 healthy male volunteers undergoing SWL for calculi of the upper urinary tract. RESULTS: Microscopic analysis of the semen samples revealed a transient decline in sperm density (24.7%), sperm motility (10%), sperm vitality (8%), and seminal fructose (27.5%) after SWL for distal ureteral stones. A distinctly higher number of spermatozoa of pathological origin was detected after SWL in the same group. There was no trace of microscopic hemospermia before shockwave treatment, but it was detected in 90% of the patients with lower ureteral calculi after SWL. Macroscopic hemospermia was detected in two of these nine patients. No deterioration of the semen characteristics and no hemospermia was observed after treatment in the control group with upper urinary stones. CONCLUSIONS: Our investigations confirmed a transient deterioration in semen quality after SWL for distal ureteral calculi, whereas no deterioration was observed after SWL for upper ureteral stones. Impaired sperm quality values returned to normal within 12 weeks after SWL, clearly indicating a damaging effect of SWL on seminal vesicle or ejaculatory duct function. The initial procreative capacity was restored in all patients.

Adult↗
PubMed2001

Ureteroscopic management of lower-pole renal calculi: technique of calculus displacement.

PURPOSE: We review our technique of ureteroscopic management of lower pole renal calculi with Nitinol basket displacement and holmium laser stone fragmentation. METHODS: Lower pole calculi are identified with a 7.5F flexible ureteroscope. In patients in whom the laser fiber reduces ureteroscopic deflection, precluding reentry into the lower pole, a Nitinol basket or grasper is used to displace the calculi into an upper pole calix for easier fragmentation. RESULTS: The Nitinol device can be passed into the lower pole through the fully deflected ureteroscope without any loss of deflection. Irrigation is significantly reduced by the basket, but this factor does not impede stone retrieval. CONCLUSIONS: Ureteroscopic management of lower pole stones is a reasonable alternative to SWL or percutaneous nephrolithotomy in low-volume stone disease. If the stone cannot be fragmented in situ, Nitinol basket capture through a fully deflected ureteroscope into a less dependent position facilitates stone fragmentation.

Equipment Design↗
PubMed2003

Comparison of clinical outcome of extracorporeal shockwave lithotripsy in patients with radiopaque v radiolucent ureteral calculi.

PURPOSE: To compare the efficacy of extracorporeal shockwave lithotripsy (SWL) in patients with radiopaque and radiolucent ureteral calculi. PATIENTS AND METHODS: Between September 2001 and August 2002, a total of 113 consecutive patients with ureteral calculi (58 radiopaque [Group 1], 55 radiolucent [Group 2]) were treated with a Multimed 2001 trade mark lithotripter under fluoroscopic monitoring. Localization of radiolucent stones was achieved after a bolus injection of contrast medium 1 mL/kg, the shockwaves being focused just below the end of contrast column. All patients were treated on an outpatient basis under analgesia and light sedation if required. The mean follow-up was 14 (range 6-23) months. Patients were reevaluated by some combination of plain films, ultrasound scanning, and intravenous urography 3 months after the treatment. Groups were compared with ANOVA and Mann-Whitney U tests. A P value <0.05 was regarded as statistically significant. RESULTS: There were no statistically significant differences in any parameter between groups. At 3 months, the success rate (stone-free status) was 87.9% in Group 1 and 89% in Group 2 (P = 0.848). Double-J catheter replacement was needed for three patients in Group 1 and for two patients in Group 2 (P = 0.693). Two patients from Group 1 and three from Group 2 underwent intracorporeal lithotripsy with ureterorenoscopy (P = 0.606). No adverse reactions to contrast medium occurred in Group 2. CONCLUSION: Patients with radiolucent ureteral calculi can be treated efficiently with SWL by contrast medium injection if ultrasonic localization is not possible.

Adult↗
PubMed1993

Percutaneous nephrolithotomy for large and staghorn calculi.

The treatment of choice for a stone load of up to 3 cm is indubitably extracorporeal shock wave lithotripsy (SWL). However, for larger stones, and particularly staghorn calculi, the choice is not that clearcut. Our experience with percutaneous nephrolithotomy (PCNL) for a stone load larger than 3 cm in 878 renal units over 9 years has left us convinced that a well-planned and determined effort at percutaneous clearance is the best option for these difficult cases. Our overall complete clearance rate in this group is 93% and ranges from 98.5% for solitary calculi to 71% for complete staghorn calculi. These results are comparable to those reported by other workers with percutaneous monotherapy and are superior to those achieved by SWL monotherapy. The complication rate was acceptably low at 4%. We conclude that the expeditiousness and the better stone-free rates of PCNL justify the slightly higher morbidity that it entails when compared with SWL monotherapy. We also prefer to aim for total clearance percutaneously, leaving for SWL only those stones that defy our best efforts.

Humans↗
PubMed1995

Outcome of extracorporeal shockwave lithotripsy monotherapy for large renal calculi: effect of stone and collecting system surface areas and cost-effectiveness of treatment.

The treatment options for large renal calculi are controversial. We report on our experience with 65 treatments of renal calculi > 3 cm using extracorporeal shockwave lithotripsy (SWL) monotherapy. We stratified our results according to stone and collecting system surface areas (measured by computer image analyses), stone location, and stone type. The overall success rate of SWL monotherapy was 27% at 3 months. The best stone-free rate (60%) was obtained for stones < 500 mm2 and located primarily within the renal pelvis. The stone-free rate for stones with surface areas > 1000 mm2 was only 8%. None of the cystine stones was treated successfully, whereas 80% of patients with uric acid stones became stone free. We estimated an average cost of $67,048 to render a patient with a large renal calculus stone free using SWL monotherapy. We recommend that other treatment options, such as percutaneous nephrolithotomy, be considered as first-line therapy for large renal calculi.

Adult↗
PubMed1996

Outcome assessment of double-J stents during extracorporeal shockwave lithotripsy of small solitary renal calculi.

The utility of indwelling double-J ureteral stents during extracorporeal shockwave lithotripsy (SWL) of renal calculi is ill defined. We evaluated 179 patients treated with SWL for small (< 20 mm in diameter) solitary renal calculi with (N = 27) or without (N = 152) indwelling ureteral stents. There was no significant difference in the stone-free rates at 1 month (both 52%) and 3 months (61% nonstented group v 67% stented group; P = 0.45) or in the retreatment rates (13.3% nonstented group v 14.8% stented group; P = 0.60). The incidence and severity of pain/renal colic were similar for the two treatment groups. There was minimal morbidity associated with SWL in either group. Placement of double-J stents for the purpose of improving stone-free rates, alleviating pain, or preventing ureteral obstruction in conjunction with SWL of solitary renal calculi < 20 mm in diameter is unnecessary.

Evaluation Studies as Topic↗
PubMed1996

The new generation Siemens Multiline lithotripter tube "M": early results in ureteral calculi.

The Siemens electromagnetic Lithostar tube "C" and the new multiline tube "M" lithotripters were compared for the in situ treatment of ureteral calculi. A series of 248 patients with a calcium oxalate ureteral stone (proven by stone analysis) more than 4 mm in diameter were treated between December 1994 and September 1995 with the tube M Multiline lithotripter. The results were compared with those of 462 patients treated in prior years with tube C. High energy levels were obtained without sedation in 11% of patients with tube C and in 61% with tube M. The proportion of patients needing additional analgetics was 11% and 6%, respectively. The percentages of patients reporting no pain at all were 7 and 77. In proximal calculi, stone-free status was achieved in 63 of 79 patients (80%) with tube C and in 82 of 91 patients (90%) with tube M (p = 0.057). In distal calculi, stone-free status was achieved in 124 of 173 patients (72%) with tube C and in 134 of 157 patients (85%) with tube M (p = 0.0027). The evacuation rate for distal ureteral stones was significantly higher with tube M, which implies that the new shock head can enable the operator to apply higher energy without sedation because of the better tolerance.

Humans↗
PubMedDate not supplied

Is antegrade ureteroscopy better than retrograde ureteroscopy for impacted large upper ureteral calculi?

OBJECTIVE: This study was planned to compare the risks and advantages of antegrade and retrograde ureteroscopy for impacted large upper ureteral calculi. PATIENTS AND METHODS: From September 1996 to February 1998, ureteroscopy was offered to 43 patients. Of these, retrograde ureteroscopy was done in 20 patients, while antegrade ureteroscopy was performed in 23 patients. All these patients were followed up to evaluate the immediate and long-term success of the procedure. The incidence and nature of complications were also noted. RESULTS: During retrograde ureteroscopy, complete stone clearance was achieved in 11 patients (55%), while pushback of the whole or fragmented calculus was seen in the rest. These patients with residual calculi were later treated by extracorporeal shockwave lithotripsy (SWL). The stone-free rate at the end of 3 months was 85%. Three patients developed minor ureteroscopy-related complications. Complete stone clearance was achieved in all patients with antegrade ureteroscopy. No intraoperative or postoperative complications were encountered. CONCLUSION: In this series, antegrade ureteroscopy was found to be a safe and effective option for impacted upper ureteral calculi and assured better results than retrograde ureteroscopy.

Female↗
PubMed2006

Percutaneous nephrolithotomy for complex caliceal calculi and staghorn stones in children less than 5 years of age.

BACKGROUND AND PURPOSE: Treatment of children with staghorn and complex caliceal calculi is one of the most challenging problems in urology. We present our experience with percutaneous nephrolithotomy (PCNL) monotherapy for staghorn and complex caliceal calculi in children less than 5 years of age. PATIENTS AND METHODS: Between 1991 and 2004, 27 boys and 9 girls aged 11 months to 4.5 years underwent PCNL for staghorn (33%) or complex caliceal (67%) calculi. The average bulk of the stones was 140.17 +/- 42.16 mm(2) (range 61-253 mm(2)). Staging of the procedure was preferred in children with renal insufficiency, urinary-tract infection, fragmentation time >60 minutes, or a stone burden requiring more than two tracts. Essential steps of the technique were a dynamic contrast study to select the appropriate-size Amplatz sheath and ultrasound guidance for renal access. RESULTS: The average operative time was 72.11 +/- 28.86 minutes. The stone-free rate was 86%, the mean hemoglobin drop was 2.2 +/- 0.95 g/dL, and the mean hospital stay was 3.5 days. Less than half of the patients (42%) were treated in a single stage, the remainder requiring multiple procedures. Only 39% could be treated with a single tract. There was statistically significant increase in the blood loss in patients requiring multiple tracts (P = 0.008); however, staging the procedure did not increase the blood loss (P = 0.06). CONCLUSION: Percutaneous nephrolithotomy is safe and effective in children less than 5 years of age. Staging the procedure, instrument modification, the timed "multi mini-perc" technique, and ultrasound-guided access help in achieving maximum stone clearance with minimal morbidity.

Child, Preschool↗
PubMed1980

A simplified sensitive method for the analysis of renal calculi.

A simple, convenient method for the analysis of renal calculi is presented. The method allows the quantitative estimation of oxalate, urate, calcium, magnesium, xanthine, and phosphate; a qualitative analysis for ammonia, carbonate, and cystine is also done. The estimations can be done with specimens of calculi as small as 1 mg. The results of analyses of some calculi from patients are presented and discussed.

Ammonia↗
PubMed1988

Uracil-induced calculi and proliferative lesions of the mouse urinary bladder.

Uracil fed as 3% of the diet to rats produces urinary calculi and consequent proliferative lesions of the bladder epithelium, including papillomatosis. We evaluated the effects of dietary uracil in two strains of mice and compared the results in males and females. Uracil was fed as 3 or 1% of the diet to male and female Swiss and C3H mice for up to 20 weeks. The 3% dose produced marked proliferative changes in the bladder epithelium by 10 weeks of administration, the earliest time at which the animals were processed for microscopic evaluation. These lesions progressed to severe nodular and papillary hyperplasia so that all of the animals fed 3% uracil had to be killed by the end of the 15th week. These animals had uracil-formed calculi. In contrast, mice fed 1% uracil rarely developed uracil calculi, and also rarely developed proliferative changes in the bladder epithelium as observed by light microscopy. Also, the labeling index was determined and showed quantitatively the degree of cell proliferation similar to that qualitatively observed by light microscopic examination. At 10 weeks of administration, there was an increased labeling index in the males compared to females in both strains of mice fed 3% uracil, but this difference was not significant at 15 weeks. Similarly, the males tended to have more severe histologic changes than the females. The results of feeding high doses of uracil are similar in mice to those previously observed in rats.

Animals↗