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PubMed1985

Investigation and treatment of renal calculi.

We have investigated and treated 176 patients who were suffering from renal calculi. The stones contained calcium in 87% of patients, predominantly urate in 11%, and rarely contained magnesium ammonium phosphate or cystine. Of the patients with calcium stones, hypercalciuria was present in 75% and was identified in 57% by the measurement of the 24-hour urinary calcium excretion, and in a further 18% by a standardization calcium "fast-and-load" test. Nine patients were found to have primary hyperparathyroidism and were treated surgically. A further 21% were suspected to have normocalcaemic hyperparathyroidism, and metabolic studies are being developed to clarify this. The treatment of hypercalciuria included a low-calcium diet, and various combinations of a thiazide diuretic, phosphate supplements and sodium cellulose phosphate. Hypercalciuria was controlled in all compliant patients, and only two developed further stones. Hyperuricosuria was rarely the sole metabolic abnormality in patients with calcium stones, though this might reflect the referral pattern of the Unit. Uric acid stones were frequently, but not invariably, associated with hyperuricosuria and acid urine, and even large uric acid calculi dissolved with a combined therapy of high fluid intake, allopurinol and an alkalinizing agent. Surgical treatment was rarely required in these patients. A stone in the renal pelvis of one patient was removed percutaneously and did not require ultrasonic fragmentation. Modern methods of investigation and treatment have greatly improved the outlook for patients with recurrent renal calculi.

Calcium↗
PubMed1990

[Treatment of ureteral calculi by extracorporeal shock wave lithotripsy].

We reviewed 465 cases of ureteral calculi treated at Jömö Urological Hospital using a Dornier HM3 lithotripter during the period from October 1985 to February 1989. The 336 men and 122 women ranged from 11 to 78 years old with a mean age of 42.2. The stone size ranged from 4 mm to 30 mm with a mean length of 10.6 mm. Complete stone elimination by ESWL was achieved in 431 of the 465 cases (92.7%). The success rate was best for stones in the lower ureter, which was 98.1 per cent (53/54). For upper and mid ureteral calculi it was 92.4 per cent (363/393) and 83.3 per cent (15/18), respectively. ESWL after push up made 100 per cent (30/30) of patients completely free of stones, while ESWL after bypass 93.0 percent (106/114) and ESWL in situ 91.9 per cent (295/321). The rate of residual stone increases in proportion to the age of patients. Minor side effects such as fever and pain were observed. Our results suggest that ESWL currently is the first therapeutic option for the majority of ureteral calculi.

Adolescent↗
PubMed1995

[Renal transplant calculi in a renal allograft treated with extracorporeal shock wave lithotripsy in a patient with persistent hyperparathyroidism: a case report].

Between 1984 and 1991, six of 105 renal transplant recipients at our institution formed urinary tract calculi after transplantation (5.7%). In these 6 patients, one case of nephrolithiasis in a transplanted kidney was treated with extracorporeal shock wave lithotripsy (ESWL). A 37-year-old woman underwent cadaveric renal transplantation twenty months before, and her renal function remained stable. However calculi in the transplanted kidney and bladder were formed and ESWL was used for the treatment of the renal calculus in the transplanted kidney. She was discharged from the hospital two weeks postoperatively while passing small gravel in the urine after successful fragmentation of the calculus without any major complications. As follow-up KUB film two weeks later demonstrated that all stone fragments had been passed, but she was treated again by ESWL four months later because IVP films four weeks later revealed recurrent calculi in the transplanted kidney. The stones were fragmented successfully and spontaneously passed with voiding. Moreover we performed total parathyroidectomy with autotransplantation for persistent hyperparathyroidism, with subsequent good clinical results.

Adult↗
PubMed1995

[Treatment of stone street after extracorporeal shock wave lithotripsy of staghorn calculi].

During ESWL monotherapy for staghorn calculi, the formation of a stone street in the ureter is often encountered, and can be a troublesome problem. At the Komaki Shimin Hospital, 75 patients with staghorn calculi were treated with ESWL monotherapy using a Dornier HM-3 lithotriptor between October 1987 and August 1992. Among them, three patients had involvement of both collecting systems. An indwelling double J catheter was always inserted during treatment. Our strategy for the treatment of stone street was as follows; observation was initially performed for one month after ESWL, as long as pyelonephritis and/or complete obstruction did not occur. In the patients without any improvement of the stone street, TUL or ESWL was then performed for removal. A stone street (stone fragments extending > or = 4 cm) was formed in 38 of 78 renal units (49%). In 14 cases (37%), it disappeared spontaneously. TUL was required in 14 unit (37%), ESWL in eight units (21%), and both procedures in two units (5%). In one unit (3%), renal function was severely damaged. In another unit, ureteric perforation occurred during the TUL procedure, and caused stone loss outside the ureter. To clarify the factors causing stone street, we compared the number of shock waves, the size of the stones, the severity of hydronephrosis and renal function in stone street formers and non-formers. However there were no significant differences among these factors. In conclusion, since it is impossible to predict stone street formation after ESWL monotherapy for staghorn calculi, patency of the indwelling double J catheter should be maintained and stone removal should be attempted after one month if necessary.

Calcium Oxalate↗
PubMed1997

Excision of urethral diverticulum calculi in a pregnant patient on an outpatient basis.

Although the incidence of urethral diverticula in women of reproductive age ranges from 0.6% to 6%, urethral diverticulum calculi are rarely reported. This report describes excision and outpatient management of urethral diverticulum calculi in a symptomatic pregnant patient. The etiology, diagnosis, and recommended therapy of urethral diverticulum calculi are discussed. Historically, surgical therapy has been considered appropriate; however, recent technologic advancements--including ultrasound and lithotripsy--may change this widely accepted method of treatment.

Adult↗
PubMed1999

A comparison of ureteroscopy to in situ extracorporeal shock wave lithotripsy for the treatment of distal ureteral calculi.

PURPOSE: The optimal treatment for distal ureteral calculi remains controversial. Most urologists offer extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy for stones that require intervention. We present data from our institution on these modalities since 1990. MATERIALS AND METHODS: We treated 187 distal ureteral calculi with ESWL (91 cases) on a Dornier HM3 or MFL 5000 lithotriptor, or with ureteroscopy (96 cases) using basket extraction with or without pulsed dye laser lithotripsy. RESULTS: Fragmentation and stone-free rates for ESWL were 80 and 73%, respectively, with no complications. For ureteroscopy the stone-free rate was 95% with a 5.2% short-term complication rate and no long-term complications. CONCLUSIONS: At our institution ureteroscopy is more efficacious than ESWL for the treatment of distal ureteral calculi.

Adult↗
PubMed1992

Use of a continuous alfentanil infusion for extracorporeal shock wave lithotripsy in the treatment of renal calculi.

Extracorporeal shock wave lithotripsy (ESWL) is the most widely used treatment for renal calculi. Newer second generation lithotripters are being produced, which are considered to be less painful than their prototypes. Thus, the trend in anesthesia for ESWL is away from general endotracheal and regional anesthesia and toward less involved and more easily monitored techniques such as intravenous analgesia (IVA). This report relates our experience with a continuous alfentanil infusion for ESWL treatment of renal calculi with a nonimmersion second generation Dornier HM-4 lithotripter model. Thirty-five patients treated pre-operatively with droperidol and midazolam, followed by a continuous infusion of alfentanil, reported excellent pain relief via a numerical pain score and manifested little, if any, hypertension or tachycardia. Stone fragmentation, fluoroscopy, and recovery time did not differ between patients receiving IVA or general anesthesia. Potential disadvantages of IVA include elevation of transcutaneous CO 2, bradycardia in 14 patients requiring the use of atropine, slightly longer ESWL time, increased number of shocks needed for fragmentation, and a small failure rate, with 11% of patients requiring general anesthesia. With proper patient selection and respiratory monitoring, IVA is highly recommended for ESWL in the treatment of renal calculi.

Adult↗
PubMed1990

Electrohydraulic lithotripsy of ureteral calculi: the Stony Brook experience.

We have used electrohydraulic lithotripsy for the treatment of ureteral calculi in a total of 29 patients. By combining the use of a 3.0 Fr electrode and a 9.5 Fr rigid ureteroscope, we have been able to successfully treat the majority of our patients with ureteral calculi. Bypass stenting of obstructing ureteral stones aided in access and effectiveness of ureteroscopy and endoscopic lithotripsy. The success rate in our series of 30 primary treatments was 80%; failures were primarily related to stone composition. In summary, we have found electrohydraulic lithotripsy of ureteral calculi to be a safe and effective treatment modality and routinely used it for stones throughout the length of the ureter that were either impacted or too large to extract primarily.

Calcium Oxalate↗
PubMed1999

Proteus mirabilis viability after lithotripsy of struvite calculi.

PURPOSE: We tested the hypotheses that Proteus mirabilis viability of struvite calculi differs after exposure to different lithotripsy modalities and that the photothermal mechanism of holmium:YAG lithotripsy is antibacterial. MATERIALS AND METHODS: Human calculi of known struvite composition (greater than 90% magnesium ammonium phosphate hexohydrate) were incubated with P. mirabilis. Calculi were randomly distributed and fragmented with no lithotripsy (controls), or shock wave, intracorporeal ultrasonic, electrohydraulic, pneumatic, holmium:YAG or pulsed dye laser lithotripsy. After lithotripsy fragments were sonicated and specimens were serially plated for 48 hours at 38C. Bacterial counts and the rate of bacterial sterilization were compared. RESULTS: Median bacterial counts (colony-forming units per ml.) were 8 x 10(6) in controls and 3 x 10(6) in shock wave, 3 x 10(7) in ultrasonic, 4 x 10(5) in electrohydraulic, 8 x 10(6) in pneumatic, 5 x 10(4) in holmium:YAG and 1 x 10(6) in pulsed dye laser lithotripsy cases (p <0.001). The rate of bacterial sterilization was 50% for holmium:YAG lithotripsy treated stones versus 0% for each of the other cohorts (p <0.01). CONCLUSIONS: P. mirabilis viability varies among lithotrites. The photothermal mechanism of holmium:YAG lithotripsy is antibacterial.

Humans↗
PubMed1999

[Correlations between crystalluria and composition of calculi].

UNLABELLED: The successful fragmentation of kidney stones by means of extracorporeal shock wave lithotripsy partly depends on stone composition. In case of incomplete or coarse fragmentation, multiple urological procedures following ESWL may be necessary for removal of obstructive fragments. It is difficult to be sure that a given stone will be successfully destroyed. X-ray examinations before treatment are useful to classify calculi as calcium stones or not. Nevertheless, such investigations are often not sufficient to identify the main crystalline phases which form the stone and that can make it either resistant or friable to ESWL. OBJECTIVE: The aim of this study was to compare crystalluria and stone composition in patients with kidney calculi. MATERIAL AND METHODS: Seventy-five untreated patients (54 males, 21 females) were included. Their first morning urine was collected three days before surgical removal of the stone. Urine samples were kept at 4 degrees C during 48 hours before examination. RESULTS: Crystalluria occurred in 97.3% of urine specimens. Weddellite was the most frequent crystalline species found in urine (66.2%), followed by carbapatite (33.1%) and whewellite (23.1%). When compared to stone composition, crystalluria was mainly made of weddellite in urines from 68% of patients with weddellite-rich calculi. Stones from patients presenting with whewellite crystals in urine were mainly composed of whewellite in 88.9% of cases. Struvite stones were associated with struvite and carbapatite crystalluria in 85.7% of cases. CONCLUSION: Crystalluria studies could be of clinical interest to predict the main crystalline phase of calcium-containing stones in order to define the best procedures for stone removal.

Adult↗
PubMed2000

Biochemical and bacteriological study of urinary calculi.

Biochemical and bacteriological study of urine, nidus and chemical analysis of 100 calculi from 100 patients admitted in the Regional Institute of Medical Sciences, Imphal from November, 1997 to October 1999 were done. About 47% of the cases had positive urine culture and nidus culture. Escherichia coli was the commonest bacteria isolated both in the urine and nidus of calculi. The commonest radical present in the calculi was calcium while the rarest was uric acid. The stones were composed mainly of calcium oxalate and/or phosphate followed by struvite, then mixed stone.

Calcium Oxalate↗
PubMed1975

[Composition of renal calculi in Hungary].

Quantitative thermal analysis was carried out of 2300 calculi collected in Hungary. These included diverse mono-, di- and trimineral stones, spontaneously excreted and surgically removed whewellite and weddellite calculi. There percentage distribution among male, female and children patients, the regularities in the composition of mixed calculi and the incidence of falsifications are discussed in detail.

Adult↗
PubMed2001

[Types of kidney calculi. Relationship with urinary biochemistry].

OBJECTIVE: To present a simple classification of the most frequent renal calculi that relates each type of calculus with the main possible etiologic factors linked to its formation (mainly urinary biochemical parameters). METHODS: The macro, microstructure and composition of 2,500 renal calculi were studied by appropriate combination of stereoscopic microscopy, IR spectroscopy and scanning electron microscopy + X-ray microanalysis. The information obtained were related with the main urinary biochemical parameters, determined by conventional analytical procedures. RESULTS: Ten main categories of renal stones, covering over 95% of all conceivable calculi, are distinguished based on their composition and structure. Etiologic factors, mainly urinary biochemical parameters, leading to the formation of stone of every category are specified. CONCLUSIONS: From the detailed study of the renal calculus important etiologic factors can be deduced. Such information complements and confirms the urinary biochemical studies. As a consequence, the corresponding treatment can be better established.

Humans↗
PubMed2001

Holmium laser lithotripsy in the management of ureteric calculi.

INTRODUCTION: To evaluate the efficacy and safety of the holmium:YAG laser in retrograde ureteroscopic laser lithotripsy of ureteric calculi. METHODS: Three hundred and twenty-five patients (256 males and 69 females) with mean age of 45 years underwent 328 retrograde ureteroscopic laser lithotripsy as the primary therapy for ureteric calculi using semirigid mini-ureteroscopes and the holmium:YAG laser (Coherent, Palo Alto, California, USA). Four consultants and three registrars performed the procedures over a period of 31 months. RESULTS: The mean largest diameter of the calculi was 8.4 mm. The mean hospital stay was 1.8 days and the mean duration for the operation was 25 minutes. One hundred and twenty-two (37%) procedures were done as day surgery cases. Complete stone-free rates after single primary treatment using only the holmium:YAG laser were 75% and 91% at 4 weeks and 12 weeks of follow-up, respectively. Including 22 (7.6%) renal units which required additional procedures, the overall stone-free rate was 97%. Seventeen cases (5.2%) needed additional extracorporeal shock wave lithotripsy (ESWL) and 5 cases (1.5%) needed an additional repeat ureteroscopy and lithotripsy for complete stone clearance. Significant complications include 1 case of ureteric perforation. CONCLUSIONS: The holmium:YAG is a safe and effective intracorporeal lithotripter when deployed in a retrograde manner in conjunction with a mini-ureteroscope.

Female↗
PubMedDate not supplied

Symptomatic small non-obstructing lower ureteric calculi: comparison of ureteroscopy and extra corporeal shock wave lithotripsy.

OBJECTIVE: To compare the success, efficacy and complications of ureteroscopy (URS) and extra corporeal shock wave lithotripsy (ESWL) for the treatment of symptomatic small non obstructing lower ureteric calculi. SUBJECTS AND METHODS: This prospective non-randomised study was conducted simultaneously at two urological referral centres, included 280 patients with symptomatic small (4-10 mm) lower ureteric calculi (situated below the sacroiliac joint), with good renal function on intravenous urography. Patients were offered both the treatment options. One hundred and sixty patients chose ureteroscopy, whereas 120 patients were treated by ESWL. Standard techniques of ureteroscopy and ESWL were employed. Patients were followed-up to assess the success rates and complications of the two procedures. RESULTS: Ureteroscopy achieved complete stone clearance in one session in 95% of patients. In six patients ureteroscopy had failed initially and was later accomplished in second session improving the success rate to 98.7%. Two patients had a proximal migration of calculus that needed ESWL. Of the 120 patients treated by ESWL, 90% achieved stone free status at three months. Ureteroscopy was needed for twelve patients (10%) where ESWL failed to achieve stone clearance. There were no significant ESWL related complications. ESWL was administered on outpatient basis, while patients needed hospitalisation and anaesthesia for ureteroscopy. CONCLUSION: ESWL can be the primary mode of treatment for symptomatic small non-obstructing lower ureteric calculi as it is minimally invasive and safe. Ureteroscopy can be offered to patients who demand immediate relief or when ESWL fails.

Adolescent↗
PubMed2002

Transduodenal extended sphincteroplasty and removal of ventral duct pancreatic calculi.

The surgical treatment of chronic pancreatitis and associated ductal calculi typically involves drainage of the main pancreatic duct or parenchymal resection. Treatment of isolated symptomatic pancreatic duct calculi is usually approached by endoscopic techniques. Herein is described a case report of operative transduodenal extraction of symptomatic pancreatic calculi of the ventral pancreas in a patient with a prior distal pancreatectomy. This case represents an uncommon yet valuable option in selected patients in whom endoscopic treatments have failed or are unavailable.

Calculi↗
PubMed1975

Bladder calculi and urothelial hyperplasia with papillomatosis in the rat following insertion of chalk powder in the bladder cavity with subsequent trauma of the bladder wall.

A suspension of chalk powder was injected into the cavity of the urinary bladder of Fischer 344 rats. Three weeks later rats were divided into 4 major groups and were given a submucosal injection. One group received a suspension of viable Chapman 4909 tumor cells, the 2nd group received a suspension of frozen-killed 4909 tumor cells, the 3rd group received a suspension of normal rat spleen cells, and the 4th group received cell-free fresh tissue culture medium. After 3 additional weeks urolithiasis was recognized in each experimental group. The incidence of calculi in the groups as listed above was 14 of 17, 6 of 11, 6 of 11, and 2 of 15, respectively. In control studies inocula consisted of tumor alone, i.e., without chalk powder. Inoculation of the 4909 rat bladder cancer cell line into the lumen of urinary bladders of rats did not result in any calculi after 3 weeks but did produce intramural tumor nodules and hyperplastic changes in adjacent host urothelium in 2 of 10 rats. The tumor inoculated in the submucosa of the bladder produced calculi and papillomas in 2 of 7 rats, and it produced intramural tumor nodules with adjacent hyperplasia of urothelium in all 7 rats.

Calcium Carbonate↗
PubMed2002

Ureteral calculi during pregnancy: review of the management at Ramathibodi Hospital.

OBJECTIVE: To review our experiences with diagnosis and management of symptomatic ureteral calculi complicating pregnancy. MATERIAL AND METHOD: Medical records of all pregnant patients documented with symptomatic ureteral calculi treated at the Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital from 1990 to 2000 were reviewed. Presenting symptoms, diagnostic studies and management of ureteral stone were evaluated. RESULTS: Twenty patients were found in this study with the mean age of 27.5 years (18-36). The mean gestational age at presentation was 18.5 weeks (12-33). Severe flank pain was the common presenting symptom (100%), 60 per cent were on the right side and 40 per cent were on the left side, 20 per cent had associated fever and 20 per cent had irritative voiding symptoms. All of the cases had micro or macroscopic hematuria. Ultrasonography was the initial test confirming the diagnosis and visualized stones were obtained in 60 per cent of the cases. Plain KUB film was done in 6 cases and stones could be seen in 5 cases (83%). Limited IVP was done in 3 cases and the diagnosis could be done in all of them (100%). Spontaneous passing of stones was noted in 14 cases (70%) and double J stents were placed in 6 cases. Ureterolithotomy was done in 2 cases and percutaneous nephrostomy with subsequent definite stone treatment in the post partum period was done in 2 cases. No abortion and no congenital anomalies of the infant were noted. Four cases had premature labor but there was no correlation with the procedures performed for treating the ureteral stone. CONCLUSION: This study provides evidence for effectiveness of diagnosis and treatment of ureteral stone during pregnancy. The appropriate management may be helpful to reduce morbidity of urinary calculi during pregnancy.

Adolescent↗