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At least 775 records · Page 43Linked to original sources
PubMed2002

Evaluation of disintegration in prevesical ureteral calculi by 3-dimensional endo-ultrasound with surface rendering.

PURPOSE: Lower ureteral calculi are accessible by transrectal endo-ultrasound, including 3-dimensional image processing with surface rendering. We analyzed the efficiency of this innovative technology compared with that of standard radiographic examinations with respect to the outcome of extracorporeal shock wave lithotripsy (ESWL) (Dornier Medical Systems, Marietta, Georgia). MATERIALS AND METHODS: In patients with prevesical or intramural calculi we performed excretory urography and transrectal endo-ultrasound using a Combison 530 device (Kretz Technik, Zipf, Austria) with integrated optional 3-dimensional image processing and surface rendering. A total of 102 ESWL cases (108 radiopaque stones, 145 ESWL sessions) were included in the study. One day after ESWL an evaluation was independently performed by a radiologist (plain x-ray) and a urologist (transrectal endo-ultrasound). Results were compared to the outcome determined during further followup. RESULTS: All stones were evaluable by endo-ultrasound with surface rendering, whereas in 27 cases the stone was hidden by extraureteral processes on followup radiography. Immediately after endo-ultrasound 8 calculi were passed. In 7 of the remaining 110 cases (6.4%) radiographic examination did not confirm sonographic findings. In these cases evaluation by surface rendering proved to be correct on followup. CONCLUSIONS: Endo-ultrasound with surface rendering proved to be highly effective for evaluating ESWL success in cases of prevesical ureteral stones. This technique is independent from bowel gas or other factors that impede radiological imaging. It is safe, easy to learn, well tolerated by patients and does not expose them to radiation.

Adult↗
PubMed2002

Extracorporeal shock-wave versus pneumatic ureteroscopic lithotripsy in treatment of lower ureteral calculi.

AIM: To compare the efficacy and complications of extracorporeal shock-wave lithotripsy (SWL) and pneumatic ureteroscopic lithotripsy (URS) in the treatment of lower ureteral calculi. METHODS: From August 1997 to June 1999, 210 patients with calculi in the distal third of the ureter were treated with SWL and the other 180 with URS. The stones were fragmented with either HB-ESWL-V lithotripter or JML-93 pneumatic lithotripter through Wolf 7.5 approximately 9.0 Fr ureteroscope. The outcome was assessed in terms of stone clearance rate, re-treatment rate and complication incidence. RESULTS: The stone clearance rate was 78.1 % with SWL and 93.3 % with URS (P<0.05). SWL had a re-treatment rate of 11.9 %, vs 2.2 % in the URS group (P<0.05). URS caused ureteral perforation in 3.3% of patients, while it was 0 with SWL (P<0.05). The differences in the incidence of other complications such as infection and stricture between the two groups were insignificant. CONCLUSION: Though the selection of these two options depends on equipments available and the expertise of the operator, we recommend URS as the optimal treatment for distal ureteral calculi.

Adolescent↗
PubMed2003

[Clinical investigation of the treatment of children urethral calculi with pneumatic lithotripsy under ureteroscopy].

OBJECTIVE: To evaluate the therapeutic effects of pneumatic lithotripsy on children urethral calculi. METHODS: Twenty-two cases of the male children with urethral calculi were treated with pneumatic lithotripsy under ureteroscopy. RESULTS: All the patients were treated successfully in a single procedure. The time of lithotripsy was (5.5 +/- 2.2) minutes, and no serious complication such as obvious hematuria, infection and urethral stricture occurred. CONCLUSIONS: It is suggested that pneumatic lithotripsy under ureteroscopy is an effective and simple way for the treatment of urethral calculi in children.

Adolescent↗
PubMed2004

Extracorporeal shockwave lithotripsy and intracorporeal lithotripsy for proximal ureteric calculi--a comparative assessment of efficacy and safety.

INTRODUCTION: Extracorporeal shockwave lithotripsy (ESWL) is the treatment modality of choice of many urologists for proximal ureteric calculi. In this study, we compared the efficacy and safety of ESWL versus ureteroscopy with holmium laser lithotripsy for the treatment of this group of stones. MATERIALS AND METHODS: Between May 1999 and October 2000, 50 patients had ESWL and another 51 patients underwent ureteroscopy with holmium laser lithotripsy for proximal ureteric calculi. The two groups were similar in age, sex ratio and stone size. ESWL was performed with the Dornier Compact lithotriptor whereas holmium laser lithotripsy was performed via retrograde ureteric access with a Wolf 7.5 Fr semirigid ureteroscope. RESULTS: Ureteroscopy with holmium laser lithotripsy was significantly better in terms of the mean procedure time (56 min in ESWL; 25 min in ureteroscopy; P < 0.001) and the 1-month stone free rate (50% in ESWL; 80% in ureteroscopy; P = 0.001). The 3-month stone free rate was also higher for ureteroscopy (78% in ESWL; 90% in ureteroscopy) but this difference was not statistically significant (P = 0.09). Minor complications of steinstrasse (6%) occurred in ESWL and proximal stone migration (8%) occurred during ureteroscopy. CONCLUSION: Ureteroscopy with holmium laser lithotripsy is a viable and safe alternative to ESWL for the management of proximal ureteric calculi.

Adult↗
PubMed2005

[Treatment of ureteral calculi with ballistic lithoclast].

OBJECTIVE: To evaluate the availability of ballistic lithoclast in treatment of ureteral calculi. METHODS: Totally 625 patients with ureteral calculi were treated with ballistic lithoclast by rigid ureteroscopy. RESULTS: Totally 610 patients were treated successfully by ballistic lithoclast with a cure rate of 97.6% (90.3% in upper ureter, 96.8% in middle ureter, 100% in lower ureter). The average time of lithoclast was (5.0 +/- 2.8) minutes and the stone-free rate was 99.2%. CONCLUSION: Ballistic lithoclast combined with rigid ureteroscopy is safe and effective in treating ureteral calculi.

Adult↗
PubMed1992

[The "in situ" treatment of ureteral calculi with extracorporeal lithotripsy].

The authors report on 80 cases of ureteral calculi treated with in situ extracorporeal shock wave (ESWL), with no retrograde or antegrade maneuvers. Success rate was high (97.5%). Forty-two calculi were located in the proximal ureter above the sacroiliac joint; 10 were in the pre-sacral ureter, and 28 in the pelvic ureter, below the inferior border of the sacroiliac joint. After ESWL, double-J stents were positioned in 5 patients and nephrostomy was performed in 4 cases with positioning of 7-F pig-tail catheters; 8 patients (10%) underwent additional post-lithotripsy urologic and radiologic examinations. Lithotripsy having failed in 2 patients (2.5%), surgery with ureterolithotomy was performed. In situ ESWL of ureteral calculi emerges from this trial as the treatment of choice and not as an alternative to urologic maneuvers or open surgery with ureterolithotomy: the latter methods are necessary only after ESWL failure.

Adult↗
PubMed2005

[High-power holmium laser with percutaneous nephrolithotripsy for kidney calculi].

OBJECTIVE: To assess the efficacy and safety of the high-power holmium laser with percutaneous nephrolithotripsy for kidney calculi. METHODS: The high-power (60 W: 3.0 J x 20 Hz) holmium laser with percutaneous nephrolithotripsy was performed on 52 patients with single kidney pelvic or calyceal stones (average stone diameter 3.1 cm), 36 patients with multi-kidney pelvic and calyceal stones (average diameter 2.8 cm), 24 patients with staghorn stones (average diameter 6.8 cm). The duration of stone surgery, stone-free rate and complication were assessed. RESULTS: The mean duration of stone surgery was 44 min, the stone-free rate was 66% (74/112) after the first session, 89% (100/112) at the end of session. 3 patients had high fever after percutaneous nephrolithotripsy, no other adverse events were noted. CONCLUSIONS: The high-power holmium laser with percutaneous nephrolithotripsy can fragments calculi quickly and reduces the length of time of operation. It is an effective and safe technique for kidney calculi.

Adolescent↗
PubMed2006

Medical management of common urinary calculi.

Nephrolithiasis is a common condition affecting nearly 5 percent of U.S. men and women during their lifetimes. Recurrent calculi can be prevented in most patients by the use of a simplified evaluation, reasonable dietary and fluid recommendations, and directed pharmacologic intervention. Serum studies and 24-hour urine collections are the mainstays of metabolic investigation and usually are warranted in patients with recurrent calculi. Although some stones are the result of inherited conditions, most result from a complex interaction between diet, fluid habits, and genetic predisposition. Calcium-sparing diuretics such as thiazides often are used to treat hypercalciuria. Citrate medications increase levels of this naturally occurring stone inhibitor. Allopurinol can be helpful in patients with hyperuricosuria, and urease inhibitors can help break the cycle of infectious calculi. Aggressive fluid intake and moderated intake of salt, calcium, and meat are recommended for most patients.

Acute Disease↗
PubMed1990

[Frequency, localization and associated disorders in urinary calculi. Analysis of 1671 autopsies in urolithiasis].

In the area of Rügen-Stralsund a maximum value of urolithiasis and cholelithiasis was found. In 27,133 autopsies the frequency of urolithiasis was 6%. Obesity, hypertension and diabetes mellitus may increase the tendency of cholelithiasis patients to develop additional urolithiasis. Ureteral and urinary bladder calculi are more frequently among male patients. In cases with benign prostatic hyperplasia the incidence of urolithiasis was not higher than in female patients. In the autopsy material multiple calculi and bilateral cases occur more frequently. Hypertension and increased heart weight did occur more frequently in patients suffering from oxalate lithiasis. Some of the calculi may develop in the terminal age of life.

Adolescent↗
PubMed1976

Composition of some urinary calculi of ruminants in Western Australia.

Forty ruminant urinary calculi, selected as being essentially inorganic and mainly obtained from sheep grazing in the drier wheatbelt areas of Western Australia, were examined by optical and X-ray diffraction techniques. Four mineral types-silica (SiO2-nH2O), weddellite (CaC2O4-2H2O), calcite (CaCO3) and aragonite (CaCO3)--were found. These minerals were present respectively in 30, 17, 13 and 1 of the 40 calculi examined and were the sole component in 12, 0, 7, and 0 calculi. One calculus was found to be composed of organic material which was subsequently shown to consist mainly of 4'-O methyl equol (4'-methoxy-7-isoflavanol, C16H16O3) with a small amount of equol and a trace of formononetin. This is the first report of a calculus of this composition. Determinative data useful for identification of 4'o-methyl equol, equol and a related substance are presented in an appendix.

Animals↗
PubMed1990

In vitro fragmentation of renal calculi of different components using electrohydraulic shock wave, ultrasound, and pulsed dye laser as energy sources: a preliminary report.

Renal calculi of five different components (whewellite, weddellite, struvite/apatite, uric acid, and cystine) received in vitro fragmentation by three energy sources currently available in endourology: electrohydraulic shock waves, ultrasound, and pulsed dye laser. Weddellite, struvite/apatite, and uric acid calculi were sufficiently disintegrated by all three energy sources. Whewellite stone was best treated by electrohydraulic shock waves, while cystine calculus was penetrated only by ultrasound. The ultrasonic lithotriptor was safer, but weaker and more cumbersome. The electrohydraulic lithotriptor was more powerful, but violent. The laser lithotriptor was both safe and powerful. However, there was not a single energy source that sufficiently disintegrated all five kinds of calculi mentioned.

Apatites↗
PubMed1991

[Personal experience with infrared spectrometry analysis of urinary calculi].

Analysis of urinary concrements has a very important place in clinical biochemistry departments, as it is one of the basic prerequisites for effective causal therapy and prophylaxis of nephrolithiasis. Qualitative chemical reactions, used most frequently, have shortcomings as regards the identification of components of calculi and do not provide a real idea on the composition of calculi (9). An accurate identification can be made only by physical methods, which, however, call for very expensive equipment. Clinical departments in Prague, Brno and Ostrava collaborate therefore with research institutes which possess the necessary equipment and where the analyses of calculi are made. Because the majority of clinical biochemical departments have limited access to modern infrared computer controlled spectrometers, this form of collaboration was used also in the authors' department.

Humans↗
PubMedDate not supplied

[Percutaneous nephrolithotomy of renal staghorn calculi. Experience with monotherapy treatment].

Seventy patients with renal staghorn calculi were treated with percutaneous nephrolithotripsy monotherapy. Nine patients (13%) required more than one nephrostomy to remove the stone: an overall success rate was obtained in 67% of the cases, with 27% of residual asymptomatic fragments. Open surgery was necessary in 4 patients for complications. No nephrectomies were carried out. Comparing complete and partial, better results as expected, were obtained in partial staghorn calculi. Evaluating results stratified per number of treatments, we obtained a stone-free rate of 35% with only one treatment, and 61% with two percutaneous sessions, at the discharge from the hospital. To date, initial percutaneous debulking of the stone followed by ESWL treatment on residual stones, seems to be the most suitable approach to branched calculi. However, in selected cases, PCNL treatment alone, can obtain removal of the stone in a significant percentage of cases, with minimal morbility, and, what's more, at the discharge from the hospital, without any ancillary procedure or rehospitalization.

Adult↗
PubMed1991

[Exclusive piezo-electric lithotripsy (EDAP LT 01) in the treatment of calculi larger than 30 mm. Pyelic, partial or total staghorn].

Thirty patients with partial of total staghorn calculi or pyelic calculi greater than 30 mm were treated by extracorporal piezo-electric lithotripsy (PEL) exclusively with an EDAP LT 01 lithotripter equipped with an ultrasound localisation system. Nineteen patients had a pyelic calculus and the others a partial (n = 9) or total (n = 2) staghorn calculus. All patients first underwent extracorporal lithotripsy (ECL). None of the patients received IV sedation or anesthesia. When fragmentation of the calculus was observed after the first session, a double J stent was inserted before the second ELC session. Before the first session, urine samples were sterile in 18 of the 30 patients; 12 of the 30 patients presented major distention of the urinary tract. Results were analysed to identify factors affecting results of this type of treatment. Patients whose calculus had completely disappeared on plain films three months after the first session were considered to be cured clinically and radiologically (14/30 = 46%). Seven patients (23.3%) were clinically cured (absence of pain and sterile urine) but there were residual fragments (1 to 3 fragments less than or equal to 4 mm). No fragmentation was obtained after the first session in 9 patients (30.7%) (1 total staghorn, 8 pyelic calculi). The mean number of sessions was 5 (range 1-15). Only 10% of the patients (3/30) presented a complication: 2 steinstrasses and 1 acute pyelonephritis. 83% of the patients without urinary tract distention and 55% of the patients whose urines were initially sterile were cured.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Urinary calculi in hypercalcemic states.

In this brief review of various hypercalcemic disorders and the likelihood of renal calculus formation, it is clearly evident that renal calculi occur much more often in hyperparathyroidism than in the other hypercalcemic states. Dystrophic calcification and nephrocalcinosis are common to all of the hypercalcemic disorders, including hyperparathyroidism, when the hypercalcemia is marked and the limit of solubility of calcium and phosphate in serum is approached. Interestingly, in sarcoidosis there are calcium oxalate crystals in variously distributed sarcoid granuloma, and the renal calculi are composed of calcium oxalate. By contrast, in hyperparathyroidism, the calculi composed of calcium phosphate predominate. This indicates a subtle and as yet undefined alteration in oxalate metabolism in sarcoidosis. An increase in urine pH occurs in hyperparathyroidism, and this enhances formation of crystalline calcium phosphate. However, the striking disparity between the frequency of calculus formation in hyperparathyroidism and that in other hypercalcemic disorders, several of which may be of relatively long duration, suggests that there indeed may be increased promoters of crystal formation in the urine of hyperparathyroid patients.

Diagnosis, Differential↗
PubMed1990

Preliminary experience with extracorporeal shock-wave lithotripsy monotherapy and bladder calculi.

During the period November 1988 to April 1989, eleven patients with bladder calculi, seen at our Centre, were offered ESWL therapy. However, only eight patients underwent ESWL. One patient passed his stone spontaneously, one requested endoscopic lithotrity as the initial mode of therapy and one underwent transurethral resection of the prostate and simultaneous endoscopic lithotrity of his bladder calculus. This series, though admittedly, small, nevertheless serves to introduce a safe and expeditious modality for the removal of bladder calculi. A high degree of patient acceptance and no treatment failures embolden us to advocate this modality as initial therapy for bladder calculi.

Adult↗
PubMed1990

Structure and composition of canine urinary calculi.

The chemical constituents of 171 specimens of canine urinary calculi have been analysed by infrared spectroscopy. The analysis revealed that 46 per cent of the total contained struvite as the major component; 26 per cent contained cystine; 16 per cent were found to be composed of whewellite and, or, weddellite; 8 per cent of urates; 3 per cent of calcium phosphate (apatite and, or, brushite) and 1 per cent of silica. A series of selected samples was also studied by scanning electron microscopy and energy dispersive X-ray analysis (EDAX). This examination revealed structures similar to human stones. Potassium and complex urates containing two or more cations were commonly found in many areas of ammonium urate and sodium urate calculi. Moreover, EDAX analysis detected a calcium enriched urate in several zones of urate calculi.

Age Factors↗
PubMed1990

Evaluation of open surgery for staghorn calculi in children.

We evaluated the results of open surgery in 19 children with staghorn calculi. The median age was 3.5 years (range 10 months to 14 years). One patient had bilateral calculi, hence 20 renal units were operated upon. Stone clearance was achieved in 19 cases by means of a Gil-Vernet pyelocalycolithotomy, alone (n = 10) or in combination with limited radial nephrotomies (n = 9). Extended nephrolithotomy was performed in only 1 case. Complete stone clearance was achieved in 13 kidneys (65%). Long-term follow-up showed that there was no stone recurrence in any of the 13 renal units rendered completely stone free at surgery. There was symptomatic stone recurrence in 1 of the remaining 7 renal units with small residual fragments left behind, while in 2 others the residual fragments were voided spontaneously. Preoperative and postoperative assessment with 99mTc-DMSA renal scans confirmed that no functional loss resulted in any of the operated kidneys. Open surgery proved to be safe and effective in the treatment of staghorn calculi in children.

Child, Preschool↗