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PubMed1997

Intracorporeal pneumatic lithotripsy for ureteral and vesical calculi.

To evaluate the effectiveness of pneumatic lithotripsy, 92 patients with 98 lower or mid-ureteric calculi and 8 with vesical calculi were treated with pneumatic lithotripsy (Swiss Lithoclast) under spinal anaesthesia. Successful stone fragmentation was achieved in 96 patients. In two patients their stones migrated to the upper ureter and renal pelvis during the procedure and so they were referred for extra corporeal shock wave lithotripsy. Total ureteral avulsion occurred in one patient and in another case attempts to dilate the stenotic ureteral orifice failed. In both cases, ureterolithotomy and ureteral reimplantation were performed. Pneumatic lithotripsy is found to be an easy, reliable and cost-effective method of endoscopic lithotripsy.

Adult↗
PubMed1990

[Clinical application of Therasonic lithotripsy treatment system for upper urinary tract calculi].

Extracorporeal shock wave lithotripsy (ESWL) using a Therasonic lithotripter was performed on 30 patients with urinary tract calculi between July, 1989 and February, 1990. The results obtained in 31 cases (one patient had bilateral renal stones) were presented. There were 22 inpatients and 8 outpatients in this series. The stone location was: renal pelvis in 15 cases, renal calyces in 10 cases, parenchyma or diverticulum of renal calyces in 3 cases, ureteropelvic junction in 1 case, and upper ureter in 2 cases. Sixteen cases (52%) became stone-free and residual stones (less than or equal to 4 mm) remained in 9 cases (overall effective rate 81%) at one month after the treatment. There were no serious complications including bacteremia and renal hematoma. We concluded that Therasonic lithotripter is useful in the management of upper urinary tract calculi.

Adult↗
PubMed1990

Surgical management of urinary calculi.

Shock wave lithotripsy is the cornerstone of the modern management of urinary calculi and is the preferred treatment for most small renal stones. Percutaneous lithotripsy is preferred for large stones and in combination with ESWL for staghorn calculi. Upper ureteral stones should be pushed back to the kidney for ESWL, if possible; otherwise they should be treated in situ. Lower ureteral stones are preferentially managed with ureteroscopy, but ESWL may also be used. A variety of methods of power lithotripsy are available: ultrasound, electrohydraulic lithotripsy, and pulsed dye laser lithotripsy. Only 1% to 2% of stone patients require open surgery; it is an important judgment to identify these patients to avoid inappropriate use of newer techniques in cases where success is unlikely. It is apparent that modern management of the patient with a urinary calculus requires access to all methods of stone removal. The surgeon and internist should not forget that the goal is to remove the stone safely, efficaciously, and economically.

Endoscopy↗
PubMed1986

Crystalline composition of equine urinary calculi.

X-ray diffraction crystallography was used to determine the crystalline composition of 18 equine urinary calculi, including stones originating in the kidney, bladder and urethra. Calcium carbonate in the form of calcite was found to be the major component in all calculi examined. Other components commonly found included weddellite and substituted vaterite. Urine deposits from a number of normal horses were also examined. The significance of these findings, as well as those from a number of previous reports, are discussed in relation to the possible aetiology of urolithiasis in the horse.

Animals↗
PubMed1986

Studies on serum mucoproteins in patients with urinary calculi.

A significant increase in serum mucoproteins in stone patients has been observed previously. The present study describes the variation of the constituents of mucoproteins obtained on hydrolysis. The serum mucoproteins of 31 patients with urinary calculi (13 with kidney stone, 7 with bladder stone and 11 with stones in other sites) were analysed and compared with that of 15 healthy control subjects, who had no personal or family history of calculi. The mucoproteins, glycosylated serum proteins, hexosamine and sialic acid were increased in all patients irrespective of the site of stone, while uronic acid decreased as compared with the control subjects. Serum fucose increased in all patients except in kidney stone formers. Uronic acid decreased in all stone formers irrespective of the site of the stone. It is suggested that a different type of mucoprotein is present in such patients.

Adolescent↗
PubMed1978

Studies in urolithiasis. III. Electron optical investigation on the morphology of the colloidal matrix of urinary calculi.

An electron optical investigation of the morphology of the colloidal matrix of renal and vesical urinary calculi revealed the presence of several morphologic forms hitherto unknown. Earlier light microscopic studies indicated that the matrix exists either as fibrils or as an amorphous matrix. The electron micrographic scanning of specimens of calculi revealed the following matrix morphologies: (i) flaky, (ii) serrated, (iii) perforated (globular), (iv) hollow tubular, (v) fibrillar, (vi) cylindrical, and (vii) pear-drop shaped. Crystalline matter was not associated with flaky and serrated matrix particles. However, some matrix particles of perforated (globular), fibrillar, and cylindrical morphologies were found to be calcified.

Humans↗
PubMed1996

[Endoscopic techniques in the treatment of calculi in the upper urinary tract].

There is no single method for treating all urinary calculi. Because of the non-invasive nature of extracorporeal shock wave lithotripsy this method has been embraced by patients and doctors alike. However, some 15-20% of the patients require more invasive methods like percutaneous nephrolithotripsy and ureteroscopy to get rid of their stones. Percutaneous nephrolithotomy is best employed for large stones (> 2.5 cm diameter), staghorn calculi, renal anatomic abnormalities and hard stones and in patients whose anatomy precludes the use of lithotriptor. With the advent of ureteroscopes of much smaller diameter, endourologic intervention has become a steadily safer and more effective means of treating stones in the ureter. With ureteroscopic techniques success rates up to 97% have been reported. A large number of stones have to be fragmented before retrieval. Both ultrasonic and electrohydraulic lithotripsy have been available since the introduction of ureteroscopic techniques. The devices, however, are limited by their size (in the case of ultrasound) and for safety reasons (in the case of electrohydraulic lithotripsy). Laser lithotripsy has received attention as an alternative method of fragmentation which also can be applied with flexible ureteroscopes.

Contraindications↗
PubMed1976

[Urolithiasis and its conservative treatment based on analysis of the calculi].

The exact analysis of urinary calculi is the condition for an aimed conservative therapy of urolithiasis. As standardized method of the analysis of urinary calculi the X-ray diffraction was introduced in the GDR. This investigation method allows a qualitative and quantitative analysis of the concrements. The possibilities of the conservative therapy of urolithiasis were explained. To this conservative treatment belong the treatment of a colic, the removal of a calculus, the litholysis and the prophylaxis of recidivations.

Colic↗
PubMed1983

Acute cholecystitis and common-duct calculi.

The detection of common-duct stones is important in the treatment of patients with acute cholecystitis. The records of 256 patients with histopathologically confirmed acute cholecystitis were reviewed retrospectively. Associated choledocholithiasis was found in 32 (12.5%). Preoperative serum bilirubin and alkaline phosphatase levels were inconsistent predictors of common-duct calculi. Gray-scale ultrasonography is useful in the diagnosis of acute cholecystitis, but its role in the detection of common-duct calculi is uncertain. Dilated bile ducts were found in only three of eight icteric patients examined with ultrasonography. Intraoperative cholangiograms were obtained in 24 of 32 patients with choledocholithiasis, and common-duct stones were successfully demonstrated in 23 of these. Intraoperative cholangiography is a reliable method of detecting common-duct calculi and should be routinely used in the surgical treatment of acute cholecystitis.

Adolescent↗
PubMed2003

Percutaneous removal of retained calculi from the abdomen.

With rising pressure placed on health service resources minimally invasive techniques requiring only short hospital admissions are increasing in importance. We describe the techniques used to remove calculi from the peritoneal cavity which had been retained after surgery and continued to cause clinical problems. In both cases described the calculi lay within abscess cavities associated with fistulous tracks to the skin. The fistulae were dilated to allow passage of therapeutic radiologic and endoscopic equipment enabling manipulation and subsequent extraction of the stones. In both cases removal of the calculi allowed complete resolution of the fistulae and the patients made a full clinical recovery. Removal of gallstones which have escaped into the peritoneum at laparoscopic cholecystectomy leading to sepsis has been described; we describe the novel management of a patient in whom extraction had already been attempted, at another hospital, without success. Removal of an appendicolith, described here in another patient, does not appear to have been reported previously.

Abdomen, Acute↗
PubMed2005

Bile infection contributes to intrahepatic calculi formation after excision of choledochal cysts.

Intrahepatic calculi complicate choledochal cysts in 7-8% of patients. Although congenital stenoses and dilatation of the intrahepatic bile ducts are considered responsible for calculi formation, intrahepatic calculi are usually formed after cyst excision. In this study, bile specimens from patients with choledochal cysts were cultured for bacteria. Results were retrospectively analyzed among the following groups: the primary excision group, consisting of 97 patients undergoing cyst excision as a primary treatment (mean age 5.0 years), the internal drainage group, consisting of 13 patients who had previous cyst-enterostomy at cyst excision (mean age 20.2 years); and the hepatolithiasis group, consisting of 12 patients with postoperative hepatolithiasis (mean age 24.2 years). Bacteria were present in the bile of 10 patients (76.9%) in the internal drainage group and in all patients (100%) in the hepatolithiasis group, but present in only 17 patients (17.5%) in the primary excision group (p<0.01). Polymicrobial infection with Gram-negative enterobacteria such as Escherichia coli and Klebsiella species was predominant in the internal drainage and hepatolithiasis groups, while nonenteric bacteria were found in the primary excision group. Bile infection through bilioenterostomy may play an important role in intrahepatic calculus formation after excision of a choledochal cyst.

Adolescent↗
PubMed1999

E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi.

BACKGROUND: The current management of patients with gallstone disease and ductal calculi consists of endoscopic stone extraction (ESE) followed by laparoscopic cholecystectomy (LC). Following the advent of techniques of laparoscopic ductal stone clearance, an alternative single-stage laparoscopic treatment was introduced for these patients. The European Association of Endoscopic Surgery (E.A. E.S.) set up a ductal stone trial to compare the relative efficacy and outcome of these two management options. METHODS: A prospective randomized controlled clinical trial compared two management options. Group A (n = 150) received preoperative endoscopic retrograde cholangiography (ERC) with ESE followed by LC during the same hospital admission, and group B (n = 150) received single-stage laparoscopic management. RESULTS: There were no significant differences between the two groups in the clinical demographic details and the pretreatment biochemical findings. In group A, 14 of 150 patients received single-stage treatment; in group B, 17 of 150 were managed by the two-stage approach (protocol violation = 31/300, 10%). In group A patients managed in accordance with randomization, ERC was successful in 129/136 (95%) and preoperative ESE succeeded in 82/98 (84%) with ductal calculi detected by the ERC. Two patients had malignancies and one refused surgery. Thus, 133 patients underwent surgery. Of this group, 116 had LC only and 17 had LC and attempted laparoscopic duct exploration. There were eight conversions to open surgery (6%), 17 complications for both stages (12.8%), and two postoperative deaths (1.5%). In group B patients managed in accordance with randomization, intraoperative cholangiography was successful in 132/133 (99%). Twenty-one (16%) had normal findings, ductal calculi were found in 109, and other pathology was noted in two (periampullary cancer, severe pancreatitis). These two patients and one other (who had gross adhesion in the triangle of Calot) were converted at the start of the procedure. Transcystic ductal stone clearance was successful in 45 of 56 patients (80%), and laparoscopic direct common duct (CBD) exploration was successful in 47 of 55 patients (85%). This group includes 53 patients who underwent primary direct exploration and two failed attempts at transcystic extraction. The conversion rate was 13%. Postoperative complications were encountered in 21 patients (15.8%), and one patient died of a major myocardial infarction (0. 75%). The one postoperative death and the 10/11 biliary complications occurred in the laparoscopic supraduodenal CBD exploration subgroup. The conversion rate was higher in group B (17 vs eight; p = 0.08). Laparotomy in the postoperative period was required in three patients in group A and four patients in group B. The group B patients were in hospital for 3 days less than patients who had two-stage management (median, 6.0, IQR = 4.25-12 vs median, 9.0, IQR = 5.5-14; p < 0.05). CONCLUSIONS: The results demonstrate equivalent success rates and patient morbidity for the two management options but a significantly shorter hospital stay with the single-stage laparoscopic treatment. The findings indicate that in fit patients (ASA I and II), single-stage laparoscopic treatment is the better option, and preoperative ESE should be confined to poor-risk patients-i.e., those with cholangitis or severe pancreatitis.

Adolescent↗
PubMed1987

Fragmentation of biliary calculi with tunable dye lasers.

The feasibility of using lasers to fragment biliary calculi was examined in vitro. Flashlamp-pumped tunable dye lasers were coupled to small-diameter flexible quartz fibers that were placed in direct contact with biliary calculi. The minimum laser energy necessary to damage a calculus was measured for wavelengths between 450 and 700 nm and for pulse durations between 0.8 and 360 microseconds. This threshold energy increased with increasing wavelength but was not significantly affected by pulse duration. Cholesterol stones had uniformly higher thresholds than pigmented ones. When a repetitively pulsed laser was used, complete fragmentation required fewer than 500 pulses and fragments were predominantly less than 2 mm. The pulsed dye laser can effectively fragment biliary calculi when transmitted through a small-diameter quartz fiber and may be useful as a tool for fragmenting retained common duct stones.

Cholelithiasis↗
PubMed1978

Comparison of endoscopic retrograde and intravenous cholangiography in diagnosis of biliary calculi.

The results of endoscopic retrograde cholangiography (E.R.C.) and intravenous cholangiography (I.V.C.) were compared in patients undergoing surgery for biliary calculi. E.R.C. gave a significantly higher rate of correct diagnosis of gallbladder calculi (p = 0.026) and common bileduct calculi (p = 0.002) than I.V.C. Biliary stones may thus frequently be present in patients with a normal I.V.C. and E.R.C. may reduce the rate of diagnostic errors in patients with symptoms of biliary disease.

Cholangiography↗
PubMed1986

[Results of sonographic diagnosis of choledochal calculi].

To evaluate sonographic accuracy in the diagnosis of choledochal calculi 44 patients were examined prospectively with a mechanical sector scanner before endoscopic retrograde cholangiography (ERC). Calculi with a diameter of more than 1.5 cm could be detected in all cases. Smaller stones (less than 1 cm) were missed in 50% of cases. To quantitate sensitivity in daily clinical practice, the data of 229 patients, suspected to have common bile duct stones, were analysed retrospectively. The overall accuracy was 76%, 90% when an experienced sonographer performed the examination and 47% if the examiner was less experienced. From these data it is concluded that the sonographic detection of choledochal calculi is influenced by the examination technique, experience of the examiner and diameter of the stones.

Adult↗
PubMed1982

Recurrent biliary calculi: duodenal diverticula as a predisposing factor.

Several studies indicate a causal relationship between duodenal diverticula and gallstone disease. The diverticula persist after biliary tract surgery, and it is therefore presumed that patients with diverticula have an increased disposition to develop new calculi in the bile ducts after cholecystectomy. To test this hypothesis, the occurrence of recurrent biliary calculi was studied in 101 patients who had cholecystectomy, all with an asymptomatic period of two years or more following the primary biliary surgery. All patients had symptoms, that indicated biliary tract or pancreatic diseases. The incidence of recurrent calculi in patients with diverticula was 87.5% (95% confidence interval, 66.9-95.8). In patients without diverticula, the incidence was 31.9% (95% confidence interval, 21.5-44.3). The difference is highly significant, and the results support the assumption tht diverticula in the area of the papilla of Vater dispose to gallstone disease.

Aged↗
PubMed1992

Sclerosing cholangitis and biliary tract calculi--primary or secondary?

The clinical features of 61 patients with sclerosing cholangitis were reviewed. This group included 23 patients with biliary tract calculi, commonly considered as excluding the diagnosis of primary sclerosing cholangitis. The aim of this study was to compare these 23 patients (group A) with 38 patients with sclerosing cholangitis free of calculi (group B). Both groups had the following features in common: (i) age at presentation, (ii) incidence of inflammatory bowel disease, (iii) extent of radiological disease, (iv) prevalence of HLA-B8 and DR3 haplotype, (v) incidence of cholangiocarcinoma, and (vi) progression to hepatic transplantation (mean follow up 49.9 months). All patients in group A were symptomatic at diagnosis compared with 23 of the 38 patients (61%) in group B. Recurrent ascending cholangitis occurred in 12 patients in group A (52%) and two patients (5%) in group B. The similarity between the two groups was maintained when the nine patients in group A who developed calculi after sclerosing cholangitis was diagnosed were excluded. It is concluded that choledocholithiasis is part of the spectrum of primary sclerosing cholangitis and that it is not necessary to invoke choledocholithiasis as the initial lesion of the bile ducts in such patients.

Adolescent↗
PubMed1983

Percutaneous transhepatic cholangiography with the Chiba needle in patients with biliary calculi.

In a prospective study, 276 consecutive patients were evaluated using percutaneous transhepatic cholangiography (PTC) with a Chiba needle prior to surgery for cholestasis. Biliary calculi were diagnosed in 109 patients. The success rate was 92.4% overall, 93.6% among patients with biliary calculi, 83.3% in those with cholelithiasis, 97.3% in those with choledocholithiasis, and 100.0% in those with intrahepatic stones. The overall morbidity rate was 4.6%, including hemoperitoneum in 1.8% and bile leakage in 2.8%. There were no deaths. This technique offers a more definitive diagnosis than noninvasive procedures, especially with small calculi, but is also more traumatic. PTC may play an important role when noninvasive methods are inconclusive or in difficult cases, particularly following surgery on the common bile duct.

Adolescent↗