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PubMed1988

Treatment of complete staghorn calculi by extracorporeal shock wave lithotripsy monotherapy with special reference to internal stenting.

Extracorporeal shock wave lithotripsy monotherapy was used to treat 41 patients with complete staghorn calculi. In 20 patients polyethylene angiographic pigtail catheters were inserted prophylactically as ureteral stents and the other 21 patients did not receive stents. Prophylactic stenting reduced the incidence of complications and the need for percutaneous nephrostomy tubes to relieve subsequent ureteral obstruction. Internal stenting maintained the sterility of the urinary tract and reduced the average hospital stay by a third. Residual stone fragments representing less than 5 per cent of the original stone mass remained in 56 per cent of the patients, particularly in those with hydronephrotic kidneys. We suggest that extracorporeal shock wave lithotripsy monotherapy with prophylactic stenting is the preferred treatment for noninfected complete staghorn calculi.

Adult↗

PubMed1988

Current operative management of urinary calculi after renal transplantation.

We examined the medical records of renal transplantation patients at our institution to determine the incidence and etiology of renal calculi after renal transplantation. Of 7 patients identified calculi formed on the basis of congenital hyperoxaluria in 2, secondary to chronic urinary infection in 1 and from iatrogenic causes in 4. We review the various surgical and radiological procedures used to treat these renal transplant patients. We also discuss the role of the new treatment modalities in managing urolithiasis in transplant recipients.

Adult↗

PubMed1988

Clinical efficacy of high frequency jet ventilation during extracorporeal shock wave lithotripsy of renal and ureteral calculi: a comparison with conventional mechanical ventilation.

The use of high frequency jet ventilation compared to conventional mechanical ventilation during general anesthesia for extracorporeal shock wave lithotripsy of renal or ureteral calculi can reduce stone movement. This decrease in stone movement theoretically lessens the total shock and energy requirements for stone fragmentation and perirenal tissue damage. To assess these theoretical advantages of high frequency jet ventilation, we studied patients undergoing extracorporeal shock wave lithotripsy to determine differences in stone movement during high frequency jet and conventional mechanical ventilation (30 patients), and in total shock requirements (1,174 patients). Mean stone movement in the 30 patients was 34.3 +/- 4.3 mm. during conventional mechanical ventilation compared to 4.1 +/- 1.9 mm. during high frequency jet ventilation (p less than 0.001). Mean total shocks were 1,542 +/- 212 (452 patients) during conventional mechanical ventilation compared to 1,217 +/- 165 (722 patients) during high frequency jet ventilation (p less than 0.001). Only 1 patient in the study had clinically significant perirenal tissue damage. We conclude that high frequency jet ventilation when compared to conventional mechanical ventilation results in clinically and economically beneficial decreases in total shocks for extracorporeal shock wave lithotripsy fragmentation of renal or ureteral calculi.

Anesthesia, General↗

PubMed1988

Combination extracorporeal shock wave lithotripsy and percutaneous extraction of calculi in a renal allograft.

Renal calculi are a well documented although uncommon complication of kidney transplantation and may be associated with significant morbidity in this immunosuppressed population with a single functioning kidney. We describe a patient who presented with 2 episodes of staphylococcal bacteremia associated with a ureteral structure and struvite calculi involving the calices, renal pelvis and proximal ureter of a cadaveric renal allograft. The patient was treated successfully with a combination of extracorporeal shock wave lithotripsy, percutaneous extraction and balloon dilation of the ureteral stricture. Renal transplant function was not altered postoperatively. In selected cases shock wave lithotripsy can be used as effective adjunctive therapy in a renal allograft harboring stones.

Combined Modality Therapy↗

PubMed1987

Operative fiberoptic nephroureteroscopy: removal of upper ureteral and renal calculi.

We tested 2 prototypes of an operating fiberoptic nephroureteroscope, measuring 3.5 and 4.5 mm. in diameter, that have an adequate working channel for auxiliary instruments and irrigation. Difficulty in passing the fiberscope through the ureteral orifice was overcome by dilation with balloon and polytetrafluoroethylene (Teflon) dilators. Our initial trial for stone retrieval under fiberscopic control was performed on 21 patients with upper ureteral and renal calculi. A stone was removed successfully in 15 of the 21 patients (71 per cent). After electrohydraulic lithotripsy calculi were extracted successfully in 9 of 11 patients (82 per cent). Three patients suffered ureteral perforation. The fiberscope was especially helpful when an upper ureteral stone moved back to the kidney during stone manipulation.

Adult↗

PubMed1986

Balloon dilation of the ureter: a means to facilitate passage of ureteral and renal calculi.

Dilation of the ureter with a balloon catheter, 20 cm. long and 6 mm. in diameter, passed over a guide wire introduced into the ureter in a retrograde or antegrade fashion has been followed by prompt painless passage of calculi as large as 6 mm. in diameter in 3 patients. Limited radiographic evaluation has revealed no significant sequelae. Our limited experience indicates that it is a safe and expedient method to facilitate passage of ureteral and renal calculi.

Aged↗

PubMed2000

Ureteropyeloscopic treatment of ureteral and intrarenal calculi.

Endoscopic lithotripsy is an essential part of the armamentarium at any complete stone treatment center. It is first-line therapy for complicated upper urinary tract calculi and for patients who fail primary extracorporeal shock wave lithotripsy. In the presented series, ureteroscopy is defined as a safe and particularly effective treatment for upper urinary tract calculi. Endoscope miniaturization, the Holmium laser, and refined surgical technique have positive results. Complications are less frequent today, even with in the most complex large stone burdens being addressed in a retrograde ureteroscopic way.

Humans↗

PubMed2003

[Diagnostic imaging of calculi in the upper urinary tract--sonography vs. computerized tomography].

The choice of the most suitable technique for radiologic evaluation of upper urinary tract stones depends on the precise clinical questions that have to be answered. Many of these questions can still be answered by plain films of the abdomen and excretory urography. This review addresses the value of ultrasonography and computed tomography (CT) with respect to the two most important clinical questions, i.e. 1) presence/extent of obstruction/hydronephrosis and perinephric abscess in patients with acute flank pain; and 2) precise location, number and size of calculi. Because its sensitivity is comparable with CT and it is widely available, ultrasonography in the hands of experienced clinicians/radiologists may be preferred for evaluation of patients with acute flank pain. However, it must be emphasized that ultrasonography may totally miss acute ureteral obstruction/hydronephrosis within the first 12-24 hours. In children as well as in pregnant women, ultrasonography is still the technique of choice, but it may be replaced by magnetic resonance urography in the future. For precise stone location or detection of calcifications, however, the speed, safety and accuracy of unenhanced helical CT make this the most sensitive method and therefore the technique of choice. It also detects urinary calculi more accurately and exposes patients to less radiation than the traditional combined plain abdominal film/intravenous urography. Furthermore, CT can most readily reveal alternative diagnoses in patients with acute flank pain and other intraabdominal pathologies than stones.

Humans↗

PubMed1991

Pulsed dye laser lithotripsy--currently applied to urologic and biliary calculi.

The flash lamp excitation of coumarin dye to produce light energy of the specific wavelength of 504 nm is the basis for the new wave of pulsed dye lasers. Numerous urological applications have been developed. Treatment of ureteral and renal calculi has proven to be an atraumatic and effective treatment modality. Most recently, this technology has been applied to the endoscopic treatment of biliary calculi. The authors review the most recent treatment techniques in both biliary and urinary stone disease.

Cholelithiasis↗

PubMed1995

Comparison of first generation (Dornier HM3) and second generation (Medstone STS) lithotriptors: treatment results with 13,864 renal and ureteral calculi.

Some reports have shown a decreased effectiveness of extracorporeal shock wave lithotripsy (ESWL*) with newer lithotriptors. We used a first generation unmodified Dornier HM3 lithotriptor to treat 5,698 patients with renal and ureteral calculi and a second generation Medstone STS device to treat 8,166 patients with renal and ureteral calculi. The treatment results were compared using the chi-square test to determine statistical significance. The stone-free rate, retreatment rate and post-ESWL secondary procedure rate were 69.5%, 4.4% and 3.1%, respectively, with the Dornier HM3 device and 72.1%, 4.9% and 2.3%, respectively, with the Medstone lithotriptor for single renal stones, and 81.5%, 5.2% and 5.5%, respectively, with the Dornier HM3 and 83.2%, 5.2% and 5.0%, respectively, with the Medstone device for single ureteral stones. There were no statistically significant different results between a second generation tubless Medstone STS lithotriptor and the gold standard unmodified Dornier HM3 instrument.

Chi-Square Distribution↗

PubMed2006

Development of multiple calculi in the duplex system ureterocele.

A 61-year-old man presented complaining of pollakisuria and nocturia. A plain radiograph of his kidney, ureter and bladder and intravenous urography revealed numerous calculi in the upper kidney of his left renal pelvis and ureterocele. A transurethral incision of ureterocele (TUI-ureterocele) and extracorporeal shock wave lithotripsy were performed. On TUI-ureterocele, the many calculi were found to be almost the same size and spherical in form. The postoperative clinical course was uneventful.

Humans↗

PubMed1982

The management of renal and ureteric calculi in renal failure.

The management of 50 patients with renal failure and renal and ureteric calculi is described. Following dialysis and appropriate surgical intervention, renal function improved in 86%. Patients with acute and acute on chronic renal failure improved to nearly normal and remained so on follow-up. Eight per cent of those treated by surgery had retained calculi and 2% developed a recurrence of stones. Sixty-eight per cent showed improvement in hypertension. The mortality rate was 8%.

Acute Kidney Injury↗

PubMed1987

The treatment of uric acid calculi with extracorporeal shock wave lithotripsy.

A review of the first 1000 patients treated with extracorporeal shock wave lithotripsy (ESWL) at UCLA revealed 21 patients with uric acid renal or ureteric calculi. Using the combination of ESWL and oral urinary alkalinisation, 16/21 patients (76%) were stone-free at follow-up 3 months later and 19 patients were stone-free at 5 months. ESWL and urinary alkalinisation are complementary methods for the non-invasive treatment of uric acid renal calculi.

Adult↗

PubMed1988

CT scanning in the diagnosis and management of radiolucent urinary calculi.

The diagnosis of non-opaque calculi can be difficult. In 4 patients with protracted symptoms, 2 had renal pelvic filling defects, 1 a possible filling defect and 1 complete obstruction of the ureter at L4. Non-opaque calculi were readily diagnosed by CT scanning. Three patients have successfully undergone surgery (2 open, 1 percutaneous) and 1 awaits percutaneous nephrolithotomy. Of two stones available for analysis, one was composed of uric acid and the other calcium and phosphate. We recommend CT scanning as the investigation of choice for unexplained filling defects in the renal pelvis and ureter or when a non-opaque calculus is suspected.

Adult↗

PubMed1990

Crystalluria, medullary matrix crystal deposits and bladder calculi associated with an acutely induced renal papillary necrosis.

A single (100 mg/kg) intraperitoneal dose of 2-bromoethanamine hydrobromide induced renal papillary necrosis (RPN) acutely in rodents and caused a transient crystalluria between 4 and 8 h after dosing. These crystals comprised struvite or magnesium ammonium phosphate (MAP) as assessed by shape, solubility, infra-red spectrum and X-ray microprobe analysis. Acid-soluble, bi-refringent crystals were also present within the renal medullary matrix during the same time period as the crystalluria. The presence of the MAP was associated with loss of the anionic renal medullary mucopolysaccharides staining. A total of 5/64 rats with a 2-bromoethanamine-induced renal papillary necrosis and monitored for up to 160 days had bladder calculi that were predominantly MAP. These data suggest that medullary mucopolysaccharide matrix disruption associated with RPN leads to a release of previously bound cations, super-saturation and the nucleation of crystalline MAP. These processes could also be implicated in the formation of MAP bladder calculi.

Animals↗

PubMed1986

Upper urinary tract calculi: extrusion into perinephric and periureteric tissues during percutaneous management.

While the goal of percutaneous management of renal and ureteral calculi is stone extraction or disintegration, perforation of the renal pelvis or ureter may allow stones or stone fragments to become extruded during endourologic manipulations. The authors have encountered six such patients: two with renal and four with ureteral calculi. Three stones were extruded into the perinephric or periureteric tissues during nephroscopy, two during attempted dislodgement with a balloon catheter, and one during antegrade passage of a ureteral catheter. All patients were managed conservatively by means of nephrostomy drainage and, in the four cases of ureteral laceration, ureteral stenting. Follow-up study, ranging from 12 to 24 months, has documented a benign clinical and radiological course. No ureteral strictures have ensued. In the absence of infected urine, urothelial laceration with calculus extrusion appears to be a benign occurrence and may be managed conservatively.

Adult↗

PubMed1997

Extracorporeal shock wave lithotripsy of radiolucent urinary calculi using the Dornier HM-3 and HM-4 lithotriptors.

Between September 1992 and June 1995, 33 patients with radiolucent urinary calculi were treated in our hospital using Dornier HM-3 and HM-4 lithotriptors. There were 11 caliceal stones, 13 in the renal pelvis, and 9 in the ureter. Stone localization was achieved in only 30 patients using intravenous urography or retrograde urography through a ureteric catheter during the procedure. All patients were treated on an outpatient basis, without anesthesia. During the 1st month following extracorporeal shock wave lithotripsy, the patients received alkalization. The overall stone-free rate at 3 months was 90%. The time of radiation exposure was in the range of the opacified stones. Extracorporeal shock wave lithotripsy using Dornier HM-3 and HM-4 lithotriptors proved to be an effective procedure to treat radiolucent urinary calculi when localization of the stone is possible.

Female↗

PubMed1982

Dissolution of bilateral renal calculi via percutaneous nephrostomy. Report of a case.

Both kidneys in a patient with multiple, bilateral renal calculi were treated consecutively by irrigation with a stone-dissolving solution through percutaneously placed nephrostomy catheters. Almost complete dissolution of the calculi was obtained. An intercurrent ureteral calculus necessitated introduction of a second catheter in one kidney, but was also successfully treated.

Adult↗