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PubMed1999

The efficacy of potassium citrate based medical prophylaxis for preventing upper urinary tract calculi: a midterm followup study.

PURPOSE: We examined the efficacy of potassium citrate based medical prophylaxis for preventing upper urinary calculous recurrence, and compared it with the stone recurrence rate in patients who only received intermittent or no medical prophylaxis. MATERIALS AND METHODS: We retrospectively reviewed the records of 493 patients with upper urinary calculi, of whom 237 men and 76 women with a mean age of 56.1 and 51.4 years, respectively, were enrolled in the study. Of the 313 participants 64 (group 1, 20.4%) received regular medical prophylaxis for 24 to 42 months (mean 27.8), 80 (group 2, 25.6%) received intermittent medical prophylaxis for 1.5 to 19 months (mean 7.9) and 169 (group 3, 54%) did not receive any medical prophylaxis. RESULTS: At midterm followup of 24 to 60 months 107 patients (34.2%) had stone recurrence. In group 1 the stone recurrence rate was 7.8%, which was significantly less (p <0.001) than in groups 2 (30%) and 3 (46.2%). Similarly new calculous events in patients with a history of multiple stone recurrence were less frequent in group 1 than in groups 2 and 3 (9.7, 47.4 and 52.2%, respectively, p <0.001). Multiple stone recurrence history, hypercalciuria, hyperuricosuria and calcium oxalate dihydrate calculi were independent risk factors for stone recurrence. CONCLUSIONS: Regular medical prophylaxis may effectively prevent stone recurrence regardless of previous treatment modalities, stone composition, metabolic abnormalities and stone-free status. Cost effectiveness, patient compliance and gastrointestinal upset may limit patient acceptability and clinical use of medical prophylaxis. However, patients with a history of multiple stone recurrence, calcium oxalate dihydrate stones, hypercalciuria and hyperuricosuria benefit from regular medical prophylaxis.

Adult↗
PubMed1990

[Endoscopic removal of urinary calculi in children].

In 55 children less than 14 years old urinary calculi have been removed endoscopically. In larger stones the ultrasonic lithotripsy has been used. Due to our experience and a review of the literature it was found that the majority of urinary calculi in children could be removed endoscopically. The open operation should be used in exceptional cases. Problems, results and complications of the endoscopic approach are described in detail.

Child↗
PubMed1990

[Experience with ESWL treatment of giant kidney and ureteral calculi (based on 1400 cases)].

On the basis of the treatment of 1400 patients who suffered from kidney and ureter stones we may conclude that 80-82% of the extractable stones can be treated with ESWL monotherapy. ESWL proved to be successful in almost every case where there were 2 or 3 cm large--or larger--kidney stones or stones at almost any part of the ureter. The extraction of the larger kidney stones can be helped with stent put up previously, nephrostome or repeated ESWL. We apply other invasive methods more and more rarely. The aiming and treatment of ureter stones which can be found at different parts of the ureter is better with adjuvant laying and diagnostic methods. In the case of staghorn calculi ESWL can be combined with percutaneous operations. In the case of large staghorn calculi traditional operations seem to be the most successful methods after which percutaneous treatment or ESWL can be performed if there are fragments left behind.

Humans↗
PubMed1989

Giant salivary calculi: an orocervical fistula caused by a submandibular gland calculus.

Large calculi of the salivary glands are rare. They may go undetected for many years. The authors report three cases of giant submandibular gland calculi. In one patient, the calculus was an incidental finding. In all patients, the mass was in the substance of the gland; in one, the configuration of the mass was unusual and it had eroded through the floor of the buccal cavity forming an orocervical fistula (the first such report) and in another the mass occupied a small portion of Wharton's duct. The histopathologic findings in all three cases were of nonspecific chronic inflammation. All the patients made a smooth recovery and had no complaints at follow-up.

Adult↗
PubMed1989

Giant vesico-prostatic and prostatic calculi.

Prostatic calculi formation after prostatectomy is an unusual and late complication. We report three such cases of giant size calculi following transvesical prostatectomy. Various aetiological factors and their prevention are discussed.

Aged↗
PubMed1988

[Extracorporeal shock-wave lithotripsy for radiolucent calculi in the upper urinary tract].

Eight years have passed since extracorporeal shock-wave lithotripsy (ESWL) was used clinically for the first time, and now its usefulness is recognized all over the world. At first, variable cases were considered to be contra-indicative, one of which was the radiolucent calculi. This time for two cases of the radiolucent calculi we performed ESWL under retrograde pyelography. Using this technique, we brought the filling defect of RP into the focus of the shock waves. The stones were effectively disintegrated and these patients became stone-free in five weeks.

Humans↗
PubMed1987

[Clinical experience with extracorporeal shock wave lithotripsy (ESWL) in renal and ureteral stones. The 3rd report: Treatment of 59 cases (64 renal stones) of complete staghorn calculi].

This report describes the treatment of 64 cases of complete staghorn calculi using extracorporeal shock wave lithotripsy (ESWL). Thirty cases (46.8%) were successfully treated using ESWL monotherapy and the rest of the cases (53.2%) required ESWL combined with an auxiliary procedure. Forty-four of the cases (68.7%) had symptoms such as fever and pain after ESWL. These cases were treated with chemotherapeutic agents and an auxiliary procedure. X-ray examination showed that the result of ESWL treatment was satisfactory in 97.4% of the 34 cases followed up for more than 12 weeks after ESWL. Based on the results of this study, the following plan of treatment for complete staghorn calculi has been adopted in our hospital. ESWL monotherapy is performed in cases without a dilated collecting system or stricture. ESWL combined with an auxiliary procedure is performed in cases with a dilated collecting system, stricture, ileal conduit and solitary kidney.

Adult↗
PubMed1984

[Effect of SA-504 subtle granules on renal or ureteral calculi].

The effect of the antispasmodic agent, SA-504 subtle granules, was studied. Ninety mg per day of timepidium bromide subtle granules was given orally to 17 patients with renal or ureteral calculi for no less than fourteen days. SA-504 subtle granules as well as the capsule showed good antispasmodic effect and stimulated spontaneous passage of ureteral calculi. No subjective or objective side effects were observed.

Adolescent↗
PubMed1983

Posterior lumbotomy: surgery for upper tract calculi.

Posterior lumbotomy, modified by the adjuvant use of nephroscopy and postoperative stents, is presented as a preferred approach to upper ureteral, pelvic, or caliceal calculi. Its limited morbidity, brief hospitalization, brief operative time, and total efficacy of removal of calculi are the standards with which newer techniques described in this symposium must be compared.

Adult↗
PubMed1983

Disintegration of renal and ureteral calculi with ultrasound.

Disintegration of stones with ultrasound under endoscopic control has eliminated size as the major limitation to percutaneous and transureteral extraction of calculi from the upper urinary tract. With virtually no side effects to soft tissues, approximately 60 per cent of all renal calculi requiring intervention can be managed percutaneously instead of by open surgery.

Cystoscopy↗
PubMed1995

[Clinical studies on treatment by ESWL using EDAP LT-02 for upper urinary tract calculi].

From July 1993 through March 1994, 512 ESWL therapy was performed on upper urinary tract calculi in 277 renoureteral units using an EDAP LT-02 Lithotripter. Of these cases, 244 renoureteral units which were followed up for more than 3 months after ESWL were examined. These included 124 renal stones and 100 ureteral stones. Complete removal or sufficient stone disintegration was obtained in 66.7, 98.0 and 94.1% in the R1, R2 and R3 groups of renal stones, respectively, and in 92.4, 87.5 and 100% in the U1, U2 and U3 groups of ureteral stones, respectively. The over-all stone-free and success rates were 78.2 and 95.2%, respectively for renal stones and 93.0% and 94.0% respectively for ureteral stones. These results were better than those obtained by LT-01 in our experiences. The newly built-in coaxial X-ray system greatly contributed to these high success rates. As side effects, there were no serious complications. It is concluded that ESWL using an EDAP LT-02 is safer and more effective for the treatment of upper urinary tract calculi.

Adult↗
PubMed1997

The role of laparoscopy in the treatment of renal and ureteral calculi.

PURPOSE: We assessed the efficacy of laparoscopy in the treatment of renal and ureteral stones. MATERIALS AND METHODS: Laparoscopic stone extraction was attempted in 11 men and 6 women 22 to 75 years old, including 6 with ureteral and 11 with renal calculi. Of the renal stones 9 were associated with a concomitant pathological condition requiring surgery. Four patients had multiple stones (2 to 93) and stone size ranged from 2 to 60 mm. (mean 15.6). RESULTS: Stones from 15 of 17 patients were removed successfully via laparoscopic techniques. Operative time ranged from 2.33 to 6.35 hours (mean 4.9). Prolonged operating times were associated with ancillary or failed procedures. Blood loss ranged from 20 to 350 ml. (mean 132.9), narcotic requirement from 0 to 100 mg. morphine (mean 26) and hospital stay from 1 to 15 days (mean 4.5). The 3 postoperative complications included prolonged ileus (2) and a retroperitoneal urinoma requiring secondary drainage. CONCLUSIONS: Laparoscopic stone removal is safe and feasible. Indications for this approach include urinary stones associated with an anatomical abnormality requiring urinary tract reconstruction and calculi for which other minimally invasive therapies failed.

Adult↗
PubMed2003

Pneumatic lithotripsy for the management of ureteric calculi.

OBJECTIVE: To determine the efficacy of Swiss lithoclast in the management of ureteric calculi and complications encountered in lithoclasty. DESIGN: A prospective observational study. PLACE AND DURATION OF STUDY: Department of Urology, Lahore General Hospital, Lahore (October 1999 - September 2001). SUBJECTS AND METHODS: Thirty ureteric stones (in 20 subjects) were treated over a 2-year period. Site, size and number of stones were noted in these patients. Swiss lithoclast, introduced through a ureteroscope, was used to break the stone. The Lithotripsy time was 30 min. Stone breakage was assessed by plain X-ray KUB or retrograde pyelography. RESULTS: Fragmentation was complete in 90 % cases. At one week follow up, 90% of patients were stone-free and at 3 months follow-up 95 % of patients had spontaneous passage of the fragments. Re-treatment was required in 5% cases. Mean hospital stay was 2.4 days. Complications (including both significant and minor) occurred in 25% of cases. CONCLUSION: Lithoclasty is safe, simple and effective procedure for ureteric calculi. However, complications of the procedure may prolong the usual 48 hours hospital stay seen in uncomplicated cases.

Adolescent↗
PubMed1983

Percutaneous nephrolithotomy. An approach to branched and staghorn renal calculi.

Using electrohydraulic lithotripsy, we removed branched or staghorn calculi from four patients via a percutaneous nephrostomy tract with local anesthesia. There were no serious complications, and the patients were able to resume their preadmission activities immediately after discharge from the hospital. Our experience suggests that, eventually, all upper urinary tract calculi may be treatable by a percutaneous approach.

Adult↗
PubMed1999

Effect of color Doppler system on the twinkling sign associated with urinary tract calculi.

PURPOSE: The aim of this study was to assess the effect of the color Doppler system on the artifact known as the "twinkling sign." METHODS: Sixty-five patients with at least 1 urinary tract calculus seen on sonography were examined with color Doppler sonography. Two color Doppler systems of 2 different generations were used. Examinations included gray-scale, color Doppler, power Doppler, and spectral evaluations of the calculus with various settings of Doppler gain, velocity range, color filter, focal depth, and acoustic power. RESULTS: A color artifact was present within and/or distal to 29 (39%) of 75 urinary tract calculi when the old generation system was used. Use of the new generation system produced this color artifact within and/or distal to 72 (96%) of the urinary tract calculi. The intensity of the artifact was affected by the acoustic output of the equipment. CONCLUSIONS: The twinkling sign is an artifact that can not only lead to misdiagnosis of vascular flow within a structure but also help differentiate a very small stone from other small echogenic structures when later generation "all-digital" systems are used. The color sensitivity of the system and acoustic power used are important technical factors that affect the production of this artifact.

Artifacts↗
PubMed1981

Ultrasonic detection of renal calculi: accuracy tested in an in vitro porcine kidney model.

Porcine kidneys containing human calculi of known size and composition were used to study the ability of ultrasound to localize intrarenal calculi. The study conducted in a blind fashion demonstrated that stones as small as 2 mm could be detected. The chemical composition was not related to the ability to detect the stone. Early trials in the operating room have been encouraging. The porcine kidney model is useful for training purposes.

Animals↗
PubMed2002

Holmium laser for management of ureterocele calculi.

BACKGROUND AND OBJECTIVES: Although most ureteral calculi will pass spontaneously, those in a ureterocele will usually not pass beyond the stenotic orifice. We address both the stone and the underlying anatomic abnormality of a ureterocele using the holmium:YAG laser. STUDY DESIGN/MATERIALS AND METHODS: We report the first use of the holmium laser to treat ureteral calculi and the ureteroceles responsible for their retention. RESULTS: Two patients have been successfully treated using the described procedure. CONCLUSIONS: The flexibility to treat both the underlying anatomic abnormality and the resultant stone with a single minimally invasive device makes the holmium laser ideal in this situation.

Adult↗