Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Calculi”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 955 records · Page 53Linked to original sources
PubMed1989

Ureteral calculi in children: review of 50 consecutive cases.

Fifty children presenting with ureteral calculi over a twenty-year period were studied retrospectively. There were 35 boys and 15 girls, with a mean age of five and a half years. Nineteen patients had a urinary tract anomaly: 11 had an obstructed megaureter, and 8 had previously undergone urinary tract surgery. Forty-four children had infection stones and the remaining 6 oxalate calculi. Infected urine was found in 35; the infecting organism was a Proteus species in 23. Metabolic abnormalities were detected in 2 children. Operative removal of the stones was done in 39 patients, and in the remaining 11 patients the stones passed spontaneously. There were 6 recurrences, all within four years of initial presentation.

Adolescent↗
PubMed1991

Therapeutic dilemmas in management of cystine calculi.

The appropriate management of patients with cystine calculi necessitates a fundamental understanding of the pathophysiology of cystinuria and a working knowledge of the available therapeutic modalities. The following case reports and review of the literature serve to illustrate that successful treatment involves a multidimensional approach to eradication of calculi with long-term follow-up aimed at prevention.

Adult↗
PubMed1991

Predisposing factors in bladder calculi. Review of 100 cases.

One hundred patients, aged twenty to ninety-two years, underwent 111 procedures for removal of bladder calculi. Most patients (88) had some type of bladder outlet obstruction. Two types of stones were identified: those that had apparently formed in the upper tract and been trapped in the bladder (17 cases) and those that appeared to have formed in the bladder in the presence of various types of outlet obstruction. Stone analysis revealed uric acid stones in 50 percent, calcium oxalate stones in 19 percent, and stones of mixed composition in 31 percent. Five patients had metabolic abnormalities predisposing to stone formation; in 2 cases, these abnormalities were discovered during the evaluation for stone disease. Treatment depended on stone characteristics, associated pathology, and the general health of the patient. A review of the literature with regard to the morbidity and mortality of combining treatment of vesical calculi and bladder outlet obstruction secondary to prostatic obstruction is included.

Adult↗
PubMed1994

Minimally invasive endourologic management of calculi in continent urinary reservoirs.

This study was done to determine whether minimally invasive endourologic management of calculi in continent reservoirs can be done effectively without compromise of urinary continence. Four patients with continent urinary diversions (1 Indiana pouch and 3 Kock pouches) were managed with trans-stomal pouchoscopic ultrasonic lithotripsy (n = 2), prone position extracorporeal shock wave lithotripsy (n = 1), or a "sandwich" combination of these (n = 1) for stone burdens up to 20 cm2. Total hospital stay ranged from one to four (mean = 2.6) days. All 4 patients were initially rendered stone free, and, with follow-up as long as twenty-five months, only 1 has had a recurrence. No patient experienced stomal leakage or other complications. This study suggests that minimally invasive endourologic management of calculi in continent urinary reservoirs can be done safely and effectively to obviate the need for more invasive percutaneous approaches or open surgery, even for some patients with large stone burdens.

Adult↗
PubMed1995

Parotid and submandibular calculi in children.

Twelve pediatric patients with parotid or submandibular salivary gland calculi were successfully diagnosed following appropriately aimed imaging methods. The treatment modalities were: secretory stimulation of the gland to induce spontaneous passage, sialolithotomy or sialadenectomy. The treatment of choice was dependent on the size and location of the calculi, as well as on the affected gland and its functional secretory state.

Adolescent↗
PubMedDate not supplied

Ultrasonic diagnosis of ureteral calculi in patients with acute flank pain.

The diagnostic value of ultrasonography (US) and intravenous urography has been compared in a prospective study comprising 123 consecutive patients with severe acute flank pain of less than 72 hours' duration. Ultrasonography was performed transabdominally with a 5 MHz sector real-time transducer. Ureteral calculi were considered the final diagnoses in 46 patients, of which 35 with and 11 without accompanying hydronephrosis. Ureteral calculi were correctly diagnosed by US in 17 patients (sensitivity 37%). If hydronephrosis with or without calculus is included as a positive sign of ureteral calculus, a correct diagnosis was suggested by US in 34 patients (sensitivity 74%). We consider US to be a valuable method in patients with previous contrast media reactions, but recommend urography as the standard imaging method when renal colic is clinically suspected.

Adolescent↗
PubMed2006

Does rate matter? The results of a randomized controlled trial of 60 versus 120 shocks per minute for shock wave lithotripsy of renal calculi.

PURPOSE: In this study we prospectively compared 2 rates of shock wave delivery, 60 and 120 shock waves per minute, to determine whether rate affects outcome with the Dornier Lithotripter S, a lithotriptor with an electromagnetic shock wave source, for renal calculi. MATERIALS AND METHODS: A total of 104 patients with uncomplicated single renal calculus were randomized and treated. Following a single treatment patients were reviewed at 3 months to determine outcome. A plain abdominal x-ray was performed and the size of any residual fragments was noted. Four patients were lost to followup, 1 in the 60 shock waves per minute group and 3 in the 120 shock waves per minute group. RESULTS: Of the 100 patients with complete followup 49 were treated at 60 shock waves per minute and 51 at 120 shock waves per minute. There was no statistically significant difference between mean stone area treated (p = 0.32) or additional analgesic use in the form of patient controlled alfentanil (p = 0.82). A successful outcome was defined by fragments smaller than 4 mm or stone-free status. At 60 shock waves per minute 59% of patients had a successful outcome compared with 61% at 120 shock waves per minute (p = 0.87) following a single treatment. Post-treatment complications were similar in both groups at 8% for 120 shock waves per minute and 10% for 60 shock waves per minute (p = 0.68). CONCLUSIONS: There was no significant difference in patient controlled analgesia use, complications or outcome between rates 60 and 120. Contrary to previous studies these results suggest that a slower rate of shock wave delivery during extracorporeal shock wave lithotripsy for renal calculi does not improve treatment efficacy with the Dornier Lithotripter S.

Adolescent↗
PubMed2004

Results with 7.5F versus 10F rigid ureteroscopes in treatment of ureteral calculi.

OBJECTIVES: To compare the success and complication rates in the treatment of ureteral stones with a 7.5F versus a 10F ureteroscope. METHODS: A total of 100 patients who were scheduled for ureteroscopy to treat ureteral calculi between December 2000 and December 2002 were randomly assigned to procedures with a 7.5F (group 1; n = 50) or 10F (group 2; n = 50) ureteroscope. The group results were compared. RESULTS: Group 1 had 36 distal, 9 middle, and 5 proximal ureteral stones. Group 2 had 37 distal, 6 middle, and 7 proximal ureteral stones. No statistically significant differences were noted between the two groups with respect to the mean stone size or operation time (P = 0.175 and P = 0.636, respectively). Pneumatic lithotripsy was used in 62% and 50% of the procedures in group 1 and 2, respectively, and stones or fragments were retrieved with basket catheters in 92% and 76% of the group procedures, respectively. The difference between the group rates for successful basket catheter extraction was statistically significant (P = 0.029). Of the patients in group 1 and 2, 84% and 80%, respectively, were stone free after a single procedure (P = 0.603). The corresponding failure rates in the two groups were 6% and 12% (P = 0.295), and the corresponding early and late complication rates in the two groups were 6% and 4% (P = 0.646). None of the patients in group 1 developed late complications. One individual (2%) in group 2 developed ureteral stenosis during long-term follow-up (P = 0.315). CONCLUSIONS: The success and failure rates revealed better outcomes for treatment of ureteral calculi with a 7.5F ureteroscope, but the differences were not statistically significant. The complication rates were similar between the two groups. Basket catheters were used more frequently with the 7.5F scope, and the rates of in situ lithotripsy and postoperative ureteral stent placement were also greater in patients treated with this instrument.

Adult↗
PubMed1991

Pancreatic duct calculi. Treatment by pulsed dye laser.

Endoscopic sphincterotomy with stone extraction has been successful in the majority of patients with biliary stones; however, large biliary stones and pancreatic stones in the smaller pancreatic duct may require a new approach. Pulsed dye laser has proven effective in treating pancreatic duct calculi during ERCP. With an outpatient procedure to eliminate pancreatic duct calculi, patients can be treated safely and effectively without major surgery. The procedure is less invasive for the patient, thereby reducing morbidity and expense.

Calculi↗
PubMed1979

The qualitative analysis of renal calculi with the polarising microscope.

The crystallographic method of Prien and Frondel for the qualitative analysis of renal calculi has been employed for seventeen years. The method was supplemented by occasional chemical tests. Advantages of the crystallographic method over other procedures are the ability to identify specific minerals even in trace amounts, the capability to analyse very small stones, and the rapidity with which analyses can be performed. Data are presented for 1653 calculi.

Humans↗
PubMed1998

Efficacy and cost-effectiveness of extracorporeal shock wave lithotripsy for solitary lower pole renal calculi.

PURPOSE: We determined the efficacy of extracorporeal shock wave lithotripsy monotherapy and compared its cost-effectiveness with percutaneous nephrolithotomy for the management of lower pole renal calculi. MATERIALS AND METHODS: The efficacy (stone-free rates at 3-months posttreatment) of shock wave lithotripsy with the modified Dornier HM3* machine was determined retrospectively in 114 patients with solitary lower pole renal calculi. Using cost data available from patient billing charges and efficacy data from the literature, the cost-effectiveness for percutaneous nephrolithotomy and shock wave lithotripsy as primary therapy was evaluated. To make this cost-effectiveness comparison, we developed a decision analysis model in which a patient in whom primary therapy failed was rendered stone-free with a secondary percutaneous nephrolithotomy procedure. RESULTS: The stone-free rates of solitary lower pole stones with a size range of less than 10, 11 to 20 and greater than 20 mm. were 76, 74 and 33%, respectively, with a single shock wave lithotripsy treatment. Based on average treatment costs for shock wave lithotripsy and percutaneous nephrolithotomy, the model results show that for stone sizes less than 2 cm. primary lithotripsy therapy followed by nephrolithotomy for failed cases is the least costly approach. For stone sizes greater than 2 cm. primary percutaneous nephrolithotomy may be more cost-effective. CONCLUSIONS: Whereas shock wave lithotripsy with the Dornier HM3 should be considered the initial treatment choice for most lower pole stones less than 2 cm., primary percutaneous nephrolithotomy should be considered for stones larger than 2 cm.

Cost-Benefit Analysis↗
PubMed1997

Complete staghorn calculi: random prospective comparison between extracorporeal shock wave lithotripsy monotherapy and combined with percutaneous nephrostolithotomy.

PURPOSE: We determined the preferred treatment of staghorn calculi. MATERIALS AND METHODS: Between January 1992 and December 1994 we performed a prospective, randomized, single center study involving 50 kidneys with complete staghorn calculi: 27 renal units were treated with extracorporeal shock wave lithotripsy (ESWL) monotherapy (group 1) and 23 were treated with combined (initial) percutaneous nephrostolithotomy with ESWL (group 2). The 2 treatment groups were compared regarding stone size, grade of collecting system dilatation and urine culture at presentation. The number of treatment sessions, narcotic doses, renal colic episodes, septic complications, unplanned ancillary procedures, length of hospitalization, total treatment duration and stone-free rate at 6 months were recorded and compared. RESULTS: At the conclusion of therapy the stone-free rate was significantly greater in group 2 than in group 1 (74 versus 22%, respectively, p = 0.0005). The complication rate was significantly greater in group 1, with 15 septic complications (fever greater than 38.5C for longer than 3 days) in 10 patients compared to only 2 episodes in group 2 (p = 0.007). The unplanned ancillary procedure rate was significantly greater in group 1 (8 procedures in 7 patients versus 1 procedure in group 2, p = 0.03). The overall treatment length was significantly shorter in group 2 (1 versus 6 months, p = 0.0006). There was no significant difference in the number of procedures performed with anesthesia or in the number of hospitalization days between the 2 treatment groups. CONCLUSIONS: Combined percutaneous nephrostolithotomy and ESWL should be recommended as the first line treatment choice for most patients with staghorn stones.

Adult↗
PubMed2003

Combined percutaneous and retrograde approach to staghorn calculi with application of the ureteral access sheath to facilitate percutaneous nephrolithotomy.

PURPOSE: We describe our technique and clinical experience with application of the ureteral access sheath for single access ablation of staghorn and partial staghorn calculi. MATERIALS AND METHODS: We retrospectively reviewed our experience with 9 patients who underwent percutaneous nephrolithotomy for staghorn (6) or partial staghorn (3) renal calculi using a combined antegrade and retrograde approach. Patient data, operative parameters, efficacy of stone ablation and convalescence parameters were reviewed. RESULTS: Mean operative time for the primary procedure was 3.1 hours with a mean estimated blood loss of 290 ml. Postoperatively, the mean analgesic requirement was 33.2 mg. MSO(4) equivalents. Hospital stay was 3.2 days. There were no major and 4 minor (44%) complications. No patient required transfusion. Complete stone clearance was achieved in 7 of the 9 cases (78%) using a single percutaneous nephrostomy tract. CONCLUSIONS: Our preliminary clinical experience using the ureteral access sheath during percutaneous nephrolithotomy for simultaneous antegrade and retrograde stone treatment has been favorable. A large renal stone burden can be successfully managed with a single percutaneous access and limited blood loss.

Humans↗
PubMed2001

Extracorporeal shock wave lithotripsy is highly effective for ureteral calculi in children.

PURPOSE: Treatment of ureteral calculi in the pediatric population represents a unique challenge. Extracorporeal shock wave lithotripsy (ESWL*) and ureteroscopy have been advocated for the treatment of such stones. We present our experience with ESWL monotherapy for ureteral stones in children in the last decade. MATERIALS AND METHODS: Between 1989 and 1999 we treated 21 boys and 17 girls with a mean age of 8 years (range 8 months to 14 years) with ureteral stones at our institution. Records were reviewed and analyzed for presentation, metabolic and anatomical anomalies, stone size and location, outcome and complications. Average stone size was 9.5 x 6.5 mm. (range 3 to 32). Stones were in the upper ureter in 17 cases, mid ureter in 2 and lower ureter in 19. All patients underwent ESWL with a Dornier HM3 lithotriptor under general anesthesia. Nephrostomies were placed in an anuric infant with bilateral ureteral obstruction and in 2 patients with nonfunctioning kidneys (4 renal units). Ureteral catheters were used in 15 patients for better identification and localization of the stone during ESWL. The catheters were removed immediately postoperatively. RESULTS: Of the patients 31 (81.5%) were free of stones after 1 session of ESWL, 5 (13.1%) after 2 and 1 after 3. One patient underwent ureteroscopy for residual fragments after 2 ESWL sessions. The stone-free rate following 1 ESWL session was 100% for ureteral calculi 10 mm. or smaller regardless of location. Of the 12 patients with stones larger than 10 mm. 8 (67%) were free of stones following 1 ESWL session. The overall success rate of ESWL was 97.3%. No child had postoperative urinary infection or ureteral obstruction. CONCLUSIONS: ESWL is an efficient and safe modality for the treatment of pediatric ureteral stones.

Adolescent↗
PubMed2001

Cystine calculi in children: the results of a metabolic evaluation and response to medical therapy.

PURPOSE: We describe baseline metabolic abnormalities and evaluate mercaptopropionylglycine plus potassium citrate treatment for urinary abnormalities and to prevent new stone formation in children with cystine stones. MATERIALS AND METHODS: Daily urinary excretions of calcium, oxalate, citrate, magnesium, urate and phosphorus were determined in 18 children with cystine stone and 24 healthy children. The cystine stone cases were treated with 10 to 15 mg./kg. alpha-mercaptopropionylglycine and 1 mEq./kg. potassium citrate daily for a median 15 months. The potassium citrate dose was adjusted to render urinary pH 6.5 to 7.5. RESULTS: There was no significant difference in baseline metabolic profile between the cystine stone and control groups except for citrate. The cystine stone group excreted less citrate than the control group (p = 0.044). After treatment median plus or minus standard deviation urinary cystine 245 +/- 233 to 140 +/- 106 mmol./mol. creatinine decreased from (p = 0.015), and urinary citrate increased from 255 +/- 219 to 729 +/- 494 mg./1.73 m.2 (p = 0.003). No serious adverse reaction was noted. Of the 15 patients with followup data 5 (33%) had 8 recurrent calculi (recurrence rate 0.64 per patient year). CONCLUSIONS: Our results suggest that further investigation of low citrate excretion is needed in cystinuric children. Potassium citrate therapy is effective in increasing urinary pH and urinary citrate. However, high recurrence rate and persistent cystinuria in our patients emphasize the inadequacy of our treatment schedule in the prevention of recurrent cystine calculi.

Adolescent↗
PubMed1999

Percutaneous management of renal calculi: experience with percutaneous nephrolithotomy in 60 children.

PURPOSE: We report our experience with percutaneous nephrolithotomy in a pediatric population in which primary as well as recurrent stone episodes are frequent and the need for less invasive procedures is imperative. MATERIALS AND METHODS: Percutaneous nephrolithotomy was performed in 60 children 3 to 13 years old (average age 6), including 44 boys (73.3%) and 16 girls (26.7%). There was a single obstructing renal calculus in 43 patients, while 17 had multiple calculi. The procedure was performed in 1 stage in 49 patients, and it was staged with preliminary nephrostomy in 11 who presented with calculous anuria and elevated serum creatinine. Normal saline was used as an irrigant and perioperatively serum electrolytes were measured to monitor fluid absorption in 18 patients. Stones were extracted intact from 40 patients (66.6%) and ultrasonic lithotripsy was performed in 20 (33.3%). RESULTS: Of the 60 patients 50 (83.3%) were rendered stone-free at 1 session. Incomplete stone clearance at 1 session was due to intraoperative bleeding requiring blood transfusion, extravasation, multiple stones that were inaccessible via 1 tract, displacement of stone fragments into an inaccessible calix and insignificant residual fragments less than 3 mm. in 2 cases each. During followup of 3 months to 6 years (average 1 year) no late complications were noted. CONCLUSIONS: Percutaneous nephrolithotomy is a safe and relatively efficacious mode of managing pediatric renal calculi. Although higher success rates are achieved in adults, caution should be exercised in children, in whom diligent attempts at stone clearance in 1 session may be made at the expense of safety.

Adolescent↗
PubMed1994

Should upper ureteral calculi be manipulated before extracorporeal shock wave lithotripsy? A prospective controlled trial.

Whether all upper ureteral stones must be manipulated before extracorporeal shock wave lithotripsy (ESWL*) is an ongoing controversy. In a prospective trial, symptomatic patients with solitary upper ureteral calculi less than 1 year in duration were alternated between ESWL in situ and pre-ESWL stone manipulation. Pretreatment excretory urograms were assessed for stone size and degree of proximal hydroureteronephrosis, which was graded from zero (no dilatation) to 3 (severe dilatation). Stone manipulation was done with the patient under intravenous sedation and local anesthesia. A total of 4,000 shock waves was given in a single session using Siemens Lithostar Plus, and treatment was repeated on days 4, 15 and 30 if required. The patients were evaluated 3 months after onset of therapy with excretory urogram and urine culture. Seventy patients qualified for the study (group 1-35 in situ and group 2-35 stone manipulation) and were comparable in relation to age and sex, stone size and degree of hydronephrosis. There was no significant difference between the 2 groups regarding the number of sessions (group 1-1.86 +/- 1.2 and group 2-2.03 +/- 1.2) or shock wave requirement (group 1-5,705.8 +/- 3,536.9 and group 2-5,549.1 +/- 3,837.2) for stone fragmentation. The degree of proximal dilatation did not contribute significantly towards the outcome (F ratio 0.675, p = 0.57). A total of 30 patients (85.5%) in group 1 had a satisfactory outcome at 3 months, while 3 (8.5%) had significant residual calculi and 2 stones could not be fragmented. Of the manipulated stones 33 (94%) were successfully cleared, while 2 patients required auxiliary procedures. Ureteroscopy was required in 1 patient for upward migration of the stent. Morbidity in both groups was comparable. We conclude that upper ureteral stones should be treated in situ to avoid the morbidity of manipulation.

Adult↗
PubMed1994

Stryker frame adaptation of the HM3 lithotriptor for treatment of distal ureteral calculi.

Treatment of distal ureteral stones with the Dornier HM3 lithotriptor depends on the localization and positioning of the calculus from a transgluteal approach. We found the Stryker frame gantry modification preferable to the standard gantry for treatment of stones in the distal ureter. We report the use of this gantry adaptation in 22 cases of distal ureteral stones. The calculi were localized in 100% of the cases and were fragmented successfully with 1 treatment in 89%. In no case was the procedure aborted secondary to nonvisualization of the calculus. Failure to disintegrate the stone requiring retreatment occurred in 11% of the cases, and was attributed to stone characteristics and not due to difficulty with visualization or placement of the calculus within the F2 focus. The average fluoroscopic time was 45 seconds. The Stryker frame modification to the standard Dornier HM3 lithotriptor allows for improved visualization and easier localization of distal ureteral calculi compared to the standard gantry.

Adult↗