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CT examinations were conducted in 47 patients with staghorn calculi in the renal pelvis. Density measurements in the region of the calculus supplied pointers to the structure of the calculus.
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A case of soft vesical calculi is reported. A 72-year-old male, visited our clinic complaining of discharge of white muddy substance. KUB film revealed calcification in the vesical region. Urinalysis showed UTI, and culture of urine was positive for Proteus mirabilis. Thereafter, the patient suffered from discharges of similar calculi several times. Two of three infrared spectroscopic charts showed mixture of calcium phosphate and ammonium hydrogen urate and that of the remaining disclosed magnesium ammonium phosphate. An alcian blue-PAS double staining of this calculus revealed the presence of acid and neutral glycosaminoglycans, and bacterial colonies. These calculi were thought to be different from the so called 'matrix calculi'.
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Struvite uroliths are found more frequently than other types of uroliths in the urinary tracts of dogs. Medical dissolution of struvite uroliths with a Swedish calculolythic diet has been evaluated. The palatability of the diet was good and only two out of a total of 69 dogs in the study could not be maintained on the diet because of diarrhea. In 19 of 33 dogs medically treated, the uroliths were dissolved over a period of one to 6 months (mean time 2.5 months). In the remaining dogs uroliths were surgically removed, and calculolytic diet was postoperatively given. Consumption of the calculolytic diet was in most cases associated with a lowered specific gravity and pH of the urine. A representative case report of medical dissolution of struvite uroliths located in the urinary bladder of a 9 year-old female cocker spaniel with a history of recurrent urolithiasis is described. It is concluded that the Swedish calculolytic diet can be used successfully to dissolve struvite in adults dogs.
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The majority of staghorn calculi (branched calculi)--25 per cent bilateral--is mainly composed of calcium phosphates, in about 2/3 with varying fractions of Struvite. Pure Struvite stones are rare. Large fractions of Struvite form a soft concrement. Infection with urea splitting bacteria arises ascending, therefore predominantly in female kidneys, except for the first decennium. Staghorn calculi without Struvite (1/3 of our cases), show extremely large growth and sterile urine. Some Struvite stones have sterile urine or Struvite without urea splitting bacteria. The shape of branched calculi depends on the form of hilus renalis and the aggressiveness of the alkaline urine and the infection. Renal cirrhosis--almost always present--follows bacterial or abacterial obstruction, depending on the degree of vascular obliteration by reactive fibrosis of the intima, with or without pyonephrotic, xanthomatous necrosis, similar to renal tuberculosis. The so-called "large stone kidney" is obstructive, aseptic and lipomatous special form of staghorn calculus and cirrhosis. Stone formation and grade of cirrhosis may be determined by tomography.
The urinary tract calculus patients seen at our Department between January, 1974 and December, 1983 were reviewed to determine the trend of urolithiasis. The urinary tract calculus patients accounted for 10.1% of all the outpatients. Recurrent calculus diseases were seen in 16.9% of male patients and in 12.1% of female patients. The frequency of recurrence was very high in the patients in their forties. Upper urinary tract calculi were seen most frequently in the patients in their forties. We could expect spontaneous passage of stone for at least 6 months in the case of a middle-sized stone (less than 6 X 10 mm). The percentage of calcium oxalate-containing stone was 73.2% in male patients and the percentage of phosphate-containing stones was 81.6% in female patients. Hypercalciuric patients were seen in 34.0% of the calculus inpatients. Urinary bacterial culture revealed positive in 33.0% of the calculus inpatients.
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We recently experienced two cases of encrustation and stone formation on double J ureteral stent which had been indwelt at pyeloplasty and at pyelolithotomy. In these patients, bacteriuria and pyuria had continued. Encrustation and stone formation were recognized by follow-up X-ray fairly soon after operation. Judging from our experience, encrustation and stone formation should be suspected in patients with persistent bacteriuria and/or pyuria and who have episodes of urolithiasis. To avoid encrustation and stone formation, the ureteral stent should be replaced more frequently.
Over the last few years there have been marked advances in both the surgical and medical treatment of urinary stone disease. At present, we have expectations of decreasing the incidence of stone recurrence in a vast majority of patients with medical therapy alone. While there are still many patients who will continue to develop new stones, decreasing their rate of new stone formation will lessen the need for surgical intervention.
Thirty canine urinary calculi, most of which had been qualitatively classified as struvite calculi, were analyzed by instrumental neutron activation analysis at the University of Missouri Research Reactor. Measurements of sodium, magnesium, aluminum, silicon, phosphorus, chloride, potassium, and calcium were possible, using a dual irradiation procedure. Magnesium was used to calculate the percentage of struvite mineral, Mg(NH4) (PO4) X 6H2O, in the calculi by making use of the stoichiometric relationship of the element magnesium to the mineral. For those calculi containing greater than 80% struvite, the mean elemental concentrations were found to be 0.12% Na, 9.35% Mg, 0.0033% Al, 12.1% P, 0.02% Cl, 0.85% K, and 2.05% Ca. A new method for determination of silicon in urinary calculi also was discussed. Two calculi were found to contain 45.0% and 37.3% silicon, and 1 mixed calculus was composed of 1.4% silicon.
Urinary stone disease is a common affliction in our society and may affect 1 to 5 per cent of the population. The physician involved in caring for the stone-forming patient must have a thorough understanding of the metabolic as well as anatomic abnormalities that may lead to repeat stone formation. The authors review the common metabolic abnormalities frequently seen in the stone-forming patient and present the current medical management of these problems. Ongoing changes in the surgical approach to urinary stones are also discussed.
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In about 20% of the cases, urolithiasis is directly linked to chronic urinary tract infection by urea splitting bacteria, essentially Proteus mirabilis. The stones are generally composed of struvite and carbonate apatite which usually occur as staghorn calculi feared because of their obstructive and infectious consequences that cause important renal damage. The case of a 48 year-old woman with chronic urinary infection is described whose right kidney showed a staghorn calculus essentially composed of newberyite, a very rare constituent of urolithiasis, and whose left kidney contained three carbonate apatite calculi. Clinical and technical examinations, relations between the two mineral constituents are discussed in this paper with a review of the literature on the subject.
Of 5 analysis tests of the 3rd International Ring Experiment for the control of the quality of methods of the analysis of urinary calculi 38 findings compiled according to 9 different techniques came in from 12 countries. The average deviation per component concerning all 5 analysis tests is considerably low with 0.10 mol proportions. The average quality measure SQ concerning all participants is approximately 2.00; it deteriorates from the X-ray diffraction method over the IR-technique to the other quantitative methods used. Advantages and disadvantages of the X-ray diffraction and IR-spectroscopic analysis are discussed. A methodically homogeneous and centralized performed analysis of urinary calculi shows advantages in the quality of the analyses.