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PubMed1978

Calculi in renal transplants.

Three patients who underwent live donor renal transplantation subsequently developed calculi in their allografts. Hypercalcaemia and secondary hyperparathyroidism were present in 2 cases and these were treated by subtotal parathyroidectomy. Urinary stagnation and infection were contributory factors in the third case and reimplantation of the ureter was necessary. In all patients no further calculi have developed following treatment and allograft function remains satisfactory.

Adult↗
PubMed1984

The impact of transurethral ureteroscopy on the management of ureteric calculi.

Transurethral ureteroscopy has now been used in an attempt to retrieve ureteric calculi in 48 patients. Six stones were located in the upper ureter, 11 in the middle and 31 in the lower third of the ureter. Successful retrieval was achieved in 27 patients at the first attempt and in 4 at a second ureteroscopy. Of the 17 failures, 7 patients have required open ureterolithotomy, 3 percutaneous nephrolithotomy and the remainder passed their stones either after in situ disintegration or ureteric meatotomy. There have been no serious complications to date. Transurethral ureteroscopy should now be regarded as the procedure of first choice in the management of ureteric calculi.

Adult↗
PubMed1988

Recurrent and residual renal calculi in children.

One hundred and thirteen children with non-metabolic urinary tract calculi were operated on between 1960 and 1983. One hundred were followed up for 3 to 17 years (mean 8.2). Seventeen children (15%) developed recurrent calculi after complete clearance at the initial operation and in 13 of these the stones recurred within 5 years. Proteus urinary infection was a constant feature of stone recurrence. Five patients required re-operation for removal of the recurrent calculus. Small residual caliceal fragments were left behind in 17 children but only 3 required surgical removal.

Adolescent↗
PubMed1990

Urethral calculi.

We present 56 patients with urethral calculi. In males the commonest location was the posterior urethra; 46 patients complained of dysuria but urinary retention was present in only 7. In 9 patients with penile urethral calculi, 6 had associated urethral disease (urethral stricture in 5 and urethral diverticula in 1). Transurethral litholapaxy or lithotripsy after retrograde manipulation was performed in 33 patients. Endoscopic manipulation was found to be the safest procedure.

Adolescent↗
PubMed1990

Lithotripsy for calculi in caliceal diverticula?

There is continuing debate about the optimum management of patients with calculi in caliceal diverticula. Extracorporeal piezoelectric lithotripsy (EPL) has the advantage of being non-invasive, whereas endourological management can treat the underlying anatomical problem. A total of 20 patients with calculi in caliceal diverticula were treated with EPL. Twelve of 16 patients with symptoms (75%) were rendered symptom-free but only 5 (25%) became stone-free. This information should be of value in counselling patients before selecting the appropriate treatment.

Adult↗
PubMed1990

Treatment of caliceal calculi.

We analysed the course of 80 "stone periods" (the time that elapses between making a diagnosis and passage of a stone, operation, or an out-patient's last check-up) in 62 patients with caliceal stones prior to the development of extracorporeal shockwave lithotripsy (ESWL) and endourology. The observation time per patient averaged 7.4 years; 16% of the stones passed spontaneously and 40% were removed surgically. The infection rate was 68% and 45% of the stones increased in size during the observation period. Retrospective evaluation showed that of 32 patients who underwent surgery, only 11 procedures were performed at the appropriate time. In the remaining 21 cases the timing of surgery was judged to have been too late because of the ensuing complications. In 8 patients stone growth led to staghorn calculi, 8 had acute obstruction with incipient urosepsis, 3 had chronic urinary infection and 1 had loss of kidney function. We believe that 83% of all caliceal stones require intervention (ESWL or percutaneous nephrolithotomy) within 5 years of diagnosis. Only 11% of patients with caliceal calculi remain symptom-free after 10 years.

Humans↗
PubMed1992

J-wire facilitates retrograde manipulation of ureteric calculi prior to extracorporeal shock wave lithotripsy.

During a 13-month period, 55 patients underwent attempted retrograde manipulation for ureteric lying above the pelvic brim. The mean stone burden was 11 mm (range 5-21); 41 stones (75%) were primary ureteric calculi and 14 (25%) were fragments resulting from extracorporeal shock wave lithotripsy to renal calculi. The method of retrograde manipulation was recorded prospectively. Retrograde flushing through an 8F angiography catheter with a mixture of saline and lignocaine gel was successful in 27 patients (49%). The insertion of a J-wire through the angiocath allowed for successful manipulation in a further 17 patients (31%). Retrograde manipulation was impossible in 11 patients (20%). There were 4 complications (7%), none attributable to the use of a J-wire.

Adolescent↗
PubMed1995

Extracorporeal piezoelectric shock wave lithotripsy as mono and multiple therapy of large renal calculi including staghorn stones in unanaesthetized patients under semi-ambulant conditions.

OBJECTIVE: To examine the effectiveness and complication rate of extracorporeal piezoelectric shock wave lithotripsy (EPL) as monotherapy for the treatment of large renal calculi. PATIENTS AND METHODS: Treatment consisted of semiambulant EPL as monotherapy combined with protective ureteric stenting in 84 patients. Three groups were established according to stone volume (borderline-stone, partial and complete staghorn). An average of 18,230 shock waves was applied in 3.76 sessions to each patient. RESULTS: No major complications were observed but there were minor complications in 33% of patients. Invasive auxiliary methods were necessary in only 12%. After a mean follow-up of 9 months (n = 72), 54% of patients were stone-free and in 22% the fragments passed spontaneously. Thus the success rate was 76%. Analysis of the three groups showed no difference in stone status during follow-up. There was no relation between the outcome of treatment and stone volume. Analysis of the patients who failed to respond to treatment showed that they were treated for longer than the stone-free group, with significantly fewer sessions per week (0.71 vs 1.28 sessions/week). It appears that higher rates of stone removal can be achieved with more frequent treatment sessions at shorter intervals. CONCLUSION: We consider semi-ambulant EPL monotherapy to be a minimally invasive alternative treatment in patients with large renal calculi, including staghorn stones.

Adolescent↗
PubMed1987

Extracorporeal shock wave lithotripsy for the treatment of urinary calculi in the elderly.

Renal calculus in the elderly patient is associated with the same symptoms and risks as in other patient populations. With the recent development of extracorporeal shock wave lithotripsy (ESWL), many older patients can now be treated for renal calculi. The Department of Urology at the University of Iowa Hospitals and Clinics has performed 107 ESWL treatments on a total of 96 patients over 70 years of age. This represents over 12% of all patients treated at our institution. No deaths related to ESWL treatment have occurred in this group, nor has increased morbidity been observed in comparison to all patients treated. In spite of the increased age and associated medical problems of this patient population, ESWL offers a safe and effective means of treating upper tract urinary calculi in the geriatric age group.

Aged↗
PubMed1977

The relation of lipids to the mineral components in salivary calculi.

Using lipid histochemical and microradiographic methods, the distribution of lipids and the inorganic component in different areas of salivary calculi was investigated. Two main groups of lipids were found, i.e. hydrophilic phospholipids and hydrophobic lipids. The hydrophilic phospholipids were shown to be composed mainly of phosphosphingosides and of the hydrophobic lipids cholesterol was demonstrated. Phosphosphingosides were localized in more or less lamellar zones as also in large homogeneous areas. In some cases the calculi were surrounded by a structureless non-mineralized zone exhibiting a strongly positive reaction for phosphosphingosides. Cholesterol was found in isolated band-formed areas. Phosphosphingosides and cholesterol were especially prevalent in areas showing a low or slight degree of mineralization. In areas showing a high degree of mineralization the corresponding lipids gave a weak or absent histochemical reaction. After EDTA-decalcification, however, an increase in the concentration of lipid was noticed in high mineralized areas, indicating a masking process. The influence of various factors on the presence and distribution of different lipids was discussed.

Autoradiography↗
PubMed1986

Comparison of treatment of renal calculi by open surgery, percutaneous nephrolithotomy, and extracorporeal shockwave lithotripsy.

This study was designed to compare different methods of treating renal calculi in order to establish which was the most cost effective and successful. Of 1052 patients with renal calculi, 350 underwent open surgery, 350 percutaneous nephrolithotomy, 328 extracorporeal shockwave lithotripsy (ESWL), and 24 both percutaneous nephrolithotomy and ESWL. Treatment was defined as successful if stones were eliminated or reduced to less than 2 mm after three months. Success was achieved in 273 (78%) patients after open surgery, 289 (83%) after percutaneous nephrolithotomy, 301 (92%) after ESWL, and 15 (62%) after percutaneous nephrolithotomy and ESWL. Comparative total costs to the NHS were estimated as 3500 pounds for open surgery, 1861 pounds for percutaneous nephrolithotomy, 1789 pounds for ESWL, and 3210 pounds for both ESWL and nephrolithotomy. ESWL caused no blood loss and little morbidity and is the cheapest and quickest way of returning patients to normal life.

Adolescent↗
PubMed1988

Clinical comparison of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy in treating renal calculi.

STUDY OBJECTIVE: To compare extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for efficacy in treating renal calculi. DESIGN: Non-randomised multicentre cohort study with 3 month follow up and 13 month data collection period. SETTING: Lithotripter centre in London, tertiary referral hospital, and urological clinics in several secondary and tertiary care centres. PATIENTS: 933 of 1001 patients treated by lithotripsy at the lithotripter centre were compared with 195 treated by nephrolithotomy. Missing patients were due to incomplete collection of data. Age and sex distributions and characteristics of the stones were similar in the two treatment groups. Two patients died in the lithotripsy group. Three month follow up was achieved in about 84% of both groups (783/933 for lithotripsy; 163/195 for nephrolithotomy). INTERVENTIONS: The nephrolithotomy group had surgical nephrolithotomy alone. In the lithotripsy group 83% (774/933) had lithotripsy alone, 11% (103/933) had combined lithotripsy and nephrolithotomy, and 6% (56/933) had lithotripsy plus ureteroscopy. Single and combined lithotripter treatments were analysed as one group and compared with nephrolithotomy. END POINT: Presence of stones three months after treatment. MEASUREMENTS AND MAIN RESULTS: Presence of residual stones was assessed by plain radiography, ultrasonography, or intravenous urography. After adjustment for age and size and position of stone for patients with single stones the likelihood of being free of stones three months after treatment was significantly greater in the nephrolithotomy group than the lithotripsy group (odds ratio 6.6; 95% confidence interval 3.0 to 14.6) and the response was particularly pronounced with staghorn calculi (62% (8/13) v 15% (141/96) patients free of stones after nephrolithotomy and lithotripsy, respectively). OTHER FINDINGS: 19%(146/775) of patients who had had lithotripsy had to be readmitted within three months after treatment compared with 14%(23/162) who had nephrolithotomy; and 64%(94/146) of readmissions after lithotripsy were for complications compared with 30%(7/23) of readmissions after nephrolithotomy. CONCLUSIONS: Nephrolithotomy may be preferable to lithotripsy for treating renal stones and it may not be wise to invest heavily in lithotripsy facilities.

Adolescent↗
PubMed1971

A combined qualitative and quantitative procedure for the chemical analysis of urinary calculi.

A better understanding of the physico-chemical principles underlying the formation of calculus has led to a need for more precise information on the chemical composition of stones. A combined qualitative and quantitative procedure for the chemical analysis of urinary calculi which is suitable for routine use is presented. The procedure involves five simple qualitative tests followed by the quantitative determination of calcium, magnesium, inorganic phosphate, and oxalate. These data are used to calculate the composition of the stone in terms of calcium oxalate, apatite, and magnesium ammonium phosphate. Analytical results and derived values for five representative types of calculi are presented.

Apatites↗
PubMed1982

Parotid and submandibular duct calculi in three successive generations of one family.

A case is reported of chronic calculous parotitis beginning in a 12-month-old child. Further questioning revealed a history of parotid calculi in her mother and submandibular calculi in her maternal grandmother. The features which indicate the diagnosis of parotid calculous disease are discussed and, from a review of the literature, some observations are made on management.

Adult↗
PubMed2003

Analysis of feline urinary calculi and urethral plugs by infrared spectroscopy and scanning electron microscopy.

The chemical constituents of 34 feline urinary calculi and five urethral plugs were analysed by infrared spectroscopy. The analysis revealed that 18 (52.9 per cent) of the calculi contained magnesium ammonium phosphate hexahydrate (struvite) as the major component; 10 (29.4 per cent) contained complex ammonium urates (three of them also containing calcium phosphate, mainly on the surface); three were composed of calcium phosphates and three were composed mainly of calcium oxalate mono and dihydrates. The urethral plugs were composed primarily of struvite, but also contained large amounts of organic matter. The examination of 16 selected samples by scanning electron microscopy and electron dispersive x-ray analysis revealed that their crystalline structures were similar to those of canine stones.

Animals↗
PubMed1978

Ultrasonic detection of nonopaque renal calculi.

Four patients with 5 nonopaque renal calculi composed of uric acid were examined by ultrasound. The calculi varied in size from a 1.5 X 1.5-cm intrapelvic stone to a staghorn calculus measuring 4 cm. All stones were satisfactorily imaged by ultrasound, allowing a diagnosis of nephrolithiasis to be made with confidence in each case. In 2 patients with poor excretion on urography, the diagnosis was not suspected prior to the ultrasound examination. The authors feel that ultrasound has great potential value in the investigation of nonopaque filling defects of the renal pelvis and in patients with urographic nonvisualization who have a high risk of uric acid lithiasis.

Adult↗
PubMed1985

Scrotal calculi: sonographic detection.

Scrotal calculi are freely moving concretions that lie in the space between the tunicae lining the scrotum and the testicles. They are believed to originate either as fibrinous deposits in the tunica vaginalis testis or as remnants of the appendix testis or appendix epididymidis that have undergone torsion and become freely movable. A sector real-time scanner with a 7.5-MHz transducer and a small-parts scanner with a 10-MHz transducer were used to visualize scrotal calculi in two patients. The ultrasonic appearance is described along with the surgical findings, and the pathogenesis of this benign process is discussed.

Aged↗
PubMed1987

Staghorn calculi: endourologic management in 120 patients.

Symptomatic staghorn renal calculi were removed from 106 of 124 kidneys (85%) with percutaneous ultrasonic lithotripsy. All remaining fragments were less than 5 mm in greatest diameter, small enough to pass spontaneously. Use of two or more access routes was necessary in 91 kidneys (73%), and 29 patients (24%) required multistage nephrolithotripsy for complete stone removal. The total operative time averaged 162 minutes per patient. The average hospitalization period was 12.5 days, and the average convalescence time after discharge was 15 days. The most common adverse effect was bleeding necessitating transfusion (57%). Infection occurred in 27% of patients and may be intrinsic to removal of these infected stones. There was one death in the study group: a patient with multiple medical problems died of myocardial infarction. Successful stone extraction requires a clear understanding of renal anatomic features, properly placed access routes, and radiologic-urologic expertise. It is concluded that staghorn calculi can be safely and effectively treated with the use of percutaneous techniques.

Adult↗