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At least 1,081 records · Page 60Linked to original sources
PubMed1997

Ureteral calculi in patients with flank pain: correlation of plain radiography with unenhanced helical CT.

PURPOSE: To determine the sensitivity and specificity of plain radiography for the detection of ureteral calculi with use of unenhanced helical computed tomography (CT) as the standard of reference. MATERIALS AND METHODS: Plain radiographs and helical CT scans of 178 patients with acute flank pain were reviewed retrospectively. Three interpretations of plain radiographs were used: (a) Original reading. This was the report made at the time of the patient's evaluation before the patient underwent CT. (b) Blinded retrospective reading. Each plain radiograph was interpreted without knowledge of the CT findings. (c) Unblinded retrospective reading. The plain radiograph of each patient whose CT scan showed a stone was reviewed with the CT scan. RESULTS: The original reading had a sensitivity of 45% and a specificity of 77% for the detection of ureteral calculi. The blinded retrospective reading had a sensitivity of 59% and a specificity of 71%. The unblinded retrospective reading had a sensitivity of 59% (95% confidence interval: 47%, 70%). CONCLUSION: Plain radiography is of limited value for aiding the diagnosis of ureteral stones. All patients with acute flank pain for whom radiologic imaging is recommended can directly undergo unenhanced helical CT; plain radiographs need not be obtained first.

Acute Disease↗
PubMed2000

Vaginal calculi in a young woman.

A case of a large vaginal stone in a 26-year-old woman is presented. Vaginal stones are relatively rare. Various causes can lead to vaginal stone formation. In our case, the calculi was due to vaginal outlet obstruction in childhood. The diagnosis is usually easy to be done. In our patient, X-ray films using frontal and lateral views of the urinary system permitted to establish the right diagnosis. Treatment can vary, depending on the cause of the stone formation and the consistency of the calculi. In this case, the treatment was surgical with simple evolution. It permitted a normal social and sexual life to this young patient.

Adult↗
PubMed2004

Pneumatic lithotripsy through pyelotomy incision during open surgery for staghorn calculi: an alternative method to anatrophic nephrolithotomy.

INTRODUCTION: Our purpose was to remove large-volume staghorn calculi with less morbidity and maximum ease without an anatrophic nephrolithotomy, with the use of a pneumatic lithotriptor during pyelolithotomy to disintegrate the branches of stones extending into the calyces and retained calyceal fragments. PATIENTS AND METHODS: Sixteen patients (17 renal units) with large-volume staghorn stones were evaluated with blood urea nitrogen (BUN), creatinine levels, urinalysis, and culture, excretory urography (IVP), and 99mtechnetium dimercaptosuccinic acid (DMSA) renal scintigraphy preoperatively. Patients were treated with a pneumatic lithotriptor at the time of open pyelolithotomy. Bilateral surgery was performed in 1 patient. The mean follow-up period was 12 (range 6-24) months. The patients were re-evaluated postoperatively at 6 months with BUN and serum creatinine measurements, urinalysis and culture, IVP, and renal scintigraphy with DMSA. Data were analyzed by one-way ANOVA test. p < 0.05 was considered statistically significant. RESULTS: After treatment, 15 of 17 renal units (88%) were rendered stone-free while residual fragments remained in two patients. Average operation time was 190 min (range 135-285) with a mean blood loss of 226 ml (range 140-425). No patient required blood transfusion. Average length of hospital stay was 4.2 days (range 3-7). Six months after surgery, mean BUN and creatinine levels were decreased from 31.2 to 28.2 mg/dl (p = 0.248) and from 1.3 to 1.1 mg/dl (p = 0.001), respectively. Renal scintigraphy with DMSA revealed an increase in ipsilateral average renal function from 39 to 43% (p = 0.043). IVP also revealed a decrease in pelvicalyceal dilatation in almost all patients with a well-functioning kidney and without any stone recurrence. No complications were encountered postoperatively except for an episode of high fever in 1 patient. CONCLUSION: Avoiding incision of the renal parenchyma and arterial clamping, without significant bleeding and the nephron loss seem to be the advantages of this technique. Kidney function can be preserved with this simple and easily applicable method, which may be an alternative procedure to anatrophic nephrolithotomy for the majority of patients with staghorn calculi requiring open surgery.

Adult↗
PubMed2004

Clinical value of crystalluria and quantitative morphoconstitutional analysis of urinary calculi.

Morphoconstitutional analysis of urinary calculi, i.e. morphologic examination combined with Fourier transform infrared spectroscopy (FTIR), is of decisive interest for the diagnosis of rare but severe inherited or acquired stone diseases such as cystine, 2,8-dihydroxyadenine, xanthine, struvite, ammonium urate or drug-containing calculi as well as primary hyperoxalurias. In the absence of early diagnosis and proper management, these diseases may lead to progressive loss of renal function. Among common forms of calcium oxalate (CaOx) stones, predominant CaOx monohydrate (whewellite) is mainly associated with hyperoxaluric conditions whereas predominant CaOx dihydrate (weddellite) is mainly associated with hypercalciuria, and this distinction is of interest to orient metabolic evaluation and preventive measures. Crystalluria examination, also based on morphology and FTIR, is a valuable diagnostic method when no stone is available for analysis. Presence of specific crystals (cystine, 2,8-dihydroxyadenine, struvite, ammonium urate) is diagnostic by itself. In all types of nephrolithiasis, serial crystalluria determination appears as a simple, cheap and reliable method to evaluate the risk of stone formation and assess the effectiveness of preventive measures. Determination of urinary crystal volume was in our experience a useful tool in the management of patients with cystinuria or primary hyperoxaluria in the post-transplantation period. In conclusion, both accurate morphologic and FTIR analysis of stones and serial crystalluria determination should be more largely used, in view of their value in the diagnosis and management of renal stone formers.

Crystallization↗
PubMed1985

Xanthine calculi in the patient with the Lesch-Nyhan syndrome associated with urinary tract infection.

A Japanese boy with Lesch-Nyhan syndrome who passed xanthine calculi is reported. After pyelolithotomy for a left renal stone, made up of ammonium urate, associated with urinary tract infection, a high dose of allopurinol was given because of the persistence of pyuria. In the present case, the administration of a high dose of allopurinol, given for the prevention of ammonium urate stone formation in infected urine, induced xanthine calculi formation and we had difficulty in the management of this patient with Lesch-Nyhan syndrome associated with urinary tract infection. However, we believe it a basic necessity to cure our patient of his urinary tract infection and prevent recurrent ammonium urate stone formation because of the risk of renal deterioration.

Allopurinol↗
PubMed1989

Slightly radiopaque uric acid calculi: impact upon therapeutic considerations?

Ten patients with slightly radiopaque urinary calculi were treated by percutaneous litholapaxy or even open surgery. The stone analysis revealed uric acid as the main stone composite suggesting that these patients should have been treated by oral litholysis alone alkalinizing the urine and decreasing uric acid levels with allopurinol. CT density measurements proved that concrements with HE less than 600 can be successfully dissolved by oral medication alone. Twenty-four patients were subsequently treated by oral citrate alkalinizing the spontaneous urine to pH 6.8-7.2 dissolving even large staghorns within 6-8 weeks. CT density measurements have become a routine diagnostic procedure when poorly radiopaque calculi are found on the standard plain film. The patient can thus be spared invasive treatment which is unnecessary in most cases.

Aged↗
PubMed1990

Medullary sponge kidney and staghorn calculi.

We describe a 65-year-old female with bilateral staghorn calculi who presented with a Proteus mirabilis perinephric abscess secondary to a ruptured lower pole hydrocalyx. Radiologic evidence was consistent with underlying medullary sponge kidney (MSK) disease. Despite expectations to the contrary, MSK, a disease notable for many risk factors capable of precipitating staghorn disease, is rarely associated with coexistent staghorn calculi. A discussion of the concurrent risk factors and a possible hypothesis regarding the lack of coexistence follows.

Abscess↗
PubMed1976

Clinical features and treatment of urinary calculi in childhood.

During the period 1926-1975, 94 children with urinary calculi were treated. The incidence, causation, localisation, symptomatology and diagnosis of urolithiasis in children are discussed. The therapeutic possibilities are also outlined. Particular emphasis is laid on therapeutic programmes for the prevention of recurrence in all varieties of urinary calculi, by means of which the recurrence rate in our own series was reduced to around 16%.

Adolescent↗
PubMed1976

Staghorn calculi of the kidneys. A. Clinical review.

A series of 91 staghorn calculi are reviewed. Possible aetiological factors are analysed. A high incidence of hypercalciuria was found, and the significance of this is discussed. The rates of complete stone clearance after conservative surgery are considered for different types of staghorn calculus and it is felt that local circulatory arrest with kidney cooling may be of value in removing stones due to Proteus. The place of elective nephrectomy in the management of staghorn calculi is discussed. Nephrectomy may be the treatment of choice in the management of large, unilateral stones in older patients.

Calcium↗
PubMed1977

An experimental model for extracorporeal renal surgery: ex situ removal of artificially induced renal staghorn calculi in ambiothermia.

An experimental model for the evaluation of surgical techniques and preservation in extracorporeal surgery is described: staghorn calculi were induced in 15 dogs by the injection of methylmethacrylate into the renal pelvis. Removal of the calculi was carried out 3-4 weeks later on a workbench, using microsurgical techniques and ex situ radiographies. 15 min of warm ischaemic and 6 h of ambiothermic preservation were well tolerated as could be demonstrated by determination of the serum creatinine following autotransplantation and immediate contralateral nephrectomy.

Animals↗
PubMed1987

Use of internal polyethylene ureteral stents in extracorporeal shock-wave lithotripsy of staghorn calculi.

Ureteral stenting during extracorporeal shock-wave lithotripsy (ESWL) of complete staghorn calculi, using an internal polyethylene pigtail catheter, was found to be an efficient prophylactic measure against the high rate of complications in these cases. In the presence of a ureteral stent the stone fragments passed more easily into the bladder, accumulation of obstructing stone streets was prevented, and internal drainage of the urine was guaranteed. The need for auxiliary measures such as percutaneous nephrostomy, ureteroscopy or ureteral meatotomy was prevented in most cases. This prophylactic measure may turn ESWL to become the primary treatment of large staghorn calculi.

Catheters, Indwelling↗
PubMed1988

Treatment of large renal calculi with extracorporeal shock wave lithotripsy monotherapy.

One hundred and twenty patients with large renal calculi (greater than 3 cm), who had not undergone previous stone-debulking procedures, were treated with extracorporeal shock wave lithotripsy (ESWL) monotherapy using a Dornier HM3 lithotripter. Stones were divided into four categories according to Rocco's classification: 20 C2, 25 C3, 51 C4 and 24 C5. Repeated treatments were necessary in 13 patients, while planned two-stage treatments were performed in 8. Pretreatment adjunctive endourological maneuvers (except for the placement of ureteral stents for visualization of 37 contrast-negative stones) were used in 16 cases (13.3%) and posttreatment maneuvers in 20 (16.6%). Open surgery was necessary in 6 patients, including one nephrectomy. Complete elimination of all concrements was documented in 74 patients (61.6%): 63 within 3 months and 11 within 6-12 months. The stone-free rates for different categories were: 80% for C2, 64% for C3, 58.8% for C4 and 50% for C5. The stone-free rate for contrast-negative calculi was 83.7% (31/37), and for radiopaque ones 51.8% (43/83) (p less than 0.001). It is concluded that ESWL monotherapy is an adequate treatment choice for some categories of large radiopaque stones and for all radiolucent ones.

Adult↗
PubMed1982

The problem of recurrences and infection after surgical removal of staghorn calculi.

A series of 99 consecutively operated patients presenting staghorn stones has been reviewed to ascertain the factors implicated in recurrent calculogenesis. 71.7% of the calculi were infection stones; 50.7% harbored Proteus species bacteria and 33.8% Escherichia coli. Struvite stones were found in 57.6% followed at long distance (18.2%) by carbonate apatite, calcium oxalate (11.1%) and mixed (9.1%) stones. Postoperative assessment revealed 17% residual stones, which enhanced infection in 46.7% of these cases and regrew to form a new dendritic stone in 33.3%; 80% of these repeat stones were struvite. 31.5% of the patients initially freed of their calculi by the operation, had true recurrences, and 56.5% of them had resistant urinary infection, caused by Proteus or E. coli (50%-50%). Progressive growth of the recurrent lithiasis occurred in 61.5% of the infected cases, while 87.5% of the recurrences occurring in patients with sterile urine remained stabilized. In the group of nonrecurring lithiasis (56.8%) only 16% had urinary infection. These results confirm the preponderant role played by infection in the pathogenesis of staghorn "malignant' lithiasis and move the authors to make a plea in favor of postoperative integrated therapy, including the use of long-term antibacterial agents and urease inhibitors.

Anti-Infective Agents, Urinary↗
PubMed1983

Calyco-ureteroplasty in the management of selected renal calculi.

Calyco-ureteroplasty was performed in 15 renal calculi patients with grossly deformed upper tracts. The procedure aimed to achieve total clearance of calculi, preserve renal function and check stone recurrence. At follow-up from 6 months to 7 years, there was no stone recurrence and all the patients maintained sterile urine cultures. There was both biochemical and radiological improvement in renal function. It is felt that this procedure may have a role in rehabilitating diseased renal units, preserves renal function and involves no parenchymal loss.

Adolescent↗
PubMed1997

The role of ESWL in the treatment of calculi with anomalous kidneys.

OBJECTIVE: To evaluate the efficacy of Extracorporeal shock wave lithotripsy (ESWL) in renal anomalies. MATERIAL AND METHODS: From 1991 to May 1995. 53 patients with calculi in anomalous kidneys presented to our clinic for treatment with ESWL. Average patient age was 39 years, a range of 6-66 years. These patients (32 male and 21 female) underwent ESWL treatments. ESWL was performed in 27 patients with urolithiasis in duplex system, 18 with horse-shoe kidneys, 4 with unilateral renal agenesis, 2 with pelvic ectopic kidneys, 1 with sigmoid kidney and 1 with L-shaped kidney. RESULTS: Among patients who completed ESWL the rate free of stones was 60.4% and the rate of clinically insignificant residual fragments was 30.2%. No sign of stone disintegration was observed in 2 patients. They underwent open surgery. The shock waves per therapy varied between 811 and 18,101. Double-J stents were placed in 13 patients. CONCLUSION: Most patients with calculi in anomalous kidneys can be managed primarily with ESWL.

Adolescent↗
PubMed1995

Predictive value of a new scoring system for the outcome of primary in situ experimental extracorporeal shock wave lithotripsy of upper ureteral calculi.

The results of primary in situ extracorporeal shock wave lithotripsy of upper ureteral calculi were analyzed retrospectively in 491 eligible patients. The treatment was successful in 371 patients (76%). Degree of obstruction, stone size, localization of stone, history of previous ipsilateral surgery, and body mass index were found to be factors that can influence the outcome of treatment. A scoring system based on these factors has been developed to select the appropriate group of patients for primary in situ extracorporeal shock wave lithotripsy of upper ureteral calculi.

Adolescent↗