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PubMed1981

[The use of mercapto-propionyl-glycine in the treatment of cystine lithiasis (author's transl)].

The authors report the first results of the use of mercaptopropionyl-glycine (M.P.G.) in the solubilising and preventive treatment of cystine lithiasis. This substance results in the formation of a soluble cystine M.P.G. complex. It increases the solubility of cystine much more than D-penicillinamine. Twenty one cases of cystinuric cystine lithiasis were treated in this way, combined with forced diuresis, alkalinisation of the urine and uricolytic treatment. In 4 of their 21 patients, calculi disappeared completely, whilst in another 3 they decreased in size. Recurrence of lithiasis was avoided in 20 patients out of 21. These impressive results are similar to those in the brief literature concerned with the substance. Toxicity is virtually nil and its efficacy make this the drug par excellence for cystine lithiasis.

Adult↗
PubMed1995

["Sand-clock" lithiasis on prostatic transurethral resection bed].

OBJECTIVES: Although uncommon, prostatic surgical bed lithiasis may present among post-TURP complications. The present study underscores the importance of diagnosis and treatment. METHODS/RESULTS: We report on a patient with magnesium ammonium phosphate hourglass lithiasis in the prostatic surgical bed one year and a half following transurethral resection due to adenomyomatous prostatic hyperplasia that was successfully treated by intracorporeal lithotripsy with the Lithoclast. The physiopathological, clinical, diagnostic and therapeutic aspects are discussed. CONCLUSIONS: This condition should be suspected in patients with dysuric syndrome post-TURP. The importance of simple complementary diagnostic procedures as DRE and plain abdominal films in discarding lithiasis in underscored. We consider retrograde endoscopic manipulation and ultrasonic lithotripsy or penumatic lithotripsy with the Lithoclast to be the safest procedures for this type of lithiasis.

Aged↗
PubMed1995

[Criteria for suspected lithiasis of the common bile duct].

Although the common bile duct is now accessed using a coelioscopic approach by an increasing number of surgical equipes, the problems related to the diagnostic iter of lithiasis of the common bile duct and the need to obtain a correct preoperative diagnosis, in order to select the most appropriate form of therapy, are of growing topical importance. Following a revision of the literature, the authors focus their attention on those studies which seem to be most interesting and important in relation to the criteria for suspected lithiasis of the common bile duct, studied in single, multivariable and preoperative analyses, namely without taking account of perioperative analyses, namely without taking account of perioperative criteria. These studies reveal the most statistically significant criteria for predicting lithiasis of the common bile duct. Although the application of these studies is not practicable, they undoubtedly arouse considerable interest. The authors have selected the simple criteria whose rigorous application may result in the selection of patients with 0 criteria, with a 1% risk of non-suspected lithiasis of the common bile duct. Perioperative cholangiography (POC) and echoendoscopy are closely correlated to these criteria. The authors outline their diagnostic iter within the framework of a prospective study they carrying out.

Gallstones↗
PubMed1994

[The laparoscopic treatment of common bile duct lithiasis].

Nowadays the laparoscopic cholecystectomy has become the main surgical therapy in the treatment of cholecysto-lithiasis. At the beginning the treatment of cholecysto-choledochal lithiasis was the sequential endoscopic-laparoscopic therapy. In fact, the endoscopic sphincterotomy allows transpapillary ablation of Common Bile Duct (CBD) stones, and the laparoscopic cholecystectomy completes the therapy. Recently we have brought the full-laparoscopic of CBD lithiasis. This has become possible on account of an improved intraoperative laparoscopic diagnostics and a better technical experience of the laparoscopic surgeon. Intraoperative examination of CBD requires suitable instruments: cholangiography is still a basic examination and now is easily performed in laparoscopy without a considerable increase of the surgical time; choledochoscopy allows an intraluminal inspection of completes the examination, supplying further detailed information. Afterwards the laparoscopic approach allows the transcystic ablation of stones, using a Dormia probe or through a choledochotomy, but is previously required for the surgeon a high-level operative and technical ability about laparoscopic surgery, in order to perform an excellent preparation of the CBD and precise stitches, making knots with extra corporeal or intra-abdominal technique. Clinical results in patients until now fully-laparoscopic treated are quite good and encourage the CBD lithiasis therapy by a mini-invasive approach, which has the advantage that's not requested the sacrifice of a sound papilla.

Cholangiography↗
PubMedDate not supplied

[Prevalence of biliary lithiasis in cirrhotics: necropsy evaluation].

In order to investigate a possible association between hepatic cirrhosis and biliary lithiasis, an analysis on 3,332 necropsy report diagnosis was carried out. Gallstones were present in 19.5% of 123 cirrhotics and in 4.9% of 3,209 non-cirrhotics patients. We concluded that lithiasis is significantly more frequent in cirrhotics than in non-cirrhotics. Chronic hemolysis, slow emptying of the gallbladder, and defective bile acidification by the gallbladder would explain such association. The male-to-female ratio of lithiasis occurrence was 2.08:1 in the cirrhotic group and 2.4:1 among the non-cirrhotics. This difference was not significant. Pigmentary gallstones were commoner among cirrhotics and significantly more frequent in cirrhotics than in non-cirrhotics. This would be explained by chronic hemolysis and by bilirubin conjugation defects. Lithiasis was more frequent in secondary biliary cirrhosis, followed by postnecrotic cirrhosis of viral etiology.

Cholelithiasis↗
PubMedDate not supplied

[Urinary retention in a child secondary to urethral uric lithiasis].

Urinary lithiasis in children is less frequent than in adults. The incidence of uric acid lithiasis in adult population is between 5 to 39% of all lithiasis. Only a third part of the urinary calculi in infancy are compound of uric acid. The most frequent uric lithiasis is that so called endemic. Usually appears in the lower urinary tract and it is not related to metabolic disturbances. We present the exceptional case of an Arabian boy 4 years old who came to the Hospital because he suffered urinary retention secondary to the fixation of uric acid stone in bulbous urethra. The treatment performed was the external urethrotomy and we could removed the stone. We emphasize that the postoperative control was done by uroflowmetry. After one year, the result is satisfactory.

Child, Preschool↗
PubMed1996

[Strategy changes in the treatment of ureteral lithiasis and nephritic colic].

Since lithotripters were first introduced to the clinical practice in 1980, extracorporeal shock wave lithotrite (ESWL) has been universally recognized as the first choice to resolve urinary tract lithiasis, ureteral calculi being the most susceptible lithiasic site for controversy. The urologist approach to the lithiasic patient has changed mainly as compared to that of ureteral calculi. These profound changes translate an undeniable advance of the extracorporeal procedures versus those of endourology, basically based on ESWL low morbidity. In those cases when lithiasis is found in a situation of nephritic colic, there is a real therapeutical chance with ESWL, thus leading to drug therapy losing its major role. We present 768 patients with ureteral lithiasis (1991-1994), 20-25% of which were examined for a nephritic colic. Once the colic situation is overcome in all instances, 35% will require a new lithotrite for complete lithiasic resolution. Overall, our rate of successful ureteral lithiasis resolution is 97% (30% need repeated session).

Adolescent↗
PubMedDate not supplied

[Apolipoprotein A1 and biliary lithiasis in hepatic cirrhosis].

A prospective study was performed in 67 male patients with cirrhosis, admitted in our Department during one year. Biliary lithiasis was found in 37% of patients. The occurrence of lithiasis was not related to age, weight or severity of liver disease. Seric total bilirubin was higher in lithiasic patients (p < 0.05). Apolipoprotein A1 levels were lower in those ones with lithiasis (p < 0.005). Apolipoprotein A1 was the only factor associated independently with the finding of lithiasis.

Apolipoprotein A-I↗
PubMed1998

[Treatment of lithiasis in patients with one kidney by extracorporeal shock wave lithotripsy].

OBJECTIVE: To describe the efficacy of extracorporeal shock wave lithotripsy in the treatment of lithiasis in patients with solitary functioning kidney. METHODS: The study comprised 56 patients with solitary kidney that had been treated by extracorporeal shock wave lithotripsy. These patients had a solitary kidney for the following reasons: 30 had undergone nephrectomy due to lithiasis, 11 had lost renal function arising from lithiasis, 9 had undergone nephrectomy for other pathologies and 6 had renal agenesis. Nine stone variables and treatment were analyzed. The same variables were analyzed and compared for statistical significance in a representative sample of 125 lithiasic patients with two kidneys who were treated by ESWL. RESULTS: Patients with solitary kidney frequently had a single calculus of < or = 1 cm located in calyces, unobstructive and did not require complementary endourological procedures. The mean number of shock waves was 8535. The psot-lithotripsy success rate was 82.1%; 98.2% had no complications. Comparison of these variables in both groups of patients showed statistically significant differences for stone location, indication for complementary endourological procedures and the number of shock waves utilized. CONCLUSIONS: In our view, ESWL is the treatment of choice in patients with lithiasis in a solitary kidney due to its high success rate and low morbidity. Stringent criteria must be employed before indicating prior endourological procedures to preserve the patency of the excretory tract and to minimize the risk of ureteral obstruction.

Adult↗
PubMed2005

Biliary lithiasis in early pregnancy and abnormal development of facial and distal limb bones (Binder syndrome): a possible role for vitamin K deficiency.

BACKGROUND: Binder syndrome is a maxillonasal dysostosis characterized by midface and nasal hypoplasia, sometimes associated with short terminal phalanges of fingers and toes and transient radiological features of chondrodysplasia punctata. Warfarin- or phenytoin-induced vitamin K deficiency during early pregnancy is a well-established etiology for this syndrome, which occurs nevertheless sporadically in most cases. CASE(S): We describe here the first case, to our knowledge, of Binder syndrome in a child whose mother presented with biliary lithiasis in early pregnancy. The mother proved to have a decrease in clotting factors II, VII, and X, and in prothrombin time, at 11 weeks of gestation, which was highly suggestive of vitamin K deficiency. CONCLUSIONS: The biliary lithiasis-induced vitamin K deficiency in early pregnancy is likely to have resulted in Binder syndrome. This observation should prompt physicians to carefully check for vitamin K deficiency in pregnant women presenting with biliary lithiasis, in order to prevent Binder syndrome in the fetus by providing intravenous vitamin K supplementation as soon as possible. Finally, reassuring genetic counseling regarding the genetic risk for future pregnancies is to be provided to the parents.

Biliary Tract↗
PubMed2005

[Infective lithiasis].

"Infection Lithiasis" refers to calculi that occur with persistent urinary tract infection. Stones composed of magnesium ammonium phosphate (struvite) and carbonate apatite, called "triple phosphate" stones, are the more common type of infection lithiasis. These stones are also called "staghorn" calculi because they may grow rapidly and fill the entire collecting system. They form during urinary infection with urea-splitting micro-organism. They may originate de novo or complicate a lithiasis when pre-existing stones are colonized with urea-splitting bacteria. They represent about 2-3% of stones referred for laboratory analysis. This article reviews the epidemiology, pathogenesis, clinical features, and management of struvite stones. A singular pathologic entity recently described, called "encrusted cystitis or encrusted pyelitis", mainly caused by Corynebacterium urealyticum is also review. Infection lithiases caused by non-urease-producing bacteria may also occur and are examined in this article. Finally, the controversial role of nanobacteria in nephrolithiasis is discussed.

Humans↗
PubMed2005

Management of coralliform lithiasis on renal allograft with bricker-type ureterointestinal anastomosis.

PURPOSE: The authors report the management of a coralliform lithiasis that occurred in a renal allograft in association with a Bricker ureterointestinal anastomosis for urinary diversion. MATERIALS AND METHODS: A 58-year-old patient with a significant previous urological history, ie, surgery for childhood incomplete bladder extrophy, trans-ileal Bricker type ureterostomy, and in the end a renal allograft, presented with hematuria and septicemia. Complete radiological examination revealed an obstructive upper tract coralliform lithiasis in the transplanted kidney. A percutaneous nephrolithotomy also was performed for surgical treatment. RESULTS: On postoperative day 2, a urinary fistula was observed at the nephrostomy orifice. The Bricker ureterointestinal anastomosis was located at the same level as the nephrostomy orifice, which maintained upper urinary high pressures as well as the fistula. CONCLUSIONS: Possible preexistent lithiasis in a donor kidney should not be overlooked. In the management of kidney stones larger than 3 cm, percutaneous nephrolithotomy remains the "gold standard" procedure even in cases of external urinary diversion. We proposed an original management of the previously described postoperative complication using a hyperpression drainage tube device in association with a JJ stent.

Humans↗
PubMed2002

[Meningeal tuberculosis and renal lithiasis. A case report].

Urinary tuberculosis is frequent in Algeria. The discovery of the disease become difficult when one of the three criterium of the diagnostic does not allow a diagnosis of certitude. The authors reported the case of a 44 years-old patient admitted to hospital for tuberculous meningitis recovery from left nephrectomy for urinary lithiasis. The histology does not find specific lesions. Then, no antituberculous treatment is prescribed. The patient has developed renal and meningitis tuberculosis associated with urinary lithiasis. Koch's bacillus is found in the urine. The evolution under medical treatment was excellent. The urinary lithiasis has hided tuberculosis and the discovery of the disease was late.

Adult↗
PubMed2001

[Treatment of lithiasis in horseshoe kidney with extracorporeal shock-wave lithotripsy].

UNLABELLED: The horseshoe kidney is the most frequent renal anomaly. As a consequence of impaired urinary drainage, urolithiasis is present in 20% of the cases. Indications for extracorporeal shock wave lithotripsy (ESWL) in the treatment of patients with anomalous kidneys is still the subject of controversy. OBJECTIVE: To evaluate ESWL efficacy in the treatment for lithiasis in horseshoe kidney. MATERIAL AND METHODS: Between april 1988 and december 1999 a total of 32 symptomatic lithiasis in 30 patients with horseshoe kidneys were managed by 65 sessions with ESWL. Until march 1999 a Dornier HM-4 electrohydraulic lithotripter was used. Posteriorly, two treatments was performed with an electromagnetic Dornier Lithotripter S. These procedures have been performed without anaesthesia or sedation for the Dornier HM-4 equipment. Analgesia with Meperidine was used for the Dornier Lithotripter S. Diuresis was not forced during or after treatment with diuretics or serotherapy. Treatments was conducted in an outpatient clinic in all cases. RESULTS: Treatment/lithiasis rate was 2.03. Following treatment 16 patients (54%) were stone-free by X-ray, 9 patients (30%) had residual fragments and in 5 patients (16%) no sign of stone disintegration was observed. Open surgery was performed in three of this patients. Better results was achieved in stones located in the renal pelvis and stone size is 10 mm or less. Clinical evolution: free of symptoms in 20 patients; chronic vague flank pain in 5 patients and acute renal colic with or without hematuria in 5 patients. No major complication was observed in our compilation. CONCLUSIONS: These results suggest that ESWL is the method of primary choice in the treatment for small lithiasis (10 mm or less) in horseshoe kidney.

Adult↗
PubMed2003

[Osseous lithiasis: an unusual condition].

Bone lithiasis is an uncommon disease unfrequent reported in the literature. Its origin is supported on urothelium and conjuctive tissue bone metaplasia. High suspicious index is needed to establish its diagnosis; where radiological signs and extracorporeal lithotripsy resistence drive to these uncommon entity. Definitive diagnosis is based on histological exam. We report a 49-year-old patient with left obstructive uropathy due to a high ureteral lumbar lithiasis who precised ureterolithectomy and partial ureterectomy after extracorporeal litotripsy failure. Histological exam confirmed bone lithiasis and squamous metaplasia. Epidemiologic, diagnostic and therapeutic aspects are briefly reviewed in literature. Bone calculus treatment includes lithectomy and urothelium resection to avoid posterior recurrence. Possible association to tumoral transformation suggests close evolutive follow-up.

Humans↗
PubMed2000

[Staghorn lithiasis in an infant related to mineral water high in calcium].

UNLABELLED: Staghorn lithiases in the infant are rare. We report a staghorn lithiasis related to high calcium intake due to the exclusive use of the mineral water Hépar. CASE REPORT: In an eight-month-old infant, an abdominal film performed for repeated urinary symptoms showed a right-sided staghorn lithiasis. Past history revealed that his diet had contained as high as four times the recommended daily intake for calcium (1,750 mg) related to the exclusive use of Hépar mineral water. The latter had been discontinued one month prior to admission. Excessive doses of vitamin D (1,480 U/day) were given at this time. Blood tests were normal. Treatment combined surgical removal of the stone by right pyelolithotomy, and three extracorporeal lithotrity courses. A postoperative infection had a simple course after antibiotics. CONCLUSION: This staghorn lithiasis is the second case report to complications associated with long-term exclusive intake of Hépar mineral water in an infant. It has been likely favored by excessive doses of vitamin D. It emphasizes the danger of the exclusive use of high-calcium mineral water.

Calcinosis↗
PubMed2004

[Biliary lithiasis in childhood: therapeutic approaches].

Until recently, biliary lithiasis was considered infrequent in childhood. According to their composition, gallstones can be classified into cholesterol stones and pigment stones. The latter are mainly composed of calcium salts of unconjugated bilirubin and are divided into hard black and soft brown stones. In children, up to 75 % of gallstones are pigment stones. Their etiology is often unknown. Biliary lithiasis in children differs from that in adults and there is very little scientific evidence on the most suitable therapeutic procedures. Symptom-free stones usually have a benign course and do not require medical or surgical treatment. Symptoms are often nonspecific and include dyspepsia and chronic abdominal pain. These symptoms are an indication for ultrasonographic scan to rule out the presence of gallstones. Cholecystectomy is the definitive treatment for gallstones but is not always indicated. Medical treatment with ursodeoxycholic acid is indicated in oligosymptomatic and asymptomatic lithiasis with transparent, soft, cholesterol-rich stones and a functional bladder and in patients with a high surgical risk.

Child↗
PubMed2004

[Xanthinuria with xanthine lithiasis in a patient with Lesch-Nyhan syndrome under allopurinol therapy].

PURPOSE: It is the intention of this report to identify appropriate analytical tests which allow for the monitoring of allopurinol treatment of patients with Lesch-Nyhan syndrome and the prevention of uric acid or xanthine lithiasis. MATERIALS AND METHODS: A 12 year old boy with Lesch-Nyhan syndrome presented with signs of compulsive automutilation, motoric and mental retardation and cerebral palsy. Paraclinical patient showed hyperuricemia and significant hyperuricosuria. During administration of allopurinol (200 mg/d) he developed fever, an urinary tract infection and dilatation of pelviureteric junction which was suspected of being nephrolithiasis. During hospitalisation, the purine metabolism was intensively monitored. The allopurinol treatment was adjusted according to clinical and laboratory data. RESULTS: The renal scanning diagnostic showed the develepment of a functionally impaired left kidney. Later this kidney had no part in tubulo-secretorical function. It was necessary to remove surgical two renal stones. The composition of the stones was exclusively xanthine. Serum concentration and urinary excretion of xanthine and hypoxanthine were massively enlarged. The elimination of uric acid in urine was normal. But subsequently, the left kidney had to be removed despite intensive care. CONCLUSION: Lesch-Nyhan syndrome is a disorder caused by congenital absence of the enzyme hypoxanthineguanine phosphoribosyltransferase and an increase of the enzyme activity of adenine phosphoribosyltransferase. Treatment should be adjusted to patient's age and weight. An adapt treatment with allopurinol and optimal fluid intake reduce the risk of uric acid or xanthine lithiasis. Laboratory monitoring includes testings for serum concentration and urinary excretion of uric acid, xanthine and hypoxanthine. Sole a normal concentration of uric acid is not sufficient for therapy control. Assessment of the urine sediment by microscopy or infrared spectroscopy will enable early detection of uric acid or xanthine lithiasis.

Allopurinol↗