ABSTRACT
Objectives To evaluate the radiological characteristics of renal stones on plain X-ray film of the kidneys; ureters and bladder (KUB) area as predictors of stone fragility during shock wave lithotripsy (SWL). Patients and Methods This prospective study included 336 patients who had a single renal pelvic stone =20 mm and were managed by SWL at 3 different centers. The patients were classified according to the radiological appearance of the stone on KUB film in terms of homogeneity; smoothness of the outline; and radiodensity in comparison to the last rib. The primary endpoint was the stone-free rate (SFR) within 3 months post-SWL. Multivariate regression analysis was used to compare the results. Results The overall SFR was 71.43. SFR was significantly higher in heterogeneous compared with homogenous stones (86vs. 53; p0.01) and in rough compared with smooth surface calculi (77vs. 61; p0.01). SFRs for stones with density less than; similar to or higher than that of the last rib were 82; 69and 56; respectively (p0.01). Multivariate analysis showed a positive proportional relationship between stone fragility (SWL outcome) and one or more favorable radiological criteria. Conclusion The radiological characteristics of renal calculi could predict their fragility after SWL. Stones which were heterogeneous; rough; or less dense than the last rib on KUB film were more likely to disintegrate during SWL
Subject(s)
Kidney Calculi , Lasers , Lithotripsy , Radiography , Ureter , Urinary BladderABSTRACT
Objectives: The aim of this work is to study the impact of using multiple windows of shock wave application on the results of ESWL therapy for renal calculi. Patients and Methods: Between January 1996 and October 2002; 676 patients with single pelvic stones ? 2.5 cm and either no or mild back pressure changes were treated by lithotripsy using the Dornier MPL 9000 with ultrasonic localization. Our patients were divided into two groups according to the total stone burden (15 mm and 15 - 25 mm) Every group was divided into two subgroups: the first subgroup was treated by a single window of shock wave coupling and the second subgroup by changing the window of shock wave coupling every 500 SW from the posterior to the postero-lateral and to the lateral side of the patient. The results were recorded and statistically evaluated. Results: For stones 15 mm we found no difference between the two subgroups regarding the total SW energy; number of sessions; pattern of disintegration and the complication and clearance rate. But the need for additional doses of analgesia was significantly decreased for the patients who were treated by multiple windows. For stones sized 15 - 25 mm; we found a statistically significant decrease in the total SW number; in the number of sessions and the need for additional doses of analgesia when multiple windows of coupling were adopted. Changing the window of coupling also resulted in a statistically significant improvement in the pattern of disintegration of the stones. The rate of complication; clearance and auxiliary measures was comparable in all subgroups. Conclusion: Changing the window of SW application improves the pattern of disintegration; reduces the number of shock waves necessary for effective treatment; decreases the number of sessions and the need for additional doses of analgesia when ESWL is done for renal pelvic stones 15 mm
Subject(s)
Kidney Calculi , Lithotripsy, LaserABSTRACT
Objective: To assess the outcome of simultaneous bilateral endoscopic surgery in the management of renal and ureteral lithiasis. Patients and Methods: Five patients were reviewed retrospectively. Two patients underwent bilateral simultaneous ureteroscopy for ureteral calculi; on two others bilateral simultaneous PCNL was performed in treatment of renal lithiasis. In one patient bilateral simultaneous ureteroscopic extraction of ureteral calculi was done prior to bilateral PCNL for renal lithiasis. Ureteral stenting was performed in all patients. In those patients who underwent PCNL a nephrostomy was done. Results: In all patients who had undergone PCNL the outcome was considered satisfactory. One of them had residual stones of less than 3 mm in both kidneys; which required only surveillance. Another patient had residual calculi in both kidneys with a diameter of 6 and 7 mm respectively. In this patient a complementary ESWL was necessary. The last patient was stonefree after the procedure. The results of simultaneous bilateral ureteroscopy assessed one month after the procedure with a plain abdominal film and renal ultrasonography were excellent since all patients were free of stones. An important haemorrhage complicating a PCNL was treated by embolization. Conclusion: Simultaneous bilateral endoscopic surgery of the upper urinary tract is a good alternative after failure of ESWL for renal and ureteral lithiasis. The risks and complications of the procedure are comparable to those of endoscopic unilateral surgery of the upper tract
Subject(s)
Disease Management , Endoscopy , Kidney Calculi , Ureteral CalculiABSTRACT
Parmi les plantes medicinales les plus utilisees en Tunisie; figure le thymus capitatus; plus connu sous le nom de thym. L'administration pendant deux semaines d'un decocte de thym ameliore la fonction renale et entraine des baisses significatives des concentrations renales en exalates; en urates; en phosphates et en calcium. Ces baisses semblent etre provoquees par les chutes des excretions urinaires de l'acide oxalique et urique et par l'elevation de la zinciurie. Une legere amelioration de la fonction renale a ete mise en evidence egalement chez les animaux traites. Ces resultats laissent supposer que le thym pourrait etre une plante de choix dans la prevention et peut etre aussi; dans le traitement des lithiases renales