Sepsis due to ureteral stones in a patient with uremia: a case report / 中华泌尿外科杂志

Urosepsis caused by upper urinary tract stone obstruction is a common critically disease in urology.However, it rarely occurs in the patient who underwent a dialysis with uremia.We report a patient who underwent an implantation of ureteral stent to control the infection, and we saved the patient with perinephric hematoma following the surgery. We removed the stones in the left ureteral through a flexible ureteroscope two month later.The hematoma was completely absorbed 6 months after the implantation of ureteral stent.

Urinary stone composition analysis of 1 972 cases in Chongqing / 国际外科学杂志

Objective:To investigate the composition characteristics of urolithiasis patients in Chongqing.Methods:From May 2017 to July 2021, clinical data of 1 972 urinary stone patients treated in the Second Affiliated Hospital of Chongqing Medical University was retrospectively analyzed. Among 1 972 patients, there were 1 323 males and 649 females, the average age was (52.7±13.8) years (aged 14-92 years). In this study, all of the patients were first divided into the central and western areas of Chongqing group ( n=1 532) and southeastern areas of Chongqing group ( n=440) according to regional differences; then according to the difference of economic development level, all patients were divided into the more developed area of Chongqing group ( n=1 491) and the less developed area of Chongqing group ( n=481). To study and analyze the influence of gender, age, region and economic development level on stone composition in patients. The distribution characteristics of urinary calculi constituents in different groups of region, gender and age were analyzed by Chi-square test, and analysis of the proportion of various urinary calculi with age were conducted by Cochran-Armitage trend test. Results:The results of stone composition analysis showed that, among the 1 972 cases, the mixed urinary stones were dominant in the urinary stones [92.9%(1 832/1 972)], in which, the most component was the calcium oxalate monohydrate+ calcium oxalate dehydrate [40.8%(805/1 972)]; among the pure stones, the most component was the calcium oxalate dehydrate [2.5%(50/1 972)]. The proportion of carbonated apatite stones [53.6%(348/649) vs 43.5%(576/1 323), P<0.05], hydroxyapatite stones [25.1%(163/649) vs 17.2%(228/1 323), P<0.05] and magnesium ammonium phosphate stones [20.6%(134/649) vs 6.3%(83/1 323), P<0.05] in female patients were significantly higher than those in male patients, but the proportion of calcium oxalate stones [91.4%(1 209/1 323) vs 80.7%(524/649), P<0.05] and uric acid stones [9.4%(125/1 323) vs 1.5%(10/649), P<0.05] in male patients were significantly higher than those in female patients. Compared with patients aged 40-70 years and ≥70 years, the proportion of carbonated apatite stones [39.6%(155/391) vs 48.4%(673/1 391), 50.5%(96/190), P<0.05], magnesium ammonium phosphate stones [6.1% (24/391) vs 12.0% (167/1 391), 13.7% (26/190), P<0.05] and uric acid stones [3.3% (13/391) vs 7.4% (103/1 391), 10.0% (19/190), P<0.05] was significantly lower for patients aged <40 years; but the proportion of calcium oxalate stones in patients aged < 40 years was significantly higher [93.6%(366/391) vs 87.2%(1 213/1 391), 81.0%(154/190), P<0.05]. In this study, there were no significant difference in stone composition between the central and western areas of Chongqing and the southeastern areas of Chongqing, and between the more developed areas of Chongqing and the less developed areas of Chongqing ( P>0.05). Conclusions:There are gender and age differences in the distribution of urinary stone components in Chongqing, but the regional and economic development level differences are not particularly obvious. Carbonated apatite stones, hydroxyapatite stones and magnesium ammonium phosphate stones were more prevalent in females, calcium oxalate stones and uric acid stones were more common in males. Calcium oxalate stones were the most common in patients aged< 40 years, carbonate apatite, magnesium ammonium phosphate and uric acid stones were more common in patients aged ≥40 years.

Evaluation of super-mini-percutaneous nephrolithotomy(SMP) for upper urinary stone of adults and children / 中华泌尿外科杂志

Objective@#To compare the safety and efficiency of totally ultrasonography-guided super-mini-percutaneous nephrolithotomy(SMP) in the treatment of upper urinary stone in adults and children(<14years).@*Methods@#From May 2015 to July 2018, 81 cases of children(53%) and 71(47%) cases of adults with upper tract stones underwent the SMP by total ultrasound guidance. In the group of children, it’s including 53 male and 28 female with 85 channels in total, the patients age ranged from 10 months to 14 years, [mean (56.0±39.7) months], The stone size ranged from 0.8-3.5 cm, [mean (1.7±0.7)cm]. About stone distribution, 42 cases of pelvic stones, 25 cases of calyceal and pelvic stones, 5 cases of calyceal stones, 7 cases of upper uretaral stones, 1 case of upper ureteral and calyceal stones, 1 case of malformation with double renal pelvis and ureter. Urinary infection rate was 86.4%(70/81), positive rate of urinary culture was 39.5%(32/81). In the group of adults, it’s including 43 male and 28 female, the patients aged from 18 to 81 years, [mean (44.1±15.4)years], The stone size ranged from 1.0-3.0 cm, [mean (1.7±0.6)cm]. About Stone distribution, 19 cases of pelvic stones, 13 cases of calyceal and pelvic stones, 7 cases of calyceal stones, 24 cases of upper uretaral stones, 3 cases of upper ureteral and calyceal stones, 1 case of malformation with double renal pelvis and ureter. Urinary infection rate was 87.3%(62/71), positive rate of urinary culture was 26.8%(19/71). The patient was placed in the lithotomy position under general anesthesia. A 5F ureteric catheter was retrogradely inserted into the collecting system and urethral catheter was placed in the bladder. The patient was then turned prone. The selected calix was punctured under ultrasound guidance by 18G puncture needle and a 0.032 inch guidewire was inserted into the collecting system. Nephrostomy tract was established using Dilators(it was done in one step for 12F and in two steps for 14F). After the corresponding size of suction-evacuation sheath was placed, the sheath was connected to the specimen collection bottle via the oblique branch of a metal connector. The miniature endoscope was inserted into the sheath to observe the collecting system and stone fragmentation was completed by using YAG laser or pneumatic lithotripter. Stone free rate after surgery at 1day(SFR) and 1 month(1 month SFR), stone size, operative time(from starting fragmentation to the end of the surgery), hemoglobin drop and hematocrit drop in the first day after surgery, rate of surgecal complications, tubeless rate(totally tubless: no ureteric stent and nephrostomy tube; tubeless: no nephrostomy tube but ureteric stent), average length of hospital stay and urinary infection were recorded and compared.@*Results@#In children group, mean operative time was (27.7±13.0)min(range 5-60 min), SFR and SFR at 1 month were 96.3%(78/81)and 98.8%(80/81), mean hemoglobin drop was (8.0±9.1)g/L(range 0-41 g/L), mean hematocrit drop was 0.026±0.029(range 0-0.135), totally tubeless rate was 86.4%(71/81), mean hospital stay was (2.5±0.9)days(range 1-5 days). Complications were observed in 9 cases and classified using Calvien grading system, Grade Ⅰ in 8 cases: postoperative fever in 4, hematuresis in 1, perirenal hematoma, postoperative distal ureteral stone in 1 cases and delayed recovery of intestinal function in 1 case, all had a spontaneous recovery without special managements; Grade Ⅲb in 1 case, massive ascites was discovered during the surgery, and rcovered by puncture drainage.In adult group, mean operative time was (31.2±15.3)min(range 7-80 min), SFR and SFR at 1 month were 97.2%(69/71) and 98.6%(70/71), mean hemoglobin drop was (11.9±8.7)g/L(range 0-32 g/L), mean hematocrit drop was 0.030±0.027(range 0-0.106), totally tubeless rate was 87.3%(62/71), mean hospital stay was(2.4±1.1)days(range 1-8 days), urinary infection rate was 87.3%(62/71), positive rate of urinary culture was 26.8%(19/71). Complications were observed in 4 cases, Grade Ⅰ in 3 cases: hematuresis in 2 and delayed recovery of intestinal function in 1 case, all had a spontaneous recovery without special managements; Grade Ⅲb in 1 case, postoperative distal ureteral stone in 1 cases and cured by ureteroscopic lithotripsy. According to data about Hb drop, risk of hemorrhage is lower in children than adult significantly(P<0.05). There is not significant difference in stone free rate, stone size, operative time, hematocrit drop, surgery complications, totally tubeless rate, stone complexity, average length of hospital stay and urinary infection(P>0.05).@*Conclusions@#With the characteristics of safe, efficacious and rapid recovery, super-mini-percutaneous nephrolithotomy(SMP) can be used as the first choice of the treatment for upper urinary stone both in adults and children.

Evaluation of super-mini-percutaneous nephrolithotomy(SMP) for upper urinary stone of adults and children / 中华泌尿外科杂志

Objective To compare the safety and efficiency of totally ultrasonography-guided super-mini-percutaneous nephrolithotomy(SMP) in the treatment of upper urinary stone in adults and children (＜ 14years).Methods From May 2015 to July 2018,81 cases of children(53％) and 71 (47％) cases of adults with upper tract stones underwent the SMP by total ultrasound guidance.In the group of children,it's including 53 male and 28 female with 85 channels in total,the patients age ranged from 10 months to 14 years,[mean (56.0 ± 39.7) months],The stone size ranged from 0.8-3.5 cm,[mean (1.7 ± 0.7) cm].About stone distribution,42 cases of pelvic stones,25 cases of calyceal and pelvic stones,5 cases of calyceal stones,7 cases of upper uretaral stones,1 case of upper ureteral and calyceal stones,1 case of malformation with double renal pelvis and ureter.Urinary infection rate was 86.4％ (70/81),positive rate of urinary culture was 39.5％ (32/81).In the group of adults,it's including 43 male and 28 female,the patients aged from 18 to 81 years,[mean (44.1 ± 15.4) years],The stone size ranged from 1.0-3.0 cm,[mean (1.7 ± 0.6) cm].About Stone distribution,19 cases of pelvic stones,13 cases of calyceal and pelvic stones,7 cases of calyceal stones,24 cases of upper uretaral stones,3 cases of upper ureteral and calyceal stones,1 case of malformation with double renal pelvis and ureter.Urinary infection rate was 87.3％ (62/71),positive rate of urinary culture was 26.8％ (19/71).The patient was placed in the lithotomy position under general anesthesia.A 5F ureteric catheter was retrogradely inserted into the collecting system and urethral catheter was placed in the bladder.The patient was then turned prone.The selected calix was punctured under ultrasound guidance by 18G puncture needle and a 0.032 inch guidewire was inserted into the collecting system.Nephrostomy tract was established using Dilators(it was done in one step for 12F and in two steps for 14F).After the corresponding size of suction-evacuation sheath was placed,the sheath was connected to the specimen collection bottle via the oblique branch of a metal connector.The miniature endoscope was inserted into the sheath to observe the collecting system and stone fragmentation was completed by using YAG laser or pneumatic lithotripter.Stone free rate after surgery at lday(SFR) and 1 month(1 month SFR),stone size,operative time(from starting fragmentation to the end of the surgery),hemoglobin drop and hematocrit drop in the first day after surgery,rate of surgecal complications,tubeless rate (totally tubless:no ureteric stent and nephrostomy tube;tubeless:no nephrostomy tube but ureteric stent),average length of hospital stay and urinary infection were recorded and compared.Results In children group,mean operative time was (27.7 ± 13.0)min(range 5-60 min),SFR and SFR at 1 month were 96.3％ (78/81)and 98.8％ (80/81),mean hemoglobin drop was (8.0 ± 9.1) g/L(range 0-41 g/L),mean hematocrit drop was 0.026 ±0.029(range 0-0.135),totally tubeless rate was 86.4％ (71/81),mean hospital stay was (2.5 ±0.9)days(range 1-5 days).Complications were observed in 9 cases and classified using Calvien grading system,Grade Ⅰ in 8 cases:postoperative fever in 4,hematuresis in 1,perirenal hematoma,postoperative distal ureteral stone in 1 cases and delayed recovery of intestinal function in 1 case,all had a spontaneous recovery without special managements;Grade Ⅲ b in 1 case,massive ascites was discovered during the surgery,and rcovered by puncture drainage.In adult group,mean operative time was (31.2 ± 15.3) min(range 7-80 min),SFR and SFR at 1 month were 97.2％ (69/71) and 98.6％ (70/71),mean hemoglobin drop was (11.9 ± 8.7) g/L (range 0-32 g/L),mean hematocrit drop was 0.030 ± 0.027 (range 0-0.106),totally tubeless rate was 87.3％ (62/71),mean hospital stay was (2.4 ± 1.1) days (range 1-8 days),urinary infection rate was 87.3％ (62./71),positive rate of urinary culture was 26.8％ (19/71).Complications were observed in 4 cases,Grade Ⅰ in 3 cases:hematuresis in 2 and delayed recovery of intestinal function in 1 case,all had a spontaneous recovery without special managements;Grade Ⅲ b in 1 case,postoperative distal ureteral stone in 1 cases and cured by ureteroscopic lithotripsy.According to data about Hb drop,risk of hemorrhage is lower in children than adult significantly (P ＜ 0.05).There is not significant difference in stone free rate,stone size,operative time,hematocrit drop,surgery complications,totally tubeless rate,stone complexity,average length of hospital stay and urinary infection (P ＞ 0.05).Conclusions With the characteristics of safe,efficacious and rapid recovery,super-mini-percutaneous nephrolithotomy (SMP) can be used as the first choice of the treatment for upper urinary stone both in adults and children.

Clinical efficacy and safety of a dual shockwave lithotripter in treating upper urinary calculi / 中华泌尿外科杂志

Objective To evaluate the clinical efficacy and safety of dual shockwave lithotripter in treating urinary calculi.Methods Data of 371 cases treated with Direx-Magna dual shockwave lithotripter was retrospectively collected from July 2016 to June 2017,including 263 male and 108 female.Their age ranged from 15 to 66 years old (mean 36.5 ± 11.0).There was 117 patients with kidney stone,183 patients with upper ureteral and 71 patients with middle or lower stone.The average diameter of stones was (11.3 ± 1.5)mm (ranging 6.9-16.3 mm).The lithotripter was set at 60 times/min/head.Comparative analysis was made between 106 cases in dual mode and 265 cases in single mode.Comparative items included shock frequency,treating time,treating energy,pain scale,stone clear successive rate and complication.Patients were followed by KUB or NCCT at 1 and 2 weeks after the procedure.Stone clear successfully was defined as stone free or with fragment ＜4 mm.Results The overall success rate was 87.3％ (324/371).Among the patients who failed in first session,21 cases were successful with a second session,7 cases were treated with retrograde intrarenal surgery.There were 19 cases lost.Clavien grade Ⅲ complication rate was 0.8％ and no server grade complications.The average treating time was (25.2 ± 8.4) minutes and the average shock was (1419 ±440)times.The dual shockwave subgroup achieved higher success rate [93.4％ (99/106) vs.84.9％ (225/265),P ＜ 0.05] with less treating time [(15.7 ± 3.8) min vs.(29.0 ± 6.5) min],lower energy [(8.9 ± 2.0) kV vs.(10.7 ± 2.8) kV] and fewer shocks (833 ± 149 vs.1 654 ± 261),compared with that of the single shockwave subgroup (P ＜ 0.01).Also,pain scales and other complications were less than those of single shockwave subgroup (P ＜ 0.01).Conclusions Our study shows the new dual shockwave lithotripsy is safe and effective in both dual and single shock wave mode.Dual mode has higher success rate and fewer complications.

Clinical efficacy and safety of a dual shockwave lithotripter in treating upper urinary calculi / 中华泌尿外科杂志

Objective To evaluate the clinical efficacy and safety of dual shockwave lithotripter in treating urinary calculi.Methods Data of 371 cases treated with Direx-Magna dual shockwave lithotripter was retrospectively collected from July 2016 to June 2017,including 263 male and 108 female.Their age ranged from 15 to 66 years old (mean 36.5 ± 11.0).There was 117 patients with kidney stone,183 patients with upper ureteral and 71 patients with middle or lower stone.The average diameter of stones was (11.3 ± 1.5)mm (ranging 6.9-16.3 mm).The lithotripter was set at 60 times/min/head.Comparative analysis was made between 106 cases in dual mode and 265 cases in single mode.Comparative items included shock frequency,treating time,treating energy,pain scale,stone clear successive rate and complication.Patients were followed by KUB or NCCT at 1 and 2 weeks after the procedure.Stone clear successfully was defined as stone free or with fragment ＜4 mm.Results The overall success rate was 87.3％ (324/371).Among the patients who failed in first session,21 cases were successful with a second session,7 cases were treated with retrograde intrarenal surgery.There were 19 cases lost.Clavien grade Ⅲ complication rate was 0.8％ and no server grade complications.The average treating time was (25.2 ± 8.4) minutes and the average shock was (1419 ±440)times.The dual shockwave subgroup achieved higher success rate [93.4％ (99/106) vs.84.9％ (225/265),P ＜ 0.05] with less treating time [(15.7 ± 3.8) min vs.(29.0 ± 6.5) min],lower energy [(8.9 ± 2.0) kV vs.(10.7 ± 2.8) kV] and fewer shocks (833 ± 149 vs.1 654 ± 261),compared with that of the single shockwave subgroup (P ＜ 0.01).Also,pain scales and other complications were less than those of single shockwave subgroup (P ＜ 0.01).Conclusions Our study shows the new dual shockwave lithotripsy is safe and effective in both dual and single shock wave mode.Dual mode has higher success rate and fewer complications.

Constituents and characteristics of urinary stones in southeast Chongqing district / 重庆医学

Objective To analysis the constituents of urinary stones in southeast Chongqing district,and provide the percep-tion and treatment of urinary stones.Methods Retrospective analysis of 1 628 random urinary stones samples in southeast Chongqing district from 2008 to 2014.The chemical constituents of stones were analysis with the clinical data.Results Urinary stones were more often found in those 30 to 70 years old,especially in males.The upper system stones were frequently founded.The percentage of mixed stones and pure stones were similar,The constituents of stones were similar to male and female,the most com-mon component of the urinary stones are calcium oxalate,which were found in 82.9% of the stones,infection stones were found 1 9.2%,but only found in renal and ureteral stones,and also increase gradually.The most common component of urinary stones in Qianjiang and Pengshui district were calcium oxalate,the infection stones were frequently found in Youyang and Xiushan district. Conclusion Chemical composition analysis of urinary stones is simple,quick and accurate,it is very important in providing infor-mation to the etiology,treatment and prevention of urinary stones.

Research of kidney injury index change before and after SWL in southeast of Chongqing / 国际检验医学杂志

Objective To study the change of kidney injury biochemical index before and after SWL in southeast of Chongqing, and toanalyze the constituents of urinary stones,thus to provide the evidence for the treatment of patients with urinary stones by SWL in southeast of Chongqing.Methods 328 patients with urinary stones form our hospital in Southeast of Chongqing during 2008 to 2014 underwent SWL were enrolled.And we detected the levels of urine mALB,serum β2-MG,BUN,Cr before and after operation.The results were statistically analyzed.The chemical constituents of stones were analyzed.Results The levels of urine mALB,serumβ2-MG obviously increased on day 1-2 after operation,and reached the peak 2 days after operation.The result after 1-2 days showed significant difference(P 0.05).Compared with the levels before operation,the levels of BUN and Cr slightly increased,with no significant difference(P >0.05).Conclusion The detection of urine mALB,serum β2-MG of patients with urinary stones before and after SWL and analysis of the chemical compositions of urinary stones could provide the evidence for the treatment of patients with urinary stones by SWL in Southeast of Chongqing.

Uso rutinario del dispositivo antimigratorio Accordion para prevenir la retropulsión de cálculos ureterales durante la litotripsia intracorpórea con laser Holmium: ¿se justifica su uso? / Routine use of Accordion® antimigratory device for preventing the retropulsion of ureteral stones during intracorporeal lithotripsy with holmium laser: is it justified?

Evaluar el impacto del dispositivo Accordion® (Percsys, Palo Alta, CA) en la prevención de la migración de cálculos ureterales. Materiales y Métodos: Un total de 68 pacientes con cálculos ureterales fueron evaluados en este estudio caso-control. 34 fueron destinados al grupo I (grupo Accordion®) y 34 al grupo II (grupo control). Como objetivo primarios se evaluó la diferencia en tiempo de fragmentación durante el procedimiento. Objetivos secundarios evaluados fueron el tiempo operatorio total, tasa de éxito en la fragmentación del cálculo, requerimiento de catéter ureteral posterior al procedimiento y complicaciones perioperatorias. Resultados: Ambos grupos de pacientes resultaron comparables en término de variables demográficas y características de la litiasis. El tiempo de fragmentación intraoperatoria fue similar entre los grupos (25 minutos en el grupo I vs 24 minutos en el grupo II; p=0,94). No fue encontrada ninguna diferencia estadísticamente significativa en tiempo operatorio total (45 minutos en el grupo I vs 50 minutos en el grupo II; p =0,67) o tasa de éxito en la fragmentación (100 por ciento grupo I vs 97 por ciento grupo II). El análisis multivariado demostró una disminución significativa en la necesidad de instalación de catéter doble J al término del procedimiento con el uso de Accordion durante la ureteroscopía (OR 0.24; CI 0,07-0,90; p=0.034).Conclusión: Ambos grupos en nuestro estudio se comportaron de manera similar con respecto a los resultados inmediatos de la ureteroscopía. La disminución en la necesidad de instalación de un catéter doble J y el costo asociado a éste constituyen un argumento a favor de utilizar el dispositivo Accordion®...

To evaluate the impact of Accordion® (Percsys, Palo Alto , CA) device in preventing stone migration. Methods: A total of 68 patients with ureteral stones were evaluated in this case control study, 34 in group I (Accordion group) and 34 in group II (control group) . As primary outcome we evaluated difference in fragmentation time during the procedure. Secondary outcomes were total operative time, stone free rates, postoperative ureteral catheter requirement and perioperative complications. Results: Both groups of patients were comparable in terms of demographics variables and stone characteristics. Intraoperative fragmentation time was similar between groups (25 minutes for group I vs 24 minutes for group II; p=0,94). No statistically significant difference were found in total operative time (45 minutes for group I vs 50 minutes for group II; p =0,67) or stone free rates (100 percent group I vs 97 percent group II). Multivariate model showed a significant decrease in the need to install a double J catheter at the end of the procedure with the use of Accordion during ureteroscopy (OR 0.24; CI 0,07 -0,90; p=0.034).Conclusions: Both groups in our study behaved similarly with respect to immediate outcome of ureteroscopy. The decrease in the installation of double J stent and the cost associated with it constitutes an argument in favor of the use of Accordion device...

Changes in Urinary Stone Composition in the Tunisian Population: A Retrospective Study of 1,301 Cases

BACKGROUND: Studies that evaluate the effect of age on stone composition are scarce. The aim of this study was to highlight the changes in epidemiological characteristics (stone composition and location) of urolithiasis according to patients' age. METHODS: We studied 1,301 urolithiasis patients with age ranging from 6 months to 92 yr (781 males and 520 females). Stone analysis was performed using a stereomicroscope and infrared spectroscopy to determine the morphological type and molecular composition of each stone. RESULTS: The annual average incidence of new stone formation was 31.7 per 100,000 persons. In 71.8% of cases, calculi were located in the upper urinary tract. Compared to other age groups, children and old men were more affected by bladder stones. Calcium oxalate monohydrate was the most frequent stone component, even though its frequency decreased with age (59.5% in young adults and 43.7% in the elderly, P<0.05) in favor of an increase in uric acid stones (11.5% in young adults and 36.4% in the elderly, P<0.05). Struvite stones were rare (3.8%) and more frequent in children than in adults. CONCLUSIONS: The analysis of these data showed that urinary stones in Tunisian patients are tending to evolve in the same direction as the stones in patients from industrialized countries.

Utility of CT Scan in Detection of Melamine - Associated Urinary Stones.

Objective To detail the utility of CT scan in detection of urinary stones induced by melamine tainted formula. Material and Methods A total of 1062 children fed with melamine-contaminated infant formula were screened for urinary stones in our institute from September through December 2008. Ultrasonography of the urinary tract system was performed in all these children. If the children with suspected stones or severe obstruction were presented after ultrasound examination, themulti-detector row CTurographic examination was advocated subsequently. Results Ultrasound examination in combination with multidetector row CT urography could increase the diagnostic rate from 3.4% (36/1062) by ultrasound examination alone to 4.6% (49/1062). Conclusions The specificity and sensitivity of the multidetector row CT urographic examination is higher than ultrasonography.

Mini-review; Melamine-related Urinary Stone Disease

Last year, an epidemic of infantile urinary stone disease developed in China. Investigation revealed that melamine-tainted diary product caused urinary stone in these infants. Young infants were susceptible to the melamine toxicity and dehydration or other stone-prone factors aggravated the toxicity. Melamine-related urinary stones were small, multiple, and mainly composed of uric acid, thus conservative treatment of hydration and urine alkalinization worked well in majority of the patients.

The feature and treatment of kidney stones and acute renal failure in children associated with infant formula adulterated with melamine / 中华急诊医学杂志

Objective To explore the feature and the optimal treatment of kidney stones in children associ-ated with infant formula which had been aduherated with melamine.Method Total of 47 cases of urinary stone and 31 cases of acute renal failure caused by urinary multiple obstruction in children associated with infant formula which had been adulterated with mlelamine in Beijing Children's Hospital University of Medical Science,form Jan-uary to November,2008 were retrospectively analyzed.Results Infant formula which had been adultemted with melamine may lead to kindey stones in 15 days.The mean age was 11-month and the ratio of male to female was 2.6:1.The kindey stones were usually multiple and mostly located either in the ureteropelvic junction or all through the ureter.In the view of the renal function resuming duration,there was no statistic difference among the acute renal failure group,operation group and the conservative group(P=0.683～0.846).In children with uri-nary obstruction and acute renal failure,hemedialysis or peritoneal dialysis was performed.83.9%were relieved by posting catheter through panedoseope and blood purification.100% of the patients resumed normal renal func-tion.81.3% of the patients without acute renal failure had recovered after conservative therapies such as infusion.Conclusions The patients associated with infant formula which had been adulterated with melamine were Usually little infants.Male were more vulnerable than female.Most of them had recovered smoothly and the renal function resumed normal after effcient therapies.

Comparative Results of Extracorporeal Shock Wave Lithotripters with Three Kinds of Shock Wave Generator / 대한비뇨기과학회지

PURPOSE: To compare the results of extracorporeal shock wave lithotripters according to three shock wave energy sources; piezoelectric (EDAP LT 01+), electromagnetic (Storz Modulith SLX) and electroconductive (EDAP- TMS Sonolith VISION), for the treatment of urinary stones. METERIALS AND METHODS: Between February 1990 and March 2006, 1,504 patients (1,691 renal units) were treated with LT-01+(group A), 2,265 patients (2,500 renal units) with a Modulith SLX (group B) and 927 patients (946 renal units) with a Sonolith VISION (group C). The success rates, number of sessions and complications were examined. Statistical analyses were also conducted according to the size and location of the stones. RESULTS: There were no significant differences in the success rates between the three groups (group A, 97.8%; group B, 98.1%; group C, 97.1%). According to the stone size, the success rate for stones more than 1cm(2) was lower in group C than in groups A and B. According to the location, group C had a lower success rate than groups A and B for renal stones, while there were no differences between the three groups in the treatment of other stone locations. The number of treatment sessions for group A was greater than those for groups B and C (group A, 3.83; group B, 1.85; group C, 1.93). Many more sessions were required for group A in comparison with groups B and C in case of renal stones, ureteropelvic junction and upper ureteral stones. The number of sessions for group B was the least for lower ureteral stones. Complications, including steinstrasse, fever, perirenal hematoma and hematuria, were detected in groups A, B and group C at 10, 15.3 and 7.1%, respectively. CONCLUSIONS: There were no differences in the success rates between the three extracorporeal shock wave lithotripters using a shock wave generator. The mean number of treatment sessions was most with the piezoelectric type; whereas, complications were most prevalent with the electromagnetic type.

Analysis of the Subjective Pain and Need of Analgesics during Shockwave Lithotripsy / 대한비뇨기과학회지

PURPOSE: The subjective pain felt by patients during shockwave lithotripsy (SWL) and need of analgesics in patients with urinary stones were investigated. MATERIALS AND METHODS: Between September 2004 and January 2006, one hundred and ninety seven SWLs were undertaken (151 patients) using a SDS 5000 (spark gap type, Comed, Korea). Ninety-five and 102 cases proceeded without premedication (no analgesics group) and diclofenac sodium, 1mg/kg IM, respectively, 30 minutes before lithotripsy (analgesics group). After the procedure, the subjective pain was estimated using a prospective questionnaire, with a 10-point visual analogue scale. RESULTS: The average subjective pain scores were 3.77 and 3.25 in the non analgesics and analgesics groups, respectively. There was no significantly difference between the two groups. However, the pain scores in the analgesics group were significantly lower in females (3.37 vs. 4.71) and cases of first SWL (3.10 vs. 4.09). In the no analgesics group, the pain score was not affected by the laterality, stone size, location of stone and tolerability, but was affected by sex, age and number of SWL attempts. In the analgesics group, the pain score was only affected by age. Seventy eight percent (74/95) and 63% (64/102) of the patients in the no analgesics and analgesics groups agreed that analgesic should not be recommended to other patients. CONCLUSIONS: The subjective pain during SWL was tolerable; therefore, routine analgesics are not required. However, on the initial SWL in young female patient, the application of analgesics is considerable.

Laparoscopic Ureterolithotomy has a Role for Treating Ureteral Stones / 대한비뇨기과학회지

PURPOSE: Shock wave lithotripsy (SWL) and ureteroscopy are used to successfully manage the majority of ureteral stones. However, some large and impacted ureteral stones still require surgery. Laparoscopic ureterolithotomy has emerged as a feasible treatment option for the patients with large and impacted ureteral stone. MATERIALS AND METHODS: Between December 2004 and October 2005, laparoscopic ureterolithotomy was performed in 12 patients who required surgical treatment. In four patients, laparoscopy was carried as a salvage procedure after failed SWL, and laparoscopy was performed in seven patients as a primary procedure for treating large and impacted stones. The mean stone size was 16mm (range: 8-28). RESULTS: All the procedures were completely laparoscopically, and all the patients were rendered stone-free after a single procedure; no complications were encountered. The mean operative time was 132.5 minutes (range: 60-220), and the mean estimated blood loss was 100ml (range: 50- 150). The mean postoperative hospital stay was 4.3 days (range: 2-7). CONCLUSIONS: Laparoscopic ureterolithotomy can be a safe and effective treatment for large and impacted stones. In selected cases, it should be considered as a primary procedure for large and impacted ureteral stones that are located at the mid and upper levels of the ureter, including renal pelvic stones.

Frequency-Doubled Double-Pulse Nd:YAG (FREDDY) Laser for the Treatment of Ureteral Stone: Initial Experience / 대한비뇨기과학회지

PURPOSE: We assessed the effectiveness, safety and accessibility of performing FREDDY laser lithotripsy for managing urinary tract calculi. MATERIALS AND METHODS: From January 1999 to May 2005, 173 consecutive patients underwent endoscopic lithotripsy with FREDDY laser lithotripsy. The numbers of patients, according to stone location, were 18 patients for the upper ureter, 11 for the mid ureter and 144 for the lower ureter. Patients were treated with a rigid endoscope on a day surgery basis. Patients were assessed 6 to 12 weeks postoperatively with KUB and ultrasound or excretory urography for determining the late obstructive complications. RESULTS: The mean stone size and mean operation time were 7.8mm and 36.6 minutes, respectively. The overall stone-free rates were 98.9%. The stone-free rates according to stone location were 100% in the upper ureter, 100% in the mid ureter and 98.6% in the lower ureter. There were no post-operative complications. Interestingly, there were no significant differences in the operation times and stone-free rates between the urologic specialists (36.7 min and 100%, respectively) and the training residents (37.1 min and 98.6%, respectively). CONCLUSIONS: FREDDY laser lithotripsy is a highly effective and safe modality for the treatment of ureteral stone. In addition, FREDDY laser lithotripsy is very feasible for training residents.

Metabolic Stone Risk Factors Associated with Papillary Calcification on Unenhanced Spiral Computed Tomography / 대한비뇨기과학회지

PURPOSE: Increasing evidence suggests that Randalls plaque contributes to the pathogenesis of urinary stone formation. The purpose of our study is to compare the incidence of the abnormal metabolic stone risk factors between the calcium stone former with papillary calcification and the calcium stone former without papillary calcification on unenhanced spiral computed tomography (CT). MATERIALS AND METHODS: A series of patients with calcium stones (n=49) underwent unenhanced spiral CT and complete metabolic evaluation after they consumed a random diet for 1 month after stone removal. Of the 49 patients, 38 patients showed papillary calcification on unenhanced spiral CT and 11 patients did not. Their blood was evaluated by using a multichannel analysis sequential multichannel autoanalyzer (SMA)-20 and PTH tests. The 24-hour urinary constituents were assayed for calcium, oxalate, citrate, total volume, phosphorus and sodium. We compared the incidence of abnormal metabolic risk factors between the two groups. Statistical analysis was performed by chi-square tests. RESULTS: The incidences of hyperuricemia were 27.3% in the patients without papillary calcification and 31.6% in the patients with papillary calcification. The incidences of hypernatriuria were 18.2% versus 42.1%, the incidences of hypercalciuria were 36.4% versus 26.3%, the incidences of hyperuricosuria were 18.2% versus 18.4%, the incidences of hyperoxaluria were zero versus 28.9%, and the incidences of hypocitraturia were 45.5% versus 44.7%, respectively. The difference between the two groups was statistically significant only for hyperoxaluria (p=0.043). CONCLUSIONS: Hyperoxaluria is the only metabolic risk factor that more frequently occurred in the patients with papillary calcification. Our date suggest that hyperoxaluria may be an important factor in the pathogenesis of papillary calcification.

Risk Factors for Urinary Stone Formation in Male Patients with Spinal Cord Injury: A 17-Year Follow-Up Study / 대한비뇨기과학회지

PURPOSE: This study was initiated to establish the hazard ratios for risk of urinary stone formation in chronic spinal cord injury (SCI) patients. MATERIALS AND METHODS: A total of 140 male patients who were injured before 1987 were eligible for this investigation and they were followed up on a yearly basis from January 1987 and December 2003. RESULTS: Over the 17 years, 39 patients (27.9%) and 21 patients (15.0%) were diagnosed with bladder and renal stones for a total of 59 and 25 episodes, respectively. On multivariate analysis, bladder stone was more common for the patients who were injured at 24 years old or older than is was for those patients who were injured at less than 24 years old (odds ratio [OR]: 2.490; 95% confidence interval [CI]: 1.092-5.677; p=0.030). In another model, the patients with complete injury had a greater risk of renal stone formation than those with incomplete injury (OR: 4.095; 95% CI: 1.295-12.944; p=0.016). We also found that renal stone was more common for the patients with urethral catheterization (UC) than for the patients who could spontaneous void (OR: 5.668; 95% CI: 1.306-24.604; p=0.021), and for patients with bladder stone than for those without bladder stone (OR: 4.678; 95% CI: 1.447-15.126; p=0.010). CONCLUSIONS: Injury characteristics are important for the development of urinary stone in chronic traumatic SCI patients. In addition, our findings suggest that for the cases who cannot undergo intermittent catheterization or when the bladder cannot empty spontaneously, suprapubic cystostomy is better than UC is regards to renal stone formation in this population.

Rupture of Ureter due to Ureter Stone

The spontaneous rupture of the ureter is a rare condition. Two cases are reported with a spontaneous rupture caused by ureteral calculi. The diagnosis was suspected by delayed post-CT KUB and confirmed by ureteroscopy. On the basis of the clinical evolution the authors discuss the diagnosis and pathogenesis of the observed ureteral rupture. Rupture of ureter must be considered as differential diagnosis of acute flank pain, especially when there is change of pain character or severity.