Impact of intestinal flora on calcium oxalate stones / 中南大学学报(医学版)

Kidney stone is one of the common diseases of the urinary system. About 80% of kidney stones are mainly composed of calcium oxalate. As a huge bacterial network, the interaction of gut microbes is complex. Intestinal microbes may play a role in the pathogenesis and prevention of kidney stones. The intestinal flora of patients with calcium oxalate stones possess unique distribution of gut microbes.

Extracorporeal Shock Wave Lithotripsy (ESWL) Versus Uretero–Renoscopic Lithotripsy (URSL) For Management Of Upper Ureteric Calculi, Our Experience At Tertiary Care Hospital.

Background: Urinary stones are the third most common affliction of urinary tract, exceeded only by urinary tract infections and pathological conditions of prostate (BPH and Prostate cancer). Extracorporeal Shock Wave Lithotripsy (ESWL) and Uretero-renoscopic Lithotripsy (URSL) are among various treatment options available. Aims and Objectives:To compare ESWLand URSLprocedural and post procedural characteristics including outcome. Methods: A Prospective study was conducted in the department of Urology, SKIMS, on 100 patients with proximal Ureteric stone, from September 2015 to July 2017.By random selection, fifty patients were subjected to ESWL and another fifty to URSL. Various parameters were recorded on preformed proforma designed for the comparative study. Results: In our study, Parameters like Age and Gender distribution, symptoms at presentation and duration of symptoms, number of stones, laterality of stones (right/left) and grade of Hydronephrosis or Hydroureteronephrosis were uniformly distributed in the two groups (URSL VS ESWL). Spinal anaesthesia (SA) or General Anaesthesia(GA) was required in URSL group only, while as local anaesthesia and sedation was required in some patients in ESWLgroup. 72% and 88% patients achieved stone clearance in ESWLand URSLgroup respectively, (p=0.046). DJ stent was used in 20% of URSL patients and none in ESWL group. Procedure time was relatively less for URSL (p=0.001). Although statistically insignificant, Post procedure hematuria and urosepsis were higher in URSL group, where as pain/colic and fever was slightly higher in ESWL group. Steinstrasse was significantly higher in ESWL group (p=0.008). Hospital stay was significantly higher in URSL group (p<0.001). Cost involvement was higher in ESWLgroup (p=0.016). Conclusion: Although ESWL is regarded as the preferred choice of treatment for upper Ureteric stone, URSL is a safe alternative, with an advantage of obtaining an earlier or immediate stone free status in patients with stone size >10mm. In patients with smaller stones (<10mm), ESWL may be considered a reasonable alternative to URSL.

Prevalencia de la composición química de uro litiasis en pacientes de clínicas privadas / Chemical composition prevalence of kidney stones in private clinic patients

Introducción: La litiasis urinaria, también denominada urolitiasis, es una enfermedad causada por la presencia de cálculos o litos en el interior de los riñones o de las vías urinarias (uréteres, vejiga). Los cálculos renales se componen de sustancias normales de la orina, pero por diferentes razones se han concentrado y solidificado en fragmentos de mayor o menor tamaño. Es una condición frecuente que afecta a más del 10% de la población, en la edad media de la vida y es más frecuente en los hombres. Predomina en personas con hábitos sedentarios o en personas con gran exposición al calor y deshidratación. El análisis por disolución de los cálculos renales nos permite evaluar la composición química del mismo y así tomar las medidas clínicas adecuadas para prevenir su formación y recurrencia. Objetivo: Describir cual es la composición química más frecuente de los litos urinarios en una clínica privada de la ciudad de Guatemala. Describir la frecuencia de presentación entre géneros y su prevalencia en los grupos de edad. Metodología: Diseño descriptivo, transversal. Se realizó el análisis por disolución del cálculo a 80 pacientes de una clínica privada. Se tomaron datos de género y edad de los pacientes. Resultados: De los 80 pacientes analizados se encontraron 75 litos urinarios compuestos por oxalato de calcio (93.75%), 4 de ácido úrico (5%) ,1 de cistina (1.25%) y 0 litos de estruvita (0%). En el estudio participaron 62 pacientes se sexo Masculino (77.5%) y 18 femeninas (22.5%), con un rango de edades de 18 a 80 años y una edad promedio de 41.4 años. Conclusión: La gran mayoría de los litos analizados en el estudio estaban compuestos de Oxalato de Calcio, lo cual concuerda con las estadísticas de la NHANES donde se afirma que aproximadamente el 80% están compuestos de este material. En esta serie se encontró que el 93.75% de los litos examinados eran de oxalato de calcio. El 76% de los pacientes con litos de oxalato de calcio son de sexo masculino y presentan una edad promedio de 46.4 años; en los litos compuestos por ácido úrico se encontró una prevalencia del 5% y el 100% de estos eran varones. Los conformados por cistina comprende solo el 1.25% encontrados en el 100% de estos en varones. No se encontraron litos de estruvita. Se concluyó que los pacientes de sexo masculino presentan mayor prevalencia en la formación de litos urinarios

Introduction: Urinary stones, also known as urolithiasis, is a disease caused by the presence of stones or calculi inside the kidneys or urinary tract (ureters, bladder). Kidney stones are made up of normal substances in the urine, but for different reasons they concentrate and solidified as fragments of various sizes. It is a common affection in more than 10% of the population in their middle age and is more common in men. Urinary stones are more prevalent in people with sedentary habits or those with high exposure to heat and dehydration. The analysis by dissolving kidney stones allows us to evaluate its chemical composition and thus take appropriate measures to prevent recurrence. Objective: The main objective was to analyze the chemical composition of urinary calculi in patients from a private clinic and find out the frequency of its occurrence between genders and age groups. Methodology: Descriptive, transversal study. Urinary calculi analysis of 80 patients performed. Gender and age data recorded. Results: Out of 80 samples analyzed, 75 urinary calculi composition was calcium oxalate (93.75%), 4 of uric acid (5%), 1 cystine (1.25%) and none of struvite (0%) found. The groups were composed of 62 males (77.5%) and 18 female (22.5%) with an age range between 18 and 80 years and an average age of 41.4 years. Conclusion: The baste majority of calculi analyzed in the study were composed of calcium oxalate, which is consistent with statistics from NHANES where approximately 80% of calculi are composed of calcium oxalate. In this study 93.75% of calculi examined were composed of calcium oxalate. Seventy-six (76%) of patients with calcium oxalate calculi are male with a median age of 46.4 years. Uric acid calculi were present in 5% and 100% of those found in males. Cystine calculi found had a prevalence of 1.25% with 100% in males and the struvite calculi were not found. It was concluded that male patients have a higher prevalence in formation of urinary calculi and oxalate ones predominate

Composición de las urolitiasis en pacientes cubanos por sexo / Composition of urolithiasis in Cuban patients by sex

INTRODUCCIÓN: las urolitiasis implican morbilidad y costos económicos sustanciales. Para su manejo resulta fundamental una evaluación clínica y de laboratorio, que incluya el estudio de la composición química. OBJETIVO: determinar la frecuencia de presentación de los diferentes tipos de urolitiasis según su composición y su relación con el sexo de los sujetos. MÉTODOS: estudio descriptivo, transversal. Se incluyeron las urolitiasis de adultos cubanos, enviadas al Laboratorio de Fisiopatología Renal del Instituto de Nefrología para estudio de composición química, en el período 2001-2011. Las litiasis fueron analizadas con un espectroscopio infrarrojo modelo Philips PU9516. Los diferentes compuestos se identificaron mediante comparación con espectros de referencia. Toda la información fue procesada automatizada (SPSS 15.0.). Se utilizó análisis de distribución de frecuencias. Para probar la existencia de diferencias entre los sexos, en cuanto al tipo de litiasis, se emplearon los tests: de independencia y exacto de Fisher. RESULTADOS: de las 1851 litiasis analizadas, 1316 (71,1 %) eran litiasis simples. Las litiasis simples de oxalato de calcio constituyeron el 46,8 % del total. Dentro de las compuestas, las más frecuentes fueron las de oxalato de calcio más fosfato de calcio (24,7 %). La frecuencia de las litiasis de oxalato de calcio y ácido úrico resultó mayor entre los hombres (p= 0,00), y las de fosfato de calcio y de estruvita (p= 0,00), entre las mujeres. CONCLUSIONES: los cálculos cálcicos, fundamentalmente de oxalato de calcio monohidratado, son los más comunes en la población litiásica estudiada. Las litiasis de oxalato de calcio y ácido úrico son más comunes entre los hombres, mientras las de estruvita y fosfato de calcio lo son, entre las mujeres.

INTRODUCTION: urolithiasis imply significant morbidity and economic costs. For its management, it is fundamental to make clinical and lab evaluation including the study of the chemical composition. OBJECTIVE: to determine the frequency of occurrence of several types of urolithiasis according to their composition and relationship with the individual's sex. METHODS: descriptive and cross-sectional study that included urolithiasis of Cuban adults sent to the Renal Physiopathology Lab of the Institute of Nephrology for the study of chemical composition in the 2001-2011 period. A Philips PU9516 infrared spectroscope served to analyze lithiasis. The various compounds were identified by comparing them with the reference spectra. All the data were collected and processed with SPSS 15.0; the frequency distribution analysis. Independence test and Fisher's exact test were used to confirm the differences between sexes in terms of type of lithiasis. RESULTS: of 1815 analyzed lithiasis, 1316 (71.1 %) were simple. Simple calcium oxalate lithiasis represented 46.8 % of the total number. In the combinations, the most frequent were calcium oxalate plus calcium phosphate (24.7 %). The frequency of calcium oxalate and uric acid lithiasis was higher in men (p= 0.00 and those of calcium phosphate and struvite (p= 0.00) in women. CONCLUSIONS: calcium stones, mainly monohydrated calcium oxalate, are the most common in the studied lithiatic population. Calcium oxalate and uric acid are the commonest in men whereas struvite and calcium phosphate are more frequent in women.

Índice calcio creatinina en el diagnóstico de la hipercalciuria en población pediátrica litiásica / Calcium Creatinine Ratio in the Diagnosis of Hypercalciuria in Gallstone Pediatric Population

INTRODUCCIÓN: la hipercalciuria constituye el principal trastorno metabólico en la litiasis urinaria. Su diagnóstico implica recolección de orina de 24 horas con riesgo de errores y se ha utilizado el índice calcio creatinina como marcador de hipercalciuria. OBJETIVOS: determinar la validez de este indicador como marcador de hipercalciuria. MÉTODOS: se realizó un estudio descriptivo, transversal por la importancia del diagnóstico de la hipercalciuria y los desacuerdos en la utilidad del índice calcio creatinina y su punto de corte óptimo. Se estudiaron 1603 sujetos litiásicos cubanos entre 2 y 19 años, a los que se les mensuró calciuria de 24 horas e índice calcio creatinina de la segunda orina de la mañana. RESULTADOS: se obtuvo correlación positiva moderada entre las variables. Para los valores de corte tradicionales del índice calcio creatinina, la sensibilidad fue 95,7 % y 81,9 %, y la especificidad 48,3 % y 66,7 %, para niños y adolescentes, respectivamente. CONCLUSIONES: el índice calcio creatinina es útil como prueba de despistaje poblacional de hipercalciuria, sin embargo para la confirmación diagnóstica se requiere ineludiblemente la mensuración de la calciuria por recolección de orina de 24 horas.

INTRODUCTION: hypercalciuria is the main metabolic disorder in urolithiasis. Diagnosis involves collecting urine for 24 hours with risk of errors and calcium creatinine ratio has been used as a marker of hypercalciuria. OBJECTIVES: determine the validity of this indicator as a hypercalciuria marker. METHODS: a cross-sectional descriptive study was conducted due to the importance of the diagnosis of hypercalciuria and disagreements on the utility of calcium creatinine ratio and optimal cutoff. 1603 Cuban lithiasic subjects were studied. Their age ranged between 2 and 19 years. 24 hour urinary calcium and calcium- creatinine ratio of the second morning urine were studied. RESULTS: moderate positive correlation between variables was obtained. For values of traditional cutting of calcium creatinine ratio, sensitivity was 95.7% and 81.9%, and specificity 48.3% and 66.7% for children and adolescents, respectively. CONCLUSIONS: calcium creatinine ratio is useful as evidence of population screening for hypercalciuria, however for diagnostic confirmation the measurement of urinary calcium is inevitably required by collecting urine for 24 hours.

Clinical Manifestations and Characteristics in Patients with Horseshoe Kidney

PURPOSE: We aimed to investigate the clinical characteristics and associated diseases in children with a horseshoe kidney and compared these data between children and adults. METHODS: We performed a retrospective analysis of the medical records and radiological findings of 43 patients diagnosed with a horseshoe kidney in the Busan Paik Hospital. The subjects were divided into the children's group (14 cases, age or =18 years). RESULTS: The study group consisted of 17 males and 26 females with a median age of 34 years. In the children's group (14 cases), 5 subjects were male and 9 were female, with a mean age of 6.7+/-6.2 years. Most of the subjects were asymptomatic and were incidentally diagnosed with horseshoe kidney during their evaluation for another disease. Among the associated diseases in the children's group, Turner syndrome was the most common (5 cases), whereas ureteropelvic junction (UPJ) stricture was observed in 2 cases (14.2%). None of the children exhibited abnormal renal function during the follow-up period. In the adult group (29 cases), 12 subjects were male and 17 were female, with a mean age of 48 years. Eighteen patients were incidentally diagnosed with horseshoe kidney during their evaluation for another disease, and 11 patients had hematuria or abdominal pain due to renal stones. Among the associated diseases in the adult group, Turner syndrome was the most common (5 cases), and UPJ stricture was observed in 5 cases; the other accompanying diseases included hydronephrosis and overactive bladder. Six patients exhibited decreased renal function (serum creatinine level >1.5) during the follow-up period. CONCLUSION: Horseshoe kidney is usually diagnosed incidentally in both children and adults. In the present study, we noted that Turner syndrome was the most common associated disease in children. In addition, most children were asymptomatic but had a high risk of urologic complications after the transition to adulthood. Therefore, children with horseshoe kidney require continuous follow-up.

Advantage of color doppler ultrasonography guidence in mini percutaneous nephrolithotomy for pediatric patients / 国际外科学杂志

ObjectiveTo evaluate the advantages of color doppler ultrasonography guidence in mini-invasive percutaneous nephrostolithotripsy(mPCNL) for pediatric patients.MethodsFrom May 2006 to August 2011,a total of 165 pediatric cases with upper urinary stone,who were treated by mPCNL with F12-F16 access route,were respectively reviewed.All procedures were under the guidance of color doppler ultrasonography,and the pneumatic lithotripsy and/or EMS ultrasound lithotripsy were used to disintegrate the stones.ResultsIn one-stage mPCNL,The average length of the stones was ( 15.82 ±6.31 ) mm,all 165 cases were treated,during which percutaneous renal access was successfully established under color doppler ultrasound guidance and stones were fragmentated.The mean duration of renal access establishment was (11.7 ± 5.3 ) min.The one-stage stone free rate was 95.2％(157/165) with the operation time of (42.6 ± 20.1 ) min.The postoperative hemoglobin aud hematocrit decline were observed in 69.7 ％ ( 115/165 ) of the cases with the value of 2.67 g/L and 2.21％ respectively when compared with their preoperative counterpart. Infection rate related to operation was 23.03％ ( 38/165 ),which was demostrated by durative or iterative fever more than 48 hours.No perioperative bleeding was recorded,and no transfusion was required.No ease experienced perirenal organ injury.Conclusions Using color doppler ultrasound guidance during m-PCNL resulted in safe and effective therapeutic method for upper urinary stone,and can be considered as measures of choice for guidence of mPCNL in pediatric patients.

The Effect of Shakuyakukanzoto for Renal Colic / 日本東洋医学雑誌

Aim:Shakuyakukanzoto is a Japanese herbal medicine that is known to be useful for the treatment of urinary stone pain. In this study, we investigated the effects of shakuyakukanzoto for acute renal colic.Methods:Twenty-five patients were enrolled in this study. Eleven patients took 5.0 g of shakuyakukanzoto powder, and 14 control patients took non-steroidal anti-inflammatory drugs (NSAIDs) for their acute renal colic. The effects were evaluated before and 15, 30, and 60 minutes after treatment with a numerical rating scale (NRS). We defined scale point zero as not having pain, and scale point ten as having the strongest pain.Results:Mean NRS scores improved from 6.7 ± 2.3 to 3.4 ± 3.5 after 15 minutes (shakuyakukanzoto group), and from 8.3 ± 1.8 to 7.0 ± 1.9 after 15 minutes (control group). NRS scores were improved immediately and significantly in both groups. The NRS score of shakuyakukanzoto group was significantly lower than that of control group at the any time after treatment. No side effects were observed in this study.Conclusion : Shakuyakukanzoto has an immediate effect, and it is more effective than NSAIDs. Shakuyakukanzoto was a useful treatment for acute renal colic.

Antilithic Effects of Extracts from Urtica dentata Hand on Calcium Oxalate Urinary Stones in Rats / 华中科技大学学报（医学）（英德文版）

This study examined the potential antilithic effects of a traditional Chinese medicine Urtica dentata Hand (UDH) in experimental rats and screened the optimal extract of UDH as a possible therapeutic agent for kidney stones.The rat model of urinary calcium oxalate stones was induced by intragastric (i.g.) administration of 2 mL of 1.25％ ethylene glycol (EG) and 1％ ammonium chloride (AC) for 28 days and was confirmed by Color Doppler ultrasound imaging.The rats in different experimental groups were then intragastrically given petroleum ether extract (PEE),N-butanol extract (NBE),aqueous extract (AqE) of UDH,Jieshitong (positive control drug),and saline,respectively.Treatment with NBE significantly reduced the elevated levels of urinary calcium,uric acid,phosphate,as well as increased urinary output.Accordingly,the increased calcium,oxalate levels and the number of calcium oxalate crystals deposits were remarkably reverted in the renal tissue of NBE-treated rats.In addition,NBE also prevented the impairment of renal function to decrease the contents of blood urea nitrogen (BUN) and creatinine.Taken together,these data suggest that NBE of UDH has a beneficial effect on calcium oxalate urinary stones in rats by flushing the stones out and protecting renal function.

Follow up of S3 cases of urinary calculi caused by melamine-contaminated infant milk powder / 中国综合临床

Objective To analyze the clinical features and prognosis of urinary calculi in children caused by melamine-contaminated milk. Methods Retrospective analysis of 53 cases of urinary calculi caused by melamine contaminated infant milk powder were performed. Clinical characteristics, lab measurements, colour Doppler ultrasound and CT examination results were collected, and the outcome of treatment and prognosis were followed up. Results In the 53 cases, there were 39 males and 14 females. The main clinical manifestations at admission included crying during urination, abdominal pain, hematuria, oliguria and anuria. Urine pH value was low with average of 5. 32 ±0. 25,blood uric acid was high with average of (638. 69 ±36. 25) μmol/L,blood urea nitrogen was high with average of (8. 35 ± 1. 97) mmol/L The colour Doppler ultrasound and CT examination showed calculi in both or one side kidney,or combined with calculi in both or one side ureter,calculi in one side ureter,or bladder calculi. After medical treatment,all calculi were exported,urine pH values increased to 6. 52 ±0. 47,blood uric acid blood and urea nitrogen decreased to (382. 31 ±29. 57) μmo/L and (5. 15 ±1.92) mmol/L No calculi reoccurred within one year of follow up. Conclusions Medical treatment of urinary calculi in children caused by melamine-contaminated milk powder was effective,and there were less stone recurrence after discharge.

Neodymium: Yttrium Aluminum Garnet Laser for Mini-Percutaneous Treatment of Upper Urinary Tract Stones / 华中科技大学学报（医学）（英德文版）

To observe the efficacy and safety of mini-percutaneous nephrolithotomy with Neodymium:Yttrium Aluminum Garnet (Nd-YAG) laser in the treatment for upper urinary tract stones, from December 2005 to September 2006, 31 patients with renal stones, 15 patients with ureteral stones and 7 patients with renal and ureteral stones underwent mini-percutaneous nephrolithotomy with Nd-YAG laser by combination of rigid ureteroscope and flexible ureteroscope under B-ultrasound guidance. Clinical data including operation time, lithotripsy time, complications and stone-free rate were analyzed retrospectively. Our study showed that the percutaneous renal access (F14-F18) was successfully established under B-ultrasound guidance in all cases. Immediate phase Ⅰ lithotripsy was performed in 47 cases through single tract, and in one case through two tracts. Delayed phase Ⅱ lithotripsy was done in 5 cases of renal stones. Operation time ranged from 55 to 180 min with an average time of 100 ± 15 min. Lithotripsy time was from 25 to 135 min and the average lithotripsy time was 65 ± 11 min. No severe complications occurred in our series. Complex renal stones were cleared in 34 of 38 cases (89.5 %). All ureteral stones were completely removed in 15 cases (100 %). It was concluded that mini-percutaneous nephrolithotomy with Nd:YAG laser for the treatment of upper urinary tract stones by combination of rigid ureteroscope and flexible ureteroscope has the advantages of effectiveness, mini-invasion, shorter operative time and safety.

Clinical Experience of Extracorporeal Shock Wave Lithotripsy (ESWL) using a Dornier Compact S / 대한비뇨기과학회지

Purpose: We analyzed the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) for treating patient with urinary tract calculi with using a Dornier Compact S(R)lithotriptor. Materials and Methods: We retrospectively reviewed the records of all the patient who had urinary calculi and who were treated by ESWL between August 1, 1996 and August 1, 2001. The location and sizes of the stones, the number of sessions, the success rate, the causes of failure and the complications of ESWL were analyzed. The definition of successful treatment was no calcification on the X-ray (plain film, KUB) or residual fragments 31mm, respectively. Conclusions: The results showed that ESWL is a highly effective and minimally invasive treatment modality as the 1st therapeutic option for urinary stones. The Dornier Compact S(R)is an efficient and safe lithotripter that's capable of treating stones in the kidney and throughout the ureter.

Current trends in the treatment of urinary stones

In the last 2 decades, the great progress of imagine techniques, endoscopic equipments and extracorporeal lithotripsy made a revolution in the treatment of urinary stones. Urinary stones now can be treated successfully by minimal invasive procedures. The means of urinary stones treatments consist of shock wave lithotripsy (SWL), percutaneous nephrostolithotomy (PCNL), ureteroscopy (URS), laparoscopy, retroperitoneal endoscopy, and laparotomy. The trends of urinary stones treatments include treating kidney stones (big or small stones), ureteral stones (in the upper third, medium third, and lower third of ureter)

Bilateral urinary stones treated by minimally invasive surgery: 2 cases report

Presention of 2 cases of bilateral urinary lithiasis treated totally by minimally invasive surgey: percutaneous nephrolithotomy, ureteroscopy and retroperitoneal laparoscopic surgery. If well equipped, almost all cases of urolithiasis could be treated by minimally invasive surgery

Experience of Extracorporeal Shock Wave Lithotripsy (ESWL) with EDAP-LT01: A Report of 660 Cases / 대한비뇨기과학회지

PURPOSE: Since ESWL had been developed, many experiences of the treatments to urinary stones with various type of lithotriptors were reported. We evaluated the efficacy of EDAP-LT01 piezoelectric lithotriptor according to the size, location of the stone, number of the treatment session, adjuvant therapy and cause of failure. MATERIALS AND METHODS: We retrospectively analyzed the data of 660 cases who had been treated with ESWL. Among the patients, the renal stones were 122, the ureteral stones were 452, and combined with renal and ureteral stones were 43 cases. The mean size of stones was 13mm (range: 4-38mm). ESWL was performed to all the patients with urinary stones except complete staghorn calculi. No anesthesia was performed except in one child (5 years old). RESULTS: Overall success rate was 94.7%, and there were close correlations between the success rate and the size. The mean number of sessions was 2.4. There was no significant complication, but 35 cases were failed by ESWL monotherapy, and auxiliary procedures were done in 21 cases. Efficiency quotient was 0.59. CONCLUSIONS: The ESWL with EDAP-LT01 seems to be effective and safe to treat the urinary stones of various location and size, even compared to the lithotriptors of other type. We also propose that ESWL monotherapy with this machine is efficient for the treatment of the partial staghorn calculi and stones larger than 30mm.

Urinary Stones following Renal Transplantation

BACKGROUND: The formation of urinary tract stones following renal transplantation is a rare complication. The clinical features of stones after transplantation differ from those of non-transplant patients. Renal colic or pain is usually absent and rarely resembles acute rejection. METHODS: We retrospectively studied 849 consecutive kidney transplant patients in The Rogosin Institute/The Weill-Cornell Medical Center, New York who were transplanted between 1980 and 1997 and had functioning grafts for more than 3 months, to determine the incidence of stone formation, composition, risk factors and patient outcome. RESULTS: At our center, urinary stones were diagnosed in 15 patients (1.8%) of 849 functioning renal grafts for 3 or more months. Of the 15 patients, 10 were males and 5 were females in their third and fourth decade. Eight patients received their transplant from living donors and 7 from cadaveric donors. The stones were first diagnosed between 3 and 109 months after transplantation (mean 17.8 months) and 5 patients had recurrent episodes. The stones were located in the bladder in 11 cases (73.3%), transplanted kidney in 3 cases and in multiple sites in one case. The size of stones varied from 3.4 mm to 40 mm (mean 12 mm). The composition of stones was a mixed form of calcium oxalate and calcium phosphate in 5 cases and 4 patients had infected stones consisting of struvite or mixed form of struvite and calcium phosphate. Factors predisposing to stone formation included tertiary hyperparathyroidism (n=8), hypercalciuria (n=5), recurrent urinary tract infection (n=5), hypocitraturia (n=4), and obstructive uropathy (n=2). Many cases had more than one risk factor. Clinically, painless hematuria was observed in 6 patients and dysuria without bacteriuria in 5 patients. None had renal colic or severe pain at any time. There were no changes in graft function at diagnosis and after removal of stones. Five patients passed stones spontaneously and 8 patients underwent cystoscopy for stone removal. CONCLUSION: Urinary stone formation following kidney transplantation is a rare complication (1.8%). Hyperparathyroidism, hypercalciuria, recurrent urinary tract infection and hypocitraturia are the most common risk factors, but often there are multiple factors which predispose to stone formation. To detect stones and determine their location and size, ultrasonography appears to be the most useful diagnostic tool. Prompt diagnosis, the removal of stones and stone-preventive measures can prevent adverse effects on renal graft outcome.

Clinical Experience of Extracorporeal Shock Wave Lithotripsy with Modulith SL-20 in 750 Urinary Calculi / 대한비뇨기과학회지

PURPOSE: Extracorporeal shock wave lithotripsy(ESWL) has been established as the first line procedure of urinary stone treatment. We studied retrospectively to evaluate the effectiveness of ESWL. MATERIALS AND METHODS: ESWL was performed in 750 cases with Modulith SL-20 electromagnetic lithotriptor from January, 1994 to June, 1997 in our Department of Urology. RESULTS: Most patients were distributed between the fourth and sixth decades 72.5%), and male to female ratio was 1.47:1. There were 750 cases of urinary stones: 172 cases of renal stone(23.0%), 529 cases of ureteral stone(70.4%), 14 cases of renal and ureteral stone(1.9%), 35 cases(4.7%) of bladder stone, and range of size was 5mm-60mm in diameter The success rate according to stone location was 76.2% In renal stone, 98.1% in ureter stone, 84.3% in renal and ureteral stone, and 71.4% In bladder stone. The success rate according to stone size measured on the KUB and sonography was 98.0% in 5-10mm, 82.0% in 11-20mm, 46.4% in 21-30mm and 40.0% over 31mm. The average number of sessions was 2.8 sessions. Of 59 cases of staghorn calculi, 16 were treated without preoperative silicone ureteral stenting, while 43 were treated with preoperative silicone ureteral stunting. The complications were gross hematuria(69.6%), flank pain(13.4%), nausea & vomiting(8.4%), fever(1.9%), steinstrasse(1.2%), perirenal hematoma(0.7%) and uremia(0.1%). The failure rate was 8.8%. The causes of failure were large stone(2.67%), difficulty in eliminating lower caliceal stones(1.33%), bladder stone(1.33%), impact stone(1.07%), caliceal diverticulum(0.93%), infundibular stenosis(0.67%), steinstrasse(0.53%), ureterocele(0.13%), and patient's desire for operation(0.13%). CONCLUSIONS: ESWL is considered to be a safe and non-invasive treatment method. ESWL therapy is less effective for stones larger than 2cm(43.4%), staghorn calculi(52.5%) or the presence of anatomical obstructions.

Comparison of the Results after Lithotripsy of EDAP LT-01+ and Modulith SLX for Urinary Stones / 대한비뇨기과학회지

We attempted to compare the result of EDAP LT-01+ lithotripsy with Modulith SLX lithotripsy for management of urinary stones. We evaluated 1,544 patients (1,731 renal units) treated with EDAP LT-01+ ESWL (Group A) and 668 patients (707 renal units) treated with Modulith SLX ESWL (Group B). The results were obtained as follows; 1. Between the group A and B, stones were located in kidney (except staghorn calculi) in 666 cases (38.5%) and 160 cases (22.6%), in staghorn calculi in 31 cases (1.8%) and 13 cases (1.8%), in ureteropelvic junction (UPJ) in 65 cases (3.8%) and 19 cases (2.7%), in upper ureter in 469 cases (27.0%) and 200 cases (28.3%), in lower ureter in 491 cases (28.4%) and 271 cases (38.3%) and in bladder in 9 cases (0.5%) and 10 cases (1.4%), respectively. 2. Success rates according to stone size were 99.4% and 99.6% in less than 1 cm:, 97.5% and 97.2% in 1 cm2 to 2 cm2, 92.4% and 91.3% in 2 cm2 to 3 cm2 and 82.2% and 78.1% more than 3 cm2 respectively in the group A and B. There. was no statistically significant difference between two groups (,p>0.05). 3. Success rates ccording to stone location were 98.8% and 100% in renal stone (except staghorn calculi) , 83.9% and 84.6% in staghorn calculi,92.3% and 94.7% in UPJ stone, 97.7% and 98.5% in upper ureteral stone, 98.4% and 98.6% in lower ureteral stone and 66.7% and 30% in bladder respectively in the group A and B. There was no statistically significant difference between two groups (p>0.05). 4. Average shock wave sessions and time (min.) were 4.0 and 1.8 and 42.1 and 28.6 respectively in the group A and B. These differences were statistically significant (p=3 days) in 1.6% and 10.7%, steinstrasse in 5.1% and 12.5%, fever (>=38 degree C) in 2.1% and 2.3% and perirenal hematoma in 0% and 0.7% respectively in the group A and B. We concluded that success rates according to location and size of urinary stone were similar between two groups. But, treatment time of the group B was significantly shorter than that of the group A. Treatment sessions of the group B were decreased compared with the group A. Gross hematuria and steinstrasse were occurred significantly more in the group B compared to the group A (p<0.05).

Comparison between Second and Third Generation Piezoelectric Lithotripsy in Children & Adolescents / 대한비뇨기과학회지

During a 9-year period 43 children and adolescents 2 to 18 years old underwent 140 extracorporeal shock wave lithotripsy (ESWL) treatments for 48 calculi. The second generation piezoelectric lithotriptor (LT01) was used in 28 cases (65%) while the remaining cases were treated with the third generation piezoelectric lithotriptor (LT02). LT02 lithotriptor differs from an earlier model LT01 in 2 important respects; a stone localization system consisting of ultrasound and fluoroscopy, and more energy per shock wave. The LT01 necessitated caudal anesthesia in 14 cases (50%) while the LT02 necessitated caudal anesthesia in 2 cases (13%) and intravenous anesthesia in 2 cases (13%). Two upper ureteral stones without ureteral dilatation and 1 mid ureteral stone, which were difficult to detect with ultrasound, could be localized by combined ultrasound and fluoroscopy on LT02. The success rate by LT01 and LT02 ESWL was 92.9% and 100%, respectively. The mean session of LT01 and LT02 ESWL was 3.6+/-.4.09 and 2.6+/-2.47, respectively, and the total storage of LT02 ESWL (93+/-97.8) was much less(p<0.05) than that of LT01 ESWL (363+/-380.3). There were no statistical differences in regard to success and the use of stents, stone size or location between the 2 lithotriptors. Six patients required adjuvant procedures, and ESWL complications were not required admission or surgical management. Therefore, LT02 piezoelectric lithotripsy, in comparison with LT01, is more efficient to localize stones and can lessen total storage by reducing treatment sessions in children and adolescents.

Pendulum-Extracorporeal Shock Wave Lithotripsy using the Lithoring Lithotriptor / 대한비뇨기과학회지

Lithoring is a third generation lithotriptor which is developed by Medas company in Italy. It is characterized by pendulum-ESWL and composed by electrohydraulic spark gap generator, computerized control system, fluoroscopic and ultrasonic focusing system, treatment table and ring. From January 1995 to December 1995, 174 patients underwent 286 treatments with Pendulum-ESWL, Lithoring. The results were obtained as follows; 1. The average numbers of treatment were 1.6 sessions and the average treatment time is 32 minutes. average shock waves were 22l2 times. 2. The locations of stone were kidney in 144 (50.4%), ureter in 139 (48.6%) and bladder in 3 (1.0%). 3. As a pre-ESWL additional manipulation, we did ureteral stent in 34 cases, and ureteral catheter in 5 cases. The position of patients was all supine position and so patients felt comfortable. The localization of stones was used by fluoroscopy in 270 cases, and ultrasound in 16 cases. 4. The average success rates were 87.1% and it was almost same compared with others. 5. No complications were reported except nausea, vomiting, fever, steinstrasse. 6. No general or regional anesthesia were required. Therefore, we suggest that extracorporeal shock wave lithotripsy with Lithoring is considered to be safe and effective treatment of urinary stones.