Urinary tract calculi: a four years' experience

To study the pattern and management of urolithiasis. This retrospective observational study was carried out at surgical D unit of Khyber Teaching Hospital, Peshawar, from January 2001 to December 2004. Data of 852 patients with urolithiasis, managed in the surgical unit in the four years period was evaluated. Information regarding age, sex, side, site, type of operation and chemical nature of the calculi was recorded on a proforma. Metabolic study was done in only selected cases. During the study period, 852 patients with urolithiasis were managed. Out of these, 577 [67.72%] were male and 275 [32.28%] were female, with male to female ratio of 1.2:1. Patients between 1 year and 85 years of age were operated. Maximum number of patients was between 3rd and 5th decade of life. Majority of the patients belonged to lower middle and poor socioeconomic groups. Chemical analysis showed calcium oxalate in 503 [60%] cases followed by uric acid in 126 [15%] cases. All the patients underwent open surgical procedures except 34 [3.9%] patients who had litholapexy, 5 [0.6%] patients had lithotripsy after insertion of double J stent. Thirteen [1.5%] patients .underwent nephrectomy for renal stone disease. Urolithiasis is a fairly common disease. Commonest calculi found were calcium oxalate

Extra corporeal shock wave lithotripsy in the management of calyceal stones

Renal stones are a life long disease characterized by formation of solid concretions within the kidney or its drainage system. The extra corporeal shock wave lithotripsy is widely used in the treatment of calyceal stones, for any given location within the calyceal system.stone, free rate varies with increasing stone size, stone composition and site of the stotne. This study was conducted to evaluate the eftectivenoss, stone free rate and complications of ESWLin the treatment of calyceal stones, also to evaluate the eftect of urinary tract infection on success rate.This study included 25 patients schoduled for ESWL for calyceal calculi exclusion crileria were body weight more than 120 Kg and stone diameter more than 2.5 cm. ESWL was done with the lithostar lithotripter. [SIEMENS LITHOSTAR II] Post ESWL assessment by plain x-ray [KUB] one day and 2 weeks after. Follow up was done by KUB monthly until patient is stone free or ESWL terminated it was found that in patients with upper calyceal stones, the success rate was 83.3%, in lower calyceal stones and in combined stones, it was 57.1%. Middle calyceal stones were all in combind cases lower calyceal stones have high success rate for the obtuse infundibulopelvic angle, wide calyceal neck and short calyx. According to number of stones, the success rate for multiple stones was 60%, while, in single stones, it was 86.6%. According to the stone burden the success rate for stones less than 1 cm was 84.6% but for stones more than 1 cm, it was 66.6%. According to the number of sessions, the mean number of sessions was 2.6 which is higher than other studies as the mean of loading voltage was 16.4 bkilovolt which is relatively low. According to stone composition, the best results were for uric acid dihydrate and calcium phosphate, the next result was for calcium oxalate dihydrate, the worst was for calcium oxalate monohydrate. According to urine culture and urosepsis, it was found that 8% of sterile cases become Infected post ESWL. Inspite of its few complications, ESWL, when properly done and when correctly indicated still provides a marvelous alternative way to solve the problem of urinary stones

Extracorporeal shock wave lithotripsy as monotherapy for staghorn calculi in high risk patients

From January 1994 to January 1996, 46 high risk patients with stag-horn calculi where selected for extracorporeal shock wave lithotripsy monotherapy. All patients had factors whether related to affected renal unit or general health that would render any invasive procedure risky and of anticipated high morbidity. Six patients were excluded from the study as they showed no evidence of stone disintegration during the initial session. We report on the remaining 40 patients - ADJ stent was applied to all patients prior to ESWL. No anaesthesia was required during treatment sessions. An average of 3.5 treatment sessions with an average total number of 9234 shock waves were applied per patient. Twenty patients [50%] were stone free after 6 months of treatment. When we added 10 patients [25%] with residual fragments of 4 mm or less constituting 5% of original stone area in unobstructive locations, satisfactory results where achieved in 75% of patients. Percutaneous nephrostomy was applied to 5 patients [12.5%] due to ureteral obstruction and blocked DJ stent, fever of 38°C or more occured in 16 patients [40%] and responded to medical measure. Renal colic occured in 24 patients [60%], subcapsular haematoma in 2 patients and relieved spontaneously. We encountered no major complications requiring surgical or major endoscopic procedure on urgent basis. No blood transfusion, no haematurea requiring embolization and no loss of any renal unit occurred in the series. Although it is established that extracorpreal shock wave lithotripsy monotherapy should not be the primary treatment for staghorn calculi, yet in high risk patients it could be a salvage procedure with an apreciable outcome and low morbidity

Anotaciones sobre litiasis renal / Annotations about nephrolithiasis

La lititasis renal es un trastorno relativamente frecuente en la practica medica. No existe en la literatura colombiana una revision reciente y actualizada acerca de este tema por lo cual se escribio la presente. En una forma practica y simplificada, pero completa, se analizan los diferentes aspectos relacionados con la litiasis por calcio y brevemente, se mencionan otros tipos de calculos. Se hace enfasis en fisiopatologia, evaluacion del paciente, manejo de la litiasis (liquidos, dieta y drogas) y nuevos metodos de extraccion de calculo. No se incluye el manejo del colico renal

Nephrolithiasis is a relatively common disease in medical practice. There are no recent, updated reviews on this topic in Colombian literature and to fill this need the present one was written. The different aspects of calcium lithiasis are analyzed in a practical and simplified although comprehensive way, emphasizing pathophysiology, patient evaluation, management of lithiasis (fluids, diet and drug therapy) and new methods for stone removal. Other types of calculi are briefly discussed. Management of the renal colic is not included

Análisis cristalográfico de cálculos urinarios / Crystallographical analysis of urinary calculi

Presentamos un estudio cristalográfico 95 cálculos urinarios escogidos al azar de un grupo de ellos obtenidos en los Hospitales Sótero del Río y Clínico de la Universidad Católica. Hay una clara mayor incidencia de hombres, con un 80% de tipo aséptico y 15% séptico. Sólo hay un 5% de casos de ácido úrico. En un 10,5% de los casos hay datos que permiten sospechar la presencia de hipercalciuria e hiperparatiroidismo