Intravenous urogram as a first line investigation in comparison with ultrasound

The objective of was to evaluate the usefulness and efficacy of intravenous urogram in patients with urinary tract pathology detected on ultrasound and X-ray KUB. The duration of the study was from September 2007 to August 2009 and a total of 250 patients were included in this cross-sectional study by non probability purposive sampling technique. Ultrasound scans and intravenous urograms were conducted by/under direct supervision of consultant radiologist. Out of 254 patients, four were unable to complete the intravenous urogram due to reaction to the contrast medium; hence a total of 250 patients were included in the final study. There were 66 male and 184 female patients. Calculi [renal, ureteric and vesical] were seen in 139 patients, pefviureteric Junction obstruction in 9, double collecting system and/or ureter in 6, neurogenic bladder in 13, horseshoe/pancake kidney in 2, ectopic kidney in 1, ureterocele in 2, cystocele in 1 and bladder mass in 7 patients. In 14 patients, the tests conducted were inconclusive and further investigations were advised. 28 patients had no detectable urinary tract pathology on any of the diagnostic modality. Intravenous urogram should not be performed routinely as a first line investigation in every patient presenting with flank pain. However, in congenital anomalies, intravenous urograms are needed and should be performed after a preliminary ultrasound

Dados demográficos, clínicos e laboratoriais de pacientes com litíase urinária em Fortaleza, Ceará / Demographic, clinical and laboratory data of patients with urinary lithiasis in Fortaleza, Ceará

OBJETIVO: Determinar os dados demográficos, clínicos e laboratoriais de pacientes com litíase urinária em Fortaleza (CE). PACIENTES E MÉTODOS: Trata-se de estudo documental baseado em dados secundários de 197 pacientes litiásicos de Fortaleza, entre 1996-2006. Foram realizadas avaliação clínica e metabólica na urina de 24 horas, para medida de volume urinário e dosagens de creatinina, cálcio, fósforo, ácido úrico, sódio, potássio e magnésio. O pH e a densidade foram determinados na primeira urina da manhã. A cistinúria foi definida por meio da análise de cristais e/ou cálculos. RESULTADOS: A relação homem:mulher foi de 1:1,7. A média de idade na primeira sintomatologia foi de 35,8 ± 13,3 anos, não havendo diferença entre os gêneros. A faixa etária mais acometida foi entre 20 e 39 anos (56,3 por cento); 72,4 por cento apresentaram cólica nefrética, 69,5 por cento procuraram a emergência médica, 46,7 por cento apresentaram um episódio de litíase e 53,3 por cento eram recorrentes. O rim direito foi o mais afetado (44,4 por cento) nas mulheres, enquanto que nos homens o acometimento foi bilateral (39,7 por cento). As principais alterações metabólicas encontradas foram hipernatriúria (80,7 por cento), seguida de hipercalciúria (48,7 por cento), hiperuricosúria (17,3 por cento) e cistinúria em 5 (2,5 por cento). A média do pH urinário foi de 5,74 ± 0,59 e da densidade urinária, de 1015,6 ± 7,1. O volume urinário foi baixo em 43 por cento dos casos. CONCLUSÃO: Em nosso meio, a litíase acomete adultos jovens entre 20-39 anos, com predominância do gênero feminino, e os distúrbios mais frequentes, em ordem decrescente, foram hipernatriúria, hipercalciúria e hiperuricosúria, associadas à baixa ingestão de líquidos.

OBJECTIVE: To describe the demographic, clinical and laboratory data of patients with urolithiasis in Fortaleza, Ceará, Brazil. PATIENTS AND METHODS: Secondary data were collected from the medical records of 197 patients with urolithiasis, during the period 1996-2006. Clinical evaluation and 24-h urine collection for measurements of urinary volume, creatinine, calcium, phosphorous, uric acid, sodium, potassium and magnesium were performed. Density and pH value were determined in a first-voided morning urine sample. Cystinuria was detected by stone and/or crystal analysis. RESULTS: The male/female ratio was 1:1.7. The average age of symptom onset was 35.8 ± 13.3 years, with no significant difference between the genders. The most affected age range was 20-39 years (56.3 percent). Patients reported renal colic (72.4 percent), emergency room attendance (69.5 percent), a single episode of lithiasis (46.7 percent) or recurrent episodes (53.3 percent). The right kidney was most often affected in women (44.4 percent), while men suffered predominantly from bilateral lithiasis (39.7 percent). The main metabolic changes observed were hypernatriuria (80.7 percent), hypercalciuria (48.7 percent), hyperuricosuria (17.3 percent), and cystinuria in 5 patients (2.5 percent). The average pH value and density were 5.74 ± 0.59 and 1015.6 ± 7.1, respectively. Urinary volume was low in 43 percent of the cases. CONCLUSION: Lithiasis was most prevalent in adults aged 20-39 years, and affected predominantly women in our region. The most frequent metabolic changes, in descending order, were hypernatriuria, followed by hypercalciuria and hyperuricosuria, associated with low fluid intake.

Alternate and incidental diagnoses on noncontrast-enhanced spiral computed tomography for acute flank pain

Our aim was to determine the incidence and spectrum of significant alternate or incidental diagnoses established or suggested on spiral computed tomography [CT] in a large series of patients with suspected renal colic. Records of all patients that had undergone spiral CT [5-mm to 7-mm slice thickness] for acute flank pain during a 5-year period were reviewed. The radiological diagnoses of urinary calculi and obstruction as well as clinical entities not suspected otherwise were analyzed. A total of 4000 CT's had been performed in the evaluation of acute flank pain. Urinary calculi had been identified in 3120 patients [78%]. There were 398 patients [9.9%] who had an alternate cause of flank pain or an incidentally detected condition on CT. Of these patients, 102 [25.6%] had more than one additional finding. A total of 153 clinical conditions had been identified mimicking flank pain secondary to calculus and obstruction. In 47 patients [1.2%], incidental solid masses had been detected. Spiral CT is a valuable technique in the evaluation of acute flank pain with uncertain clinical diagnosis. A wide spectrum of alternate and additional diagnoses including abdominal solid organ tumors and other significant abdominal conditions such as pancreatitis can be established or suggested on spiral CT performed for suspected acute urinary colic

Chemical components of urinary stones according to age and sex of adult patients.

OBJECTIVE: Report the relationship of composition with age and sex of the patients. MATERIAL AND METHOD: A series of 426 urinary stones, 33 from the lower (LUT) and 393 from the upper urinary tract (UUT) of adults, were analyzed for their chemical composition using infrared spectroscopy. The majority of LUT stones were from males (n = 26) and in the age group beyond 60 years (n = 20). RESULTS: Calcium oxalate (CaOx) and uric acid and urate (UA-UR) were the main constituents in LUT stones of males and UA-UR and magnesium ammonium phosphate (MAP) of females. While UA-UR was distributed in all age group of males, it was only detected in elderly females. In cases of UUT stones, the peak finding for both sexes was for the 50-59-year-olds (age class). The MAP component was found more commonly in UUT stones of females, particularly in the younger age groups. CaOx and calcium phosphate (CaP) were the main components of UUT stones in both sexes (CaP was slightly more common in females) with the highest proportion in the 30-49-year-olds (age class), thereafter they declined and were replaced with UA-UR. CONCLUSION: Although the proportion of LUT stones in the present study was small, the present findings agree with previous studies on the role of both age and sex in the etiopathogeny of urinary stones.

Combined urethrolithotomy with vesicolithotomy in an 18-months old boy

We present a case of 18 months old male child who reported with acute urinary retention. He had a urethral calculus along with a vesical calculus. He was subjected to combined external urethrotomy and open vesicolithotomy in one sitting. The patient made a smooth post operative recovery and was followed up for 6 months

Urolitiasis en el niño / Urolithiasis in children

La urolitiasis en el niño ha aumentado en frecuencia durante las últimas décadas, posiblemente debido a los cambios en los hábitos dietéticos especialmente en relación al mayor consumo de sodio y de proteínas. El niño con urolitiasis debe ser evaluado desde el punto de vista metabólico, ya que en un importante número de pacientes se logra identificar una causa de esta índole. Actualmente, la mayoría de los casos que ameritan tratamiento quirúrgico pueden ser manejados mediante técnicas endoscópicas y de litotripsia, gracias a los avances logrados recientemente en el desarrollo de estos procedimientos. Es importante el trabajo en equipo de urólogos pediátricos para el manejo quirúrgico y el nefrólogo pediatra para el diagnóstico etiológico y para la prevención de recurrencias. En la mayoría de los casos resulta suficiente el tratamiento no farmacológico con la adopción de hábitos nutricionales saludables. Se discuten los aspectos generales de la génesis de la urolitiasis, sus manifestaciones clínicas en la edad pediátrica, los métodos diagnósticos de laboratorio y de imágenes en el tratamiento tanto médico como quirúrgico. Asimismo se analizan los diferentes trastornos metabólicos que puedan dar origen a la formación de cálculos urinarios, con especial atención a la hipercalciuria, la cual continúa siendo la causa más frecuente de urolitiasis tanto en niños como adultos.

Role of bacteria in Urolithiasis [in vivo study]

The different bacterial species that were isolated from human renal stones: Pseudomonas aerugniosa [urease +ve], Proteus mirabilis, Citrohacler freundii, Klebsiella pneumonia, Staphylococcus aureus, Pseudomonas aeruginosa, [urease -ve], and Escherichia coli, succeeded in stone formation in rats' kidneys, this was determined by examining tissue sections of the kidneys. However, urease producing bacteria revealed more severe than non-urease ones, which influenced, markedly, in increasing urine volume after 10 days of bacterial injecting followed by a decline after 20 - 30 days, however, pH was acidic during the first ten days of injection, changed to alkalinity later, whereas those had been injected with non-urease producers, did not show such changes in their urine.

Avaliação dos métodos de imagem no diagnóstico da urolitíase: revisão da literatura / Evaluation of imaging methods in the diagnosis of urolithiasis: review of the literature

O objetivo deste trabalho foi comparar a tomografia computadorizada helicoidal com os métodos imaginológicos atualmente disponíveis para a abordagem dos pacientes com dor lombar aguda e revisar brevemente as características fisiopatológicas da urolitíase e a evolução da sua abordagem diagnóstica. Foi revista a literatura publicada nos últimos 30 anos, comparando os seguintes métodos: radiografia simples de abdome, urografia excretora, ultra-sonografia e tomografia computadorizada helicoidal. Esta última se mostrou método de alta sensibilidade e especificidade para o diagnóstico de urolitíase, sendo que, virtualmente, todos os cálculos são identificados por este método, exceto em pacientes em uso de indinavir. A radiografia simples de abdome associada à ultra-sonografia têm acurácia semelhante à tomografia computadorizada helicoidal, contudo, esta foi superior como método de avaliação isolado. A literatura sugere que a tomografia computadorizada helicoidal é útil na avaliação de pacientes com dor lombar aguda quando disponível, possibilitando também o diagnóstico diferencial entre as várias doenças que simulam os sintomas de urolitíase.

The aim of this study is to compare helical computed tomography with imaging studies currently used to evaluate patients with acute low back pain. In addition, we briefly review the pathophysiology of urolithiasis. The literature published in the last 30 years was reviewed, and the following methods were discussed: plain abdominal radiographs, intravenous pielography, ultrasound of the urinary tract, and helical computed tomography. Helical computed tomography showed high sensitivity and specificity for detecting urolithiasis, virtually showing all stones, except in patients receiving indinavir. The accuracy of plain abdominal radiographs associated with ultrasound was similar to helical computed tomography, although the latter showed superiority as an isolated method. Data from literature suggest that whenever helical computed tomography is available, it is helpful in the evaluation of low back pain and also allows differential diagnosis between conditions that mimic the symptoms of urolithiasis.

Prediction of upper urinary tract calculi using an artificial neural network.

OBJECTIVES: To evaluate the possibility of using an artificial neural network (ANN) in upper urinary tract calculi prediction. MATERIAL AND METHOD: Data of 168 upper urinary tract calculi patients treated in the Division of Urology, Department of Surgery, Songklanagarind Hospital from January 1997 to December 2000 were reviewed and classified into 6 catagories and 20 characteristics. 100 items were used in training and 68 in testing for an ANN designed with 3 layers: 20 nodes for an input layer, 5 nodes for a hidden layer and a node for the output. RESULTS: Output data between 0-0.38 indicate free of calculi, 0.65-1 indicate prone to have calculi, 0.38-0.65 indicate probable calculi and further need investigation. CONCLUSION: An ANN with error back-propagation training can be used in diagnosing the presence of upper urinary tract calculi. The accuracy of prediction depends on a previous history of calculi, nephrocalcinosis, 24 hour urine assay for citrate and urine culture.

Absceso perinefrítico, revisión de casos. Servicio de Urología HEALF 1992- 2003 / Abscess perinefrítico, revision of cases. Service of Urología HEALF 1992 - 2003

,l presente estudio es una revisión de 34 casos de pacientes con abscesos perinefríticos, manejados por el servicio de urología del Hospital Escuela Antonio Lenin Fonseca, entre enero de 1992 y diciembre del 2003. Los resultados del estudio se discuten con relación a los hallazgos de revisiones de casos expuestos en la literatura internacional. El objetivo general del estudio es: Describir las características generales de:Epidemiología, cuadro clínico, agentes etiológicos, diagnostico, tratamiento y evolución de los pacientes con absceso perinefrítico, manejados por el servicio de urología del Hospital Escuela Antonio Lenin Fonseca entre 1992 y el 2003. La edad promedio de los pacientes estudiados fue de 45.9 años, oscilando entre 28 y 73 años. La relación entre hombres y mujeres es de 1:1.2. difiriendo significativamente de la mayoría de los reportes que es de 3:1. (7, 9,11 y 13) La litiasis urinaria y la diabetes mielitus figuran como los principales factores que favorecen la aparición del absceso perinefrítico con 72 porciento, asociadas a obstrucción urinaria que representó el 62.5 porciento de los pacientes. Los signos y síntomas, fueron de tipo general e inespecíficos, dificultando él diagnostico clínico y retrasando el tratamiento. El diagnostico bacteriológico del absceso perinefrítico es infrecuente, al 43.7 porciento de los pacientes no se les practico ningún tipo de estudios bacteriológicos. Las bacterias aisladas tanto de urocultivos, como de cultivos del pus fueron: Klepsiela, E. Coli y Proteus

Evaluation of urinary calculi by infrared spectroscopy

To analyze urinary calculi composition and its relationship with gender, age, calculus weight, color, and location. Two hundred and forty one patients with urinary calculus, who had undergone open lithotomy from June 1999 to April 2001, were enrolled in this prospective study which was performed by Tehran and Oroomieh Medical Sciences Universities. The calculi compositions were analyzed by infrared spectroscopy in Bonn University. Statistical analyses were made by paired t test. One hundred and forty five males with a mean age of 40.4 years and 96 females with a mean age of 42.5 years were enrolled in this study. Mean calculus weight was 4.28 gr. Mean calculus number was 4.33. Thirty four [14.1%] calculi were pure [carbonate apatite: 2, brushite: 1, uric acid: 19, cystine: 3, weddellite: 6, mono- NH4-urate: 2, struvite: 1], 207[85.6%] were mixed and none of them contained octa-caphosphate, apatite, newberyte, 2,8-dihydroxyadenine, mono-Na-urate, or xanthine. Weddellite was found in 77% of calculi. It comprised more than 50% of them in 26% of cases. Whewellite crystals were found in 78% of calculi. It comprised more than 50% of them in 46% of cases. The most common pure calculus was uric acid and the most common component of calculi was whewellite followed by weddellite. Although there is no comprehensive study on urolithiasis incidence and prevalence in Iran, it can be concluded that whewellite and weddellite may be the most common components of urolithiasis in Iran and uric acid calculi are the most common pure calculi. There was no significant difference in calculi composition in our study

Calculse de vias urinárias em ambulatório do sistema único de saúde - estudo de modelo de atendimento em saúde pública / Urolithiasis in public health services - a prevention protocol for outpatients

Objetivo :A calculose de vias urinarias apresenta altos níveis de incidência e recorrência, segundo dados de literatura, importando em gastos para o sistema de saúde. Métodos Foram analisadas retrospectivamente 2.648 consultas realizadas em ambulatório público desenhado para o atendimento de pacientes com litíase, no Ambulatório de Especialidades do Sistema único de Saúde em Ribeirão Preto, cidade de médio porte no interior do estado de São Paulo e que apresenta a maior concentração de médicos por habitantes do país. Resultados:Apresenta-se a prevalência, alguns aspectos epidemiológicos, clínicos, de tratamento e do seguimento da urolitíase. Discussão :Ressalta-se que, quanto ao estudo da doença, há o limite imposto pela atividade exercida em ambulatório público, considerando-se a pesquisa de calciúria, oxalúria e uricosúria. Enfatiza-se o alto nível de abandono e a pronta resolutividade do método. Conclusões :Propõe-se uma atividade que nao resulte em gastos adicionais para o Estado, exercida por neurologista e com enfoque na prevenção da doença, utilizando um protocolo de atendimento desenhado para o sistema público.

La nueva y vieja tecnologia en el tratamiento de la litiasis urinaria / Old and new tecnology in treatment of urinary lithiasis

Se presenta una revisión del manejo de la urolitiasis a la luz de las diferentes tecnologías disponibles. El autor expresa su aproximación y experiencia personal en el manejo del paciente con litiasis, enfatizando en la disponibilidad de las diversas tecnologías, especialmente en ciudades intermedias y hace una invitación a los colegas al trabajo en equipo, optimizando los conocimientos individuales para beneficio del paciente

Litiasis urinaria en pediatría / Paediatric urolithiasis

Existe escasa información sobre litiasis urinaria pediátrica en Chile. Objetivo: Conocer las características epidemiológicas, clínicas y de la boratorio de esta patología. Pacientes y Métodos: Se diseñó un estudio prospectivo que incluyó ingresos hospitalarios y consultas externas por litiasis en el Hospital de la Pontificia Universidad Católica. Se elaboró una ficha que consignó identificación, antecedentes familiares, caracterización clínica, laboratorio y tratamiento. Resultados: Entre enero de 1997 y diciembre del 2000, 52 niños ingresaron al protocolo, (26 mujeres), con edad promedio de 8 años (rango 2 meses a 16 años 5 meses). El 50 por ciento tenía antecedentes familiares de urolitiasis. Los síntomas y signos al momento de la consulta fueron: dolor abdominal en 23 (44 por ciento), hematuria en 21 (40 por ciento), fiebre en 13 (25 por ciento), eliminación de cálculo en 11 (21 por ciento), vómito en 11 (21 por ciento), e infección urinaria en 9 (17 por ciento). En 9 (17 por ciento) fue un hallazgo. Se hospitalizaron 26 niños, correspondiendo a 1,6 niños con litiasis por cada 1000 ingresos en dicho período. En el estudio, 12 (23 por ciento) pacientes, tenían malformaciones urinarias, siendo las más frecuentes: doble sistema pielocalicilar (4), estenosis pielouretral (2) y reflujo vesicouretral (2). Catorce (37 pot ciento) pacientes presentaban alteraciones metabólicas al estudio, de los cuales 11 (79 por ciento) resultaron ser hipercalciuria idiopática. En cuatro (8 por ciento) la litiasis ocurrió durante períodos de inmovilización prolongada. Trece pacientes (25 por ciento) tuvieron estudio bioquímico del cálculo: todos incluían oxalato de calcio puro o en su forma mixta. Diez (20 por ciento) pacientes requirieron tratamiento urológico. Conclusiones: Los síntomas de consulta más frecuente fueron dolor abdominal, hematuria y fiebre. La mitad tenían antecedentes familiares de litiasis urinaria. El 23 por ciento tenían malformaciones urinarias y el 37 por ciento presentaban alteraciones metabólicas. El estudio bioquímico del cálculo indicó en todos la presencia de oxalato de calcio puro o mixto.

Cystine urinary lithiasis in Thailand: a report of five cases.

Cystine urinary stone is an autosomal recessive hereditary disease, frequently recurring and resisting fragmentation by Shockwave lithotripsy. As cases have never been reported before in Thailand, five cases of renal cystine stones at Ramathibodi Hospital were reported. Two were in the same family. In all cases the stones were removed by open surgery or percutaneous nephrolithotomy. Postoperatively, all the stones were analyzed by infrared spectroscopy for cystine. In two cases, cystine stones were also identified by scanning electron microscopy. Urine was analyzed for cystine by sodium cyanide-nitroprusside test, its concentration by spectrophotometry and cystine crystals were identified by the new crystal induction technique under light microscopy. By high-performance liquid chromatography (HPLC) test, urinary dibasic amino acids (ornithine, lysine, arginine) in these cases were also found to be significantly elevated. Clinical findings, diagnosis, treatment and prevention of cystine stones are reviewed.