Use of the probability of stone formation (PSF) score to assess stone forming risk and treatment response in a cohort of Brazilian stone formers

Introduction The aim was to confirm that PSF (probability of stone formation) changed appropriately following medical therapy on recurrent stone formers. Materials and Methods Data were collected on 26 Brazilian stone-formers. A baseline 24-hour urine collection was performed prior to treatment. Details of the medical treatment initiated for stone-disease were recorded. A PSF calculation was performed on the 24 hour urine sample using the 7 urinary parameters required: voided volume, oxalate, calcium, urate, pH, citrate and magnesium. A repeat 24-hour urine sample was performed for PSF calculation after treatment. Comparison was made between the PSF scores before and during treatment. Results At baseline, 20 of the 26 patients (77%) had a high PSF score (> 0.5). Of the 26 patients, 17 (65%) showed an overall reduction in their PSF profiles with a medical treatment regimen. Eleven patients (42%) changed from a high risk (PSF > 0.5) to a low risk (PSF < 0.5) and 6 patients reduced their risk score but did not change risk category. Six (23%) patients remained in a high risk category (> 0.5) during both assessments. Conclusions The PSF score reduced following medical treatment in the majority of patients in this cohort. .

Urolithiasis: Phytotherapy as an adjunct therapy.

Role of herbal drugs and medicinal plant extracts in the successful treatment of urolithiasis, classified as the third most common urinary tract diseases is well documented. Ayurvedic plants and their components mediate antilithogenic effects by altering ionic composition of urine, being diuretic, antioxidant or having antimicrobial activity. Therapeutic peptides and proteins have unique place in pharmaceutical biotechnology due to their critical roles in cell biology. The innovation in antilithiatic proteins is that they are anionic, rich in acidic amino acids which make oxalate unavailable by interacting with calcium and have EF Hand domain which is a characteristic feature of various calcium binding protein like calgranulin, osteopontin. The review provides a background on the pathogenesis of urolithiasis and medical treatments. It focusses on the present research evaluating the scientific basis of antilithiatic potential of various plants and role of plant proteins as therapeutic agents thus opening new vista in the management of urolithiasis. Further investigations are required to fully decipher the mode of action of the potent biomolecules so as to exploit their preventive and therapeutic potential.

The S.T.O.N.E. Score: A new assessment tool to predict stone free rates in ureteroscopy from pre-operative radiological features

Objective: To develop a user friendly system (S.T.O.N.E. Score) to quantify and describe stone characteristics provided by computed axial tomography scan to predict ureteroscopy outcomes and to evaluate the characteristics that are thought to affect stone free rates. Materials and Methods: The S.T.O.N.E. score consists of 5 stone characteristics: (S)ize, (T)opography (location of stone), (O)bstruction, (N)umber of stones present, and (E)valuation of Hounsfield Units. Each component is scored on a 1-3 point scale. The S.T.O.N.E. Score was applied to 200 rigid and flexible ureteroscopies performed at our institution. A logistic model was applied to evaluate our data for stone free rates (SFR). Results: SFR were found to be correlated to S.T.O.N.E. Score. As S.T.O.N.E. Score increased, the SFR decreased with a logical regression trend (p < 0.001). The logistic model found was SFR=1/(1+e.

Urinary tubular enzyme excretion in children with nephrolithiasis and urolithiasis with hydronephrosis

Objective: Nephrolithiasis and urolithiasis are recurrent conditions associated with significant morbidity and economilc impact. Previous studies have suggested that cell- crystal interactions lead to tubular damage and/or dysfunction. To find further proof for these observations, a metabolic evaluation [including serum and urine biochemistry and urinary enzyme excretion] was done in children with nephrolithiasis and urolithiasis with hydronephrosis

Patients and Methods: This study included two groups: 10 normal children [controls] and 32 children with calcium oxalate urinary tract stones. The latter group was further subdivided into those with nephrolithiasis [n=12] and urolithiasis with hydronephrosis [n=20]. Levels of uric acid, oxalate, calcium, magnesium and inorganic phosphorus in 24-hour urine and serum were determined. Urinary N-acetyl-beta-D-glucosaminidase [NAG], beta-galactosidase [beta-GAL], beta-hexosaminidase [beta-Hex], angiotensin converting enzyme [ACE] and gamma glutamyl transferase [y-GT] levels were also determined colorimetrically

Results: Increases in urinary excretion of oxalate, calcium, magnesium and inorganic phosphorus were the major abnormalities found in stone forming patients. Elevated urinary NAG, beta-GAL, beta-Hex and ACE levels were also noted in patients compared with controls. Urinary excretion of oxalate, NAG, beta-GAL and ACE was significantly elevated in children with nephrolithiasis compared to those with urolithiasis and hydronephrosis

Conclusion: Abnormal urine biochemistry seems to have a role in the risk for urinary-tract stone formation in children. Hyperoxaluria can induce tubular cell injury mainly in proximal tubules, which is more pronounced in children with nephrolithiasis. The tubular injury manifested by enzymuria occurs before alteration of renal functions and blood biochemistry. Urinary tubular enzymes should be screened in children with urinary tract stones

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