Diagnosis and treatment of four cases of asymptomatic and non-hydrous ureteral calculi / 北京大学学报(医学版)

This paper analyzed the clinical data, diagnosis and treatment of 4 asymptomatic patients with ureteral calculi without hydrops in our hospital from October 2018 to January 2019, and comprehensively discussed the previous literature. The 4 patients in this group had no obvious clinical symptoms, no positive stones were found in the B-ultrasound of the urinary system, and no hydroureter and hydroureter of the affected side was found. Urinary CT scan confirmed ureteral stones. They were all located in the lower ureter, and the stones obstructed the lumen. The stones were round and smooth, and there was no obvious hyperplasia and edema in the surrounding mucosa. The lithotripsy was completed in the first-stage operation, and the DJ catheter was left behind for one month after the operation. Based on the clinical diagnosis and treatment process of the 4 cases of asymptomatic calculi in this group and the analysis of previous studies, these patients were mostly detected by imaging examinations or other systematic imaging examinations during the regular review of urinary calculi. Ureteral stones with obstruction did not necessarily have stone-related symptoms. The onset of renal colic involved an increase in intraluminal pressure, related stimulation of nerve endings, smooth muscle spasms caused by stretching of the ureteral wall, and systemic changes in cytokines and related hormones. Cascade reactions, etc., were associated with the movement of stones down. Ureteral stones without hydrops were mostly located in the lower ureter, which had a certain buffering effect on obstructive pressure. Asymptomatic ureteral calculi could also induce irreversible damage to renal function, and the proportion of damage increased with the diameter of the stone. Patients with a history of urinary calculi, especially those with asymptomatic stones for the first time, should be paid attention to during clinical follow-up. At present, there are few research reports on asymptomatic and non-accumulating ureteral calculi. We analyze the clinical diagnosis and treatment process and characteristics of this group of patients combined with previous literature to provide a reference for the diagnosis and treatment of such patients.

Predicting model based on risk factors for urosepsis after percutaneous nephrolithotomy / 北京大学学报(医学版)

OBJECTIVE@#To analyze the potential perioperative risk factors that affect the development of urosepsis following percutaneous nephrolithotomy (PCNL) for upper urinary tract calculi with a regression model, and to develop a nomogram for predicting the probability of postoperative urosepsis after PCNL according to the identified independent risk factors.@*METHODS@#We retrospectively analyzed the clinical data from consecutive 405 cases of upper urinary tract calculi treated by one-phase PCNL between January 2013 and December 2016 in our clinical department. According to whether the patients developed urosepsis or not after the surgery, the patients were divided into two groups. Perioperative risk factors that could potentially contribute to urosepsis were compared between the two groups. By a Logistic regression model, univariate and multivariate statistical analyses were carried out for the occurrence of postoperative urosepsis, to identify the independent risk factors affecting the development of postoperative urosepsis. From this model, a nomogram was built based on regression coefficients.@*RESULTS@#The PCNL procedures of the 405 cases were performed successfully, and there were 32 cases that developed urosepsis after the PCNL, and the incidence of urosepsis was 7.9% (32/405). A multivariate Logistic regression model was built, excluding the factors with values of P>0.05 in the univariate analysis. Multivariable Logistic regression analysis identified the following factors as independent risk factors for urosepsis after PCNL: diabetes mellitus history (OR=4.511, P=0.001), larger stone burden (OR=2.588, P=0.043), longer operation time (OR=2.353, P=0.036), increased irrigation rate (OR=5.862, P<0.001), and infectious stone composition (OR=2.677, P=0.036). The nomogram based on these results was well fitted to predict a probability, and the concordance index (C-index) was 0.834 in the nomogram model sample and 0.802 in the validation sample.@*CONCLUSION@#Diabetes mellitus history, higher stone burden, longer operation time, increased intraoperative irrigation rate, and infectious stone composition are identified as independent risk factors to affect the development of urosepsis after one-phase percutaneous nephrolithotomy for upper urinary tract calculi. A nomogram based on these perioperative clinical independent risk factors for urosepsis could be used to predict the risk of urosepsis following PCNL.

Does Stone Entrapment With Uro-Net Improve Ho:YAG Laser Lithotripsy Efficiency in Percutaneous Nephrolithotomy and Cystolithopaxy?: an In Vitro Study

Purpose to test the effect of stone entrapment on laser lithotripsy efficiency. Materials and Methods Spherical stone phantoms were created using the BegoStone® plaster. Lithotripsy of one stone (1.0g) per test jar was performed with Ho:YAG laser (365µm fiber; 1 minute/trial). Four laser settings were tested: I-0.8J,8Hz; II-0.2J,50Hz; III-0.5J,50Hz; IV-1.5J,40Hz. Uro-Net (US Endoscopy) deployment was used in 3/9 trials. Post-treatment, stone fragments were strained though a 1mm sieve; after a 7-day drying period fragments and unfragmented stone were weighed. Uro-Net nylon mesh and wire frame resistance were tested (laser fired for 30s). All nets used were evaluated for functionality and strength (compared to 10 new nets). Student's T test was used to compare the studied parameters; significance was set at p < 0.05. Results Laser settings I and II caused less damage to the net overall; the mesh and wire frame had worst injuries with setting IV; setting III had an intermediate outcome; 42% of nets were rendered unusable and excluded from strength analysis. There was no difference in mean strength between used functional nets and non-used devices (8.05 vs. 7.45 lbs, respectively; p = 0.14). Setting IV was the most efficient for lithotripsy (1.9 ± 0.6 mg/s; p < 0.001) with or without net stabilization; setting III was superior to I and II only if a net was not used. conclusions Laser lithotripsy is not optimized by stone entrapment with a net retrieval device which may be damaged by high energy laser settings. .

Flexible ureteroscopy and Holmium:YAG laser lithotripsy for stone disease in patients with bleeding diathesis: a systematic review of the literature

INTRODUCTION AND OBJECTIVES: The management of urolithiasis in patients on anticoagulants presents a challenge to the endourologist. Due to multiple comorbidities, it may be impossible to safely discontinue the anticoagulant treatment. Other modalities such as shock wave lithotripsy and PCNL are contraindicated in these patients, so ureteroscopic treatment may be the only option. We conducted a systematic review of the literature to look at the safety and efficacy of ureteroscopic management in these patients. METHODS: Systematic review and quantitative meta-analysis was performed using studies identified by a systematic electronic literature search from January 1990 to August 2011. All articles reporting on treatment for stones in patients with a bleeding diathesis using ureteroscopy and a Holmium:YAG laser were included. Two reviewers independently extracted the data from each study. The data was included into a meta-analysis and discussed. RESULTS: Three studies were identified reporting on 70 patients (73 procedures). All patients had stone fragmentation using Holmium laser. The mean stone size was 13.2mm with a range of 5-35mm. The quality of the included studies was modest. Stone free status was achieved in sixty-four patients (87.7%). There were no major complications and only 11% of the patients developed minor complications with only 4% rate of minor bleeding. CONCLUSIONS: Retrograde stone treatment using ureteroscopy and holmium laser lithotripsy can be safely performed in patients with bleeding diathesis with a low complication rate.

Vias de acesso para tratamento de cálculos urinários: influência da introdução da videolaparoscopia / Access way for treatment of urinary calculi: impact of the introduction of laparoscopy

Avaliar a influência da laparoscopia na rotina cirúrgica do Serviço de Urologia do HC-UFMG. Métodos: Foi feita uma análise retrospectiva de todas as cirurgias, para tratamento de cálculos, realizadas no HC-UFMG entre janeiro de 2004 e outubro de 2008. Resultados: No total foram realizados 613 procedimentos e 4.850 litotripsias extracorpóreas (LECOs). Ao estratificarmos o tipo de procedimento cirúrgico realizado em função do tempo, temos que: no período inicial do estudo (2004), houve apenas seis (4,7%) casos de litíase tratados pela via laparoscópica, já no ano de 2008, os procedimentos laparoscópicos corresponderam a 17 (15,2%) casos. Conclusões: As principais modalidades no tratamento de cálculos urinários são os procedimentos endoscópicos e a LECO. A laparoscopia, apesar de ter indicações limitadas, vem ganhando espaço frente à cirurgia aberta, principalmente nos casos refratários a tratamentos menos invasivos.

This paper aims to determine the influence of the laparoscopy in the treatment of urinary stones in a tertiary hospital (HC-UFMG). Methods: We reviewed our data from January 2004 to October 2008. All patients, who underwent surgery in our institution for the treatment of urinary calculi, were enrolled. Results: Six hundred and thirteen procedures and 4,850 shock wave lithotripsy (SWL) were performed. In the first year of the study (2004), only six (4.7%) cases were done by laparoscopic approach, whereas in the last year (2008) a total of 17 (15.2%) cases were performed using the laparoscopic technique. Conclusion: The SWL and the endoscopic surgery remained as the first line treatment of urinary stones, during the whole period studied. The laparoscopic technique, despite its limitations, is getting acceptance (over the traditional open procedure) and is indicated in those cases where minimally invasive techniques have failed.

Experience of upper urinary tract stones with dornier mpl 9000 lithotripter

To report our experience with Dornier MPL9000X Lithotripter in terms of safety, efficacy and complications in the management of upper urinary tract stones. Retrospective study. From 19[th] April 1998 to 15 August 2007 in the department of Nephrology, Chandka Medical College, Larkana. All patients who had renal calculi up to 2.5cm in size were selected for extra corporeal shock wave lithotripsy with Dornier MPL 9000 on the basis of clinical examination, laboratory investigations, X-Ray, intravenous urography and ultrasonography. Simple analgesics /sedation were used before the procedure, except in children where general anesthesia was used. A total of 1965 patients were treated with 3930 sessions [Average 4.1 sessions per patients]. Male to female ratio was 1.8:1. Average age of the patients was 35.3 years. The average stone burden was 1.8cm in diameter. Stone did not break in 3.3% cases, where as in 53 [2.69%] cases partial fragmentation had occurred. Over all success rate was 84%. About 10.2% cases were lost to follow up. Complications like colic pain, transient haematuria and stein Strasse was observed in 33%, 17% and 2.5% respectively. Extra corporeal shock wave lithotripsy for renal calculi was simple, safe and effective in selected group of patients

Use of traditional Chinese medicine in the management of urinary stone disease: [review]

Objective: To assess the evidence-based literature supporting the use of traditional Chinese medicine Kampo herbal and Acupuncture in stone disease management. Materials and Methods: Four of the most commonly used herbal components of Kampo medicine in the treatment of stone disease are described according to their in vitro and in vivo effects. We also reviewed the role of Acupuncture in urologic clinical setting as well as its proposed mechanisms of action and results. Medline database was assessed using isolated and conjugated key words (Chinese Medicine, Kampo, Chinese Herbal, Calculi, Stone Disease, Kidney, Acupuncture, Herbal Medicine). Articles were reviewed and summarized. Results: Herbal medicine has been proven to be free from side-effects and therefore suitable for long term use therapy. Its antilithic beneficial effects include increased urinary volume, increased magnesium excretion (Takusya), inhibitory activity on calcium oxalate aggregation (Takusya, Wulingsan and Desmodyum styracyfolium), inhibition of calcium oxalate nucleation and hydroxyapatite internalization (Wulingsan). In contrast, acupuncture, has shown to be effective as a pre-treatment anxiolytic and analgesic during colic pain and extracorporeal shock wave lithotripsy treatment, reducing the need for complementary sedative drugs. Conclusion: Chinese traditional medicine is promising as regards its role in stone prevention. An effort must be made in order to standardize study protocols to better assess acupuncture results since each procedure differs in regards to selected acupoints, electrostimulation technique and adjunct anesthetics. Similarly, standardization of Kampo formulations and acceptable clinical endpoints (imaging vs. symptomatic events) is needed.

effect of some organic compounds in the dissolution of calcium oxalate monohydrate crystals

Calcium oxalate monohydrate [COM] is considered as the main inorganic crystalline compound of human urinary stones. The mechanisms of its formation and dissolution are not well understood. A number of questions about the promoting and inhibiting factors still remain unanswered. Dissolution rates of COM crystals were studied in absence and presence of aniline [A], ethyl-[2-N-arylamino] acetate [AE] and N-phenyl glycinop hydrazide [AH]. The results showed that dissolution of COM crystals measured at 37°C, I= 0.15 mol.dm[-3] and pH = 6.5 was found to follow surface controlled mechanism [n=2]. The effect of aniline A, Ethyl- [2-arylamino] acetate [AE] and Nphenyl glycimoyl hydrazide [AH] on the dissolution rate of COM was found to follow the sequence A>AE>AH. The flexibility and increase of the basisty are, mainly, responsible factors for this order of inhibition

Antilithiatic activity of leaves of Dalbergia rubiginosa Roxb

Renal calculus is a common and recurrent problem occurring in about 4% of the world population. The traditional system of Indian medicine suggests several herbs against lithiasis. One such plant is Dalbergia rubiginosa Roxb. which belongs to the family Leguminosae. The effect of alcoholic and aqueous extracts of the leaves of Dalbergia rubiginosa Roxb. [DRL] against lithiasis induced by 1% glycolated water for 35 days in male Wistar rats was tested in this study. Rats were fed with ethylene glycol [1%] mixed with drinking water for 35 days. Simultaneous treatment with the extracts of DRL considerably reduced the urinary risk parameters such as calcium, oxalate, phosphate, proteins and raised magnesium. These observations lead to the conclusion that the extracts are effective against Iithiasis. Phytochemical analysis of alcoholic and aqueous extracts of the leaves was also carried out

Role of non contrast helical CT in predicting the outcome of extracorporeal shock wave lithotripsy

To evaluate the usefulness of urinary calculi attenuation values from non-contrast computed tomography [NCCT] in predicting the outcome of treatment by extracorporeal shock wave lithotripsy [ESWL]. Between 1[st] January 2007 and 30[th] June 2008, we evaluated 178 patients undergoing ESWL for solitary urinary calculi. All patients had NCCT at 120 Kv and 240mA on a helical CT scanner. During each ESWL session 3000 shock waves were given to a maximum of 3.0Kv.A final plain X-ray of the kidney, ureters and bladder was taken 12 weeks after the last ESWL session. Fragments of /= 750HU, 52 [84%] needed three or fewer ESWL sessions and 57[92%] had complete clearance. Of patints with calculi of>750HU, 40 [74%] required three or more ESWL sessions, and 32[60%] had complete clearance. The best outcome was in patients with calculus diameters of<1.1 cm and mean densities of 750HU and diameter of > 1.1cm; 18[75%] needed three or more ESWL sessions and the clearance rate was only 50%. The calculus density was a stronger predictor of outcome than size alone The HU measurement of urinary calculi [stone density] on pretreatment non contrast CT predicts the stone free rates after ESWL. This might help in planning alternative treatment in patients with a probable poor outcome, and to increase the efficiency of ESWL, thus decreasing the cost of treatment

Surveying ESWL impact on pancreatic enzymes

Urinary stones are the third most common disease of urinary tract. More than 90% of renal stones are successfully treated by ESWL with a success rate of 68-86%. The present study was conducted to survey ESWL impact on pancreatic enzymes. This descriptive-analytic study was performed on 87 patients suffered from renal stone. For all patients, a questionnaire including the demographic features, stone characteristics, and ESWL data, was filled, then, the serum lipase and amylase titers were obtained both before and 24 hours after ESWL. Data were analyzed by SPSS software. The study population included 58 men and 31 women with the mean age of 40 years. 48 had right-sided renal stones versus 39 with left-sided stone. The serum titers of amylase and lipase showed an increment in 57.5% and 61%, respectively, however, this increment was above normal range in only two patients. There was statistically significant association between the increment of serum amylase and lipase [P=0.0001]. The increased serum amylase and lipase was more common in left ESWL. Only in one case of right renal stone, the serum lipase and amylase showed significant elevation following ESWL. In spite of the harmlessness of ESWL for pancreas, it is recommended to measure serum lipase or amylase in ESWL of right kidney to detect the rare cases of acute pancreatitis

Pediatric cystine calculi in west of Iran a study of 22 cases

Cystinuria is an autosomal recessive disorder which clinically presents as cystine calculi. In this study, we reviewed cystine calculi cases in the west of Iran to determine their common presentations and response to different therapeutic modalities. Between 1999 and 2005, we had 22 pediatric patients [11 boys and 11 girls] with cystine calculi. The demographic characteristics and clinical data of the patients as well as the treatment results were reviewed. The mean age of the patients was 34.20 ' 42.99 months [range, 4 to 156 months]. They were followed for a mean duration of 23 months [range, 3 to 70 months]. Thirteen patients [59.1%] had bilateral and 9 [41%] had unilateral kidney calculi. The sizes of the calculi were between 2 mm and 20 mm. Nine patients [41%] had renal atrophic changes and 1 [4.5%] had obstructive acute renal failure. Hydration and urinary alkalinization were administrated to all of the patients which yielded an excellent result in 54.5% and a poor response in 27.2%. Captopril started for 5 patients was effective only in 1. D-penicillamine had no favorable response. Extracorporeal shockwave lithotripsy was successful in 5 attempts and failed in 4. Surgical interventions were performed for 13 patients [59.1%] and 6 [27.2%] required more than 1 surgical operation. We recommend metabolic workup of childhood urolithiasis and appropriate medical management of its underlying disease. We also recommend minimally invasive urologic techniques including shockwave lithotripsy only when there are clear indications for nonmedical procedures

Shock wave treatment in medicine.

Extracorporeal shock wave therapy in orthopedics and traumatology is still a young therapy method. Since the last few years the development of shock wave therapy has progressed rapidly. Shock waves have changed the treatment of urolithiasis substantially. Today shock waves are the first choice to treat kidney and urethral stones. Urology has long been the only medical field for shock waves in medicine. Meanwhile shock waves have been used in orthopedics and traumatology to treat insertion tendinitis, avascular necrosis of the head of femur and other necrotic bone alterations. Another field of shock wave application is the treatment of tendons, ligaments and bones on horses in veterinary medicine. In the present paper we discuss the basic theory and application of shock waves and its history in medicine. The idea behind using shock wave therapy for orthopedic diseases is the stimulation of healing in tendons, surrounding tissue and bones.

Is stone radiodensity a useful parameter for predicting outcome of extracorporeal shockwave lithotripsy for stones <= 2 cm?

PURPOSE: Several factors determine the success of extracorporeal shockwave lithotripsy (SWL) for kidney stones: stone size, stone location within the collecting system, stone type, and the SWL machine used. It has been suggested that stone radiodensity, as determined either by plain radiography or computed tomography attenuation values, may be an independent predictor of SWL success. We examined the outcome of SWL for solitary stones less than or equal to 2 cm located within the renal pelvis, based on their radiodensity. MATERIALS AND METHODS: 211 patients with solitary renal pelvic stones measuring less than or equal to 2 cm were treated on a Dornier Doli 50 lithotriptor under general anesthesia. The radiodensity of the stone was determined to be either less than, equal to, or greater than the radiodensity of the ipsilateral 12th rib. Stone-free rates (SFR) were determined at 3 months by kidney, ureters and bladder (KUB) plain X-rays. Patients requiring re-treatment or auxiliary procedures were considered failures of SWL. RESULTS: Follow-up SFR information was available in all 211 patients. Stone composition was available in 158 (75 percent) treated patients, but no correlation was found between stone radiodensity and stone composition. For stones <= 10 mm within the renal pelvis, the SFRs were similar (71 to 74 percent regardless of stone radiodensity). For stones between 11 and 20 mm, the SFR was 60 percent if the stone had a radiodensity > 12th rib compared to a SFR of 71 percent if the stone radiodensity was <= 12th rib. However, these differences in SFRs were not statistically significant. CONCLUSIONS: On the Doli machine, stone radiodensity alone does not predict lithotripsy treatment outcome for stones <= 1 cm within the renal pelvis. This parameter is probably only useful as the stone size becomes larger than 1 cm, and should be used in conjunction with other stone parameters to select appropriate therapy.

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

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.

A litotripsia extracorpórea no tratamento de cálculos urinários em crianças / Extracorporeal lithotripsy for the treatment of urolithiasis in children

Objetivo: cálculos urinários atingem de 5 a 10por cento da população em alguma fase da vida. Destes casos, somente 2 a 3por cento são crianças.O tratamento da litiase urinária na faixa pediátrica, com o uso de métodos minimamente invasivos, representa uma alternativa cada vez mais atraente. O presente trabalho objetiva apresentar resultados de litotripsia extracorpórea como tratamento minimamente invasivo de litiase urinária na infância.Métodos: no periodo de setembro de 1991 a setembro de 2000, foram tratadas e acompanhadas 87 crianças, sendo que seis delas tinham dois cálculos; portanto foram tratados 93 cálculos urinários.Foi utilizado o equipamento de litotripsia extracorpórea por ondas de choque, da Dornier-Philips.Resultados: os cálculos piélicos, caliciais superiores e médios foram fragmentados e eliminados na porcentagem de 87,7por cento e 77,8por cento, respectivamente. Os cálculos localizados no cálice inferior foram eliminados em 64,7por cento. Dos três casos de cálculo coraliforme, somente um ficou livre do cálculo (33,3por cento). Os dez pacientes com cálculo ureteral ficaram livres de litiase (100por cento). Os cálculos vesicais foram tratados e eliminados em 60por cento dos casos.Conclusão: a litotripsia extracorpórea demonstrou ser uma forma eficiente de tratamento de cálculos piélicos, caliciais, ureterais e vesicais...